The VETgirl TEAM, Dr. Justine Lee and Dr. Garret Pachtinger, just returned from the Hill's Global Symposium in Washington D.C. From working dogs to the White House to renal disease in dogs and cats, this was an amazing event featuring renowned veterinary experts from all over the world.
If you were not able to attend this amazing 2-day veterinary symposium, the VETgirl team is here to give you some important pearls of wisdom that we took home with us!
- In the emergency situation, we have been taught to use the ABCD triage protocol (e.g., Airway, Breathing, Circulation, Disability). On the battlefield, however, medical professionals take a slight twist to this assessment tool, using the MARCH protocol (specifically the M2ARCH protocol) which stands for Massive hemorrhaging / Muzzle, Airway, Respiration, Circulation and Hypothermia. This casualty assessment allows the military to perform rapid patient assessment and minimize morbidity and mortality.
- With disease (such as renal disease) as well as age, we see patients develop sarcopenia (which means that they lose muscle mass). The loss of muscle mass is not just a change in physical appearance, rather the loss of muscle mass has been associated with an increase in morbidity. Specifically, when a patient loses more than 30% muscle of their muscle mass, they are at an increased risk of disease including pneumonia, cardiovascular disease, and even an increased risk of death! This is why there is such an intense focus on the importance of nutrition, particularly in our renal disease patients.
- Many speakers discussed not only the importance of renal disease, but rather, the emphasis on the early detection of renal disease. Traditionally, we see patients develop polyuria and polydypsia when they lose 66% of their renal function and azotemia (elevation in BUN and creatinine) when they lose 75% of their renal function. With this standard testing, veterinary professionals catch renal disease at the stage 3 or 4 of IRIS classification. It is difficult to manage stage 3 or 4 patients (who have proteinuria, activation of the RAAS system, retention of phosphorus, and oxidative stress) as they have advanced disease by that time. With the advent of the SDMA test, we are now better able to diagnose renal disease earlier in stage 1. This allows early recognition and early treatment.
- The SDMA test has been shown to be elevated in dogs 9.8 months before creatinine elevation in dogs and 17 months before creatinine elevated in cats. This allows the veterinary team to consider early intervention and therapy months before they would have with the traditional renal value testing.
- Using the SDMA test, the concern for renal disease is present when the result is greater than 20 ug/dL. If the value is between 15-19, this is a grey zone and requires the clinician to IMM (investigate, manage, monitor). This may include repeat diagnostics (e.g., CBC, chemistry, SDMA, urinalysis, urine culture, etc.) within several weeks.
- If you have a patient that is showing signs of anemia secondary to renal disease (e.g., due to lack of erythropotein), darbepoetin may be a medication to consider. Darbepoetin is a recombinant human erythropoietin analog, shown to be longer acting as compared to erythropoietin. It is given less frequently (once weekly). In cats, use of darbepoetin showed an increased survival from 283 days as compared to 83days with human erythropoietin.
- Using appetite stimulants or anti-emetics in cats? You may need to brush up on your dose and/or frequency of administration guidelines! Mirtazapine in cats is a great appetite stimulant, but may need to be given more frequently than once every 3 days as previously thought. If it is not working once every 3 days, try a lower dose (1/8 of a 15 mg tablet) once per day for healthy cats. However, in cats with renal disease, dosing every 3 days is still recommended. As for anti-emetics, VETgirl's favorite antiemetic is maropitant due to it's potency and safety. However, there are some out there that still use ondasetron or dolasetron. Ondasetron has a poor bioavailability and likely needs to be given 3, if not 4 times a day in our feline patients. Dolasetron, as well, likely needs to be given twice daily to have a notable benefit.
- Not social media SAAVY? This is the time to get on the social media train! Several speakers discussed the importance of visible and mobile friendly websites, branding on social media (notably Facebook), and interaction with your millennial clients.
The VETgirl team was excited to be part of this amazing symposium. If you missed it and want some more awesome tips and info...CLICK HERE to watch the full presentations of the lectures and receive CE credit!
As always, keep on learning!
Garret and Justine
The fine print: This blog, along with the video content (e.g., including Facetime LIVE, 411 summaries of the conference) and social media promotion was sponsored by Hill's.