Behavioural Drugs for FLUTD?

Re: Behavioural Drugs for FLUTD?

Gareth Dowdeswell — Wed, 09 Mar 2011 18:14:34 GMT

[quote user="Kate Richardson"]

Oh thats good, (that the case has come back, not obviously that the cystitis has got worse!) Dare I say, maybe the 'stress'of going to the cattery exacerbated the problem.......

Re behavioural referrals, some behaviourists will do home visits, which is obviously more ideal as they can visualise what is going on, but assume they just didn't want to take the behaviour side further at all?

[/quote]

No, I told them that I'd recommend a home visit but they really weren't interested - had cats all their lives etc.

Cat went into a cattery because the owner's didn't want friends to have to look after the cat at home - guess it's the lesser of 2 evils compared to the stress of owner's cancelling holidays to look after the cat!

Re: Behavioural Drugs for FLUTD?

Kate Richardson — Wed, 09 Mar 2011 17:51:40 GMT

Oh thats good, (that the case has come back, not obviously that the cystitis has got worse!) Dare I say, maybe the 'stress'of going to the cattery exacerbated the problem.......

Re: Behavioural Drugs for FLUTD?

Gareth Dowdeswell — Wed, 09 Mar 2011 17:37:23 GMT

The case has come back to me! It only went to another vets as it was in a cattery for a few days and the cattery thought the cystitis was getting worse.

Steroids made no difference to the cat, owners were not at all up for behavioural referral so have started on behavioural meds but warned they may well not work. Will update this thread.

Re: Behavioural Drugs for FLUTD?

Bob Russell — Tue, 08 Mar 2011 11:33:41 GMT

I refer to my grumble about a vet making a 'spot-diagnosis' based on a single short consultation rather than evidence.

Re: Behavioural Drugs for FLUTD?

Anthony Todd — Mon, 07 Mar 2011 20:00:22 GMT

[quote user="Bob Russell"]Some get steroids to stop them tearing themselves apart.[/quote]

Wheeeyyy, we're back on the dreaded steroids again.

I refer to the many answers I''ve given many times before.

Steroids, like greed are good!!

Re: Behavioural Drugs for FLUTD?

Bob Russell — Mon, 07 Mar 2011 12:18:33 GMT

My point and grumble is not related to the treatment for a particular problem (skin or otherwise) but it is the 'spot diagnosis' or I am such a wonderful bl**dy vet that I can make a diagnosis of atopy (or skin cancer or anything else) just by looking at a patient for five minutes. This is the I don't need to biopsy/blood test/x-ray because I am so arrogant/full of bul*sh**t that I 'know' the answer because I am me!

Many of my patients do not get the level of work up that they would get at referral for example. Some get steroids to stop them tearing themselves apart. I compromise often but at least I am honest with the clients when my treatment is covering up symptoms rather than curing.

As a student seeing practice I was warned not to take my dog to a particular vet because he was an enthusiast for diagnostic euthanasia! He could not be proved wrong once his patient had gone to the crematorium. I did not believe it until I spent an afternoon watching one of his clinics. He is long gone from the profession and this world!

Re: Behavioural Drugs for FLUTD?

Mark Hedberg — Mon, 07 Mar 2011 10:13:48 GMT

Extremely well put point! I know a precise diagnosis isn't always possible, that's why I said "as precise as possible".

I totally agree with "A blinkered pursuit of a prompt and definitive diagnosis is frequently not in the patients and/or client's best interest."

Re: Behavioural Drugs for FLUTD?

Malcolm Ness — Mon, 07 Mar 2011 09:43:43 GMT

I agree with the gist of what you say but I take issue with the specifics.

[quote user="Mark Hedberg"]there needs to be as precise a diagnosis as possible[/quote]

In fact, there needs to be a well thought through case management plan. A blinkered pursuit of a prompt and definitive diagnosis is frequently not in the patients and/or client's best interest.

[quote user="Mark Hedberg"]On the spot diagnosing is a bit dangerous [/quote]

Herein lies the rub!. A best guess made by one with a medical or veterinary qualification is not a diagnosis, it is just confident bulldust.

Re: Behavioural Drugs for FLUTD?

Mark Hedberg — Mon, 07 Mar 2011 07:55:06 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Mark Hedberg"]or to phrase it more politely, symptomatic treatment relieves some of the animal's suffering, which is a consideration that does take a bit of priority over money.[/quote]

Quite so.

And in the hypothetical situation under discussion, symptomatic treatment gets you a fee.

[/quote]

Agreed. Still not entirely sure what your point is; nobody works for free, and I'm reasonably confident even you have charged a client a consult fee on occasion. Should i see this hypothetical patient for free then?

Re: Behavioural Drugs for FLUTD?

Evelyn Barbour-Hill — Mon, 07 Mar 2011 00:08:31 GMT

[quote user="Mark Hedberg"]or to phrase it more politely, symptomatic treatment relieves some of the animal's suffering, which is a consideration that does take a bit of priority over money.[/quote]

Quite so.

And in the hypothetical situation under discussion, symptomatic treatment gets you a fee.

Re: Behavioural Drugs for FLUTD?

Anthony Todd — Sun, 06 Mar 2011 20:31:00 GMT

[quote user="Mark Hedberg"]Or looking at it from the pet's point of view, symptomatic treatment relieves some of the suffering, which is part of that oath I seem to remember taking...[/quote]

At last,consideration of the patient!! and the suffering or distress. Symptomatic treatment usually relieves all of the symptoms [talking about itchy dogs and cats particularly].

And, come on, how often is your comprehensive and expensive work-up really going to change your treatment, of course, depending on symptoms.

The itchy westie, tearing itself apart, isn't really going to benefit in the short term from the workup, if ever; the polydipsic 4yo lab, certainly will but then it's not really suffering.

If you get all high and mighty the owner sweeps out, suffering not relieved, goes to another vet and gives an adjusted history until a vet is found that will relieve the symptoms.

There was a cartoon years ago in MVP:

"I just want the dog to get better doc, so skip the lab tests" and he has a point....

Re: Behavioural Drugs for FLUTD?

Mark Hedberg — Sun, 06 Mar 2011 19:24:38 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Mark Hedberg"]

So then they transfer to a second practice saying "I want this sorted, sorted now, I paid £xyz at this other place before and i'm not paying £abc for any workup here i want this itching/diarrhea/galloping twinkletoes to stop NOW."

And sometimes you can talk him/her into working it up; often you're forced to just treat the symptoms.

[/quote]

Or of course you could say "I'm sorry, but I don't work that way. I will have to investigate this properly if I am to treat your pet." But of course if they decline your terms then you don't get any money out of it.

[/quote]

Exactly. Or looking at it from the pet's point of view, symptomatic treatment relieves some of the suffering, which is part of that oath I seem to remember taking...or to phrase it more politely, symptomatic treatment relieves some of the animal's suffering, which is a consideration that does take a bit of priority over money.

Re: Behavioural Drugs for FLUTD?

Evelyn Barbour-Hill — Sun, 06 Mar 2011 17:59:20 GMT

[quote user="Mark Hedberg"]

And sometimes you can talk him/her into working it up; often you're forced to just treat the symptoms.

[/quote]

Re: Behavioural Drugs for FLUTD?

Kate Richardson — Sun, 06 Mar 2011 11:06:22 GMT

I'm sure we have all been 'the other vet' at some stage. However there is a difference between treating the symptoms, telling the clients that is what you are doing and that you are working on a presumptive diagnosis (and documenting this in your records), and telling the client definitively that Fluffy has x,y or z and recording that diagnosis with no evidence to back up this diagnosis. Nothing wrong with a presumptive diagnosis as long as the clients are aware of the investigations that should be done to make a definitive diagnosis and have declined them. However I am sure most clients forget the word 'presumptive', especially when the presumption turns out to be wrong.

Re: Behavioural Drugs for FLUTD?

Mark Hedberg — Sat, 05 Mar 2011 22:37:57 GMT

[quote user="Bob Russell"]

On a number of occasions pets that I have been working up logically have been seen by another vet and diagnosed 'on the spot' as X,Y or Z. Not sure if these vets are just better than me or too bl**dy lazy to do the job properly. Unfortunately this approach makes them look good and me not especially if the 'cure' is prednisolone!

Not much point in screaming 'its not fair' is there?

[/quote]

Have been "the other vet" a few times. While I totally agree that there needs to be as precise a diagnosis as possible, there's often quite a lot of pressure from a client who's spent £xyz for what they feel is no improvement. So then they transfer to a second practice saying "I want this sorted, sorted now, I paid £xyz at this other place before and i'm not paying £abc for any workup here i want this itching/diarrhea/galloping twinkletoes to stop NOW."

And sometimes you can talk him/her into working it up; often you're forced to just treat the symptoms. The bright side is that that the pet has some relief and you can buy some time to persuade the owner to diagnose and treat the underlying causes instead of the surface symptoms.

Yes, sometimes that means (hopefully rarely) preds.

That said, I have always done my absolute best to support the work a previous practice has done. On the spot diagnosing is a bit dangerous in my opinion, because when you get it wrong it can often be badly wrong. If I am treating symptoms I make it abundantly clear to clients this is what I am doing; I tell them my suspicions and what I'd like to do to rule out a particular disease, but I don't do spot diagnosis unless it's an ear infection or rotting teeth or a putrid abcess or something rather blatant dripping on my table.

Re: Behavioural Drugs for FLUTD?

Kate Richardson — Sat, 05 Mar 2011 13:17:11 GMT

[quote user="Bob Russell"]On a number of occasions pets that I have been working up logically have been seen by another vet and diagnosed 'on the spot' as X,Y or Z. Not sure if these vets are just better than me or too bl**dy lazy to do the job properly. Unfortunately this approach makes them look good and me not especially if the 'cure' is prednisolone![/quote]

Oooooh these are the ones that really annoy me too! I'd go with too lazy/over confident/arrogant maybe. Have lost count of the number of animals I've seen with a definitive diagnosis made with no work up whatsoever. Really bugs me.

No Anthony, I don't work in London N10, I am very lucky to work with reasonably intelligent clients in the main. Am never leaving! I do tend to forget that not everyone has this luxury, so I can only apologise for this. This website has been good in making me very much more aware of the benefits of my current job, and the daily struggles other vets have in different parts of the country/different practices, so I can say it helps me keep my feet on the ground and remember I have got it good! So thankyou.

Re: Behavioural Drugs for FLUTD?

Bob Russell — Sat, 05 Mar 2011 12:44:14 GMT

[quote user="Anthony Todd"]

[quote user="Bob Russell"]Another vets rang up for the history yesterday,[/quote]

My sympathy and empathy too. I was told by an eminent dermatologist in practice of a weird skin he had seen; biopsy, scrapes, bloods etc. etc. still undiagnosed but most possibilities eliminated.

Met the owner in the street and was informed that said skin had gone to another vet, skin cancer diagnosed by visual inspection and euthanasia as treatment efficiently prescribed.

Mind you did you diagnose it as "ideopathic" and they Googled the word?

[/quote]

Not much point in screaming 'its not fair' is there?

Re: Behavioural Drugs for FLUTD?

Anthony Todd — Sat, 05 Mar 2011 12:25:04 GMT

[quote user="Bob Russell"]Another vets rang up for the history yesterday,[/quote]

My sympathy and empathy too. I was told by an eminent dermatologist in practice of a weird skin he had seen; biopsy, scrapes, bloods etc. etc. still undiagnosed but most possibilities eliminated.

Met the owner in the street and was informed that said skin had gone to another vet, skin cancer diagnosed by visual inspection and euthanasia as treatment efficiently prescribed.

Mind you did you diagnose it as "ideopathic" and they Googled the word?

Re: Behavioural Drugs for FLUTD?

Bob Russell — Fri, 04 Mar 2011 17:58:23 GMT

[quote user="Gareth Dowdeswell"]

Another vets rang up for the history yesterday, so think won't be finding out how this one ends! Thanks for all the replys tho, have got plenty of ideas for the next case I see. Always seem to be the cases I put the extra effort into that die or go to another vets...

[/quote]

Makes you sick doesn't it? Owners of pets where you think you have done a bad job will praise you to the hilt and make you feel guilty. Owners of pets you have worked really hard on and made an extra effort turn round and give you a metaphorical kick in the teeth! Funny old world.

Re: Behavioural Drugs for FLUTD?

Anthony Todd — Fri, 04 Mar 2011 17:40:56 GMT

[quote user="Richard Carter"]Had a cat most unstressed ever but if a whiff of a thunderstorm was developing, blocked up. If you took a urine sample and put it on the shelf could have grown a pretty impressive crystal garden. Think his problem (pre acid balanced food) was that if he even hesitated to urinate for a day or so, problems would start. Keep the SG low by what ever means available - water, milk, soup, wet food, cortisone. Also think lot to be said for cats using litter trays or avoiding rather then ending up with urinary retention then leading to irritation/problems.[/quote]

Agree with all of that but might add change the pH depending on crystals and/or feed low Mg and/or oxalate food, and better wet but it smells in the morning as does the stuff in the litter tray.....

Re: Behavioural Drugs for FLUTD?

Anthony Todd — Fri, 04 Mar 2011 17:37:33 GMT

[quote user="Kate Richardson"]f you don't think stress is involved, why then do some (and I emphasise some, not all) cases resolve when you deal with the 'stress' in the cats life?[/quote]

Yeah but it's not the stress per se it's the effect the stress has on the urine qualities and quantities.

Some owners must ask "What's ideopathic mean?"..... Geez, if you lived in London N10 you'd agree......

Re: Behavioural Drugs for FLUTD?

Anthony Todd — Fri, 04 Mar 2011 17:33:09 GMT

[quote user="Mark Holmes"]Can I suggest another approach to the repeatedly blocking cat [/quote]

in fact the whole post.

Agree bloody indwelling catheters solve nothing, I prefer to back flush twice daily, or when the bladder gets full, with an I/v cannula and manually express the bladder. Cats seem to get used to the idea and it can take 3 odd weeks for bladder contraction to function normally.

I assume you changed the diet etc. I believe I have seen crystals on ultrasound when the bladder is "shaken" looking just like a "sparkler" you wave indoors at drunken functions, but it was at a demo of something from memory.

I'd be delighted if you had got back a negative for crystals from the lab then found the paste [excellent description BTW] in the bladder.

My stress levels are dropping as I type, must go and have a pee to celebrate......or take a Valium.

Re: Behavioural Drugs for FLUTD?

Richard Carter — Fri, 04 Mar 2011 13:51:50 GMT

Had a cat most unstressed ever but if a whiff of a thunderstorm was developing, blocked up. If you took a urine sample and put it on the shelf could have grown a pretty impressive crystal garden. Think his problem (pre acid balanced food) was that if he even hesitated to urinate for a day or so, problems would start. Keep the SG low by what ever means available - water, milk, soup, wet food, cortisone. Also think lot to be said for cats using litter trays or avoiding rather then ending up with urinary retention then leading to irritation/problems.

Comments about relying on cultures before treating antibiotics is dangerous in cats - very low sensitivity, high false negatives. cat urine notorious for being a most unsuitable medium to transport microbes in and they then get bugs that don't culture easily anyway

Re: Behavioural Drugs for FLUTD?

Kate Richardson — Fri, 04 Mar 2011 09:36:52 GMT

I guess then it depends on how you explain things to the owner. I would say that we don't know excatly what causes these recurrent urinary tract problems, ie it is idiopathic, but we do suspect there are many factors involved, one of which is stress. No one is saying that stress alone is the sole cause! Most owners don't want to believe their cat is stressed so I would they think they would prefer to know their cats problem is idiopathic!

If you don't think stress is involved, why then do some (and I emphasise some, not all) cases resolve when you deal with the 'stress' in the cats life?

Re: Behavioural Drugs for FLUTD?

Anthony Todd — Thu, 03 Mar 2011 20:55:08 GMT

[quote user="David Beattie"]

[quote user="Anthony Todd"]

If stress really is a factor just treat with anti-stress drugs alone. This is what they do with humans with a stress disorder.

[/quote]

The extra-beneficial placebo effect of knowing you're having your stress decreased medically might not fly so well for cats... indeed depending on the cat's temperament, the daily administration of a medication (if given directly orally) could either act to ameliorate its stress levels (if it values the interaction with the owner that this regimen necessitates) or increase its stress levels (if it values being left alone and hates nothing more than being physcally restrained and medicated).

[/quote]

This is another reason why I can't go with the "stress" idea, for all the reasons I've tried to explain.

The trouble is that "stress" is such an acceptable idea for the owner as opposed to "ideopathic" which basically means we don't know, and, I guess, if the cat gets better then that's the important thing.

I wish someone would measure Mg++ and oxalate ionic concentration in some of these "ideopathic" cases; might be some surprises.