Steph Sorrell
Forum Replies Created
-
AuthorPosts
-
1. in case in inappetence cat and highly suspicion of neutrophilic cholangitis (but no feeding tube yet), do you use injectable steroids like dexamethasone (dexafast), as I have seen people starting treatment with s/c dexamethasone. is the right thing to do as it hasn’t been mentioned even once during CPD.
So ideally would base treatment on biopsies as biochemical parameters and ultrasound cannot distinguish between an infectious neutrophilic cholangitis or an inflammatory lymphocytic cholangitis. In cases that cannot afford a full work up I would start with abs- usually pot amox for couple weeks and if no improvement then switch to steroids. I usually use IV steroids until eating and then oral pred
2. omeprazole or famotidine for vomiting cat or cat with IBD, is there any proof that it is worth prescribing it? obviously worth giving as an antacid in case of CKD. What do you think about it?
I personally do not, as antacids are only really benefical if there is Gi ulceration so would not routinely use.
3. Feline imha with confirmed positive mycoplasma pcr doesn’t require steroids at all? What if the owners cannot afford blood transfusion, will steroids make any difference in recovery? again oral prednisolone vs iv dexamethasone.
If using steroids, i would only use a very short course like 3-5days for the immune mediated component and would use iv if inappetant, or oral otherwise. If using for too long, this will make it much harder to clear the mycoplasma infection. Antibiotics alone are usually sufficent.
4. kidneys- CKD should we always consider imaging (ultrasound/ x rays to rule out kidneys stones etc? or it is more in acute cases?
Ideally i would as nephroliths can be treated if they are obstructive, so I would consider i all cases. It can also be helpful to r/o pyelonephritis, or less likely neoplasia.
Interested to hear others thoughts on the above qus!
Best wishes,
StephI love gabapentin for feline patients!
I do tend to now use lower doses for renal patients based on the study below
I havent personally used it on cases but do suggest it to referring vets as think it is low risk and anecdotally does seem to help some. These cases can be nightmare to manage so anything else we can use is a bonus!
Really good points.
As Scott said there is limited data so we will need to see what happens in the real world.
It is being marketed for the “happy” diabetic with regular monitoring, especially in the first 2 weeks for ketosis and in this case tx would be stopped and insulin started with appropriate management.
There can be inital weight loss, but over time in the limited study the side effects did improve. The theory being that as insulin resistance decreases, the serum glucose will also decrease, and therefore the urinary loss of glucose reduces, so in the studies they did report improvement in PU/PD/PP and reduced weight loss.
One of the main side effects apart from risk of DKA is diarrhoea, which can be seen in high number of cases but is reported to be self limiting and not necessitating treatment as such.
Risk of UTIs is a concern and in the SPE they suggest regular cultures which I have to say I dont necerssarily agree with as we wouldnt treat a subclincial bacteriuria. We dont recommend it routinely for insulin treatment diabetics, and these cases often have glucosuria too.
The other thing we will need to be aware of is that we will be seeing euglycaemic DKA cases which is atypical to normal and will need have KA on our radar and supplement glucose at an earlier stage in these cases.
I think there is loads to learn and I am looking forward to hearing more robust studies to see if it does have a place.
Replying to scott@vtx-cpd.com 02/10/2023 - 12:51
The choice of probiotics is an interesting one as we know that they are all so different. I agree with Scott that there is limited evidence so we often go with what we are most used to. Hopefully over time we will have studies to compare different types to know which are best.
Yes, I did a small study but we only published it as an abstract but showed that when we used probiotics and ronidazole we reduced the rate of relapse in cats with tritrichomonas.
Replying to scott@vtx-cpd.com 25/09/2023 - 19:25
Fab, thanks so much Scott. I couldnt find any commercial monitoring (apart from PT which isnt reported to be accurate) in my research so good to know can be used without specific monitoring.
Best wishes,
StephHi Sarah,
Thanks for sharing. I have only used this when there is no other choice and fortunately did not have any complications but this is really useful to know.
Best wishes,
StephReplying to Nadia C. 10/09/2023 - 23:29
Hi Nadia,
Sorry for the super late reply! This is really interesting. I had not heard/used this product before so thanks for bringing it to my attention.
As Sarah says, it is important to not have cross contamination with these products to ensure it is solely a single source protein.
Best wishes,
StephReplying to scott@vtx-cpd.com 22/09/2023 - 15:42
This is really interesting Liz and Scott.
Scott- are you monitoring these patients on rivaroxaban crudely with PT or able to do anti X assay?
Steph x
This is a great question and agree don’t think there is a simple answer from the textbooks.
It has been documented in glomerular disease such as in this paper
https://journals.sagepub.com/doi/10.1016/j.jfms.2007.11.007
I think we can assume there may be haemturia due to nephriti/glomerulonephritis. I think one of the main things is that we don’t routinely do biopsies on these cases so we don’t fully understand the underlying pathophysiology.
Would be interested to hear if anyone else has any thoughts!
Best wishes,
StephReplying to scott@vtx-cpd.com 17/09/2023 - 15:07
Fab study!
I always offer removal as the risk of peritonitis and potential complications can be so severe. I dont think I am brave enough to advocate leaving but it is great to have more scientific evidence to base decisions on.
Replying to scott@vtx-cpd.com 17/09/2023 - 15:05
I use them alot in dogs, but have never used in a cat. I think the cat would need to be really calm/sedate to tolerate but will definitely think of it for the future!
Thanks for the fab video Andy
Best wishes,
StephReplying to scott@vtx-cpd.com 17/09/2023 - 14:54
I really like the MILA catheters too. I have to say I usually unblock and then use a fresh catheter to leave in.
I also tape in like the image to allow some flexibility and to decrease any possible pain.
Best wishes,
StephHi Sarah,
It is always crucial to do a blood smear and evaluate this alongside haematology. Also if you have an in house machine with a dot plot then this can be really useful to look at to see if the results can be trusted.
I think with feline samples the most common error we see is low platelets and something that can cause abnormal automated counts is high numbers of heniz bodies.
The below study showed that low plt counts are frequently found on automated cell counters in cats and thought to be due to combination of platelet aggregation and the impedance method of cell differentiation by size.
Norman EJ, Barron RC, Nash AS, Clampitt RB. Prevalence of low automated platelet counts in cats: comparison with prevalence of thrombocytopenia based on blood smear estimation. Vet Clin Pathol. 2001;30(3):137-140. doi: 10.1111/j.1939-165x.2001.tb00422.x. PMID: 12024313; PMCID: PMC7488585.
The below study showed that high frequency of Heniz bodies in cats can lead to interference with automated CBC analysis resulting in erronous interpretation if not accompanied by blood smear analysis.
Dondi F, Vasylyeva K, Serafini F, et al. Heinz body-related interference with leukocyte and erythrocyte variables obtained by an automated hematology analyzer in cats. J Vet Diagn Invest. 2019;31(5):704-713.
Hope this helps,
StephReplying to Steph Sorrell 30/08/2023 - 14:56
Sorry meant to say Silke Salavati from Edinburgh Uni!
-
AuthorPosts
