BSAVA follow up...

RE: BSAVA follow up...

Bob Russell — Mon, 24 Apr 2017 12:50:50 GMT

As a minimum I X-ray the lower arcade of teeth in cats. Takes a few seconds, is parallel and even the most inexperienced can get good images. If there are going to be neck lesions lurking there are likely to be signs there.

That said, once things are set up it does not take much time to do the lot so that is what I generally do!

I bought a set of "children" sized forceps more out of interest than anything else. Much too large for most stuff but can be useful when extracting large teeth and sometimes the odd shapes can be just what is needed. Good way to spend £30 but would not spend more!

RE: BSAVA follow up...

Martin Atkinson — Mon, 24 Apr 2017 12:41:26 GMT

[quote user="Anthony Todd"]

So I go to have a quiet relaxing time away from all this at Wembley and the referee is

Martin **** Atkinson!!

[/quote]Yup one of my sidelines I like to keep quiet about, makes you wonder how I fit it all in with my busy life. They wouldn't let me referee Arsenal v Man City as I'm a Gunners fan!

RE: BSAVA follow up...

Martin Atkinson — Mon, 24 Apr 2017 12:38:42 GMT

[quote user="Virginia Campbell"]She didn't rehome as he was a nervy cat and so attached to her, we thought he would just have same problem elsewhere.[/quote]A misunderstanding of cat psychology. Cats are attached to places not people, it would have forgotten about its owner in 2 weeks. It is the change in routine with the cats sitter not the absence of its owner that is the issue. It would probably have done fine elsewhere. But try telling that to the average owner who believes the cat depends on them.

RE: BSAVA follow up...

Evelyn Barbour-Hill — Sun, 23 Apr 2017 20:24:06 GMT

[quote user="Rob Davis"]

[quote user="robloxley"]John Robinson was keen on extracting teeth using forceps[/quote]

As he is a human dentist this doesn't surprise me. Forceps extraction is a much more commonly used technique in human dentistry. There is a whole range of different forceps designs for specific human teeth and it is a technique which will be much more familiar to human dentists than vets. My concern is that if it is not performed well, then tooth fractures are much more likely.

[/quote]John may be a human dentist but he has devoted the last 30 years or so of his career to veterinary dentistry.

You cannot apply the human technique of forceps extraction to cats, dogs, horses or rabbits because the anatomy is different. What you can do is apply the forceps much earlier in the process, once it has been started by correct use of luxators (or, of course, by the disease process). Ten years or so ago when teaching undergraduates I insisted that they had to first extract a tooth without ever touching a pair of forceps, and that forceps were only there for a tooth that you could pull out with your fingers if only your fingers were the right shape. I still think this is a good principle to learn on, but now I let the pupil apply the forceps much earlier, and teach them how to use the forceps properly. It is a skill which has to be acquired by practice. If you try it without this skill, you will break the teeth.

Human dentists do indeed have an astonishing range of different shapes of forceps for extractions. Every one of them falls within the range of "bad" via "useless" to "worse than useless" for veterinary use. They are all too big and have complicated shapes. The veterinary dealers still sell these things as they always have done, giving them sometimes rather fanciful descriptions in a pretence that they are designed for veterinary use. Don't waste your money. The only extraction forceps you need for dogs and cats are what the dealers usually call "small-breed" forceps, with a spring and not too much angulation about them, certainly no weird configuration.

Have a clear-out of all those ancient forceps, elevators and chisels.. There is a charity you can send them to: they refurbish them and send them to third-world countries in order to replace the pliers and hacksaws (which for many of us will bring back bitter-sweet memories of the "dental kit" we were presented with in our earlier jobs )

[quote user="Rob Davis"]I also don't personally believe in full mouth radiography as a general necessity (I think it is mostly American specialists who advocate this).[/quote]

American specialists come out with a good deal of bollshot sometimes. I do however nearly always do a full-mouth survey in a cat, because it's such a quick process. In the dog it's more usually radiograph anything suspicious and anything planned for extraction; also in a mouth where there's periodontitis everywhere and one needs to be sure what's hopeless and what's not. Several times in such cases I have discovered a tooth with much greater bone loss than suspected, or with significant periapical lucency resulting from perio-endo disease despite a fairly mild external appearance. Such a tooth would need extraction and I would not have known without the radiograph.

RE: BSAVA follow up...

Rob Davis — Sun, 23 Apr 2017 11:09:33 GMT

[quote user="robloxley"]John Robinson was keen on extracting teeth using forceps[/quote]

[quote user="robloxley"]He was also not an advocate of full mouth radiographs in every cat to look for 'hidden lesions' (though was radiographing every tooth he was removing) - so should we be doing this or are we looking for things that aren't causing the cat a problem?[/quote]

I also don't personally believe in full mouth radiography as a general necessity (I think it is mostly American specialists who advocate this). Undoubtedly you will identify pathology which would otherwise be missed, but it is not necessarily clinically relevant. I do think that full mouth radiography should be performed in any cat which has tooth resorption. There was a study done fairly recently which suggested that radiographing the lower 07s in cats had a high sensitivity (?95% from memory) for picking up tooth resorption, in other words, if neither 307 or 407 had resorption then you could be 95% sure that there were no other areas of resorption in the mouth.

Any snippets to share from the discussion on dry socket?

RE: BSAVA follow up...

Rob Loxley — Sun, 23 Apr 2017 09:12:44 GMT

[quote user="GrooveJet"]Sooooo... did ANYONE learn ANYTHING else at BSAVA???[/quote]

John Robinson was keen on extracting teeth using forceps, where traditionally it was taught to just use luxators/elevators until the tooth is very loose -have tried what he was advocating and it does work.
He was also not an advocate of full mouth radiographs in every cat to look for 'hidden lesions' (though was radiographing every tooth he was removing) - so should we be doing this or are we looking for things that aren't causing the cat a problem?
Interesting discussion on dry socket in the Q&A following.

RE: BSAVA follow up...

Anthony Todd — Sun, 23 Apr 2017 00:02:03 GMT

[quote user="Kate Richardson"]

So you believe Virginia and Julie but not me and martin

[/quote]

This was the first time 2 cases on the forum were described which were controlled solely by psycho drugs and quoted directly by some who had observed the cats dirrctly which I thought was undoubtedly pretty solid evidence.

Others had said things like "it has long been known " etc without giving an actual case history or trials, just pathology or pathogenesis.

Yep, been through the whole thread again and Virginia tried a cat on and off a psycho drug and Julia also controlled a case with a psycho drug which for me was pretty conclusive.

So I gave them both 5 stars

RE: BSAVA follow up...

grumpyoldman — Sat, 22 Apr 2017 23:32:01 GMT

The NHS spends £650m a year trying to avoid amputating terrible foot injuries in diabetics who cannot or will not control their own disease properly, and then amputates them anyway .

RE: BSAVA follow up...

Anthony Todd — Sat, 22 Apr 2017 21:32:26 GMT

[quote user="Martin Atkinson"]You could make a mistake in your management of the case if you put 2+2 together and make 5![/quote]

So I go to have a quiet relaxing time away from all this at Wembley and the referee is

Martin **** Atkinson!!

RE: BSAVA follow up...

Miriam Lodewyks — Sat, 22 Apr 2017 15:33:28 GMT

Sooooo... did ANYONE learn ANYTHING else at BSAVA???

RE: BSAVA follow up...

Kate Richardson — Sat, 22 Apr 2017 13:55:17 GMT

So you believe Virginia and Julie but not me and martin

RE: BSAVA follow up...

Anthony Todd — Sat, 22 Apr 2017 11:00:13 GMT

duplicated

RE: BSAVA follow up...

Anthony Todd — Sat, 22 Apr 2017 10:58:11 GMT

[quote user="Virginia Campbell"]I am convinced that one was a purely stress induced cystitis.[/quote]

Fair enough.

RE: BSAVA follow up...

Virginia Campbell — Sat, 22 Apr 2017 10:15:04 GMT

Yes we have a psycho cat on our books who gets cystitis (blood in urine, not just peeing in the wrong place) every time we try to pull him off clomicalm so we have stopped trying. Not on any other meds.

I have euthanased one that used to get horrendous cystitis every time his owner travelled abroad for work, even though she got a cat sitter in, multiple water sources in usual places, on wet c/d food long term. He was really sore with it. She didn't rehome as he was a nervy cat and so attached to her, we thought he would just have same problem elsewhere. Lovely owner who had done full workup. I am convinced that one was a purely stress induced cystitis.

RE: BSAVA follow up...

Anthony Todd — Fri, 21 Apr 2017 18:20:46 GMT

[quote user="Julie Innes"]

At the risk of being shot down for anecdotes again (bear in mind you DID ask, Anthony, if anyone had seen a stressed cat cured with psych drugs!), I had a horrific overgroomer that was totally self-traumatising completely cured with amitryptilline. (resists adding "so there".... )

[/quote]

No ! this is EXACTLY the sort of thing I believe everyone should be aware of!!

This is just the [only] place to spread this sort of information.

So never had any steroids? No changes in the skin? No concurrent allergy removal [usual story]

And the one described here previously that licked the fur off the top of all four legs???

We,ourselves, had an cat with a facial derm which we were advised was "psycho" but had a food allergy ie was relieved by steroids andcured by diet trial.

"Psycho" cats do occur and you modvets need to be able to differentiate and treat them but you need to be accurate diagnostically.

A "psycho cat "who responds to steroids and flea control, well....

RE: BSAVA follow up...

Julie Innes — Fri, 21 Apr 2017 18:01:11 GMT

RE: BSAVA follow up...

Martin Atkinson — Fri, 21 Apr 2017 09:00:19 GMT

[quote user="Anthony Todd"]I don't mind if you say stress [because of a dominant cat?] causes dehydration; causes urinary concentration; causes crystals to pptate.[/quote]Funny that because no one has said that except you! I've accepted that a stressed cat may not drink as much because its access to safe drinking sources is compromised and therefore concentrate its urine which may be more irritant to the exposed bladder endothelium but there's still no suggestion crystals are implicated.

[quote user="Anthony Todd"]What I do take issue with is that stress directly makes ions aggregate. ie gives obvious chemical and physical changes.[/quote]And you'd be right to take issue if that was what has been said but it hasn't. At the risk of a permanent headache I suggest you read the explanation re the GAG layer.

[quote user="Anthony Todd"]There was a cat described on here that licked the fur from all four legs. That's more like a stress or psychological condition, no pathology, weird distribution.[/quote]So why do you accept that as a sign of stress? There's no proof it is the cause any more than if you remove the stressers the cat stops psychogenic grooming just as its FIC will clear up. Why will you accept one but not the other?

And that is (probably) my last word on the subject, if you want to live in ignorance that is your choice.

RE: BSAVA follow up...

Anthony Todd — Thu, 20 Apr 2017 19:14:46 GMT

[quote user="Robin Grimmer"]Au contraire - if you can identify the cause of the stress and then eliminate it, you stand the best chance of a permanent cure - as in the case described by Julie above.[/quote]

I don't mind if you say stress [because of a dominant cat?] causes dehydration; causes urinary concentration; causes crystals to pptate.

What I do take issue with is that stress directly makes ions aggregate. ie gives obvious chemical and physical changes.

My example is cooling urine which, when "unstressed" in a test tube, will pptate crystals.

Julie's example is really unexplained rather than proved; what and where did the cat go, how much did it drink and what did it eat etc.

Not to say the observation is made up or inaccurate but let's face it, there could be many explanations.

There was a cat described on here that licked the fur from all four legs. That's more like a stress or psychological condition, no pathology, weird distribution.

Love to hear of any "stressed" cats that got better on psycho drugs alone.

But, like "hormone deficiency", if it floats your boat and more importantly, the client's, then go for it.

RE: BSAVA follow up...

Robin Grimmer — Thu, 20 Apr 2017 16:31:31 GMT

[quote user="Anthony Todd"]

What gets me is that diagnosing "stress" as the direct cause diminishes the chance of a permanent cure.

[/quote]

Au contraire - if you can identify the cause of the stress and then eliminate it, you stand the best chance of a permanent cure - as in the case described by Julie above.

RE: BSAVA follow up...

Anthony Todd — Thu, 20 Apr 2017 15:43:27 GMT

[quote user="Martin Atkinson"]

Similarly "stress" fur licking etc is always accompanied by flea advice, as this can "add to the "stress" and "trigger" the licking.

[/quote]

snap!

I was only paraphrasing the other great authority.

RE: BSAVA follow up...

Anthony Todd — Thu, 20 Apr 2017 15:39:39 GMT

[quote user="Gillian Mostyn"]With respect, Anthony, maybe the cause and frequency of the cases we see now has changed.[/quote]

I couldn't agree more and I'm sure they have, but when I say "I didn't see this or that" or "mine got better on this or that" I'm accused of misdiagnosis, idiocy, or at least, just mis-treatment.....

How common was feline diabetes back in the day with cats on high fat, high animal protein wet food etc. etc.?

How common was feline lipidosis or diabetes or obesity way back then?

How common are ear mites now? etc. etc.

I can't help feeling that the highly palatable owner friendly [from intake to excretion] but totally alien dried cereal based diet with all the added chemical adjustments for pH etc is having consequences on feline health and disease patterns.

The irony is we had to deal with "hormone deficiency" and you've got "stress".

Hormone deficiency was debunked pretty quickly, so we'll see about stress....

RE: BSAVA follow up...

Gillian Mostyn — Thu, 20 Apr 2017 12:57:15 GMT

IMO there has been quite a big change in how many cats 'live' over the last 20 to 40 years. There are now more indoor cats in multi-cat households, or even outdoor cats with a very 'competitive' territorial area due to the sheer numbers of cats in high density housing. Most cats are to some degree overweight. I also think that cat owners are much more aware of their pet's habits, and will not only notice that their cat is urinating differently, but will also be prepared to bring them in and pay for treatment.

With respect, Anthony, maybe the cause and frequency of the cases we see now has changed. I certainly see much much fewer true 'blocakges' due to crystals these days - the majority of cases now being in cats that have had recurrent or recent dysuria. Most are overweight and many are indoor cats.

RE: BSAVA follow up...

Martin Atkinson — Thu, 20 Apr 2017 10:18:49 GMT

RE: BSAVA follow up...

Anthony Todd — Thu, 20 Apr 2017 09:51:58 GMT

[quote user="Julie Innes"]Suggests to me that stress must be a part of it[/quote]

Don't know when Go Cat changed their formula but, fair enough, n=1.

And, of course, some cats are very choosy when it comes to water so may have found a better source.

I accept stress can = reduced water intake, and can =urinary stasis which may pptate FUS etc.

What gets me is that diagnosing "stress" as the direct cause diminishes the chance of a permanent cure.

Always "reduce stress" is accompanied by advice and changes which relate to crystal or stone formation, ie diet change and water intake which are not really to do with stress.

Similarly "stress" fur licking etc is always accompanied by flea advice, as this can "add to the "stress" and "trigger" the licking.

The condition are relieved but the logic isn't.

RE: BSAVA follow up...

Julie Innes — Thu, 20 Apr 2017 09:07:32 GMT

If you want to be anecdotal, my first cat we had as a student had recurrent cystitis (in and out of litter tray, passing blood in urine). Lived as single cat in student flat, fed go-cat (I know, bear in mind we were poor and this was 25 years ago!), outside during the day and in at night. Went to the Vet School for all the tests, no crystals, nothing. Had recurrent antibiotics through the years. When I qualified and later moved to a house where he could get in and out as he pleased, the cystitis stopped, despite same dry food. Suggests to me that stress must be a part of it