As veterinarians, we’re all partial to particular areas of practice. You might be the surgery superstar who’d love to spend every day gowned and gloved or the dermatology whiz your colleagues run to when they’re stumped by skin.
But no matter how experienced we are, we also have areas of practice where we’re less confident.
When you’re managing a case that’s outside your comfort zone, a trusted clinical reference can help you double-check your steps and reassure you that you’re on the right track.
In this blog post, see how a clinical decision support tool like Plumb’s Pro™ can help bolster your confidence while you work through a complicated case of blindness in a cat.
Meet Your Patient and Pet Owner
Today, you’re seeing Chloe, a 15-year-old spayed female domestic shorthair. Her owner, Margaret, is concerned about Chloe’s vision as she’s noticed Chloe bump into furniture and walls a few times over the last 2 days.
Margaret is also concerned that Chloe has lost weight over the last few months despite having an excellent appetite. Chloe has also started drinking from the bathroom faucet and urinating more than usual.
Chloe is indoor-only, and there are no other pets in the household. She’s up-to-date on vaccinations and has generally been healthy.
On physical exam, Chloe’s body condition score is 4/9. She is tachycardic (240 beats per minute) with a grade II/VI systolic heart murmur, and her thyroid gland feels mildly enlarged. She has anisocoria, with the right pupil appearing mydriatic, and her direct and indirect pupillary responses are reduced bilaterally. Her menace response is absent bilaterally. Otherwise, her physical exam is unremarkable.
You ask your technicians to perform a blood pressure test in a quiet, dark room. Her blood pressure is 170 mmHg, indicating hypertension.
Stay on Track with Practical, Peer-Reviewed Veterinary Guidance
You’re concerned that Chloe may have hyperthyroidism and that her ocular signs might be due to hypertensive retinopathy.
But ophthalmology is not your strong suit, so you’d like reassurance that you’re on the right track. A refresher on hypertensive retinopathy would be helpful. You’d also like to double-check what you might expect to see on a fundic exam and ensure you haven’t missed any steps.
You turn to Plumb’s Pro™, open the Dx & Tx on hypertensive retinopathy in cats, and review the section that covers typical physical exam findings.
You’re reminded to try a cotton ball test and to elicit a dazzle response. She has an absent dazzle response in both eyes and doesn’t visually track the cotton ball you drop.
You review the Dx & Tx to determine what you might see on a fundic exam and then perform direct ophthalmoscopy. You think you can appreciate retinal hemorrhages and tortuous retinal vessels in both eyes, with the right eye being more severe.
Based on these findings, you’re fairly confident in your diagnosis of hypertensive retinopathy, so you turn back to the Dx & Tx to decide on your next steps.
The Dx & Tx monograph reminds you to screen for renal disease and hyperthyroidism and consider potential cardiac and neurological assessments.
Get the Ball Rolling With Baseline Diagnostics
You create an estimate that includes an in-clinic complete blood count, serum chemistry panel and total thyroxine concentration (total T4), and urinalysis. You also recommend referral for cardiac and neurological workups.
Your technician reviews the estimate with Margaret, who elects to proceed with laboratory testing but declines referral for cardiac or neurological workup.
Chloe’s laboratory results reveal an increased total T4 value. She has mild increases in her liver enzymes and a mild erythrocytosis on her CBC, both of which you suspect are secondary to hyperthyroidism. The remainder of her bloodwork is unremarkable.
Her urine is well-concentrated (USG 1.037) with no proteinuria.
Ensure Clarity and Understanding With Pet Owner Education
You need to discuss hypertensive retinopathy and hyperthyroidism with Margaret, but you know there’s a lot of information for her to take in.
Margaret must also fully understand and closely follow your recommendations to prevent damage to Chloe’s other organs and increase the odds of her regaining vision.
To help Margaret absorb the details, you print the clinical handouts on hyperthyroidism and hypertension and take them into the exam room with you. You go over them with Margaret, highlighting the most important points.
You recommend amlodipine to treat Chloe’s hypertension and discuss the possibility that Chloe may regain vision if you can swiftly get her blood pressure under control.
You go through the options for treating hyperthyroidism, including methimazole, iodine-restricted diets, and radioactive iodine therapy. After your discussion, Margaret elects to proceed with methimazole treatment.
Prescribe With Confidence and Protect Against Drug Interactions
You haven’t prescribed amlodipine for quite some time. While you’re pretty sure you can use it alongside methimazole without risking a drug interaction, you quickly confirm that’s the case using the drug interaction checker.
You review the drug monographs for both drugs and use the built-in calculator in Plumb’s Pro™ to calculate the dosages to prescribe.
Before you send Chloe home with her medications, you turn back to the Dx & Tx monographs on hypertensive retinopathy and hyperthyroidism and review the clinical follow-up and monitoring sections to make a plan for follow-up visits.
You let Margaret know you’d like to recheck Chloe’s blood pressure in 2 days and decide on further follow-up measurements based on how treatment is going. You’d like to repeat Chloe’s bloodwork in 2 to 3 weeks.
You open the drug handouts on methimazole and amlodipine, add a personalized note to Margaret with your monitoring recommendations, and then email them to Margaret.
You dispense amlodipine and methimazole and let Margaret know you’ve emailed handouts with more answers to common questions, so she can explain Chloe’s treatment to her family and keep an eye out for adverse effects.
With Plumb’s Pro™, you’re equipped with the expert guidance you need to approach any case—especially one outside your comfort zone. To see Plumb’s Pro™ in action, watch a free on-demand demo.