Chronically Lame Cat

Re: Chronically Lame Cat

Kate Richardson — Sun, 30 Dec 2012 11:52:57 GMT

Have I missed something but I haven't read that this cat is being treated with frusemide??

I agree Michael, owners are often very capable of injecting their cats and its a good way of medicating, often forgotten

Re: Chronically Lame Cat

Michael Woodhouse — Sun, 30 Dec 2012 02:03:14 GMT

[quote user="Mark Hedberg"]Suggestion: Crush the frusemide in a small pea sized ball of marmite; smear it on paw/tongue/face and cat will lick it off. (very sticky, very hard to shake off.)[/quote]

Or dispense a bottle and instruct owner in injection technique - just like with a diabetic cat.

I quite often get owners to inject their pets.

Re: Chronically Lame Cat

Kate Richardson — Sat, 29 Dec 2012 18:24:50 GMT

I tend to go on what the cat is telling me in these sort of cases- if it is painful enough to need metacam, and is eating and drinking and behaving normally otherwise, it gets metacam. Yes I do do bloods/urine ideally in cats on long term meds, but base my decision on the cat. If I know the cat has renal insufficiency I will try to reduce the dose to the lowest effective dose if possible. I deal with a lot of geriatric cats with multiple old age issues requiring management and arthritis is one of those issues and in my experience as long as they continue to eat and drink normally I do not find the renal disease progresses more rapidly than I would expect if I add metacam to the mix. In a lot of cases, if there is significant discomfort they eat and drink better and renal values can actually improve. I discuss the risks and benefits fully with owners first and strongly emphasise to these owners that if Tiddles isn't eating or drinking as normal on a particular day, or if they are unwell for any other reason, that they shouldn't give the metacam on those days as I believe that it is only detrimental if hydration is reduced and thus renal perfusion is also reduced.

[quote user="alison howell"]

Most cats in the study had creatinine within the normal range (stage 1- and part of stage 2) - which probably wouldn't be identified as renal failure in many cases - it would be interesting to know the effect of meloxicam on cats with raised creatinine.

I am interested to know if many vets are picking up cats at this early stage of renal failure - asymptomatic, with normal bloods. Are many doing bp and urine pro:crea ratio as a screening test on older cats?

[/quote]

Yes if you check USGs and bodyweight regularly in older cats. IRIS ranges for creatinine and phosphate are lower than most labs reference ranges, but a USG of < 1.035 in an older cat (in any cat actually) raises suspicion in my mind and warrants repeating and monitoring and further urine tests such as UPC (not always elevated in renal insufficiency), bloods, BP etc

Re: Chronically Lame Cat

Mark Hedberg — Tue, 25 Dec 2012 15:46:35 GMT

[quote user="Anthony Dennison"]

No. Cat's had raised urea and creatinine for about 3 years, slowly creeping up. Think the creatinine from bloods take today was in the low 300s, so looking at IRIS stage 3/4? Can't give the cat tablets as gets stressed out so never been medicated. Think the owners do the bare minimal with the cat unfortunately. Amputation was offered but they thought the anaesthetic risk was too great

[/quote]

Suggestion: Crush the frusemide in a small pea sized ball of marmite; smear it on paw/tongue/face and cat will lick it off. (very sticky, very hard to shake off.)

Re: Chronically Lame Cat

Chris Geddes — Tue, 25 Dec 2012 13:06:10 GMT

[quote user="Anthony Dennison"]

[/quote] Renal diet?

Re: Chronically Lame Cat

Gerry Henry — Tue, 25 Dec 2012 11:20:03 GMT

Er, sorry to digress but the elbow ... FNA or core biopsy (care nerve/artery) will tell you nature of mass and therefore probable outcome. Have you done one yet ?

Re: Chronically Lame Cat

David Mills — Tue, 25 Dec 2012 01:26:02 GMT

[quote user="Anthony Todd"]

Glad to see the tide may be turning for steroids at last, at least as far as animal comfort is concerned.

[/quote]

Not really sure about this, actually. What a wonderful Xmas present that would be - inject 10 cats with depo-med and 10 with water and reassess owner perceptions 4 wks later. In short: Where. Is. The. Evidence. (WHITE for the purposes of those who were born after the invention of iso).

Does it matter who funded the study(ies) if its retrospective? Both studies were carried out by primarily non-affiliated clinicians. It is deliciously ironic, then, that first opinion clinicians who, on this forum, have oft harped on about outdated 'EBM = experience based medicine' claptrap are now, purely because it doesn't fit their world view, calling into question the validity of a study, which, whilst imperfect, certainly is pretty rigorous and has impressive numbers.

I would love, by comparison, to see the drugs these people prescribe per week, that are based solely nd utterly on licensing - which is, of course, on data published from drug comapnies without any recognisable terms... sigh. Who cares, I suppose, what the eternally dogmatic and cynical think?

Re: Chronically Lame Cat

mariette asselbergs — Mon, 24 Dec 2012 22:39:21 GMT

"Bad Pharma" was my Xmas present to my new young colleague....

Re: Chronically Lame Cat

Anthony Todd — Mon, 24 Dec 2012 15:43:01 GMT

[quote user="mariette asselbergs"]Just wondered: who funded this study?([/quote]

Yes, read "Bad Pharma" and ask the above question after single every "study"!

Glad to see the tide may be turning for steroids at last, at least as far as animal comfort is concerned.

Re: Chronically Lame Cat

vs0u — Mon, 24 Dec 2012 15:38:26 GMT

When I want a cat to go on long term I would advise a blood test and if that was ok they would be assumed to be ok to go on meloxicam long term - but this may include many of those within IRIS stage 1 and 2.

Re: Chronically Lame Cat

mariette asselbergs — Mon, 24 Dec 2012 08:21:22 GMT

Yes nice.

Just wondered: who funded this study?(Don't get access to the whole text, only the abstract.

Mariette

Re: Chronically Lame Cat

David Mills — Thu, 20 Dec 2012 22:53:21 GMT

[quote user="Louise Alexander"]

[quote user="Thomas Johnson"]Does anyone know of any research to indicate whether NSAIDs or glucocorticoids are more nephrotoxic to animals with pre-existing renal disease? There was apaper published last year (I think) which showed no deterioration in renal parameters in cats treated with half dose meloxicam.[/quote]

http://www.ncbi.nlm.nih.gov/pubmed/21906984

Retrospective case-control study of the effects of long-term dosing with meloxicam on renal function in aged cats with degenerative joint disease

'These results suggest that a long-term maintenance dose of 0.02 mg/kg of meloxicam can be safely administered to cats older than 7 years even if they have CKD, provided their overall clinical status is stable'

[/quote]

Glad someone mentioned this. What is very interesting is:

"There was less progression of renal disease in the 'renal group' treated with meloxicam compared to the age- and IRIS-matched cats with CKD not given meloxicam"

For me, this study, and others:

http://www.ncbi.nlm.nih.gov/pubmed/22821331

http://www.ncbi.nlm.nih.gov/pubmed/18440263

successfully overturn the dogma of 'CRF cats = no NSAIDs' which is based on theoretical contraindications, and evidence-bereft, with the proviso it's used at half the licensed dose. I just wonder how much of a disservice we do to 1000s of cats by labouring under the theoretical (expert-led) dogma.

Re: Chronically Lame Cat

Louise6732 — Thu, 20 Dec 2012 18:11:33 GMT

http://www.ncbi.nlm.nih.gov/pubmed/21906984

Retrospective case-control study of the effects of long-term dosing with meloxicam on renal function in aged cats with degenerative joint disease

Re: Chronically Lame Cat

Anthony Dennison — Thu, 20 Dec 2012 17:58:16 GMT

Re: Chronically Lame Cat

James Laidlaw — Thu, 20 Dec 2012 17:34:43 GMT

Doesn't sound good...

Re: Chronically Lame Cat

Anthony Dennison — Thu, 20 Dec 2012 17:30:27 GMT

[quote user="James Laidlaw"]Could you not just FNA the soft tissue swelling in house? Diff quick might I've you a better picture of inflammatory vs neoplasia and pretty quick and cheap to do.

[/quote]

Although it is soft tissue, on palpation (managed to get my hands on the cat after my initial post) it feels pretty damn solid, not sure FNA will produce much of anything viable except perhaps some blood contamination.

Anyhoo, the cat has been discharged now and the owners are pretty anti-workup of any kind which is unfortunate. I can speak to the vet who normally sees him and ask if she'll be able to convince them when he comes in for his next check up.

Re: Chronically Lame Cat

Thomas Johnson — Thu, 20 Dec 2012 17:08:36 GMT

[quote user="Anthony Dennison"]

to be honest that was my suggestion, especially as NSAIDs are an issue due to renal problems

[/quote]

This is a view I hear quite often, but the datasheets advise against the use of glucocorticoids in animals with renal disease, for example Depo Medrone: "Systemic corticosteroid therapy is generally contra-indicated in patients with renal diseases."

Does anyone know of any research to indicate whether NSAIDs or glucocorticoids are more nephrotoxic to animals with pre-existing renal disease? There was apaper published last year (I think) which showed no deterioration in renal parameters in cats treated with half dose meloxicam.

Re: Chronically Lame Cat

James Laidlaw — Thu, 20 Dec 2012 17:08:19 GMT

Could you not just FNA the soft tissue swelling in house? Diff quick might I've you a better picture of inflammatory vs neoplasia and pretty quick and cheap to do.

Re: Chronically Lame Cat

Utlendigur — Thu, 20 Dec 2012 15:43:00 GMT

I think I can see a fissure on the lateral view, but the surrounding bone also looks abnormal (resorption/lysis rather than proliferation as I'd expect with a callus) - ? pathological fracture. THe soft tissue swelling seems to be lying more proximally than I'd expect and also seems very pronounced to be secondary to a joint problem. Is the triceps tendon intact? I'd be suspicious of some sort of soft tissue neoplasia causing secondary bony changes

Re: Chronically Lame Cat

Anthony Dennison — Thu, 20 Dec 2012 15:25:35 GMT

to be honest that was my suggestion, especially as NSAIDs are an issue due to renal problems

Re: Chronically Lame Cat

Michael Woodhouse — Thu, 20 Dec 2012 15:01:52 GMT

My crappy monitor not very clear. Could it be an osteomyelitis from an old cba? Month on clindamycin?

I expect a red star but some cats improve amazingly with arthritis if given good old Depo-medrone