Sarah Keir's Groups Activities

Sleep apnoea associated with CHF due to MMVD?

Holly Lee — Wed, 22 Sep 2021 06:52:32 GMT

Hi all,

I would appreciate any cardiology opinions on the following.

10yo CKCS been on pimobendan for 12 months then tipped into CHF. When this happens she developed marked URT noise which settled when furosemide was initiated. Lung ultrasound confirmed she had pulmonary oedema at the time and there is no sign of this now but she is better on TID furosemide (1mg/kg TID).

I had been assuming the URT noise was due to some BOAS type issues with her being CKCS which had been exacerbated by the increased respiratory effort of tipping into CHF, which fitted in with this reducing when we increased her back from BID to TID furosemide.

However the owner has now mentioned to me that she has episodes during sleeping where she will stop breathing for around 15 seconds, and her heart rate slows during this time. The owner is VERY vigilant about monitoring resting RR which are stable around 24-48bpm; HR at home is typically around 130bpm.

My first thought was that it was a sleep apnoea type issue due to some upper respiratory narrowing, probably an overlong soft palate. However I came across one experimental study suggesting that pulmonary hypertension could cause a sleep apnoea or irregularities in breathing during CHF. I don't have the skill to assess pulmonary hypertension on ultrasound and funds for a specialist scan may be limiting.

Has anyone any experience of these signs? Any thoughts as to whether it's cardiac or unrelated trigger?

The complicating factor is that she now needs a dental, which is an anaesthetic concern but allows us to assess her upper airways some more. My thought is how much I need to prioritise getting a specialist echocardiography referral prior to this.

Thanks for any thoughts,

Holly

Medicine Society (SAMSoc) Autumn Meeting

Sarah Keir — Mon, 04 Oct 2021 12:45:52 GMT

Hi All,

It is only just over 4 weeks until the SAMSoc Autumn meeting on Wednesday 3rd November so if you've been putting off buying your ticket, now is the time to do it! This is a virtual meeting so no need to travel to a venue.

We have a fantastic and varied programme for you including a look at the new kid on the block 'Brucella canis', an update on the feline pancytopaenia investigation from the group at the RVC, a presentation on the emerging infectious disease of Bartonellosis from Professor Breitschwerdt from the USA, chronic pain in medicine cases by Matt Gurney, an update on myesthenia gravis and a look at imposter syndrome and perfectionism.

The whole day meeting is only £60 for members and £100 for non-members; it costs £29 to become a member for a year. SAMSoc is a BSAVA affiliated group that supports interests in internal medicine for everyone.

For more details and to book go to https://www.samsoc.org/meetings/2021-autumn-meeting

We also have a poster competition so if you have any unusual or interesting case reports or research then please consider entering - there are cash prizes. Entries only require a digital poster and a 3 minute pre-recorded presentation and shortlisted candidates will be get free registration for the full day. For the poster competition see https://www.samsoc.org/competitions/call-for-autumn-2021-poster-entries

Autumn Meeting and poster competition

Sarah Keir — Mon, 04 Oct 2021 12:44:25 GMT

It is only just over 4 weeks until our Autumn meeting on Wednesday 3rd November so if you've been putting off buying your ticket, now is the time to do it!

The whole day meeting is only £60 for member and £100 for non-members; it costs £29 to become a member for a year. SAMSoc is a BSAVA affiliated group that supports interests in internal medicine for everyone.

For more details and to book go to https://www.samsoc.org/meetings/2021-autumn-meeting

Alpaca and TB testing

Mike Dale — Sun, 08 Aug 2021 07:32:28 GMT

Long time since I wielded TT syringes. Can someone explain to me what is the fair scientific solution to this situation? People keep asking me because I'm a vet but I don't have current knowledge to give an opinion.

Which Ophthalmoscope ?

janine redman — Sun, 12 Sep 2021 19:27:17 GMT

Looking at purchasing an ophthalmoscope , what’s the difference between 3.5 and 2.5 mv ?
any advice on desk top charger , USB charger , ordinary batteries etc

thanks

Re: [SAMSOC Forum] Medicine consultancy with peripatetic ultrasound

Sean Henney — Tue, 14 Sep 2021 21:06:00 GMT

Hi Sarah

Have you thought about contacting VDS to discuss the PI pitfalls of offering a medicine opinion?

Sean Henney

From: Sarah Keir <bounce-sarahandjim@vetsurgeon.org>
Sent: 14 September 2021 19:35
To: samsoc.forum@vetsurgeon.org <samsoc.forum@vetsurgeon.org>
Subject: [SAMSOC Forum] Medicine consultancy with peripatetic ultrasound

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Sarah Keir

I'm setting up as a peripatetic ultrasonographer and will use my medicine hat with this too to help advise the vets who have cases they would like me to scan. I have been advised to keep the medicine consultancy/advice out of the ultrasonography service, though this was by someone who soley did peripatetic ultrasonography. Can anyone think why it might be a good idea to keep separate? I'm thinking it is a good USP - not just a report on lumps but what the vet could do about it. I'm not sure how I could do a peripatetic medicine service. Is anyone willing to chat to me/message me about this?

Thank you in advance,

Sarah

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Medicine consultancy with peripatetic ultrasound

Sarah Keir — Tue, 14 Sep 2021 18:34:51 GMT

Thank you in advance,

Sarah

Help with ideas to approach to persistent anal gland infection

Yantha Smyth — Wed, 28 Jul 2021 06:52:01 GMT

Hi everyone,

I have a 2yo Poodle, ME, who presented a few weeks ago with distress around rear end after a bout of diarrhoea. He had essentially become obstipated by a big ball of faecal matter stuck to anus with the fur. The anal glands both had fluorescent green purulent discharge. The GI upset resolved, and the sore anal region settled down, but both glands still have signs of infection and intermittent scooting in spite of 3 weeks of antibiotics amoxyclav, and weekly expression to monitor content.

Last week I took a swab for culture, flushed the glands and instilled some flamazine. Swapped the amoxyclav for Stomorgyl The culture result has returned ‘normal flora and mixed anaerobes’ so not especially helpful.

I am wondering what to do from here. The owner reported a scoot episode yesterday- once in about a week. Due to see again today/tomorrow. No signs of allergic skin disease otherwise, peri-anal skin appears normal too. Diet is jumbled and he does have waxing/waning GI signs on and off.
Recent bloods and ACTH stim to rule out Addisons normal.

My thoughts include

- steroids?

- apoquel?

- dietary trial? GI biome….hypoallergenic…

- add profibre?

Many thanks for any input/suggestions. I must have been lucky until now with these resolving uneventfully at the first stage.

Yet another new vet school!

Stephen Pointing — Fri, 28 May 2021 19:33:03 GMT

Having managed with 6 vet schools until about 2000 when Nottingham arrived on the scene I see in today's news that there is a plan for a new vet school to be established in Aberdeen. That will mean almost a doubling of vet schools since the beginning of this century. Is such an increase necessary or justified? Will there be enough jobs for all the graduates? Perhaps this is a good time to be retiring.

CGU? Not Line of Duty.....

Helena Rymaszewska — Mon, 10 May 2021 18:36:30 GMT

https://www.thetimes.co.uk/article/how-city-fat-cats-have-turned-your-local-vet-into-a-cash-generating-unit-x2bxtchwp?shareToken=6d8cf51bd302ba89775ef34fca540ae8

so IVC see vet practices as Cash Generating Units ?????????

PLN treatment

Rebecca Martin — Thu, 20 May 2021 13:23:14 GMT

I have a 9yo FN Bichon Frise with IRIS stage III/IV, pre-hypertensive (BP 155mmHg), proteinuric (UPC 3, inactive sediment, checked on a number of occasions) CKD.

Clinically stable, eating renal food well. The only other issue is moderate periodontal disease (that I am debating whether to do a dental on...)

A slow gradual, step-wise, increase in benazepril (to 1mg/kg BID) failed to influence the UPC whatsoever.

I have introduced telmisartan (approx 0.75mg/kg SID) twice over the past week, however, on both occasions, vomiting and diarrhoea has been seen within 12-24h of treatment administration, which has resolved with supportive treatment.

What next? Enalapril trial? Combine the 2 former drugs at lower doses of each?

Do the dental sooner in case this is implicated in the increased UPC?

Thanks in advance,

Rebecca.

VetSurgeon Zoom: IR35, locums and umbrella companies

Arlo Guthrie — Wed, 21 Apr 2021 09:40:45 GMT

[quote user="Francisco Gomez"]I want Zoom![/quote]

Tangent of: RE: Locums & IR35 & heated discussions online

OK let's try this out.

Let's hold the first VetSurgeon.org Zoom meeting, on the subject of IR35, Locums and umbrella companies.

First, I need to know who you would like to attend. An accountant / tax specialist? Someone from one of the corporates to explain the challenges at their end? (might be difficult, but I can ask). Anyone else?

And what subjects would specifically would you like to discuss, or questions you would like to get and answer to.

Also, any preference for time of day or day of week?

Corporates, locums, IR35 and umbrella companies.

Arlo Guthrie — Sat, 10 Apr 2021 07:51:10 GMT

What are everyone's plans now that some corporations have responded with a blanket rule refusing to contract with locums other than through umbrella companies, or as employees, even when they run the gov.uk test and come out fine?

Hypoallergenic diets - Purina HA

Neil Wheadon — Tue, 13 Apr 2021 12:58:02 GMT

Help

I'm unfamiliar with Purina HA

I have a dog that needs a food trial for allergic dermatitis

Recommendations? I'm in an IVC practice

Thanks in advance

Neil

Idexx (DX Catalyst machine) issues

Julie Innes — Thu, 22 Apr 2021 14:34:31 GMT

I'm not happy. I have an Idexx DX catalyst and lasercyte machine, purchased around 4 or 5 years ago (sadly no option to lease) . Recently we had an issue with the sample drawer not locking- it's not a hard fix, there is a you tube video that shows you how to put the bar back in place, but it came to the point where we were having to fix it every time we wanted to use it. So we called Idexx asking if we needed a new part etc. Key issue here: we don't have a maintenance contract, and I really resent these on principle. I don't buy extended warranties for anything I buy, as I prefer to take the risk and accept that if a problem/ issue arises I will need to pay to fix it. I prefer to pay for actual faults/ parts than a random specified amount.

Idexx did some kind of remote update yesterday after we called them, and now the bloody machine won't work at all- it has a new issue, and apparently can't carry out any of the checks it needs to in order to run. Called them today to politely ask if they could undo what was done yesterday, so that we could at least use it. Apparently not. Can someone come out and take a look at it (I'm thinking the non-locking issue is a mechanical (minor) issue. No. Not unless I want to take out a 3 year maintenance contract. If I take out a 3 year contract (c. £1500 in total) they will give me another (probably refurbished) machine. I explain I don't want a maintenance contract, I just want someone to come out and look at it, happy to pay for that. Not possible. Ok, then maybe I'll get an electronic engineer out to look at it. Apparently that's "not allowed" (???) The only other option is for me to hand over £1500 and they will give me a refurbished machine, which isn't really what I want.

2 points really to this post

1. anyone any idea of who other than Idexx might be able to look at the machine and advise? (Even though its "not allowed- will I get arrested??)

2. Is this right that there is no option to pay as you go for faults? Is it so archaic of me to want to pay only for the faults we have rather than all the faults we might have, whether that might end up more expensive or not?

or any other experiences/ ideas/ suggestions (including throw the bloody thing out of the window and look at other options)?

And breathe ....