Spaying Post op HELP PLEASE!!

RE: Spaying Post op HELP PLEASE!!

Martin Atkinson — Fri, 22 Dec 2017 10:08:11 GMT

[quote user="Tomás Basto"]Unfortunatelly the cat passed away yeasterday evening. Ive rarely seen such potent virus.[/quote]At least you cannot be faulted for effort and hopefully the client doesn't blame you, albeit with reservations as suggested in my second paragraph. It would be interesting if you could do a PM examination and take samples from spleen. liver, gut etc in order to confirm FCV peracute disease.

[quote user="Tomás Basto"].....we had a cat with the same angioedema and fever, inexistent ulcers 3 weeks ago ( sheding virus till 2 months) that didnt went to surgery,[/quote] So were these cats from the same household? If not this must question the hygiene in your practice. We know that the virus can be shed in faeces rather than just droplet and can survive for a long time on fomites. I'd worry about how well recovery cages, litter trays and water/feeding bowls are being cleaned!

It might have a bit less of a conundrum if you'd told us this before

RE: Spaying Post op HELP PLEASE!!

Tomas B — Thu, 21 Dec 2017 17:59:03 GMT

Unfortunatelly the cat passed away yeasterday evening. Ive rarely seen such potent virus. She didnt have any URT signs or even oral ulcers or something like that. It was just fever and angioedema. The NSAIDs couldnt control it and not even the antibiotics (cefazoline, enrofloxacin and metronidazol).

Im suspecting Systemic FCV because it is common in vaccinated cats and even though the prognosis is better in juveniles than in adults, she couldnt make it.

The surgery went well and she started to develop the fever 4 days after surgery (incubation period 2-5days FCV) and we had a cat with the same angioedema and fever, inexistent ulcers 3 weeks ago ( sheding virus till 2 months) that didnt went to surgery, so reaction to anesthetic agent to me is not a differential in this case at all.

Obviously she could have been a carrier but such high values on the oral mucosa and blood for FCV titres, im really guessing the systemic form.

Thank you guys for sharing oppinions and feedback.

Nice christmas to you all

RE: Spaying Post op HELP PLEASE!!

Martin Atkinson — Thu, 21 Dec 2017 17:33:39 GMT

[quote user="Bob Russell"]If you had been qualified 32 years you would have seen loads of these symptoms as a result of the use of Saffan i/v anaesthesia. [/quote]I found it was mild and transient, no comparison really.

[quote user="Anthony Todd"]Did the "reaction" follow your initial treatment [eg NSAIDs] ie was the reaction not to the cellulitis but to the drugs in treatment?[/quote]The epidemiology of Roland's cases fits per-acute FCV syndrome, he's said one cat followed the other, there is no history or giving medication prior to the onset of treatment and the likelihood of two animals having the same drug reaction is low even if there was.

RE: Spaying Post op HELP PLEASE!!

Anthony Todd — Thu, 21 Dec 2017 17:22:34 GMT

[quote user="roland bulkyn-rackowe"]Each presented with what initially looked like an abscess of one limb that then affected the face and all limbs with icterus and persistent fever. They were isolated (at home!) and recovered with nursing over 3 weeks.[/quote]

Did the "reaction" follow your initial treatment [eg NSAIDs] ie was the reaction not to the cellulitis but to the drugs in treatment?

RE: Spaying Post op HELP PLEASE!!

Roland Bulkyn-Rackowe — Thu, 21 Dec 2017 16:14:26 GMT

I've seen two possible virulent calici virus. In their case (two cats in the same household, 2 days apart), neither had been seen for any procedures or examinations in the previous several months. They were young adult siblings and vaccinated. I shut down the surgery for deep cleaning after they were seen.

Each presented with what initially looked like an abscess of one limb that then affected the face and all limbs with icterus and persistent fever. They were isolated (at home!) and recovered with nursing over 3 weeks.

RE: Spaying Post op HELP PLEASE!!

Anthony Todd — Thu, 21 Dec 2017 15:58:34 GMT

[quote user="Martin Atkinson"]Keep up Tony, that's what Jenny and I are both suggesting! And I didn't one star you.[/quote]

I thought you two were suggesting that an acute infection was causing the swollen feet without any of the usual signs of calicivirus??

The cat may, instead, be a carrier so your theory is hard to prove unless you could get a rising titre??

You're not a one star coward; if something's wrong or nasty you'd say so!!

PS from my NHS citation earlier:

Angioedema is often the result of an allergic reaction.

ibuprofen and other types of NSAID painkillers .
among a string of others

I wonder if the C/S included a NSAID??

RE: Spaying Post op HELP PLEASE!!

Bob Russell — Thu, 21 Dec 2017 15:58:09 GMT

[quote user="Julie Innes"]

Interesting case, Tomas! I'm 22 years qualified and have never seen this, so could well be worth writing it up. thanks for teaching me something new, too! Hope the wee cat does ok

[/quote]

If you had been qualified 32 years you would have seen loads of these symptoms as a result of the use of Saffan i/v anaesthesia. Was not the Safe aneasthetic it was supposed to be.

These reactions tended to happen quite rapidly during and immediately after use of the anaesthetic. Drug reaction has to be a possibility but only one of several.

Any updates?

RE: Spaying Post op HELP PLEASE!!

Martin Atkinson — Thu, 21 Dec 2017 13:54:35 GMT

[quote user="Anthony Todd"]Not to rain on anyone's parade, but couldn't the cat be a calici carrier and this reaction is totally separate?[/quote]Keep up Tony, that's what Jenny and I are both suggesting! And I didn't one star you.

RE: Spaying Post op HELP PLEASE!!

Robin Grimmer — Thu, 21 Dec 2017 12:12:53 GMT

I agree. I think it's a red herring.

RE: Spaying Post op HELP PLEASE!!

Anthony Todd — Thu, 21 Dec 2017 12:09:26 GMT

[quote user="Tomás Basto"]We have sent the blood and did lacrimal smear and the result: SYSTEMIC CALICIVIRUS[/quote]

Not to rain on anyone's parade, but couldn't the cat be a calici carrier and this reaction is totally separate?

Totally unrelated but in my first year of practice in NZ I woke up one morning with both hands, to my wrist joint, swollen enormously, couldn't get any gloves on or fist my hand...

No ideas, just went away in a day or two

RE: Spaying Post op HELP PLEASE!!

Martin Atkinson — Thu, 21 Dec 2017 11:42:49 GMT

[quote user="Jenny Boyd"] I agree that oedema on its own might not be enough to convince me without URT signs,[/quote]Again AFAIR there were not necessarily URTI symptoms typical of FCV, it is the systemic involvement which is characteristic. The virus is also shed in faeces not just by aerosol.

It strikes me there are similarities with FCoV being a benign disease in most cases but can transform to FIP if the necessary concurrent conditions and stressors are involved.

RE: Spaying Post op HELP PLEASE!!

Jenny Harris — Thu, 21 Dec 2017 11:20:50 GMT

No I agree Martin, which is why I asked how they diagnosed this. I agree that oedema on its own might not be enough to convince me without URT signs, crusting or ulcerated lesions or a history of being in a shelter environment...

RE: Spaying Post op HELP PLEASE!!

Martin Atkinson — Thu, 21 Dec 2017 11:06:45 GMT

[quote user="Jenny Boyd"]out of interest- how have they determined it is the virulent form- is it just calici positive in conjunction with the suggestive systemic signs? [/quote]I haven't seen one but the reports of symptoms were of cats with ulcerative lesions not just a bit swollen. Also when I researched this, AFAIR there was not an antigenic difference between regular and per-acute FCV virus, the diagnosis is on epidemiology: very high morbidity in vaccinated cats in multi-cat/shelter environment and on post-mortem lesions involving systemic organs. I'm not sure I'd rely on PCR from the normal sites i.e. URT and eyes. Still I'm happy to be corrected and updated.

RE: Spaying Post op HELP PLEASE!!

Julie Innes — Thu, 21 Dec 2017 08:46:44 GMT

Interesting case, Tomas! I'm 22 years qualified and have never seen this, so could well be worth writing it up. thanks for teaching me something new, too! Hope the wee cat does ok

RE: Spaying Post op HELP PLEASE!!

Anthony Todd — Thu, 21 Dec 2017 08:42:46 GMT

[quote user="Joyce Whitehead"]

It’s not on IV clavulanate/Amox is it? We had problems (quite well documented I think) with a human generic causing apparent alllergif reactions a few years ago with Iv use in dogs. Can’t remember which brand though. But it presented as swollen face/feet etc.

[/quote]

There's a surprise"

RE: Spaying Post op HELP PLEASE!!

Jenny Harris — Wed, 20 Dec 2017 20:08:20 GMT

No I’ve never had a case- good luck!

out of interest- how have they determined it is the virulent form- is it just calici positive in conjunction with the suggestive systemic signs?

be sure to practice excellent barrier nursing as apparently these are horribly contagious! ABCD guidelines have a little bit of info on systemic calici if you haven’t looked already.

hope the kitten pulls through

RE: Spaying Post op HELP PLEASE!!

Tomas B — Wed, 20 Dec 2017 19:39:03 GMT

Hi guys. Thanks a lot for the entire feedback.

Bloodwork normal. eco normal. No airway distress. Just fever, persistent fever.

We have sent the blood and did lacrimal smear and the result: SYSTEMIC CALICIVIRUS

We are thinking about writing a case report, we dont see that many with these symptoms here in Portugal, what about you guys?

Thank you very much

RE: Spaying Post op HELP PLEASE!!

Jill Butterworth — Wed, 20 Dec 2017 18:35:13 GMT

Drug reaction and post op sepsis are my main differentials too. Can you do an abdominocentesis and do a smear? Ps Could the kitten have too much fluid in the panic?

Even if referral isn't an option, a medical specialist at your local vet referral hospital might take the time to discuss the case and give you advice.

Also/instead it might be worth posting this on the Veterinary ECC (Emergency and Critical Care) Small Talk Facebook page run by Shalier Jasani. You have to ask to join, as on this site, and be approved (to show you are a vet or nurse), but this is just such a case that would be discussed by the emergency vets on there. It's worldwide so there's sure to be somebody awake to read your post. You will get lots of suggestions, maybe too many!

RE: Spaying Post op HELP PLEASE!!

Joyce Whitehead — Wed, 20 Dec 2017 17:09:45 GMT

RE: Spaying Post op HELP PLEASE!!

Anthony Todd — Wed, 20 Dec 2017 16:20:04 GMT

Anyone ever seen a peritonitis after a C/S?

Anyone ever seen a peritonitis not responsive to "3 antibiotics"?

I can't believe a C/S could ever lead to major complications apart from haemorrhage.

If you do ex-lap and the stumps look suspicious surely antibiotics will be the first line treatment any way?

Google "angiodema" in people. Can be drug reaction and antihistamines [corticosteroids?] indicated, so I'd use them in this case.

https://www.nhs.uk/conditions/angioedema/causes/#medication

has lots of clues.

RE: Spaying Post op HELP PLEASE!!

Edward Jones — Wed, 20 Dec 2017 09:03:39 GMT

Has the cat eaten, drank, defecated or urinated at all since the spay?

I'd echo the above - look for surgical complications first.

RE: Spaying Post op HELP PLEASE!!

Michael Woodhouse — Tue, 19 Dec 2017 22:18:51 GMT

I agree that septic peritonitis would be my major differential in an animal recently having had surgery and interested in the surgical site. I'd be inclined to ex lap.

What 3 antibiotics? Also consider drug reaction as a possible cause of the swollen paws.

RE: Spaying Post op HELP PLEASE!!

Robin Grimmer — Tue, 19 Dec 2017 21:54:43 GMT

Sepsis? Need bloods abdo tap and ultrasound poss open up again to explore the wound and check the stumps. The fact that you said the wound/ suture was swollen makes me suspicious of infection. What suture material did you use?

RE: Spaying Post op HELP PLEASE!!

Iain Richards — Tue, 19 Dec 2017 21:35:44 GMT

What anaesthetic? Might be worth a dose of steroid

RE: Spaying Post op HELP PLEASE!!

Jenny Harris — Tue, 19 Dec 2017 20:57:53 GMT

Any blood results/imaging findings to help us?

virulent systemic calici is very contagious- any other cats showing similar signs? Any upper respiratory signs?