education | pearls-of-wisdom | 2021 Pearls of Wisdom

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American Association of Feline Practitioners
2021 Hybrid Conference • September 30 – October 3, 2021
Anesthesia, Analgesia, & Surgery

Pre-Conference Day
Thursday, September 30, 2021

 

Providing for the Behavioral Needs of Each Cat, Dr. Valarie Tynes

  1. Failure to attend to a cat’s environmental needs is a likely cause for many medical conditions, problem behaviors, and ultimately results in poor feline welfare. Attention to the cats’ environmental needs cannot be an “afterthought”. It must be a priority.
  2. One of the most important needs, critical to the good mental health of every living thing, is the need for choice and control over their environment. We have taken most choice and control away from domestic animals. Finding ways to increase choice and control for pet cats is one way that we can improve their behavioral health and welfare. 

 

The New Cat Parent: How to Exceed Their Expectations for Feline Healthcare & Wellbeing, Dr. Natalie Marks

  1. The digital presence of a veterinary hospital is KEY. Hospital teams need to EMBRACE texting, as texts have a 99% open rate, and 95% of them are read in the first 3 minutes. Practice websites should have significant functionality for emailing, requesting appointments, chat features, and be unique and tell your story!
  2. Vaccine verbiage needs to be updated to today’s pet parent. It’s essential to ask the right type and form of history questions. Vaccine empathy is new and needed for so many first-time pet parents. Listen, hear concerns, imagine the client point of view, and give nonverbal cues.
  3. The Internet of Medical Things is the next step into collaborative medical care between veterinarians and pet parents. These medical devices help with detection of scratching, food/water consumption, licking associated with joint pain, sleep disturbances, body weight trending, and biometric data. These are great supplements to current practices using telemedicine apps and AI.

 

To Cut or Not to Cut: Incorporating New Technologies & Avoiding the Pitfalls in the Treatment of Feline Uroliths, Dr. Jody Lulich

  1. Nutritional dissolution of feline struvite uroliths is the most effective and compassionate therapy. To improve dissolution outcomes, strengthen your mineral prediction by using CALCulate on the improved Minnesota Urolith Center App and assess radiographs; consider pain medication initially to minimize dysuria and the chance of urethral obstruction (stone obstruction during dissolution is rare); recheck radiographs in 2 weeks to assess therapeutic efficacy; check-in with clients often to enhance compliance, and do not dissolve urethral stones.
  2. For some veterinarians, minimizing stress is considered the primary treatment to prevent urethral obstruction of undetermined cause. However, diagnosis and prevention of idiopathic urethral obstruction and urethral plugs are confounded because urinary catheterized, which is often performed prior to radiography, can mask and obliterate the cause resulting in many cases being misclassified as idiopathic. No studies have identified that idiopathic urethral obstruction is caused by stress or prevented by elimination of stress. In contrast, prospective controlled studies proved that struvitolytic diets are highly effective at preventing reobstruction caused by urethral plugs and idiopathic (undetermined) disease.

 

ISCAID Antimicrobial Use Guidelines: Which Antimicrobial, What Dose, & For How Long?, Dr. Jane Sykes

  1. Bacteriuria is only considered urinary tract infection if there are associated clinical signs of lower urinary tract disease (dysuria, stranguria, hematuria) or evidence of pyelonephritis (azotemia, leukocytosis, fever). New rapid bacterial tests (e.g., Rapidbac) can facilitate point-of-care diagnosis of non-bacterial causes of lower urinary tract signs in cats.
  2. Recommended initial treatment for lower urinary tract infection is 3-5 days with amoxicillin or TMS; for pyelonephritis is 10-14 days with a fluoroquinolone. There is a trend for shorter durations of treatment to minimize selection for resistant bacteria.

 

Current Concepts in Feline Vaccination, Dr. Jane Sykes

  1. The final vaccine in the kitten series should be given no earlier than 16-20 weeks of age. Consideration should be given to performing the one-year booster at 6 months of age. The inter-vaccine interval may optimally be no less than 4 weeks.
  2. Vaccination for feline leukemia virus is underperformed. FeLV vaccines are considered core for cats less than a year of age and thereafter should be given to at-risk cats every 1-3 years depending on the level of risk.

 

Is a Positive Really Negative? Interpretation of Diagnostic Tests for Infectious Diseases, Dr. Jane Sykes

  1. Before jumping to conclusions that ‘negative’ means ‘does not have the infection’ and ‘positive’ means ‘does have the infection’, ask yourself what the target of the assay is (antibody or organism) and why a negative might be a false negative, or a positive might be a false positive.
  2. Focus on selecting and interpreting results for the disease that is in question. Remember, the positive predictive value suffers when the disease is not likely based on the signs present. Multiple diagnostic tests may be required to make a proper diagnosis.

 

Update on Feline Viral Infections: Pearls of Wisdom, Dr. Jane Sykes

  1. The availability of quantitative provirus PCR for FeLV can help determine whether a cat is regressively infected (virus integrated into cat DNA, nonproductive infection with good prognosis) or progressively infected (productive infection with associated FeLV-associated disease). PCR testing for FIV should be considered in cats that are antibody negative but have signs consistent with feline AIDS, as they may not be able to produce antibodies or have immune complexes that bind up antibodies and make it undetectable.

 

Friday, October 1, 2021

 

The Intertwine of Fear & Pain: A Spinning Wheel with Implications for Cats & Their Caregivers, Dr. Tamara Grubb

  1. Pain causes fear/anxiety/stress (FAS) and FAS intensifies the level of pain so the provision of adequate analgesia requires treatment of both conditions. Many drugs that work in the descending inhibitory limb of the pain pathway (e.g., gabapentin, pregabalin, serotonin-norepinephrine reuptake inhibitors) can decrease both FAS and pain and should be considered for treatment, but little to no cat-specific research information is available for most of these drugs.
  2. Animals instinctively hide pain as an evolutionary instinct for survival. Preventing pain/FAS is preferable to attempting treatment of pain/FAS and cat caregivers need to be educated on the signs of pain, like changes in behavior and mobility. Searching the internet for advice is a normal cat caregiver activity and veterinarians should direct those searches to websites with valid scientific information on pain and analgesia in cats, including the positive impact of gentle handling (catvets.com). 

 

Purrfecting Your Acute Pain Assessment Skills, Dr. Sheilah Robertson

  1. There are three validated acute pain tools for cats; two include observation and interaction. The Feline Grimace Scale (FGS) is observational only and can be performed quickly making it a good screening tool.
  2. All team members can easily and quickly learn to use the FGS.

 

Having the Nerve: Local Anesthetic Techniques You Should be Using – Part 1, Dr. Mark Epstein

  1. According to industry (including AAHA/AAFP guidelines), local anesthetics should be utilized in every surgical procedure.  
  2. Liposome-Encapsulated bupivacaine (Nocita®) has established 3-day efficacy as a nerve block agent for digit surgery in cats, but many off-label uses have been utilized. Post-release data reveals with good sterile technique, a single vial maintains stability for 4 days and sterility for 5.

 

A Pain Most Malicious: Understanding, Preventing, & Treating Maladaptive Pain, Dr. Tamara Grubb

  1. Maladaptive pain is also called ‘pathologic’ pain, it has no biological value (ie, it is not ‘protecting’ the patient from tissue injury or further damage to healing tissues) yet causes health, behavior, and quality of life/welfare adverse effects. Chronic pain is primarily maladaptive pain. An example is osteoarthritis which has no cure, so the pain is not ‘protecting’ tissues while they are healing.
  2. Maladaptive pain should be treated in lieu of treating the underlying cause which is generally not treatable. Maladaptive pain results from not only the inciting cause of pain but also from changes in the pain pathway, making the pain difficult to treat. Multimodal analgesia is required for effective analgesia.

 

Having the Nerve: Local Anesthetic Techniques You Should be Using – Part 2, Dr. Mark Epstein

  1. Orofacial blocks are used for any surgery of the maxilla, mandible, and associated soft tissue. The pre-frontal (rostral maxillary) block should not have the needle inserted inside the foramen, but properly performed can still render anesthesia to the entire carnassial tooth and M1
  2. The sacrococcygeal (caudal epidural) block can be performed with a 22g needle and is equally effective if between Cx1-2. The block numbs and relaxes all of the tissue of the perineum for any procedure of this area, including easing the passage of urinary catheters in obstructed male cats.

 

Lunch & Learn #1: What the Guidelines Say on Identifying, Evaluating, & Managing Feline Hypertension, Dr. Mark Acierno

  1. Getting accurate blood pressure is environment-dependent. Obtaining accurate blood pressure in a cat is dependent on creating a safe comfortable environment. Blood pressure measurements should only be obtained after the patient has acclimated to the environment and before any other parts of the exam. The room should be away from barking dogs and other distracting noises. Unless they create an unnecessary distraction, the family members should be present for the process. Restraint should be kept to an absolute minimum.
  2. Veterinarians have new options for the treatment of feline hypertension. For many years calcium channel blockers have been the mainstay of feline anti-hypertensive therapy. The availability of new FDA-approved therapies in the form of angiotensin-converting enzyme inhibitors provides the clinician with exciting new treatment options.

 

Lunch & Learn #2: What is Your Patient Telling You? Integrate All the Moving Parts, Dr. Guillermo Couto

  1. Less than half of the cats with systemic infection/inflammation/sepsis have a high white blood cell count and neutrophil count.
  2. Large neoplastic hematopoietic cells (i.e.; leukemia, lymphoma) appear within the monocyte population in most flow cytometry analyzers.

 

Lunch & Learn #3: Don’t Stress! Practical Management of Feline Lower Urinary Tract Disease, Dr. Jessica Markovich

  1. Water remains the most important nutrient of concern, and a variety of options are available to encourage increased water consumption. Increasing dietary water or flavoring the water have been found to be effective strategies.
  2. Dietary supplements can help with the stress response.  L-tryptophan is a precursor for serotonin and melatonin synthesis.  Alpha-casozepine is a protein originating from cow’s milk that has an affinity for gamma-aminobutyric acid (GABA) receptors in the brain resulting in an anxiolytic effect.

 

Lunch & Learn #4: Identifying & Treating Chronic OA Pain: Help is on the Way!

  1. A validated pain score has been developed the Feline Musculoskeletal Pain Index (FMPI) which gives the power of observation to caregivers in the home.
  2. Most households have a “smartphone” with photographic and video capability. In the comfort of the home range, the locomotion of a cat may be most reliably observed and largely absent from the examination room.
  3. Neutralizing antibodies against nerve growth factor (NGF) are analgesic in rodent models, naturally occurring degenerative joint disease (DJD) pain in dogs and chronic pain in humans.
  4. Clinicians have an obligation to balance the importance of relieving pain and the impact that their plan may have on the relationship between cat and caregiver.

 

I’m Old, Painful, & My Mouth Hurts: Dental & Other Protocols for Patients with Pre-existing Pain, Dr. Tamara Grubb

  1. Frailty is often present in senior cats (see 2021 AAFP Feline Senior Care Guidelines), meaning that physiologic reserve is lacking and aggressive physiologic support for cardiovascular, respiratory, and thermoregulatory systems is required for safe anesthesia.
  2. Preexisting pain (e.g., pain from periodontal disease, injury, or osteoarthritis) exacerbates the overall intensity of pain during and after procedures that cause acute pain (eg, during dental procedures or surgery), making the overall pain harder to control and anesthesia harder to maintain at an appropriate/safe plane of anesthesia. Thus, analgesic protocols for acute pain, including seemingly minor pain, should be more robust if preexisting pain is present.

 

Feline Pain Management Beyond Opioids & NSAIDs: Part 1, Dr. Mark Epstein

  1. In the spinal cord dorsal horn, NMDA-receptor calcium ion channels open under the condition of massive or sustained binding by excitatory neurotransmitters and become a key component of central sensitization. Ketamine is a potent NMDA-receptor antagonist, and subanesthetic ketamine CRI should be utilized for all patients with existing, or at risk for, maladaptive pain. These patient populations include patients experiencing severe trauma (pre-existing, or high surgical dose), nerve injury, or pre-existing chronic inflammation or pain.
  2. Nerve Growth Factor upregulates in areas of chronic inflammation and is part of both peripheral and central sensitization. Anti-NGF Monoclonal Antibody is a therapeutic rendering of a pain-modifying effect by decreasing peripheral sensitization.

 

Anesthesia & Analgesia for Cats with Cardiac and/or Airway Comorbidities, Dr. Tamara Grubb

  1. Prevention or alleviation of stress is critical for anesthetic safety as decreased stress will promote the effective use of sedatives and anesthetic drugs at low doses. Higher doses of these drugs can cause dose-dependent respiratory and cardiovascular adverse effects. Pre-visit anxiolytics and robust, multimodal analgesia protocols should be used in all patients to decrease stress. In most patients, anxiolytics and analgesics should be continued after discharge from the hospital.
  2. For cats with asthma, avoid excessive stimulation of the airway by ensuring the patient is adequately anesthetized before intubating and extubating before the cat starts to swallow. Administer albuterol if bronchoconstriction occurs. For cats with hypertrophic cardiomyopathy, choose anesthetic/analgesic protocols that promote a low heart rate and prevent a decrease in systemic vascular resistance (e.g., avoid anticholinergics and drugs that cause vasodilation like acepromazine).

 

Feline Pain Management Beyond Opioids & NSAIDs: Part 2, Dr. Mark Epstein

  1. Gabapentin downregulates pre-synaptic calcium channels, thus minimizing the release of excitatory neurotransmitters in the dorsal horn of the spinal cord. Its pain-modifying effect can therefore be described as diminishing central sensitization
  2. The pharmacokinetics of tramadol mirrors that in humans, creating an opioid metabolic and a metabolite that enhances inhibitory neurotransmitters serotonin and norepinephrine. It has been shown to have a pain-modifying effect in cats undergoing surgery and with Degenerative Joint Disease. However effective, it is bitter and can also elicit neurologic adverse effects at higher doses.  

 

Anesthesia & Analgesia for Cats with Endocrine Comorbidities, Dr. Tamara Grubb

  1. Prevention or alleviation of stress is critical for anesthetic safety as a stress-mediated response from travel, hospitalization, restraint, surgery, pain, etc. can exacerbate the negative effects of endocrine disease (e.g., tachycardia, hypertension, hyperglycemia, catabolism, etc.). Pre-visit anxiolytics and robust, multimodal analgesia protocols should be used in all patients. In most patients, anxiolytics and analgesics should be continued after discharge from the hospital.
  2. Loss of glycemic control can be minimized in diabetic cats using the protocols listed in point 1, by monitoring serum glucose throughout the procedure, and by feeding the cat a small meal of most food as soon as it is conscious enough to safely swallow food. Exacerbation of hyperthyroid-induced negative effects can be minimized by using the protocols listed in point 1 and by the support of normal blood pressure, gas exchange, and body temperature along with rapid treatment of any arrhythmias that occur.

 

Is Your Anesthetized Patient in Trouble?, Dr. Sheilah Robertson

  1. Most anesthetic-related deaths occur in the early recovery period (first 3 hours).
  2. All cats should be observed and monitored closely during recovery while being provided external heat sources and oxygen if required.    

 

Saturday, October 2, 2021

 

The Whole Package: Anesthesia & Surgery Tips for Common but Sometimes Tricky Cases, Drs. Sheilah Robertson & Bryden Stanley

  1. Hyperkalemia (K+ > 7.00 mmol/L) is a life-threatening complication of feline urinary obstruction and can result in cardiac arrest; it must be addressed quickly and prior to attempting to relieve the obstruction.
  2. Calcium gluconate given intravenously is the quickest method to stabilize cardiac conduction while other efforts are initiated to lower blood potassium levels.

 

Intestinal Anastomosis: Tips to Make it Easier, Dr. Howard Seim

  1. Adopt a specific criterion for suturing the intestine that guarantee’s a leak-proof closure.
  2. Unique ways of utilizing instruments to facilitate an accurate anastomosis.

 

Making End of Life Decisions, Dr. Sheilah Robertson

  1. End-of-life decisions are based on Quality-of-Life assessments made by the owner with the veterinarian’s guidance.
  2. The financial, emotional, and physical/time budgets of the owners are also incorporated into decision-making.

 

Visceral Organ Biopsy, Dr. Howard Seim

  1. This session will show you how to acquire diagnostic samples with every biopsy.
  2. Focus on the importance of getting multiple organ biopsies in each case.

 

The Last Appointment: How to Navigate Smoothly Through Euthanasia Appointments, Dr. Sheilah Robertson

  1. Feline euthanasia should be a 2-step process. Sedation or general anesthesia should precede euthanasia.
  2. If intravenous access cannot be achieved, intra-renal injection of euthanasia solution is a good alternative in a fully anesthetized cat.

 

Surgery of the Pancreas, Liver, & Biliary System, Dr. Howard Seim

  1. Patients presenting with a pancreatic mass may be helped by abdominal exploratory and mass removal.
  2. Cats with bile duct adenocarcinoma resulting in biliary obstruction can be palliated by diverting bile directly into the duodenum.

 

Lunch & Learn #1: Monitoring the Difficult Diabetic Cat:  Role of Continuous Glucose Monitoring, Dr. Catharine Scott-Moncrieff

  1. Management of diabetic patients requires attention to detail and appropriate monitoring depends on both the owner and patient. 
  2. Multimodal monitoring is ideal. Continuous glucose monitoring is affordable, easy to use in private practice, and avoids many of the pitfalls of blood glucose curves.

 

Lunch & Learn #2: Enhancing Compliance & Reducing Stress:  A Modern Perspective on Feline Parasite Protection, Dr. Robert Lavan

  1. Pet owners take home more months of flea and tick protection, on average, when the clinic prescribes a longer-duration product. Bravecto Topical for Cats lasts 2-3 times longer per dose compared to other flea and tick products that are dosed monthly.
  2. When cat owners purchase flea and tick products with gaps between purchase transactions, the gap between doses is smaller and the amount of protection time delivered by the flea and tick medication is longer when a product with extended duration is used.

 

Lunch & Learn #3: Digital Cytopathology: Real-time Expert Help in Your Everyday Practice, Dr. Eric Morissette

  1. Pathologic changes in cytology can be challenging to identify without the expertise of a clinical pathologist.
  2. Re-think your approach to cytology with fast, accurate analysis of digital slide images by an expert clinical pathologist.

 

Creating a Culture of Perioperative Safety in Your Clinic, Drs. Sheilah Robertson & Bryden Stanley

  1. Multiple research studies show that anesthesia and surgical checklists save lives and decrease complications in humans and veterinary patients.
  2. Checklists foster better communication and teamwork.

 

Wound Management Secrets, Dr. Howard Seim

  1. Inform attendees that feline skin can be ‘stretched’ for 7-10 days.
  2. Illustrate a simple technique that allows you to stretch the skin to help close chronic wounds.

 

Managing Feline Ear Polyps, Dr. Howard Seim

  1. The majority of feline ear polyps originate in the middle ear.
  2. Ventral bulla osteotomy is most likely the best option to cure the problem.

 

The Whole Package: Anesthesia & Surgery Tips for Common but Sometimes Tricky Cases in Kittens & Young Cats, Drs. Sheilah Robertson & Bryden Stanley

  1. The most common cause of delayed recovery in kittens and young cats is hypothermia and every effort must be made to prevent and treat hypothermia; this starts as soon as the kitten enters the clinic.
  2. Younger cats (< 6 months of age) may require higher doses or more frequent dosing of opioids to provide analgesia.

 

Feline Subtotal Colectomy, Dr. Howard Seim

  1. Subtotal colectomy for the treatment of megacolon in cats is no longer considered a salvage procedure.
  2. Cats have an amazing ability to tolerate massive large bowel resection by ileal adaptation.

 

Colopexy for the Treatment of Recurrent Rectal Prolapse, Dr. Howard Seim

  1. Permanent reduction of a rectal prolapse can be performed by suturing the colon to the body wall.
  2. It is very important to scarify each peritoneal surface to ensure the development of a mature scar.

 

Sunday, October 3, 2021

 

Please note: We currently don’t have Pearls for the Dr. Michael Lappin sessions.

Detecting, Diagnosing, & Monitoring Feline OA Pain: A Practical Approach, Dr. Duncan Lascelles

  1. Owner education is critical to the successful identification of cats with OA-associated pain, but owner education does not need to be involved or burdensome – simple graphics, cartoons and visuals can be used on practice websites and in clinic.
  2. Video captured by the owner is an ideal way to assess the ability of cats to function in their home environment and gives the veterinarian important clues to where musculoskeletal problems may be located.

 

NSAIDs for Chronic Pain Control in Cats: An Update, Dr. Duncan Lascelles

  1. NSAIDs are effective for alleviating long-term musculoskeletal pain in cats. Clinical data clearly shows that NSAIDs can be safely used in cats with concurrent CKD without necessarily making the CKD worse, however, these data are in cats with CKD that are still of a reasonably good body condition score.
  2. Dose reduction over time intuitively makes sense but must be done carefully with regular assessment of the individual cat using, for example, the FMPI-sf. So-called ‘low doses’ of NSAIDs have not been assessed for efficacy.

 

How to Perform a Successful Orthopedic Examination, Dr. Duncan Lascelles

  1. Critical to a successful hands-on orthopedic evaluation of a cat is having a calm, relaxed approach and being willing to perform the examination in whatever position the cat is most comfortable in.
  2. Assessment of muscle mass can provide clues as to where OA pain may be located. Cats are relatively flexed creatures, and often initially resist the extension of joints. 

 

Perineal Urethrostomy & Other Options in Cats with FUS, Dr. Bryden Stanley

  1. The PU procedure requires a meticulous technique to open up into the pelvic urethra, ensuring minimal tension on the closure by adequately mobilizing the urethra and utilizing two tension-relieving sutures at the 10 o’clock and 2 o’clock positions. In addition, accurate apposition of mucosa to the skin is essential, and best achieved with at least 2.5x magnification and good illumination.
  2. If the urethral mucosa is damaged due to repeated catheterizations or if it splits during the procedure, consider leaving a Foley catheter for several days post-operatively. For revisional urethrostomies, learn how to undertake a transischial urethrostomy as described by Bernade and Viguier, Vet Surg 33:246-252, 2004.

 

Anti-NGF mAbs for Chronic Pain Control: The Science, Dr. Duncan Lascelles

  1. In the developing foetus and young animal, the neurotropohin nerve growth factor (NGF) is critical for the normal development of the nervous system. In the adult, although NGF does have ongoing diverse beneficial effects, its primary role is ‘pronociceptive’ in tissues where it is overexpressed.  
  2. NGF is expressed and produced by compromised tissues of joints with osteoarthritis. NGF increases the sensitivity of sensory nerves; increases the number of neurotransmitters released at the central terminal, so facilitating synaptic transmission; increases the density of ‘pain receptors’ expressed on sensory nerve endings; increases the role sensory nerves play in neurogenic inflammation; promotes angiogenesis; and promotes neuronal sprouting in the joint. 

 

Revisiting Halsted’s Principles (But Not His Habits!): Tips to Better Surgery, Dr. Bryden Stanley

  1. We will all make mistakes in our surgical career, and one of the most important things is to remember and review these missteps, to understand how they happened, and prevent a recurrence. Knowing the 7 Halsted’s Principles, defined over a decade ago, is still a valuable asset in decreasing complications and optimizing outcomes.
  2. Solid, solid knowledge of anatomy is absolutely critical to being a good surgeon; understanding the function of all organs and the impact of their resection or modification. Appropriate fine, sharp instrumentation, serious surgical planning (and alternative planning!) will also optimize outcomes and decrease stress in surgery. Positioning your patient with close attention, and cultivating a calm, controlled, meticulous, and planned approach to each surgery will pay dividends on your results.

 

Lunch & Learn #2: Procedural Sedation & Analgesia in the Cat, Dr. Brad Simon

  1. Feline patients often require procedural sedation and analgesia (PSA) for various procedures. Complications may arise, especially when risk factors are present. The choice of drug protocol depends on the procedure and the health status of the patient.
  2. The results of clinical and experimental trials are difficult to extrapolate to every case, and an individualized approach to PSA should be taken. Monitoring, fluid therapy, and good practices are paramount for successful PSA in cats.

 

Lunch & Learn #3: Stem Cell Therapy in the Domestic & Exotic Feline: Could This Be the Answer to Your Difficult Cases?, Dr. Robert Harman

  1.  Stem cells are a multi-modal therapy addressing inflammation, immune dysfunction, fibrosis, and tissue regeneration by reacting specifically to local tissue injury signals.
  2.  Stem cell therapy can be utilized by general practitioners and by specialists and does not require specialized in-clinic equipment.

 

Anti-NGF mAbs for Chronic Pain Control: The Evidence, Dr. Duncan Lascelles

  1. Nerve growth factor (NGF) plays an important role in OA-associated pain. Monoclonal antibodies against NGF (anti-NGF mAbs) have been produced – mAbs that are species-specific for the cat and the dog.
  2. In Europe and other parts of the world, an anti-NGF mAb (frunevetmab) has recently been approved for alleviating OA-associated pain in cats – given as a once-monthly injection. Published data show consistently positive results across studies and measured dimensions (e.g. owner and veterinary examinations). 

 

Chylothorax: An Update, Dr. Bryden Stanley

  1. Idiopathic chylothorax continues to be a challenging condition, poorly understood, and with mediocre outcomes following surgical intervention. Recent adjuncts to management, such as placement of long-term pleural ports, make the condition much less stressful for the cat to manage.
  2. Optimal treatment depends upon 1) obtaining an accurate CT lymphangiogram, 2) identifying and ligating the thoracic duct and any collaterals, and 3) ablating the cisterna chyli. It may be useful to undertake pericardectomy in many cats.

 

Wearables for Diagnosis & Monitoring of Pain: Where Are We?, Dr. Duncan Lascelles

  1. The future of improved diagnosis and monitoring will be the integration of varied and rich data sets in real-time. Wearable and implantable sensors have been garnering more attention as they offer opportunities to access such continuous, real-time data across multiple varied dimensions. However, with the high-frequency longitudinal data generated comes the challenge of managing this data, and interpreting the biological meaning.
  2. The relationship between long-term musculoskeletal pain and activity is varied and complex, and the successful use of physical activity monitors will require fully understanding this relationship.

 

Atypical Cutaneous Infections in Cats, Dr. Bryden Stanley

  1. The classic signs of atypical mycobacterial infections are the development of discolored (purple) skin with thinning and alopecia, often in the axilla, flank or inguinal fat pad areas. They will often develop punctate fistulation with serous, watery purulent drainage. The lesions are often mistaken for cat bite abscesses in the early course of the disease, but they persist or recur despite therapy. The causative mycobacteria are non-tuberculous, rapidly-growing, acid-fast, Gram-positive bacilli that have a tropism for fat.
  2. Atypical mycobacterial infections will almost always require a combination of surgical resection and prolonged antibiotic therapy – often fluoroquinolones. They typically will not respond to antibiotics alone. Surgery should be meticulous and thorough, concentrating on the removal of all affected skin and subcutaneous tissues – which are characteristically discolored.

On-Demand

 

Environmental Needs for Cats with DJD: Preserve Access to Promote Comfort, Dr. Margaret Gruen

  1. Environmental modifications are a key feature in the management of cats with DJD, and understanding their needs provides a framework for addressing them. Individual patterns and preferences exist, but providing safe spaces and opportunities for choice and control in their environment decreases stress and improves the quality of life.
  2. Because cats don’t display their full range of behavior in the clinic, owner engagement in looking for DJD pain and recognizing stress is critical in the management of these cases; tools exist (or can be developed) to help owners know what to look for and provide tips for environmental modifications.

 

Feline-Friendly Handling & Interactions: Evidence-based Techniques, Dr. Ilona Rodan

  1. Even if you have worked with cats for years – even in a cat-only practice – this presentation is for everyone and their veterinary teams, with evidence-based techniques to interact with and handle cats. The evidence proves that what is best for the cat is safer for us, more efficient, and enhances team satisfaction and client loyalty.
  2. The information is shared in ten steps to readily incorporate it into your practice whatever your current handling techniques. It starts and ends at home where the problems begin and end, taking you through the most efficient methods of working with both in-patients and hospitalized and boarding cats.

 

Hands-Free Radiology: Strategy, Training, & Implementation Ideas, Dr. Dennis Keith & Ms. Carolyn Spivock

  1. Elevate your radiation protection strategy by implementing Hands-Free Radiology as a way to bring all three ALARA principles to bear:
    • Time – Reduce retakes through training, sedation of appropriate patients, and proper equipment maintenance.
    • Distance – Emphasize passive restraint that allows the technician to step out of the room, or move at least 6 feet from the table.
    • Shielding – Hold everyone accountable for wearing appropriate PPE. Let your techs know that their safety comes first.
  2. Remember to have patience with yourself, your team, and the patients. Even with great training and communication, these techniques may take time for the team to learn, the hospital to adopt and the clients to understand. It is worth the time investment to improve team and patient safety and reduce the overall stress of all involved.

 

What About Cats? Rehabilitation Techniques for Feline Patients, Dr. Kristin Shaw

  1. The first step in developing a rehabilitation plan is to establish a diagnosis, and the first step in any plan is to manage pain. Cats show pain by changes in their behavior, activity, and personality, and these changes are best identified by the cat owner. Suggest that your clients keep a video log of their cat’s activity over their life so that they can notice subtle changes over time.
  2. Exercise is the foundation of rehabilitation. Exercise plans should mimic normal cat behavior (hunting, jumping) and multiple short bouts of exercise over the day can be more effective than a single 20-30 minute session. Cat owners can be instructed to create an obstacle course in their home. Some cats can benefit from hydrotherapy if there is a patient and skilled rehabilitation professional guiding the session.

 

Cats Gotta Scratch: The Case Against Feline P3 Amputation, Dr. Robin Downing

  1. 1.4 million feline euthanasias in shelters annually. At least half are behavior related with inappropriate elimination leading the list at 37 to 43% among reasons for relinquishment.  Destructive scratching is VERY low on the list.
  2. Onychectomy (feline toe amputation) has long and short-term complications, including pain, hemorrhage, soft tissue swelling, nerve trauma, infection, and lameness (Patronek 2001; Mission et al 2002).

 

Managing Chronic Pain Following P3 Amputation, Dr. Robin Downing

  1. Chronic maladaptive pain results from a cascade of events that includes altered anatomy (conformation), injury, inflammation, repetitive injury, and inadequate pain management early.
  2. Successful treatment of cats with chronic maladaptive pain means reframing the task to one of management rather than treat to cure.

 

Management of the Emergent Feline Patient, Mr. Harold Davis

  1. The initial patient assessment can potentially mean the difference between life and death. As a result, the primary survey (ABCDE’s of emergency care) can help one to approach all emergencies in a consistent, systematic approach. If a life-threatening problem is identified the resuscitation or treatment is initiated immediately, sometimes even before we have a diagnosis. Once the primary survey is complete then a secondary survey may be undertaken. That is, a timely, systematic, and directed evaluation of each body system for injury is performed. Injuries of a lower priority are addressed following initial stabilization. If you are not using some type of systematic approach to assessment, consider doing so.
  2. Fluid therapy plays an important role in the management of the emergency patient. Obviously, venous access is an important component to fluid therapy. We must be prepared for using alternative approaches for gaining access when confronted with difficult venous catherization. Examples include making a relief hole in tough skin, performing a venous cut down, using various catherization sites, or placing an intraosseous catheter placement. Once we have venous access one of two approaches will be used to administer intravenous fluids, the “shock dose” approach or the daily fluid therapy plan approach or a combination of both. In the “shock dose” approach we administer the shock dose in ¼ dose increments and reassess perfusion parameters, looking for a resolution in poor perfusion parameters. In the daily fluid plan, we administer a volume of fluids to correct dehydration, meet daily maintenance needs and replace abnormal losses. The veterinary technician plays a key role in all aspects of delivery and monitoring of the patient on fluids.

 

Nursing Management of the Urinary Obstructed Cat, Mr. Harold Davis

  1. The nursing process was used as a framework for this discussion. The nursing process can be applied to any patient care situation, especially complex cases. It is a method of making clinical decisions or a way of thinking and acting to a clinical event of concern to the veterinary technician / nurse. The nursing process provides an organized, systematic approach to solving clinical problems. Traditionally, the nursing process comprised five phases or components: assessment, nursing diagnosis (nursing conclusion), planning, implementation, and evaluation. Consider learning more about the nursing process and utilize in your nursing care.
  2. Veterinary Technicians play an important role in the delivery of patient care through our interactions with the client. We provide support, education, and guidance for the client, simply put, one of our roles is client education. We educate them about the continued care their pet/fur baby will need and how to best accomplish the care. We work to support a positive patient outcome.

 

Anesthetic Monitors: Understanding Their Use & Limitations, Ms. Heidi Reuss-Lamky

  1. Selection of an inappropriate cuff size is the most common source of errors.If the cuff is too narrow or too loose, the reading will be falsely high. If the cuff is too wide or too tight, the reading will be falsely low. Acceptable cuff locations include the forelimb, tail and hindlimbs, where the areas proximal to the carpus and tarsus work best. The ventral tail is a good choice in cats.
  2. It is important to realize that all patients experience some degree of hypotension during general anesthesia, and if the patient has pre-existing conditions that decrease blood pressure, hypotension will be exacerbated during anesthesia.

 

Who Needs an Anesthetic Plan? YOU DO!, Ms. Heidi Reuss-Lamky

  1. Careful pre-anesthetic assessments are essential to identify physiological, pathological, or drug-related factors that may complicate a patient’s anesthetic management. It is important to assess an ASA rating and consider and assess multiple factors prior to anesthetizing every patient.
  1. It is imperative to understand that surgical patients can be faced with life-threatening situations during the postoperative period. These patients may already have or develop hypoxia, hypothermia, hypotension, hemorrhage leading to anemia, emergence delirium, vomiting, or cardiac arrhythmias (possibly leading cardiopulmonary arrest), in the minutes and hours following surgery. Furthermore, postoperative patients should be frequently assessed for pain, and additional analgesic medications administered as needed.

 

Purr-fect Feline Anesthesia, Ms. Heidi Reuss-Lamky

  1. Obtain a good light source or laryngoscope to ease visualization of the feline laryngeal area during intubation. Never force intubation.
  2. 60% of fatalities occurred during first 3 hours of recovery. Greater patient monitoring and management during this time period is recommended

 

Anesthesia Mistakes Awareness, Ms. Heidi Reuss-Lamky

  1. Consider the use of a positive pressure relief safety valve to prevent barotrauma in feline patients. These can be utilized in both a circle and non-rebreathing circuit.
  2. Intra-operative monitoring documentation is imperative for optimizing all anesthetic procedures. In addition to allowing informed, flexible, and well-timed responses to changes in the patient’s status, it can also serve as a database for comparison prior to subsequent anesthetic episodes.

 

Pain Scoring for Dummies, Ms. Heidi Reuss-Lamky

  1. Evaluation for pain should be part of every physical exam. Ideal pain scoring scales would create minimal inter-observer variations, and incorporate factors such as the type and duration of surgery, severity of pain associated with the procedure, hospitalization, age, and concurrent diseases as well as individual variability.
  2. Pain assessments for cats should include both undisturbed cage observations and reactions associated with gentle handling techniques and wound palpation. Behavioral markers associated with discomfort may include a hunched posture or splinting of the abdomen, anorexia, lowered head position, growling, closed eyes, hiding or reaction to palpation, but facial expression changes such as furrowed brow, squinted eyes, whisker positioning or ear tip distance are currently under investigation (see Feline Grimace scale). Cats in severe pain are usually depressed, motionless, and silent

 

Detecting Feline Chronic Pain, Ms. Alison Gottlieb

  1. Any feline behavioral issue should be evaluated and treated for pain. 
  2. Detecting feline chronic pain is a challenge but possible.

 

Treatment of Chronic Pain, Ms. Alison Gottlieb

  1. Have a multimodal plan and support owners through it. 
  2. Euthanasia should be considered when pain can no longer be alleviated. 

 

Feline Chronic Pain: Getting Cat Owners on Board, Ms. Alison Gottlieb

  1. As a profession, we need to educate each other and owners. 
  2. We need to teach owners what to look for and support them through the process. 

 

Feline Nursing Care for the Hospitalized Patient, Ms. Alison Gottlieb

  1. Everything should be aimed at reducing stress, get creative and give gabapentin.
  2. Stressful and detrimental practices (force feeding, pulse ox awake) should be avoided, as nurses we need to be their advocates.