scott@vtx-cpd.com
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Replying to Katherine Howie 31/03/2025 - 10:07
Welcome Kath!
We are so lucky to get to work with you!
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 Felipe M. 31/03/2025 - 00:10
Thank you again!
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 🙂
Hi Raquel,
Yes, I’ve encountered a few cases where the Heimlich manoeuvre—or variations of it—have been discussed or even demonstrated for clients, particularly with large-breed dogs who are ball-obsessed or toy-driven. While it’s not fool proof, I do think it can be a valuable emergency tool when used appropriately and with proper instruction.
The video you linked (https://www.youtube.com/watch?v=idjTNvJ9fzs) demonstrates a technique that can be effective in clearing obstructions, though it’s not the classic Heimlich manoeuvre. For those looking to see a more traditional approach, this video (https://www.youtube.com/watch?v=fAIz3zD2l60) shows a more textbook-style Heimlich technique adapted for dogs of various sizes.
Given how quickly things can escalate with airway obstructions, I completely agree that pre-emptively educating owners—particularly those with high-risk dogs—could be life-saving.
Best,
Scott
Replying to Cristina M. 25/03/2025 - 21:46
Hi Cristina,
Not a made-up thought at all. You’re spot on. There is a small study that looked into oral maropitant for chronic bronchitis in dogs.
Grobman & Reinero, JVIM 2016 (PMID: 26995558)
They gave maropitant at 2 mg/kg every 48 hours for 14 days in dogs with confirmed airway inflammation and found that cough frequency and visual analogue scores improved significantly, but there was no reduction in airway inflammation on BAL. So essentially, it may act as a cough suppressant, but not as an anti-inflammatory and definitely not a replacement for corticosteroids.So while it didn’t tick all the boxes, it at least provides some scientific support for the anecdotal reports we’ve all heard.
And yes, I’m with you. Nasal saline flushes are still very much worth doing. If we’re not getting magic from maropitant, we can at least feel good about the value of some old school mechanical decongestion.
Thanks again for the great comment.
Scott 🙂
Replying to Lesley M. 23/03/2025 - 18:00
Me too!!!!!!!
We are on the same page!
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 - 09:14
It literally popped up right after we were having this discussion… I swear the internet knows what we are talking about!!!!!!!!!
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
Replying to Helen S. 24/03/2025 - 10:15
Thank you for sharing Helen.
I hope you are having a wonderful week!
Scott 🙂
Replying to Sybil Dryburgh 24/03/2025 - 15:12
Haha!
I am glad I am not the only one!
Scott 🙂
Replying to Cristina M. 24/03/2025 - 18:25
Hi Cristina,
I spent the whole of yesterday going around proclaiming my new knowledge and was very excited to dispense cyclosporine to a patient and be able to tell the owners to pop it in the freezer. But honestly, it does feel like I might be the only person who did not already know this. I have been laughing at myself all week as it completely passed me by.
And yes, I completely agree. It really is inspiring that these little gems come from all corners of the profession. The exchanges we have, both formally and informally, really are such a valuable part of what we do.
Hope you have a great week too.
All the best,
Scott
Hi Raquel,
The Minnesota Urolith Center recommendation to perform routine urine cultures every one to three months in dogs with a history of struvite stones is based on the fact that infection-induced struvites are caused by urease-producing bacteria, most commonly Staphylococcus pseudintermedius. These organisms raise urinary pH and promote precipitation of magnesium ammonium phosphate, making early detection and treatment of even asymptomatic infections theoretically beneficial for preventing recurrence.
When it comes to evidence, the picture is a bit nuanced. The 2019 ISCAID Guidelines recommend against treating subclinical bacteriuria in most dogs, unless they are at increased risk due to immunosuppression, pending urinary tract surgery, or recurrent urolithiasis. For dogs with previous infection-induced struvite uroliths, the guidelines acknowledge that monitoring and possibly treating subclinical bacteriuria may be warranted, particularly in the first six to twelve months following stone dissolution or surgical removal. That said, there is currently no strong evidence showing that routine prophylactic urine cultures or treating asymptomatic infections leads to better long-term outcomes or reduces recurrence if the dog is clinically stable.
A reasonable approach might be to perform urine cultures every three months during the early post-treatment period, especially in dogs that are high-risk or have a history of multiple stone episodes. If subclinical bacteriuria is detected and the organism is urease-producing, treatment could be justified, particularly if there are signs of rising urinary pH or if the sediment suggests crystal formation. Over time, if the dog remains stable, is on a preventive diet, and has consistently acidic urine with no signs of active crystalluria or urinary discomfort, it may be reasonable to stop routine cultures and simply monitor with urinalysis. If the pH starts to trend upward or if the sediment changes, that would be a good point to consider a culture again.
When discussing this with clients, I usually explain that some bacteria in the bladder are benign bystanders, while others are more disruptive and can promote stone formation. It’s important to strike a balance between preventing future stones and avoiding unnecessary antibiotic use. I might say something like, “Some bacteria are just visitors, others rearrange the furniture; we only treat the latter if they’re likely to cause trouble.”
So, in summary, while routine cultures may have a place early in the monitoring period or in high-risk individuals, long-term prophylactic culturing and treatment of subclinical bacteriuria is probably not necessary for most dogs. The decision should be tailored based on individual risk factors, urinary trends, and the bacterial species involved.
Happy to discuss further if needed.
Scott 🙂
Hi Rachel,
Great questions.
Even in the pre-regenerative phase, there should still be evidence of red blood cell destruction, as the immune-mediated process has already begun. The only thing missing at that point is the elevated reticulocyte count, which typically takes a couple of days to develop. You can still expect to see spherocytes, ghost cells, and potentially positive results on in-saline agglutination or the Coombs test.
For the agglutination test, if macroscopic agglutination persists even after dilution (such as 1:4 or higher), and you’ve ruled out rouleaux microscopically, that can be strongly supportive of IMHA. The Coombs test can also still be positive in the pre-regenerative phase, though its sensitivity can be reduced if the patient is already on corticosteroids. A positive result is helpful, but a negative doesn’t rule out the diagnosis.
If my clinical suspicion is high and I’ve reasonably ruled out other causes of anaemia such as haemorrhage, microangiopathy, or infectious disease, I’ll usually start immunosuppressive therapy even before the regenerative response becomes apparent.
Hope that makes sense and that you’re enjoying the course! Always happy to chat more.
Best,
Scott
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