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Clinical Practice

January 30th, 2019

What Antibiotic Do I Use For…?

What antibiotic should I be using with suspected infectious cholangiohepatitis in dogs?

The most common bacterial infections of the liver ascend through the biliary system from the duodenum, and include Staphylococcal spp, E coli, and Clostridia. Good old Amoxycillin clavulanate at 20mg/kg BID would be an ideal choice to cover these most common organisms. If I am not seeing a response (resolution of pyrexia, reduction of liver enzymes), I get suspicious that this may not be a bacterial infection and consider liver biopsy / bile cytology and culture, and recommend further testing before escalating antimicrobial coverage.

Choices, choices..

Technology

January 29th, 2019

The Regurgitating Frenchy

Unfortunately, French bulldogs (and all brachycephalics) are predisposed to several causes of regurgitation, including decreased oesophageal tone, sliding hiatal hernia, and pyloric stenosis. We could do ultrasounds, endoscopy and radiographs several times over, and still miss a diagnosis due to the dynamic nature of all of these conditions. Fluoroscopy is an ideal modality for examining these patients – they can have a meal, while we watch. From this, we can measure the oesophageal motility, the movement of the stomach through the hiatus of the diaphragm diagnosing hiatal hernia, and delayed gastric emptying consistent with pyloric stenosis.

Clinical Practice

January 24th, 2019

Getting to the Bottom of Anal Sacculitis

I have actually had buckleys success treating culture positive anal sacculitis with systemic antimicrobials – the more you give, the more resistant the bacteria are in there – but they are always in there…

The best medical success I have had is flushing weekly for 4-6 weeks and instilling a topical antibiotic + cortisone into the gland. I just thread a 22g catheter (without stylet!) into the duct, and attach a saline syringe and flush. My favourite ointment to instil is Panalog, but if you can’t get that either chloramphenicol + a cortisone-containing ophthalmalogic preparation seems to do the trick. I’ve also sucessfully used manuka honey a few times, but you have to use a big catheter because it’s so thick!

Regarding when to go to surgery: If the anal sac feels large and flaccid after a couple of flushes, I usually take them out. If they are full and feel like they have good tone, I tend to persist with medical managment.

Technology

January 15th, 2019

SUB Systems

We are seeing a run of ureteral obstructions in cats! Blocked Ureters are becoming more and more common, likely due to a combination of better detection and increasing incidence of calcium oxalate stones due to diet trends. We have been placing artificial ureters (subcutaneous ureteral bypass, or SUBs) in several cats recently, all of them going very well. Typical presentation is vomiting +/- anorexia, and a palpably enlarged or painful kidney (right more common than left). Some cats do not become azotaemic as their other kidney is still functional, so may go undiagnosed. Ultrasonography by someone trained to observe renal pelvic dilation and ureteral distension is sufficient to diagnose this, and the recommendation is usually to place a bypass as medical management fails in 85% of patients.

In the News

January 11th, 2019

Rethinking Age of Desexing

Say What Now?!

What age should we be desexing dogs? Well, that’s controversial. The AVA recommend desexing somewhere between 4 months and 1 year of age, at the vet’s discretion. Below is a great summary of the impact of desexing (Goh, Compendium August 2016 – the full article is free to access at the Compendium website) – Longevity is increased in desexed dogs, but we can see that it predisposes to a number of other conditions. My approach is very breed dependent – For example, Dachshunds desexed early (<12 months) have double the risk of intervertebral disc disease than late desexed dogs, so I would recommend between 12 – 18 months for them.

Cruciate ligament disease is more common in large breed dogs desexed at <6mo, so I would delay to 12 months. The trend towards desexing females at 6 months of age was due to the increasing risk of mammary tumours with each oestrus cycle (Schneider et al, 1969), which has been challenged in a recent publication which suggests desexing females at <2.5y rather than before oestrus onset) (Bronden et al, Vet Rec. 2010). There are several papers available referring to individual breeds, their predispositions and the recommendations for desexing.

#foodforthoughtfriday

Clinical Practice

January 10th, 2019

NSAID’s in CRF

The relationship between NSAIDs and chronic renal failure is a bit tricky. We know they can cause acute renal injury but the association with CRF is not as clear. Cats with CRF treated with meloxicam have a longer life expectancy than those not treated as they are euthanised for their OA!

In some patients with stable stage 2 CRF we recommend NSAIDs for OA management, but monitor renal parameters two weeks after starting, then three monthly ongoing. It is important to educate owners that dosing when dehydrated may trigger acute renal failure, so it is best they contact you for alternative pain management strategies if their kitty is unwell.

Technology

January 8th, 2019

Ultrasound vs. CT in Large Dogs

Have you ever tried to ultrasound a large breed dog, and just felt like you’re missing something up under the ribs? Us too… all the time, even with the best of the best probes. Abdominal CT in sedated dogs has recently been found as significantly better at detecting mass lesions than Ultrasound in dogs > 25kg. In addition, we get information on surrounding muscle and bone, and if there is a mass, a quick “met-check” CT of the thorax is easy, and cheaper than adding on radiographs. We may be suggesting this in large or deep chested dogs as an alternative to ultrasound, and option of doing under sedation rather than GA will bring the costs down too. #technologytuesday

Fields et al, Vet Radiology and Ultrasound, 2012.

In The News

January 3rd, 2019

Grain Free Diets

Recent research has made the association between dilated cardiomyopathy (DCM), and grain free diets, but what exactly in the diet is causing this? This was originally assumed to be associated with Taurine deficiency, but a recent study shows that 90% of dogs with DCM have NORMAL taurine levels! (link to a great article about this here http://vetnutrition.tufts.edu/2018/11/dcm-update/).

So what should we be recommending for our patients? The reality is that nothing is right for all patients. The boutique brands are poorly quality controlled, home cooked diets rarely meet nutritional requirements, and raw food diets carry infectious and zoonotic risks. Luckily, veterinary nutritionists can provide online consultations and unbiased commercial recommendations for the patients with special needs (eg that cat with diabetes, inflammatory bowel disease and chronic kidney disease). Contact us on 9452 2933 for more information or to submit a request.

Trivia Night

January 2nd, 2019

Save the Date

Join NVS + NEVS for an evening of fun, frivolity, and veterinary trivia! Friday, March 1st. Location TBC.

RSVP to info@northsidevetspecialists.com.au