scott@vtx-cpd.com
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Replying to Samantha T. 07/05/2025 - 19:14
Welcome Sam!
Thank you for your brilliant contribution, and thank you for the cute kitten picture!
Scott 🙂
Replying to Christina Frigast 08/05/2025 - 09:36
I think owners hate the idea of and E-tube… but most in my experience cope much better than they think they will!
Scott 🙂
Replying to Christina Frigast 08/05/2025 - 09:41
Sadly these are all on the more expensive end of treatments!
Thanks again for sharing all these brilliant thoughts.
Scott 🙂
Replying to Christina Frigast 08/05/2025 - 09:47
Good news!
Thank you again for sharing these brilliant cases!
I hope you are having a great week.
Scott 🙂
Replying to Rodolfo L. 08/05/2025 - 11:38
Rodolfo!
Thank you so much for joining us and for being part of the course!
We are very lucky to get to work with you!
Scott 🙂
Replying to Yvonne McGrotty 03/05/2025 - 16:29
Thanks so much, Yvonne. Really appreciate your perspective, and completely agree that the benefits of reducing stress with gabapentin often outweigh the theoretical risks, especially given how much physiologic disruption severe stress can cause. Thanks also for sharing the Stevens et al. paper, a great reference to have on hand.
Have a great week!
Scott
Replying to Christina Frigast 04/05/2025 - 11:04
Hi Christina,
That’s a great question about FIP and transfusions. In general, I do think blood transfusions can have a role in selected cases, particularly when the anaemia is moderate to severe and clearly affecting clinical status. That said, many cats with FIP develop a non-regenerative, inflammatory anaemia that they tolerate reasonably well for some time. If the cat is bright, eating, and stable, I’d often hold off unless there is functional compromise or clear evidence of progression.
Your decision to monitor conservatively, especially with xenotransfusion as the only option, sounds entirely appropriate. Some referral hospitals may opt for early transfusion as a stabilising measure if further procedures or stressors are anticipated, but I think either approach can be valid depending on the context.
I also think the availability of FIP treatment really changes the equation. With GS products and remdesivir now accessible, we’re often able to initiate therapy promptly and see rapid improvement, which can stabilise haematologic parameters and help avoid interventions like transfusion altogether. If antiviral therapy is within reach, I would lean toward starting that and reserving transfusion for cases that are clearly decompensating.
Thanks again for raising such a thoughtful point.
All the best,
Scott 🙂
Replying to Christina Frigast 04/05/2025 - 11:10
Hi Christina,
Yes, in that situation I probably would have used co-amoxiclav IV at 20 mg/kg q8h, even with the Clamoxyl LA on board, particularly if I had growing concern for sepsis or deterioration. While it’s not ideal to overlap two β-lactams, the clinical priority in a potentially decompensating patient shifts toward ensuring adequate plasma concentrations and broad-spectrum IV coverage. Clamoxyl LA can be unpredictable in terms of achieving therapeutic levels in more severe or rapidly evolving infections, especially given its depot nature.
As for the marbofloxacin, this referenced dose is also higher than I would normally use. The 2 mg/kg IV dose is what’s commonly referenced in formularies for standard use in dogs, and I think it was entirely reasonable here. If you were treating a more resistant gram-negative infection or concerned about achieving higher tissue levels (e.g. with prostatitis, pyelonephritis, or septic peritonitis), there is some precedent for higher-end dosing (up to 4 mg/kg), but I would generally only consider that with strong justification or lack of alternative agents. For most systemic use where enrofloxacin isn’t an option, 2 mg/kg IV is a solid choice.
I hope you have had a great weekend,
Scott 🙂
Replying to Christina Frigast 04/05/2025 - 11:36
Hi Christina,
That all makes perfect sense, and I completely agree. Feeding tubes remain underutilised in many settings, even though early nutritional support has clear evidence for improving outcomes and potentially shortening hospital stays. While cost is often cited as a barrier, it rarely reflects the true balance between timely intervention and the morbidity associated with delayed nutritional support.
The recent JAVMA paper by Freilich and Jugan (2025) underscores this point. In their retrospective review of 295 dogs and cats, the median time to feeding tube placement was two days, and only 18 percent of patients had specific feeding instructions recorded in the medical record. Earlier placement—particularly of nasogastric tubes—and weekday admissions were associated with shorter delays, while initial use of oesophageal tubes or weekend admission prolonged time to feeding initiation.
Regarding contraindications, I tend to avoid nasogastric or nasoesophageal tubes in patients with active vomiting or uncontrolled regurgitation, significant nasal or upper airway trauma, marked coagulopathy (especially if epistaxis could be difficult to control), reduced mentation without a protected airway, or high aspiration risk in the absence of safe positioning. That said, for borderline cases, I’ve used very slow trickle feeding via syringe driver to monitor tolerance and reduce the risk of reflux or regurgitation, which can be helpful as a stepwise approach.
The 2024 JSAP study by Camacho and Humm provides further reassurance about the safety of both nasoesophageal and nasogastric tubes. In their randomised controlled trial of 97 animals, tube misplacement into the respiratory tract occurred in just 3.1 percent of cases, and most complications during placement were minor. There were no significant differences in vomiting or regurgitation rates between the two tube types once placed. Although radiography remains the gold standard for confirming placement, the study noted that negative pressure at the thoracic inlet and capnography may offer useful adjunctive confirmation.
However, rare but serious complications do occur. A 2023 JAVMA study by Odunayo et al. described 13 dogs that developed pneumothorax following NG tube misplacement into the tracheobronchial tree. Of these, five died or were euthanised, and most required thoracocentesis or thoracostomy tube placement. The overall incidence was low (0.3 percent of nearly 4,800 placements), but it highlights the need for vigilance and rapid response to respiratory compromise following placement.
As for oesophagostomy tubes, the 2019 JVIM study by Nathanson et al. reviewed complications in 225 patients (123 cats, 102 dogs). They reported an overall complication rate of 44 percent, with similar rates in cats and dogs. Most were minor, but infectious complications requiring surgical debridement occurred in a subset, and three patients were euthanised due to severe tube-related issues. No particular patient characteristics predicted complications, so consistent monitoring and client education remain critical for managing these patients safely at home.
Altogether, I think the evidence supports earlier and more confident use of feeding tubes, ideally starting with NG or NE in hospital and transitioning to E-tubes if prolonged support is expected.
I always say to owners that the placement of an oesophageal feeding tube often gets you out the hospital quicker!
All the best,
Scott 🙂
Hi Kath,
Thanks for starting such a great discussion. One thing I’ve always wondered about is the potential for CO₂ buildup in makeshift oxygen cages. I know commercial units are designed with airflow and venting in mind, but when we’re improvising with taped-off crates or incubators, how much of a concern is that accumulation? Have you ever seen clinical signs that made you suspect CO₂ was becoming an issue, or do you take any specific steps to prevent it when using DIY setups? I’d be really interested to hear your thoughts on that.
Scott
Replying to Neus E. 28/04/2025 - 10:34
Neus!
We are so lucky to have you join us!
Thank you for being brilliant!
Scott 🙂
Replying to Neus E. 28/04/2025 - 10:33
Thank you so much for sharing this!
Scott 🙂
Replying to Neus E. 28/04/2025 - 10:31
Hi Neus,
Thanks so much for jumping in, completely agree with all of this. Diagnosis and targeted treatment are absolutely the priority, and I also tend to reserve specific albumin supplementation for cases where the clinical signs (rather than the number) really demand it. I think your point about using plasma more for oncotic support and to reduce crystalloid volume in SIRS-type patients is key. And yes, nasogastric tubes are such a practical way to get early nutrition in without needing full anaesthesia—great option while stabilising before considering anything more invasive.
Really helpful summary.
Scott 🙂
Replying to Jane Sedgewick 30/04/2025 - 11:05
Hey Jane.
I agree that from a safety and convenience perspective, using the full 100 mg gabapentin dose per cat makes a lot of sense, especially when compounded formulations aren’t an option. Most of the evidence we have supports 100 mg as both well tolerated and clinically effective for mild to moderate stress reduction. I haven’t seen any meaningful changes in bloodwork parameters (including T4) following a single dose, and the recent hyperthyroid study also supports that it doesn’t interfere with testing. So unless there are concerns about sedation depth or underlying disease, I think sticking with 100 mg is very reasonable for most patients.
On the Bonqat front, we’re in the same boat. It’s great to finally have a licensed option, but the cost and cascade considerations are tricky. As you say, sedation is technically listed as a side effect, but in the context of pre-visit anxiety or fractious hyperthyroid cats, that’s often exactly what we’re hoping for. I do wonder whether we’ll see more targeted studies directly comparing pregabalin and gabapentin head-to-head, which might help justify broader use (or not).
Would be great to hear if anyone has used Bonqat consistently and how it compares clinically in terms of onset, depth of sedation, and owner perception.
Have a great weekend.
Scott 🙂
Sarah!
Always such a joy to have you join us!
Thank you so much for your support, we really appreciate it.
Let me know if you have any questions.
Scott 🙂
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