Book Review

This is an amazing book. There are 37 contributing authors including RS Bagley, JW Bartges, DM Boothe, D Gunn-Moore, MR Lappin, J Levy, D Zoran and, of course, Jacquie Rand.

In the preface, Dr. Rand says “One difficulty students had using the acronym DAMNPIT, was that in formulating a list of likely diseases causing the problem, they often omitted obvious diseases. When they first listed the organs or body systems that could cause the signs, and then used DAMNPIT, it increased their score rate. Sometimes the organ system is not evident when the signs are not organ-specific, and to help them walk through the thought processes, they were first encouraged to answer the question ‘What mechanisms can be responsible for the these signs?’ [MECHANISM?], ‘Which organs or body systems cause this problem?’ [WHERE?], and ‘What disease/s cause this problem?’ [WHAT?]”

The book is designed to help make us expert diagnosticians because “high-level surgery skills and in-depth knowledge of drugs may be useless if the wrong diagnosis is made.” Each problem should be characterized by the 3 C's: chronicity (duration), character and concern (severity/frequency/size). The example in Chapter one (p. 2-3) is “the problem ‘sneezing and nasal discharge’ may be characterized as 2 months duration (chronicity), purulent (character), and occurring approximately six times/day-moderate severity (concern).” The DAMNPIT acronym helps list diseases that can cause the problem:

• D: degenerative

• A: anomaly (congenital)

  accident (e.g. volvulus, intussusception)

• M: metabolic (e.g. electrolyte, hormonal)

  mechanical (e.g. foreign body, urolith)

• N: neoplasia

  nutritional

• P: physical (e.g. heat, cold, water, fire) psychological

  pharmacological (drug effect)

• I: infectious (viral, bacterial, mycoplasma, rickettsial, protozoal, fungal, parasitic)

  immune

  iatrogenic

  idiopathic infarct

• T: trauma

  toxic/adverse drug

Each chapter title is based on the presenting sign. There are 68 chapters divided into 16 sections (upper respiratory, lower respiratory, heart disease, urinary tract, acute illness, weight loss/chronic illness, sick with specific signs, abnormal lab data, Gl tract, neurological, abnormal gait, behavioral, skin, queen & kitten, eye, and drugs).

The chapter presents a differential diagnosis list that ranges from most probable to least likely. In other words, the most likely diagnosis is described first in the chapter, then the second most likely and so on.

Each chapter begins with a summary that asks Mechanism? Where? and What?. In the summary the diseases are listed in the DAMPIT formula and are bolded if they are important rule outs and the bolded diseases are starred with 0-3 stars based on importance.

I'll use chapter 21, “The yellow cat or cat with elevated liver enzymes” by Albert E Jergens (p. 421-423) as an example. This information and more is found in the summary on the first three pages of the chapter. Page numbers are included that guide the reader to an in depth explanation of each of the differentials.

“Key Signs

• Jaundiced cat.

• Jaundice occurs when serum bilirubin values exceed 2.0mg/dl.

• Jaundice results from either increased erythrocyte hemolysis or hepatobiliary disease.

• Most cats with jaundice have hepatic lipidosis, cholangiohepatitis syndrome (CHS) or extrahepatic biliary obstruction (EHBO).

• Non-jaundiced cats with elevated liver enzymes may or may not have liver disease. The degree of dysfunction is assessed by bile acid analysis and the cause determined by liver cytology and/or biopsy if indicated.”

  The quick reference summary of diseases causing a yellow cat or cat with elevated liver enzymes is divided into pre-hepatic, hepatic and post-hepatic

• Hemolytic processes causing clinical signs are usually associated with PCV<18% Inflammation/Infection

  Mycoplasma haemofelis (Hemobartonella felis) *

• Jaundice caused by primary hepatic parenchymal diseases

• Jaundice caused by decreased or impaired biliary excretion

There is an amazing amount of information in this book and it is presented with a world-wide perspective:

(p.25: “The cat with signs of chronic nasal disease” by Jacquie Rand) “Cryptococcus neoformans gattii is found in the developing flower of the Red River gums and forest red gums; high concentrations of organisms are found in the bark and the accumulated debris surrounding the base of the tree. These trees have been widely exported around the world from Australia.”

The world is becoming a smaller place so it is good to know the complete differential for a problem. Your next cat patient may be from Europe, Australia or Asia!

There are occasional anecdotal comments which could aid in diagnosis and treatment:

(p.15: “The cat with acute sneezing or nasal discharge” by Jacquie Rand) “Montelukast (Singulaire 0.25-1 mg/kg SID)…anecdotal evidence suggests that montelukast may reduce sneezing and nasal discharge associated with Bordetella.”

The information is presented so it is easier to remember:

(p.443: “The cat with abdominal distention or abdominal fluid” by Anthony Abrams-Ogg) “In the “8F” classification scheme the causes of abdominal distention are fluid, fat, food, feces, flatus, fetus, formidable organomegaly, and feeble abdominal musculature. The most common causes of moderate to marked abdominal distention in cats are physiologic-pregnancy and obesity. The most common pathologic cause is abdominal fluid.”

(p. 481 “The Bleeding Cat” by Anthony Abrams-Ogg)

• “Bleeding due to a platelet disorder tends to be cutaneous and mucosal.

• Bleeding due to a coagulopathy tends to be subcutaneous and internal.”

(p. 734: “The cat with signs of chronic small bowel diarrhea” by Debra L Zoran)

• “The four recognized pathophysiologic mechanisms that cause diarrhea include osmotic, secretory, increased permeability and altered motility.”

I compared the DIC information (p.481, “The bleeding cat” by Anthony Abrams-Ogg) to a recent Journal of the ACVIM article on cat DIC and the information was consis tent with the JACVIM article.

The neurology and dermatology section are excellent. There is an entire chapter on anisocoria and an entire section on abnormal gait:

(p.921 “The weak and ataxic or paralyzed cat” by Paul A. Cuddon)

“Hypervitaminosis A

• Cervical and thoracic limb hyperesthesia and rigidity

• Thoracic limb lameness

• Chronic progressive ataxia

• Reluctance to move

• Chronic tetraparesis to paralysis”

Something to consider in the ataxic cat whose owner is giving cod liver oil instead of fish oil!

The dermatology section includes Neotrombicula autumnalis (harvest mites: I have only diagnosed them once in my very first year of practice!), cutaneous lymphoma (this section is better than any of the dermatology books I have read), alopecia mucinosa, acquired cutaneous fragility syndrome, and traumatic panniculitis. Wow!

The final section 16 on drugs begins with a chapter on “Special considerations related to drug use in cats” and ends with Dawn Merton Booth's “Comprehensive list of recommended dosing regimens”, an excellent 50-page formulary just for cats! I use her AAHA drug formulary several times a day so this is a special treat!

Obviously any book will have some areas that are lacking but complaints with Problem-based Feline Medicine are rare. There are no pictures, graphs, charts, etc. The chapter on regurgitation does not mention psychological causes and I do believe stress figures in there somewhere. The behavioral section only covers aggression and anxiety-related problems but there is a really good list of the different types of aggression in the summary section.

Because the chapters are authored by different people, there is some information that doesn't agree with other chapters. For instance, the upper respiratory section mentions that Bordetella bronchiseptica causes mandibular lymphadenopathy while the enlarged lymph node chapter does not mention Bordetella.

I think this book would be most helpful in practice whether you are a neophyte or a long-time practitioner.

I will be returning to the ACVIM forum in Seattle in June and hope to have information from that amazing meeting in the August pink pages.

Sara

OBITUARY

Jim Richards

Galatians 5:27: “But the fruit of the Spirit is love, joy, peace, patience, kindness, goodness, faithfulness, gentleness and self-control.”

Dear friends,

It is with great grief that I am writing to inform you of the passing of Jim Richards. For those of you who knew him, you hold memories of Jim's warm and open smile, his honesty and humility, his quiet humour and loving presence. Jim was always able to step into conversations which had any element of discord and easily add a: “Why don't we think about this, in another way” thereby re-establishing harmony. He never wanted the spot light. For those of you who didn't have the joy of getting to know Jim, I'd like to tell you a bit more about him.

Jim was a man filled with a deep faith and direction. His mild manner masked a keen mind, which could overview a LOT of information. I got to know him through his leadership on the Vaccine Guidelines Panel where he had to direct, guide, coerce and manage twelve of us in this last 2006 version to get the massive project completed. Even when up against deadlines and at his most weary, he never let his frustration spoil our fraternity. Over three versions of the Guidelines and a decade of interactions, we remain friends.

Jim was Director of the Cornell Feline Health Center, Director of The Dr Louis J Camuti Memorial Feline Consultation and Diagnostic Service, a service of the Cornell Feline Health Center, and Editor-in-Chief of CatWatch, a publication of CUCVM. He served as AAFP President in 2004 and was on the current Board of Directors.

Jim had many passions. He loved his family, was devoted to the well-being of cats and cat people, was a musician and a long-time motorcycle enthusiast. Sadly, two of these were involved in his untimely death. Whilst riding with friends on Sunday, April 22nd, he swerved to avoid hitting a cat and flipped his motorcycle. He died from his injuries without ever regaining consciousness on Tuesday, April 24, 2007. How sad yet also appropriate that he should have been doing two of the things he loved most: biking and saving cats.

Our thoughts and love go to his wife, Anita, his sons Jesse and Seth and his mother. Jim was a remarkable person. We will not see his combination of gifts and personality again. As Fred Scott wrote, “Jim would want to pass on his blessings and thanks to all of you. Keep on improving the health and well being of all those cats that Jim so dearly loved”. I feel blessed to have known and been touched by you, JimBob.

Sadly, Margie Scherk