Page 400 - WSAVA2018
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 25-28 September, 2018 | Singapore
Starting dose is 5-10 mg/kg. Look for a trough level of about 500 ng/ml on regular basis. In most dentists opinion it is only really effective AFTER teeth are removed. However, it has shown promise in resistant cases.
Laser therapy is not proven at all, most clients and RDVM’s are very unhappy with the long term results. It is very expensive and short term relief only.
Surgical Therapy: Extraction is currently the ONLY effective long term treatment for this disease process in cats. In our experience, the sooner this is done, the better that cats do both post-operatively as well as long term.
For extractions to be successful, the teeth must be COMPLETELY removed. Therefore post-operative radiographic confirmation of complete extraction of the tooth roots is recommended. Following the insurance of complete removal of the teeth, perform aveloplasty to remove the periodontal ligament and smooth rough bony edges. This is typically performed do this with a rough diamond bur.
Studies report a 60% success rate when all teeth caudal to the canines are extracted, however our experience has not been as good. However, whole mouth extractions have a success rate of approximately 90-95% for clinical remission. Slight faucitis may remain, but pets are comfortable. In addition, the rare cases that don’t completely respond are generally much more responsive to medical therapy.
If there is NO inflammation to the canines or incisors (which is rare), then the owner is given the option of leaving the canines. However, if these are inflamed, all teeth should be extracted.
Resistant Cases
In the rare cases where the teeth have been fully extracted but inflammation and pain continues, other therapies are needed. The current treatment of choice in the USA is cyclosporine. Another option, which appears to work better in Europe is feline interferon. Finally, UC Davis has had some success with Stem Cell Therapy.
J. Beatty1
1University of Sydney, Sydney School of Veterinary Science, Camperdown, Australia
How I approach a cat with pleural effusion Professor Julia Beatty
Sydney School of Veterinary Science, University of Sydney, NSW 2006
Cats with pleural effusion often have severe respiratory compromise at the time of presentation. Cats with respiratory compromise should be identified early, handled as little as possible and stabilized. Fortunately, most or all of the information required to localise the dyspnoea can be obtained from observation of the patient and a minimally invasive physical examination. The clinician has to juggle stabilization, localisation and owner communication while remaining vigilant for clues which allow ranking of the differentials to formulate a diagnostic plan.
Triage at reception is important to identify dyspnoeic cats early. All sick cats should be observed in their carriers on arrival at the clinic regardless of the owner’s description of the presenting complaint. This is because dyspnoea may be subtle or absent prior to travelling. Such is the propensity of the cat to compensate for gradual onset respiratory compromise by reduced activity that signs may not be seen by even the most observant owner. It
is important that all members of the care-giving team, including reception staff, are trained to be vigilant for dyspnoeic emergencies and to take appropriate action.
  Where respiratory distress is noted or suspected, immediate stabilisation is indicated. The techniques used and the order in which they are carried out depends on assessment of the individual patient.
· Reduce oxygen requirements by placing the patient
in a cool, quiet environment and minimising handling to reduce oxygen demand.
· Supplemental oxygen Options for short term oxygen delivery to the dyspnoeic cat include oxygen cham- ber, mask and flow-by. The method that is best toler- ated by the patient should be used. Struggling must be avoided. An oxygen chamber or cage is a useful way to deliver oxygen without the need for restraint.
· Intravenous access should be achieved at the earli- est opportunity
· Light sedation may be beneficial for dyspnoeic cats to reduce anxiety (eg butorphanol).
· Therapeutic thoracocentesis is carried out after im-

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