Veterinary Medicine - November 2008 - (Page DM15)

Robertson: So you look for a signi cant difference and also the trend. Steiner: Yes, and the clinical findings—how is the cat doing? Robertson: With chronic disease, it would depend on the individual cat. If you’re giving corticosteroids, such as prednisone, prednisolone, or dexamethasone, the recommendation is to retest 10 to 14 days after initiating therapy. We’ve talked about supplementing cobalamin in cats with intestinal disease. When would you recheck cats with an elevated Spec fPL that you supplemented with cobalamin? Williams: When giving cobalamin, we generally wait about a month to check that the cobalamin replacement is working. Unless something changes, it is reasonable to wait four weeks and recheck the Spec fPL at the same time. If you are not worried about cobalamin and just number to determine this? Steiner: It depends on the case. Some cats have mild elevations of Spec fPL and are clinically normal. If I have ruled out risk factors and concurrent conditions in those cats I will do a trial therapy with corticosteroids, but if there is no response then I really just monitor them. However, if the increase of Spec fPL is more severe or the cat has clinical signs I would be more aggressive in trying to treat the cat. Twedt: Another good time to reevaluate a cat with chronic pancreatitis is when the patient has been progressing well and then it gets sick. Is it a are-up of the pancreatitis or is something else occurring? The Spec fPL test might help direct us. If the cat is running consistent values, gets sick and Spec fPL has not changed I would look for something else causing the signs. Robertson: Thank you for participating in today’s roundtable discussion on feline pancreatitis. It “If the pancreatitis improves with prednisone therapy, the diabetes itself becomes easier to regulate.” — Dr. Jane Robertson want to recheck this Spec fPL, then retesting every two to three weeks is fine. That is based on experimental studies done in Greece where researchers induced mild transient pancreatitis in cats, and as those cats recovered there was a steady decrease in Spec fPL toward normal after two weeks. Therefore, if the result is still elevated two or three weeks later, something more chronic is going on. You are not dealing with a mild episode of a transient disease. Steiner: I also use two to three weeks as a recheck interval initially. If the Spec fPL is mildly elevated initially and two to three weeks later it is unchanged or only mildly decreased, I’m not going to keep rechecking it every two to three weeks. I’ll do it every three months and then every six months. Of course the goal is for the patient to have a normal Spec fPL concentration, but many cats will not normalize completely. We believe many of them will have some residual inflammation. Forman: If you recheck and the result is unchanged, you might decide to add a treatment or change your therapy. How do you use that was an informative discussion, but it is also quite clear that there is still a lot that is unknown about this disease in cats. I would like to summarize what we have discussed today. Cats with pancreatitis are lethargic and present with nonspeci c clinical signs. The prevalence of the disease is unknown but is more common than previously believed. There are no speci c ndings on routine laboratory work that con rm a diagnosis of pancreatitis. The Spec fPL test is the most sensitive and speci c laboratory test available for diagnosing pancreatitis in cats. It is common for cats to have other concurrent illnesses including IBD, cholangitis, hepatic lipidosis, and diabetes mellitus. Treatment involves uid therapy, pain control, antiemetic therapy, and nutritional support in acute cases. In cats with chronic pancreatitis, diet selection is often important, appetite stimulants, antiemetics, and pain control may be required, and glucocorticoid therapy is often effective. Management of concurrent diseases is critical, and serial Spec fPL measurements can be helpful in managing this disease. Now that the Spec fPL test is a widely available diagnostic and monitoring tool, hopefully we will continue to learn more about this elusive disease. 15

Table of Contents Feed for the Digital Edition of Veterinary Medicine - November 2008

Veterinary Medicine - November 2008 Contents Leading Off Editors' Guest Just Ask the Expert Letters Practice Makes Perfect Clinical Exposures Practice Matters Idea Exchange Author Guidelines A Challenging Case: Esophageal Leiomyoma in a Dog Osteoarthritis in Cats: What We Now Know About Recognition and Treatment Product Preview CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - November 2008

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