scott@vtx-cpd.com

Replying to Sarah Clements 03/06/2025 - 12:43

Hi Sarah,

Great question. CRP can potentially be useful for monitoring response in pyothorax cases, but unlike pneumonia, there’s very little published data specific to pleural infections in dogs or cats.

Most of what we know comes from extrapolation — particularly from studies in bacterial pneumonia. In those cases, CRP has been shown to decline rapidly with effective treatment, and normalization correlates well with clinical recovery. A good example is the Viitanen et al. (2017) study, where CRP-guided therapy shortened the duration of antibiotics in dogs with pneumonia without increasing relapse risk (Viitanen et al., JVIM, 2017). However, that study did not include any cases of pyothorax.

In practice, I find serial CRP helpful as an adjunct in monitoring pyothorax, particularly when:

Culture is negative or mixed

Imaging is slow to resolve, or drainage is partial

You’re considering the timing of antibiotic taper or discontinuation

A declining CRP trend usually parallels clinical and radiographic improvement, so it can help support a decision to de-escalate therapy. But because the pleural space is more complex (e.g., biofilm formation, anaerobes, limited perfusion), I wouldn’t use CRP alone to guide treatment length.

In people, CRP and procalcitonin have some use in empyema follow-up, but even there, it’s usually paired with imaging.

Hope that helps.

Scott 🙂

Thanks Janette – this is a really valuable summary and I appreciate the link to the review. The balance between neonatal vitality and maternal welfare is often overlooked in practice.

What’s your current go-to for premeds in emergency C-sections?

Scott 🙂

Replying to Josep B. 02/06/2025 - 04:52

Thanks Josep!

Scott 🙂

Thanks Mark.

Your go-to combination of buprenorphine, gabapentin, and meloxicam is very similar to what many of us reach for in the first instance, and there’s sound rationale behind each. That said, it’s worth keeping in mind that while these medications are commonly used and make intuitive sense in painful inflammatory bladder conditions, none of them have been robustly studied for non-obstructive FIC in terms of efficacy beyond placebo.

In fact, a recent consensus summary (authored by the amazing Sam Taylor) highlights that analgesics such as NSAIDs, opioids, gabapentinoids, and even frunevetmab (anti-NGF monoclonal antibody) have not yet been formally evaluated in clinical trials for this indication. That doesn’t mean they shouldn’t be used—pain management is absolutely recommended—but it does mean we need to weigh their potential benefits against the stress of administration, especially when oral dosing is difficult or negatively affects cat behaviour. Gabapentin is helpful in many cats, but we have to be honest that in some cases, the stress of medicating may actually worsen the condition by increasing perceived threat and reducing control.

Other drugs like prednisolone, pentosan polysulfate, and glycosaminoglycans have not shown significant benefit in blinded studies, although both placebo and treatment groups often improve—possibly related to better home care, handling, or reduced threat perception (e.g. giving meds in a treat or encouraging owner-cat bonding). These behavioural and environmental influences may explain why MEMO (multimodal environmental modification) consistently shows better long-term results than medications alone.

Trazodone is one I’ve seen used selectively in cats that are extremely hypervigilant or live in high-arousal home environments, but I rarely use it personally.

Amitriptyline and fluoxetine remain options in refractory or relapsing cases, particularly if there’s concurrent urine spraying or clear evidence of chronic stress or anxiety. However, these should ideally be started with behavioural guidance and close follow-up. Fluoxetine has been associated with urinary retention in some reports, and any use for behavioural modification should always accompany MEMO, not replace it.

I am not a huge fan of subcutaneous fluids in these cases. There’s no evidence it improves outcome, but it may make sense on a case-by-case basis. I wouldn’t do it routinely unless there’s a clear clinical rationale.

I’ll also make sure Sam sees this!

Consensus guideline link: https://journals.sagepub.com/doi/10.1177/1098612X241309176

Scott 🙂

Hi Mark,

Thanks so much for the questions.

For FMT in cats, the core principles mirror canine protocols, though feline-specific studies are limited. Donors should ideally be healthy indoor-only cats with no history of GI disease, recent antimicrobials, or ongoing medication. Screening typically includes CBC/biochem, faecal float, Giardia ELISA, and a full PCR panel for infectious enteropathogens. Some centres pool donor faeces, but single-donor protocols tend to be preferred for traceability and consistency.

Material is usually fresh (processed and administered within 6 hours), though frozen samples (stored at –80°C with 10% glycerol) can be used in some settings. Most transplants are delivered via retention enema under light sedation, though oral and nasoesophageal approaches are being explored. A typical course involves 1–3 treatments depending on response. To be honest I will actually GA my feline transplant patients due to the higher risk of aspirating the transplanted material than dogs.

It’s also worth flagging a recent feline case series in JFMS (Lee et al., 2025; DOI: 10.1177/1098612X251337274), which describes adverse events in nine cats undergoing FMT. These included lethargy, vomiting, diarrhea, inappetence, weight loss, and transient GI pain. Events were managed with antimicrobials, antiemetics, and supportive care. Importantly, 8/9 cats still showed positive clinical response (7 complete, 1 partial), highlighting both the potential and the need for caution.

For a great recent review of both FMT and probiotics in small animals, including practical donor selection and preparation advice, you might also find this helpful:

https://www.advancesinsmallanimalcare.com/article/S2666-450X(24)00006-3/fulltext

On the probiotic front, Vivomixx, Visbiome, and Sivomixx probably represent the most evidence-based blends in terms of documented strain content, viability, and peer-reviewed outcomes—particularly in dogs, though feline data is building. Visbiome Vet has the most strain-specific research and independent verification of capsule content. Fortiflora is still widely used and palatable, but contains only one strain and less independent efficacy data.

I’ll also make sure Steph sees your comment, I’d be really interested in her thoughts.

Scott 🙂