scott@vtx-cpd.com

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scott@vtx-cpd.com
Keymaster

15:40 29/11/25

Hi Joanne,

The introducers/tunnelers you’re seeing (MILA ETUN14, ETUN18, etc.) are only for large oesophagostomy tubes (10–30 Fr). They cannot be used for the small 4 Fr and 8 Fr tubes I recommended earlier.

4–5 Fr and 8 Fr tubes = nasal tubes
→ These are placed directly through the nostril and do NOT need an introducer.
→ Just order the tubes themselves.

10–14–18–20 Fr tubes = oesophagostomy tubes
→ These do require a tunneler/introducer, and that’s why the sizes start at 12 Fr and up.

So in short:

Yes, your clinic can order 4 Fr and 8 Fr tubes — no introducer needed.

The introducers you found are for a completely different type of feeding tube (E-tubes).

You only need a tunneler if you plan to place oesophagostomy tubes, not nasal tubes.

For reference, here is the product link you found (for the oesophagostomy tunneler):
https://www.milainternational.com/products/esophagostomy-feeding/tunneler-for-length-adjustable-esophagostomy-feeding-tubes.html

I have popped a MILA discount code below.

Scott 🙂

Screenshot-2025-11-29-073839

scott@vtx-cpd.com
Keymaster

13:47 29/11/25

Hi Riley,

Thanks for sharing this, it was a great read and very timely. I actually had a recent case that pushed me to revisit the SGLT2 literature in more detail, and this paper pulls together a lot of the physiology that we often only reference indirectly. What struck me is how many of the proposed mechanisms, particularly around reducing tubular workload, oxidative stress, and maladaptive hyperfiltration, seem highly relevant to our feline CKD population.

I ended up starting Senvelgo in a diabetic cat with stable CKD who was also on pred and had a previous SUB placement, which would normally make you hesitate based on the product guidelines. But the cat was eating, hydrated, and difficult to stabilise with insulin, so we trialled it with close monitoring. The cat has done extremely well, and reading this review afterwards really reinforced why that might be the case.

The cardiology angle you brought up is equally interesting. Given the early and consistent benefits seen in humans with both systolic and diastolic dysfunction, it feels inevitable that these drugs are going to become part of the conversation for late Stage B2 MVD and potentially HCM in cats. The proposed effects on interstitial fluid balance, fibrosis, energetics, and neurohormonal tone all make sense for our cardiac patients, especially as an adjunct rather than a replacement.

Overall, the physiology presented here suggests we may be underutilising SGLT2 inhibitors in stable CKD and selected cardiac patients, especially where glucose-independent benefits are the goal. Like Liz said, I suspect a lot of the veterinary data is already in the pipeline, and it will be very interesting to see how this class evolves in our clinical protocols.

Scott 🙂

scott@vtx-cpd.com
Keymaster

16:08 15/11/25

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 🙂

scott@vtx-cpd.com
Keymaster

16:02 15/11/25

Replying to Graeme E. 10/11/2025 - 10:03

Hey Graeme!

Lovely to see you here. I hope all is well your end!

I definitely defer to Liz for this one!

Scott 🙂

scott@vtx-cpd.com
Keymaster

22:50 09/11/25

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

Sounds sensible!

Thanks for sharing.

Scott

scott@vtx-cpd.com
Keymaster

22:49 09/11/25

Replying to Christina Frigast 06/11/2025 - 09:47

No problem!

I must try and get a video of the technique! I will try and share here.

Scott 🙂

scott@vtx-cpd.com
Keymaster

22:48 09/11/25

Replying to Christina Frigast 06/11/2025 - 09:53

Hi Christina,

That’s a really good question, and I think it’s one of the key practical considerations with this technique. In the pilot study, they didn’t use prophylactic antibiotics, and all wounds healed uneventfully, which suggests that for fresh, clean, low-tension lacerations, infection risk is minimal if you can still perform a good flush and ensure there’s no devitalised tissue before apposing the edges.

In human medicine, where the Hair Apposition Technique (HAT) has been used for years, most commonly for scalp lacerations, antibiotics are not routinely indicated either. Several large studies and systematic reviews have confirmed very low infection rates (typically <2–3%) without antibiotic use, provided wounds are clean, well irrigated, and not heavily contaminated or located in high-risk areas. The standard human protocol is thorough cleansing and drying, local anaesthetic jelly if needed, then hair or fur apposition with tissue adhesive only. Antibiotics are reserved for contaminated, bite, or crush injuries, or for immunocompromised patients.

I’d apply the same reasoning here, for acute, clean, simple lacerations in calm, healthy animals, I wouldn’t routinely start antibiotics. But if there’s any delay in presentation, visible contamination, significant soft tissue trauma, or underlying systemic disease, I’d still consider a short prophylactic course.

It would be great to see follow-up studies in the veterinary setting reporting longer-term infection rates and bacterial culture data, but for now, I’d approach it like any other clean primary closure, lavage well, keep it dry, and skip antibiotics unless there’s a clear reason.

Scott

scott@vtx-cpd.com
Keymaster

04:42 06/11/25

Hi Pauline,

Thanks so much for the lovely message — I’m really glad you enjoyed the liver course!

O-tube complications can definitely be frustrating, and what you’re describing (infection and tube migration) are among the most common challenges. Even when placement technique is good, small variations in tunnelling length, stoma care, or patient behaviour can make a big difference.

Consider a soft neck wrap to reduce friction and movement.

Ensure stoma cleaning at least once daily with dilute chlorhexidine or saline, followed by thorough drying.

Apply a hydrocolloid dressing (e.g., DuoDERM) under the flange for the first week if tolerated.

Encourage owners to rotate the tube gently 90° once daily after 3–5 days to prevent crusting and adherence.

One of the biggest contributors to infection and irritation is movement — making sure the tube is well secured and that owners are meticulous about dressing changes, cleaning, and redressing at home makes a huge difference.

You could also consider a one-off “surgical” dose of antibiotics at the time of placement.

We’ve had good results using the MILA Guardian™ protective foam disc with chlorhexidine, which helps reduce bacterial load and friction at the stoma site:

https://www.milainternational.com/mila-guardiantm-protective-foam-disc-with-chlorhexidine-chg-1.html

I hope that helps!

All the best,

Scott 🙂

scott@vtx-cpd.com
Keymaster

04:29 06/11/25

Replying to Christina Frigast 21/10/2025 - 11:51

Hi Christina,

Totally with you, that’s been my trajectory too. The trial nicely validates what many of us have moved toward in practice: peri-op cover for the unwell/pyrexic or higher-ASA dogs, but no routine post-op antibiotics for the stable, uncomplicated pyometras. It’s also helpful that they explicitly excluded the septic/ASA 4–5 group, so we’ve got a clear line for stewardship without compromising care.

Out of interest, for your OOH cases that are borderline (mildly pyrexic but otherwise stable), are you sticking with a single pre-op dose or extending to 24 h?

All the best,

Scott

scott@vtx-cpd.com
Keymaster

04:25 06/11/25

Replying to Riley D. 21/10/2025 - 20:11

Riley,

Are you finding that some don’t require GA or sedation?

Scott 🙂

scott@vtx-cpd.com
Keymaster

04:23 06/11/25

Hi Christina,

I agree that a sacrococcygeal epidural can be a really nice option in those more compromised blocked cats where you want to avoid or minimise general anaesthesia. It provides excellent analgesia to the perineum, tail, penis, urethra and anus, and often gives enough relaxation to make urethral catheterisation much smoother under light sedation.

Overview

Clip and surgically prepare three to four vertebral spaces cranial to the tail base.

Identify the sacrococcygeal space by palpating the most mobile joint just caudal to the sacrum.

Flex the tail dorsally to the point of maximum flexion and insert a 25 G needle with a 1 ml syringe at a 30–45° angle, bevel facing the tail.

A small “pop” can often be felt as the needle passes the ligamentum flavum.

Aspirate to ensure you’re not in a vessel, then inject slowly.

Drugs and doses

Bupivacaine 0.22 mg/kg ± morphine 0.1 mg/kg → provides 4–12 h of analgesia

Alternatively lidocaine 0.1–0.2 ml/kg (2 %) → provides 1–2 h of analgesia
Always use preservative-free formulations.

Complications

Complications are rare, but can include incomplete block, infection, or abscessation. Systemic lidocaine absorption is unlikely because the total dose is low. Leakage of injectate can occur at this site but is less likely than with lumbosacral approaches.

In my experience, once you’ve done a few, it’s a simple and quick technique that can make unblocking smoother and provide meaningful postoperative comfort. I still proceed with GA for the more painful or fractious cases, but for azotemic or hyperkalaemic cats this can be a very practical and safe approach.

Also — the new 2025 iCatCare consensus guidelines on feline lower urinary tract disease (Taylor et al., J Feline Med Surg 2025; 27(2):1098612X241309176) are brilliant and include a great summary of this exact technique and when to consider it. Highly recommend giving it a read if you haven’t yet.

Scott 🙂

scott@vtx-cpd.com
Keymaster

04:11 06/11/25

Replying to Christina Frigast 21/10/2025 - 10:04

Hi Christina,

I hope all is well with you?

I completely agree, it definitely feels like one of those techniques that could bridge the gap for clients who might otherwise decline wound closure because of cost, or when sedation feels disproportionate to the injury. I was surprised at how simple it looks in practice once you see the step-by-step diagrams.

I think with the right patient temperament (and maybe the right nurse on hand!), it could become a very practical tool for those small, clean wounds we see out of hours. It’ll be interesting to see if a larger follow-up study looks at owner satisfaction, cosmesis, or infection rates longer-term.

All the best,

Scott

scott@vtx-cpd.com
Keymaster

04:08 06/11/25

Replying to Pauline Brauckmann 20/10/2025 - 19:42

Hi Pauline,

That makes perfect sense, sounds like you get plenty of real-world experience with envenomations there! I think your plan to reserve Denamarin for cases that develop liver changes is absolutely the right approach.

Thanks so much for being part of the course and for contributing to the discussion!

Best,

Scott 🙂

scott@vtx-cpd.com
Keymaster

20:26 31/10/25

Replying to Anna M. 29/10/2025 - 11:46

Hi Anna,

I’m really glad you’re enjoying the course, that’s great to hear!

You’re absolutely right that there’s some nuance in how we approach screening for acromegaly in diabetic cats. The newer data suggest it’s more common than we used to think. The recent German cross-sectional study by Guse et al. (J Feline Med Surg 2025; 27[1]:1098612X241303303) reported increased IGF-1 (>746 ng/mL) in 17.5% of 97 diabetic cats tested, and a positive correlation between IGF-1 and insulin dose (median 1.63 U/kg/day vs 0.86 U/kg/day, P = 0.018). That aligns with earlier findings from the RVC and elsewhere suggesting that 15–25% of diabetic cats may have hypersomatotropism, even though only a subset show overt clinical acromegalic features.

In practice, I don’t test every diabetic cat, I reserve IGF-1 screening for those showing insulin resistance (typically >1.5 U/kg/injection or poor glycaemic control despite good technique, diet, and concurrent disease management). Testing all diabetics will certainly detect mild or subclinical cases, but these often don’t alter management unless there’s genuine insulin resistance or poor control. The review by Scudder & Church (J Feline Med Surg 2024; PMID 38323402) reinforces this selective approach, emphasizing that hypersomatotropism-induced diabetes typically manifests as highly variable or refractory hyperglycaemia.

Regarding comorbidities, pancreatitis remains very common, depending on criteria and assays, around 30–50% of diabetic cats show either historical or concurrent evidence of pancreatitis. Many of these fall under the “triaditis” umbrella (IBD, cholangitis, pancreatitis), and we often suspect at least low-grade pancreatic inflammation in poorly controlled or relapsing diabetics.

Your practical advice for inappetent diabetics is exactly what I suggest:

If they’ve eaten ≥ 50% of their normal meal, it’s generally safe to give the usual insulin dose (or modestly reduce it if there’s concern).

If they’ve eaten < 50%, skip that dose and monitor. Safety always outweighs perfect glycaemic control in these situations, especially if owners don’t have home glucose monitoring. Hope that helps, and I’m delighted you’re finding the material useful. Best, Scott

scott@vtx-cpd.com
Keymaster

15:12 26/10/25

Replying to Rachel C. 24/10/2025 - 16:45

Thanks again for the great questions and forum interaction Rachel!

I hope you are having a lovely weekend.

Scott 🙂
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