scott@vtx-cpd.com
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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
Hi Rosanna,
You’re absolutely right, Elura (capromorelin) is technically available in the UK only via a Special Import Certificate (SIC) at the moment, and the cost is definitely on the high side. I spoke to Elanco and they confirmed it’s not officially available in the UK yet, despite being listed on the VMD database. It hasn’t been launched or marketed here, so it has to be imported under an SIC if you want to use it.
We used to get capromorelin (for dogs, Entyce) through Ramapharma in the UK. That might still be an option worth exploring: https://www.ramanpharma.com/. Are you currently getting the dog version through anyone? Honestly, I would just use that in cats if needed, especially for off-license appetite stimulation in palliative or CKD cases where cost and access are limiting factors.
If you do want to go the Elura route, you’d need to apply for a Special Import Certificate through the VMD. Supply is usually arranged through a wholesaler that handles imports.
As far as I’m aware, there is no data directly comparing capromorelin and mirtazapine in cats, so we can’t say it’s better or worse based on evidence. That said, I’ve found it effective in practice. Cats often respond well, though many do salivate quite a lot after administration.
Also worth noting, there’s a good safety study on capromorelin in cats:
Randomized Controlled Trial
J Vet Pharmacol Ther. 2018 Apr;41(2):324–333. doi: 10.1111/jvp.12459
Evaluation of the safety of daily administration of capromorelin in cats
Wofford JA, Zollers B, Rhodes L, Bell M, Heinen E
PMID: 29057482 https://pubmed.ncbi.nlm.nih.gov/29057482Two studies looked at daily oral administration in cats over 14 and 91 days. Doses up to 60 mg/kg were tested. Adverse effects were mostly mild and included vomiting, hypersalivation, lethargy, head shaking, and lip smacking. No significant differences in clinical pathology values were seen between treated and placebo groups.
Hope that helps.
Scott
Replying to Raquel M. 22/03/2025 - 17:03
My goodness!
South Yorkshire to the Cayman Islands… that is quite the variety!
Scott 🙂
Replying to Laura S. 23/03/2025 - 13:28
Hi Laura,
I know, right? There really are so many positive anecdotal reports. It does make you wonder whether we’re seeing a bit of a placebo effect, or if some of the benefit is just from the saline or the act of flushing itself. Either way, it looks like we’re back to trusty saline for now.
Re the nebuliser, yes, absolutely. LOVE a nebuliser. My favourite for cats is the BreathEzy one as it’s really quiet, which makes a huge difference for feline compliance. I’ve had a few chronic rhinitis cases where the owners bought their own, but I’ve also worked in clinics that loaned them out with a deposit system, which can be a really good solution for short-term use.
The one I showed in the lecture was the Philips InnoSpire Essence, which is a reliable tabletop compressor. It was paired with either a Flexineb or Aeromask in the photo. These masks are designed for equine use originally, but they adapt well to cats and small dogs. You can usually source them via vet supply companies or equine suppliers.
Here’s the Flexineb link I mentioned: https://www.breatheazy.co.uk/product/cats/flexineb-c2/
Let me know if you want any more info or links.
Scott 🙂
Replying to Laura S. 23/03/2025 - 13:28
Hi Laura,
I know, right? There really are so many positive anecdotal reports. It does make you wonder whether we’re seeing a bit of a placebo effect, or if some of the benefit is just from the saline or the act of flushing itself. Either way, it looks like we’re back to trusty saline for now.
Re the nebuliser, yes, absolutely. LOVE a nebuliser. My favourite for cats is the BreathEzy one as it’s really quiet, which makes a huge difference for feline compliance. I’ve had a few chronic rhinitis cases where the owners bought their own, but I’ve also worked in clinics that loaned them out with a deposit system, which can be a really good solution for short-term use.
The one I showed in the lecture was the Philips InnoSpire Essence, which is a reliable tabletop compressor. It was paired with either a Flexineb or Aeromask in the photo. These masks are designed for equine use originally, but they adapt well to cats and small dogs. You can usually source them via vet supply companies or equine suppliers.
Here’s the Flexineb link I mentioned: https://www.breatheazy.co.uk/product/cats/flexineb-c2/
Let me know if you want any more info or links.
Scott 🙂
Hi Raquel,
Yes, I’ve looked into the KeyScreen™ GI Parasite PCR from Antech. It’s a multiplex PCR that screens for 20 intestinal parasites from a single fecal sample and reportedly detects 2x more infections than standard in-clinic fecal flotations (O&P), which could be really helpful in those low-burden or intermittent shedding cases.
Some useful features:
Detects benzimidazole resistance in hookworms, which can guide treatment choices
Flags the zoonotic potential of Giardia
Offers fast, sensitive detection for earlier intervention
It also aligns with CAPC recommendations for routine parasite testing—four times in the first year for puppies/kittens and one to two times per year for adults, depending on lifestyle and risk factors.That said, I’m struggling to find a clear list of exactly which parasites it includes. Do you know? I get the impression it’s more focused on parasites and worms, whereas the IDEXX faecal PCR panels seem more geared toward bacterial pathogens (like Campy, Salmonella, Clostridium, etc.). If that’s the case, this might actually be a useful complementary test, especially in routine or preventive care. I haven’t personally used it yet, though.
Best,
Scott
Replying to Raquel M. 19/03/2025 - 15:18
Hi Raquel,
Thanks so much for your reply — it was really interesting to hear your perspective, especially with your experience working in the Caribbean and having trained in the UK. I can imagine the shift in disease prevalence must have been quite an adjustment!
Your approach sounds really sensible and practical. I think it’s reassuring that a positive heartworm result in an asymptomatic dog doesn’t necessarily mean surgery has to be cancelled, especially when there are no signs of advanced disease or cardiac changes, and you’ve got informed consent. I’ve also come across the recommendation to avoid elective surgery during heartworm treatment, but like you, I’m not sure how much actual data backs it up — it’s mentioned on VIN and elsewhere, but I’d love to see more specific studies to guide us.
The ehrlichiosis side of things is equally interesting. I haven’t come across any formal studies specifically looking at the benefits of screening before elective procedures, but your anecdotal experience highlights a real-world need for it in endemic areas. I presume the bleeding you saw was due to thrombocytopenia? That seems to be the key issue with E. canis in a surgical context.
The challenge with screening, of course, is that many patients may have positive serology but not be clinically affected — so I wonder if it might be more useful to simply perform a blood smear and haematology ahead of surgery and screen specifically for thrombocytopenia. That feels like a more targeted and clinically relevant approach, especially in settings where broad screening for tick-borne disease isn’t practical. It could help identify dogs at risk of bleeding without overinterpreting past exposure.
If I come across any studies on this topic, I’ll definitely share them here. Thanks again for such a thoughtful and insightful reply — it’s great to learn from your experience.
Scott 🙂
Sorry!
One more random question… how exactly is it that they do the palatability work? Do they do it with sick or well animals?
I know they pay humans to taste food… but never thought about how this works for our patients. Most of the prescription diets are for ‘sick’ animals so must be tricky to do palatability in these populations?
Scott 🙂
Replying to Georgia 21/03/2025 - 15:55
Very helpful!
Thank you!
Scott 🙂
Replying to Georgia 21/03/2025 - 16:00
Thanks for the reply!
I did see that JFMS had just published this article this week:
https://pmc.ncbi.nlm.nih.gov/articles/PMC11874005/pdf/10.1177_1098612X251320877.pdf
Scott 🙂
Replying to Laura S. 21/03/2025 - 18:03
Hi Laura,
Ah, thank you for sharing this. I’m genuinely disappointed (and a little deflated) to read the JFMS study. It very much doesn’t support the use of intranasal maropitant, despite all the anecdotal promise and theoretical basis we’d been leaning on. I had completely missed this paper, so I really appreciate you and your colleague bringing it to the table.
So now we’re left in a tricky spot. The evidence says “no benefit,” but part of me still wonders if there’s a place for it in the most refractory cases, where we’re trying to do something to help these poor cats breathe. Of course, any use now really has to be framed as off-label and not evidence-supported, and I think this study will rightly temper some of the optimism that’s been floating around.
Thanks again for sharing. I’ll share it in other forums too.
Scott 🙂
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