Cats Galore in Istanbul

Cats, cats, cats, lots of cats in the street of Istanbul. This week I had the pleasure to give a couple of lectures about cat surgery and oncology at the First ever Cat Congress of Turkey. Warmly hosted by Dr. Mustafa Aktas and his team, we were welcomed and treated like royalty (although I did refuse an official picture with a sultan outfit). Cats are everywhere on the streets and they are treated well, they seem happy, well fed and allowed to prowl the streets without interference. As a matter of fact, Istanbul seems a cat capital as dogs were few to be found.IMG_6224

I was asked to talk about a couple of typical cats problems and the ones I chose will not surprise you: cat skin and the differences with the D-word. Cat mammary tumors and Cat SCC. I also had the pleasure to do a combi lecture with the famous Dr. Craig Clifford. We teamed up to talk about cat liver tumors, cat thymoma and injection site sarcomas.

As we have discussed a few of these issues on our podcats, I will link these lectures to our podcast in this blog. Here is my 3-second take on each disease:

  1. Injection site sarcoma. Seem to be less common which is good, but is a bad tumor in general, so watch it where you vaccinate! No more vaccines in between the shoulder blades, on the chest and hip regions! We like to vaccinate in the periphery of the cat, ie distal limbs and tail
  2. Feline liver tumors. Ever heard of the lucky cat syndrome? That certainly normally does not apply for feline tumors. They tend to be nasty, except liver tumors. The most common tumor is relatively benign and can be cured with surgery. I love those pedunculated masses!
  3. Cat thymoma is also most likely not invasive, Craig said if you open up the cat and hold it upside down, they tend to fall out! Typical medonc statement, obviously, but there is some truth to it. They tend to be noninvasive but do expect some adhesions. With careful dissection, most will come out in one.

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  1. Cat squamous cell carcinoma is a tough disease, especially around the face. Big margins are often not possible and hence a tendency for recurrence and progression. We referred to a recent article in which PDT (photodynamic therapy) was used with success in smaller lesions. https://www.ncbi.nlm.nih.gov/pubmed/29359611
  2. Cat mammary tumors are almost always malignant (85% of the cases) and should be treated aggressively. We just did a podcast on them so if you are interested just download our podcast and start listening to number 7. In short, (staged) bilateral mastectomies is the way to go! https://purrpodcast.net/podcast-archive/
  3. Last but not least, we discussed some cat reconstruction techniques of the face. Cat skin is awesome to work with but there are some major principles you need to think of. One of these is the importance of the subcutaneous layer in your closure. Always close with a solid subcutaneous suture pattern to prevent wound complications. Listen to our podcast with Dr. Bryden Stanley for more tips.

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Istanbul is a great place to visit, for work or for holidays. It is safe, people are friendly and there is lots to see. We would definitely recommend it, especially if you like cats!

 

Are you still living in the Stone age?

You know what? I am going to talk about one of my main soapbox topics: the mismanagement of urinary stones by surgery. What? You are a surgeon, how can you say that? Isn’t surgery the fastest and quickest way to get rid of them? Don’t stones get stuck when you try to dissolve them? No, no, no, no, noooooooo!

50% of all stones submitted to the Minnesota Urolith Center are struvite stones. 50%!!! What-the-feline-and-canine-f….? Correct, although we have advocated using diets for struvite stones for years and years, this number has not changed. Just to put it in perspective this is 50.000+ struvite cases a year and that covers only the ones that are submitted. Are we totally out of our minds?

Struvite stones can be dissolved safely in dogs and cats within a couple of weeks using the appropriate diet according to every urinary specialist. Yes, it is a bit more complicated in dogs than in cats (as they are almost always infected; ie the dogs NOT the cats). But still, 50% of stones all over the world are cut out for NOTHING. And no, I am a surgeon and I do love surgery, but I also am convinced that DO NO HARM is more important than me cutting out things, just because.

So what are we doing about it? Dr. Jody Lulich (Urology professor at the MUC), Dr. Susan Little, famous catvet, and I have decided to start a movement to stop struvite submissions by 2020. We have a FB page (do the plegde), we do lectures all over the world and we will carry the cone of shame everywhere we go for people that still want to cut out struvite stones.

https://www.facebook.com/struvitepledge/

We also realise we need to make this message simple, we listened to you and came up with a very simple and logical plan of attack.

This is it:

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Cats: Urinary signs – take a radiograph (all you need) – check the MN urolith app for most likely stones – put them on a diet for 2-3 weeks (be strict) – recheck with radiograph:

Option A Stone is smaller – keep on trucking and keep them on the diet!

Option B Stone is as big as before – Check for compliance (Awwww I felt so bad for my cat so I just sprinkled a bit of over the counter beef jerky over its food) and if ok take the stone out by any means you like (we like minimally invasive btw).

In dogs, the only addition is to check for urinary infection and use appropriate antibiotics with the diet. Sometimes it can take a bit longer for the stones to dissolve, but still.

What about surgery being faster? BS, you do not prevent the stones from coming back after surgery, induce more stones by implanting foreign bodies and you should know how many people leave in undetected stones. And, additionally,  you torture the animal for nothing.

What about stones getting stuck? Are you serious? It really does not happen with struvite dissolution. And if it happens, it is most likely not a struvite stone anyway.

What about compound stones? If they were not that rare (only 10% of all stones submitted), it would be a good excuse, but most stones are struvite or Ca-oxalate.

Check out the awesome MN Urolith app in your favorite app store. The CALCulator is an amazing tool that will check more than 500k animals to predict what stone it may be in a specific breed, sex, and age of an animal. So if you have a 4-year-old DSH F cat you have a 69% change of a struvite stone!

https://www.vetmed.umn.edu/centers-programs/minnesota-urolith-center/whats-new

And although my mantra is keep on cutting, we do need a mindset change for struvites. Keep on dieting!

For more info:

www.purrpodcast.net

https://www.facebook.com/GVETSX

https://www.facebook.com/PurrPodcast/

 

Our next lecture is announced! NYC here we come…,

How can I be so lucky that I will be both going to NYC and have a seminar with one of my favorite co-speakers at the same time? On Friday November 9, Dr. Susan Little and myself with talk tinsel and what to do when it gets stuck in the cat.

I love abdominal surgery and I love cats, so what better for a surgeon to have this combo in the OR? The bad news is that cats do often not show the severe clinical signs we see in dogs with GI obstructive disease and they like to eat string foreign bodies.

String or linear foreign bodies mean bad news. They get stuck and the bowels start crawling up the string causing major havoc and damage to the intestinal wall with possible perforations as a result. Add the nondescript clinical feline signs to this concoction as you have a possible life threatening disease issue.

Immediate surgery is often the key to success especially after endoscopic removal has proven to be impossible. But do not do surgery before you check one major location of the string and that is under the tongue!

Cats with string foreign bodies have a worse prognosis that other things that they like but should not eat! As in all cases, early detection and quick surgery after solid stabilization have the best prognosis for the feline patient!

Oh well, this is in a nutshell what we will be talking about! And the best news is that we are podcasting live. So everyone will be able to enjoy this later on our awesome #purrpodcast!

Purring away

It is no secret I love cats. Too bad I am allergic and this was the main reason why I chose to be a surgeon (so I can be around my furry friends without sneezing). As a surgeon, you can always wear gloves and a mask when animals are around and not be seen as a crazy dude. Cats are awesome, they are solitary, give attention when they want and are amazing athletes, all traits I truly admire. I also have made my mind up, as soon as a true low-allergy cat is available, I am in! So, if you have suggestions, let me know!

By the way, I am also allergic to dogs, which makes my choice to be a veterinarian interesting, especially from an upper respiratory aspect. When asked (at a young age), why I wanted to be a companion animal vet, my answer was standard: the only thing that I am not allergic to is horses and rats and my allergist made it clear that that was an exposure issue and not a ‘you can do rats’ in the future opportunity.

Cats are truly amazing and sadly under-researched. The mantra a cat is not a little dog is pretty well accepted, but if that is the case, what should I do when there is so little literature available? This question I posed to Dr. Susan Little, famous catvet and author of multiple textbooks about cat medicine. We were in Brazil at the time and I was amazed at how many people were carrying the Dr. Susan cat bibles to have them signed. This is not an easy task, knowing how heavy those books are.

The light bulb went off when we received the same questions over and over during every seminar we gave. The question is irrelevant, but the answer was not that difficult. It was also about a topic that was widely talked about, and one that literature was available for. That puzzled us and we concluded that next to a limitation of information there was also a hurdle to absorb the right info.

So Dr. Susan and I decided to start a new venture (as we had not enough on our plates already) and started the purrpodcast, a podcast all about veterinary medicine of the feline species. we realized that most vets are too busy anyway to read. The last thing, I want to do when I come home is read another article. But what I do enjoy, is listening to podcasts in the car and although my commute is a 2 x 30 min, I still digest high quantities of podcast info.

So, now we are 9 episodes into our venture and 4500 downloads later. We both enjoy working together, picking out topics and interviewing awesome cat heroes. It was a match made in heaven. We discussed cat stones, invaginations, GDV, etc. and interviewed the awesome Dr. Sarah Boston and Dr. Sheilah Robertson and have some many topics to talk about. Yes, the quality of the recordings is not top notch (yet) due to our crazy schedules and skype lives, but the content is great and we get such awesome feedback! Thank you!

If you want to listen to the podcast, download it from any podcast platform (Apple, android, stitcher, i-heart radio, etc. or use this direct link: bit.ly/purrpodcast and join us on FB or IG!

So what is next? Dr. Susan and I are planning to do a Purrpodcast live at NYVET. We already tried one in Malaysia and the audience was awesome, the recording less so :-). Thus, NYVET it is gonna be! If you are there join us for this unique opportunity, can’t wait to see you there and in the meantime, keep on cutting!

 

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