Improving both clinical condition and quality of life
Prolonging survival time
Slowing the progression of renal disease
Once chronic kidney disease has been diagnosed, it is recommended:
Stop any drugs with certain or potential nephrotoxicity;
Identify and treat any concurrent disease influencing renal function and determining renal damage. In some patients, other pathologic conditions (such as endocrinopathies) can make difficult either staging renal disease and setting an adequate therapy;
Investigate all causes leading to renal damage and, if possible, treat it. Sometimes, a renal biopsy can be useful to evaluate histologic lesions; in case of proteinuria, results of renal biopsy can provide a specific diagnosis and therapy;
To apply a conservative approach of clinical conditions associated to kidney failure such as metabolic, acid-base and electrolytic imbalances. Therapy is addressed to correct hydration and mineral disorders, acid-base alterations and nutritional impairments. Patients benefit from symptomatic treatment improving their quality of life although azotemia is not significantly modified as this is undoubtedly just one of the factors contributing to the clinical picture of renal patients.
As general recommendations, clinically stable dogs and cats affected from CKD should undergo a clinical examination and laboratory evaluations based on their IRIS stage (www.iris-kidney.com)
every 12 months in IRIS stage 1
every 6 months in IRIS stage 2
every 4 months in IRIS stage 3
every 6-8 weeks in IRIS stage 4
Clinical Evaluation– Other than general and particular clinical examination, a special attention goes to the nutritional condition of the patient, determined by body weight, Body Condition and Muscle Condition Score (available both for dogs and cats at WSAVA). Nutritional status of patients affected by CKD is related to risk of developing uremic crisis and mortality: bad nutritional condition is associated to higher risk of uremic crisis and mortality for renal related causes. Blood pressure is determined too and hypertensive patients are put under treatment.
Laboratory exams– Once CKD has been diagnosed, Veterinarian proceeds to request the laboratory exams useful to identify concurrent pathologies known to determine renal damage or the progression of kidney disease. After the initial evaluation of a complete blood count, biochemistry and urinalysis (included UPC) the Veterinarian will be requesting further exams based on patient’s laboratory results and clinical history such as exams for infectious disease, endocrinopathies, ect.
Below are IRIS stages and most common disorders by stage (modified from Polzin, 2006 and 2019)
Clinical signs
IRIS stage
Polyuria/Polydipsia
1-4
Proteinuria
1-4
Hypertension
1-4*
Urinary infection
1-4
Hyperphosphatemia
2-4
Hypopotassemia
3-4
Anemia
3-4
Metabolic Acidosis
3-4
Anorexia and weight loss
3-4
Vomit
3-4
Dehydration
3-4
*although it is possible to identify hypertensive patients in any stage of the disease, the prevalence of hypertension increases with increasing of IRIS staging
Hematuria describes a condition in which is observed presence of blood in the urine. It could be a result of diseases of the urinary tract – kidney, ureter, urinary bladder, urethra; or by diseases of the genital tract – prostate, penis, prepuce, uterus, vagina, vestibule. It can be classified as: macroscopic (visible to the naked eye), or microscopic (increased number of RBC in the urine, observed during microscopic examination). In general, hematuria can be a result of multiple reasons, as follows [1]:
Urinary tract origin
Trauma
Urolithiasis
Neoplasia
Inflammations (UTI, etc.)
Parasites (Dioctophyma renale)
Coagulopathy (Warfarin intoxications, etc.)
Renal infarction
Renal pelvic hematoma
Vascular malformations
Kidney polycystic disease
Genital tract origin
Trauma, Neoplastic or Inflammatory diseases of the genital tract
Estrus
Subinvolution of placental sites
For Idiopathic Renal Hematuria, we speak when the origin of RBC in the urine cannot be associated with any of the above-enumerated reasons and is of a renal origin. It is a very rare condition, which occurs in middle and big-sized young dogs (younger than 5 years of age), occasionally has been observed in older dogs and cats. Microscopic IRH is found by incidence during urine microscopic exams when macroscopic one is observed by the owners and described as unusual darker coloration of the urine. The condition is mostly unilateral and can be periodic – with a period of no bleeding. Since there is a release of RBC into the urine, anemia can be present in ranges from none to severe. Further, we will take a look and discuss the available treatment options.
Clinical case
The dog was brought to me by his owner, who observed “Cola-like” coloration of the urine in the last 2-3 days. According to the owner’s description, there are no changes of the dog’s behavior and, according to him, the micturition is normal and does not cause discomfort.
The patient:
3-year-old male mongrel dog
25 kg BW, normal body score
Neutered when he was 8 months of age
Vaccinations up to date and according to the protocol
Living indoors
No data for traumas
No medications or treatments in the last 6 months
Physical examination
During the physical examination, no abnormalities were observed, body temperature, heart and respiratory rate, and blood pressure were in the normal ranges. No any tegument abnormalities or signs of traumas. Dog temperament was relaxed and friendly.
Clinical diagnostic tests
The CBC was normal, with an RBC count near the left border reference value. Tests for Babesiosis and Lyme disease were negative. A sterile probe of urine was collected by US-guided cystocentesis and examined. Urine-specific gravity was slightly elevated, presence of erythrocyte was confirmed by microscopic examination, microbiological culture was negative. Pigmenturia was excluded after centrifugation of the urine sample, which resulted in a clear separation between RBC (collected at the bottom of the test tube) and urine (supernatant).
The performed x-ray did not reveal any abnormalities (uroliths, tumors). The ultrasound examination did not result in any abnormalities in the urogenital tract – renal parenchyma was with normal structure.
Idiopathic Renal Hematuria was diagnosed by exclusion as a result of performed test procedures and obtained results.
Additional information about the diagnostic approaches for hematuria in dogs and cats can be found in [2]
Treatment options
For treating Idiopathic Renal Hematuria we have few options available, we could differentiate as:
Invasive. Surgical cauterization of both ureters before the urinary bladder, and observing which kidney is the bleeding one, sclerotization of the kidney with povidone-iodine and silver nitrate [3][4] [5]. This method can be used and for bilateral hematuria. For cases with unilateral bleeding leading to severe anemia, ureteronephrectomy is recommended [1]
Since the dog doesn’t present anemia and invasive methods are more complex for performance and maintenance, I have directed my decision towards a non-invasive treatment option.
Non-invasive. It was described that IRH results from elevated blood pressure inside the glomerular arterioles leading to their higher permeability for RBC. This was observed by multiple studies and reports and the effect of ACE2 inhibitors, especially Benazepril, over the arterioles in the renal glomerulus was demonstrated [6] [7] [8]. In addition, during my studies in FMV-Timisoara, I had the opportunity to observe the treatment of a hunting dog with IRH, using Benazepril with good results (Dr. Doru Morar, FMV-Timisoara).
The dog was treated with Benazepril in dose 0.40mg/kg per os every 24h. In the following days was observed visible reduction of the hematuria – by the owner’s account, urine coloration became normal. Repeated urinalysis revealed the persistent microscopic presence of RBC with a tendency of reduction during the time. Blood pressure was normal and without indications for hypotension during treatment.
Conclusion
Dogs diagnosed with IRH with absent to mild anemia can profit from treatment plan with ACE2 inhibitors – surgical methods are not widely available, are expensive, require hospitalization of the animals, and nephrectomy deteriorates the quality of life for young animals (in cases the IRH becomes bilateral this can lead to a negative outcome for the patient).
Olympic Athlete Laura Muir is helping host a virtual run at BSAVA Virtual Congress (25-27 March 2021) this year, to highlight the physical and mental health benefits of being active. She has made three inspirational videos to encourage delegates to step out for wellbeing.
As well as being a qualified vet, having studied at the University of Glasgow, Laura Muir is the British record holder over the 1500m, a five-time European Champion and is aiming to claim her first Olympic medal at the Tokyo Olympics this summer. She will be encouraging Congress delegates to put their best running feet forward during the three days of Congress.
Laura has made three illuminating videos to show how she has successfully balanced running with her veterinary studies, revealing the low points as well as the high points and how the key is to focus on the positives. In the videos Laura is interviewed by vet and runner Brian Faulkner who achieved the extraordinary feat of running 31 marathons in 31 days. Brian will also be speaking at Congress in the Lessons from Lockdown session on the Saturday.
“There are so many things in life you can’t control,” said Laura. “My own philosophy that keeps me going is ‘do the best that you can do’. For students it’s about remembering all the hard work they’ve put in over the years. To get to where they are in vet school, is a huge achievement in itself. For practitioners who perhaps have had a bad day, taking a moment to remember just how many animals they’ve helped might just keep that negative experience in context.”
Brian Faulkner agrees; drawing on his coaching experience, he refers to something he affectionately calls ‘bitch spay-ophobia’. When students and colleagues become fearful that they may cause more harm than good he reminds them of the bigger picture and that the long-term benefits of performing such procedures are the very reason why many wanted to become vets in the first place.
Participants can support each other by posting details of their run or walk on the Congress platform in the Health and Wellbeing chat room. There are no set times or distance, and delegates are encouraged to take part at a pace, time and location that suits them. Prizes will be awarded for the best selfie taken and posted on Twitter or Instagram tagged #BSAVAVirtualRun .
For extra motivation runners will be able to join the BSAVA running community via the Health and Wellbeing chat room where they can pose questions for Laura and other runners and can share their own experiences and achievements. Attendees can listen to the three motivating videos from Laura at the Health and Wellbeing stand in the exhibition, in which she speaks about Laura the athlete, Laura the vet and Laura the person.
“Whether you are a seasoned runner or have never broken out of a walk we are encouraging everyone to participate,” said BSAVA President Professor Ian Ramsey. “Becoming more active is beneficial to health and wellbeing in so many ways and we are hoping to inspire delegates to lace up their trainers, clock up some miles and feel the difference.”
It’s free to join the BSAVA Virtual Run and you can sign up here.
BSAVA Run is part of a motivating range of wellbeing sessions at Congress this year: Keynote speakers Dr Ranj and Jenny Campbell drawing on their own experiences to emphasise the importance of wellbeing. In addition, delegates can exercise their bodies as well as their minds with yoga and some restorative meditation practices.
Veterinary Surgeon at Khramova STS Soft tissue surgery
Kyiev, Ukraine
Complications on unabsorbable suture materials are not widespead in the countries where absorbable suture material or tissue sealing with electrocautery or Ligasure devices are used. But it’s still seen as a consequence of using unabsorbable multifilament suture material. It is considered, that such reactions arise because of lack of sterility during the surgery, and bacteria forming biofilms on the sutures as a result. As a reaction from the body granulomas form around the sutures and lately they might cause formation of fistulas. The most common surgeries when we can see such complications are bitch spays.
Periods of time, when fistula(s) form can be quite different. From my personal experience it can happen a cuople of weeks after the surgery, but it also happens as late as several years after spaying. The longest period in my practice was 10 years after the surgery.
The clinical appearance is usually typical: owners notice fistula(s) on the abdomen or lateral parts of the pet with exudate or pus. Rarely it can be just a painful skin inflammation on the flank without actually a fistula there. A lot of dogs demonstrate unwillingness to run and jump without any obvious lameness. Another clinical sign can be pollakiuria in the cases when granuloma forms around the uterus stump.
The tentative diagnosis can be made via clinical appearance. But in all the cases it’s mandatory to perform an ultrasound of the abdomen in order to check all the possible granulomas, that can be asymptomatic. The areas of interest during the ultrasound are caudal poles of the kidneys and uterus stump. It’s quite important to check whether the ureters are involved in the granulomas, as it makes the case much more complicated. CT can be much more useful in checking the organ involvement and planning the surgery.
The СBСs are usually unremarcable or with signs of inflammation. In cases where granulomas have formed around the ureters the patient can show signs of azotemia (post-renal) and we will see high urea and creatinine in biochemistry panel.
The only possible option to treat the patient is surgical removal of the granulomas with the suture material inside or just the suture material from the ventral body wall. The therapeutic approach: using antimicrobials, flushing and draining the fistulas can help for some period of time, but then the problem will arise again.
The surgical approach to such cases is always the same: remove all the sutures from the body wall (often with a part of it in case of severe inflammation and thickening) and remove all the sutures and granulomas from the abdomen via middle-line laparotomy. Nevertheless, a lot of such surgeries are quite complicated because granulomas tend to be firmly connected with kidneys and it’s mandatory to remove them without injury of the kidneys. Another problem can be to free the ureter from the granuloma without breaking it or sometimes you have to reimplant them to the bladder or partly resect. It can be quite tricky to remove the granuloma from the uterus stump as they tend to be firmly connected with the dorsal part of the bladder. Sometimes other organs can be involved like omentum and intestines that leads to partial resection.
In severe cases you can observe hydronephrosis because of the mechanical compression of the ureter, and in such cases the kidney must be removed.
After removing granulomas it’s important to check whether all the suture material has been removed, and to flush and suture the peritoneum. The actual absesses around the sutures are quite rare.
After closing the abdomen don’t forget to check and flush and maybe drain if nessesary all the fistulas. If you have removed all the implants, the fistulas will resolve in about a week.
The prognisis in such cases depends on how much all the other organs (kidneys, ureters, bladder) are involved in granulomas, so it can vary from excellent to grave.
Synovial cell sarcoma is the most common jointtumor in dogs. It is a malignant neoplasm arising from mesenchymal cells outside the synovial membrane of joints and bursas1 . In dogs, synovial cell sarcomas usually occur in large breeds, with a predisposition for flat-coated and golden retrievers1,2 . Middle-aged dogs are most commonly affected, and there is no sex predilection. Synovial cell sarcomas usually involve the larger joints, but any joint can be affected.
Other joint tumors reported in dogs include fibrosarcoma, myxoma, malignant giant cell tumor of soft tissue and others. Recently, histiocytic sarcomas have been reported in the periarticular tissue of large appendicular joints3 .
Synovial cell sarcomas are locally aggressive with a moderate-to-high metastatic potential, depending on histologic grade. The average survival time with SCS is around 30 months, which is significantly better prognosis compared to the most common canine neoplasia- osteosarcoma.
Limb amputation is recommended for treatment of the SCS tumor because local recurrence is significantly lower compared to marginal resection.
In the recent years, an amputation alternative- limb sparing procedure, was developed. The first animal case (2008) with integrated prosthesis included bilateral tibial stem implantation4. The more recent procedure ITAP (Integrated Tanscutaneous Amputee Prosthesis)-Stanmore Implants Worldwide Ltd, UK, is demanding technique that consists of low limb amputation and metal stem medullary canal insertion, aiming long term bone-implant integration. Suggested period for this integration has been suggested to be 6 weeks5. This is the most vulnerable period that demands high degree of implant stability, allowing bone tissue ingrowth into the implant micropores. Once stable implant- stem fixation occurs, an external limb prosthesis attachment gives the opportunity for weight baring and some degree of limb functional recovery.
Abstract
This case report presents the short term functional result after application of ITAP technique in a five years old golden retriever. The dog’s tarsal joint was affected by synovial sarcoma. Custom manufactured implant with rigid locking plate fixation was developed. The goal of the implant design was solid fixation allowance of immediate weight baring, even before the stem integration. The follow up period of the case is 3 months post operatively. The patient revealed very good pain free limb function, starting almost immediately after the amputation.
Case report
A 5 years old male Golden retriever dog, weighting 39 kg was presented at Central Vet Clinic – Sofia. The owner reported low grade lameness with the left hind leg, lasting for more than one month and badly responding to NSAIDs.
Clinical examination
We did a thorough clinical exam, revealing normal over-all condition, moderate obese body score, choleric temperament. We found mild (II/IV) left hind leg weight baring lameness. Thickening of the left hock joint was noticed. Mildy decreased ROM with mild pain were appreciated in the affected joint.
Diagnostics
Orthogonal radiographs of the left hock revealed diffuse intrinsic joint swelling. We found aggressive bone lysis areas (mostly severe at distal fibula) and moderate aggressive periosteal reaction (mostly affecting the tarsal bones). No abnormalities were detected on preoperative 3-view thoracic radiographs, abdominal ultrasound, echocardiography, and blood tests.
Fine- needle aspirates were taken. Cytology revealed numerous clusters of plump, oval to spindloid cells often with moderate cellular atypia. Considering this , the signalment and the imaging findings, a diagnosis of joint sarcoma was suggested.
A decision for limb sparing surgery by low trans-tibial amputation and integrated limb prosthesis (ITAP) was made.
Implant planing and manufacturing
A custom-made ITAP implant was manufactured using CNC machinery with additional welding process. Medical titanium (grade 4) was used for the production. The implant desired shape and size of the was predetermined using only radiographs. The straight shape and straight medullary canal made the design simple enough, so no necessity for computer tomography imaging and planning was found. The ITAP implant components included a 7 mm (rough surface) intramedulary stem, 3, 5 mm locking plate part, drilled titanium collar (flange) and most distally smooth 8 mm titanium rod (outside part). Locking 4 mm screws were produced corresponding to the plate locking mechanism.
A custom made exoprostheis was manufactured using combination of plastic polymer, rubber and metal elements. The length was conformed (with mild underestimation) to the natural foot size. Angulation of 135 degree of was planned to mimic the natural hock joint position. Shock absorbing (spring) design was developed.
Comment:
The titanium flange role is the reduction of epithelial downgrowth and good soft-tissue integration.
Anesthetic protocol
Premedication with Medetomidine and Butorphanol was used, followed by Propofol induction. The maintenance was sustained by Isoflurane and Ketamin drop in the fluid sack. Epidural block with Ropivacaine was provided just before the surgery.
Cimicoxib (Cimalgex) was prescribed for 7 days post op. No opioids were used in the recovery period.
Surgical technique
For the surgical intervention, the dog was positioned in dorsal recumbency. After macroscopic evaluation, transverse sharp dissection of soft tissues, covering the distal tibial dyapihis was done. Four centimetres distance proximally from the edge of the tarsal lump was aimed. Muscles tendons (including common calcaneal tendon) were severed. A strict haemostasis by electrocautery and ligation of the main blood vessels was achieved. Minimally invasive approach (bone tunnelling) was used for the insertion of the plate element under the soft tissue on the medial side. Mild contouring of the proximal plate part was needed to fit the tibia shape. No canal drilling was needed- the stem part was impacted quite easily into the soft bone marrow tissue. Gentle axial hammering ensured good bone to flange contact.
Muscle tendons and crural fascia free ends were sutured to the special designed flange holes. After gentle subcutaneous fat debridement the skin edges were sutured over the flange surface. Special attention was emphasised so the circular skin defect was closed with an “appropriate” tension- no skin abundance, but also with no excessive tension on the stitches.
Immediate post op care
Preventive antibiotic therapy (Amoxcillin calvulonic acid) and NSAIDs (Cimalgex) was prescribed for 7 days
A Modified Robert Jones bandage was applied over the amputee stump. The bandage was removed after three days and the exoprosthesis was attached, with similar soft bandage applied around the stump.
Strict cage rest with very short leash walks was emphasised in the immediate post op period.
A recheck radiograph at six weeks post op demonstrated solidly homogenous bone-implant contact area, suggesting osteointegration in process.
Pathohistology diagnosis
“Moderate differentiated synovial cell sarcoma.”
Atypical spindle shaped cells with indistinct borders and variable amounts of eosinophilic fibrillar cytoplasm and stroma. The long term prognosis is good but still variable.
Functional result
The dog revealed very good comfort after the procedure, with immediate weight baring. Light protective bandage was used to cover the distal stump area and prosthesis for two months post op. The followed period (within 3 months) revealed very fast and pain free limb usage with milld lameness (II/V)
Leash walk 6 day post op.
Going for a walk 14 day post op.
2 months post op
3 months post op
CONCLUSION
Locking plate ITAP design can provide adequate stability needed for implant osteointegration, while early limb usage is allowed. The role of shock absorbing exoprosthesis for success is unclear. This fast functional recovery can make the ITAP procedure more attractive and better accepted by the owners of pets that need similar limb sparing surgeries. Further investigations may demonstrate ITAP complications variabilities (ratio) and long term results.
Transient Postural Vestibulo-Cerebellar Syndrome is a condition that present as pronounced vestibulo-cerebellar signs. In this syndrome transient postural symptoms present as vestibulo-cerebellar signs after altering the position of the head.Vestibular deficits related to head posture have been described, introducing the relationship of nodulus and uvula pathology to various vestibular signs elicited by the postural changes of the head.
Case report:
Signalment: Adopted from a shelter mix breed female dog without previous history.The age of the dog was estimated to be 7-8 months based on general appearance and teeth condition.
Case presenting sings: Vestibular episodes during sniffing and eating or head position changing(Transient vestibular signs as vertigo and nystagmus caused by changing the posture of the head). Symptoms are not progressive.
Clinical examination: Good overall condition ; Internal body temperature- 38,9; Normal respiratory and heart rate; Color of mucous membranes – pink; CRT – 1,5 sec.
Neurological examination:
Mentation: Normal
Behavior: Normal
Gait: Normal( no signs of cerebellar ataxia when the dog plays or runs)
Cranial nerves: normal
There was no change in conscious proprioception and bladder function was normal.
Magnetic resonance of the head was performed with GE MRI 1.5 Tesla.
MRI findings:
The T1W and T2W sagittal and transversal images showed reduced size of the nodulus and uvula of the caudal cerebellum with CSF filling the space normally occupied by cerebellar parenchyma.This is particularly visible on T2W images due to the hyperintensity of the surrounding CSF.These imaging findings were considered most likely to represent congenital caudal cerebellar hypoplasia.
There is no histopathological examination providing a definitive diagnosis, but the most likely diagnosis is Congenital Caudal Cerebellar Hypoplasia.
No treatment was recommended. There is no progression of the clinical sings 4 months after the examination.
Septic peritonitis is an inflammatory condition of the peritoneum that occurs secondary to microbial contamination. Septic peritonitis may have a wide variety of clinical courses and outcomes, with high morbidity and mortality. The definitive diagnosis usually relies on the identification of toxic and/or degenerate neutrophils with foreign debris and/or intracellular bacteria in the peritoneal fluid. A thorough understanding of the treatment options and prognosis is crucial to decision making and comprehensive care.
Despite the numerous advancements in recent years, severe abdominal sepsis (with associated organ failure associated with infection) remains a serious, life-threatening condition with a high mortality rate in both veterinary and human medicine.
Vacuum Assisted Closure is a type of therapy used mainly for wound closure; it works by reducing atmospheric pressure on the wound bed.
In septic peritonitis the advantage of Vacuum Assisted Closure is that the system gently pulls fluids out of the abdomen, removes bacteria and helps clean the peritoneal cavity.
The system requires special dressing, a vacuum pump and various types of cycles can be used.
In septic peritonitis VAC therapy is used with an open abdomen technique. Open abdomen is a viable alternative to repeated laparatomy or continuous peritoneal lavage. The main advantages of open abdomen are prevention of intra-abdominal hypertension and abdominal compartment syndrome and early identification of intra-abdominal complications. Maintaining an open abdomen creates numerous management challenges – development of fistula and infection.
Case presentation:
The patient is an 2 years and 6 months old American Staffordshire Terrier, intact female. She presented on September 14th for vomiting. The vomit persisted even after simptomatic treatment, so further investigation was recommended.
Initial blood tests were performed – cbc + biochemstry (attachment 1a, 1b 1c).
On abdominal ultrasound (performed by my colleague, dr. Raluca Munteanu) – a jejunal foreign body with a diameter of 2.4 cm was diagnosed (attachment 2).
Surgery was performed and a nut was retrieved from the patient’s jejunum; also, marked ischemia of the involved intestine was seen and it was decided to continue with an enterectomy of the affected area. 10 cm of jejunum were excised and a termino-terminal apositional suture was performed.
On September 15th the patient was discharged and treatment was continued with Amoxicilin + Clavulanic Acid, Metronidazole, Omeprazole and Sucralfat for the following 7 days.
pic 3
Initially, the patient’s clinical evolution was positive, but on October 2nd she presented at the hospital for fecaloid vomit. An abdominal x-ray was performed and a gastric foreign body was detected (picture 3). An endoscopic retrieval was performed and a stone was removed from the patient’s stomach.
Patient was discharged with simptomatic treatment, but the vomiting relapsed on October 8th; new abdominal radiographs were performed, free peritoneal fluid and gas were detected and a laparatomy was recomended.
pic 4
General anaesthesia was induced according to standard protocol. An exploratory laparatomy was performed and multiple adherences were diagnosed (pic 4); at the point of the previous suture no leakage could be identified, but the intestine was distended with gas and fluid cranial to the enterectomy site.
picture 6
Another enterectomy was performed, this time the excised part being approximately 60 cm of the jejunum. Duodenum and ileon were individualized and maintained (picture 6).
After copious peritoneal lavage (500 ml of sterile saline/kg) we decided to try VAC with an open peritoneum for septic peritonitis management. We used an VivanoMed® Abdominal Kit (attachment 7).
The abdominal wall was sutured to the sponge in the VivanoMed® Abdominal Kit, the draining machine was attached to it and a leakage test was performed (video 1). In order to secure the abdomen a tie-over bandage was used to keep the VAC machine in place.
For the next 5 days continous pressure was applied at 40 mmHG. During the first 2 days, approximately 1 litre of septic fluid was drained. In the next 3 days, less and less fluid was obtained.
On day 5, another surgical intervention was performed in order to change the usable parts of the VivanoMed® Abdominal Kit. The following 5 days, fluid collection was decreased and smears from it showed marked reduction of bacteria. On the 10th day no more bacteria could be identified in the peritoneal fluid.
On the 10th day, the abdominal kit was removed and routine abdominal closure was performed. Patient was discharged from the hospital and further evolution was good. On the 14th day recheck patient showed no more vomits, stool was normal and general status was good.
During VAC therapy – creatinine, BUN and albumin were monitored (attachment 8 and 9). Even though hypoalbuminemia persisted throughout the hospitalization period, there was no need for albumin suplementation as no peripheral oedema had developed.
Discussion
Septic peritonitis is a complex process initiated most commonly by a bacterial focus, causing damage and inflammation of the primary and surrounding organs and usually culminating in circulatory shock, multiorgan failure and death. This process has been historically difficult to treat, with high mortality rates in both veterinary and human patients, despite aggressive medical and surgical treatment.
In this patient a deffinitive source for peritoneal infection could not be determined during later procedures; it is hypothesised that bacterial translocation could have occured secondary to increased permeability of the intestinal mucosa. It is also hypothesised that ingestion of the second foreing body (the gastric stone) was just a simptome of gastrointestinal disturbance.
During the 10 days of VAC treatment patient was hospitalized and closely monitored. Fluid production decreased after the first 2 days of treatment; on the last day no more fluid could be retrieved from the peritoneal cavity. Although the dog was managed with an open abdomen, no signs of pain or discomfort was seen. The patient managed to go out for walks with the VAC machine attached to the abdomen. Pain was controlled with buprenorphine – 10 mcg/kg every 12 hours. During the entire period antibiotherapy was continued and, after VAC placement, steroids (prednisone) were started at a dose of 1 mg/kg/24 h.
Even though in the first days after surgery the patient had developed a short bowel syndrome, on the 14th day recheck stools were back to normal. It is believed that the organism adapted to the shortened jejunum and digestion and absorbtion normalized.
At the time of publishing, the patient is doing well and is now back to presurgical weight and general status.
15 January 2021 – The full programme for the 2021 Virtual Congress of the British Small Animal Veterinary Association (BSAVA) is now live.
This year’s edition of one of the world’s largest event for the small animal veterinary sector will be held from Thursday 25 to Saturday 27 March. It is set to deliver everything people expect of BSAVA Congress – and more:
Excellent International speakers, more than 130 hours of CPD and an extensive range of practice resources to take away.
A new, more interactive formula
With more than 100 speakers and a new format that blends clinical, practical and interactive content across a massive number of topics, Congress is highly relevant for every member of the practice. Shorter sessions and the introduction of new two-speaker sessions on day-to-day topics will focus on the information vets need to know in primary care practice with regular opportunities for delegate engagement and questions.
“Following months of meticulous planning we are thrilled that the programme is now live,” said Professor Ian Ramsey, President of the BSAVA. “The sheer range and high quality of our speakers and content, together with our new, more dynamic format takes webinar learning to a new level.”
Who’s who of the veterinary world
The list of speakers is akin to an international ‘who’s who’ of the veterinary world. As a small taster of what’s in store, Holger Volk (Germany) will present on aspects of neurology on a shoestring, including a case-based panel discussion. Bianca Hettlich (Switzerland/Germany) will present a case-based interactive session to help general practitioners decide if a lameness case is of orthopaedic or neurological origin and will be busting some myths. The USA’s Ernie Ward will be speaking about recruitment and retention.
The speakers – including Mike Willard (USA), Jens Ruhnau (Denmark), Daniel Pang (Canada) and Milinda Lommer (USA) – will give short ‘live’ presentations, often in joint sessions, allowing ample time for discussion allowing a dynamic interaction.
The list of UK speakers includes Rebecca Geddes (kidney medicine and nursing), Nicki Reed (feline nursing), Sarah Heath (behavioural alopecia), Adrian Boswood (asymptomatic cardiac patients), Jane Ladlow (BOAS surgery), Penny Watson (liver biopsies, feline triaditis), Dick White (the surgical team); Tim Nuttall (atopic dermatitis), John Chitty on several rabbits, small furries and exotics topics, and many more.
130 hours of CPD available on the platform for two months
Four simultaneous live streams will deliver 80+ live sessions covering 24 module topics, together with a library of 100 on-demand webinars and other resources for the practice to bring delegates more than 130 hours of CPD. Many modules have relevant presentations woven in to make them suitable for the whole practice team from clinical directors to practice nurses and managers. There will also be a dedicated exhibitor stream every day. BSAVA Congress headline sponsors include Idexx and Hill’s Pet Nutrition.
The live and on-demand content will be available to delegates on the platform for 60 days, and then via the BSAVA Library.
“Delegates will be able to develop their skills and knowledge on topics they see regularly in practice,” said Professor Ramsey. “To make things even easier we will be providing practical resources such as client handouts for delegates to take back to their clinics. This, coupled with many speakers sharing their own notes and practical resources means less note-taking and a quicker and easier way for delegates to share what they have learnt with their colleagues.”
Great value with rates starting at just £99 +VAT
On the social side the focus is on bringing people together on-line to share light-hearted entertainment and laughter. Delegates can throw some shapes with a virtual disco, exercise their bodies as well as their minds with yoga and unwind with some restorative meditation practices.
“This year’s BSAVA Congress is going to be the most innovative ever and deliver like never before,” said Professor Ramsey. There is plenty of relevant and engaging CPD for every practice professional, with all the convenience of a virtual event. If you haven’t already taken a look at the programme and registered, I urge you to do so now. With prices starting at just £99 (approx. €110) +VAT for BSAVA and FECAVA members*, it represents really great value.” The Congress will be held in English.
*As FECAVA member, proof of membership of one of FECAVA’s member associations may be required. To check, please visit https://www.fecava.org/associations. Veterinarians who are members of WSAVA through their national organisation can claim a 10% discount on the BSAVA non-member rate.
Called ‘Global Principles of Veterinary Collegiality’, the document springs from discussions held during a VIP Summit at WSAVA World Congress in July 2019. During the meeting, veterinary leaders from around the world expressed concern at the additional stress caused to veterinarians by poor communication and collegiality within teams and among colleagues. They highlighted the additional pressures that this was placing members of a profession already challenged by well-being and mental health issues.
The document was launched on Monday January 18, known as ‘Blue Monday’, claimed to be the most depressing day of the year. While some country veterinary associations already have a Code of Conduct, many do not and FECAVA and WSAVA hope that their initiative will help all of their member associations to commit to a common standard of behavior in order to support the profession as it works to achieve the ideals of patient care as set out in the WSAVA Veterinary Oath.
The Global Principles were authored by WSAVA Past Presidents Dr Shane Ryan and Dr Walt Ingwersen, and FECAVA Senior Vice President Dr Wolfgang Dohne. The document sets out the key principles of professional collegiality which they identify as involving equal and reciprocal relationships between veterinary individuals and groups.
Dr Wolfgang Dohne
Commenting, Dr Wolfgang Dohne said: “Poor collegiality and communication add to stress and frustration among veterinary professionals and hold back veterinary teams. Mutual respect, courtesy and support of especially junior team members, together with good communication, results not only in a better working environment, but also in better clinical outcomes. It improves animal welfare and encourages the concept of life-long learning. These goals are at the heart of FECAVA and its national member organizations and we are proud to be co-signatories of this document.”
Dr Shane Ryan
Dr Shane Ryan added: “The mental and emotional well-being of the entire veterinary team and, consequently, our ability to ensure the health and welfare of our animal patients, can only be enhanced by practicing in a harmonious, collegial environment. The principles outlined in the document allow for courteous and respectful interaction with our fellow veterinarians to encourage a more productive and welcoming workplace. Strengthening collegiality is an important element of the WSAVA’s strategy to advocate for the profession globally to bring about positive change.”
The associations plan to follow up the Global Principles with an infographic for practical use in companion animal clinics. It will be unveiled during the joint WSAVA/FECAVA Online Congress which takes place in March 2021. The document and infographics will be translated into multiple languages.
Through its member associations, FECAVA represents more than 25,000 companion animal veterinarians in 39 European countries. FECAVA strives to improve the veterinary care of pets through professional development. It also provides a voice for companion animal issues at European level and works closely with other European veterinary organizations and stakeholders.
The WSAVA aims to advance the health and welfare of companion animals worldwide through creating an educated, committed and collaborative global community of veterinary peers. It currently represents more than 200,000 veterinarians through 110 member associations. Its annual World Congress brings together globally respected experts to offer cutting edge thinking on all aspects of companion animal veterinary care.
The workshops organised by the Romanian Society of Orofacial Surgery and Veterinary Dentistry (RSVD) is becoming a tradition. The tiltle of the workshops that were organized in several cities of Romania was “Treatment options and prophyaxis in periodontal disease” (in dogs and cats, of course). As you already know, periodontal disease is the most common pathology in pets and it can have severe local and systemic complications that affect the quality of life of our beloved cats and dogs. Although it is very common, the disease is mostly treated in very advanced stages when the teeth cannot be saved anymore. The workshops lasted for 2 days. On the first day, the participants, both veterinarians and veterinary students, gained more knowledge regarding conscious oral examination, detailed oral examination under sedation, dental charting, specific instruments, scale and polish and oral homecare.
The second day was dedicated to the more pragmatic treatment option in advanced stages of periodontal disease: the dental extraction. The participants learned a lot regarding indications and contraindications of dental extractions, dental blocks, simple extractions, surgical extractions and possible complications of dental extractions. Both days started with theoretical presentations and ended with the practical part so that the participants could exercise their new dental skills. The founding members of RSVD, Dr. Raluca Zvorasteanu, Dr. Iulia Milin, Dr. Dan Sebastian and Dr. Elena Nenciulescu, were also the speakers of the events. “The main purpose of the Romanian Society of Orofacial Surgery and Veterinary Dentistry is to bring together veterinarians, veterinary nurses and veterinary students to raise awareness of the importance of veterinary dentistry, to increase the professional level of veterinary dentistry in Romania and also to defend the values and interests of the Romanian veterinary community”, said Dr. Raluca Zvorasteanu, President of RSVD. According to Dr. Zvorasteanu, at least 9 out of 10 patients have some sort of dental disease and 100% of patients need oral homecare. “We like to promote prophylaxis as <the best treatment option> ”.
Treatment of CKD aims at:
