2022 ISFM Consensus Guidelines on Management of the Inappetent Hospitalised Cat.

PRACTICAL RELEVANCE: Inappetence may have many origins and, as a presenting sign or observation in the hospitalised patient, is common in feline practice. Nutritional assessment of every patient is encouraged, to identify the need for, and appropriate type of, intervention indicated. The impact of malnutrition may be significant on the feline patient, perpetuating illness, delaying recovery, slowing wound healing and negatively impacting gut health and immunity. Delayed intervention may result in the cat's deterioration; hence prompt control of contributing factors such as the underlying illness, pain, nausea, ileus and stress is vital to optimise voluntary food intake. Management is multimodal, comprising reduction of stress, medications and assisted nutrition in the form of tube feeding or parenteral nutrition. Use of antiemetic, analgesic, prokinetic and appetite stimulant medications may restore appetite, but placement of feeding tubes should not be delayed. Feeding tubes are generally well tolerated and allow provision of food, water and medication with minimal stress, although clinicians must be aware of complications such as stoma site infections and refeeding syndrome. CLINICAL CHALLENGES: Cats are vulnerable to malnutrition owing to their unique metabolism and specific nutritional requirements. Moreover, their nature as a species means they are susceptible to stress in the hospital environment, which may result in reduced food intake; previous negative experiences may compound the problem. In particular, an inappropriate clinic environment and/or handling may cause or exacerbate inappetence in hospitalised patients, with negative impacts on recovery. Postponing interventions such as feeding tube placement to await improvement, owing to clinician or caregiver apprehension, may hinder recovery and worsen nutritional deficits. EVIDENCE BASE: The 2022 ISFM Consensus Guidelines on Management of the Inappetent Hospitalised Cat have been created by a panel of experts brought together by the International Society of Feline Medicine (ISFM). Information is based on the available literature, expert opinion and the panel members' experience.

A Dog with an Office: The Process of Embedding a Wellness Dog Intervention in a University Setting.

Universities are places to promote the wellbeing of people who learn, work, and live within them. This article reports on an innovative, holistic, and embedded wellness dog program that was developed by the Faculty of Nursing to support the wellbeing of students, faculty, and staff. The innovation included a collaborative partnership between two faculties (the faculties of Veterinary Medicine and Nursing), and the targeted purchase, training, and socialization of a wellness dog. Pet wellness programs have the potential to be an important mental health intervention on university campuses. While the program was postponed due to COVID-19, the purpose of this article is to share processes used to create the wellness dog program, with suggestions regarding implementation and evaluation.

What Do Veterinary Students Value about Service Learning? Insights from Subsidized Clinics in an Urban Environment.

To promote accessible veterinary care in the community and to help students refine their communication skills, the University of Calgary, Faculty of Veterinary Medicine (UCVM) partnered with the Calgary Urban Project Society (CUPS), a human services organization, to develop the UCVM-CUPS Pet Health Clinics. These clinics are a service-learning experience where third-year students provide services to those facing barriers to veterinary care in Calgary, Alberta. The clinics are offered at CUPS for 6 weeks at 1 day per week. Each student participates in one 4-hour lab; running two 90-minute appointments. In this mixed-methods article, the question was asked: How does a communication-based veterinary service learning program impact students' perception and knowledge of their skills and their perceived role in community outreach to underserved populations and their animals? All third-year veterinary students (N = 30) participated in the 2018 UCVM-CUPS Pet Health Clinics. Students completed a demographics survey, and a pre- and post-clinic questionnaire. Statistical analysis was used to compare pre- and post-clinic responses, and to determine relationships between questionnaire responses and the demographics survey data. Students were significantly more in agreement with statements that demonstrated confidence in their medical knowledge, technical abilities, and communication skills after participating in the program. There was significantly more disagreement to continue volunteering after graduation, but many planned on providing community outreach. Overall, students felt a strong sense of social responsibility and were motivated to help underserved populations. The findings suggest that communication-based, service-learning experiences are related to greater social awareness and enhance students' clinical skills including communication.

The use of veterinary point-of-care ultrasound by veterinarians: A nationwide Canadian survey.

This survey assessed how veterinary point-of-care ultrasound (VPOCUS), including abdominal and thoracic focused assessment with sonography for trauma (AFAST, TFAST), is used across Canada. Seventy-four veterinarians completed an online survey; 88% (65/74) used ultrasound, 94% (61/65) performed AFAST, and 69% (45/65) performed TFAST. Reasons for not performing VPOCUS included no machine/poor quality machine, lack of experience/confidence, and lack of training/education. Abdominal effusion, and pleural and pericardial effusion were the most frequently diagnosed AFAST and TFAST pathologies, respectively. Lung and cardiovascular ultrasound examinations were infrequently performed. Subpleural consolidation was rarely included in VPOCUS. Most respondents performed VPOCUS, with AFAST being more frequently and confidently preformed than TFAST. More training, education, and standardization of techniques appear to be key elements to help build confidence and experience, particularly with regard to TFAST applications and diagnosis.

Utilisation de l'échographie au lieu d'intervention par les vétérinaires : une enquête pancanadienne. Cette enquête visait à évaluer comment l'échographie au lieu d'intervention vétérinaire (VPOCUS), incluant l'évaluation abdominale et thoracique avec l'échographe pour un trauma (AFAST, TFAST), est utilisée à travers le Canada. Soixante-quatorze vétérinaires ont complété une enquête en ligne; 88 % (65/74) utilisait l'échographie, 94 % (61/65) effectuaient AFAST et 69 % (45/65) effectuaient TFAST. Les raisons invoquées pour ne pas effectuer VPOCUS incluaient aucun appareil/équipement de pauvre qualité, manque d'expérience/confiance et manque de pratique/formation. Les effusions abdominales de même que les effusions pleurales et péricardiques étaient les pathologies AFAST et TFAST les plus fréquemment diagnostiquées, respectivement. Les examens échographiques pulmonaires et cardiovasculaires étaient effectués peu fréquemment. La consolidation sub-pleurale était rarement incluse dans les VPOCUS. La plupart des répondants réalisaient VPOCUS, avec AFAST effectué plus fréquemment et avec plus de confiance que TFAST. Plus de pratique, de formation et de standardisation des techniques semblent des éléments clés pour aider à bâtir la confiance et l'expérience, particulièrement en ce qui concerne les applications et le diagnostic des TFAST.(Traduit par Dr Serge Messier).

Establishment of reference values of the caudal vena cava by fast-ultrasonography through different views in healthy dogs.

BACKGROUND: Clinical assessment of intravascular volume status is challenging. In humans, ultrasonographic assessment of the inferior vena cava diameter, directly or as a ratio to the aortic diameter is used to estimate intravascular volume status. OBJECTIVES: To ultrasonographically obtain reference values (RV) for caudal vena cava diameter (CVCD ), area (CVCa ) and aortic ratios using 3 views in awake healthy dogs. ANIMALS: One hundred and twenty-six healthy adult dogs from clients, students, faculty, or staff. METHODS: Prospective, multicenter, observational study. Two observer pairs evaluated CVCD by a longitudinal subxiphoid view (SV), a transverse 11th-13th right hepatic intercostal view (HV), and a longitudinal right paralumbar view (PV). Inter-rater agreements were estimated using concordance correlation coefficients (CCC). For body weight (BW)-dependent variables, RVs were calculated using allometric scaling for variables with a CCC ≥ 0.7. RESULTS: The CCC was ≤0.43 for the CVC/aorta ratio at the PV and ≤0.43 in both inspiration and expiration for CVC at the SV. The RVs using allometric scaling for CVCa at the HV for inspiration, expiration, and for CVCD at the PV were 6.16 × BW0.762 , 7.24 × BW0.787 , 2.79 × BW0.390 , respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: The CVCD , measured at the HV and PV in healthy awake dogs of various breeds has good inter-rater agreement suggesting these sites are reliable in measuring CVCD . Established RVs for CVCD for these sites need further comparison to results obtained in hypovolemic and hypervolemic dogs to determine their usefulness to evaluate volume status in dogs.

The effects of oral administration of Yunnan Baiyao on blood coagulation in beagle dogs as measured by kaolin-activated thromboelastography and buccal mucosal bleeding times.

We examined the effects of oral administration of Yunnan Baiyao (YB) on hemostasis by measuring buccal mucosal bleeding times (BMBTs) and doing citrated kaolin-activated whole-blood thromboelastography (TEG). In a randomized controlled crossover trial 8 beagle dogs were given either placebo or 1000 mg of YB orally every 12 h for 5 consecutive treatments. Blood was drawn 24 h before treatment and 2 and 24 h after the last treatment, and the BMBT was measured in each sample in duplicate. The TEG analysis was done in duplicate 60 ± 5 min after sample collection. There were no adverse effects of treatment and no significant differences between the control and treatment BMBTs or TEG parameters at any time point. Significant differences were found between baseline and 24 h after the last treatment within the treatment group for the TEG parameters LY30 and LY60 and within the control group for the TEG parameters MA, G, LY30, and LY60. Thus, at the dose and frequency of administration in this study YB did not appear to have any clinically significant effects on the measured coagulation parameters. The differences within the treatment group were likely due to analytic error since similar differences were seen in the control group. Further studies with a larger sample, as well as more direct measures of platelet function, are needed.

Nous avons examiné les effets de l'administration orale de Yunnan Baiyao (YB) sur l'hémostase en mesurant le temps de saignement de la muqueuse buccale (TSMB) et en faisant une thromboélastographie (TEG) de sang entier après activation par de la kaoline citratée. Lors d'un essai en croisé randomisé et contrôlé, huit chiens beagle ont reçu soit un placebo ou 1000 mg de YB par voie orale à chaque 12 h pour cinq traitements consécutifs. Du sang a été prélevé 24 h avant le traitement et 2 et 24 h après le dernier traitement, et le TSMB mesuré dans chaque échantillon en duplicata. L'analyse TEG a été faite en duplicata 60 ± 5 min après le prélèvement de l'échantillon. Il n'y eut aucun effet néfaste du traitement et aucune différence significative entre le groupe témoin et le groupe traité pour ce qui est des TSMBs ou des paramètres de la TEG à tous les points d'échantillonnage. Des différences significatives ont été trouvées entre les valeurs de base et 24 h après le dernier traitement à l'intérieur du groupe traité pour les paramètres LY30 et LY60 de la TEG et à l'intérieur du groupe témoin pour les paramètres MA, G, LY30 et LY60 de la TEG. Ainsi, à la dose et à la fréquence d'administration utilisées dans la présente étude, YB ne semble pas avoir d'effet clinique significatif sur les paramètres de coagulation mesurés. Les différences dans le groupe traité sont fort probablement dues à une erreur analytique car des différences similaires ont été notées dans le groupe témoin. Des études supplémentaires avec un échantillonnage plus grand, ainsi que des mesures plus directes de la fonction des plaquettes sont requises.(Traduit par Docteur Serge Messier).

Effects of Yunnan Baiyao on blood coagulation parameters in beagles measured using kaolin activated thromboelastography and more traditional methods.

Yunnan Baiyao is anecdotally widely used in veterinary medicine for its pro-coagulation properties. There are no studies determining its effect on clotting tests. The purpose of this study was to determine the effect of oral Yunnan Baiyao (YB) on hemostasis by measuring coagulation via kaolin activated citrated whole blood thromboelastography (TEG), prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, and d-dimers. The study was a prospective, randomized controlled crossover trial. Eight healthy University of Calgary owned beagles were treated orally with either Yunnan Baiyao or placebo every 12 h for 5 treatments. Blood was collected immediately before treatment, 2 h after the last treatment, and 24 h after the last treatment. TEG analysis was run 30 ± 5 min after blood collection. All other coagulation analyses were sent to a reference laboratory for further analysis. No treatment adverse effects were observed. Oral YB increased R-time significantly within the YB group, but the increase was still within canine reference ranges. No other changes were observed. Oral YB at the dosage and frequency administered in this study did not produce any significant improvement in hemostatic parameters. There is a need for further research and scientific evidence for YB use and dosage.

ISFM Consensus Guidelines on the Diagnosis and Management of Feline Chronic Kidney Disease.

PRACTICAL RELEVANCE: Chronic kidney disease (CKD) is one of the most commonly diagnosed diseases in older cats. In most cats, CKD is also a progressive disease and can be accompanied by a wide range of clinical and clinicopathological changes. These ISFM Consensus Guidelines have been developed by an independent panel of clinicians and academics to provide practical advice on the diagnosis and management of this complex disease. CLINICAL CHALLENGES: Although CKD is a common clinical problem in cats, the manifestations of disease vary between individuals. Thus there is a need for careful and repeat evaluation of cats with CKD and adjustment of therapy according to individual needs. In addition to addressing problems arising from CKD and improving quality of life (QoL) for the patient, therapy may also target slowing the underlying progression of disease and hence prolonging life. While maintaining QoL is of paramount importance in our patients, this can be challenging when multiple therapies are indicated. In some cases it is necessary to prioritise therapy, given an understanding of what is likely to most benefit the individual patient. EVIDENCE BASE: In preparing these Guidelines, the Panel has carefully reviewed the existing published literature, and has also graded the quality of evidence for different interventions to help to provide practical recommendations on the therapeutic options for feline CKD. This is a field of veterinary medicine that has benefited from some excellent published clinical research and further research findings will undoubtedly modify the recommendations contained in these Guidelines in the future.

Focused assessment with sonography in nontraumatized dogs and cats in the emergency and critical care setting.

OBJECTIVE: To evaluate the use of abdominal- and thoracic-focused assessment with sonography for trauma (AFAST and TFAST) in nontraumatized dogs and cats in the emergency and critical care setting and to compare prevalence of free fluid identified via these techniques between stable and unstable patients. DESIGN: Prospective observational study. SETTING: University Distributed Veterinary Learning Community. ANIMALS: One hundred client-owned dogs and cats presenting to an emergency service with no evidence of trauma. INTERVENTIONS: AFAST and TFAST performed within 12 hours of presentation. MEASUREMENT AND MAIN RESULTS: Free fluid was identified on AFAST or TFAST in 33% of dogs and cats in this study. Free fluid was identified in 27 of 36 (75%) cardiovascularly unstable or dyspneic patients, compared to 6 of 64 (9%) stable patients. A significantly greater proportion of unstable patients had free fluid compared to stable patients (P < 0.0001). CONCLUSIONS: Results of this study support the use of AFAST and TFAST to detect free fluid in nontraumatized dogs and cats in the emergency and critical care setting, particularly patients that are unstable on presentation.

A comparison of tissue oxygen saturation measurements by 2 different near-infrared spectroscopy monitors in 21 healthy dogs.

OBJECTIVE: To determine whether a difference exists in tissue oxygen saturation (StO2 ) measurements between 2 near-infrared spectroscopy monitors on the sartorius muscle in healthy dogs. DESIGN: Prospective experimental study. SETTING: University veterinary teaching facility. ANIMALS: Seventeen healthy student volunteered dogs and 4 healthy veterinary medicine teaching dogs. INTERVENTIONS: An Inspectra 650 and INVOS 5100C StO2 probe were simultaneously placed on the medial right and left sartorius muscles of each dog for 2 minutes of real-time recording while standing and in left lateral recumbency. Left and right probe locations were reversed for both standing and lateral measurements. The peak value over the first 30 seconds on the Inspectra was also recorded. MEASUREMENTS AND MAIN RESULTS: Peak StO2 values on the Inspectra over 30 seconds yielded an average of 89.9 ± 4.8%. There was no significant difference between groups above or below 9 kg, or between male and female dogs. The 2-minute averaged mean for the Inspectra was statistically higher than the INVOS (87.7 ± 5.47% and 64.1 ± 5.51%, respectively). The linear mixed-effects model showed that there is a 1.82% decrease in StO2 when standing compared to left lateral recumbency, which was elicited on both machines. On average, the INVOS underestimated the StO2 by 23.7% compared to the Inspectra. CONCLUSIONS: The INVOS significantly underestimates StO2 when compared to the Inspectra. Given this difference is on average 23.7%, StO2 cut off values used to guide therapy based on Inspectra readings cannot be applied to the INVOS. While there was a statistically significant difference in standing versus lateral positions on both devices, it is unlikely to be clinically significant. Studies using different devices should not be directly compared, and it is important to use the same monitor when taking serial measurements.

Long-term outcome of cats and dogs with acute kidney injury treated with intermittent hemodialysis: 135 cases (1997-2010).

OBJECTIVE: To determine the long-term outcome for small animal patients with acute kidney injury (AKI) treated with intermittent hemodialysis (IHD). DESIGN: Retrospective case series. ANIMALS: 42 cats and 93 dogs treated with IHD for AKI. PROCEDURES: Medical records of cats and dogs treated with IHD for AKI from January 1997 to October 2010 were reviewed. Standard methods of survival analysis with Kaplan-Meier product limit curves were used. The log-rank, Mann-Whitney, and Kruskal-Wallis tests were used to determine whether outcome, number of IHD treatments, or duration of hospitalization was different when dogs and cats were classified according to specific variables. RESULTS: The overall survival rate at the time of hospital discharge was 50% (21/42) for cats and 53% (49/93) for dogs. The overall survival rate 30 days after hospital discharge was 48% (20/42) for cats and 42% (39/93) for dogs. The overall survival rate 365 days after hospital discharge was 38% (16/42) for cats and 33% (31/93) for dogs. For all-cause mortality, the median survival time was 7 days (95% confidence interval, 0 to 835 days) for cats and 9 days (95% confidence interval, 0 to 55 days) for dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Cats and dogs with AKI treated with IHD have survival rates similar to those of human patients. Although there was a high mortality rate prior to hospital discharge, those patients that survived to discharge had a high probability of long-term survival.

Primary peri-aortic hemangiosarcoma in a dog.

A 10-year-old intact male Norwich terrier dog was evaluated for progressive, intermittent increased respiratory effort. Thoracic radiographs, ultrasonography, and computed tomography were used to identify a caudodorsal thoracic extrapulmonary mass and the presence of pulmonary metastasis. Blood transfusion and stabilization measures were not successful and the patient died. Necropsy confirmed the origin of the mass to be the adventitial layer of the aorta and determined it to be hemangiosarcoma. This is a rare site for the primary lesion.

Hémangiosarcome péri-aortique primaire chez un chien. Un chien Norwich terrier mâle intact âgé de 10 ans a été évalué pour effort respiratoire intermittent accru progressif. Des radiographies thoraciques, une échographie et une tomodensitométrie ont été utilisées pour identifier une masse extrapulmonaire thoracique caudodorsale et la présence de métastases pulmonaires. Une transfusion de sang et des mesures de stabilisation n'ont pas eu de succès et le patient est mort. La nécropsie a confirmé l'origine de la masse comme étant la couche adventice de l'aorte et a déterminé qu'il s'agissait d'un hémangiosarcome. Il s'agit d' un site rare pour une lésion primaire.(Traduit par Isabelle Vallières).

Anemia of renal disease: what it is, what to do and what's new.

PATIENT GROUP: It is estimated that 15-30% of geriatric cats will develop chronic kidney disease (CKD), and that 30-65% of these cats will develop anemia as their renal disease worsens. Anemia of renal disease is multifactorial in its pathogenesis, but the main cause is reduced production of erythropoietin, a renal hormone that controls the bone marrow's production of red blood cells, as kidney disease progresses. PRACTICAL RELEVANCE: It is important to recognize the presence of anemia of renal disease so that adequate treatment may be instituted to improve quality of life and metabolic function. Erythrocyte-stimulating agents (ESAs), such as epoetin alfa, epoetin beta and darbepoetin alfa, have been developed to counteract the effects of decreased erythropoietin production by the kidneys. These treatments, which are the focus of this review, have 83% similarity in amino acid sequence to the feline hormone. On average, the target packed cell volume (>25%) is reached within 3-4 weeks of ESA therapy. CLINICAL CHALLENGES: The use of ESAs has been associated with a number of complications, such as iron deficiency, hypertension, arthralgia, fever, seizures, polycythemia and pure red cell aplasia (PRCA). Darbepoetin has a prolonged half-life compared with epoetin and thus can be given only once a week, instead of three times a week. The incidence of PRCA appears to be decreased with darbepoetin use when compared with epoetin use in cats. EVIDENCE BASE: There is limited published evidence to date to underpin the use of ESAs in cats. This review draws on the relevant publications that currently exist, and the authors' personal experience of using these therapies for over 5 years.

Vascular access for extracorporeal renal replacement therapy in veterinary patients.

Vascular access is the first and most basic requirement for successful extracorporeal renal replacement therapy (ERRT). Dual-lumen catheters are the most commonly used method of vascular access for ERRT in veterinary patients. An adequately functioning dialysis catheter allows for smooth and efficient patient management, whereas a poorly functioning catheter frustrates the technician, doctor, and patient. These catheters are fairly quick to place but require meticulous care for optimal function. The most common complications are thrombosis and infection. Monitoring catheter performance should be a routine part of dialysis patient care.

Equipment commonly used in veterinary renal replacement therapy.

Hemodialysis is a highly technical procedure that requires specialized equipment that is not used in other areas of veterinary medicine. Certain hemodialysis-specific monitoring equipment is also employed.