scott@vtx-cpd.com
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Hi Pauline,
Thanks so much for the lovely message — I’m really glad you enjoyed the liver course!
O-tube complications can definitely be frustrating, and what you’re describing (infection and tube migration) are among the most common challenges. Even when placement technique is good, small variations in tunnelling length, stoma care, or patient behaviour can make a big difference.
Consider a soft neck wrap to reduce friction and movement.
Ensure stoma cleaning at least once daily with dilute chlorhexidine or saline, followed by thorough drying.
Apply a hydrocolloid dressing (e.g., DuoDERM) under the flange for the first week if tolerated.
Encourage owners to rotate the tube gently 90° once daily after 3–5 days to prevent crusting and adherence.
One of the biggest contributors to infection and irritation is movement — making sure the tube is well secured and that owners are meticulous about dressing changes, cleaning, and redressing at home makes a huge difference.
You could also consider a one-off “surgical” dose of antibiotics at the time of placement.
We’ve had good results using the MILA Guardian™ protective foam disc with chlorhexidine, which helps reduce bacterial load and friction at the stoma site:
https://www.milainternational.com/mila-guardiantm-protective-foam-disc-with-chlorhexidine-chg-1.html
I hope that helps!
All the best,
Scott 🙂
Replying to Christina Frigast 21/10/2025 - 11:51
Hi Christina,
Totally with you, that’s been my trajectory too. The trial nicely validates what many of us have moved toward in practice: peri-op cover for the unwell/pyrexic or higher-ASA dogs, but no routine post-op antibiotics for the stable, uncomplicated pyometras. It’s also helpful that they explicitly excluded the septic/ASA 4–5 group, so we’ve got a clear line for stewardship without compromising care.
Out of interest, for your OOH cases that are borderline (mildly pyrexic but otherwise stable), are you sticking with a single pre-op dose or extending to 24 h?
All the best,
Scott
Replying to Riley D. 21/10/2025 - 20:11
Riley,
Are you finding that some don’t require GA or sedation?
Scott 🙂
Hi Christina,
I agree that a sacrococcygeal epidural can be a really nice option in those more compromised blocked cats where you want to avoid or minimise general anaesthesia. It provides excellent analgesia to the perineum, tail, penis, urethra and anus, and often gives enough relaxation to make urethral catheterisation much smoother under light sedation.
Overview
Clip and surgically prepare three to four vertebral spaces cranial to the tail base.
Identify the sacrococcygeal space by palpating the most mobile joint just caudal to the sacrum.
Flex the tail dorsally to the point of maximum flexion and insert a 25 G needle with a 1 ml syringe at a 30–45° angle, bevel facing the tail.
A small “pop” can often be felt as the needle passes the ligamentum flavum.
Aspirate to ensure you’re not in a vessel, then inject slowly.
Drugs and doses
Bupivacaine 0.22 mg/kg ± morphine 0.1 mg/kg → provides 4–12 h of analgesia
Alternatively lidocaine 0.1–0.2 ml/kg (2 %) → provides 1–2 h of analgesia
Always use preservative-free formulations.Complications
Complications are rare, but can include incomplete block, infection, or abscessation. Systemic lidocaine absorption is unlikely because the total dose is low. Leakage of injectate can occur at this site but is less likely than with lumbosacral approaches.
In my experience, once you’ve done a few, it’s a simple and quick technique that can make unblocking smoother and provide meaningful postoperative comfort. I still proceed with GA for the more painful or fractious cases, but for azotemic or hyperkalaemic cats this can be a very practical and safe approach.
Also — the new 2025 iCatCare consensus guidelines on feline lower urinary tract disease (Taylor et al., J Feline Med Surg 2025; 27(2):1098612X241309176) are brilliant and include a great summary of this exact technique and when to consider it. Highly recommend giving it a read if you haven’t yet.
Scott 🙂
Replying to Christina Frigast 21/10/2025 - 10:04
Hi Christina,
I hope all is well with you?
I completely agree, it definitely feels like one of those techniques that could bridge the gap for clients who might otherwise decline wound closure because of cost, or when sedation feels disproportionate to the injury. I was surprised at how simple it looks in practice once you see the step-by-step diagrams.
I think with the right patient temperament (and maybe the right nurse on hand!), it could become a very practical tool for those small, clean wounds we see out of hours. It’ll be interesting to see if a larger follow-up study looks at owner satisfaction, cosmesis, or infection rates longer-term.
All the best,
Scott
Replying to Pauline Brauckmann 20/10/2025 - 19:42
Hi Pauline,
That makes perfect sense, sounds like you get plenty of real-world experience with envenomations there! I think your plan to reserve Denamarin for cases that develop liver changes is absolutely the right approach.
Thanks so much for being part of the course and for contributing to the discussion!
Best,
Scott 🙂
Replying to Anna M. 29/10/2025 - 11:46
Hi Anna,
I’m really glad you’re enjoying the course, that’s great to hear!
You’re absolutely right that there’s some nuance in how we approach screening for acromegaly in diabetic cats. The newer data suggest it’s more common than we used to think. The recent German cross-sectional study by Guse et al. (J Feline Med Surg 2025; 27[1]:1098612X241303303) reported increased IGF-1 (>746 ng/mL) in 17.5% of 97 diabetic cats tested, and a positive correlation between IGF-1 and insulin dose (median 1.63 U/kg/day vs 0.86 U/kg/day, P = 0.018). That aligns with earlier findings from the RVC and elsewhere suggesting that 15–25% of diabetic cats may have hypersomatotropism, even though only a subset show overt clinical acromegalic features.
In practice, I don’t test every diabetic cat, I reserve IGF-1 screening for those showing insulin resistance (typically >1.5 U/kg/injection or poor glycaemic control despite good technique, diet, and concurrent disease management). Testing all diabetics will certainly detect mild or subclinical cases, but these often don’t alter management unless there’s genuine insulin resistance or poor control. The review by Scudder & Church (J Feline Med Surg 2024; PMID 38323402) reinforces this selective approach, emphasizing that hypersomatotropism-induced diabetes typically manifests as highly variable or refractory hyperglycaemia.
Regarding comorbidities, pancreatitis remains very common, depending on criteria and assays, around 30–50% of diabetic cats show either historical or concurrent evidence of pancreatitis. Many of these fall under the “triaditis” umbrella (IBD, cholangitis, pancreatitis), and we often suspect at least low-grade pancreatic inflammation in poorly controlled or relapsing diabetics.
Your practical advice for inappetent diabetics is exactly what I suggest:
If they’ve eaten ≥ 50% of their normal meal, it’s generally safe to give the usual insulin dose (or modestly reduce it if there’s concern).
If they’ve eaten < 50%, skip that dose and monitor. Safety always outweighs perfect glycaemic control in these situations, especially if owners don’t have home glucose monitoring. Hope that helps, and I’m delighted you’re finding the material useful. Best, Scott
Replying to Rachel C. 24/10/2025 - 16:45
Thanks again for the great questions and forum interaction Rachel!
I hope you are having a lovely weekend.
Scott 🙂
Replying to Mihai R. 12/10/2025 - 18:29
That’s a really great question!
I’ll make sure Ingrid sees your message, as I know she’ll have some excellent insights to share regarding post-op radiography, case efficiency, and workflow management!
Scott 🙂
Replying to Jo T. 13/10/2025 - 15:14
Hey Jo!
So glad it was helpful!!!!!!!!!!
I hope you have a lovely week.
Scott 🙂
Replying to Mihai R. 13/10/2025 - 19:48
Hello!
‘Quite generous with my osteotomy’… you should get that on a t-shirt! HAHAHA! There us a whole line of dentistry merchandise right there!
Thanks again for the question. I will make sure Ingrid sees this.
Have a great week.
Scott 🙂
Replying to Elizabeth G. 12/10/2025 - 19:42
No problem!
I hope you are enjoying the course.
Scott 🙂
Replying to Mihai R. 12/10/2025 - 17:07
I use it for all my bleeding noses now!
Most of the bleeding noses I see I have cause the bleeding by performing nasal biopsies!
I hope you are having a lovely weekend.
Scott 🙂
Replying to Rosie Webster 09/10/2025 - 19:40
Thanks so much, Rosie! 😊 It’s brilliant to have you with us, and I’m really glad you’re enjoying the lectures so far. Wishing you all the best as you make the move into primary practice! We really appreciate your ongoing support!
Scott 🙂
Replying to Victoria R. 12/10/2025 - 07:24
Sadly, I do not!
Interestingly this week we had a client send us their gym progress pictures by mistake… which as you can imagine was followed by another rather frantic email!
Scott 🙂
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