Kitten with sore nasal philtrum

RE: Kitten with sore nasal philtrum

Anthony Todd — Wed, 27 Jan 2016 22:36:14 GMT

[quote user="Kate Richardson"] but I have seen some scary pictures of cats skin following corticosteroid treatment when the underlying diagnosis turned out to be viral,[/quote]

Have you got access to the pics or the reference?

Not challenging, just interested in cats' skin disease and can't recall a viral one, sorry, just found the cowpox one.

RE: Kitten with sore nasal philtrum

Virginia Campbell — Wed, 27 Jan 2016 20:59:44 GMT

[quote user="Anthony Todd"] if you explain these theoretical risks to the owner you'll be blamed for any disease, incident, accident, or behavioural abnormality for the rest of the cat's life[/quote]

I know you were talking about interfering with vax response specifically, but I tend to discuss the most common risks of most treatments I use, explain my risk/benefit thinking, get the nod from the owner and briefly record the discussion on the record. I don't trawl through the datasheet with the owner talking about everything , but for example with an older cat that's shredding its face with allergy and the owners have instituted diet, flea control and other immune modulating therapy to the best of their long term financial and practical means and its not enough, then I talk about intermittent or long term pred use, briefly discuss diabetes and heart disease, owner and I agree that we'll risk it for the cat's happiness, record on notes, all is well. Haven't been blamed yet and if I was, I'd have the ammo to prove my case.

RE: Kitten with sore nasal philtrum

Kate Richardson — Wed, 27 Jan 2016 20:35:48 GMT

Bob RussellI've just checked my notes from feline congress last year (on dermatology) and Herpes virus would be a contender- nasal planum can be affected. Can look same as eosinophilic granuloma complex. I think the age of the kitten is what concerns me as it would be unusual to have an EG at this age? Aidan Foster at Langford is a good feline dermatologist, so it might be worth a call/email to him to get his thoughts? Has the kitten ever had any flu signs at all in its life? Could it be a vaccine related reaction? I don't know the answers to these questions, so if you do contact Aiden, let me know the answers!

[quote user="Bob Russell"]

Would a dose of a short acting steroid be that risky even in the face of a viral infection? Anti inflammatory doses rather than immunosuppressive levels.

[/quote]

Potentially I think it is possible, but I don't know is the honest answer- I would have thought an anti-inflammatory dose wouldn't be too detrimental, but I have seen some scary pictures of cats skin following corticosteroid treatment when the underlying diagnosis turned out to be viral, so I would go cautiously and with full owner understanding if they don't want to do any form of diagnostics. Topicals of no use as will be licked off immediately. Frustrating! (as an aside how do you stop a 3 year old picking a scab on her nose she sustained from being a t*t and is not healing because she keeps fiddling with it {other than bandaging her hands up...}) If they don't want to do diagnostics then you could trial famcyclovir as worst case scenario is it is unlikely to do any harm, just may do no good!

RE: Kitten with sore nasal philtrum

Anthony Todd — Wed, 27 Jan 2016 18:36:46 GMT

[quote user="Francisco Gomez"] waiting now for the rain of red stars...[/quote]

None from me, 'cos I know how difficult "rodent ulcers" are to cure but if you're going to use steroids [that's corticosteroids for the pedants] it's best to use a larger rather than a smaller dose.

I suspect, the alleged caveat of poor or no immunity following vaccination with steroids [not supported by any practical evidence that I can find] is again theoretical, but the usual reason for not fixing something.

I'd go for Depomed so we can share our red-stars but, I wager, the cat and owner will thank us.

[quote user="Francisco Gomez"]A few days of constant licking and the lesion is going to be much worse whatever the trigger.[/quote]

Amen to that!

Trouble is if you explain these theoretical risks to the owner you'll be blamed for any disease, incident, accident, or behavioural abnormality for the rest of the cat's life particularly, as I have said, there ain't much evidence to support it.

RE: Kitten with sore nasal philtrum

Francisco Gomez — Wed, 27 Jan 2016 17:09:03 GMT

[quote user="Bob Russell"]

Would a dose of a short acting steroid be that risky even in the face of a viral infection? Anti inflammatory doses rather than immunosuppressive levels.

A few days of constant licking and the lesion is going to be much worse whatever the trigger.

Nice to see I am not the only one unsure what to do!

[/quote]

I would probably explain the risks to the client and reach for Dexamethasone Phenylpropionate (Dexafort, Animal Health) and give a dose of a 0.05ml/kg SC.. which for that kitten size is probably a minute dose. Then give a another SC dose of 0.05ml of Amox/Clav (Synulox, Zoetis) and hope the client can follow it up with 12.5mg/kg BID of Synulox tablets (or equivalent).

I would then arrange to see the kitten before the weekend for re-assessment.

I don't think a short-active injectable will achieve much. If I had it, I would've used Voren..

... waiting now for the rain of red stars...

RE: Kitten with sore nasal philtrum

Bob Russell — Wed, 27 Jan 2016 16:48:37 GMT

Would a dose of a short acting steroid be that risky even in the face of a viral infection? Anti inflammatory doses rather than immunosuppressive levels.

A few days of constant licking and the lesion is going to be much worse whatever the trigger.

Nice to see I am not the only one unsure what to do!

RE: Kitten with sore nasal philtrum

Kate Richardson — Wed, 27 Jan 2016 16:39:54 GMT

[quote user="Clare Tapsfield-Wright"]Calici ulcer ? Any on the tongue ? [/quote]

Good idea, Herpes virus can also cause lesions, so impression smear + swabbing for FHV/FCV PCR would be a good idea- prob don't want to use corticosteroids if its viral.

RE: Kitten with sore nasal philtrum

Anthony Todd — Wed, 27 Jan 2016 15:07:43 GMT

[quote user="Bob Russell"]Not considered demodex though!![/quote]

Don't demodex only live in hair follicles?

And rodent ulcers have to start somehow??

RE: Kitten with sore nasal philtrum

Bob Russell — Wed, 27 Jan 2016 15:03:54 GMT

No lesions anywhere else in the mouth or anywhere else for that matter. So far views are pretty much in line with my thoughts. Not considered demodex though!!

RE: Kitten with sore nasal philtrum

Clare Tapsfield-Wright — Wed, 27 Jan 2016 14:41:46 GMT

Calici ulcer ? Any on the tongue ?

RE: Kitten with sore nasal philtrum

Thomas Johnson — Wed, 27 Jan 2016 14:36:44 GMT

[quote user="Francisco Gomez"]

looks like an indolent ulcer - steroids and ab cover? - never seen them in a cat that young.

[/quote]

I'd be thinking the same, but might it be worth scraping it for demodex before giving it steroids? I think any topical treatment would be a waste of time as the kitten will just lick it off.

RE: Kitten with sore nasal philtrum

Francisco Gomez — Wed, 27 Jan 2016 12:56:58 GMT

If the watch says 10.35, I'd be guessing those scratches happened about 9 o'clock ...

RE: Kitten with sore nasal philtrum

Anthony Todd — Wed, 27 Jan 2016 12:49:55 GMT

[quote user="Francisco Gomez"]looks like an indolent ulcer[/quote]

Well if it isn't yet it soon will be, or a "rodent ulcer"?!

I do wonder whether you can prevent an antibody response with steroids, I know it's theoretically a very bad idea but, actually, would they totally block a vaccine response?endon injection.

The exact amount of systemic corticosteroids and the duration of their administration needed to suppress the immune system of an otherwise healthy child are not well defined.

from: [cherry-picked, I know]

http://www.aaaai.org/ask-the-expert/live-viral-vaccines.aspx

The consequences of letting a developing lesion like this seem much worse than a possible failure of vaccination, particularly if you give another shot later and, as Kate suggests a third shot to be sure.

RE: Kitten with sore nasal philtrum

Kate Richardson — Wed, 27 Jan 2016 12:25:38 GMT

Can you do some impression smears? I agree with Francisco, but I would like a little more justification for using corticosteroids first, but I would use a short acting one initially, but would perhaps defer 2nd vaccine and follow with a 3rd?

RE: Kitten with sore nasal philtrum

Francisco Gomez — Wed, 27 Jan 2016 12:22:45 GMT

looks like an indolent ulcer - steroids and ab cover? - never seen them in a cat that young.

RE: Kitten with sore nasal philtrum

Anthony Todd — Wed, 27 Jan 2016 12:11:51 GMT

[quote user="Hannah Wynne Richards"] I bet you know who will suggest steroids [/quote]

Yup, it'll need them sooner or later.

It's not as daft as suggesting topical anything on a cat's lips.....

RE: Kitten with sore nasal philtrum

Hannah Wynne Richards — Wed, 27 Jan 2016 11:09:39 GMT

I bet you know who will suggest steroids - even though it's half way through it's vaccination course!

Is lip salve safe in kittens? If so, the owners could smear some on their fingers, and then the kitten's lips.

Grumpyoldman might even suggest tarmac

Wynne