scott@vtx-cpd.com

I love this discussion!

I think you raise a great point about the one VS and one RVN presented with a GDV and another emergency at the same time.

I have definitely been faced with this situation overnight in practice in the early days of my career.

That decision making about what to do when can be really tricky… and stressful1

Scott 🙂

Replying to Raquel M. 01/04/2025 - 14:58

No problem!

It is always a pleasure to help where I can! Did you enjoy the live day?

Scott 🙂

Great post!

Absolutely agree. Malnutrition is a massive barrier to recovery, and it’s frustrating how often it gets overlooked or addressed too late. In my experience, feeding tubes are underutilized, especially NG or O tubes, likely due to concerns about aspiration, placement difficulty, or a lingering perception that they’re too invasive. But when implemented early and appropriately, they can make a huge difference, even for short-term support. I’ve seen patients recover significantly faster just from receiving consistent nutritional support. I often tell owners and O tube is actually a ticket home in many cases!

We need to normalize feeding tube use, particularly in critical or cachectic patients, and start thinking of early nutritional intervention as proactive medicine rather than a last resort. One missed opportunity I see often is failing to place an oesophageal feeding tube while a patient is already under general anesthesia for another procedure. It’s such a simple addition that can dramatically improve outcomes. And we have to remember how easily oesophageal tubes can be removed if the patient begins eating on their own. There’s very little downside to placing them preemptively.

I’m also a fan of appetite stimulants like mirtazapine and capromorelin, which can be really effective in some cases, especially when used alongside other supportive care. But I think we sometimes rely on them too heavily instead of moving forward with a feeding tube when the situation really calls for it.

Another often-overlooked use is with nasogastric tubes, not only for nutrition but also for gastric decompression in cases like parvovirus. They’re incredibly versatile and valuable tools.

That recent study by Dumont et al. (J Vet Intern Med, 2023) really stood out to me. It reviewed the tolerability of naso-oesophageal feeding tubes in dogs and cats sent home and found that 94% of owners were satisfied with the experience. Complications were mostly minor, and no major adverse events occurred. This data really challenges the hesitation many of us have about sending patients home with these tubes. I’ve routinely discharged patients with NE tubes, but not NGs, so I found this paper quite interesting and a good prompt to rethink that approach.

I am really happy sending patients home with O tubes, but not sure how I feel about the NE tubes! Would love to hear other thoughts on this!

Scott 🙂

Replying to Raquel M. 25/03/2025 - 13:18

Hi Raquel,

Thanks for the detailed follow-up, really helpful context. Given that history of chronic dysuria, confirmed staph (possibly aureus), and the recent cystotomy, I’d absolutely consider her high-risk for recurrence, so your proactive approach makes complete sense.

Great to hear she’s transitioned to Hill’s c/d wet food post-op. That’s a solid choice for long-term management.

Using a human lab on island for cultures and sensitivity can definitely be a useful cost-saving option, especially in areas where turnaround time or access is limited. You’re right to note that antibiotic panels are typically tailored toward human formularies, so that’s an important point to clarify with owners upfront, particularly if you end up with an organism that’s only susceptible to drugs we don’t routinely stock or use in veterinary medicine.

One limitation to be mindful of is that human labs may underperform when it comes to detecting some of the more veterinary-specific or fastidious urinary pathogens. For example, they might miss Corynebacterium urealyticum, Proteus mirabilis with atypical resistance patterns, or Staphylococcus pseudintermedius if they don’t routinely speciate coagulase-positive staph beyond aureus. They also might not provide MICs, which are often more helpful in veterinary practice than just “S/I/R” interpretations. That said, if you’ve had good success with this lab in past cases and results have matched clinical outcomes, it sounds like a reasonable option, especially with cost being a concern and no pet insurance available.

It’s great that you’re already using radiography routinely for urolith monitoring. It really is one of the most practical tools for early detection of recurrence and is useful even when the stones are too small to be causing clinical signs yet. It also gives some peace of mind when counselling owners long term.

I completely agree with your approach of targeting an appropriate pH based on the specific urolith type. That’s a subtle but important aspect of prevention that often gets overlooked. For struvite cases like this, keeping things slightly acidic with the right diet is usually sufficient, but it’s helpful to have a sense of her real-world pH fluctuations. If the owners are open to it and capable, having them check pH at home can provide some additional insight into daily variation, especially when we’re trying to fine-tune dietary management. As long as expectations are set that we’re watching for general trends and not single readings, it can be a very useful adjunct.

All the best,

Scott 🙂

Honestly, the biggest barrier for me is not wanting to have that slightly awkward conversation with the owners!

Just me?!

Scott 🙂

Replying to Georgia 24/03/2025 - 09:28

This is actually really interesting.

I don’t normally consider changing to an alternative renal diet. That is definitely something I would consider in future.

Scott