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Kathryn B.

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  • Kathryn B.
    Participant
    20:13 23/10/22

    I think I would repeat biochem with a fresh sample in case it’s artefact due to sample haemolysis, is that value compatible with life?! If the hyperkalaemia is a true result I’d consider ACTH stim as history and other labs could fit with Addisons. ARF/urinary obstruction doesn’t really fit with the history and renal parameters. ECG to see if the hyperkalaemia is causing issues and consider treating with insulin/cardioprotection with Ca++ if indicated. But I’d start shock fluids and dex for Addisons whilst waiting for external lab ACTH stim results and that would maybe sort out the electrolytes without any specific Tx for the hyperkalaemia?

    Kathryn B.
    Participant
    16:14 23/10/22

    Replying to Holly D. 19/10/2022 - 10:30

    Have you tried gabapentin? I have no personal experience but there was a Lancet study in 2012 showing it was an effective cough suppressant in people. Don’t know if there’s any studies looking at this in dogs. Just thinking liquid gaba could be an option for your little dog.

    Kathryn B.
    Participant
    18:15 17/10/22

    Replying to Liz Bode 17/10/2022 - 17:58

    Thanks Liz, I’ll definitely order those! It took over an hour to drain what I did get out, after that there was still too much effusion to get diagnostic chest films. Referred it for tumour hunt, on CT horrible necrotic mediastinal mass with multiple pulmonary mets so sadly not a happy ending. Had PM at referral centre and looked like it was probably a haemangiosarc. Lovely dog, only three years old 😢 I’m having a run of sad cases at the mo!

    Kathryn B.
    Participant
    16:23 17/10/22

    Interesting, I’ve never used trazadone in cats, definitely one to try! I sometimes give gaba orally on admit to cats in for echo, sometimes it takes the edge off a bit but generally I still need some torb/alfax onboard too, but that may be my slow scanning!

    Kathryn B.
    Participant
    16:19 17/10/22

    Hi Liz and Scott, quick question I hope that’s ok! I was wondering what you use for thoracocentesis in large breed dogs? I had a lovely young Golden Retriever with bilateral haemorrhagic pleural effusion in last week. I drained almost a litre of pleural fluid out using a butterfly catheter (I need to order the fancy three way taps you don’t have to twiddle, what are they called?!), there was clearly loads more fluid on ultrasound but I could not get it to drain, I wonder if my butterfly was too short? I tried green IV catheters but they kept kinking so weren’t successful. Would you use a cow size needle or something with more finesse?! I keep meaning to order in some Mila chest drains – would they be suitable for pleural effusion cases for both initial therapy and longer term management if required? Thanks

    Kathryn B.
    Participant
    08:19 12/10/22

    Replying to [email protected] 12/10/2022 - 05:41

    Thanks Scott, that’s really helpful. I’ll let you know where the case goes! 🙂

    Kathryn B.
    Participant
    21:02 11/10/22

    My first appointment this morning was a PUPD so I thought yep I’m all over this one… But no, it’s one of those ones with nothing to go on. Older MN Labrador, noted by owner to be PUPD for three weeks (not yet quantified intake), no change in demeanour, no change in appetite, no other new symptoms. Nothing out of the ordinary on exam, weight stable. Free catch urine USG 1.019, stix all -ve. Haematology and biochemistry including electrolytes (calcium we run is total rather than ionised) all within reference ranges. I’ve asked the owner to measure water intake and drop in another urine sample to see if isosthenuria is persistent. Is it correct that conditions such as DI, HAC etc would be unlikely as isosthenuric rather than hyposthenuric? Would you consider running an SDMA as this USG could fit with early CKD before the patient becomes azotaemic? Cysto for C&S? I hate those PUPD cases where you do initial tests and can tell the owner a million things you’ve ruled out but not what the problem actually is… Thanks

    Kathryn B.
    Participant
    17:20 03/10/22

    Hi Scott. Interesting paper! Just wondering which lab you use for measurement of ionised calcium? We don’t have an EPOC or similar, and our usual reference lab (Idexx) doesn’t offer ionised calcium. Thanks 🙂

    Kathryn B.
    Participant
    17:13 03/10/22

    Thank you for a great lecture. I have a few questions please:

    1) We use triple combination anaesthesia for most of our cat neuters. I like to use bup in place of torb as I think it should provide better analgesia, but some of our nurses prefer torb as they feel it provides better sedation. What are your thoughts? If using bup what dose would you use as part of a triple?

    2) We have a Doppler BP machine rather than an oscillometric device so can only measure systolic BP. What value would your minimum SBP (rather than mean BP) be under GA?

    3) I have vague memories of hearing a new formulation of bup is available (maybe some kind of sustained release or patch or something?!) – what is it and is it licensed in the UK?!

    Thank you

    Kathryn B.
    Participant
    17:01 03/10/22

    Hi, really enjoyed the dermatology refresher, most of the anti-pruritic drugs didn’t exist when I qualified! Just a few ear questions:

    1) For atopic patients presenting primarily with itchy ears, once any infection is under control how frequently would you use a topical GC (be that Recicort, Cortavance or cleaner with GC added) to keep the symptoms at bay?

    2) What is your favourite technique for managing aural haematomas, apart from treating the underlying issue? I generally use systemic pred, some of my colleagues drain and install depo, others stent… I’ve not been able to find a good review comparing all the options

    3) Do you culture otitis cases where you identify rods on cytology, or is there no merit in doing so when the MIC are based on systemic concentrations and we’ll probably be using topical antimicrobials?

    4) What is your favourite off licence ‘recipe’ for horrible Pseudomonas ears +/- TM rupture? I tend to use flamazine alongside a mixture of Trizchlor with dex added (and maybe some Baytril) but I’m never sure if what I’m using is ok and if I am making it up and using it with an appropriate frequency or dose

    Thank you 🙂

    Kathryn B.
    Participant
    13:35 27/09/22

    Replying to Liz Bode 26/09/2022 - 18:04

    Thanks Liz, that’s really helpful. I will definitely be avoiding midazolam in the future!

    Kathryn B.
    Participant
    13:21 20/09/22

    Hi Liz, thank you for a great lecture, really helpful. I just have a few question please:

    – one of our brachy dog patients had aspiration pneumonia recently and was started on co-amox and doxycycline by our local referral centre. Would the doxy in this case be used more as as immunomodulator than an antibiotic? I remember it being drummed in to me a uni (a long time ago) that you shouldn’t use a bactericidal and bacteriostatic antibiotic together, have the thoughts on this changed?!

    – on a similar theme… coughing brachys we tend to start on omeprazole thinking that will reduce the risk of aspiration pneumonia, but is that actually a bad idea as you said proton pump inhibitors make gastric contents a better milieu for bacterial growth?

    – what are your preferred sedatives for echo of ‘well’ dogs e.g. for substaging B1 vs. B2 MVD, looking for LA dilation in a cat after hearing a murmur in a booster? Cats I try conscious, if not possible 100mg gaba orally (50mg if tiny cat) and leave two hours, if naughty progress to 0.1 ml midaz and 0.1 ml alfax Im (doses for 4kg ish cat) so can place IV then trickle in more Alfax iv if needed. Dogs I use torb 0.2-0.4 mg/kg IV with midazolam 0.25 mg/kg. Mainly using midazolam under what I think is now the misguided belief that it is ‘the’ heart drug, but I tend to find it makes my patients trippy and ever harder to scan than they were without sedation!

    – for patients with a cough do you prefer radiographs under GA to allow manual inflation, and if so what drugs do you use for premedication in both the well and the unwell patient?

    Thank you 🙂

    Kathryn B.
    Participant
    20:44 08/09/22

    Replying to Mariska H. 07/09/2022 - 02:56

    Hi Mariska. I’ve recently discovered dry prep urine cytology which I have found a revelation! Spin urine down, resuspend just in what’s left in the tube, put a drop onto a slide and use another slide to smear, leave to dry then stain with DiffQuick. The detail you get for looking at cells/bacteria is a million times better than with Sedistain (Sedistain still best for crystals though). Just in case you’d not come across this technique, as I only learned it recently. Kathryn

    Kathryn B.
    Participant
    20:34 08/09/22

    Replying to [email protected] 08/09/2022 - 20:17

    Fab thank you

    Kathryn B.
    Participant
    19:48 08/09/22

    Replying to [email protected] 08/09/2022 - 16:36

    I find WBC indices in particular challenging e.g. if the neuts are just a few integers up numerically is that significant, and is it mild or severe? And if they are low normal is that all ok or actually they were really high but now they’re all being consumed and it’s actually really bad?!
    On an unrelated note, I am mathematically challenged and cannot understand titre results, or understand those C&S results where you have the letters S, I and R in upper and lower cases in a row, if you know of any good resources to help me understand! Thanks!

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