scott@vtx-cpd.com
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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 🙂
Replying to Victoria R. 12/10/2025 - 07:25
If I am being honest…
When I look at the image of the hair all glued together… it all looks like a bit of a mess! Hhaha!
It also seems like a bit of a faff to me!
Scott 🙂
Hello again!
I have popped a reply from Hilary and Tori below:
“Oh, great questions, and firstly, I hope you’re feeling better soon! There seem to be far too many colds going around for this time of year!
You’re absolutely right that exposure and sensitisation are central to the development of atopic dermatitis (AD), but we don’t necessarily need patients to be over a year of age before we can make a diagnosis. While the typical age of onset is between 6 months and 4 years, we do occasionally see very young dogs, even as early as 14–16 weeks, presenting with clear clinical signs of AD, sometimes quite severely affected.
It’s all about pattern recognition and ruling out other causes of pruritus, particularly ectoparasites. Using Favrot’s criteria can really help guide your reasoning in younger patients. When you’re confident there’s no ectoparasitic burden, an atopic process should remain high on your list, especially with classic signs such as itchy ears, face, paws, axillae, or ventrum.
As for your question on brachycephaly and conformation, there isn’t evidence that these features directly reduce the age of onset or cause AD. However, we do see AD more frequently in these breeds, likely due to a combination of genetic restriction (small breeding pools) and environmental influences. Conformational issues can certainly exacerbate AD by worsening secondary factors like skin barrier disruption or chronic inflammation, but they don’t inherently cause immune sensitisation earlier in life.
Now, onto diets, and yes, it’s a real minefield! Owners often want to “add a little something” for flavour, but unfortunately, that completely defeats the purpose of a diet trial. I often explain it with a simple analogy: giving a dog on a strict elimination diet “just a little treat” is like giving someone with a peanut allergy a fun-sized Snickers every day, they’ll never improve! That usually gets the message across.
When possible, I prefer clear, controlled diets with known ingredients, either home-prepared single protein diets (e.g. kangaroo, rabbit, ostrich, with butternut squash or sweet potato if tolerated) or a commercial hydrolysed diet. Hydrolysed diets are generally best for practical use, but they must be fed with absolutely no additional treats or toppers. For clients struggling with palatability, making a simple meat gravy or puree from the chosen protein and freezing it in small portions can help, just make sure the pet actually likes it before committing to a full batch!
Cats, of course, tend to be less cooperative in this process, but that’s another discussion altogether!”
I hope that helps!
Scott 🙂
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