scott@vtx-cpd.com
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Thank you for all of the replies so far!
A 5-year-old neutered male DSH was presented to a referral hospital in Scotland for lethargy, coughing and wheezing of 1 month’s duration, as well as hypercalcaemia (3.3 mmol/l; reference interval [RI] 2–3 mmol/l) detected by the referring veterinarian. Defaecation, thirst and urination were normal. The cat was fed a good-quality commercial diet, and routine vaccinations and prevention against external and internal parasites were up to date. It was an indoor/outdoor cat and an avid hunter, with no travel history outside of Scotland. On physical examination, the cat had harsh lung sounds with a normal respiratory rate (25 breaths/min) and effort. The peripheral lymph nodes were increased in size; the remainder of the physical examination, including a retinal examination, was unremarkable.
Haematology, serum biochemistry (including thyroxine) and urine analysis were unremarkable, except for hypercalcaemia (ionised calcium [iCa] 1.75 mmol/l [RI 1.1–1.35 mmol/l]). Ionised hypercalcaemia was confirmed with a repeated blood sample, and there was no haemolysis or lipolysis. Feline immunodeficiency virus antibody and feline leukaemia virus antigen were negative, and blood pressure was normal.
What are your DDX for the hypercalcaemia?
Could this tie in with the respiratory changes and does this help narrow down your DDX?Scott 🙂
Replying to Lizzie J. 21/06/2023 - 10:15
Hey Lizzie.
Thank you for your brilliant reply!
I love your answer… there is definitely something going on!!!
I am sorry about my delay. I just wanted to make sure others got the opportunity to answer too. I purposely shared little information about the case so we focused on the images. I totally agree, I think there is a relatively generalised alveolar/interstitial pattern.
Differential diagnoses included infectious pneumonia (bacterial, parasitic, protozoal, viral or fungal), primary or metastatic neoplasia or, less likely, idiopathic pulmonary fibrosis. The spine and vertebrae were carefully examined in all radiographs for the presence of osteolytic lesions, and none were found.
I will share some more information about the case!
Scott 🙂
Replying to Francesca Lamb 11/06/2023 - 17:35
Hello Francesca.
Thank you so much for your brilliant reply. I am sorry about my delay. I just wanted to make sure others got the opportunity to answer too. I purposely shared little information about the case so we focused on the images. I totally agree, I think there is a relatively generalised alveolar/interstitial pattern.
Differential diagnoses included infectious pneumonia (bacterial, parasitic, protozoal, viral or fungal), primary or metastatic neoplasia or, less likely, idiopathic pulmonary fibrosis. The spine and vertebrae were carefully examined in all radiographs for the presence of osteolytic lesions, and none were found.
I will share some further information about the case!
Thank you again for the reply. I hope you are enjoying the course.
Scott 🙂
Hello Rosie.
Lovely to hear from you. This is a great topic! I did mention this in the pulmonary parenchymal disease session, I am sorry if it was not clear. I did do back and check the recording… it is in there! 🙂 These are the most helpful papers:
https://pubmed.ncbi.nlm.nih.gov/35348224/
https://pubmed.ncbi.nlm.nih.gov/35616241/
https://pubmed.ncbi.nlm.nih.gov/28032360/I would be comfortable stopping the antibiotics once the CRP had normalised. As far as I am aware IDEXX and Woodley’s are the only ones doing in house CRP. Woodley’s do the VCHECK machine:
https://www.woodleyequipment.com/product/667/Vcheck-V200-Point-of-Care-Analyser
Are you using a lot of CRP in practice?
Hope this helps.
Scott 🙂
Replying to Helen S. 14/07/2023 - 09:27
Hey Helen.
I found this really interesting. There were 2 points that particularly stood out to me/made me think:
“1. Connect the dots. Successful leaders help their employees understand how their individual contribution aids the broader organizational mission and the customers or clients they serve. This isn’t only true for companies with lofty missions. People in any type of job can feel important when their leaders help employees connect the dots, Edmondson said.”
I thought this was really interesting and really important. Particularly when we often now work for such large organisations. I think this is of even more value when we are facing challenges in the profession related to redundancy at the moment. Particularly when some of the lower paid support staff are being effected the most.
“2. Public recognition. Organizations should build employee recognition into the culture, Prilleltensky said. Public praise reinforces a job well done and motivates others. “When giving praise, the more specific you can be about an employee’s contribution and achievements, the better,” he said.”
This is another interesting one! I suppose it made me think about ‘public praise’. What is the best way to publically praise someone? Would love to hear the thoughts of the group.
Thanks again Helen.
Scott x
Replying to Helen S. 14/07/2023 - 09:27
Hey Helen.
I found this really interesting. There were 2 points that particularly stood out to me/made me think:
“1. Connect the dots. Successful leaders help their employees understand how their individual contribution aids the broader organizational mission and the customers or clients they serve. This isn’t only true for companies with lofty missions. People in any type of job can feel important when their leaders help employees connect the dots, Edmondson said.”
I thought this was really interesting and really important. Particularly when we often now work for such large organisations. I think this is of even more value when we are facing challenges in the profession related to redundancy at the moment. Particularly when some of the lower paid support staff are being effected the most.
“2. Public recognition. Organizations should build employee recognition into the culture, Prilleltensky said. Public praise reinforces a job well done and motivates others. “When giving praise, the more specific you can be about an employee’s contribution and achievements, the better,” he said.”
This is another interesting one! I suppose it made me think about ‘public praise’. What is the best way to publically praise someone? Would love to hear the thoughts of the group.
Thanks again Helen.
Scott x
Replying to Dan T. 14/07/2023 - 10:53
Thanks Dan.
This is really helpful. To be honest, I think my first task will be to actually find out what the company values are when I am locumimg. If I am being honest, I would not be able to recall what the values were for the last clinical job I had. I am going to be looking in to that. I think being more aware, and making others aware of the company values is a start.
This has also made me think really carefully about the fact that we do not have company values with vtx. We have a directors meeting next week and this is now top of the agenda!
Scott x
Replying to Cristina M. 14/07/2023 - 12:13
No problem.
Questions seem to create more questions! In a good way!
Scott 🙂
I agree!
Such a simple thing bust so important.
I am just about to start doing so locum clinical work and made sure to have my name embroidered on my scrubs (something I would never thought to have done before!).
Again, such a simple thing but makes all of the team members feel valued. I also think it is important not to forget EMS students and students generally. We were all there once and they must not be forgotten.
Thanks again for sharing.
Scott 🙂
Replying to Dan T. 13/07/2023 - 20:29
This is really interesting Dan.
Thank you for such detailed answer. I will spend some time considering my own values. I also think that we need to do this as a company at vtx, so we will look at this together as a group too.
I think the main point for me is concerning the company values and how they are determined. The need to feel lived and authentic. I seems the best way of doing this is to involve as many of the team as possible in the decision making! I have a few more questions:
1. If we are working for a big corporate with central core values, is it wrong to come up with a clinic specific set?
2. What about individual team values? Even as part of a bigger hospital, do you think it is appropriate for individual departments to have a set of values, or is this too divisive?
Thanks again.
Scott 🙂
Replying to Helen S. 12/07/2023 - 16:35
Thank you so much for this Helen.
Thank you for taking such time and consideration with this answer, I really appreciate that.
This all makes a lot of sense. The examples of core values that you have given are also really helpful.
I would say the Huel’s number 2 is also my favourite… I think if I could only chose one it would be that.
Thanks again.
Scott 🙂
Replying to Cristina M. 13/07/2023 - 13:47
Hello Cristina!
Thank you so much for joining us and congratulation on your new role.
It is lovely to see people joining us all the way from Italy. I hope you are keeping safe in the heat!
Scott 🙂
Hey Helen!
Thank you so much for sharing this, I will look forward to having a listen.
I know this is less about leadership specifically, but I love Stephen Bartlett’s “The Diary of a CEO” podcast:
https://podcasts.apple.com/gb/podcast/the-diary-of-a-ceo-with-steven-bartlett/id1291423644
Thanks again for sharing.
Scott 🙂
Replying to Darlene G. 12/07/2023 - 17:06
Hello Darlene,
Lovely to hear from you! I hope you are enjoying the course.
I agree, the jugular vein is indeed the one that you will get the best sample from. However, I would avoid using the jugular in severely thrombocytopenic patients. I would use the cephalic for these samples as a pressure dressing can be applied afterwards.
A bit of a compromise I think!
Scott 🙂
Replying to Liz Bode 06/07/2023 - 19:57
Thanks pal.
Really helpful. I have a funny feeling you might have actually scanned this patient?!
I will share what we did next!
Scott 🙂
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