scott@vtx-cpd.com
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Sophi, thanks for the questions.
Injectable Amoxicillin is definitely an option. Especially as we are moving towards shorter courses of drugs. The problem comes with long-acting antibiotics by injection. I totally understand the need for these due to our patients being difficult to tablet (cats – cough, cough). However, 2 weeks of action is probably excessive.
Good old Amox LA… right!?
I could not find good evidence that these coated catheters were at higher risk of irritation, but there definitely is this possibility I would think. It seems there is not a massive benefit to these catheters, so normal catheters seem to do fine!
Scott 🙂
Hey.
Yes, I used a combination of marbofloxacin and clindamycin. I would then change depending on culture, but many cases will come back with a surprising negative culture. Treatment with an antimicrobial drug with activity against anaerobes should be continued regardless of culture results because fastidious anaerobic bacteria could be present.
I must admit that I do not use continuous suction in these cases. I would place chest drains and use intermittent suction. We tend to use continuous suction for some pneumothorax cases:
These one-way valves can help with pneumothorax too:
Hope that helps.
Scott 🙂
I really just went for the headline with this one! I really needed to read a bit more… which I have:
Chia seeds are high in fibre and omega 3 fatty acids, phenolic acid derivatives, and flavonoids. There is some evidence to suggest they may act to bind intestinal calcium and decrease resorption of calcium from bone. This paper was designed as a retrospective case series investigating the use of chia seeds to reduce serum calcium levels in three cats with uncontrolled hypercalcemia.
Over a two-year period, three spayed female domestic shorthaired cats were diagnosed with idiopathic hypercalcemia. All cats had elevated total calcium and ionized calcium, normal PTH, calcitriol and calcidiol, low to undetectable PTHrP, and unremarkable thoracic radiographs and abdominal ultrasound. All cats were uncontrolled after 6 weeks of diet change, however had not been trialed on steroids or bisphosphonates.
Owners were directed to soak 2g/cat/day of chia seeds in water to allow mucilage formation, after which this was mixed into the cat’s diet. Supplementation was continued for 4 weeks prior to recheck of ionized calcium. At the 4 week recheck, serum calcium levels had normalized in all three cats, and remained normal 6 weeks after this.
The presence or absence of adverse effects and ease of administration were not described in this study.
There are several limitations to this study. It is a very early descriptive study with a small sample size that is unblinded, uncontrolled, and retrospective. All cats enrolled had vey mildly elevated ionized calcium levels, and all cats were trialled on different diets. None of the diets were among the highest fibre on the market.
At this point, this study in and of itself does not suffice to demonstrate that chia seeds are superior or equivalent to standard practices in controlling hypercalcemia in cats.
Really interesting though!
Scott 🙂
Hey.
Sorry about the delay in getting back to you about this case. We can maybe talk more about this one at one of the live sessions. I would agree that if the cat is not currently displaying signs of lower urinary tract disease, there is no strong indication to be treating again with antibiotics. I would agree with you that these organisms are likely to be due to contamination.
What is the cat’s blood doing at the moment? Has the creatine continued to be increased?
I would keep a very close eye on that blood pressure as these values really are in the realm of when you would start to think about treatment.
Would the owner consider an abdominal ultrasound? This might be a good time to get the cat in for ultrasound and cystocentesis while sedated. I think it would be good to look at the kidneys and see if there is any current sign of invention there (pelvis dilation)?
Hope that helps.
Scott 🙂
Hello hello!
Great question and so excited to have you on the course! I have tried to answer the question below and expand a little about pyelonephritis as I do not touch on it so much in the course.
Pyelonephritis is an inflammation involving the renal pelvis but also the renal parenchyma. In companion animals, it is usually seen in the context of a complicated urinary tract infection due to bacteria that have ascended from the lower urinary tract.1 However, different routes of infection (e.g., haematogenous) can occur.
This disease is a common sequel in companion animals with predisposing conditions that compromise systemic immunity, significantly change the urinary composition, or impair the host defence mechanisms of the urinary tract (ranging from abnormalities in voiding to pre-existing tissue abnormalities in the upper urinary tract). If left untreated, bacterial pyelonephritis will give rise to permanent and progressive damage of the involved kidney, can expand to a retroperitoneal abscess or even could lead to septicaemia.
Bacterial pyelonephritis is cited as a complication in patients with a systemic disease hampering their immune system, such as hyperadrenocorticism in dogs or cats with feline immunodeficiency virus infection. Glucosuria, either of renal origin or because of diabetes mellitus also is associated with complicated urinary tract infections. Structural changes of the kidneys, accumulation of material (e.g., a blood clot or nephrolith) in the renal pelvis, and pyelectasis due to ureteral obstruction, will make it easier for uropathogens to colonize the upper urinary tract. Similarly, anatomical disorders like ectopic ureters or functional abnormalities as occur in vesicoureteral reflux (VUR) can facilitate the further ascension of urinary tract infection.
Apart from these host-related factors, bacterial characteristics regarding their capacity to persist in the urine, adhere to the uroepithelium, relocate intracellularly, form a biofilm, and develop antimicrobial resistance19 will also impact their virulence.
Hope that helps!
Scott x
It really is!
Thank you. The fact that we are doing our LUTD course together is mind-blowing too!
I feel like I am the Michelle to her Beyonce… but I am OK with that!
Scott 🙂
This is really interesting.
Thank you for sharing Liz!
Scott x
Thank you!
Glad you enjoyed it! It is a bit of a dry subject but really important!
Scott 🙂
I must admit I sometimes struggle to keep the kids quiet!
They may end up featuring a bit in some of the sessions!
Scott 🙂
Great question.
I am not sure there is one paper that totally answers this question. Several trials involving people with acute pancreatitis have demonstrated the attributes of enteral, rather than parenteral, nutrition, including decreased mortality rates. So we know we definitely have to feed them and not withhold food. In one study enteral feeding a low-fat diet via oesophagostomy tube in dogs with severe acute pancreatitis, within the first 12-24 hours of admission, was well tolerated and resulted in fewer complications when compared with parenteral nutrition. In another study, dogs with pancreatitis were fed very low fat diets (e.g., less than 25 g fat per 1000 kcal), although no significant difference in the degree of pancreatic physiologic response in healthy dogs fed diets with 16% or 5% crude fat (as fed) was reported.
Dietary management for cats with acute pancreatitis has not been well described. Excessively high fat foods should probably be avoided. Early placement of a nasogastric or esophagostomy tube is important in anorectic cats due to their risk of hepatic lipidosis. In a study of 55 cats with suspected acute pancreatitis, nasogastric tube feeding was well tolerated.
Overall, in the acute pancreatitis case, I would not get too tied up in the actual fat percentage. Choosing a food with a lower fat content is probably a good idea, but any nutrition is better than none. I do not think we have to reach for anything ultra low fat.
In chronic cases…
It is recommended that obese or hypertriglyceridemic pancreatitis dogs or cats be fed ultra-low fat diets, with fat percentage on a dry matter basis (DMB) ≤10% for dogs and ≤15% for cats. Non-obese dogs and cats without elevated triglycerides may be fed diets with <15% and <25% fat DMB, respectively. While there are commercial dog foods available which meet these criteria, there are fewer cat foods. Some low calorie or senior diets, which may not contain sufficient calories for an ill cat, are low in fat. Adverse effects have been reported with tube feeding elemental diets to cats, so a better approach may be to use a liquid diet formulated for use in cats if using a nasogastric tube. If esophageal tube feeding is used or the cat has returned to voluntary eating, a diet with moderate fat content may be used (e.g., most commercial adult maintenance diets).
Hope that helps.
Scott 🙂
Thank you all for the feedback.
Emma… you are being unnecessarily harsh on yourself here. These are indeed lymphocytes and they do have atypical features. They are large and have prominent nucleoli. The most concerning thing about this population of cells was how abundant they were! They seemed to be in higher numbers than red blood cells in places.
Scott 🙂
Sorry!
My fault. I have edited the link now in the post. Should be the right one.
Let me know if any problems.
Scott 🙂
It is really interesting.
I must admit we carry out transfusions quite a lot and do use drip pumps. This is mostly from a transfusion management point of view. Without a pump, it is obviously much more difficult to control the rate. In a larger dog where we can control the rate, then I would not use a pump.
I still think you can’t do without a pump in small dogs and cats.
Scott 🙂
I will pop another case on the forum today!
Scott 🙂
Hello.
I think buying a slide box is also a really good thing to do… means you can always go back and look later for learning. I admit it is challenging to find the time to do these sorts of things… especially the way things are in practice at the moment! I honestly think the best resource is the following website:
It is my go-to for all things blood smear related!
Hope that helps.
Scott 🙂
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