cat with skin condition

Re: cat with skin condition

Anthony Todd — Wed, 04 Dec 2013 20:19:56 GMT

Re: cat with skin condition

Martin Atkinson — Wed, 04 Dec 2013 17:39:02 GMT

[quote user="Anthony Todd"]Show me one case in a cat given a sensible dose for a sensible time ie until signs are controlled, even if repeated as necessary, and I'll publicly apologise![/quote] They are all so long ago that I have no records and have no recollection of the dose so you can keep you hat on your head. All I know is that I have no need to resort to the drug and take the risk anyway because treatment with other means has been successful.

Re: cat with skin condition

Anthony Todd — Wed, 04 Dec 2013 16:06:48 GMT

[quote user="Martin Atkinson"]all I know is that I've seen them in cats following Ovarid treatment.[/quote]

Sure, but I quoted the massive dose used in one male cat....which you conveniently[?] glossed over.

Show me one case in a cat given a sensible dose for a sensible time ie until signs are controlled, even if repeated as necessary, and I'll publicly apologise!

I never did and I used loads of the stuff with brilliant results in real problem cases.

Re: cat with skin condition

Martin Atkinson — Wed, 04 Dec 2013 15:53:16 GMT

[quote user="Anthony Todd"]

That makes it worse; so it causes mammary tumours in cats which you say are oestrogen dependent but will treat mammary tumours in women which are also oestrogen dependent.

Unless the fibroadenomatous hyperplasia in the [male] cat is progestogen dependent and not analogous to human female mammary tumours???

[/quote]I'm not saying anything other than megestrol is a progestogen analogue and IF mammary tumours in women are oestrogen dependant then a progestogen may be a logical treatment - its a big IF, I don't know. Equally I don't know if all mammary tumours in cats are progestogen or oestrogen dependent, all I know is that I've seen them in cats following Ovarid treatment.

Re: cat with skin condition

Anthony Todd — Wed, 04 Dec 2013 14:54:03 GMT

[quote user="Martin Atkinson"] The confusion comes from the est bit in the word. Megestrol is in fact a synthetic progestogen not an oestogen and therefore I deduce may be used to treat oestrogen dependent mammary tumours in women.[/quote]

That makes it worse; so it causes mammary tumours in cats which you say are oestrogen dependent but will treat mammary tumours in women which are also oestrogen dependent.

Unless the fibroadenomatous hyperplasia in the [male] cat is progestogen dependent and not analogous to human female mammary tumours???

Re: cat with skin condition

Martin Atkinson — Wed, 04 Dec 2013 14:34:52 GMT

[quote user="Sammy82"]

I am confused by this too, how can megestrol be a breast cancer treatment? I always thought some (not all) mammary tumours in dogs and cats have estradiol receptors, therefore reduction of estradiol (=spaying) would be beneficial as it can slow down the growth of estradiol dependent masses. Do some (human) tumours have growth inhibiting estradiol receptors?

[/quote] The confusion comes from the est bit in the word. Megestrol is in fact a synthetic progestogen not an oestogen and therefore I deduce may be used to treat oestrogen dependent mammary tumours in women.

Re: cat with skin condition

Richard Carter — Wed, 04 Dec 2013 14:21:45 GMT

[quote user="Andrew Kent"]I'm not sure where this protocol for cyclosporine comes from but bone marrow suppression is not one of the concerns with this drug [/quote] Thanks for that - probably a short circuit between something heard from someone somewhere who might have heard of someone using it - will reconsider some of the options again!!

Re: cat with skin condition

Andrew Kent — Tue, 03 Dec 2013 09:31:43 GMT

[quote user="Richard Carter"]If I were to rate efficacy to side effects, I would have to put cyclosporine as worst - despite current dermatologists being quite enthusiastic - any medication that has the potential to destroy bone marrow, requires full blood counts every 3 months, potentially has effects on the owner etc cannot be taken too seriously as first option line of treatment[/quote]

I'm not sure where this protocol for cyclosporine comes from but bone marrow suppression is not one of the concerns with this drug (unlike other immunosuppressants). It may increase risk of cancers, may increase risk of infections but I wouldn't worry about the bone marrow and wouldn't routinely take bloods to monitor this in animals on treatment. Clearly we do this when thinking about certain diseases (e.g. treating IMHA etc) but I wouldn't do this for a dog receiving it for skin disease.

Andy

Re: cat with skin condition

Anthony Todd — Mon, 02 Dec 2013 20:46:35 GMT

[quote user="Sammy82"]I am confused by this too[/quote]

There's this

http://vet.sagepub.com/content/26/2/104.full.pdf

but look at the massive dose rates, and the age of the cats......

And look at the doses in this case of fibroadenomatous hyperplasia in a 1.5 year male cat,

The cat was presented to the clinic again, 38 d after initial presentation, with continuing pruritus. The therapeutic regime was modified at this time to include oral megestrol acetate (Ovaban; Schering-Plough), 1 mg/kg BW, q24h for 5 d, and then 0.5 mg/kg BW, PO twice weekly for 21 d. This prescription was refilled 33 d after initiation of the oral megestrol acetate treatment, so that the cat received 1 mg/kg BW, PO, q24h for 2 d, followed by 0.5 mg/kg BW, PO, q24h for 16 d.

and that's as well as methylpred at 4mg/Kg

No mention of flea control for its persistent irritation either.....

and there's a lot of other references.

Re: cat with skin condition

Sammy82 — Mon, 02 Dec 2013 19:23:49 GMT

Re: cat with skin condition

Anthony Todd — Mon, 02 Dec 2013 17:59:28 GMT

Haven't used it [I'm a dinosaur] but it's cutting edge and all free-thinking (or fee-thinking) vets think it's state-of-the art...

[quote user="Richard Carter"]Cortisone is probably the safer option and as Anthony has said, most cases will respond really well to long term treatment at very low levels - 1 - 2.5mg pred eod/ etd is the goal. Some cats do not respond to cortisone unless the classic text book doses of 1 - 2 mg/kg is used and this will cause iatrogenic HAC and is not sustainable.[/quote]

For the last time you can get control in almost all cases by using a single adequate to high dose of your favourite steroid and repeat when signs recur with no taper.

Low continuous doses often don't work at all , or if they do that's 'cos the itch is intermittent and the cat/dog isn't scratching all the time!!!!

[quote user="Richard Carter"]the goal of having 1/2 tablet (2.5mg ovarid) every 14 - 21 days is unlikely to cause diabetes or mammary hyperplasia or adenocarcinomas[/quote]

I think you get better results with a one single 5mg Ovarid only if and when recurrence; if that gives quick relief then try a single 2.5mg, again one dose only.

Nobody has commented on the relationship between Ovarid [megestrol] as a treatment for advanced breast cancer in humans and as a cause in the cat....???

The humans are right on it as an appetite stimulant though.....

Re: cat with skin condition

Bob Russell — Mon, 02 Dec 2013 13:50:08 GMT

[quote user="Anthony Todd"]

[quote user="Bob Russell"]Occasional mammary tumours as well, always highly malignant![/quote]

Were these entire queens?

Is there any data on this?

How does this sit with the use of megestrol as a treatment for breast cancer in women??

The only mammary cancer in cats I can recall was in entire breeding queens, not that there were many around.

Mind you I did use megestrol at minimal and occasional dose rates.....

[/quote]

Not used Ovarid for quite a few years but my memory (non-evidence based!) suggests most were male cats!

Owners love not having an itchy cat so safe doses and recommendations to taper doses often fell on stony ground! Fat cats but satisfied owners!

Re: cat with skin condition

Richard Carter — Mon, 02 Dec 2013 13:35:48 GMT

If I were to rate efficacy to side effects, I would have to put cyclosporine as worst - despite current dermatologists being quite enthusiastic - any medication that has the potential to destroy bone marrow, requires full blood counts every 3 months, potentially has effects on the owner etc cannot be taken too seriously as first option line of treatment.

Cortisone is probably the safer option and as Anthony has said, most cases will respond really well to long term treatment at very low levels - 1 - 2.5mg pred eod/ etd is the goal. Some cats do not respond to cortisone unless the classic text book doses of 1 - 2 mg/kg is used and this will cause iatrogenic HAC and is not sustainable.

It is in these situations where the cause cannot be eliminated or identified that I would then consider ovarid but not at the text book doses and as Anthony again has said, a tapering dose with the goal of having 1/2 tablet (2.5mg ovarid) every 14 - 21 days is unlikely to cause diabetes or mammary hyperplasia or adenocarcinomas but does have an amazing ability to stop the mutilations some of these cats are doing to themselves. If the dose is more frequent than this then yes diabetes, usually the classic type 2 is the same as for any cat being exposed to a constant hyperglycaemia and you would probably be get the same problems on constant cortisone use.

Re: cat with skin condition

Rob Loxley — Mon, 02 Dec 2013 13:30:49 GMT

[quote user="Niall Taylor"]Or... you could give it "by injection" (as we vets say).[/quote]

The information was on home dosing p/o by the owner for skin flareups

Re: cat with skin condition

Niall Taylor — Mon, 02 Dec 2013 12:59:11 GMT

[quote user="robloxley"]there is some interesting information on using dexamethasone injection p/o[/quote]

Or... you could give it "by injection" (as we vets say).

Niall

Re: cat with skin condition

Rob Loxley — Sun, 01 Dec 2013 23:26:09 GMT

[quote user="Anthony Todd"]the modern way, by many fine-thinking vets is not to give relief to the animal?[/quote]

According to whom? The OP has already mentioned using steroids for relief.

Dug out the link to a recent(ish) webinar on managing feline allergic skin disease at http://www.thewebinarvet.com/novartis-webinars/ (1st video)
For cats that need steroid medication but can't be tabletted, there is some interesting information on using dexamethasone injection p/o

Re: cat with skin condition

Anthony Todd — Sat, 30 Nov 2013 23:33:11 GMT

"What kind of steroid dose rate did you use as a single dose?"

Shot of methylpred, 0.4ml ,which I think is 20mg for a normal sized cat, repeat if recurrence; concurrently with total flea and environmental control [for the 80% of cases back in the day.

( percentage may be lower now with excellent and conpliant flea control now available, and more awareness generally)

5mg Ovarid weekly if the skin is broken until complete resolution, or just one 5mg, repeat if recurs.

Or 10mg pred as necessary in a single dose but never more than twice in one week and definitely not daily or every 2 days. If that gives good relief then try 5mg, single dose if recurs.

I'd back Ovarid if I had to choose but I did realise that it had the potential for side effects so tried to use the "weaker" drugs if I thought best.

Re: cat with skin condition

Anthony Todd — Sat, 30 Nov 2013 23:18:22 GMT

I never claimed these were immediate cures (and might likely use a short course of steroids to relieve initial symptoms), but the cat is 3.5yrs old with problem going on since 6wks old, so as well as a short-term fix we need a longterm plan, and trying to reduce the sole reliance on drugs with known longterm potential for side effects is a good aim in many fine-thinking vets opinion.

This is what you wrote. What did you do if "the initial symptoms" recurred which, even I will admit, will recur whilst you are getting your long-term plan together or even getting the environment flea-free, which is harder to do and even harder for an owner to accept, which fortunately most of these cases are.

No mention of repeating the short course of steroids?! So the animal just irritates away?

Of course there is, and was, no reliance on drugs unless there was a recurrence of irritation which did happen as the 2 year time-limit for flea control slowly ticked away.

There was never a continuous dose in a normal itchy dog or cat unless the skin was broken. If it was it was essential to keep the steroids going until the skin was completely healed. If you didn't you and the animal were back exactly to square one in 12-24 hours.

With a single dose, at a minimal effective dose rate, only when symptoms recur, there is no "potential for side effects" at all.

Which [big yawn] seems to be an unbelievably hard concept for all those fine-thinking vets to grasp....

Re: cat with skin condition

Nicola Cole — Sat, 30 Nov 2013 21:06:48 GMT

[quote user="Anthony Todd"]

The other thing is to use steroids only as necessary and in single doses ie not continuous and reduce dose to minimum single dose that is effective.

[/quote] What kind of steroid dose rate did you use as a single dose?

Re: cat with skin condition

Rob Loxley — Sat, 30 Nov 2013 18:52:07 GMT

[quote user="Anthony Todd"]So you don't relieve the irritation?[/quote]

Yawn; read what I wrote.

[quote user="Motown"]he uses Ovarid, as it often works when nothing else does[/quote]

But as a first line, which is what is being proposed here?

Re: cat with skin condition

Anthony Todd — Sat, 30 Nov 2013 16:00:55 GMT

[quote user="Niall Taylor"]And there's little to beat it for the treatment of rodent ulcers![/quote]

+1 for all of that post but will the young guns listen: I doubt it.

They might if we'd actually treated any cases successfully, I suppose, but probably not 'cos we didn't do any tests or take samples and they just got better anyway.....

Re: cat with skin condition

Niall Taylor — Sat, 30 Nov 2013 15:33:08 GMT

[quote user="robloxley"] So why is giving a long acting (weeks to months) injection of methylpred preferable to giving an oral course of the same rug???????[/quote]

My money's on compliance

Although obviously there will be pharmacodynamic differences with different routes of administration.

Niall

Re: cat with skin condition

Niall Taylor — Sat, 30 Nov 2013 15:29:48 GMT

[quote user="Bob Russell"] I remember the days when Ovarid was given 'because' miliary eczema was hormonal! The data sheet doses were pretty high back then and lazy, obese cats were not unusual and clearly at risk from DM. Occasional mammary tumours as well, always highly malignant!

These risks had to be balanced with the welfare issues associated with the level of self-trauma, pain and suffering which was the alternative in a lot of cases.[/quote]

We always used to use pretty low doses - 2.5 to 5 mg twice weekly maximum initially, going down to once weekly or even less once an improvement was seen and we saw few, if any side effects. Megoestrol acetate apparently has about half the 'corticosteroid' effect of methyl-prednisolone apparently so I imagine there must be some other effect of this compound than that, given that it will occasionally succeed in cases where methyl-pred has failed. It's not a classic glucocorticoid but is a potent anti-androgen.

And there's little to beat it for the treatment of rodent ulcers!

Cheers,

Niall

Re: cat with skin condition

Anthony Todd — Sat, 30 Nov 2013 00:27:48 GMT

[quote user="robloxley"] so as well as a short-term fix we need a longterm plan[/quote]

Sure, but in the meantime, while the longterm plan is formulated [let alone working] the modern way, by many fine-thinking vets is not to give relief to the animal?

I cannot see the disadvantage of giving relief with a single dose of steroids whilst these diagnostic plans, regimes and samples are being run. And, if it is a single dose of the lowest effective amount, the "potential for side effects" is nil.

[quote user="robloxley"]What if the irritation is chronic??[/quote]

And many itchy cats and dogs will end up that way, which is when one has to resort to the regime I have been banging on about!

Fortunately the vast majority, now that everyone recognises the main eliminatable allergens, don't need steroids much, if at all.

[quote user="robloxley"]What utter guff![/quote]

So you don't relieve the irritation? I mean quickly and completely for a variable length of time, sure, and repeat it as above?

This is the approach I've been trying to change viz, the animal tearing itself apart whilst the fine-thinkers among us formulate a long-term plan.....

Does the use of relieving steroid, but in the way I have described, interfere with, distort or in any way affect any future diagnosis or resolution of the condition?

[quote user="robloxley"]So why is giving a long acting (weeks to months) injection of methylpred preferable to giving an oral course of the same drug?[/quote]

Sorry that was meant as a comment on the two drugs, methylpred versus megestrol, for instance with rodent ulcers or eosinophilic granulomas, where you do need repeated treatment with more than one dose until those type of lesions have completely resolved.

So, in these cases, but only in these specific conditions, there is no difference and either route will give resolution eventually and sometimes it's easier to get owners' compliance with a long-acting jab.

Re: cat with skin condition

Rob Loxley — Fri, 29 Nov 2013 21:01:54 GMT

[quote user="Anthony Todd"]tearing themselves apart for weeks or months because vets had been faffing about with so many theoretically effective treatments of which antihistamines, "trialling different antihistamines and EFAs" and " IgE serology for atopy " and etc. are only a few[/quote]

[quote user="Anthony Todd"]I once, and not so long ago, went to a lecture where a noted pathologist said she "didn't treat a skin case at all until she had a diagnosis". What does the poor itchy thing do in the meantime?

[/quote]

[quote user="Anthony Todd"]any steroid given as a single dose, at the minimum effective dose, only when the irritation recurs[/quote]

What if the irritation is chronic??

[quote user="Anthony Todd"]any steroid given as a single dose, at the minimum effective dose, only when the irritation recurs, is the only humane way to treat these unfortunate animals[/quote]

What utter guff!

[quote user="Anthony Todd"]And still we get "medrone p/o, taper to lowest effective dose" instead of an effective dose as necessary...
... although depomedrone sometimes worked better inexplicably[/quote]

So why is giving a long acting (weeks to months) injection of methylpred preferable to giving an oral course of the same drug???????