scott@vtx-cpd.com
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Perfect!
Please post the outcome when you have more information. Will be interesting to see.
Scott
Hello!
Hope you are well. Interesting case. Those bile acids are pretty impressive. I think repeating the sample if you have any doubt is never a bad idea. I am not sure how much more ammonia would add to this case, I am not sure I would bother running that. Aquired shunts definitely have to be a consideration but you could not completely rule out a congenital shunt! I have diagnosed them in 11-year-old dogs before!
Typical cutoff values for pre- and postprandial bile acids are 15 mcmol/L and 25 mcmol/L, respectively. Pre- and postprandial bile acids elevations have been reported to be 99% sensitive and 95-100% specific for the diagnosis of a PSS in dogs and cats. A study investigating the sensitivity and specificity of fasting bile acids in diagnosing PSS found them to be 93% and 67% in dogs, and 100% and 71% in cats, respectively. When increasing the cutoff value to 58 mcmol/L in dogs and 34 mcmol/L in cats the sensitivity was unchanged in dogs (91%) and was decreased in cats (83%), but the specificity increased in both species (84% in dogs, 86% in cats).
Falsely elevated postprandial values can occur with lipemia. When used as a test of hepatobiliary function, the magnitude of elevation in serum bile acids does not allow differentiation of the category of disease, with the exception that patients with vacuolar hepatopathy rarely have marked elevations (greater than 75-100 mcmol/L).
If increased next steps would definitely be abdominal imaging (ultrasound or CT).
Hope that helps.
Scott 🙂
Hahah!
Yes, you are right. A PEG tube and a MILA chest drain.
Scott 🙂
Yes! Indeed!
There is another tube…
Scott 🙂
Yes,
I think trimethoprim is the most reasonable choice.
Scott 🙂
Yes,
I think trimethoprim is the most reasonable choice.
Scott 🙂
Thank you, everyone.
Hope you are all having a lovely weekend.
Scott 🙂
Thank you so much for this.
Really helpful. I also wanted to ask about the use of platelet products in cases of immune-mediated thrombocytopenia. I am currently involved in a study where we are trialing the use of lyophilized platelets in these cases. I notice in your literature that you do not recommend your platelet products in these cases. Can you explain that a bit more?
Thank you again.
Scott 🙂
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
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