Vomiting cat

Re: Vomiting cat

Martin Atkinson — Fri, 03 Jun 2011 09:42:29 GMT

[quote user="Andrew Kent"]

My issue with them in cats is that I see more of the chronic pancreatitis type cases where I want to monitor quantitative levels and less of the acute pancreatitis cases that I see in dogs so it may make them a less useful tool?

Andy

[/quote]

It is an isue with cats that even with acute cases of pancreatitis the fPL may have declined and return a normal result after a few days and remain stubbornly normal in chronic cases so with the lack of other specific symptoms and available lab tests this condition remains a challenging one to diagnose in cats. I wonder if, whereas Idexx view canine SNAP CPL to be most useful as a means of ruling out pancreatitis in the dog with a negative test perhaps feline SNAP fPL will be more useful for ruling it in if it returns a positive. The cat I mentioned in an earlier post was tested for fPL really just as a batch of tests and I was a bit surprised it returned such a high level as it wasnt showing classical symptoms of pancreatitis and I was expecting everything to point more to intestinal lymphoma or IBD and use that as a lever to get the owner to go for biopsies. But as suggested earlier, given the cross-morbitity in these conditions, perhaps I shouldn't have been surprised.

Re: Vomiting cat

Andrew Kent — Thu, 02 Jun 2011 19:14:21 GMT

Yes you can order them as the cPL, we've just got a box in. Cost the same as cPL SNAP I believe.

Andy

Re: Vomiting cat

Martin Atkinson — Thu, 02 Jun 2011 18:16:08 GMT

[quote user="Graham Bilbrough"]

SNAP fPL is now available in the UK.

[/quote]

Does that mean I can now order it from Idexx Graham?

Re: Vomiting cat

Kate Richardson — Thu, 02 Jun 2011 15:52:51 GMT

Hi Graham. it was ages ago so no, don't have the samples still. Forgive me, it may have been the other way round, as you suggest, in that snap said positive, actual pli was within normal range. I can't honestly remember! Either way, I didn't find the speed of result, correct or not, actually changed how I managed these cases, so preferred to just send a sample and obtain a true value. Cheers Kate

Re: Vomiting cat

Graham Bilbrough — Thu, 02 Jun 2011 15:27:04 GMT

Hi, Kate.

I'm very surprised to hear that--did you get someone from IDEXX to investigate this?

We normally hear quite the reverse. As you know, SNAP fPL and cPL "show their spots" when the pancreatic specific lipase is abnormally high (e.g. >=200 units in the dog). That is not the same as saying the patient has pancreatitis; rather, it says "abnormally high, get quantification with the reference lab version of the test". The IDEXX Labs does not say the result is consistent with pancreatitis until the concentration is higher (e.g. >=400 units). The test is designed to give you most confidence in the negative. Clients with a "sample spot" may well find that they get a reference laboratory report saying "300 units--that's abnormally high, but not yet consistent with pancreatitis"

I am not suggesting operator error was the cause for your discrepants; but, this is by far the most common cause for the very few cases of 'consistent with pancreatitis' at the reference laboratory despite a 'normal cPL' on the SNAP device.

Was it the sample serum samples used for both SNAP cPL and Spec cPL? cPL has a half-life of about 24 hours in the dog.

I suspect you no longer have the samples, but I'd be happy to look into this if it's still possible.

All the best

Graham

Re: Vomiting cat

Kate Richardson — Thu, 02 Jun 2011 14:17:55 GMT

[quote user="robloxley"]Likewise, but as a good instant rule-out it might be useful[/quote]

Problem I had with the canine snap pli was I got a couple of negatives that came back from the lab for confirmation as raised PLI. So lost faith in it after that. An inaccurate diagnostic test is as bad if not worse than not doing the test at all in my opinion.

Re: Vomiting cat

Graham Bilbrough — Thu, 02 Jun 2011 13:59:03 GMT

SNAP fPL is now available in the UK. And, yes, it'll be cheaper to do the SNAP fPL with, where needed i.e. "abnormally high fPL concentration", Spec fPL at IDEXX Wetherby, than it is to do the Spec fPL as a stand-alone.

Re: Vomiting cat

Rob Loxley — Thu, 02 Jun 2011 13:46:40 GMT

[quote user="Kate Richardson"]I'd rather wait for an accurate PLI measurement, as treatment is unlikely to be affected by the result initially.[/quote]

Likewise, but as a good instant rule-out it might be useful. Also the pricing on the canine PLI was such that it was no more expensive to do the snap then send it off than to just send it off.

Re: Vomiting cat

Rob Loxley — Thu, 02 Jun 2011 13:45:12 GMT

[quote user="Martin Atkinson"]So was this IBD/pancreatitis co-morbdity or have I just put a lymphoma case into temporary remission?[/quote]

Yes.
But if the owner wouldn't go for chemo it's maybe academic? Is chlorambucil out of consideration?

Re: Vomiting cat

Richard Fox — Thu, 02 Jun 2011 12:16:44 GMT

If you can't do further diagnostics then how would anyone expect you to know ?

Re: Vomiting cat

Martin Atkinson — Thu, 02 Jun 2011 11:58:44 GMT

I have a feline patient that was initially presented as losing weight, not grooming and anorexic presumed to be due to its severe periodontitis but further investigation was warranted. Cat was admitted for dental work but had the most awful diarrhoea in the kennel and I could feel thickened intestinal loops and mesenteric lymph nodes. This was confirmed on X-ray (no ultrasound) standard biochemistry was unremarkable except for moderately raised amylase and hypophosphatemia with a stress hyperglycaemia (9.6), haematology normal but urine was very concentrated SG 1.050 and a UPC of 0.6. Cat was treated with fliuds for dehydration and the dental work carried out. A specfPL later came back as 30, B12 and folate both low, the cat looked so sick and with the abdominal signs and cachexia I was concerned it might be intestinal lymphoma and to rule in/rule out that or IBD and wanted to take biopsies but the owner declined due to age and guarded prognosis as she wouldn't do chemo anyway. I gave it immunosuppresive doses of preds, B12 and antibiotics and 2 weeks on its faeces are normal, appetite good, cat bright and gaining weight and the abdominal contents feel normal. So was this IBD/pancreatitis co-morbdity or have I just put a lymphoma case into temporary remission? I'm taering the preds and time will tell but the owner is happy - for now.

Re: Vomiting cat

Kate Richardson — Thu, 02 Jun 2011 11:24:49 GMT

[quote user="robloxley"]

I hear IDEXX are soon to launch snap fPL in the UK

[/quote]

I didn't find the canine snap test very helpful, so I don't have high expectations for the feline one. I'd rather wait for an accurate PLI measurement, as treatment is unlikely to be affected by the result initially. If I suspect pancreatitis, I treat for pancreatitis.

Re: Vomiting cat

Bob Russell — Thu, 02 Jun 2011 10:45:25 GMT

[quote user="Graham Bilbrough"]

I know you wouldn't, but don't forget the co-morbidity that is so common with feline pancreatitis.

[/quote]

I suspect this will progress to diabetes if we cannot get the owner to co-operate. He is unlikely to allow more detailed investigation at this stage but I would like to get ultrasound at least done. In this case cost is not really the driving factor but the cat is very 'over-protected'

Re: Vomiting cat

Richard Fox — Thu, 02 Jun 2011 10:25:32 GMT

Cool - X-fingers

Re: Vomiting cat

Graham Bilbrough — Thu, 02 Jun 2011 10:24:13 GMT

I know you wouldn't, but don't forget the co-morbidity that is so common with feline pancreatitis.

Re: Vomiting cat

Bob Russell — Thu, 02 Jun 2011 09:52:00 GMT

fPLI 31ug/l (Normal 0.1-3.5). Pancreatitis it is (hopefully) so time to bully the owner into dealing with the obesity problem.

Re: Vomiting cat

Rob Loxley — Wed, 01 Jun 2011 23:29:43 GMT

[quote user="Bob Russell"]I know they can be sent direct to Idexx but I suspect the Bank Holiday will have delayed the results. We must get some labels so we can send them directly to them.[/quote]

I hear IDEXX are soon to launch snap fPL in the UK

Re: Vomiting cat

Anthony Todd — Wed, 01 Jun 2011 19:15:34 GMT

[quote user="Bob Russell"]Could this be an expensive fur ball?[/quote]

Or bezoar now passing through??

All the tests seem rather too normalish to put the thing off food and, by the sound of it, the cat may well have eaten a hearth rug, the fridge inself or a Yale key [posts passim]....

Re: Vomiting cat

Kate Richardson — Wed, 01 Jun 2011 17:04:32 GMT

Oh well, main thing is cat is happy again. Not sure if reality ever sinks in with some people!

Re: Vomiting cat

Bob Russell — Wed, 01 Jun 2011 17:01:21 GMT

TDDS for convenience and quality - a great set up.

I know they can be sent direct to Idexx but I suspect the Bank Holiday will have delayed the results. We must get some labels so we can send them directly to them.

This cat is normally 'polyphagic' so no change there. The cats are on obesity but 1.5Kg of the food is used every 14 days and he is unwilling to bring the cats in for weight checks!

Diabetes is inevitable and it will be fun getting this one onto insulin! Not sure when reality will sink in. We will continue to work at this one!

Re: Vomiting cat

Kate Richardson — Wed, 01 Jun 2011 16:45:11 GMT

Where do you send your feline PLI to? We use TDDS for external lab work cos they are awesome, but I do send feline PLIs to Idexx cos of the quick turnaround, usually 2 days, whereas TDDS have to send them away (to the US?) and usually take at least a week. (Something to do with Idexx having control over the test or something???)

Is appetite back to normal eating or is cat now polyphagic? Lets hope it doesn't become diabetic before the bill get's paid!

Re: Vomiting cat

Bob Russell — Wed, 01 Jun 2011 15:07:02 GMT

No results back. Cat is eating the owner out of house and home. He has given £50 to Save the Children to say thank you! Save the Bob fund would have made me happier.

Could this be an expensive fur ball?

Re: Vomiting cat

Kate Richardson — Wed, 01 Jun 2011 13:43:26 GMT

Agreed- early renal disease will present with weight loss, and usually have a normal appetite, and the owners may have noticed the cat has been drinking a bit more and the only other clinical finding will be a low USG with normal urea/creat. UPC is certainly indicated if the USG is low (but a sediment exam is essential alongside the UPC) but IME, UPC is rarely elevated at this point in time. USG much more important, and a hell of a lot cheaper.

In this case tho, as Bob has stated, he was waiting for a urine to be passed, would have done a cysto if nec, but the cat was unco-operative and would likely need sedation and the owner was unwilling at that stage. Had it been absolutely essential to the cat's immediate problem and treatment plan, no doubt he would have persuaded the owner to let him do so. However, the cat presented with vomiting and anorexia, and drinking more for a short period prior to presentation, blood glucose was 11.2, which isn't above the renal threshold, so whilst a urine would have been a useful addition to the bloods, and I always like to know as much as possible about any cat I am treating, early renal insufficiency would be very unlikely to be the primary cause of the presenting clinical signs and diabetes also an unlikely cause of the presenting signs. Not impossible, but unlikely.

[quote user="Chris Milligan"]Pancreatitis isn't all that common in cats[/quote]

I disagree.

[quote user="Bob Russell"]

With regard to pancreatitis in cats I was under the impression that it is very common but clinical signs are not! I await correction on that one.

[/quote] Absolutely. And still difficult in a lot of cases to definitively diagnose.

Have you had the PLI results back yet?

Re: Vomiting cat

Chris Milligan — Wed, 01 Jun 2011 13:03:44 GMT

I know it doesn't show up on bloods - that's why i'm suggesting it could be early stage, but he hasn't done the tests (including UPC) to rule it in or out

Re: Vomiting cat

Julian Earl — Tue, 31 May 2011 13:35:18 GMT

[quote user="Chris Milligan"]

I note you haven't posted urine results - USG could be valuable (this may be early onset renal disease, though BUN is normal), more of a concern would be dipstick results - for me helpful in ruling out diabetes and proteinuria. To my mind in old anorexic cats with weight loss you must always rule out as a priority neoplasia, renal disease, diabetes. Also, in this cat I would want to be sure of its worming history as eosinophilia is a sign of parasitic infection. [/quote]

Early-stage renal disease won't show up on bloods; urinary protein/creatinine ratio is more sensitive.