RE: Nephrolithiasis and pain management

Rob Loxley — Mon, 30 Nov 2020 22:32:00 GMT

I saw a cat just like this, maybe drop me an email ;)

RE: Nephrolithiasis and pain management

David Mills — Mon, 30 Nov 2020 21:10:22 GMT

Just take them out if they're causing pain. Very straightforward, one side then the other 6 weeks later. Very simple op and normally do very well. 11yo isn't geriatric. Normally are bilateral, not sure being bilateral makes any difference to outcome.

RE: Nephrolithiasis and pain management

Beats — Mon, 30 Nov 2020 11:20:55 GMT

General comments (not really specific to a case):

I'm not a fan of giving cats with presumed calcium oxalate uroliths/nephroliths preds as I reckon it increases calcium urine excretion (I might be wrong however).

I've never used tramadol nor amantadine in a cat (but I'm not necessarily opposed to trying tramadol, just never have).

I use a lot of meloxicam in cats and that is my general go-to analgesia drug, but in some steroids seem to work better.

Rightly or wrongly, I might give prazosin to a cat with suspected calcium oxalate uroliths.

In a younger cat I might consider picking out the nephroliths if genuinely convinced that that is where pain is coming from (slice kidney, pick out through bleeding mess, glue back together), but I can't imagine I would think this a worthwhile plan in average 11year old Persian.

If a cat has well concentrated urine i don't think I have ever seen a UTI unless has been catheterised first.

If the calcium level on blood is high, what do you propose doing differently?

Steroids often relieve I signs in cats. GI signs can be quite unpleasant. Finding a diet that suits often relieves GI signs in cats.

If Hills CD multicare pouches were well tolerated by the GI tract then that would be an excellent diet (if affordable...) for a cat with known calcium oxoate issues. Otherwise, any wet food that was well tolerated by the guts would be great. I'd want to take a thorough dietary history.

There is nothing more annoying than having a client turn up requesting drugs that another "vet" has recommended to them. [I had one last week: "My vet-physio recommended ketamine injections and amytryptalline for my arthritic large breed old dog as his acupuncture isn't cutting it any more", "no problem, can I have the prescription she gave you please?", "She didn't give me a prescription.", "Oh! That's odd, I wonder why? Maybe she forgot", "She said to get the drugs from you and gave me a website to look at", "Maybe she emailed the prescription to the website then and you can get them there?", "I think she just thought you wouldn't know my dog needed these drugs", "No, I wouldn't have known, it is odd a vet prescribing drugs that she doesn't have and forgetting to give you the prescription to get them elsewhere - I mean, what if you remembered the name wrong and told me the wrong thing - I would just assume it was fine even though I had never heard about that use of that drug as you had told me that your vet-physio has said so... maybe you best go back and get a proper prescription written down to be on the safe side. Here's some metacam in the meantime to see if it helps."]