scott@vtx-cpd.com
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Replying to Becky Cooper 01/11/2021 - 15:17
Hello.
I hope you are well. It was indeed! We had to do a bit of editing… not sure everyone needed to hear my social catch up with Mairi at the beginning!
Will be uploaded in the next couple of days.
Hope you are enjoying the course.
Scott 🙂
Replying to Emma Holt 26/10/2021 - 20:05
Thanks Emma.
I would totally agree. I still always assess vulvar conformation in recurrent UTI cases.
I would indeed consider surgery where there were recurrent problems and everything else had been ruled out.
Hope you are enjoying the course.
Scott 🙂
Replying to Synnove S. 27/10/2021 - 08:23
Synnove.
Thank you so much for your question and your kind words.
Regarding bladder wall culture, this really has to be a tissue biopsy. Taking a roll prep from the bladder wall surface would probably still only represent what was going on in the bladder. The culture really has to be from the tissue to get an understanding of what is going on in the actual bladder wall. This can be done with surgical or cystoscopic biopsies.
The main issue with treating the inflammation and not infection is that there are many other factors at play regarding host immunity that will also be dealing with the infection. Whether bladder colonization causes clinical disease ultimately depends on bacterial gene expression. Bacteria contain genomic islands encoding fitness factors that promote commensalism and/or virulence factors and dictate the severity of the UTI.
The NSAIDs are just dealing with the inflammation. The hope would be that multiple other body factors will be dealing with the infection. There is no doubt that these situations when there are clinical signs, will require antibiotics.
I hope that helps.
Let me know if you have any other questions.
Scott 🙂
- This reply was modified 3 years ago by scott@vtx-cpd.com.
Replying to Jeanette Tungesvik 27/10/2021 - 13:24
Hello Jeanette.
This is a brilliant question. Basically, I would not treat in this case if there are no associated clinical signs.
Subclinical bacteriuria is not uncommon, even in individuals with no known predisposing factors. Rates of 2.1–12% have been reported in healthy dogs, with higher rates (15–74%) in groups such as dogs with diabetes mellitus,
morbidly obese dogs, puppies with parvoviral enteritis, dogs with acute disk herniation, chronically paralyzed dogs and dogs treated with cyclosporine or glucocorticoids. Study of subclinical. No evidence of an association between
subclinical bacteriuria and risk of development of cystitis or other infectious complications has been reported in dogs or cats, although study has been limited. A study of 101 healthy female dogs identified bacteriuria in nine (8.9%) and found no association with subsequent cystitis development over a 3 month follow-up
period. Bacteriuria was not associated with fever or survival in a study of paralyzed dogs. In humans, there is abundant support that antimicrobial treatment is not needed for asymptomatic bacteriuria. Treatment guidelines such as Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults and European Association of Urology guidelines on urological infections do not recommend treating asymptomatic bacteriuria in almost all patient groups. While treatment might eliminate the current bacteriuria event,
recolonization often follows. A systematic review in humans concluded that while bacteriuria may be
eliminated in the short-term, the effect is not sustained and recolonization is common, leading to no impact on overall morbidity or mortality.I would definitely not treat and monitor for now. I don’t think that there would be much value in culturing this sample.
Do you think the dog is underweight due to nutrition?
Hope that helps a bit.
Scott 🙂
Replying to elaine elder 12/10/2021 - 17:52
Hey Elaine!
They do indeed! Various studies have shown that α2-agonists reduce the perioperative levels of stress-related hormones and thus attenuate the stress response of surgery in dogs. Alpha2-agonists, typically xylazine, have been reported to induce an increase in serum glucose by suppressing insulin release, stimulating glucagon release, or both, in β and α cells of the pancreas, respectively. However, medetomidine given at doses of 10 and 20 μg/kg BW, IV, decreased insulin values significantly but was not found to alter plasma glucose concentrations in normal beagles. Differences in plasma glucose concentrations are likely associated with the greater specificity of medetomidine, compared with that of xylazine, at the α2-adrenoreceptors. The hyperglycemia associated with xylazine has been attributed to the actions at both the α2- and α1-adrenoreceptors.
The following study did demonstrate this effect in cats:
Effects of dexmedetomidine on glucose homeostasis in healthy cats
Abstract
Objectives
Alpha(α)2-agonist administration has been documented to increase blood glucose concentrations in many species. The aim of this study was to further describe the effect of dexmedetomidine on glucose and its regulatory hormones in healthy cats.Methods
A randomized crossover study using eight healthy cats with a 14 day washout period was used to assess the effect of dexmedetomidine (10 μg/kg IV) and saline on glucose, cortisol, insulin, glucagon and non-esterified fatty acid (NEFA) concentrations at 0, 20, 60, 120 and 180 mins post-administration. Glucose:insulin ratios were calculated for each time point.Results
Within the dexmedetomidine group, significant differences (P <0.05) were detected: increased median (range) blood glucose concentrations at 60 mins (11.55 mmol/l [5.9–16.6 mmol/l]) and 120 mins (12.0 mmol/l [6.1–13.8 mmol/l]) compared with baseline (6.05 mmol/l [4.8–13.3 mmol/l]); decreased glucagon concentrations at 120 mins (3.8 pmol/l [2.7–8.8 pmol/l]) and 180 mins (4.7 pmol/l [2.1–8.2 pmol/l]) compared with baseline (11.85 pmol/l [8.3–17.2 pmol/l]); decreased NEFA concentrations at 60 mins (0.281 mmol/l [0.041–1.357 mmol/l]) and 120 mins (0.415 mmol/l [0.035–1.356 mmol/l]) compared with baseline (0.937 mmol/l [0.677–1.482 mmol/l]); and significantly larger (P <0.05) glucose:insulin ratios at 60 mins compared with baseline. Insulin and cortisol concentrations were not significantly changed after dexmedetomidine administration.Conclusions and relevance
Feline practitioners should be aware of the endocrine effects associated with the use of α2-agonists, particularly when interpreting blood glucose concentrations. The transient effects of dexmedetomidine on glucose homeostasis are unlikely to significantly affect clinical practice.Hope that helps.
Scott 🙂
Replying to Anisha A. 14/10/2021 - 15:21
Hello Anisha.
I hope you are well and enjoying the course.
I put your question to Felipe in the live Q&A last night. It was the first question I asked him in fact!
The recording will be available by the end of the week.
If you have any other questions let me know.
Scott 🙂
Replying to Rebecca C. 18/10/2021 - 19:16
Hello again.
Hope you are safe and well. I have popped some thoughts down regarding your other questions too:
The amount of blood vs. EDTA can definitely have am effect on the sample. What tubes do you use. It might be having a chat with the lab/manufacturer about the variability. Collection of a small blood volume with placement into a standard EDTA tube will cause shrinkage of red blood cells, because EDTA is hypertonic. This will cause a false decrease in the mean cell volume (MCV) and false increase in mean cell hemoglobin concentration (MCHC) of red blood cells. Crenation of red blood cells (echinocyte formation) will also be evident on the blood smear. This is a common artifact that we see in hematologic samples. Too much blood compared to EDTA will increase the risk of clot formation.
There is not an exact gauge guideline. Venipuncture should be minimally traumatic to minimize platelet activation and should be done using a minimum of a 23G needle, 21-22G is also fine for small animals. I would not go lower than 23G.
Regarding smears; any smears (blood or FNA) are best kept out the fridge once air dried. It is best to get them to the lab (as with everything) as soon as possible.
Hope that helps. Let me know if you have any questions.
Scott 🙂
Replying to Shona M. 25/10/2021 - 19:04
Hey.
Our half term was last week in Scotland… so kids were not so much of an issue up here! 🙂
Will get the recording up ASAP.
Scott 🙂
Replying to Lesley M. 25/10/2021 - 19:46
Hey!
No pressure to speak. I am just conscious that I sometimes speak too muck and want to make sure people have time to ask questions too.
Hope you enjoyed the session.
Scott 🙂
Replying to Emma A. 25/10/2021 - 23:51
Hello.
Thank you so much for your lovely feedback.
I will pass these questions on to Jon and get back to you ASAP.
Scott 🙂
Replying to Anisha A. 14/10/2021 - 15:21
Hello Anisha.
I hope you are safe and well.
I will make sure to ask Felipe this question tonight at the Q&A.
Hope you are enjoying the course.
Scott 🙂
Replying to Alison Docherty 25/10/2021 - 13:44
Hello!!!!
How lovely of you to join us again!
Hope all is not too mad up there in Livingstone!
Scott 🙂
Replying to SAM LILLEY 20/10/2021 - 23:01
Hey Sam.
Big shout out for popping a picture on your profile too!
Nice to see everyone’s face.
Have a lovely week.
Scott 🙂
Replying to Jeanette Tungesvik 21/10/2021 - 11:03
Lovely to hear from you Jeanette!
I am looking forward to learning too!
Hope you have a lovely week.
Scott 🙂
Replying to Laura M. 24/10/2021 - 15:04
Hello!
It is a great question. The ones we use are very specific to the machine we have in the lab:
https://www.woodleyequipment.com/product/562/InSight-Urinalysis-MS-11-Urine-Strips
Generally, you should always use veterinary-specific dipsticks. Regardless of the dipstick you use, some of the test panels are not reliable in our patients. Urobilinogen, nitrates and leukocytes, are not accurate in small animal patients, as they are neither sensitive nor specific.
Just another couple of quick points:
The ketone panel on the dipstick test is only for acetoacetate and acetone (and not beta-hydroxybutyrate), although it is extremely rare for diabetic ketoacidosis patients to not produce any acetoacetate. In our feline patients, any hyperbilirubinuria is abnormal, but this may be normal in a dog depending on urine concentration.
Hope that helps.
Scott 🙂
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