Cat Chest Rads

Re: Cat Chest Rads

Anthony Todd — Mon, 07 Apr 2014 22:18:58 GMT

[quote user="ruths"]I'd certainly scrape the dog too as if I see the mite then I've got a diagnosis[/quote]

I think they used to say 12 scrapes before you can say it isn't. I'd rather see the signs on the owner and just go for it than risk getting negatives and the condition, in owner and dog, rages on.

Of course, in a week or so there are such obvious signs of improvement that you know; just about the time your results come back.

[Medicos are usually hopeless with scabies and usually give them, dare I say it, the dreaded, steroid cream....]

Re: Cat Chest Rads

ruths — Mon, 07 Apr 2014 20:19:23 GMT

Sorry I misread your comments -) I sort of agree in as much as I would treat for sarcoptes if I felt it was a possibility- but these days the therapy for most external parasites is the same anyway. I'd certainly scrape the dog too as if I see the mite then I've got a diagnosis and then I can advise accordingly. Again, with the ringworm, if it goes away with topical therapy then fair enough but I wouldnt shave an animal and give oral anti-fungals without a positive diagnosis. Wrt to itchy animals having full bloods - I must admit to have never seen that as a first line approach and I'd surprised. I've taken bloods for sarcoptes and to screen for cushings, thyroid etc but never as a first line approach. Vomiting dog- depends totally on the case . If I felt it was a secondary GI disease such as renal failure, Addison's, hepatic disease etc then I might do bloods. If it was a severely ill animal then I would do bloods to see if the vomiting had caused problems such as low protein, low potassium etc as these would need managing appropriately with my fluid therapy, or need correcting pre surgery. Obviously, the skill is in recognising which cases need that level of intervention. I suspect we are saying similar -not diametrically opposed , things here. I feel that we need to be very aware of why we are taking bloods or doing diagnostic tests before we do them, and effective clinical reasoning combined with taking a good history and carrying out a thorough clinical exam must be part of this decision making process..

Re: Cat Chest Rads

Anthony Todd — Mon, 07 Apr 2014 16:56:10 GMT

[quote user="ruths"]Anthony, I do take your points but you are approaching the case as a ' dinosaur ' and stating that you have never been wrong[/quote]

Sorry you misunderstood me. I said that, providing a dog has lesions that look like scabies and the owner has the tell tale itchy pinpricks on the inside of the forearms or sometimes round the neck then it is scabies and for that, and only that, I have never been wrong.

Let's face it, the chances of confirming scabies without multiple skin scrapes is not good, as I recall, so my method has merit I think.

Similarly if a dog or a cat has lesions suspicious of ringworm and the owner has a typical lesion then, again, the animal was treated for ringworm.

Apart from those two rules of thumb I've been wrong more than most and I wouldn't begin to pick an Addisons without all the tests needed.

I could add the typical white rimmed oral ulcers in an terminal uraemic cat but apart from those three I can't think of any other condition that I could or would diagnose on appearance alone.

Even the "classic" superficial hypersensitive pyoderma has turned out to be ringworm [er, it was on the hind legs, not the belly] so I've got that wrong once too.

Remember if I ,or the dinosaur was wrong, the animal didn't get better so it came back to bite you but, back in the day, it was nice to diagnose and treat successfully in one hit, well the clients seemed to think so anyway.

Mind you there were bad vets then too and I saw a cat that had been on Megace [the human version of Ovarid] for yonks with it's flea allergy...

It's the idea, all pervading these days, that nothing can be diagnosed, let alone treated, without loads of tests, often not related [I mean full bloods for an itchy or vomiting dog!] which upsets me.

Re: Cat Chest Rads

ruths — Mon, 07 Apr 2014 10:04:37 GMT

Anthony, I do take your points but you are approaching the case as a ' dinosaur ' and stating that you have never been wrong. About 22yrs ago, I diagnosed my first case of Addison's I was well chuffed and mentioned it to an older colleague- 'I've see my very first case of Addison's today!' His reply- 'I doubt it' to never be wrong maybe a fantastic place for 'dinosaurs' but I would expect that the rest of us would have to expect to make mistakes and try to mitigate this by carrying out the best diagnostics we can and use first line therapies that tend not to exacerbate the issue if our suspicions are wrong. In my experience, client management is the way to go - explaining the reasons why a full diagnosis effectivel treatment takes time and what 'being worng' might do to make he situation worse is usually effective. Obviously, when I get to a situation where I'm always right I won't need to invce the clients in this. I spend quite a lot of time with students and try very hard to explain my clinical reasoning to them so they can try to work it all out for themselves. Sadly, there is no substitute for the sort of experience that both you and I have as more mature members of the profession... But I hope to try to bridge the gal between 'no idea' and 'of course I know that, it's obvious!' by unpicking decision making in practice and working out how and why I just know stuff.

Re: Cat Chest Rads

grumpyoldman — Sun, 06 Apr 2014 19:46:48 GMT

chronic asthmatic changes and secondary compensatory r sided cardiomegaly , pred and possibly vetmedin avoid prils till the pulmonary situation improved as initial drop in bp will make pulmonary odema worse.

Re: Cat Chest Rads

Anthony Todd — Sun, 06 Apr 2014 19:29:44 GMT

[quote user="ruths"] but the two quick and easy examples above[/quote]

So would you wait for the scrape or the culture in the two examples I quoted? Ringworm culture takes a fortnight or used to?

If you insist you would wait, then I rest my case, and providing the tell-tale signs are there, I've never been wrong and nor have other dinosaurs either.

[and, in the only case of demodex I've ever seen in a cat], confirmed by scrape too, the owner, a model from New York, all the way to see PJI, now sadly gone, lifted her tank top to disclose a similar "rash" on her abdomen, creating a sudden intense interest in human dermatology by all the male students of the time......

They didn't scrape her.

But that's just an aside.

Re: Cat Chest Rads

ruths — Sat, 05 Apr 2014 15:03:32 GMT

I tried to add a smile to that post but for some reason it didn't attach -))

Re: Cat Chest Rads

ruths — Sat, 05 Apr 2014 15:02:25 GMT

I'm not getting into t teaching people to suck eggs situation... But that's the reason why I try to make an effective diagnosis before I start on treatments that can potentially do harm to my patients. If the therapy is really unlikely to do harm then I will make a judgement but the two quick and easy examples above are not unique and the principle of 'do no harm' is overarching both of the examples above. ( incidentally, my years of working in the charity sector mean that I am less likely than most to want to investigate my human client's physical signs

Re: Cat Chest Rads

Anthony Todd — Sat, 05 Apr 2014 10:01:09 GMT

[quote user="ruths"] And I do find it odd that one would be so derisory of making a diagnosis before starting therapy -it's rather dad and a tad embarrassing to diagnose scabies after a colleague has stuck an itchy dog on steroids. Even more embarrassing when the owner has recently started itching[/quote]

Gimme a break! Why do people always quote an extreme and very unlikely example to justify sometimes weeks of faffing about with allergy tests etc, without any relief for the animal.

Ironically, in this example, and a tip from a dinosaur; always look at the inside of the owners arms if you are suspicious of scabies.

Nice red itchy pinpricks; classic. Sometimes you don't need to do, and charge, for a test.....

The classic place, [or round the neck] and diagnostic confirmation of scabies without scrapes, which aren't always confirmatory.

Sorry no lab fee and confirmed during the consultation so treatment starts on day one. "Eurax" is totally effective for people too.

Good for ringworm diagnosis on the fly, amazingly common confirmation, saves a week of waiting ,often not recognised by GPs.

Re: Cat Chest Rads

ruths — Sat, 05 Apr 2014 01:13:54 GMT

I totally agree wrt the bronchio interstitial pattern- I think I said so earlier--- And I do find it odd that one would be so derisory of making a diagnosis before starting therapy -it's rather dad and a tad embarrassing to diagnose scabies after a colleague has stuck an itchy dog on steroids. Even more embarrassing when the owner has recently started itching

Re: Cat Chest Rads

Anonymous — Sat, 05 Apr 2014 00:16:49 GMT

There is no left atrial enlargement nor pulmonary venous congestion (looking at 2nd radiograph from top in particular), so congestive heart failure is extremely unlikely. There is a widespread bronchointerstitial pattern. Main ddx would be feline asthma, eosinophilic bronchopathy etc. If they cannot afford to go for BAL, I'd put her on preds 0.5mg/kg bid for at least 7 days (possibly 14), then trying to taper down and a course of doxicycline because latent infections are often present in asthma. Might be worth mentioning the use of an inhaler if she is on long term corticosteroids....

Re: Cat Chest Rads

Anthony Todd — Thu, 20 Mar 2014 18:47:19 GMT

[quote user="robloxley"]

[quote user="Anthony Todd"]FHS, why is the diagnostic cart, nowadays, always put before the therapeutic horse?[/quote]

Because it is a very good tool for investigating these cases, widely available, simple (in my opinion), quick, non-invasive etc.; why not make use of what the 21st century has to offer?

[/quote]

Sure, in this one I'm well and truly shafted, but in so many cases [er, not this one] all treatment is withheld, and the animal and the owner suffers, sometimes for days, whilst the diagnosis is pursued and often with a "so-what" result.

Particularly in the often futile search for an allergen whilst the animal suffers via the "therapeutic" elizabethan collar.

Usually skins, I admit, but if you follow the threads there are lots where no treatment [usually steroids] is given as it is stated, rather loftily, that it will "interfere" with the diagnosis, although it will give enormous relief to the animal which is, after all, the result we are after.

This is a change from the days of "say something, do something, give something" of Tandy and Hughes which I always followed.

I admit this pericardial effusion case blows all that out of the water before I get more red stars and ridicule!

Re: Cat Chest Rads

Rob Loxley — Thu, 20 Mar 2014 17:48:41 GMT

[quote user="Anthony Todd"]FHS, why is the diagnostic cart, nowadays, always put before the therapeutic horse?[/quote]

Because it is a very good tool for investigating these cases, widely available, simple (in my opinion), quick, non-invasive etc.; why not make use of what the 21st century has to offer?

Re: Cat Chest Rads

Anthony Todd — Thu, 20 Mar 2014 15:34:33 GMT

[quote user="Robin Grimmer"]

Because a pericardial effusion would need completely different treatment ie pericardiocentesis.

[/quote]

Whoops, in fact one reference says in caps "NO LASIX PLEASE"...... as. apparently, because of the effect on the heart it actually makes it worse!

It is important to remember that standard medications used in the treatment of congestive heart failure (e.g. diuretics, vasodilators) decrease venous filling pressure and increase the severity of cardiac tamponade. NO LASIX PLEASE! If the ability to perform pericardiocentesis is not immediately available, IV fluid therapy should be administered rather than standard therapy for congestive heart failure. The practitioner should also remember that in a stable patient, the presence of pericardial effusion enhances the ability to visualize intrapericardial mass lesions.

So I'm wrong again.

Re: Cat Chest Rads

Hannah Wynne Richards — Thu, 20 Mar 2014 13:51:59 GMT

Tom I'm glad I'm not the only one who hasn't the faintest idea what Yetc stands for !

Wynne

Re: Cat Chest Rads

Robin Grimmer — Thu, 20 Mar 2014 13:02:33 GMT

Because a pericardial effusion would need completely different treatment ie pericardiocentesis.

Re: Cat Chest Rads

Anthony Todd — Thu, 20 Mar 2014 10:59:57 GMT

[quote user="robloxley"]

[quote user="Tom Ward"]+1 for ultrasound, though I for one find that pretty tricky with a normal 1st opinion practice probe in cats[/quote]

YMMV but I would hope assessment for pericardial effusion and measurement of LA diameter wouldn't be beyond any small animal practice with a scanner?

[/quote]

FHS, why is the diagnostic cart, nowadays, always put before the therapeutic horse?

Particularly, in this case, when it's pretty well the only horse available.

Re: Cat Chest Rads

Tom Ward — Wed, 19 Mar 2014 23:18:19 GMT

[quote user="robloxley"]

YMMV

[/quote]

Excuse my lack of online vocabulary, but what is YMMV??

Re: Cat Chest Rads

Rob Loxley — Tue, 18 Mar 2014 17:48:03 GMT

[quote user="Tom Ward"]+1 for ultrasound, though I for one find that pretty tricky with a normal 1st opinion practice probe in cats[/quote]

YMMV but I would hope assessment for pericardial effusion and measurement of LA diameter wouldn't be beyond any small animal practice with a scanner?

Re: Cat Chest Rads

Tom Ward — Tue, 18 Mar 2014 16:26:01 GMT

[quote user="Anthony Todd"]

[quote user="Tom Ward"]My first knee jerk reaction[/quote]

would be to put it on frusemide and see if it helped.

Cat might feel better and I don't think it'll do any harm.

After all the therapeutic options are limited and frusemide won't interfere with further investigations for lungworm etc. will it?

[/quote]

Exactly. Frusemide is also much more likely to help than fenbendazole, on the balance of probability given that cardiac disease is probably more common than parasitic causes! (Though fenbenazole is also pretty cheap and safe)

Re: Cat Chest Rads

Anthony Todd — Tue, 18 Mar 2014 16:23:24 GMT

[quote user="Tom Ward"]My first knee jerk reaction[/quote]

would be to put it on frusemide and see if it helped.

Cat might feel better and I don't think it'll do any harm.

After all the therapeutic options are limited and frusemide won't interfere with further investigations for lungworm etc. will it?

Re: Cat Chest Rads

Tom Ward — Tue, 18 Mar 2014 15:42:40 GMT

My first knee jerk reaction was 'parasitic', but there is definitely cardiomegaly, and though the pattern looks more bronchoalveolar than interstitial, cats don't really read the books when it comes to CHF. +1 for ultrasound, though I for one find that pretty tricky with a normal 1st opinion practice probe in cats

Re: Cat Chest Rads

mariette asselbergs — Mon, 17 Mar 2014 14:25:26 GMT

"subjecting the patient to slight exercise "

How do you exercise a cat (slightly) :-)

Re: Cat Chest Rads

Darren Long — Sat, 15 Mar 2014 16:10:15 GMT

I can see a patchy interstitial pattern and i am suspicious of a more bronchial pattern particularly more caudodorsally. I am not sure if i can see a pulmonary bleb in the lower third of the 7-8th rib space between the heart apex and diaphragm, however this may be artefact. The heart silhouette does appear larger. Was this a sedated radiograph or GA?

My approach would be to perform echocardiography first and if this was within normal limits then the next investigation would be bronchoalveolar lavage, ideally with bronchoscopic guidance. This is relatively easy to perform blind if you do not have access to a bronchoscope. In-house cytology of the wash can be performed in house both if you are happy with assessment and if finances are a concern.

The wheeze makes me more suspicious of airway disease being a big part of the picture you are seeing, however this does NOT exclude heart disease. If they cannot afford a test then possibly perform an in-house blood smear to look for evidence of inflammation or eosinophilia for allergic airway disease or lungworm?

My approach if i were unable to perform any diagnostics would include treatment for aelurostrongylus abstrussus with fenbendazole, some clinicians advocate the use of doxycycline for a treatment trial for infection, particularly mycoplasma in cats, however treatment trials, although they have their place, aren't ideal.

Some clinicians would possibly give a dose of frusemide to an adequately hydrated cat and assess response or re-radiograph. Be cautious with this method though as cats are exquisitely sensitive to frusemide.

Re: Cat Chest Rads

vanessab — Thu, 13 Mar 2014 17:06:27 GMT

Studies in cats have mixed reports. I have a cat that went into CHF at age 3 and is still alive at 13 (with a large left atrium which has been reported as a negative prognostic indicator) and have seen plenty of other patients with primary cardiac disease living normal life spans. still +1 cardiac ultrasound for next step esp before considering steroids etc.