scott@vtx-cpd.com
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Replying to Katherine Howie 12/05/2024 - 21:11
Hi Kath,
Indeed, xenotransfusions have a fascinating history! Early in the history of transfusion medicine, there were attempts to use animal blood for human transfusions. One of the most notable cases involved Jean-Baptiste Denis, a French physician who, in the 17th century, transfused sheep blood into humans. This was done with the hope that the animal blood could cure a variety of ailments, including “stupidity.” Unfortunately, these attempts often ended in failure and even death due to severe immune reactions.
I do wonder sometimes about the progression of treatment for human “stupidity”—have we come that far?
Best regards,
Scott
Replying to Raquel M. 23/05/2024 - 22:49
Hi there,
I’m glad to hear you’re doing well! Yes, avoiding the hamstring muscles in cats and dogs when administering intramuscular injections is indeed a common practice. It’s interesting to hear that some students from North America were not familiar with this approach. While it’s a well-established practice in many veterinary settings, it’s possible that variations in training and protocols exist across different regions and educational programs.
If you have any further questions or need clarification on this or any other topic, feel free to ask!
Best regards,
Scott 🙂
Hello Raquel,
Great question! The method for measuring urine specific gravity (USG) with a refractometer can indeed vary.
Using a drop of urine prior to centrifugation is a quick and convenient method. However, it may not provide accurate results if there is debris or sediment present in the urine sample, as this can affect the refractive index. On the other hand, using the supernatant after centrifugation removes any sediment or debris, potentially providing more accurate USG measurements.
The decision to use one method over the other may depend on factors such as the condition of the urine sample and the specific requirements of the case. In some situations, such as when analyzing urine with visible sediment, using the post-centrifugation method may be preferred to obtain more accurate results.
Using both methods and comparing the two values can be a useful approach, especially if there are discrepancies between the measurements. This can help ensure the reliability of the USG measurement and provide additional information about the composition of the urine sample.
Ultimately, The vast majority of samples are analyzed pre-centrifuge. I would routinely do it before centrifuge.
Hope this helps!
Scott 🙂
Hello Raquel,
Urine dipstick tests for animals can indeed differentiate between hemoglobin/myoglobin and red blood cells (RBCs), although their accuracy can vary depending on factors such as the specific dipstick used and the condition of the sample. Generally, these dipstick tests can detect the presence of blood in the urine, which may indicate bleeding or other underlying conditions.
Freshly collected urine that is red, brown, or black suggests the presence of blood, hemoglobin, myoglobin, or some of their degradation products. The urine concentration, pH, and time in contact with blood can affect color. Red blood cells progressively disintegrate and release hemoglobin in urine, which may be oxidized to methemoglobin and result in brown or black urine color. A negative reagent strip test for blood in red, black, or brown urine suggests the presence of a chromogen other than hemoglobin or myoglobin.
A positive reagent strip test for blood should be followed by analysis of the urine sediment. If the discoloration is due to hematuria, there will be numerous red blood cells and increased turbidity. In contrast, urine remains transparent when the color change is due to hemoglobinuria. If no red blood cells are present on microscopic examination of the urine sediment, hemoglobin or myoglobin should be suspected.
I would suggest additional investigations to differentiate these possibilities, such as ruling out oxidized bilirubin and analyzing serum bilirubin concentration. Furthermore, examination of the plasma color may aid in differentiating these explanations. If the discolored urine is due to myoglobin, the plasma will usually be clear because myoglobin is not bound significantly to proteins and is rapidly excreted.
If plasma from a non-traumatic venipuncture sample is pink, it is suggestive of hemoglobin. Hemoglobinemia and hemoglobinuria are indicative of significant intravascular hemolysis, resulting from various conditions such as immune-mediated destruction of red blood cells or fragmentation due to microangiopathic conditions.
Overall, I would use the dipstick as a guide and not to definitively determine the difference between blood and hemoglobin.
Best regards,
Scott 🙂
Hello!
I hope you are well.
Yes, avoiding intramuscular injections in the caudal thigh area to prevent iatrogenic sciatic nerve damage is a prudent practice in both dogs and cats. The sciatic nerve is located in close proximity to this region, and inadvertent injection into or near the nerve can lead to significant complications. Instead, opting for alternate injection sites with less risk, such as the quadriceps or lumbar muscles, can help mitigate this potential risk.
I tend to avoid this injection site altogether. Instead, I opt for the lumbar muscles, which are generally better tolerated and present fewer risks.
Scott 🙂
Replying to Hannah Willetts 23/05/2024 - 14:54
Hi Hannah,
In cases where clear clinical signs persist despite initial calcium supplementation, addressing the immediate symptoms takes precedence over concerns regarding mineralization. The risk of inducing hypercalcemia and subsequent mineralization issues is generally lower in these acute scenarios compared to prolonged exposure. In situations where further IV calcium is considered necessary but repeat EPOC (iCa) testing isn’t feasible due to financial constraints, you might consider a cautious approach.
One option could be to administer a lower dose of IV calcium, perhaps titrated to the patient’s response and clinical signs, while closely monitoring for any signs of hypercalcemia. Additionally, supportive treatments such as fluids and monitoring electrolyte levels may be beneficial.
It’s always a balancing act between providing adequate treatment and avoiding potential complications, so individualized patient care and close monitoring are key.
Best regards,
Scott
Replying to Hannah Willetts 23/05/2024 - 15:23
Hi Hannah,
You’re very welcome! I’m glad I could provide some helpful information for you. It’s always good to expand our knowledge and consider new approaches, especially when dealing with complex cases like hypoalbuminemia. If you have any more questions or if there’s anything else you’d like to discuss, feel free to reach out anytime.
Best regards,
Scott 🙂
Replying to Aileen D. 23/05/2024 - 16:03
Hi Aileen,
Welcome to the forum, and thank you for introducing yourself! It’s great to have you here. Respiratory cases can indeed be challenging, but it’s fantastic that you’re looking to improve your knowledge in this area. The course should be a valuable resource for honing your skills in x-ray interpretation and thoracic ultrasonography.
I’ll also be sharing some x-rays in the forum, so feel free to join in the discussions and share your insights. Feel free to ask any questions or share your experiences as you progress through the course. We’re all here to support each other.
Best of luck, and I hope you find the course helpful and rewarding!
Warm regards,
Scott 🙂
Hi Liz,
Thanks for sharing these exciting updates on treating congenital diseases in dogs! The stenting for pulmonic valve issues, especially for those tricky R2A cases or where BVP didn’t quite do the job, sounds really promising. Great to hear the short-term data is looking good.
The AVP II devices for those tiny pups with PDAs are fascinating too. Being able to go through the femoral vein and avoid a thoracotomy is such a game-changer.
Looking forward to seeing how these advancements continue to develop!
Cheers,
Scott 🙂
Hi Raquel,
I hope you’re well. For thoracocentesis in dogs and cats, a highly recommended reference is the “Textbook of Veterinary Internal Medicine” by Stephen J. Ettinger and Edward C. Feldman. It provides a detailed explanation of the procedure, including indications, techniques, and potential complications.
Additionally, “Small Animal Critical Care Medicine” by Silverstein and Hopper offers a comprehensive guide on emergency procedures, including thoracocentesis. This resource includes step-by-step instructions and tips for performing the procedure safely and effectively.
If you need any specific details or have any questions about the procedure, feel free to reach out! I have popped some of my guidelines above.
Kind regards,
Scott
Thoracocentesis Guide for Dogs and Cats
What is Thoracocentesis?
Thoracocentesis, also known as a chest tap or pleural tap, is a procedure to remove air or fluid from the thoracic cavity. It can be both diagnostic and therapeutic, especially in emergency situations.When is Thoracocentesis Needed?
Respiratory distress (increased breathing rate and effort)
Dull lung sounds (a fluid line may be identified with effusion)
Confirmed by thoracic radiographs (pleural effusion, pneumothorax) and/or ultrasound (effusions)
Contraindications:Severe coagulopathies
Diaphragmatic hernias
Avoid penetration of intestinal loops or liver (use ultrasound guidance)
Potential Complications:Hemothorax (bleeding into the chest)
Iatrogenic pneumothorax (collapsed lung caused by the procedure)
Laceration of intrathoracic organs
Acute death from stress or over-restraint
Equipment Needed:Butterfly catheter or plastic catheter with fenestrations
Extension set (for butterfly catheter, extension set is usually not needed)
Three-way stopcock
Syringe (10 to 60 mL depending on the size of the animal)
Graduated cylinder or bowl to collect and measure fluid
Sterile gloves and aseptic scrub solution
Procedure:Positioning the Patient:
Sternal recumbency or standing for removing pleural effusion or pneumothorax
Lateral recumbency if needed for pneumothorax
Preparation:Pre-oxygenate the patient if necessary
Clip and aseptically prepare the tapping region
Prepare a sterile environment for the equipment
Needle Selection:Cats and small dogs: 1 to 1.5 inch (2 to 3.5 cm) butterfly needle or 22-23 gauge needle
Medium dogs and large cats: 1 inch (2.5 cm) needle or 20-22 gauge over-the-needle catheter
Large dogs: 1.5 inch (4 cm) needle or 14-20 gauge over-the-needle catheter
Insertion Site:Typically at the 7th or 8th intercostal space (ICS) for fluid
8th or 9th ICS for air
Insert the needle just cranial to the rib to avoid intercostal vessels and nerves
Aspiration:Attach the needle to the extension set, stopcock, and syringe
Apply gentle suction to generate negative pressure
Orient the needle ventrally for fluid and dorsally for air
Stop if blood is aspirated, if lungs rub against the needle, or if the patient moves excessively
Continue until fluid flow stops or until negative pressure is reached (do not remove all air immediately to avoid re-expansion injury)Replying to Alison Knight 19/05/2024 - 19:00
Hi Alison,
It’s great to hear from you! Returning to work can be both exciting and challenging, especially when you’re surrounded by enthusiastic new graduates. East Lothian is a nice part of the world.
If there’s anything specific you’re looking to refresh or any particular cases you’d like to discuss, feel free to reach out. Whether it’s brushing up on diagnostic techniques, exploring new treatment options, or managing challenging cases, I’m here to help. It’s always good to exchange knowledge and experiences, and I’m sure your new colleagues can also learn a lot from your experience.
Looking forward to hearing more from you!
Best regards,
Scott
Hello Liz and everyone,
Thank you for the warm welcome! And thank you to everyone for joining the course.
A little about myself: I’m one of the other directors of VTX and a specialist in small animal internal medicine. While I’m no good at cardiology, I’m happy to answer any medicine questions you might have!
I’m looking forward to the journal club in July and to engaging with everyone on the forum. It will be great to exchange knowledge and experiences.
Best wishes,
Scott
Replying to Jon H. 14/05/2024 - 15:00
Hi Jon,
Welcome to the group! We’re really honoured to have you with us and look forward to learning from your expertise.
Scott 🙂
Replying to Suzi Bailey 15/05/2024 - 18:00
Hi Suzi,
It sounds like you’re in a challenging situation with your cat. Osteonecrosis is indeed a known side effect of long-term bisphosphonate use, including alendronate. While your cat has been stable on alendronate with resolved mild azotemia, the potential risks of long-term use should be carefully considered.
If the cat is stable and responding well to the current treatment, it might be prudent to continue monitoring closely and discussing the potential risks and benefits with the owner.
This is a tricky one! It is never a side effect that I have witnessed in real life (knowingly) but feline specialists such as Danielle Gunn-Moore and Stephanie Sorrell are moving away from using it for this reason. If the cat is doing well and tabling is difficult, I would not be rushing to change.
Would it be an option to try diet and chia seeds in this case and see if you could transition off?
You may find this reference helpful: Link to the PubMed article.
Best regards,
Scott
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