Lungworm?

Re: Lungworm?

Bob Russell — Mon, 15 Jul 2013 14:45:12 GMT

"In endemic areas administration of the product every four weeks will prevent angiostrongylosis by reducing immature adult (L5) and adult parasite burden where concomitant treatment against cestodes is indicated"

Pretty hot off the press!!

Re: Lungworm?

Rob Loxley — Sat, 13 Jul 2013 08:43:56 GMT

[quote user="Julie Innes"]I thought milbemax had always had a "protective" type licence[/quote]

It always had a 'treatment' claim

Re: Lungworm?

Julie Innes — Fri, 12 Jul 2013 23:33:30 GMT

I thought milbemax had always had a "protective" type licence (ie does it not stop development of larvae rather than prevent infection??)

Re: Lungworm?

Rob Loxley — Fri, 12 Jul 2013 22:47:46 GMT

[quote user="Julie Innes"]I use milbemax/ frontline combo or milbemax/ advantix, but advise clients of the limitations of milbemax regarding lungworm and pretty much let them decide.[/quote]

You did read Bob's comment on the new license indication for milbemax vs lungworm?? Worth speaking to novartis.

Maybe that's why we've not seen any lungworm as heavy milbemax users - or maybe Bayer have blown it out of all proportion?,...

Re: Lungworm?

Julie Innes — Fri, 12 Jul 2013 22:33:41 GMT

I'm in Scotland, and despite people, sorry Bayer, saying ther is definitely lungworm here, I have yet to diagnose a case (touch wood)

Thanks to their adverts, however, I have had at least 12 hysterical clients on the phone this week because there was a slug in the garden!

Problem with advocate as routine is that we do have a significant tick issue here, and advocate doesn't do ticks. or tapeworm. So it means adding lots of preventative products together, and clients aren't prepared to pay for that on a monthly basis (here). I use milbemax/ frontline combo or milbemax/ advantix, but advise clients of the limitations of milbemax regarding lungworm and pretty much let them decide.

Re: Lungworm?

Kate Dawes — Fri, 12 Jul 2013 16:17:19 GMT

[quote user="Sarah Keir"]It is a real threat as even if not common, the consequences are potentially very serious.[/quote]

I agree, we have had 3 or 4 confirmed cases in the last year (Bristol) and now advise monthly advocate. One of these cases was a young (and apparently healthy) lab bitch that I had the misfortune to spay, (gradual and horrible realisation towards the end of the op that not only was it oozing from everywhere, but there was not a clot to be seen!), thankfully survived, A vasorum confirmed on faecal. Since this we advise that all routine neuters have had two doses of advocate or get client to sign a disclaimer if not.

Another dog in for skin biopsies, wouldn't stop bleeding from sites, A vasorum diagnosed on referral after blood transfusion. Also a couple of odd neuro cases, one confirmed A vasorum, another v suspicious and responded to fenbendazole.

We don't know how common it is, but I think it's a serious enough threat for us to educate owners and let them make up their minds

Re: Lungworm?

mariette asselbergs — Fri, 12 Jul 2013 13:26:32 GMT

"The only thing we need to figure out is the stand itself."

We use an empty 5 l plastic drum upside down. A hole(s) in the top for the funnel(s).

Cut away a good size window in the side to be able to access the outlet.

Works nicely.

Mariette

PS collect three days of faeces and keep in the fridge, mix before choosing a 50g sample for the test.

Re: Lungworm?

Bob Russell — Fri, 12 Jul 2013 11:20:02 GMT

Apparently Milbemax now has a lungworm 'prevention' claim added to its licence! Details apparently to follow!

Re: Lungworm?

Bob Russell — Thu, 24 Nov 2011 16:39:46 GMT

I said I would make a new thread for the case that triggered my first lungworm question! Perhaps this is the right time and the histopathologists can follow if they wish!

Re: Lungworm?

Tim Mainland — Thu, 24 Nov 2011 16:06:54 GMT

Is anybody doing routine in house/practice baermann or wet smear screening for Angiostrongylus larvae? If so, any incidence figures?

Serology results are interesting, Graham. Do you have any UK picture from your own lab's screening - Baermanns etc?

Please can the histopathologists among you make a new thread?! Can't you find somewhere else to play?

Re: Lungworm?

Bob Russell — Thu, 24 Nov 2011 15:57:31 GMT

Update!

Not going well. Biopsies taken (referral centre) and unable to stop bleeding so clotting disorder was suspected but retesting has shown normal clotting times.

Vasculitis now suspected and dog collapsed last night, white as a sheet. Scans show no obvious bleeding elsewhere. It may well be that the cyst that looked as if it was not a cyst may, after all be a cyst.

Unfortunately not looking good. Anyone seen cases of vasculitis?

Re: Lungworm?

Sarah Keir — Thu, 24 Nov 2011 10:21:24 GMT

I work in the south east. We have had confirmed cases of A. vasorum, confirmed clinical cases caused by A. vasorum and even a death confirmed as due to A. vasorum (external post mortem). There is a letter, I think, published in the Vet Record of a dog that had never left Glasgow diagnosed with it.

It is a real threat as even if not common, the consequences are potentially very serious.

My own dog had it but luckily a study (by a vet student - my sister) identified it before more serious effects than exercise intolerence.

Sarah

Re: Lungworm?

Bob Russell — Thu, 24 Nov 2011 09:27:31 GMT

I know about lungworm identification in the Chichester area but this is about 40 miles from us. A reliable blood test for lungworm exposure would be a godsend!

Bayer have done a great marketing job with Advocate and lungworm 'prevention' and many of our clients are aware. Most of my CPD on the subject has been through talks arranged by Novartis and these fairly independent talks suggest an element of hype and scaremongering going on. I am not saying lungworm is not a serious pathogen, it clearly is but needs to be kept in perspective.

I have not had a confirmed case in years and the last one was a new arrival to the area.

Re: Lungworm?

David Mills — Thu, 24 Nov 2011 00:15:57 GMT

[quote user="alex gough"]

My feeling that the take home message from my colleague is that there are some things we do that we can insist are not options if we are so-minded, of which closing the wound is one of them.

[/quote]

Is this really the basis of your surgeon's argument for compulsory histology? Speechless, intellectually, professionally. Is it a referral practice perchance?

Re: Lungworm?

Graham Bilbrough — Wed, 23 Nov 2011 22:13:01 GMT

Well, serology hasn't been used to "look" north of Birmingham yet. But, we do find the parasite using the Baermann technique in samples received from further north. Given enough time with MapPoint, we could probably make a map for the whole of the UK.

I should mention, as I've already been 'phoned, that A.vasorum serology is not currently available at the reference labs in the UK. Sorry.

Re: Lungworm?

Gillian Mostyn — Wed, 23 Nov 2011 22:02:26 GMT

that's great Graham......but what about those of us north of Birmingham??

I still haven't diagnosed a case....

Re: Lungworm?

Graham Bilbrough — Wed, 23 Nov 2011 20:21:11 GMT

www.vetsurgeon.org/.../4113.Schnyder-et-al_2D00_A.vasorum_2D00_survey-DE-and-UK_2D00_4-Fig.ppt.pdf

This is relevant to the conversation.

Thanks

Re: Lungworm?

jamie winstone — Wed, 23 Nov 2011 15:07:07 GMT

No David you are not alone, I support your stance completely. If by sending an excised mass for histology it will not change the treatment at all, the purpose of the test becomes academic and can only be of value to the owner. To suggest that I would repeat surgery before recurrence of any removed lump would not be a popular move with owners in my practice.

Histology is always offerred to help with the question "Is it Cancer Vetinary?", but when pushed with financial realities only about a third take up the offer. (Or is it just those who are insured!)

Getting back to the OP. I have recently been in touch with our outside Lab to find out their diagnosis of lungworm. Their response was they had yet to find a case.

This leaves me a little uneasy as I am only too aware that the general perception of the public is that the profession overtreats in many cases.

Jamie

Re: Lungworm?

Bob Russell — Wed, 23 Nov 2011 14:47:09 GMT

The 'problem' mass I removed and did not keep but with hindsight should have done was incised after surgery and found to have dark grey, thick gunk with a consistency of toothpaste in the middle! In this case it looked like a duck, walked like a duck and quacked like a duck but seems to have been something impersonating a duck! Scrapping some cells off a mass makes good sense.

There is a bit of red starring going on at the moment!

Re: Lungworm?

Anonymous — Wed, 23 Nov 2011 13:59:44 GMT

[quote user="alex gough"]I had better speak for myself rather than anyone else, so here are my thoughts.[/quote]

And I don't disagree with any of those thoughts. Indeed I almost always recommend histo and if the owner declines keep the mass in a pot. I just think it's not every case where histo is necessary to the extent that not doing it is akin to not operating or closing the wound or whatever.

[quote user="alex gough"]The relative merits of wound closure and histopathology are not relevant. [/quote]

I agree this has been a rather silly discussion, but it was the suggestion that the latter was as important as the former that started it.

[quote user="alex gough"]Finally - FNAs are not as sensitive and specific as histology.[/quote]

Again, couldn't agree more. But some simple skin masses like MCT's and keratinized cysts can be fairly reliably diagnosed with a pre-operative FNA at very little expense and with a little more help to your surgical planning than a retrospective histo result.

Those 2 masses looked identical clinically - I excised one with narrow margins and the other with 2cm margins. Of course I'd recommend histo on both after excision, but I'd tailor the discussion on benefits to the individual pet/owner and let them decide on whether this was worth £50 or whatever.

If it's a removed mass, I can help the client decide on whether histo is worthwhile for them by scraping some cells off the mass and examining them in the time it would take to go to the postbox. Unlike an FNA, I rarely find that to be acellular.

I'm guessing from the red-starring I'm in the minority opinion here, so I'll leave this thread to discussion of lungworm.

Re: Lungworm?

Kate Richardson — Wed, 23 Nov 2011 13:33:29 GMT

Totally agree Alex. Being able to give a prognosis is equally as important as any other reason for performing histopathology. At the end of the day, it is the owner's choice, but as always, it should be an informed choice. If they don't take your advice, then that's up to them, and if comes back to bite them on the bum, then they have to accept that responsibility, and not be able to point the finger at you.

And also agree that FNAs are not always accurate, some are acellular, some miss the actual lesion, and diagnosis by visual assessment of a mass can be even less accurate.

Re: Lungworm?

Alex Gough — Wed, 23 Nov 2011 13:25:49 GMT

I didnt give the red star either!

I had better speak for myself rather than anyone else, so here are my thoughts. There are a significant number of cases in which post excision histology will significantly change one's approach to a case. The advantage of a histological diagnosis is that 1. you can decide on whether to go back to get better margins. This is probably the single most important factor that can change the outcome of many of these cases - getting adequate excision at the start (or with a follow up surgery that includes the original surgical wound/scar).

2. You can give the owners a prognosis, which is incredibly important to some people

3. You can institute medical therapy if appropriate. And this can be cheap, palliative treatment like piroxicam/metacam or pred for suitable cases

4. You can institute more intensive therapy if appropriate and the owners request it, such as chemo and radio.

Bear in mind how many owners will ask for one thing, and then having had a few hours to cogitate/assess their finances/decide how important the animal is to them, will change their minds.

The disadvantages of not performing histology are that you lose all those possibilities, and further, if you don't store the sample, you will never get that chance again.

My feeling that the take home message from my colleague is that there are some things we do that we can insist are not options if we are so-minded, of which closing the wound is one of them. The relative merits of wound closure and histopathology are not relevant.

Finally - FNAs are not as sensitive and specific as histology, and a significant number of cytologies will have either incomplete information (what sort of round cell tumour for example) or an incorrect diagnosis. Mast cell tumours are more of an exception than a rule.

Alex

Re: Lungworm?

Martin Atkinson — Wed, 23 Nov 2011 12:06:30 GMT

[quote user="David Beattie"]

Martin, I'm certainly not trying to insult your intelligence.

I'm only trying to make the point that if either for reasons of owner finance or opinion, they would not permit further intervention (e.g. going back for wider margins had these been 'incomplete', drainage LN FNA, Ki67, Masivet) then the value of the histo is really rather questionable.

If I'm insulting anyone (and I'm honestly not trying to), it would be the surgeon that Alex works with. Just because a client can afford histo, does not mean they can afford those further, usually much more costly, interventions - like yourself, I would usually only send histo if the client has intentions to act upon the results. To charge them for the histo without an option and tell them it is essential doesn't seem right to me - I don't follow the logic that this can be considered in any way comparable to closing the wound, even at hyperbole.

[/quote]

I know you're not insulting anyone David that's why I said it wasn't personal, there's no offence taken. I certainly agree with your second paragraph and always talk to the owner about their intentions, some can't afford or don't want to pay for further (probably expensive, invasive surgery or potentially harmful chemo) therapy and a few just want to act Ostrich. Some other posters mentioned saving lumps for further reference which is especially useful for these sorts of scenarios, I too am making a collection, but it starts to become a problem for the day you have a clear out as to what to do to dispose of relatively large volumes of formalin.

PS I didn't give you the red star!

Re: Lungworm?

Anonymous — Wed, 23 Nov 2011 11:17:40 GMT

Martin, I'm certainly not trying to insult your intelligence.

Re: Lungworm?

Martin Atkinson — Wed, 23 Nov 2011 11:03:41 GMT

[quote user="David Beattie"]

and my point was merely what was the value of the histo in this case --> if something else is done as a result, then that's valuable; if you make a suprise finding like a MCT when thought was a lipoma, then don't do anything differently, I wouldn't see any real value to that; that is why I asked what changed because of the histology.

[/quote]

Good another Python fan. Quite honestly I can't remember what I did as a result of the histology in this case, but I certainly would have gone back in and taken wider margins if they hadn't been clear, or even done a drainage lymph node FNA. Now I'd do clever things like looking for Ki67 and possibly ordered the Masivet. This isn't personal but it is a bit of an insult to my intelligence to even suggest that I wouldn't have acted upon the results of histology if I'd bothered to send for it and the client had paid for it.