Vomiting cat with swollen face

RE: Vomiting cat with swollen face

Anthony Todd — Thu, 24 Dec 2015 13:26:30 GMT

[quote user="Anthony Dennison"]It is also massively to do with clients. With Dr. Google raising his ugly head more and more often, people want to know what caused their animal to be sick almost as much as getting it better.[/quote]

Yes, I think this is a massive difference and it's going to become more important. I think uni. teaching has swung that way too. [even if the animal, in many cases may not see it that way!]

I think there are a lot of times, like this one, where you won't ever get a diagnosis so there is no need to delay the likely treatment, as there won't be many treatment options anyway.

No reason not to continue with diagnosis concurrently.

I went to a lecture around 20 years ago where a vet said she wouldn't give any treatment before she had a diagnosis, full stop, period!

Back in the day clients wanted the animal fixed, and if there had to be a diagnosis obtained well, OK, but, sort of, if you really need to, or "Don't you know?".....

In most cases the animal was "fixed" because the diagnosis was not going to influence the treatment [eg allergic dermatitis] and if it didn't fix it then, and only then, would the more obscure possibilities be investigated. [but the Nuvan Top would have kicked in by then

RE: Vomiting cat with swollen face

Anthony Dennison — Thu, 24 Dec 2015 12:51:07 GMT

[quote user="Anthony Todd"]I often get the impression that modvets are much more concerned with giving a diagnosis than giving a treatment.[/quote]

All vets I should imagine. With our scientific minds and training, why wouldn't you want to know what's going on with the cat? Personally, with cases like this, I am glad the cat is better but also a bit annoyed I don't know why. It may be the steroids are just a temporary suppression of clinical signs and once they wear off we'll be back to square one. And that is with proper doses of steroids before Anthony uses that well-used pro-steroid argument.

It is also massively to do with clients. With Dr. Google raising his ugly head more and more often, people want to know what caused their animal to be sick almost as much as getting it better.

RE: Vomiting cat with swollen face

Anthony Todd — Thu, 24 Dec 2015 12:41:30 GMT

[quote user="Anthony Dennison"]I gave the cat a good slug of dex last week and since then there has been no vomiting or diarrhoea, he is eating like a horse and his face looks better. I've dispensed some preds to give over this weekend if he does go downhill again as I won't be back in until next Tuesday, but it's looking promising.[/quote]

Come on, all I was suggesting is that if you had done this on first exam the result would have been the same, as above and the cat would be happier sooner.

As I laboriously tried to point out if the cat was not better or relapsed then and only then go through the diagnostic procedure.

After all there are only a finite things you can do to treat an animal so why not start them ASAP?

2 days delay in the diagnosis or relief for the cat in 2 hours.

I often get the impression that modvets are much more concerned with giving a diagnosis than giving a treatment.

Of course sometimes the diagnosis is essential and treatment cannot, and should not, be given until it is made but not, IMHO, in this case.

In the case in question you still haven't a diagnosis but the cat is better [I assume] so it's a win for the cat ,belatedly, I guess.

As far as the financial measurements and assessment of employees you have only to look at the threads on the subject, no aspersions to/on anybody, including you Anthony, but financial performance measurement is usually necessary in some form or another in most organisations.

RE: Vomiting cat with swollen face

Martin Atkinson — Thu, 24 Dec 2015 12:13:58 GMT

[quote user="Anthony Todd"]

[quote user="Martin Atkinson"]Haven't you learned by now he's playing Devils Advocate Virginia.[/quote]

No I wasn't.

[/quote]That's what worries me!

RE: Vomiting cat with swollen face

Anthony Dennison — Thu, 24 Dec 2015 09:05:16 GMT

[quote user="Anthony Todd"]As some vets are now paid on turnover, and rated on it as well, my remark isn't so "snippy".[/quote]

Well I'm not Anthony. In fact, I have been in trouble in the past for going for the cheaper options for the benefit of the client. I'm a little insulted you think I have done all this just to line my pockets. Are you telling me when you were in practice back in the good old days you were never concerned about your practice's income? If you say no, you're lying.

[quote user="Anthony Todd"]Even charities have to watch what they spend.[/quote]

Yes they do. But the quickest and cheapest way of figuring it out is often a single blood test which then directs treatment, better than trying one thing after the other and watching the cat get ill. Since I've been working with this RSPCA branch their monthly vet bill has, on average, halved, but their expenditure on diagnostic testing has increased as a percentage of their total bill. What does that tell you?

I would love to see Anthony back in practice being clinically and financially appraised on a daily basis. Might make him take of those rose tinted steroid specs.

RE: Vomiting cat with swollen face

Anthony Todd — Wed, 23 Dec 2015 20:36:04 GMT

[quote user="Virginia Campbell"]This snippy comment[quote user="Anthony Todd"]the old way doesn't earn as much, I admit.[/quote] made me take the bait this time though. Plus it's fun to play along occasionally. [/quote]

As some vets are now paid on turnover, and rated on it as well, my remark isn't so "snippy".

Remember my vet with the animals on Ceporex for 4 weeks after a dental....

Even charities have to watch what they spend.

PS Has anyone measured the positive/negative ratio for the various tests? ie how many, say, haemo tests, return an abnormal value?

RE: Vomiting cat with swollen face

Anthony Todd — Wed, 23 Dec 2015 20:27:34 GMT

[quote user="Martin Atkinson"]Haven't you learned by now he's playing Devils Advocate Virginia.[/quote]

No I wasn't but I'll try again.

The cat would have improved and been apparently normal after the treatment whether it was given before, during or after the diagnostics.

Why not see what the treatment did before the diagnostics? Do you blood test every apparently healthy cat for FELV etc. etc. or only the ones who have vague illnesses?

Your logic with regard to subsequent come-backs would suggest you do. Let's face it cats with subsequently serious illnesses start off pretty asymptomatic, sometimes for months, so the argument for testing everything that leaves the charity is a good one.

This may be now standard charity practice, and, depending on incidence etc, sounds like a good policy.

All the other procedures could have waited a day or two and been done if there had been no response, charity animal or not.

The results would have been the same.

In the case of the "inappetent pyrexic"cat [posts passim] at least the treatment was given at the same time as all the tests were done, but my remarks would be the same ie wait and assess response in 48hrs on revisit before all the tests available.

Of course there are cases where instant bloods and tests are needed urgently [before I get jumped on] but IMHO these two aren't them.

RE: Vomiting cat with swollen face

Hannah Wynne Richards — Wed, 23 Dec 2015 20:22:31 GMT

You can build an extra 100 pens in a shelter, and you'll have an instant improvement of 100 in the homeless situation - then you hit the barriers. After that you're back to the situation where you can only accept a stray when another pen is freed.

Wynne

RE: Vomiting cat with swollen face

Virginia Campbell — Wed, 23 Dec 2015 19:26:43 GMT

[quote user="Martin Atkinson"]Haven't you learned by now he's playing Devils Advocate Virginia.[/quote]

Yeah, I know. This snippy comment[quote user="Anthony Todd"]the old way doesn't earn as much, I admit.[/quote] made me take the bait this time though. Plus it's fun to play along occasionally.

RE: Vomiting cat with swollen face

Martin Atkinson — Wed, 23 Dec 2015 19:12:04 GMT

[quote user="Virginia Campbell"]

[quote user="Anthony Todd"]All the dinovets I know would have done that on one day one and warned owner to return in max 48 hours for recheck, or further diagnosis, but nowadays it's the other way round![/quote]

Yes. But.

[/quote]Haven't you learned by now he's playing Devils Advocate Virginia. You might as well go and bang your head on the wall.

RE: Vomiting cat with swollen face

Virginia Campbell — Wed, 23 Dec 2015 18:47:39 GMT

Yes. But. This is a shelter cat. Different kettle of fish. It might surprise you to learn that shelter cats will often get more money spent on diagnostics and definitive treatment than owned cats. The reason is pretty simple: you need to get cats "processed" and fit for rehoming as soon as possible to keep a decent turnover going - shelter space is always at a premium so if you can get them diagnosed and fixed or euthed quickly then there is a pen space freed up for another cat in need.

Also, you need to be as sure as you can be that the cats you are sending out are as fit as they appear. If you make it look better with pred without making any attempt at diagnostics, send it to a new home on pred and then it crashes with FIP/neoplasia/FIV/FeLV in the new home, it will either get bounced back to the charity, or diagnosed and treated elsewhere at even greater expense and the new owner will turn up on the charity's doorstep waving the invoice and annoyed that they have been given faulty goods. This really damages the charity's reputation and the cat suffers.

In this case decent efforts have been made to diagnose the cat, rule out sinister euthanasable problems as far as possible and at least we know it's FIV/FeLV negative, so the future rehomers aren't going to be storming the barricades about their existing cats being put at risk by the newcomer.

We do most of the work for our regional Cats Protection branch and would likely have handled this case in a similar manner to how it has been handled. A client-owned cat would likely have been offered workup vs shot of dex and see how it goes at first consult. Some other examples include:

- our rate of surgery vs Vidalta in hyperthyroid cats is higher for the CP cats than owned cats. We give owners the choice of all the hypert4 options; CP cats just get stabilised on meds as quick as possible then surgerised if at all fit for it - much easier to rehome if new owners don't have to shell out for Vidalta.

- anything with oral resorptive lesions gets the affected teeth extracted - no "wait and see" even for one tiny innocent looking RL on a lower first PM. They go out the door of the shelter with a Bristol Dental Grading Score of 0 or 1. CP headquarters keep records of post rehoming complaints/bounce backs, with reasons stated by new owner, for each branch. Our branch had a total of zero complaints last year for dental reasons.

- client owned cats with recurrent otitis due to a polyp get the TECABO vs lifelong sporadic ear meds conversation. CP cats get cleaned up with meds then TECABO'd on the affected side. It's expensive but the cat is ready to rehome as "fixed" as you can make it.

This might sound terribly extravagant with charity money but actually works out more cost effective for the CP as far as £ spent / cats successfully rehomed per year is concerned- I imagine the RSPCA may be similar.

RE: Vomiting cat with swollen face

Anthony Todd — Wed, 23 Dec 2015 16:10:20 GMT

All the dinovets I know would have done that on one day one and warned owner to return in max 48 hours for recheck, or further diagnosis, but nowadays it's the other way round!

I still commend the dinovet approach, cat gets relief earlier, owner happy earlier, and thinks more of you.

Of course, if you treated the cat straight away the owner can't say "why didn't you do that last time?" and [silently] thinks] save me a couple of hundred quid....

You can have another go at diagnosis on revisit when [probably] the signs will be more obvious but the old way doesn't earn as much, I admit.

RE: Vomiting cat with swollen face

Hannah Wynne Richards — Wed, 23 Dec 2015 14:09:31 GMT

Congrats

Wynne

RE: Vomiting cat with swollen face

Mark Hedberg — Wed, 23 Dec 2015 11:16:34 GMT

Great to hear, glad to know cat's on the mend.

Cheers,
Mark

RE: Vomiting cat with swollen face

Anthony Dennison — Wed, 23 Dec 2015 10:53:44 GMT

Update on this case:

I gave the cat a good slug of dex last week and since then there has been no vomiting or diarrhoea, he is eating like a horse and his face looks better. I've dispensed some preds to give over this weekend if he does go downhill again as I won't be back in until next Tuesday, but it's looking promising.

RE: Vomiting cat with swollen face

Martin Atkinson — Wed, 16 Dec 2015 10:45:15 GMT

[quote user="Anthony Dennison"]

[quote user="Martin Atkinson"]Bit stumped but what about the possibility of FCV per-acute syndrome, they can get GI and cutaneous symptoms with that? A worry in a shelter so I would be cautious.[/quote]

No conjunctivitis, epiphora,blepharospasm or flu signs. Just a swollen face causing the lower lids to roll in.

[/quote]I don't suppose it is this as symptoms would have progressed rapidly but when the first cases were seen several years ago no-one did either. Forget flu like signs with FCV peracute syndrome. The symptoms were characterised by cutaneous lesions and multiple organ failure due to vasculitis. Evil disease and highly contagious even in vaccinated cats (well the FCV vaccine hardly works anyway)! Just saying because if in doubt very strict barrier nursing and isolation is required.

RE: Vomiting cat with swollen face

Anthony Dennison — Wed, 16 Dec 2015 10:34:26 GMT

Thanks, saw that but it's a single day in London - long way to travel from the vicious north!

BSAVA have a stream at congress on medicine on a shoestring, will try and get to those.

RE: Vomiting cat with swollen face

David Mills — Wed, 16 Dec 2015 10:12:23 GMT

[quote user="Anthony Dennison"]One of those frustrating moments where the shelter staff want you to do everything but the manager, who holds the purse strings, is more reluctant.[/quote]

The joys of shelter medicine.

There's a decent looking conference in January from the Association of Charity Vets, cheap and relevant CPD (I'm not a member or involved with the conference, just popped up on a website):

http://www.associationofcharityvets.org.uk/

RE: Vomiting cat with swollen face

Kate Richardson — Wed, 16 Dec 2015 10:11:42 GMT

[quote user="Anthony Dennison"]

[quote user="David Mills"]Sounds an odd case. In the absence of a diagnosis, and if cat bright otherwise, I would be tempted to give a shot of dex (decent dose) to see if it resolves or improves both to vo/swelling, in which case may support an allergic component.[/quote]

This is what I was thinking. One of those frustrating moments where the shelter staff want you to do everything but the manager, who holds the purse strings, is more reluctant.

[/quote]

I was wondering if allergic as well- histamine release can cause nausea and vomiting and would explain the swollen face. Also consider that the two are unrelated. But I would also be tempted to give some dex as well

RE: Vomiting cat with swollen face

Anthony Dennison — Wed, 16 Dec 2015 09:55:19 GMT

This is what I was thinking. One of those frustrating moments where the shelter staff want you to do everything but the manager, who holds the purse strings, is more reluctant.

RE: Vomiting cat with swollen face

David Mills — Wed, 16 Dec 2015 09:35:09 GMT

[quote user="Anthony Dennison"]Thing is, if it is FIV/FeLV positive, apart from a bit of GI signs it's actually quiet a bright and friendly cat, so I'd be looking to do a second test a few weeks later to confirm it.[/quote]

For borderline or 'strange' positives, you can send blood away (at reduced cost) to (I think) Glasgow for confirmation - check with GMAH, they likely have a system in place for this.

Sounds an odd case. In the absence of a diagnosis, and if cat bright otherwise, I would be tempted to give a shot of dex (decent dose) to see if it resolves or improves both to vo/swelling, in which case may support an allergic component.

RE: Vomiting cat with swollen face

Anthony Dennison — Wed, 16 Dec 2015 09:23:07 GMT

No conjunctivitis, epiphora,blepharospasm or flu signs. Just a swollen face causing the lower lids to roll in.

[quote user="Matt Hilary"]Any specifics on breed? Discomfort/abnormalities on abdominal palpation? Temperature? Bile acids on biochem? Diet (and any history of diet change?)? Repeat scan to see if liver changes consistent?[/quote]

Ginger DSH brought in as a stray. Nothing on abdo palp, temp to start was a little low, 37.9degC, but has come back up again. When I was scanning and looking at the stomach/proximal duodenum, he didn't much like the probe being pushed in. Our biochem panel doesn't have bile acids on but TBil was normal, ALKP was low (<10, range 23-212). Cholesterol was also a little low. Don't have an in house haematology machine so don't have that currently.

Probably is some dietary change as (despite what I tell them EVERY WEEK) cats can sometimes get a different thing each day. Strict instructions to feed RC sensitivity control only in small meals now.

[quote user="Virginia Campbell"]Any sick young cat with an unknown history gets an FIV/FeLV snap test from me fairly early on in the game as you can get all manner of weirdness, although as this is an RSPCA cat I expect you've already done this. I also stick FIP on the list of possibilities as the vasculitis it can cause can throw up weird signs anywhere, though I suppose if not pyrexic and globulins normal, a bit less likely[/quote]

Normally if the cat comes through GMAH in Salford they will do. This cat may have been a stray brought direct to the shelter, so will look into testing that. Thing is, if it is FIV/FeLV positive, apart from a bit of GI signs it's actually quiet a bright and friendly cat, so I'd be looking to do a second test a few weeks later to confirm it.

RE: Vomiting cat with swollen face

Virginia Campbell — Tue, 15 Dec 2015 22:22:48 GMT

Any sick young cat with an unknown history gets an FIV/FeLV snap test from me fairly early on in the game as you can get all manner of weirdness, although as this is an RSPCA cat I expect you've already done this. I also stick FIP on the list of possibilities as the vasculitis it can cause can throw up weird signs anywhere, though I suppose if not pyrexic and globulins normal, a bit less likely. A PITA to diagnose, but it'll often declare its hand within a few weeks and become more obvious. The last few cases I had were just a bit off for a couple of weeks, then occasionally a wee bit pyrexic and it took a while for the bloods to become interesting. I had one that developed scrotal swelling a week before it developed classic abdominal effusion.

RE: Vomiting cat with swollen face

Matt Hilary — Tue, 15 Dec 2015 16:56:05 GMT

Any specifics on breed? Discomfort/abnormalities on abdominal palpation? Temperature? Bile acids on biochem? Diet (and any history of diet change?)? Repeat scan to see if liver changes consistent?

RE: Vomiting cat with swollen face

Martin Atkinson — Tue, 15 Dec 2015 16:45:25 GMT

Bit stumped but what about the possibility of FCV per-acute syndrome, they can get GI and cutaneous symptoms with that? A worry in a shelter so I would be cautious.