scott@vtx-cpd.com

Replying to Laura S. 07/12/2025 - 11:50

Hi Laura,

Really interesting case, and only in vet medicine do we get to say “nerf gun bullet enterotomy” with a straight face!

I completely understand your thought process. Cats add another layer of complexity because we have fewer comfortable multimodal options, and they can be trickier to keep adequately analgesed without stacking side effects.

A transient pyrexia post enterotomy is not unusual, and I agree that if the cat is bright, eating and clinically well, we often end up making a judgment call in the moment. A single NSAID dose in an otherwise stable cat with good perfusion is unlikely to cause harm, but the theoretical concerns around GI healing are the same as in dogs, reduced mucosal perfusion and possible impact on anastomotic strength are the reasons manufacturers advise caution.

I think the key is exactly what you have done, good pain control with buprenorphine, careful monitoring,
and a case by case decision when temperature, comfort and demeanour all point towards needing a bit more support.

Do let us know how she does!

Scott 🙂

Replying to Naomi M. 09/12/2025 - 11:24

Great choices!!!

I hope all is well and you are enjoying the course.

Scott 🙂

Replying to Raquel M. 10/07/2025 - 18:53

Hey Raquel!

Hope to see you on Thursday!

Scott 🙂

Replying to Emma Johnstone 03/12/2025 - 16:05

Hi Emma,

Thanks so much for sharing your experiences. Bulldogs certainly seem overrepresented in cystine stone cases, and as this study showed, quite a few intact males behave as androgen-dependent (Type III) cystinuria. When that is the case, castration can have a dramatic effect on urinary cystine excretion, and if the cystine:creatinine ratio drops substantially 30 to 90 days after surgery, some dogs may not need to stay on a urinary diet long term. If the ratio does not fall, or if stones recur, then we are probably dealing with Type I or II cystinuria, where diet and sometimes medical therapy become much more important.

Regarding tiopronin, I have used it on three occasions and unfortunately have always encountered side effects significant enough that we had to stop the drug. I have seen the myopathy twice, presenting as staggering and difficulty chewing. I may have been unlucky, but it has made me cautious. The published adverse-effect profile in dogs is fairly limited, but one retrospective study reported adverse events in around 13 percent of treated dogs. These included proteinuria, thrombocytopenia, anemia, increased liver enzymes and bile acids, lethargy, dermatologic changes such as pustules or a dry crusty nose, behavioural changes including aggression, a sulfur odour to the urine and myopathy. Onset ranged from 1 to 36 months (mean 7.8 months), and effects resolved once the drug was discontinued. Tiopronin has also been associated with Coombs-positive regenerative spherocyte anemia, in which case it must be stopped immediately and the dog treated appropriately.

Given this, I now reserve tiopronin for dogs that clearly need it after castration and diet have been fully assessed, rather than as a routine addition.

Do you happen to know which UK laboratories are currently measuring urinary cystine excretion?

Thanks again.

Scott 🙂

Replying to Emma Johnstone 03/12/2025 - 16:43

Thank you for the reply, Emma, and I hope life in practice is going well. Hopefully you won’t be working too much over Christmas!

I think that’s a very reasonable and thoughtful take. I agree that 18 IU BID isn’t excessive for a dog of that size, especially when the clinical signs are stable, the urine culture is negative, and there are no indications of systemic instability (e.g. weight loss, PU/PD, lethargy).

I also agree that the fructosamine can be helpful, but in this kind of case where the home BG data looks decent and the patient is clinically doing well, it might not need to be the deciding factor. Repeating it post-dental once inflammation is resolved seems like a fair strategy if needed for reassurance.

Just to add, fructosamine is not a perfect test. It reflects an average of glycaemic control over the preceding 2–3 weeks, but it can be influenced by factors such as serum protein turnover, inflammation, hyperlipidaemia, and acute glycaemic spikes. It doesn’t always correlate tightly with clinical control, especially in patients with ongoing inflammation or changing insulin sensitivity. In this case, it may well have been elevated due to the chronic oral infection and associated stress response, and I think repeating it after stabilisation makes more sense than relying too heavily on a single result.

And I’m with you, as long as hydration is good, and we have peri-op BG monitoring in place, I wouldn’t be inclined to delay the dental, particularly if the oral pathology is contributing to discomfort or glycaemic variability. Prioritising the dental for the dog’s comfort feels like the right thing in most cases like this.

Just to update you, this particular dog did go on to have the dental, which ended up being quite extensive (including multiple extractions and management of an oronasal fistula). She recovered very well and remained clinically stable throughout. Post-operatively, we’ve seen some encouraging improvement in her blood glucose values, although there is still some variability and we’re continuing to monitor. Overall, I do think proceeding with the dental was the right call for her.

Thanks again for sharing your thoughts!

Scott 🙂

Replying to Mihai R. 11/11/2025 - 16:11

Hello!

Lovely to hear from you. I hope you are enjoying the course.

I will make sure Ingrid sees this.

Scott 🙂

Replying to Christina Frigast 06/11/2025 - 09:42

Sounds sensible!

Thanks for sharing.

Scott