scott@vtx-cpd.com

Replying to Emma F. 02/11/2021 - 20:37

Hey Emma.

Thank you so much for this. I will pass on to Jon. I am so pleased you are enjoying the course.

Scott 🙂

Replying to Emma Holt 21/08/2021 - 10:04

Emma,

Thanks again for your amazing answer here.

I just wanted to shar the full report from the pathologist:

Site Liver

Microscopic Description

Liver: Preservation is moderate and nucleated cellularity is low to moderate. Slide no4 contains
predominantly dense blood. The remaining scans contain variable amounts of fresh blood and small lipid
spaces. There are low to moderate numbers of well-differentiated hepatocytes arranged in sheets and clusters. Low numbers of erythrocytes and focal clusters contain low numbers of small clear punctate
vacuoles. There is rare focal moderate intracanalicullar bile stasis (bile casts). There are rare isolated
slender fusiform mesenchymal cells (presumed to be fibroblasts). Streaked nuclear material is frequently
associated with a parasite clusters and, in these areas, neutrophils and small lymphocytes occasionally
appear overrepresented. Infectious agents and atypical cells are not identified.

Microscopic Interpretation

Moderate focal cholestasis. Mild focal discrete vacuolar change.

Comments

Aspirates have harvested predominantly fresh blood however, within the hepatocytes there is evidence to
support cholestasis and although this is focal, it is moderate. The mild indiscrete vacuolar change is
non-specific and may be associated with elevated metabolic stress associated with inflammation of
varying aetiologies (hepatic and nonhepatic), as well as metabolic disease (e.g. pancreatitis).
Overt inflammation and infectious agents are not identified however this is a relatively small sample. The
fibroblast presence may be compatible with fibrosis however, this requires histopathology for definitive
diagnosis. Given the slightly increased numbers of leukocytes associated with hepatocytes, although overall
leukocyte numbers do not appear elevated mild inflammation cannot be excluded. Biopsy with
histopathology for evaluation of tissue architecture and tissue culture may be of value should changes
persist.

You basically were spot on!

Scott 🙂

Replying to Jeanette Tungesvik 28/10/2021 - 14:59

Thanks.

Keep us updated with how the case gets on.

Scott 🙂

Replying to Rachel Roper 12/10/2021 - 13:49

Again, a brilliant question.

Geographic data is lacking a little, and is being worked on as we speak.

Annual vaccination with 4-serovar vaccines is generally recommended for at-risk dogs, regardless of breed, with the understanding that the definition of “at-risk” may vary geographically. In geographic locations in which infection occurs in urban, backyard dogs, all dogs may be at risk, and the vaccine may be considered part of a core vaccination protocol. In other locations, only dogs that contact wildlife, swim, hunt, or roam on farmland may be at risk.

Funnily enough, I recorded a podcast about this exact subject, including a chat with a PhD student who is working on this right now:

https://medivetpodcast.podbean.com/

Hope that helps.

Scott 🙂

Replying to Emma A. 25/10/2021 - 23:51

Hello.

Some thought from Jon. Hope this helps:

“I always ligate tissue pedicles in the crush of a clamp – it compresses or breaks the surrounding connective tissue meaning that you can get a tighter knot on a ligature. If the new grads are horrified that you’re tying in to a crush, I’m equally horrified that they’re not!! If there is more tissue in the ligature, it will constrict the pedicle less. I would always suggest using a ‘3 clamp technique’, tying in to the crush of the most proximal clamp and then tearing / cutting between the remaining more distal 2 x clamps. Sometimes, for space reasons, I’ll place two clamps, then more the 1st one around to the opposite side of clamp number two, then tie in to the original crush – let me know if this doesn’t make sense. I also ‘flash’ the clamps for pedicles – so set the ligature into the crush, then release the above clamp as you tighten the knot, then replace the clamp in the same place.

There is lots of evidence now to say that catgut is really not a safe material to use. I would try and move away from this if possible.

Miller’s knots are fine. I wouldn’t know how to use one! I can tell you that Leitch published a paper a few years ago showing that there are better ones (constrictor, strangler and something else). I love a Weston knot myself. Standard square knots are spot on though – I’d probably get a bleed if I started trying to tie Millers.

Yep – I always close the abdomen with continuous PDS. I can think of 2x occasions when I used interrupted, but they were dogs that had blown their guts across the floor about 8 weeks post coeliotomy and had a collagen maturation disorder.”

Hope that helps.

Scott 🙂

Replying to Ilse v. 31/10/2021 - 06:09

Hello.

This is a brilliant question that I am not sure I am going to be able to give a definitive answer to. The consensus statement states:

“We suggest that thromboprophylaxis be initiated at the time of diagnosis and continued until the patient is in remission and no longer receiving prednisone or prednisolone”.

I must admit that I often do not continue this long. The maximum risk period for mortality associated with IMHA appears to be the first 2 weeks after initiation of treatment. This period represents the phase when pathophysiologic risk factors for thrombosis are maximal, likelihood of transfusion is highest, and any prothrombotic effect of immunosuppressive medications is greatest, if related to dosage. The risk of haemorrhage from recommended antithrombotic dosages is likely to be small. As the disease process responds to immunosuppression, the likelihood of thrombosis may diminish, but the continued use of immunosuppressive medications may generate ongoing thrombotic risk. Some dogs may require lifelong low doses of glucocorticoids to maintain remission. We suggest that thromboprophylaxis be discontinued if such dogs have been in remission for 6 months and no other risk factors exist.

I would usually use a combination of rivaroxaban and clopidogrel. I would normally discontinue the rivaroxaban after the first couple of weeks and discontinue the clopidogrel once the weaning of the steroid dose starts.

Hope that helps.

Scott 🙂

Replying to Alison Docherty 01/11/2021 - 12:34

Hey Alison.

I hop you are well and enjoying the course.

I would also love to hear what everyone’s thoughts are. I tend to use the MILA systems for this. I really do love their products. They can be on the wee bit more expensive side, but I think works really well:

https://www.milainternational.com/index.php/clinical-categories/urology/closed-urine-collection-systems/closed-system-urine-collection-kits-and-replacement-bags.html

Hope that helps.

Scott 🙂