Gianluca Bini, DVM, MRCVS, DACVAA, explains how to manage medications for veterinary patients before they go under anesthesia

Video interview with Dr Bini

When patients are coming into the clinic for a procedure that requires anesthesia, there is a chance they could be on other medications. While some are safe to have in their system during anesthesia, there are some that can do more harm than good. 

During this interview with dvm360 on his lecture's presented at the Fetch Kansas City Conference in Kansas City, Missouri, Gianluca Bini, DVM, MRCVS, DACVAA, explains what current guidelines say about medications and anesthesia, plus preparing your client service representatives to help communicate which drugs are safe, and which are not, with clients. 

 So some of these patients may come in with, and this is not all of them, but some of them may come in with some drugs that may affect the RAS systems, so like benazopril and alpril and misarter and all of those, the AAHA guidelines from 2020 forestation drugs and cats recommend to discontinue those. There are reports of untreatable hypertension when these drugs were given in the morning before anesthesia. So it's really important that we pay close attention to what a patient is coming in with. 

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Gianluca Bini, DVM, MRCVS, DACVAA, discusses the importance of monitoring medications patients are taking before going under anesthesia to determine if it is safe or not.

Managing medications prior to anesthesia

Veterinary parasitology is key to animal health, focusing on parasites that harm the wellbeing of companion animals, livestock, and wildlife. Constant developments in diagnostics, treatment, and prevention methods—like vaccines and targeted therapies—are enhancing parasite management, ensuring better animal welfare. 

Check out the following 3 articles on recent developments in parasitology, including an experimental vaccine to protect honeybees, an Elanco parasiticide that advanced to final FDA administrative review, and a new method of controlling tick populations.

Vaccine in development against deadly honeybee pathogen

: Deformed wing virus (DWV) is recorded in more than 90% of honeybee colonies worldwide. The virus causes deformed wings, which can affect honeybees’ mobility, and result in death. A study by Dalan Animal Health, Inc, has shown extremely promising results for a vaccine that protects against the most common variant of the virus.

Credelio Quattro advances to final FDA administrative review

: Elanco announced Credelio Quattro has completed all major and minor technical sections with the FDA and has moved into the final 60-day administrative review. The parasiticide is expected to seek approval for indications that would give the product coverage for fleas, ticks, heartworms, and internal parasites.

Study uncovers new method of controlling tick populations

: Ticks, as blood-feeding arthropods, have a diet that is naturally deficient of essential B vitamins. Researchers from the Hebrew University of Jerusalem in Israel discovered a way to take advantage of this natural deficiency to control tick populations and, in turn, tick-borne diseases.

Don’t miss these 3 articles covering recent developments in veterinary parasitology

3 must-reads on developments in parasitology

Brennen McKenzie, VMD, MSc, MA, discusses how metabolic dysfunction impairs health in aging canines

Understanding metabolic dysfunction

Brennen McKenzie, VMD, MSc, MA, discussed common metabolic changes that are risk factors for disease and declining health in canines, in an interview with 

®. A clinical practitioner, he is also director of veterinary medicine for biotechnology company Loyal, which is developing therapies to extend healthy lifespans in canines.

McKenzie was speaking today about metabolic dysfunction and common mechanisms that lead to aging as a presenter at the 2024 Southwest Veterinary Symposium in Fort Dallas, Texas. The talk also addresses interventions that can help prevent health decline in canines.

A partial transcript of the interview is as follows:

: So, metabolic dysfunction is one of the ways in which aging makes us more vulnerable to disease and disability and health problems and, ultimately, to mortality. And we think it's a particularly important component of aging because it's modifiable. It's something we might be able to change in order to extend health and lifespan.

The basic components of metabolic dysfunction are changes in insulin sensitivity and the levels of insulin in the blood, changes in adipose tissue—how much of it there is, where it's located, the kind of metabolic functions that it's pursuing, and the impact of that on health. And then changes in blood lipids; things like cholesterol and triglycerides and fatty acids. The last one is particularly interesting, because we tend to ignore those in veterinary medicine, our patients don't get atherosclerosis and don't have, MIs and strokes, the way that humans do.

But it turns out that changes in all 3 of those things, in insulin and adipose tissue and blood lipids, are really important risk factors for disease and for health outcomes in older dogs. So metabolic dysfunction is this aging related change in all 3 of those things, and we've done some interesting research connecting those biomarkers to actual clinical outcomes, which is something that's new.

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Brennen McKenzie, VMD, MSc, MA, discusses how metabolic dysfunction impairs health in older dogs, in a dvm360 interview.

Understanding how metabolic dysfunction affects canine aging

The feline gut microbiome, a collective term that refers to the communities of microorganisms residing in the gastrointestinal tract of cats, has become an area of growing interest and research in veterinary medicine. Felines possess several unique gastrointestinal traits distinct from other companion animals. Cats are obligate carnivores and their taste buds are responsive to amino acids, but not sugars.

 They have a shorter digestive tract relative to their body length and lower food retention time than dogs, as well as a less-developed cecum.

The pH of a cat’s stomach is highly acidic, ranging from 1 to 2, which is important for the breakdown of proteins and the eradication of pathogens.

 Cats also possess higher levels of proteolytic enzymes, such as pepsin, which optimize protein metabolism.

 They are notably deficient in amylase, rendering carbohydrate digestion less efficient when compared with canines and other animals with higher amylase activity.5 However, multiple studies have shown that cats are capable of digesting properly processed carbohydrates with over 90% digestibility.

 Further research into the ability of a cat to metabolize different macronutrient compositions has shown that cats, like other mammals, can adapt their nutrient metabolism in response to dietary changes.

Although they are obligate carnivores, cats still possess a rich gastrointestinal (GI) microbiome capable of fermenting nutrients, such as carbohydrates, in their hindgut. This article will explore the role of some of the different bacterial species of the cat GI microbiome and their role in feline health and disease.

Want to learn more about the microbiome? 

Check out dvm360's microbiome resource center

A healthy feline gut microbiome is diverse and balanced. Key bacterial phyla include Firmicutes (36% to 50%), Bacteroidetes (24% to 36%), Actinobacteria (4% to 7%), and Proteobacteria (11% to 12%).

 The abundance and function of each of these phyla are influenced by multiple factors, including age, breed, diet, living environment, and other environmental exposures.

 Below are some specific genera and their functions within the feline gastrointestinal tract:

: These bacteria are known for their role in fermenting lactose to produce lactic acid, thus helping to lower the pH of the gut, which inhibits harmful bacteria. They also contribute to the overall health of the intestinal lining and support the immune system.

: This genus includes both beneficial and pathogenic species. Beneficial 

 species help in fermenting complex carbohydrates and producing short-chain fatty acids (SCFAs), like butyrate, which are crucial for colon health.

 species are efficient at breaking down complex molecules like polysaccharides. They produce SCFAs, primarily propionate and acetate, which serve as energy sources for colonocytes and have anti-inflammatory properties.

: Known for their role in carbohydrate metabolism, 

 species help break down dietary fibers as well as produce SCFAs.

: These bacteria are essential for the fermentation of dietary fibers, leading to the production of SCFAs like acetate. They also play a pivotal role in modulating the immune system and preventing the colonization of pathogenic bacteria.

): While often associated with pathogenic strains, nonpathogenic 

 strains are part of the normal gut flora and contribute to vitamin K synthesis and the competitive exclusion of harmful bacteria.

: This species degrades mucin, playing a significant role in maintaining the gut barrier and immune modulation.

The balance of these bacterial populations is crucial for maintaining gut health. Dysbiosis, or the imbalance of gut microbiota, is linked with various diseases in cats, including:

Chronic inflammatory enteropathies (CIE):

CIE is a chronic inflammatory condition characterized by persistent GI symptoms. Studies show that cats with CIE often exhibit a reduced diversity of gut microbiota, particularly a decrease in beneficial firmicutes, lactobacilli and bifidobacteria, and an increase in pathogenic genera staphylococci spp, streptococci spp, 

 spp microorganisms, as well as the fungi 

 The altered microbial composition can contribute to chronic inflammation, diarrhea, and malabsorption.

Acute and chronic diarrhea in cats has been linked to dysbiosis. The overgrowth of opportunistic pathogens like 

 and a decrease in beneficial bacteria is commonly seen.

Cats with CKD had a significantly decreased fecal microbial richness and diversity as well as increased uremic toxin production.

 These disturbances further worsen renal dysfunction and increase systemic inflammation.

Like in other species, the gut microbiota in obese cats tends to differ from their lean counterparts. Obese cats have a significant reduction in microbial diversity as well as a decreased ratio of firmicutes to bacteroidetes. Pathways related to fatty acid synthesis are significantly more prevalent in the microbiomes of obese cats compared to those of normal-weight cats, which may influence nutrient absorption and fat storage.

The GI microbiome of cats, primarily consisting of firmicutes, bacteroidetes, proteobacteria, and actinobacteria, plays a vital role in health and disease. Understanding these microbial populations holds significant promise for treating various feline diseases, particularly those involving chronic GI inflammation and metabolic disorders.

Bradshaw JW, Goodwin D, Legrand-Defrétin V, Nott HM. Food selection by the domestic cat, an obligate carnivore. 

. 1996;114(3):205-209. doi:10.1016/0300-9629(95)02133-7

Griffin S. Feline abdominal ultrasonography: What’s normal? What’s abnormal? The diseased gastrointestinal tract. 

. 2019;21(11):1047-1060. doi:10.1177/1098612X19880434

Telles NJ, Simon BT, Scallan EM, et al. Evaluation of gastrointestinal transit times and pH in healthy cats using a continuous pH monitoring system. 

. 2022;24(10):954-961. doi:10.1177/1098612X211062096

Laflamme DP, Backus RC, Forrester SD, Hoenig M. Evidence does not support the controversy regarding carbohydrates in feline diets. 

. 2022;260(5):506-513. doi:10.2460/javma.21.06.0291

Kienzle E. Carbohydrate metabolism of the cat 1. Activity of amylase in the gastrointestinal tract of the cat

https://doi.org/10.1111/j.1439-0396.1993.tb00793.x

Thiess S, Becskei C, Tomsa K, Lutz TA, Wanner M. Effects of high carbohydrate and high fat diet on plasma metabolite levels and on i.v. glucose tolerance test in intact and neutered male cats. 

. 2004;6(4):207-218. doi:10.1016/j.jfms.2003.09.006

Morris JG, Trudell J, Pencovic T. Carbohydrate digestion by the domestic cat (Felis catus). 

. 1977;37(3):365-373. doi:10.1079/bjn19770040

Green AS, Ramsey JJ, Villaverde C, Asami DK, Wei A, Fascetti AJ. Cats are able to adapt protein oxidation to protein intake provided their requirement for dietary protein is met. 

. 2008;138(6):1053-1060. doi:10.1093/jn/138.6.1053

Lester T, Czarnecki-Maulden G, Lewis D. Cats increase fatty acid oxidation when isocalorically fed meat-based diets with increasing fat content. 

. 1999;277(3):R878-R886. doi:10.1152/ajpregu.1999.277.3.R878

Russell K, Murgatroyd PR, Batt RM. Net protein oxidation is adapted to dietary protein intake in domestic cats (Felis silvestris catus). 

. 2002;132(3):456-460. doi:10.1093/jn/132.3.456

Hoenig M, Thomaseth K, Waldron M, Ferguson DC. Insulin sensitivity, fat distribution, and adipocytokine response to different diets in lean and obese cats before and after weight loss [published correction appears in 

. 2007;292(1):R227-R234. doi:10.1152/ajpregu.00313.2006

Gooding MA, Flickinger EA, Atkinson JL, Duncan IJH, Shoveller AK. Effects of high-fat and high-carbohydrate diets on fat and carbohydrate oxidation and plasma metabolites in healthy cats. 

. 2014;98(3):596-607. doi:10.1111/jpn.12126

Lyu Y, Su C, Verbrugghe A, Van de Wiele T, Martos Martinez-Caja A, Hesta M. Past, present, and future of gastrointestinal microbiota research in cats. 

. 2020;11:1661. doi:10.3389/fmicb.2020.01661

Deng P, Jones JC, Swanson KS. Effects of dietary macronutrient composition on the fasted plasma metabolome of healthy adult cats. 

. 2014;10:638-650. doi.org/10.1007/s11306-013-0617-7

Bugrov N, Rudenko P, Lutsay V, et al. Fecal microbiota analysis in cats with intestinal dysbiosis of varying severity. 

. 2022;11(2):234. doi:10.3390/pathogens11020234

Assessment of novel causes and investigation into the gut microbiome in cats with chronic kidney disease.

 Dissertation. Colorado State University, 2020.

Ma X, Brinker E, Graff EC, et al. Whole-genome shotgun metagenomic sequencing reveals distinct gut microbiome signatures of obese cats. 

. 2022;10(3):e0083722. doi:10.1128/spectrum.00837-22

Research into the feline gut microbiome continues to evolve, revealing the complex relationship between microorganisms in the gastrointestinal tract and overall health.

Feline gut microbiome 101

CE sessions being presented at the Southwest Veterinary Symposium are addressing ECGs, veterinary technician care and other topics in cardiology 

Caring for patients with cardiac conditions

Lucy Sumners, RVT, VTS(ECC), from the University of Florida Small Animal Hospital in Gainesville, is presenting 3 education sessions on cardiology Friday, September 27, 2024, at the Southwest Veterinary Symposium in Fort Worth, Texas. In an interview with 

, she previewed these lectures and shared her goal for them. The topics include electrocardiograms (ECG) interpretation and common abnormalities in cardiology, tachyarrhythmia and Bradyarrhythmia, and cardiac emergencies with triage and veterinary technician care.

Sumners is also presenting 3 sessions on Saturday, September 28, at the SWVS event. These sessions will discuss marijuana toxicosis, gastrointestinal diseases, and acute kidney management.

The following is a transcript of the video:

: I really want people to feel more comfortable with evaluating [Electrocardiograms] (ECGs) and recognizing abnormalities for heart disease. That's probably the biggest thing that I hear during my training sessions is, ‘Oh, I'm so bad at ECG. I'm so bad. I know that there's something wrong, but I don't know what it is.’ And so giving them kind of practical ECG examples and then tying it in with videos, so the first lecture is just the very basics: What are our most common ECG abnormalities that we see in the emergency room? What do we need to do at that point? And then the next one delves into dysrhythmias even more. And so, if it's a tachyarrhythmia, what are we doing? And what disease process is it associated with versus a Bradyarrhythmia? Then I do a quiz at the end.

The last lecture is just about the triage of nursing care for these patients, because it is quite frequent that our older animals get heart disease, and they may not just go to an emergency clinic, they may show up at the general practice, and it's okay. So what do you do in this in this stage? Because there are things you can do, even if you don't have specialty equipment.

If you scan any discussion board about attendance or tardiness, you will quickly see that you are not alone. At some point, every manager battles the issue of attendance and ponders how to update their employee handbook. Some create a 4-page document to detail every scenario they can think of, whereas others are so rigid they border running afoul of the law. The challenge is to position your policy somewhere between “just show up to work on time,” and “it doesn’t matter why you were absent; you’re fired.” To accomplish this feat, there are some key areas to consider: Assess what is causing the issue, know the laws, know what should be in the policy, and be creative based on your workplace culture.

This may be your question during that moment of frustration when you hear that someone called off work or is late yet again. Do you ever consider the root cause? It is worth the time to delve into the root cause, both to work with individuals to resolve the issue and to check on the culture of the practice. Numerous factors can contribute to people being absent or tardy at work. These reasons can be broadly categorized into personal (eg, family obligations), health-related, work-related (eg, job dissatisfaction, burnout, conflict), and external factors (eg, traffic, commute, weather disruptions).

It is also important that management examine its role in the issue. Things like bullying or allowing conflicts to go unchecked can lead to tardiness or absenteeism. Management must take steps to address these issues and hold the team to an attendance policy—one that establishes clear guidelines and expectations for attendance, punctuality, and time-off requests.

Before crafting your policy, be aware of legal requirements, including the Fair Labor Standards Act, the Family and Medical Leave Act (FMLA), the Americans with Disabilities Act (ADA), state and local laws, the Pregnancy Discrimination Act, and Equal Employment Opportunity laws. Next, use the following outline to define expectations and guidelines in your policy:

Clearly state the importance of punctuality and management’s expectations.

Specify the expected work hours, start and end times, and meal and break periods.

Clarify to whom the policy applies (ie, everyone, full-time, part-time).

Explain the recordkeeping system, notification process, and how to make requests for time off and for accommodations.

Be specific; don’t just say “excessive absences”—state exactly how many is too many. The same goes for tardiness: Is 5 or 15 minutes late for a shift considered tardy?

It’s also a good practice to periodically review and update the policy to ensure it remains aligned with changing laws, regulations, and organizational needs.

The goal of your policy is to minimize absenteeism and tardiness, be manageable, and be consistently enforced. There are many possibilities when it comes to crafting a policy, including the following:

Points are assigned for missing work. Determine the different infractions you want to list (eg, late for shift, call off, no call off/no show).

Determine how many infractions are too many and in what time frame.

Be careful to avoid assigning points regardless of the reason (eg, medical, disability, sick leave).

2 points: Employee misses an entire shift without calling out at least 16 hours beforehand

2 more points: Employee misses an entire shift without calling out at least 2 hours beforehand

Points expire 2 months after the date they are assigned. If an employee receives 3 absence infractions and 8 points within a 2-month period, Amazon will consider firing them.

This type of policy records attendance infractions on a rolling time period (3-month, 6-month, or 12-month period). Employees are required to maintain a certain level of attendance over a specified time frame while also allowing for occasional absences. After the specified period ends, the record is cleared (eg, clear only the oldest infractions).

The policy should state what the infractions are and how many will trigger disciplinary action. For example, “Accumulating 4 infractions in a rolling 3-month time frame will result in…” or “On the first of every month, any infractions received 90 days prior will be removed as part of the rolling 3-month time frame.”

Another example may reset the calculations, such as, “Accumulating 12 infractions in a 12-month period will result in…” or “Every January 1, any infractions accumulated in the prior 12-month time period will be removed, and the calculation will start over for the next 12 months.”

A set number of unplanned absences and tardiness incidences are allowed without requiring a specific reason.

The employee is still required to notify their supervisor in advance.

This type of policy seeks to respect personal privacy if the employee does not want to disclose the reason for the absence.

Note that your policy should be customized to meet your practice’s specific needs and goals.

Don’t ignore the power of recognition and rewards

The other half of attendance policies that is not often heard of is rewards. Why not reward the excellent attendance behavior you want? Excluding emergencies and those covered by FMLA or ADA, reward those not having any attendance infractions, be it every month, quarter, and/or year. Either enter those names with no infractions into a drawing for a bonus or gift card or give all those with zero attendance infractions a gift card, bonus, or additional hours of paid time off.

The goal of an attendance policy is to establish clear expectations and guidelines regarding attendance and punctuality. Whether your policy is lenient or strict, a well-communicated and consistently enforced attendance policy can contribute to the team’s success in delivering exceptional client service and patient care.

Anderson G. What is an attendance point system? Examples and template. Workforce.com. March 24, 2023. Accessed August 12, 2024. 

https://workforce.com/news/what-is-an-attendance-point-system-examples-and-template

Communicating expectations is key for staff adherence