‘Tis the season for making resolutions, and while I wouldn’t say I like to set hard and fast resolutions, I do think about areas where I want to focus more attention. In 2024, I’m focusing my attention on professional resolutions. As a relief doctor, I have the unique opportunity to learn new things at various clinics. However, I’ve been out of school long enough that I tend to rely on muscle memory, and in the day-to-day chaos of the clinic, I often forget to implement the new things I learn. Here are the top 5 things I’m focusing on in clinic this year:
1. Reach for amoxicillin over amoxi/clav for urinary tract infections.
If we look at the International Society for Companion Animal Infectious Diseases (ISCAID) guidelines for bacterial urinary tract infections in dogs and cats, amoxi/clav is not recommended initially because of the lack of evidence regarding the need for clavulanic acid and the desire to use the narrowest spectrum possible while maintaining optimal efficacy. Plumbs also cites that while amoxi/clav is an acceptable option, it is not recommended as empirical therapy. Amoxicillin (without clavulanic acid) achieves high concentrations in the urine and is preferred for empirical therapy. And while we’re on the topic of UTIs, I’m also trying to shorten the course of antibiotic therapy to 3-5 days (per ISCAID guidelines) instead of drawing it out for 7-14 days.
2. Stop prescribing metronidazole for acute colitis cases.
There has been a lot of evidence coming forward over the last few years that metronidazole is unnecessary and could actually worsen dysbiosis when prescribed empirically. Dietary management with bland, easily digestible food and/or fiber-based food is just as efficacious for most noninfectious acute colitis. While on this topic, I’m still trying to unteach myself the term HGE and start utilizing acute hemorrhagic diarrhea syndrome (AHDS) instead. I also think I’m going to be more judicious about truly diagnosing AHDS by ensuring the appropriate parameters are met (elevated PCV; low TP; one episode of vomiting; watery, very bloody diarrhea that looks almost like pure blood; rapid response to intravenous fluids), instead of every time there’s some blood noted in the stool.
3. Talk about mobility early and often.
It’s an exciting time in veterinary medicine for pets with *future* osteoarthritis. And I say future because, unfortunately, for some of our pets with advanced OA, the new monoclonal antibody drugs on the market, while still very beneficial, are a little too late. My goal is to start talking about mobility at mid-adulthood so we can get in front of this disease instead of playing catch-up. This is when supplements are crucial, and weight loss could be manageable. We should be helping owners understand when their animal starts showing signs of discomfort/pain prior to full-on OA. Sharing the multimodal approach with them through handouts on medications, supplements, physical therapy, acupuncture, laser, weight loss, etc, will allow them to feel some ownership in addressing their pet’s issues.
4. Behavior… in cats!
I feel like during/after the pandemic, I changed how I talk with owners about dog behavior and puppy socialization, but, as it tends to be in veterinary medicine, cats are often forgotten. Unfortunately, though, cats tend to be our most challenging (I say that lovingly) patients due to fear, anxiety, and stress. So my goal is to start talking to cat owners about the anxiety and stress their cat (young or old) might be having during veterinary visits and at home (I’m looking at you FLUTD boys!). On that note, I also want to do a better job of assessing how a pre-veterinary pharmaceutical protocol worked for a pet and be willing to tailor it as needed.
5. Back to basics.
Fortunately, and unfortunately, all at the same time, my physical examination and many conversations I have in the exam room have become second nature to me. So, lately, once I leave the exam room, I stop and say, “Did I really palpate the lymph nodes? Did I actually address flea/tick/heartworm prevention? I mentioned their pet needs a COHAT soon, but did I bring up brushing their pet’s teeth or other at-home dental care options?” As a relief doctor, this can be challenging because at some hospitals, the conversation about what vaccines and preventive care are being done during that visit is discussed initially with the assistant/nurse (which is great!), but at other clinics, it might not be.