education | pearls-of-wisdom | 2020 | 2020 Pearls of Wisdom

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American Association of Feline Practitioners
2020 Virtual Conference • October 3 & 4 and 24 & 25, 2020
Feline Head & Neck: Diseases, Disorders, & More

Saturday, October 3, 2020

 

Feline Grimace Scale for Acute Pain Assessment, Dr. Paulo Steagall

  1. The Feline Grimace Scale (FGS) is a novel valid, simple and reliable tool for acute pain assessment based on changes in facial expressions (action units). Ear position, orbital tightening, muzzle tension, whiskers and head position are scored from 0-2, and the final score provides guidance on the administration of analgesics.
  2. Participants may learn more and download the scale for clinical use at www.felinegrimacescale.com

 

Painful Conditions of the Head, Dr. Paulo Steagall

  1. New studies have advanced our knowledge on feline orofacial pain particularly in cats undergoing multiple dental extractions
  2. Ocular and ear painful conditions/procedures are significant issues in feline practice that have been neglected and underdiagnosed. Further studies are warranted

 

Chronic Seizure Management for Cats, Dr. Heidi Barnes Heller

  1. Phenobarbital controls the majority of seizures in the majority of cats, regardless of the underlying etiology
  2. Monitor the seizure pattern (frequency, duration of seizure and for evidence of cluster seizures) after starting anticonvulsant therapy.

 

Respiratory Emergencies: Triaging the Feline Patient, Ms. Alison Gottlieb

  1. Resist the urge to handle and potentially perform diagnostics on these patients.  This additional stress can often be the difference in survival.
  2. Often hydration is not our priority in these cases, consider holding off on IV catheter

 

The Three “A’s” of Acute Pain Management: Anticipate, Assess, & Alleviate, Dr. Sheilah Robertson

  1. By anticipating the severity and duration of pain resulting from a procedure the clinician can choose appropriate drugs and non-drug therapies. Analgesic therapy begins before surgery and continues during and after recovery from anesthesia.
  2. Pain can only be treated effectively if you look for it and assess it using a validated assessment tool.
  3. Insufficient control of pain in the early post-operative period can result in persistent post-surgical pain, described and continues experience of pain after tissue healing has occurred.

 

It’s a New World, Introducing the 2020 AAFP Retrovirus Testing & Management Guidelines, Dr. Susan Little

  1. The patient-side test kit you pick matters. In independent studies, Witness and Anigen test kits are less likely to show a positive result when a cat has FIV antibodies from vaccination, not infection. The IDEXX test kit has the best sensitivity and specificity for FeLV. You should pick a test kit that best suits your needs based on your knowledge of local conditions.
  2. Cats with discordant FeLV test results over time may be cats with regressive infections. We are now able to stage FeLV infection as regressive or progressive by looking at quantitative PCR results. This is important, because cats with progressive infections are more likely to have FeLV-related health problems and are more likely to transmit the virus than cats with regressive infections.

 

Placement & Maintenance of Nasogastric Feeding Tubes in Cats, Dr. Lisa Powell

  1. When placing a nasogastric (NG) tube in cats, it is IMPERATIVE that a lateral chest x-ray is performed to assure proper placement with the stomach.  This x-ray should include the laryngeal area.  If at all possible, a boarded radiologist should review the x-ray to confirm proper placement within the gastric lumen.
  2. An e-collar should be worn at all times while the NG tube is in place to prevent accidental dislodgement from the patient.  The cm marking at the entrance to the nares should also be noted and monitored for continued assurance of proper tube location.

 

The Future is Now:  21st Century Fecal Testing Technology in Your Practice, Dr. Cory D. Penn

  1. The fecal examination for screening and diagnosis of parasitic infections is probably one of the most common laboratory procedures performed in veterinary practice. Year-round parasiticides are excellent preventative medications but do not guarantee that pets will not have intestinal parasites. For this reason, the current recommendation from CAPC is to screen patients at least 4 times during the first year of life by fecal flotation with centrifugation. After the first year of life, adult dogs and cats should be screened at least 2 times per year (depending on patient health and lifestyle factors).
  2. The VETSCAN IMAGYST system is a platform that was developed to provide a simpler, easier, and more methodical fecal examination, which is less influenced by different fecal preparation methodologies or level/experience of an examiner. It is composed of 3 elements which includes a sample preparation device, an automated commercially available scanner, and data analysis by deep neural networks. VETSCAN IMAGYST is powered by deep learning image recognition technology to help veterinarians make accurate and timely intestinal parasitic diagnoses for patients at the point-of-care.

 

Feline Oral Squamous Cell Carcinoma: Recent Advances, Dr. Michael Nolan

  1. With the exception of very small rostral mandibular lesions, prognosis is poor for feline oral SCC. Radiotherapy is often the most effective available tumor-directed treatment; it provides pain relief, and can reduce tumor size for an average of 3-6 months. Referral of patients for enrollment in clinical trials is essential to successful development of new/effective therapies.
  2. Even when prognosis for survival is poor, quality of life can best be supported through provision of adequate: (a) nutrition; (b) hydration; and (c) analgesia.

 

Neurologic Examination for Busy Practitioners, Dr. Heidi Barnes Heller

  1. Whenever possible a complete neurologic examination is preferred. However, when this is not possible a focused neurologic examination, targeting the area of interest, is key when evaluating cats.
  2. The proprioceptive pathways can be evaluated many ways including using paw replacement testing, tactile placing, hopping or wheelbarrow walking. Practitioners should consider the temperament of the cat and choose the appropriate approach for each cat.

 

Special Considerations on Feline Ears, Dr. Alison Diesel

  1. Cat ears tend to be a bit more sensitive when compared to dogs. As such, they should be “handled with care”; the cotton ball cleaning technique should be utilized when cleaning feline ears to help minimize the chance of developing neurological abnormalities.
  2. Otodectes infestation is a common cause of otitis externa in cats, especially younger kittens. Instilling mineral oil into the canals prior to cleaning will help dislodge adhered debris and minimize trauma to the externa canal.

 

Sunday, October 4, 2020

 

Finding Our Path to Honor Ourselves as We Live the Veterinary Oath, Dr. Kimberly Pope-Robinson

  1. We are not broken and in fact living our perfectly imperfect lives.  And we each have permission to find our unique path to career sustainability in veterinary medicine.
  2. Finding the path towards recognizing, embracing, and connecting to both our sinkers and balloons will not be easy.  We are each worthy and capable in traveling on our individualized journeys to achieving sustainability in this beautiful yet challenging profession. 
  3. Although it is challenging, finding self-forgiveness is the foundation to enjoying a sustainable career in veterinary medicine. You have permission to begin on your own journey in staying connected to yourself while working in the veterinary profession.

 

Allergic Dermatitis, Dr. Alison Diesel

  1. Cats with allergic skin disease can present with at least one of four common cutaneous reaction patterns, including head and neck pruritus. When this is the ONLY reaction pattern observed, food allergy should be thoroughly investigated.
  2. There are many therapeutic options that exist for managing feline atopic syndrome; these need to be considered in light of patient, client, and veterinarian considerations to have the most success. If immunotherapy is included as part of the management strategy, referral to a veterinary dermatologist may be most effective.

 

Feline Herpesvirus 101: Why, What, & How?, Dr. Jessica Meekins

  1. Feline herpesvirus-1 (FHV-1) is the most common cause of conjunctivitis and corneal ulcers in domestic cats. The top differential infectious etiology for feline conjunctivitis is Chlamydia felis. Conjunctival cytology is a quick, easy, and minimally invasive diagnostic test to provide support for a specific conjunctivitis diagnosis.
  2. There are two distinct ocular manifestations of FHV-1: the classic cytolytic infection and the less common immune mediated stromal keratitis. Fluorescein staining helps to distinguish between these manifestations, with cytolytic infection resulting in corneal ulceration (positive stain retention). 

 

Feline Pain: Detecting, Identifying Options, & Advocating for Your Patients, Ms. Alison Gottlieb

  1. Cats are masters at hiding (pain, illness, and themselves) this must be a key factor when considering analgesia! When in doubt, always err on the side of pain.
  2. We are all aware that cats are not small dogs, they do appreciate opioids and NSAIDS as much as their canine counterparts.

 

Kitten-caboodle: A Selection of Various Feline Dermatoses, Dr. Alison Diesel

  1. Immune-mediated skin disease should be suspected when there is a rather symmetrical distribution of skin lesions, when non-haired skin is also affected, and if lesions develop rather acutely. Biopsy is typically indicated when immune-mediated skin disease is of concern.
  2. Persian cats in general are predisposed to dermatophytosis infections when compared to other cat breeds. They may present with not only a “classic” appearance (e.g. folliculitis lesions), but they are also the only breed reported to develop dermatophytic pseudomycetomas – a deep, nodular form of the infection.

 

Feline Herpesvirus: Review of Treatment Strategies, Dr. Jessica Meekins

  1. The goal of targeted antiviral therapy is to decrease virus replication (virustatic) rather than to kill the virus (virucidal); FHV-1 can be controlled but not eliminated after establishing a carrier state within the host. Some cats with a competent immune system may mount a sufficient defense against the virus without the need for antiviral drug intervention.
  2. Three criteria to determine if antiviral therapy may be indicated include: 1) if conjunctivitis is present and moderate to severe, 2) if a corneal ulcer is present, and 3) if there are significant signs of ocular discomfort (i.e., blepharospasm, epiphora). Given the role of stress in exacerbating viral reactivation, treatment must be well tolerated to avoid being counterproductive.

 

Is the Kitty Crazy? Feline Hyperthyroidism, Dr. Kathy Engler

  1. High normal total T4 in sick cats or cats losing weight is highly suspicious for hyperthyroidism; further evaluation should be done before ruling the condition out.
  2. Support the nutritional needs of the patient while evaluating cause of weight loss (from hyperT4 or other causes) with products like Mirataz to improve outcomes.
  3. Sugar-coated Felimazole tablets can sometimes be hidden in the top of “pyramid” of canned food allowing the cat to ingest the tablet with their first bite of food.

 

CKD: Prediction of Future Diagnosis, Early Diagnosis, Staging, & Management Strategies, Dr. Dennis Chew

  1. Trends in serial laboratory evaluation can be used to become aware of an impending diagnosis of CKD. AI/ML tools (such as RenalTechTM) have the potential to detect subtle changes in data points and trends in patient status that often escape routine detection by busy practitioners. RenalTechTM has the ability to predict which cats will, and which cats will not develop CKD within the next two years. Predicting disease may allow treatments designed to prevent or slow the emergence of CKD in the future, but this has not yet been proven.
  2. SDMA and creatinine should be used at the same time to assign an IRIS CKD stage AFTER diagnosis of CKD.

 

Unintentional Weight Loss: Feline Dwindles, Dr. Grant Gugisberg

  1. Unintentional weight loss is a common disorder in cats. Owners need help recognizing this issue.  
  2. Each cat needs a tailored diagnostic and treatment plan. Management may require multi-modal therapy. Mirataz® (mirtazapine transdermal ointment) (Dechra Veterinary Products, LLC) is the only FDA- approved weight gain drug for cats.  Constant monitoring of weight is essential for successful outcomes.

 

Look What the Cat Dragged In: Emerging Infections & Infestations Facing Felines Today, Dr. Susan E. Little

  1. Parasite and infection risks are dynamic and ever changing. Although owners are often unaware, vector-borne infections are surprisingly common in pet cats, and prevalence of some parasites is even higher in cats than in dogs. Routine veterinary care that includes strategies to limit the impact of common parasites and vector-borne diseases benefits both cats and their owners.
  2. These infections are more common in outdoor cats, but primarily indoor cats also have a clear, documented risk of infection and infestation. Indeed, pet cats that spend most or all of their time inside often have a particularly close relationship with their human family, making limiting these infections especially important.

 

Pouncing on Pain: Managing Feline Osteoarthritis Cases, Dr. Elizabeth Colleran

  1. Chronic pain changes the body and can make controlling it more difficult the longer the pain persists without therapy.  Learning how cats manifest pain is crucial for caregivers and veterinarians because of the cat’s different repertoire for social communication, differences in locomotion over dogs, and differences in behavior when experiencing pain. 
  2. Treating chronic pain requires a careful balance of effective multimodal treatment planning, the impact on the relationship between beloved cat and caregiver, and regular evaluation of the efficacy of treatment and appropriate adjustments. 
  3. There are multiple nontraditional modalities that can and should be included in a multimodal plan for chronic pain. Creating a plan that is tolerable and effective will be more possible when incorporating these nonpharmacological techniques.  Recent studies have demonstrated a new technology for treating chronic pain in cats which, when available, will be a strategic part of a compassionate plan for the management of chronic pain in cats.

 

Otitis in the Cat: Keys to Diagnosis & Therapy, Dr. Alison Diesel

  1. Bacterial and yeast otitis are infections secondary to an underlying disease process. In cats where recurrent infectious otitis is identified, the primary problem should be thoroughly evaluated and managed to have the best chance of effective management.
  2. When purulent bacterial otitis is identified in a feline patient, the presence of a mass should be thoroughly investigated. While yeast overgrowth and cocci in the absence of white blood calls may indicate a different perhaps less malignant underlying problem (e.g. allergies, endocrine disease, cornification defects), purulent otitis externa is really seen only with a mass.

 

Otic Polyp: Etiology, Presentations, & Treatments, Dr. Bryden Stanley

  1. Otic polyps in cats are benign masses arising from the middle ear. They can grow and extend into the external ear canal and/or the nasopharynx. Appropriate imaging is important, as polyps can be bilateral. Not all cats present at a young age, so always have this condition on your list of differentials.
  2. Some polyps are amenable to careful traction followed by medical management. But definitive treatment to remove residual or recurrent polyps is to perform a ventral bulla osteotomy.

 

Ophthalmic Drugs & When to Use Them, Dr. Jessica Meekins

  1. Many ‘human’ ophthalmic drugs are used in an off-label manner in veterinary patients. It is important to ensure owner compliance and increase the likelihood of a successful treatment outcome by emphasizing the reason for prescribed medications and by demonstrating how to appropriately administer them.
  2. The majority of cases of feline surface ocular disease are viral, meaning that topical antibiotic therapy is unnecessary. Exceptions exist when corneal ulcers are present (in order to prevent secondary bacterial infection) and when primary bacterial (chlamydial) conjunctivitis is suspected.

 

Think Like a Cat: How to be Feline Friendly at Home & in the Practice, Dr. Kelly St. Denis

  1. Cats don’t see & experience the world the way we do.  In order to be truly Cat Friendly, we need to understand the way they think and feel about their veterinary visit experiences, and adjust our behavior to meet their needs.  We need to understand that fear, and sometimes pain, are major contributing factors to their perception of the visit.
  2. A Cat Friendly visit starts at home with proper client support including carrier selection, use of the carrier, and preparation for departure for the visit.  This support and preparation sets the tone for the remainder of the visit.

 

Saturday, October 24, 2020

 

AAFP Case Rounds: Bill the Cat, Dr. Craig Webb

  1. Feline lower airway disease may be caused by parasites (e.g. aelurostrongylus, heartworm), inflammatory processes (i.e. asthma, chronic bronchitis), or pneumonia (i.e. bacterial, aspiration).  Key features in the cat’s history may be critical to the diagnosis; hunts mice (aelurostrongylus), coughs daily (chronic bronchitis), concurrent GI disease (aspiration).
  2. Bronchoalveolar lavage utilizing the endotracheal tube technique is an easy, safe, and quick way to get invaluable information; cytology & culture.

 

Update on Treatment Strategies for Feline Chronic Gingivostomatitis, Christopher Snyder

  1. Treatment of FCGS remains a very frustrating condition in feline veterinary dentistry.  Most indicators suggest that full or partial mouth extractions continue provide the best initial opportunity for “curing” the disease. 
  2. Following extraction, if resolution of disease does not occur, various techniques to immune modulate patients provide the next best option for long-term management.

 

Nutrition for the Hospitalized Patient, Dr. Christopher Byers

  1. No patient should be allowed to enter into a negative energy state unless owners impose restrictions on recommended nutritional interventions.
  2. Clinicians are strongly encouraged to embrace the use of temporary supplemental feeding tubes to help patients achieve nutritional requirements during hospitalization.

 

Cat Naps During a COHAT: The Complete Plan for the Feline Dental Patient, Mary Berg

  1. A COHAT includes more than just cleaning the crowns of the teeth.  Each step is from educating the client to the discharge appointment is vital to the success of the procedure.
  2. Using different tips for the power scaler on the crowns of the teeth and below the gumline is important to ensure a thorough cleaning process is completed.  Use fine or flour grit pumice for polishing ensure the removal of the micro etches on the tooth that will increase plaque accumulation.

 

Mastering Feline Dental Radiograph Interpretation, Dr. Christopher Snyder

  1. Full mouth dental radiographs are indicated in every feline patient, at each dental procedure, at least for the very purpose of screening for tooth resorption.  
  2. Dental radiography is most important for determining the treatment recommendation for resorbing teeth and to understand the best approach to surgical extraction.

 

Diagnosis & Treatment of Chronic Nasal Disease in Cats: Part 1, Dr. Phil Padrid

  1. Symptoms of nasal disease in young cats are most frequently caused by Herpes virus infection (FHV-1).
  2. FHV-1 causes symptoms that come and go in frequency.
  3. Symptoms of FHV-1 can be in remission for years and then re-occur with no apparent cause.
  4. Bacteria are never the primary cause of chronic nasal symptoms in cats.
  5. L-P rhinitis is the most common cause of nasal symptoms in cats other than FHV-1.
  6. Symptoms of L-P rhinitis can be controlled but the disorder is rarely curable.

 

Tips & Tricks for Great Feline Dental Radiographs, Mary Berg

  1. A diagnostic x-ray includes visualization of 2-3 mm of bone around the apex of the root and the level of the alveolar bone.  The crown does not need to be on the x-ray.
  2. Dental radiographs are an essential part of the oral exam.  The crown is just the tip of the iceberg. Approximately 42% of dental pathology is found subgingivally. 

 

Feline Hypertension: Diagnosis, Treatments, & Management, Dr. Clarke Atkins

  1. The RAAS system is activated in systemic hypertension, particularly in the face of chronic kidney disease. Chronic RAAS activation is devastating to many tissues, including the heart, vessels, and kidney, all of which are involved with and damaged by the barotrauma of hypertension.  Additional cell death and fibrosis produces dysfunction of each of these tissues.
  2. RAAS activation remains, even when blood pressure is controlled unless specifically suppressed. This can be accomplished with ACE-I, such as enalapril and benazepril, ARB (angiotensin receptor blockers, such as telmisartan) and MRA (mineralocorticoid receptor antagonists, such as spironolactone).  To date, it appears that telmisartan is the most effective of these in controlling blood pressure in hypertensive cats.

 

One Size Won’t Fit All:  Tailoring Weight Management Plans for Cats, Dr. Julie Churchill

  1. By implementing a complete nutritional assessment at every patient visit, the veterinary team has the opportunity to help proactively prevent unhealthy weight gain and establish the veterinary care team as an expert in their cat’s nutrition.
  2. Every member of the veterinary healthcare team can play a vital role in communicating, engaging and supporting the cat owner in implementing weight management plans. Consistent messaging from the team will provide good service and great care to the client and the cat.
  3. No single approach or weight management plan will meet the needs of all cats or their families. An individualized plan including specific feeding recommendations and monitoring will increase the chance of success.

 

Hydration Fixation: Beyond the Water Bowl, Dr. Jason Gagne

  1. Cats that are inadequately hydrated may be at risk for certain medical conditions, including chronic kidney disease, obesity, urolithiasis, constipation, and diabetes mellitus.
  2. Nutrient enriched water supplementation should be considered in cats that would benefit from increased fluid intake, better total body hydration, increased urine volume, and/or decreased urine specific gravity.

 

Gastroesophageal Reflux: An Under-Recognized Source of Pain, Dr. Christopher Byers

  1. Anesthesia induces relaxation of the LES, thus increasing the risk of gastroesophageal reflux.
  2. Gastroesophageal reflux is traditionally clinically silent. Therefore, diagnosing GER can be challenging and requires capsules that transmit esophageal pH, pH probes, and/or impedance probes. Determining the cause of a patient’s reflux is further challenging.

 

Diagnosis & Treatment of Chronic Nasal Disease in Cats: Part 2, Dr. Phil Padrid

  1. Symptoms of nasal disease in young cats are most frequently caused by Herpes virus infection (FHV-1).
  2. FHV-1 causes symptoms that come and go in frequency.
  3. Symptoms of FHV-1 can be in remission for years and then re-occur with no apparent cause.
  4. Bacteria are never the primary cause of chronic nasal symptoms in cats.
  5. L-P rhinitis is the most common cause of nasal symptoms in cats other than FHV-1.
  6. Symptoms of L-P rhinitis can be controlled but the disorder is rarely curable.

 

Pain Management & Anesthesia Concerns in Feline Dental Patients, Mary Berg

  1. Dental procedures performed on animals are painful, and it is our duty as veterinary technicians/nurses to ensure that our patients are as comfortable as possible.  Before performing many dental procedures or oral surgery, the delivery of local nerve blocks is an effective way to create preemptive analgesia.
  2. Pain can be pathologic if left untreated.  Pain can cause an increased risk of infection, delayed wound healing, reduced food, and water intake; inability to move, altered sleep patterns; and altered behavior patterns.  Some or all these consequences may prolong convalescence and may predispose the patient to an adverse outcome.

 

Sunday, October 25, 2020

 

Update in Feline Gastro-Enteric Syndromes, Dr. Margie Scherk

  1. While the mechanisms remain unknown, IBD appears to transform into small cell lymphoma in some cats. New non-invasive tests (biomarkers) are appealing but are still not as reliable or conclusive as flow cytometry or PARR. Surgical biopsies are preferable to endoscopically harvested samples, however laparoscopy is a satisfactory alternative for collecting good quality biopsy specimens.
  2. Pathophysiology in the biliary tree is the main source of liver disease in the cat. Diseases of the gallbladder are likely more common and under-recognized. Despite vague clinical signs, cholecystitis should be considered in cats with hyperechoic gallbladder wall with/without sludge. Percutaneous ultrasound guided cholecystocentesis is an underutilized but useful technique for determining how to manage these cases.

 

Raising Awareness of Osteoarthritis: Identify & Diagnose Affected Cats, Dr. Sheilah Robertson

  1. As many as 60-90% of cats have radiographic joint changes consistent with osteoarthritis (OA), yet only an estimated 10% are diagnosed and treated.
  2. The most likely reason we are not ‘finding” these cats is that owners do not connect behavioral changes with pain and assume their cat is “getting old”. Unlike dogs, limping is rarely seen in cats with OA.
  3. We must educate owners on the behavioral changes related to pain in cats (“what pain looks like”), so they seek our expertise to confirm and treat long term pain.

 

Nutritional Management of Chronic Enteropathies: A Review of the Recent Research in Cats, Dr. Becky Mullis

  1. Results of a recent clinical study demonstrate that Gastrointestinal Biome Feline begins to work quickly to improve diarrhea or constipation in client-owned cats, within 24 hours. Additionally, the majority of cats with diarrhea or constipation fed Gastrointestinal Biome are likely to have a positive or complete response within 72 hours. Some cats with constipation may require multimodal therapy depending on severity of constipation and underlying cause.
  2. Fiber sources rich in antioxidant and anti-inflammatory compounds can be more effective than traditional fiber sources in improving clinical response in cats with diarrhea or constipation.

 

Putting Vaccines into Perspective, Dr. Christopher Lee

  1. While zero risk creates a scenario to skip vaccination, any level of risk should raise the potential opportunity to protect the patient through vaccination.
  2. Non-enveloped viruses easily move via fomites and represent a reason to maintain core vaccines for all cats.  

 

Creating a Multimodal Plan to Combat Long-term Pain: Why Physical & Mental Health Must be Considered, Dr. Sheilah Robertson

  1. Chronic pain is a disease in itself despite the inciting cause(s). It often multifaceted with inflammatory, neuropathic and functional components therefore more that one drug or modality is required for treatment.
  2. The mind-body connection is important to understand. There is substantial overlap between how the brain processes emotional and physical pain.
  3. Stress, anxiety and fear make the pain experience worse, therefore appropriate environmental modification, enrichment, distraction and social interactions for each patient are a key component to each treatment plan.

On-Demand

 

ABVP: Is It For Me?, Dr. Amy Hinc

  1. Board Certification in Feline Practice through ABVP is not an easy process, and it takes time.  The application process is not meant to be completed in one month or even one year.  Be patient and don’t become disappointed or disenchanted just because it takes time!
  2. As a group, the Feline Diplomates are here for you.  Do not hesitate to reach out for help and support.

 

Acute Seizure Management for Cats, Dr. Heidi Barnes Heller

  1. Benzodiazepine drugs are still the drug of choice for acute, in hospital seizures.
  2. Levetiracetam and propofol may be alternatives if benzodiazepine drugs are not avaible, or ineffective.

 

Cats Don’t Read Textbooks: Commonly Found Oral Pathology of Felines, Mary Berg

  1. An oral examination involved more than looking at the teeth. It is vital to exam the entire oral cavity in cats including the oropharynx, palate, tongue, sublingual and lymph nodes in addition to the teeth.     
  2. It is crucial to be able to identify oral pathology and anomalies.  It is equally important to record the pathology on dental charts.   A thorough dental examination includes both conscious and anesthetized examinations as well as charting disease processes, pathology and anomalies, and treatment plans.

 

Chronic Pain: Is It All in the Head?, Dr. Beatriz Monteiro

  1. The pain experience is a result of the conscious perception of ‘pain messages’ arriving in the cerebral cortex from the peripheral and central nervous systems. However, it is in the latter where this message can be modulated. Chronic pain such as osteoarthritis is a classical example of pain causing central sensitization.
  2. The perception of pain is highly influenced by emotions and it is generally accepted that positive emotions inhibit pain whereas negative emotions increase pain. For this reason, promoting positive emotions in cats with chronic pain can contribute to both analgesic effects and improved feline welfare.

 

Cyberbullying & the Veterinary Profession, Dr. Phil Padrid

  1. Management training on handling client complaints that improves the experience for both the client and veterinarian is critical.
  2. When a client is so upset that they take the time to post negative online reviews, it is often about the client feeling as if they were not heard.

 

Every Practice’s Struggle: How to Attract, Retain, & Motivate Your Veterinary Talent, Dr. Taylor Tillery

  1. The top reasons veterinarian associates leave their current employer are for: opportunities for higher compensation, more flexible schedules, career growth or because of leadership issues and their lack of responsiveness to feedback.
  2. You can’t expect your employees to exceed the expectations of your customers if you don’t exceed the employees’ expectations of management.

 

Face & Head Reconstructive Techniques in Cats, Dr. Bryden Stanley

  1. From the cat’s perspective, the ultimate outcome for reconstruction of face, head and neck defects is to be pain- free and to be able to function normally (ie, eat, breathe, etc), with cosmesis being a secondary goal. Discussion with the owner about this is critical, as the face is where they look most frequently.
  2. There are a number of fairly robust flaps that can be used to cover defects in the muzzle, head and mandibular regions, which are more suitable than free grafts or tension-relieving techniques. Closures should be in a minimum of 2 layers, and frequently 3 layers in more mobile regions such as the lips.

 

A Transformational Nutritional Approach to Managing Cat Allergen Fel d1, Dr. Ebenezer Satyaraj

  1. Allergies to cats affect about 1 in 5 adults worldwide.
  2. More 96% of people with sensitivities to cat respond to the primary cat allergen, Fel d1.
  3. Fel d1 is produced by all cats, there are no truly hypo-allergenic cats
  4. Function of Fel d1 in cats is not known, hence any approach in managing Fel d1 should not interfere with its production
  5. Our data demonstrates a novel approach to simply, safely and effectively neutralize Fel d, utilizing an anti-Fel d1 IgY antibodies (derived from chicken egg) added to cat diet.

 

Feline Head Trauma, Dr. Alison Gottlieb

  1. Never assume it is just head trauma, regardless of how it happened or presents. 
  2. Analgesia and nutrition are key; the earlier the better.

 

Feline Hyperesthesia, Cognitive Dysfunction, & Other Mystery Diseases, Dr. Heidi Barnes Heller

  1. Hyperesthesia syndrome is a collection of clinical signs without an identified etiology (yet) therefore treatment may include anticonvulsant therapy, anti-inflammatory therapy, behavioral modification and treatment or antibiotics.
  2. Feline cognitive dysfunction syndrome is diagnosed by exclusion of other causes therefore it is critical to perform thorough physical, neurologic and biochemical and possibly radiological evaluation prior to providing this diagnosis.

 

Feline Respiratory Patients: A Delicate Balance, Dr. Alison Gottlieb

  1. Observation is essential and often our best tool, eyes and auscultation provide much more information than a pulse-ox!
  2. Low stress handling and anti-anxiolytics are imperative for these delicate patients.

 

Management of Traumatic Brain Injury, Dr. Christopher Byers

  1. Clinicians are strongly encouraged to use the modified Glasgow Coma Scale upon initial evaluation of traumatic brain injury patients, as well as serially throughout the duration of therapy to help assess response to therapies.
  2. Multimodal therapy, including use of hyperosmotic agents, oxygen therapy, and interventions to reduce cerebral metabolism, is essential for maximizing the likelihood of a positive outcome.

 

Maximizing Regional Anesthetic & Pain Management for Dentistry & Oral Surgery Patients, Dr. Christopher Snyder

  1. Cats, more so than any other companion animal species, demonstrate dental conditions that frequently are endured chronically before they are surgically addressed- those being tooth resorption and feline chronic gingivostomatitis.
  2.  Correct use of regional anesthetic blocks, with the addition of opioids locally, provide an opportunity to not only experience an anesthetic procedure without the severe cardiorespiratory depressive effects of general anesthesia, but to also transition to a home oral pain management regimen.

 

Measuring Feline Orofacial Cancer Pain, Dr. Michael Nolan

  1. Indicators of acute and perioperative pain (e.g., heart rate, respiratory rate, pupil size) are generally regarded as poor measures of cancer pain.
  2. Behaviors elicited in response to palpation of the affected area provide the most objective clinical measure of cancer pain. However, altered pain states are present in cats even when there is no clinically appreciable discomfort. Therefore, provision of analgesic therapy should be considered essential in all cats with oral and oropharyngeal malignancies.

 

Nasal Tumors & Neuro-Oncology in Cats, Dr. Michael Nolan

  1. Sinonasal carcinomas are uncommonly reported in the literature. Recent data are encouraging, and indicate that definitive-intent radiotherapy is associated with prolonged survival (median survival times >14 months). This can be achieved using either conventional full-course RT, or an increasingly accessible form of treatment called stereotactic RT (or radiosurgery), which is typically given as 3 consecutive daily treatments.
  2. CNS lymphomas are generally regarded as carrying a grave prognosis. But for some patients, this may just reflect a historical trend of undertreatment. Cats with spinal lymphoma often have disease which: (a) is limited to the vertebral canal; and (b) should respond favorably to radiotherapy {+/- chemotherapy}.

 

Navigating Those Dental Complications That Make You Go…Hmmm!?, Dr. Christopher Snyder

  1. The most common complication encountered discussed in this lecture is likely associated with root fracture or dislodgement of root remnants. 
  2. Remember to take advantage of techniques that provide better visualization- wide surgical flap creation, interoperative radiographic imaging to evaluate the location of root remnant and approach retrieval through the elevation through the buccal bone, laterally.

 

New AAFP Cat Friendly Certificate Program, Dr. Kelly St. Denis

  1. Cats don’t see & experience the world the way we do.  In order to be truly Cat Friendly, we need to understand the way they think and feel about their veterinary visit experiences, and adjust our behavior to meet their needs.  We need to understand that fear, and sometimes pain, are major contributing factors to their perception of the visit.
  2. A Cat Friendly visit starts at home with proper client support including carrier selection, use of the carrier, and preparation for departure for the visit.  This support and preparation sets the tone for the remainder of the visit.

 

Novel Seizure Therapeutics for Cats, Dr. Heidi Barnes Heller

  1. Transdermal phenobarbital and levetiracetam are available but there are limitations including response to treatment, and efficacy with both products.
  2. Extended-release levetiracetam was safely used in healthy cats and may be a viable option for epileptic cats however data has not been published regarding efficacy in in epileptic cats

 

Pesky Parasites & Infections Regionalized to the Head & Neck Area, Dr. Alison Diesel

  1. Isoxazoline flea preventatives are an excellent option for managing ectoparasites in the feline patients. Given the safety profile as well as wide variety of parasites that these medications effect, they should be a stable in the feline practitioner’s arsenal.
  2. Bacterial pyoderma presents differently in cats than it does in dogs. In particular, the eosinophilic lesions including eosinophilic plaques, granulomas, and indolent ulcers can be 100% antimicrobial/antibiotic-responsive. Steroids are often not needed for these skin lesions in cats.

 

Regenerative Medicine & the Feline Patient, Dr. Robert Harman

  1. Stem cells will produce a wide variety of bioactive compounds in response to the specific injury environment in which they are placed, providing injury-specific therapy.
  2. Stem cell therapy is not magic and re-treatment may be needed, so cell banking of extra cells for future need is a critical part of the initial cell processing program.

 

Tips & Tricks for Successful Extractions & Achieving Predictable Healing, Dr. Christopher Snyder

  1. Most often challenges with extractions occur because of less-than-ideal surgical visualization.   
  2. Treating each tooth as if it were its own surgical patient, with adequate surgical exposure, lighting, suction and magnification provide the best opportunity to not only get oneself out of an extraction complication, but to prevent a complication from happening.

 

Understanding Feline Hypertension, Dr. Clarke Atkins

  1. Although diastolic blood pressure measurement has value, it is somewhat difficult to attain in cats.  For this reason, we rely upon systolic blood pressure.  This measurement approximates pulse pressure which is thought to be the most important instrument of cardiovascular barotrauma. 
  2. The 2017 ACVIM Consensus Committee on Hypertension, provides values only for systolic blood pressure, having altered the values for normal to be less than 140mmHg.  While this is very likely the true cutoff for blood pressure in this species.  To assume that we can measure with the precision, accuracy and repeatability with current tools and expertise is naïve. I urge that you consider most cats, without signs of target organ damage and systemic blood pressures <160mmHg to be normal.  Certainly, enhanced monitoring reducing salt intatke might be of use.  An exception would be a hypertensive cat, whose pressure has been controlled but is still >140mmHg.  I would continue to cautiously work to bring the blood pressure down.   
  3. If an animal shows signs of HYPOtension while on treatment to lower blood pressure or for heart failure, believe it, even if the blood pressure is normal upon evaluation in the clinic.  Blood pressure will rise with excitement and can mask the fact that hypotension is a problem for the cat.  Short-term hypotension is generally not problematic, but if prolonged, reduced tissue perfusion (particularly to kidneys of an aged cat) may have serious and possibly permanent consequences.

 

Unique Feline Corneal Diseases, Dr. Jessica Meekins

  1. Corneal sequestrum, eosinophilic proliferative keratitis-conjunctivitis (EPKC), and acute bullous keratopathy (ABK) are three unique corneal diseases that every feline practitioner should be familiar with diagnosing and treating. The diagnosis is largely based on clinical appearance, and treatment may be surgical (e.g., sequestrum), medical (e.g., EPKC), or a combination of surgical and medical (e.g., ABK).
  2. While attempts have been made to implicate FHV-1 as a causative agent for each of these conditions, the role of the virus in their development remains unclear. This is largely due to the ubiquitous nature of the virus in the domestic cat population; many normal cats are FHV-1 carriers, making it difficult to establish a cause and effect relationship between the virus and these unique feline corneal diseases.  

 

Update on Diabetes Mellitus in Cats, Dr. Deborah Greco

  1. Cats are obligate carnivores; therefore, a necessary part of treatment for diabetes mellitus is a change of diet to a high protein, low carbohydrate formulation.  Most wet/canned food will suffice as long as it does not contain rice or sauce.
  2. The type of insulin and the location of insulin injections are important in regulating diabetes and in inducing a clinical remission of diabetes.  Glargine insulin is the insulin of choice for remission and insulin should never be given in the “scruff” of the neck. 

 

Uveitus: Ocular Manifestations of Systemic Disease, Dr. Jessica Meekins

  1. Uveitis may be an ocular manifestation of systemic disease. The majority of adult cats with anterior uveitis are ultimately diagnosed with idiopathic uveitis, while young cats and cats with posterior uveitis are often experiencing an ocular manifestation of systemic disease (i.e., infection, neoplasia, etc.).
  2. Idiopathic uveitis must remain a diagnosis of exclusion after eliminating specific causes with a targeted diagnostic workup. Idiopathic uveitis carries the risk of local ocular sequelae such as secondary glaucoma, cataract, and lens luxation, which are conditions that can be blinding and painful.

 

What is It? Differentiating Medical from Behavioral, Dr. Valarie Tynes

  1. Physical health and behavioral health are intricately interrelated. Try to avoid looking at them as an “either/ or” diagnosis. There will often be aspects of both involved. Just because you cannot find a cause for a physical condition does not automatically mean that a condition has a behavioral cause. Use your knowledge of behavior, learning and physiology to determine what the most likely cause of the problem is and treat presumptively if needed.
  2. Social stress is probably one of the more commonly overlooked and misunderstood causes of behavioral change and several medical conditions in cats. This problem occurs because most cat owners have no understanding of normal cat social behavior or of the environmental and behavioral needs of the cat. Many problems could be prevented if clinicians did more preventive education regarding environmental and behavioral needs of cats.