Eosinophilic granuloma?

Re: Eosinophilic granuloma?

Anthony Todd — Sat, 05 May 2012 12:12:19 GMT

There, there, sweetie, don't throw your rattle out of the pram, just because she made it better and you didn't." />

Re: Eosinophilic granuloma?

Martin Atkinson — Sat, 05 May 2012 11:40:14 GMT

[quote user="Sarah Burston"]Thanks for all your advice. I started it on ovarid- 5mg every 3 days- and after 3 weeks the cat is looking really good. [/quote] From the Ovarid police: yes of course its looking good QED for dinovets

Re: Eosinophilic granuloma?

Anthony Todd — Fri, 04 May 2012 23:34:27 GMT

[quote user="Sarah Burston"]

Thanks for all your advice. I started it on ovarid- 5mg every 3 days- and after 3 weeks the cat is looking really good. The hair is growing back and all the inflammation has gone down, and the owner is really happy too! I'll taper the dose down now so fingers crossed it keeps doing well.

[/quote]

That's a pretty high dose. IMHO, almost teutonic [;-)] so I'd taper pretty quick. Unless it's a big fat cat one 5mg until, and only if, irritation starts again is enough. And the fleas are controlled totally?

You don't want the Ovarid side effect police after you, they can be really nasty and have been rumoured to issue red-stars.

You're controlling symptoms and making the patient better without lots of tests and a presumptive diagnosis, not best practice at all.......!!

Re: Eosinophilic granuloma?

Sarah Burston — Fri, 04 May 2012 18:19:58 GMT

Re: Eosinophilic granuloma?

Sarah Burston — Fri, 04 May 2012 18:19:57 GMT

Re: Eosinophilic granuloma?

Anthony Todd — Thu, 26 Apr 2012 23:58:54 GMT

[quote user="James Allsop"]some of these cats that had had repeat courses of steroid +/- antibiotic[/quote]

I wonder whether these cats had really really chronic EG with well developed secondary infection and granulation.

I assume the speaker was in a second opinion practice?

The longer these EGs had been present the harder they were to fix, IMHO.

I wonder how thick these lesions she was treating were?

Mine were usually <2mm with hardly any apparent granulation tissue.

Re: Eosinophilic granuloma?

Anthony Todd — Thu, 26 Apr 2012 23:53:00 GMT

[quote user="Martin Atkinson"]I do not infer that all vets who use depomedrone are dinovets[/quote]

Finally we're getting there!

What actually bugs you is not the steroids themselves, but their injudicious continuous use? And I totally agree.

Where we differ is you seem to be too anti-steroid even in a case that's ripping itself apart

[quote user="Martin Atkinson"]But I have never found the need for it in any of my dermatitis cases.[/quote]

as you say, and I give them to control distressing symptoms straight away and still embark on an investigation which, let's face it, end's up being fleas or sometimes diet UNLESS the steroid response is poor or absent.

In which case further invasive lab tests can be started, but how common is that?

I wonder what happened with the OP's cat by the way???

Re: Eosinophilic granuloma?

James Allsop — Thu, 26 Apr 2012 19:19:55 GMT

[quote user="Simon Neuhoff"]

The CPD at Langford was very good

The French lady who presented has 25 years experience and has been working in America. She is also starting a study on the subject so I consider her an expert.

[/quote]

I also attended this CPD and the most intriguing thing for me was her experience that some of these cats that had had repeat courses of steroid +/- antibiotic would not only respond well but have a long term cure by use of 4 weeks amoxy/clav - this effect seemed to be negated if steroids were given concurrently (although she conceeded that many of these cats will require an initial dose of steroid to alleviate the pruritis). The speaker is trying to investigate the possibility that staph aureus is releasing some kind of toxin that may be acting as an allergen in these cases. I hope that she is able to complete her study and work out what role staph is playing in these frustrating cases.

Re: Eosinophilic granuloma?

John Rimmer — Thu, 26 Apr 2012 17:08:33 GMT

It's about twice the cost of pred, but a lot lot cheaper than Atopica. I too have come across the dermatologists who use it first line for generalised AD, and there was a study which showed that it was as effective as Atopica.

Re: Eosinophilic granuloma?

Martin Atkinson — Thu, 26 Apr 2012 16:33:50 GMT

[quote user="John Rimmer"]

Don't forget Cortavance as an alternative to pred/Ovarid when Atopica is ruled out due to expense. It isn't licensed in cats of course, though I feel I can justify with cascade. Much as I am not completely anti-Ovarid like some others on here, I do try everything else first, Cortavance being one of them. Justified in cascade IMHO due to potential side effects of pred/Ovarid. Martin, I resent your insinuation that anyone who uses these products is a "Dinovet". I've met plenty of dermatology diplomats who use the products. I would agree that those who use (Ovarid particularly) first line need to get with the 21st Century - but please don't insinuate any use constitutes poor practice. Re your patient that suddenly got better when given steroids at the other practice - would it have hurt to give a short course to the poor suffering animal alongside antibiotics if secondary pyoderma to give short term relief, break the cycle, etc before investigating properly? I've suffered from eczema and was given steroids straight away by a human dermatologist - and I needed them - it was bloody itchy.

[/quote] Firstly: thanks for mentioning it because I agree with the use of Cortavance but it is not inexpensive itself and although it is not at first sight useful for whole body application for generalised pruritis, I have heard that this protocol is now the treatment of choice by some dermatologists for atopic dermatitis. Secondly: I do not infer that all vets who use depomedrone are dinovets, only those who use it as a first line of treatment because they can't be bothered or are not savvy enough to work up the case or use alternatives first. But I have never found the need for it in any of my dermatitis cases. Finally: I cannot remember the exact details of the case I referred to in this instance but it is not out of the question that having ruled out parasitic, bacterial or fungal causes I gave it a short acting corticosteroid to see if it was responsive as I sometimes do but I would then have embarked on an investigation to find a better method of long term control. This does not mean that I would not concede that some animals are only going to be controlled with long-term steroids I just condemn those vets who don't try less potentially harmful therapy first especially the vet in question in the case referred to because he didn't even bother to phone me to get the history first. Dinovet and unethical - what a combination but sadly a common one.

Re: Eosinophilic granuloma?

Rob Loxley — Thu, 26 Apr 2012 15:55:27 GMT

[quote user="Bob Russell"]Interesting that the bumf from MSD states that Activyl leaves 98.4% of households free of fleas within three months of first treatment. Is this really possible? If so then it is probably the answer![/quote]

My reading was that if you start with a flea infestation, you need to treat with Activyl for 3 months to get it under control (assuming no new fleas coming in) - correct me if I'm wrong but that seems pretty slow; why not use an adulticide and a household spray wouldn't that get things resolved much quicker?

Re: Eosinophilic granuloma?

Anthony Todd — Thu, 26 Apr 2012 13:07:47 GMT

[quote user="Kate Richardson"]Why depomed Anthony- why not a shorter acting corticosteroid?[/quote]

Sometimes I used a short acting dexamethasone Q [I think it was called] as a [now maligned] diagnostic aid if it didn't look like a typical EG but depomed gave up to 14 days or longer supression, sometimes one shot only, and inevitably, as the owner hardly ever came back until all the healing had been negated, a longer acting single shot gave a longer healing/supression of irritation time.

Pred orally never seemed to give as good supression and, of course, getting the dose daily or twice daily is not always guaranteed.....

Admittedly short acting steroids don't have the alleged side effects that long-acting ones do but as I've explained, I only used them to effect, and I think others in my practice did as well.

Re: Eosinophilic granuloma?

Simon Neuhoff — Thu, 26 Apr 2012 12:56:56 GMT

[quote user="Neil Wheadon"]

The CPD at Langford was very good

The French lady who presented has 25 years experience and has been working in America. She is also starting a study on the subject so I consider her an expert.

Synopsis

1) Take an impression smear of the lesions. If you see neutrophils then treat with antibiotics as in some cases this will cure them (reason why is unknown)

2) Institute radical flea control for at least 2 months. Frontline and Advocate were used together at 2 weekly intervals (month aprt for each drug.)

3) Look for Dermatophytosis. In cats it can look like anything so Woods light, check hair plucks and culture

4) After this look for allergies. The take home point was

a) Blood tests don't work at all, as cats with allergic skin disease don't display an increase in IgE

b) If are going to skin test, this can be altered by stress within 20 minutes of a cat even looking at a waiting room. She has then sitting in the car, immediate admission and GA

So what about therapy.

1) Steroids were mentioned frequently as a treatment. I asked afterwards for the dose of prednisolone. Her regime is 1-2mg SID for 10 days then EOD for 10 days, then stop for 2 months. Depomedrone can be used, however if use for a year will induce diabetes.

2) Anti-histamines. Again I asked her after the meeting. Piriton is the best. 4mg BID. It alters the behavour and returns the cat to a grooming behavour and so are much more comfortable

3) Ovarid Yes it was mentioned, but considered a bit too risky

4) Atopica. Works well.

I hope this helps

Neil

[/quote]

Thanks for the synopsis Neil. if I can add one bit to your last comment - when it comes to Atopica use in cats - read the label! ;-) If you don't or just skim across it you'll miss the crucial bit about how to use the syringe delivery device correctly. Just for the record it was my wife who didn't read the manual properly - NOT the man this time ;-)

Re: Eosinophilic granuloma?

Kate Richardson — Thu, 26 Apr 2012 12:18:53 GMT

[quote user="Anthony Todd"]I'll let you use smilies or a smiley, if you must, if you'll give cats that are ripping or licking themselves apart one, just one, shot of Depomed at the dose of < or= 5mg/Kg while you do your investigations.[/quote]

Why depomed Anthony- why not a shorter acting corticosteroid?

Re: Eosinophilic granuloma?

Mark Hedberg — Thu, 26 Apr 2012 08:50:47 GMT

[quote user="Anthony Todd"]

, and was told they had got a second opinion and it was diagnosed visually and straight away as a cancer, and the dog was put down......]

[/quote]

Interesting, pentobarb seems to sort out a surprising variety of medical issues...

Re: Eosinophilic granuloma?

Anthony Todd — Thu, 26 Apr 2012 01:45:32 GMT

[quote user="Martin Atkinson"]I feel as a contemporary word it doesn't really matter.[/quote]

Martin, Ok, last word from me.

Duh.... you're right "smilies" is plural.... "smiley " is singular I'm sorry!

I'll let you use smilies or a smiley, if you must, if you'll give cats that are ripping or licking themselves apart one, just one, shot of Depomed at the dose of < or= 5mg/Kg while you do your investigations.

I'll be happier, the cat will be happier, the client will be happier 'cos the cats happier, and you never know, your subsequent investigations might find another cause apart from fleas.

[As a total aside, and to show how most clients should be in Rm 101, a mate of mine and a derm expert [JW] was trying to work out a weird skin and had done all the investigations including biopsy etc.

Saw the client in the street, inquired after the dog, and was told they had got a second opinion and it was diagnosed visually and straight away as a cancer, and the dog was put down......]

Re: Eosinophilic granuloma?

Rob Davis — Wed, 25 Apr 2012 18:52:39 GMT

[quote user="Alet Engelbrecht"]ince this is a skin problem forum - I feel this is the most appropriate place to ask this question - Does the flea in the FLEVOX Vetoquinol advert bother anyone else, or is it just me who wants to crush it?[/quote]

Drives me nuts.... I keep thinking I've got something crawling across my screen - it gets me every time!

Re: Eosinophilic granuloma?

Evelyn Barbour-Hill — Wed, 25 Apr 2012 18:18:22 GMT

[quote user="Alet Engelbrecht"]is it just me who wants to crush it?[/quote]

No.

I thought it might be possible to shoot it, but it isn't.

Re: Eosinophilic granuloma?

Alet Engelbrecht — Wed, 25 Apr 2012 18:11:01 GMT

Since this is a skin problem forum - I feel this is the most appropriate place to ask this question - Does the flea in the FLEVOX Vetoquinol advert bother anyone else, or is it just me who wants to crush it?

Re: Eosinophilic granuloma?

Alet Engelbrecht — Wed, 25 Apr 2012 18:00:00 GMT

[quote user="Martin Atkinson"]low and behold, 'after you tried to rip me off his skin got better after one injection' (of depo-medrone of course).[/quote]

LOL, I hear it all the time now. Even with the fairly young cat with lymphoma (simonasal btw), when I discussed all the options with both husband and wife (separately of course), including the chemo or only steroids, nothing and eventually pts. The owner went to another vet (someone I know and respect at least, I am sure he discussed all the same options), and came back to me to tell me how wonderful the depo injection was.

On another note, I have recently come across a very strange antibiotic regimen for skin problems. How about cephalexin bid on Wednesday and Saturday ongoing? Anyone? Apparently, it works a charm and I am an idiot for not knowing any studies or protocols where this is used. (Obviously alongside predniselone eod as well).

Re: Eosinophilic granuloma?

John Rimmer — Wed, 25 Apr 2012 17:22:54 GMT

Re: Eosinophilic granuloma?

Bob Russell — Wed, 25 Apr 2012 16:37:48 GMT

I generally include the comment that I can get the symptoms to go away almost instantly by giving steroids but this is covering up symptoms, not identifying and treating the cause! I also warn people that allergies are incurable (hayfever comparison) and symptom control is the aim. I leave the door open for steroids if the owner or patient gets to the end of their tether!

I am not steroid phobic and my real nightmare cat is on alternate day preds and Piriton. When the cat was first presented as a second opinion the skin over the jugular was torn to shreds. The other problem cat is on Atopica!

If we can manage the clients expectations they are a little less likely to jump ship! Those that look as if they are losing confidence are referred if I can persuade them.

Re: Eosinophilic granuloma?

Martin Atkinson — Wed, 25 Apr 2012 14:56:33 GMT

[quote user="Alet Engelbrecht"]It seems to me that practices/vets that dispense steroids 'more easily' than others, have a higher percentage of bonded clients [/quote]

Some of my most bonded clients are escapees from steroid abusive practices: yes God forbid me mentioning it; including one cat that developed DM after Ovarid treatment for FAD and one dog that developed generalised demodex after treatment with corticosteroids in ever increasing doses for an itchy skin that was never properly investigated. That said I had one client with a (probably) atopic dog that was nearing the end of an extensive diagnostic trail and being treated conservatively (parasite control, EFA's, shampoos, anti-histamines), when they jumped ship to a steroid abusing dinovet and, low and behold, 'after you tried to rip me off his skin got better after one injection' (of depo-medrone of course).

Re: Eosinophilic granuloma?

Martin Atkinson — Wed, 25 Apr 2012 14:45:54 GMT

[quote user="Anthony Todd"]and I think it's "smiley"[/quote]

Blame this forum then - click on the 'smilie' in the tool bar and see how it's spelled. I feel as a contemporary word it doesn't really matter. Don't want to get entrenched on that do we?

Re: Eosinophilic granuloma?

Anthony Todd — Wed, 25 Apr 2012 14:29:52 GMT

[quote user="Martin Atkinson"]Just to make sure you don't take that too badly[/quote]

[sigh] I'll just have to be a hypocrite and you'll just have to stay entrenched.

Mine, at least, got some early relief and most didn't relapse and none became diabetic that I knew of.

and I think it's "smiley"

A smiley, smiley face, or happy face, :) or :D is a stylized representation of a smiling humanoid face, commonly occurring in popular culture. It is commonly ...