What would you treat this cat with?

RE: What would you treat this cat with?

Kate Richardson — Sun, 16 Oct 2016 20:53:42 GMT

Have you checked blood pressure? Could be a spinal bleed secondary to this with secondary cardiac changes

RE: What would you treat this cat with?

Ashlea — Sat, 15 Oct 2016 17:06:05 GMT

Update on the cat - I gave buprenorphine and sent her home on Metacam as she walked better during the afternoon but was still painful over the pelvis. I saw her again yesterday and she was still very painful over her pelvis but walking better and her hindlimb gait was much better. Her feet are warm and her pulses are fine.

I'm pretty convinced that it's an acute arthritic flare up or pelvic fracture, the claws were not scuffed but if it's not thromboembolic disease she must have injured herself somehow. I can't do any radiographs due to cost so at the moment if we can control her pain over the weekend I'm going to look into clopidogrel as I think metacam may be needed for a while - the cat certainly is a massive risk for thromboembolism.

RE: What would you treat this cat with?

rhmrcvs — Thu, 13 Oct 2016 22:09:34 GMT

Luca Ferasin , excellent cardiologist. Our experience is as he described, underlying cardiac dz therefore clots . Have tried thrombolytics etc over years , but most only go on few wks. If pain cannot be controlled pts .

RE: What would you treat this cat with?

Anthony Todd — Thu, 13 Oct 2016 15:50:36 GMT

Not wishing to teach my grandchildren to suck eggs but nobody seems to have mentioned examining the hind [and front] claws for "accident damage" and the nail-beds for pink or purple colour.

RE: What would you treat this cat with?

Bob Russell — Thu, 13 Oct 2016 15:43:46 GMT

Luca Ferasin now at CVS's new referral centre.

I have had such poor results over the years and the pain is excruciating. I either refer for euthanasia or do it myself!

Had one last night! In agony and thankfully no funds to do anything too clever. My first question is should we be treating this? If not too distressed I would have used aspirin but so far either referred (died) or euthanased (died).

RE: What would you treat this cat with?

David Mills — Thu, 13 Oct 2016 15:22:50 GMT

[quote user="Sarah Keir"]That one passed me! But now I need to decide if I want to pay $32 to read it![/quote]

If you PM me an email address you may receive an early Christmas present...

RE: What would you treat this cat with?

Sarah Keir — Thu, 13 Oct 2016 14:58:44 GMT

It was published last year. Seems clopidogrel is more effective than aspirin - but the confidence intervals are quite wide to say the least. I haven't read the study yet so I can't see the incidence of cardiac dz with ATE in the study, but I never seem to see them without both.

https://www.ncbi.nlm.nih.gov/pubmed/26776588

That one passed me! But now I need to decide if I want to pay $32 to read it!

RE: What would you treat this cat with?

Anthony Dennison — Thu, 13 Oct 2016 09:16:40 GMT

[quote user="Robin Grimmer"]

Not saying in this case, but in a classic case of FATE, ie no femoral pulses, cold hind legs plus underlying heart disease has anyone ever had any success with these? Because I generally go for euthanasia.

[/quote]

Anecdotally I've had some success with using Cartrophen off-license, and my other half uses it regularly with success in multiple cases. Use it instead of heparin.

However, the majority of ATE's I see are euthanased.

RE: What would you treat this cat with?

David Mills — Wed, 12 Oct 2016 23:42:58 GMT

[quote user="Sarah Keir"]

Clopridogrel is probably more effective at preventing clots than aspirin - but apart from an abstract, we are still waiting for the FATCAT trial to be published in full.

[/quote]

https://www.ncbi.nlm.nih.gov/pubmed/26776588

[quote user="Clare Tapsfield-Wright"]Do you find they recur Emily? I always found them soul destroying to see and the underlying problems intractable. [/quote]

I always push for euth on these. As GOM said, there has been some prospective data on this and most recur within 150 days, associated with probably the most severe pain a cat can suffer.

In this case, if you're looking to treat, then metacam and aspirin +/- plavix. In people, aspirin and nsaids are commonly taken alongside each other for such a reason - i.e. the anti-platelet effects of aspirin are well below the analgesic effects, same applies in cats (q72h dosing).

But, ideally, PTS.

RE: What would you treat this cat with?

grumpyoldman — Wed, 12 Oct 2016 22:52:24 GMT

I remember a very nice Italian guy who spent 10 years getting a PhD on these cases somewhere flash in the US ,who spoke at the BSAVA and basically said even the ones that get better for a few weeks(few and far between) reoccur often within 6 weeks and get bagged. Luca Ferrara or something similar was his name . I think some fool you because they only block either the internal or external femoral arteries ,not both and reperfuse for a while before it all goes pear shaped again or a renal artery or a thoracic limb gets involved .

RE: What would you treat this cat with?

Clare Tapsfield-Wright — Wed, 12 Oct 2016 21:56:51 GMT

Do you find they recur Emily? I always found them soul destroying to see and the underlying problems intractable.

RE: What would you treat this cat with?

Emily Rainbow — Wed, 12 Oct 2016 21:11:14 GMT

We do get quite a few home. Those that are more unilateral have a better prognosis and those that show some improvement fairly quickly following initiation of treatment do best.

They get NSAIDs, opioids, IVFT, heparin, aspirin, clopidogrel and physio as a start. Often also various heart meds if deemed appropriate.

We have one in at the moment that was admitted this morning. In 8 hours we can now find pulses in his hindlimbs with Doppler when we were unable to this morning so hopefully he'll be a doer!

RE: What would you treat this cat with?

Iain Richards — Wed, 12 Oct 2016 19:48:54 GMT

Agreed. Most likely saddle thrombus, usually PTS as so painful

RE: What would you treat this cat with?

Robin Grimmer — Wed, 12 Oct 2016 19:44:58 GMT

RE: What would you treat this cat with?

Sarah Keir — Wed, 12 Oct 2016 18:58:23 GMT

Clopridogrel is probably more effective at preventing clots than aspirin - but apart from an abstract, we are still waiting for the FATCAT trial to be published in full.

RE: What would you treat this cat with?

Ashlea — Wed, 12 Oct 2016 18:56:40 GMT

[quote user="Michael Woodhouse"]If money is short then Metacam will offer analgesia and some anti-platelet activity.[/quote]

Funny you should say that, it's what I decided to do for now in the end. She's pretty painful around her pelvis still so I'm doing a few days of Metacam until we've decided what to do with her back end then will switch to aspirin. I'm not sure money's going to stretch to radiographs unfortunately (I only ever seem to post about the cases with limited funds!) so even if a pelvic fracture is suspected we'll just need to go for rest and pain relief.

RE: What would you treat this cat with?

Michael Woodhouse — Wed, 12 Oct 2016 18:02:42 GMT

If money is short then Metacam will offer analgesia and some anti-platelet activity.

RE: What would you treat this cat with?

Emily Rainbow — Wed, 12 Oct 2016 17:22:18 GMT

I think i'd be treating as a thromboembolism secondary to cardiac issues if money tight.

Opiod Analgesia, aspirin +/- clopidogrel or heparin. Perhaps consider fortekor etc ongoing to try and manage the heart? Could always cage rest with Physio and see how you get on?

RE: What would you treat this cat with?

Ashlea — Wed, 12 Oct 2016 17:15:36 GMT

Thank you - money is limited I think but I'll definitely discuss radiographs. As far as I know aspirin can't be used with other NSAIDs.

RE: What would you treat this cat with?

Thomas Johnson — Wed, 12 Oct 2016 17:12:32 GMT

[quote user="Ashlea"]I'm not entirely sure which bit of the cat to concentrate on first, without the heart changes I'd definitely be concentrating on the pain for now. I'm wondering whether the heart changes are incidental but I don't want to ignore them. Would starting aspirin be a good idea after addressing the pelvic and hip pain?[/quote]

I would consider running a proBNP to assess heart function further, and I wouldn't discount a pelvic fracture on normal palpation so I would consider a quick GA to get some radiographs. The other question that comes to mind, and to which I don't have the answer, is whether it's possible to use NSAIDs such as Metacam for pain relief at the same time as aspirin to prevent clots?