scott@vtx-cpd.com
Forum Replies Created
-
AuthorPosts
-
Thank you again for another brilliant video!
Scott 🙂
Replying to Nikki McLeod 02/03/2025 - 15:48
Totally agree!
Do you do this sort of training in your nurse clinics?
Scott 🙂
Replying to Bethany Deadman 02/03/2025 - 17:17
Hi Bethany,
Thanks for your message. I completely agree that at-home analgesia for patients with liver disease can be a real challenge, especially when options like opioids aren’t feasible outside of a hospital setting.
Gabapentin could be an option in this case, particularly as part of a multimodal approach. Given its primary renal excretion and minimal hepatic metabolism, it is generally a safer choice in liver-compromised patients compared to NSAIDs or paracetamol. That being said, I’d be really interested to hear Felipe’s thoughts on its role in visceral pain.
Regarding NSAIDs, I would be quite hesitant in a dog with a liver mass, particularly if synthetic function is compromised or there is concurrent portal hypertension, coagulopathy, or gastrointestinal fragility. NSAID-induced hepatopathy is rare but can occur idiosyncratically, and as you mentioned, the risk of GI ulceration is always a concern.
It’s great to hear that you have had good success with IV paracetamol in-hospital, particularly in pancreatitis, post-op GI cases, and painful autoimmune conditions like IMPA. It does seem to be underutilized in some settings, despite its potential benefits in those scenarios.
Let me know your thoughts, and I’d love to hear Felipe’s perspective as well.
Best,
Scott 🙂
Replying to Sarah Noponen 02/03/2025 - 17:38
Hi Sarah,
Great to hear your thoughts! I completely agree, I really wish they had looked at smaller teams too since that would be far more representative of what many of us deal with in branch practices and overnight teams. When there are only two or three people, you really have to work efficiently and make use of whoever is available.
I’ve seen the same thing with larger teams, without clear role assignment things can get disorganized quickly. I really like your idea of a CPR Role Chart that’s planned at the start of the day. It would help ensure that everyone knows their role before an emergency happens rather than trying to figure it out in the moment.
I agree that regular refreshing and training is the golden ticket, it’s just finding the time.
Scott 🙂
Replying to Bethany Deadman 02/03/2025 - 17:31
Hi Bethany,
It’s great to hear from you, and I really like the approach your practice has taken with assigning crash roles in ASA 3 or above patients. That’s such a smart way to ensure everyone is prepared rather than scrambling in an emergency.
I completely agree that involving VCAs and receptionists can make a real difference when team numbers are limited. Giving them CPD opportunities for CPR training not only makes them more confident but also means they can step in effectively when needed. I also agree that minimising these situations is the best approach!
Scott 🙂
Replying to Sarah Noponen 02/03/2025 - 17:43
Sarah, it’s so lovely to hear from you!
I completely agree, once a client has decided their cat won’t tolerate an inhaler it can be really difficult to change their mindset. I’ve found that breaking it down into small, manageable steps and focusing on positive reinforcement can sometimes help, but even then some owners are understandably skeptical. Do you find that demonstrating the process in clinic makes a difference, or do you have any strategies that have worked particularly well for reluctant clients?
I also really like this resource for teaching cats to accept the AeroKat chamber. It provides a structured approach that some owners might find helpful:
Scott 🙂
Replying to Georgia 03/03/2025 - 10:14
This is so interesting!
There is so much to consider. I would never have considered looking at all of these elements of a diet and company.
So helpful!
Scott 🙂
Hi Georgia,
I often see urinary diets being used inappropriately, often because a patient has had a few urinary crystals rather than a clinically significant urolithiasis or recurrent issue. Longer term use is probably more relevant in cats with calcium oxalate stones or in dogs with urate or cystine stones where dietary management is a key component of prevention.
I hadn’t realized weight gain was such a widespread issue with these diets. Have you found certain brands or types to be more problematic in this regard?
Really interesting! Have a great week everyone!
Best,
Scott 🙂
Replying to Nikki McLeod 02/03/2025 - 14:37
Hey pal.
I think you are EXACTLY right! people think you can just immediately start puffing drugs in a cats face… sadly not the reality…
Scott 🙂
Hi Raquel,
Thanks for sharing this! Yes, I’m familiar with the WASAVA guidelines and the ENOVAT recommendations for antimicrobial use in canine acute diarrhea. I think they provide a strong evidence-based approach to antimicrobial stewardship, particularly in reinforcing that antibiotics should be avoided in mild to moderate cases unless there are indicators of significant systemic inflammation.
One area where I diverge slightly is their stance on probiotics. While the guidelines remain neutral due to the evidence balance, I still strongly recommend their use in practice. Even if the magnitude of benefit isn’t always substantial, probiotics are generally safe and contribute to gut microbiome support, so I continue to advocate for their inclusion in treatment plans.
Additionally, I think it’s important to consider other adjunctive therapies, such as fecal microbiota transplantation (FMT) and clay-based products, both of which can be highly beneficial in acute diarrhea management. There’s growing literature supporting their roles, and I’ve included a couple of references below:
ENOVAT Guidelines on Antimicrobial Use in Canine Acute Diarrhea: https://www.sciencedirect.com/science/article/pii/S1090023324001473?via%3Dihub
Probiotics and Gut Microbiome in Acute Diarrhea: https://pubmed.ncbi.nlm.nih.gov/32562450/
Clay-Based Therapy for Gastrointestinal Disorders: https://pubmed.ncbi.nlm.nih.gov/39094622/
Would love to hear your thoughts on this as well!Best,
Scott
Replying to Rachel L. 01/03/2025 - 16:12
Thanks Rachel,
I hope you have enjoyed the ophthalmology course too. Your approach to nutritional management in diabetic pets is really interesting, and I completely agree that diet plays a major role in both stabilizing and achieving remission, particularly in cats.
Your experiences with Katkin and prescription diabetic diets align with a lot of the research on macronutrient management in diabetic patients. While high-protein, low-carb diets have been shown to increase remission rates in cats, the broader literature also emphasizes that each diabetic patient should be managed individually, taking into account body condition, comorbidities, and feeding preferences. The work by Parker and Hill (2023) highlights this well, noting that while diet modification can help glycaemic control, many animals don’t necessarily require a diet change, especially if they’re already on a complete and balanced diet with controlled feeding schedules. However, in cases like your Sheba-fed cat, where remission was achieved but later lost, it raises the question of how much dietary composition shifts over time and whether that might impact long-term glucose control.
I also appreciate your approach to diabetic dogs. While the literature suggests that prescription diabetic diets don’t always provide a clear advantage over a balanced adult maintenance diet, your success in stabilizing patients quickly supports the idea that a higher-fibre approach can improve glycaemic control. The study emphasizes that fibre can help regulate postprandial glucose spikes, though it also notes that calorie intake and body condition score are just as critical. Your shift towards immediate prescription diet use rather than modifying the existing diet over time makes a lot of sense, especially from a cost-effectiveness and clinical stability perspective.
Another key takeaway from the research is that meal timing relative to insulin administration is less rigid than traditionally thought. While twice-daily meal feeding is often recommended with intermediate-acting insulins, newer approaches with basal insulins may not require such strict meal-insulin pairing. Given that some of your cats have responded to diet alone, it also reinforces that metabolic control isn’t solely about insulin, it’s about the broader picture of energy intake, weight management, and overall consistency.
It sounds like your recent cases have gone exceptionally well, whether that’s luck or refined management strategies, it’s fantastic to see such positive outcomes. Thanks for sharing your insights, really enjoyed hearing about your experiences! Would love to hear if you’ve noticed any trends in long-term dietary adherence among owners, do they stick with the recommendations or do they revert to old habits over time?
Thanks again!
Scott 🙂
Hello!
What a great question! This is not something I have direct experience with, but I spoke to some collegues and pulled together some information I hope is useful:
Platelet-rich plasma (PRP) is an emerging regenerative therapy in veterinary medicine, particularly in orthopedic conditions such as osteoarthritis and tendon injuries. It has been widely used in human medicine, but its efficacy in dogs remains an area of ongoing research and debate.
What is PRP?
PRP is a concentrated portion of blood rich in platelets, which contain growth factors that promote tissue healing and reduce inflammation. It can be injected into joints, soft tissues, or used as a platelet-rich fibrin clot (PRFC) to enhance tissue regeneration.
Mechanism of Action
Platelets contain transforming growth factor beta (TGF-β1) and platelet-derived growth factor (PDGF), which modulate inflammation by reducing pro-inflammatory cytokines (IL-1, TNF-α) and inhibiting destructive enzymes such as matrix metalloproteinases (MMPs). The goal is to enhance the body’s natural healing response at the site of injury.
PRP Preparation
PRP is typically prepared by centrifugation of whole blood, separating platelets from red blood cells and white blood cells. The final composition varies between commercial systems, individual patients, and species, affecting treatment outcomes.
Higher platelet concentrations provide more growth factors but may not always be beneficial.
White blood cell content influences inflammatory response, with leukocyte-poor PRP potentially being more effective for chronic conditions.Current Evidence in Veterinary Medicine
1. PRP in Canine Osteoarthritis (OA)
Bergström et al. (2024, Vet Sci) investigated PRP with stromal vascular fraction (SVF) in dogs with elbow OA. Improvement in gait symmetry was observed, but overall efficacy was inconclusive.
Full paper: https://www.mdpi.com/2306-7381/11/7/296
Bland (2015) suggested PRP as a promising treatment for hip osteoarthritis, with some dogs showing reduced pain and improved mobility.2. PRP in Cruciate Ligament Disease & Post-Surgical Recovery
Volz et al. (2024, J Small Anim Pract) conducted a randomized controlled trial comparing PRP, hyaluronic acid, and no injection post-TPLO for cranial cruciate ligament rupture.
No significant improvement in recovery, osteoarthritis progression, or limb function was observed.
Full paper: https://onlinelibrary.wiley.com/doi/10.1111/jsap.137043. PRP vs. NSAIDs in Joint Disease
RaulinaitÄ— et al. (2023, Vet Sci) compared PRP to NSAIDs in dogs with CCLR and patellar luxation.
PRP reduced inflammation and improved muscle strength more effectively than NSAIDs.
Full paper: https://www.mdpi.com/2306-7381/10/9/5554. PRP & Photobiomodulation Therapy (PBMT) in Osteoarthritis
Alves et al. (2023, Animals Basel) found that PRP combined with PBMT (laser therapy) led to greater and longer-lasting pain relief and improved mobility compared to PRP alone.
Full paper: https://www.mdpi.com/2076-2615/13/20/3247
Comparison with Human MedicineThe debate over PRP’s efficacy is not unique to veterinary medicine.
Campbell et al. (2015, Arthroscopy) reviewed PRP for knee osteoarthritis in humans and found symptomatic relief for up to 12 months, especially in early-stage OA. However, variability in PRP preparations made conclusions difficult.
Full paper: https://www.arthroscopyjournal.org/article/S0749-8063(15)00395-8/fulltext
Clinical ConsiderationsPRP appears safe but its effectiveness varies depending on platelet concentration, white blood cell content, and patient factors.
No clear superiority over traditional treatments such as NSAIDs, hyaluronic acid, or corticosteroids has been consistently demonstrated.
PRP may have a role in multimodal therapy, especially when combined with laser therapy or other regenerative treatments.
Conclusion
The jury is still out on PRP’s efficacy in veterinary medicine. While some studies show promising results, others indicate no clear benefit over conventional therapies. Given the variability in PRP preparations and patient response, more high-quality, controlled trials are needed.
I hope thus helps! I would love to hear how you get on with this! I would also love to hear if any others have more direct experience!
This also seems like a useful resource: https://www.aaha.org/wp-content/uploads/globalassets/05-pet-health-resources/pain-management/aaha-arthrex-poster-front-small-booklet-trends-nov-2022-web.pdf
Scott 🙂
Replying to Raquel M. 24/02/2025 - 16:21
No problem!
Let me know how you get on with the product!
Have a lovely weekend.
Scott 🙂
Hello everyone,
I went down a bit of a ketamine rabbit hole after you started this discussion—I didn’t realize people were using ketamine in such a sporadic subcutaneous way, and I think that’s really interesting.
I also came across this case report that I thought was worth sharing. A dog accidentally received an extreme ketamine overdose—338 times the intended dose—due to a misinterpretation of an electronic treatment sheet. The dog was on a 67.6 mg/kg/hr CRI for four hours, receiving 270 mg/kg total, and developed tachycardia, hyperthermia, anisocoria, and hypoglycemia. Fortunately, with aggressive supportive care, he made a full recovery within 18 hours without lasting effects.
The case is published in Can Vet J. 2023 Mar;64(3):235–238 (PMC9979721, PMID: 36874544) and highlights both the potential resilience of patients in extreme circumstances and the importance of clear doctor-technician communication when using electronic treatment sheets.
Scott
Thanks again for the great question.
Are you using paracetamol a lot in your practice?
Scott 🙂
-
AuthorPosts