could do with some advice

Re: could do with some advice

Gerry Henry — Wed, 08 Feb 2012 14:52:12 GMT

Preds or Leukeran, preds work for me every time. It will recur (usually during cold snaps) so my advice would be to watch the cat for any odd premonitory activity, often, for some bizarre reason, licking cement or breeze block. We have two on the go at present, the owners can spot onset at the very early stages making treatment easier and more effective. Continental medicine is often a bit odd.

Re: could do with some advice

Martin Atkinson — Wed, 08 Feb 2012 10:02:29 GMT

[quote user="Robin Grimmer"]

My sister lives in the US and has many animals. She often asks me about the treatment her vet gives (whom she rates highly).

'I try and be diplomatic but I do sometimes disagree with his treatment.'

[/quote]

Lets be honest, the vet does hasn't to be abroad for that often to be the case!

Re: could do with some advice

Hannah Wynne Richards — Wed, 08 Feb 2012 09:42:00 GMT

Any RCVS medicine Specialists around?

Wynne

Re: could do with some advice

Kate Richardson — Wed, 08 Feb 2012 09:04:05 GMT

"Azathioprine zaps cats" is a phrase I remember from university. Not recommended in cats as can cause fatal myelosuppression. AIHA is usually secondary, but in some cases no cause can be found and it is assumed to be primary.

Re: could do with some advice

Dagmar Steele — Wed, 08 Feb 2012 05:25:45 GMT

Usually Azathioprin would not be my choice of first line medication in a cat. But we don't know enough about this case (investigations done, underlying causes detected, other meds tried) to frown on it. There are dose recommendations in textbooks and people do use it in cats.... It's a difficult situation as Lorna's niece naturally is worried and seeks all advice she can get. One can't just shrug it off saying I'm too far away. On the other hand meddling with other vets treatments is a no go area. But looking at the case and mentioning if something goes horribly wrong seems ok to me, at least we're all humans and not without fault - even a German vet can be wrong sometimes :-)

Re: could do with some advice

Robin Grimmer — Tue, 07 Feb 2012 23:32:44 GMT

Funnily enough I too have a case of this on the go at the moment. Negative for Haemobartonella or whatever they are calling it this month.

Started off with a PCV of 15% now at 26%. I also agree with azathioprine being a definite no-no in cats.

My sister lives in the US and has many animals. She often asks me about the treatment her vet gives (whom she rates highly).

I try and be diplomatic but I do sometimes disagree with his treatment.

Re: could do with some advice

Mark Norcott — Tue, 07 Feb 2012 22:39:04 GMT

Take your points on meddling in other vets cases but...most 'experts' do not recommend the use of azathioprine in cats due to the potential for severe (even fatal) myelosuppression. The BSAVA Formulary does not recommend the drug be given to cats.

Depends on the severity of the anaemia but often prednisolone alone will suffice. Cyclosporin would probably be next best immunosuppressive agent to add. Could also consider chlormabucil (Leukeran).

Needs working up to try and find cause - could be primary or secondary (FeLV, FIV, Haemoplasma (FIA), FIP; inflammatory diseases; neoplasia (lymphoma)).

Could add doxycycline for FIA (10mg/kg/d - flush with water after administration).

Re: could do with some advice

Lorna McHardy — Tue, 07 Feb 2012 22:35:50 GMT

I have no intention of interfering if the case is being managed appropriately, and even if it isn't, I'm not going to barge in heavy-handed. I'm being quite careful what I say, but neither am I going to ignore her. If a client who had done some research came to me with concerns voiced by another vet about a possible contraindication of a drug I was using, I would, at the very least, go and double check. And offer some sort of explanation as to why I'm using it; nor would I consider either the concern or the question unreasonable. It may be a pain in the backside when people question why we do things, but that is their right. That's why it's usually best to have a good reason, if possible.

Meanwhile, I've checked a German textbook, and I'm getting a sense that there's a cross channel divide here... it is indeed mentioned as the treatment of choice in that one, whereas the formulary here says it's definitely not to be recommended. My niece says he told her about possible side effects, so fair enough. And so far, there don't seem to be any options that haven't been explored. All in all, her trust seems justified!

Re: could do with some advice

Stephen Courtney — Tue, 07 Feb 2012 22:18:17 GMT

^^^ What he said.

It would be rude to interfere, and it sounds like the case is being managed appropriately. Don't worry about drug names either - they are different in many countries and your niece didn't even tell you exactly what was going in.

Azathioprine takes a while to kick in and it is not unreasonable in certain cases to start using it straight away. With appropriate monitoring there is plenty of time to see trouble coming.

Re: could do with some advice

Michael Woodhouse — Tue, 07 Feb 2012 21:08:59 GMT

My advice in these cases is to leave well alone!

How would you feel if you were happily managing a case and their German brother in law was a vet who thought that you had picked the wrong steroid and wasn't happy about the immunosupression agent. Have you tested for X, Y & Z etc etc.

You can't doctor a cat in mainland Europe, so don't try!

Re: could do with some advice

Andrew Kent — Tue, 07 Feb 2012 20:30:19 GMT

Azathioprine is not recommended as a 'normal' treatment for IMHA, better options in the cat would be Chlorambucil or cyclosporine in refractory cases but the work up is key and underlying conditions (esp FIA) are more common.

Andy

Re: could do with some advice

Dagmar Steele — Tue, 07 Feb 2012 20:14:16 GMT

Azathioprin is recommended in cats with AIHA, 2-2,5mg/kg sid so that seems fine. Depo medrate wouldn't be my first choice though, I'd rather use pred. I'm interested in any investigations in underlying causes, though maybe there are no conclusive results. I'm keeping my fingers crossed, keep us posted please. Whereabout in Germany is your niece?

Re: could do with some advice

Clive Ansell — Tue, 07 Feb 2012 19:07:23 GMT

I have a case on the go at the moment which has responded very well to prednisolone; initially at 4mg/kg/day, and it is now down to 1mg/kg/day with no relapse as yet, and last haematology was normal . I'll try it on eod next if haematology is still ok.