Freddy is a now 3-year-old MN Maine coon. Shortly after the owner acquired him from the breeder at 12 weeks of age, he was showing signs of ill thrift, including poor body condition, no weight gain and poor appetite.

Fred developed a head tilt and liver enzyme elevations at 6 months old. He was referred to an Internal Medicine specialist for further workup. He was having trouble eating and had a right-sided head tilt and a wide stance /ataxic gait.

He underwent additional bloodwork to look for a cause and had a CT scan, primarily looking for a reason for his failure to thrive. Nurses putting him under GA for imaging had to balance a safe anaesthetic protocol for both a neurological patient and also a young patient. Anaesthetists were consulted. CT showed brain changes found with CNS FIP. He was started on a nucleoside analogue, Remdesivir, IV for 5 days then transitioned to oral GS-441524 for 80 days. Nursing for Freddy was more intensive to start as he was having trouble moving around and using his litter box. Nurses had to make sure he kept clean, as well as offer different foods to tempt him to eat. Mentation was closely monitored as well. IV catheter care was important to make sure his IV doses of remdesivir weren’t going SC.

5 days later he was transitioned to oral medication and discharged, eating well and walking normally. 2 days after discharge a possible seizure was noted and then further neurological deterioration was seen. Freddy was re-hospitalised and started back on injectable Remdesivir as well as oral Prednisolone. Again nursing care for Freddy involved closely monitoring his neurological status and reporting any changes seen, keeping his IV catheter patent so he could receive his IV drugs and making sure he was taking his oral medication.

Freddy was discharged home again after 7 days of IV and 3 days of SC remdesivir. He was started on a bit higher dose of GS and was sent home with a tapering dose of Prednisolone.

Its that emergency that all ways comes in when you are short staffed, you have a full hospital and near the end of your shift. In this case a 7 year old male neutered German Shepherd Dog presented after hours to emergency for non productive retching a hard stomach and wanting to lie down. The patient had an initial triage and a TPR performed. The patient initially presented quiet alert and responsive, HR of 160, with no heard murmurs of arrhythmias. Respiration was panting with clear, lung sounds. On abdominal palpation the patient was tense, painful and tympanic on percussion. The remaining clinical examination was unremarkable. The patient blood work showed a PCV 48% which was with in a normal range of 35%-45%, TP 70 (normal values range from 6.5-8.0gm/dl), Glucose 6.8mmol/L, Lactate 1.7mmol/L and APTT 138sec; all other blood work was with in a normal range. At this point the patient had a once of dose of intramuscular opioid for analgesia. After this the patient had a large bore catheter placed in the cephalic vein, was stabilised with intravenous fluid bolus'. After a quick AFAST the patient had a single right lateral radiograph performed to confirm GDV. GDV patients can present in respiratory distress due to the pressure of the stomach pressing on the diaphragm, oxygen was supplemented to the patient while heater was being prepped for surgery.. The stomach was decompressed via percutaneous trocarisation method. GDV is an acute ilife threatening condition that mostly affects large breed dogs and is the enlargement of the stomach and rotation of the mesenteric access. With owner consent the dog was taken to surgery. The patient was pre medicated with a once of bolus of fentanyl and induced with propofol and maintained on an FLK CRI with maintenance anaesthetic isoflurane. Surgery was performed by the veterinarian where the stomach was de rotated and a gastropexy performed. In this case the spleen was well and remained. The patient was stitched up after flushing the abdomen and the patient was taken o recovery. After 24 hours in hospital care, after the dog had recovered and commenced eating the patient was discharged home. With appropriate care, quick acting and stabilisation, the willingness from the owner to perform surgery a GDV can be a very rewarding emergency patient that presents to the emergency department after hours.

Medicine: AGASACA (anal sac adenocarcinoma)

Signalment: Leo - Canine - Male Neutered - Labrador x - 9 years - 14.2kg

Reason for presentation:
Leo’s owners reported difficulty defecating and visual swelling in the perianal region with the discovery of a lump during rectal examination by his regular veterinarian. Surgical removal of bilateral anal sacs revealed a small tumour in one, which was sent for histopathology.
Diagnosis of the tissue sample confirmed AGASACA and at the request of Leo’s owners, a chemotherapy protocol was prepared by Veterinary Oncology Specialists.

Purpose of chemotherapy:
Chemotherapy was selected for palliative purposes and to reduce recurrence of tumour to surrounding tissue. Being fear aggressive Leo presents a challenge therefore a sedation plan has been implemented to manage concerns surrounding delivery of a cytotoxic drug and the safety of staff involved. Leo’s VOC chemotherapy protocol for managing anal sac adenocarcinoma is Doxorubicin.

Preparation:
Due to fear aggression the reduction of external stressors for Leo is crucial, therefore consistency of care involved his primary medicine specialist, medicine resident and medicine oncology nurse. Leo’s owners administer Trazadone 250mg PO 2hrs prior to his appointment which provides enough sedation for compliant physical examination (PR) and blood sample collection to determine if chemotherapy is able to proceed. Chemotherapy may only proceed if Leo’s neutrophil count is >3.0x109 /L

Discussion:
If blood test results determine chemotherapy will proceed Leo's sedated with Medetomidine at 0.002mcg/kg IM. Once sedation's been achieved Leo’s owners leave, enabling IVC placement and preparation for delivery of his chemotherapy. Doxorubicin dosage is determined by Leo’s current weight using a body surface area calculation (Body surface area in m2).
PPE is worn throughout handling of chemotherapy to reduce risk of exposure in the case of a splash of spill. Doxorubicin is drawn up and delivered with NaCL 0.9% solution using a closed system transfer device as a CRI over a 20 minute period. On completion of chemotherapy Leo’s sedation is reversed with Atipamezole at the same dose rate as his sedation.

Conclusion:
Leo continues to tolerate his sedation and chemotherapy protocol well with his owners reporting lethargy to be his most reported side effect. While successful remission of AGASACA using chemotherapy has not been proven to improve survival, it may provide some benefits. Our ongoing focus is Leo’s palliative care by provision of managing pain with analgesia, antiemetics to control nausea and probiotics to manage and prevent gastrointestinal upsets.

Zelda, a 1yr 8m female Doberman, presented for a planned laparoscopic spey and prophylactic gastropexy. She had previously been diagnosed with Type 1 von Willebrand disease (vWD).

Type 1 vWD is an inherited platelet disorder characterised by a deficiency of von Willebrand Factor (vWF). Type 1 vWD is not associated with spontaneous bleeding, but results in prolonged, excessive bleeding after trauma or surgery that can be life-threatening. Normal vWF antigen (vWF:Ag) activity is above 75%. Zelda had a baseline vWF:Ag activity of 13%. Any surgical procedures in a patient with vWD should be undertaken with extreme care and pre-planning, ideally in an environment where vWF:Ag can be monitored and blood products are on hand.

Due to the severity of her disease, peri-operative management of her vWF deficiency was overseen by the lead criticalist, Dr Claire Sharp, and Zelda.
Zelda was admitted the day before surgery for pre-treatment with fresh frozen plasma (FFP) at a little over 1 unit per 10kg body weight as per standard recommendations, with the goal of increasing her vWF:Ag activity to safe levels before surgery. On the day of surgery, despite prior FFP, her vWF:Ag activity was 8%. So an additional 3 units of FFP, and desmopressin (a medication that increases release of vWF into circulation), were administered prior to surgery. Despite this pre-treatment Zelda had significant ooze during surgery and further FFP was given post-operatively. Zelda had new abdominal haemorrhage overnight and required ongoing blood products, including packed red blood cells (pRBC), to maintain cardiovascular stability.

The following day, due to ongoing bleeding, the decision was made to take Zelda back to surgery; this time a full laparotomy to improve surgical control of haemorrhage. Further blood products including fresh whole blood and FFP, as well as more desmopressin, were given perioperatively. Significant bleeding was present from the falciform fat, and a tiny defect in the splenic capsule, so the falciform fat was removed and a splenectomy performed. Abdominal blood was aseptically collected and autotransfused. Post-operatively serial monitoring of vWF was performed, and further blood products given. Zelda’s transfusions of FFP, pRBC, FWB and autotransfusion, totalled 28 units of blood products and 1L of her own blood; well and truly qualifying as a Massive Transfusion.

Once the bleeding had stopped, Zelda spent several more days in the ICU, managing her fluid balance, ileus, polyuria and pigmenturia secondary RBC breakdown. She was discharged home after 8 days.

Radiation therapy is used as one of the options to treat cancer. With the recent advanced technology - the TrueBeam Linac, more cancer types and locations can be treated with far less side effects compared to the conventional Linac. Introduction of the TrueBeam Linac, how different it is and how it made impossible possible will be mentioned in this presentation along with a few cases. Some radiation planning terminology will be explained to broaden knowledge of people who have never been involved with veterinary radiation therapy treatment.

“Bandit” presented to the hospital on the 4th of May minimally responsive, with swelling around his face and neck. The owner informed doctors he had found a snake in the garden (snouted cobra (Naja annulifera), neurotoxic venom). He presented with the following parameters: temperature of 38.6 °C, heart rate of 126 bpm, respiratory rate of 32 brpm, severe lung sounds heard. “Bandit” was given 2 vials of anti-venom intravenously over a period of 30 minutes, he was induced with propofol and intubated, he was maintained on a propofol CRI at 9mL/kg/hour and put onto a mechanical ventilator. On 5 May 2021, when the doctors were removing the urinary catheter, they found that it was stuck, “Bandit” was induced and intubated once again for radiographs where they found the urinary catheter to be knotted and kinked within the bladder. The ins and outs of the anaesthetic that followed is discussed.

This document outlines a novel pet food rating system addressing the limitations of existing ingredient-based rating systems. Current systems rely heavily on ingredient lists, which can be manipulated to present products more favorably. The proposed system provides a non-biased evaluation of pet food products by considering a holistic range of factors that reflect their nutritional value, manufacturing processes, quality, and intent.

Objective:
The goal is to offer consumers a clear and reliable means of assessing pet food products before purchase, thereby increasing trust, transparency, and integrity in the pet food industry.

Key Elements:

Complete & Balanced Claims: Evaluates if a pet food product meets essential nutritional requirements set by regulatory bodies (AAFCO, FEDIAF, NRC) through formulation, laboratory analysis, or life stage feeding trials. Products undergoing life stage feeding trials receive higher ratings.

Manufacturing and Quality Standards: Considers adherence to GMPs, quality standards, and HACCP implementation, whether accredited or not. Brands that outsource manufacturing score lower as they often lack oversight and accountability.

Product Performance Criteria: Assesses a pet food’s impact on pet health, including palatability, digestibility, stool quality/output, and long-term feeding trials. This provides insights into real-life product performance and manufacturer commitment.

Scientific Credentials: Evaluates the scientific basis of pet food claims, distinguishing between soft science (general literature) and hard science (specific benefits, target species data). Also considers energy density calculations and feeding guide accuracy.

Ingredients Analysis: While still important, less emphasis is placed on the ingredients list due to common marketing tactics. Instead, it evaluates ingredient quality, sourcing transparency, and suitability for the target pet species.

Rating System:
The system employs a straightforward 5-star scale, allowing customers to quickly understand the overall quality of a pet food product without delving into complex details. This empowers customers to make informed decisions based on a comprehensive assessment of nutritional value, manufacturing integrity, performance, scientific credibility, and ingredients.

Conclusion:
The proposed rating system shifts from ingredient-based evaluations to a comprehensive, objective approach, addressing the pitfalls of current systems. It equips customers to prioritize their pets' well-being through informed purchasing decisions and applies to all pet food formats (raw, processed, wet, semi-moist, air-dried, freeze-dried, or dry).

This comprehensive system promises a significant improvement over existing rating methods, fostering greater consumer trust and enhancing the overall quality and transparency in the pet food industry.