1.The GP hook

Three brisk GP updates: when canine plasma can buy time in coagulopathic cats, how to define sepsis without hand‑waving, and what Librela’s new safety wording actually means in consults—plus quick GI extras we think change the day-job.

2.The GP View

Why this matters in first‑opinion practice:

We’ve also pulled in quick GI nuggets that might change Monday’s plan: a metoclopramide CRI loading‑dose paper, and a controlled trial where a single faecal microbiota transplant didn’t beat diet change in chronic enteropathy. As ever, we separate evidence, product information and personal experience—and keep it GP‑practical.

  • Feline blood and plasma logistics are tough in GP. If canine plasma can safely buy time in a bleeding cat, that’s a genuine out‑of‑hours option when referral or feline donors aren’t realistic.
  • “Is this sepsis?” isn’t academic. The updated definition asks us to evidence organ dysfunction, not just SIRS plus “probably infected”. That changes our admission notes, triage language and owner conversations.
  • Anti‑NGF monoclonal antibodies: owners still ask about the safety. Knowing exactly what’s now on the data sheet (and how rare it is) helps you be clear and calm without minimising risk. And a three‑monthly feline option could improve real‑world compliance.

3.Canine plasma in cats: when, why and the real‑world risks

A recent JVECC paper (July/August) reported on cats with clinical coagulopathy given canine fresh frozen plasma (FFP). Headline takeaways discussed in the episode:

Practical implications we discussed:

Doses reported in that series were described as high (20–40 ml/kg).

If a cat is bleeding with a documented coagulopathy and you only have canine FFP in the freezer, brief the owner that this is a one‑off, time‑buying xenotransfusion with reaction risk. Pair it with definitive therapy (for example, vitamin K if rodenticide is suspected) and close monitoring.

  • In one retrospective single‑centre series of eight cats (nine transfusions), seven transfusions corrected the coagulopathy.
  • Another data set of 14 cats receiving canine plasma products reported partial or complete normalisation of abnormal PT/APTT in several cases.
  • Suspected acute transfusion reactions occurred in two cats in that 14‑cat set, described as acute respiratory distress.
  • This is about buying time in secondary coagulopathies. FFP provides clotting factors; it is not a platelet fix.
  • Where feline products are unavailable and a cat is actively coagulopathic and decompensating, canine FFP may be considered with informed owner consent. It’s a temporary bridge, not a cure.
  • Risks are real. Cats are prone to transfusion reactions in general, and xenotransfusion adds another layer. The team highlighted not to xenotransfuse twice.

4.Is sepsis actually sepsis? The updated definition

The new consensus (JVECC, July) moves us beyond “SIRS + suspected infection = sepsis”. To call it sepsis now, you need:

Examples of organ dysfunction discussed:

Why this helps in GP:

Suspect infection + SIRS picture? Actively look for organ dysfunction: mentation, BP, lactate, acid–base, respiratory parameters, coagulation. If present, you can call sepsis and escalate.

  • Evidence of infection
  • Evidence of a dysregulated host response (your SIRS‑type picture)
  • Evidence of organ dysfunction
  • Altered mentation
  • Hypotension or the need for vasopressors
  • High lactate or persistent metabolic acidosis
  • Respiratory dysfunction
  • Coagulopathy
  • It clarifies language with owners and referrers. A pyo with fever and tachycardia isn’t automatically “septic” unless there’s organ dysfunction too (e.g. hypotension plus rising creatinine or high lactate).
  • It can justify earlier escalation when the dysfunction box is clearly ticked.
  • What does escalation look like in our world? Aim for 24-hour care, warn owners of steep hospitalisation costs due to intense monitoring and discuss value of referral. Prognosis is guarded to worse and can change in either direction within hours.

5.Anti‑NGF monoclonal antibodies: safety update and a new feline option

What changed:

How rare is “very rare”?

Clinical nuance from the episode:

Feline developments:

“This class of drug is on the UK data sheet for very rare joint‑related adverse effects—less than 1 in 10,000 animals. Thousands of doses have been given worldwide and most dogs do well. We’ll monitor closely and stop if anything worries us.”

  • Librela’s UK product information was updated in May to include very rare adverse effects: joint swelling, joint pain, bone and joint disorders, and soft tissue ossification.
  • The VMD has described increasing multi‑source evidence of an association, which appears to have prompted the SPC change (as noted in the VMD/product information).
  • As discussed on the show, “very rare” on the data sheet means less than 1 in 10,000 animals affected. That frames the risk in consults without dismissing it. It’s still a conversation to have before starting or continuing therapy.
  • Many older, lean, painful dogs appear to have meaningful quality‑of‑life gains on anti‑NGF therapy.
  • Be thoughtful in younger dogs: prioritise diagnosis and surgical/orthopaedic referral discussion first, rather than “slinging” an anti‑NGF at vague lameness.
  • A three‑monthly feline anti‑NGF monoclonal antibody (Portela; relfovetmab) was approved by the UK VMD on 30 July. It’s a subcutaneous injection every three months. Early study signals were described as encouraging, with some improvement as early as three days in the material discussed, but real‑world experience is still limited.
  • The podcast noted that the specific “very rare” adverse events listed in dogs are not automatically transferable to cats; monitoring is ongoing.

6.Seizing the ileus window: metoclopramide CRI loading

A May paper discussed on the pod suggested:

Why it matters:

Team experience:

A paper highlighted that metoclopramide CRIs may take ~3.25 hours to reach steady state without a loading dose. If you use them a lot, consider whether a loading dose could close that gap in your sick, regurging patients.

  • Without a loading dose, metoclopramide CRIs can take about 3.25 hours to reach steady state.
  • Proposed loading doses (then start the CRI):
  • If targeting 1 mg/kg/day: 0.05 mg/kg IV loading
  • If targeting 2 mg/kg/day: 0.1 mg/kg IV loading
  • For those regurgitating, ileus‑ridden HGE/AHDS‑type patients, three hours is a long time to wait for motility support. A loading dose could plausibly help sooner.
  • Charlotte reports frequent, positive experiences with metoclopramide CRIs in severe ileus. Brendan is more ambivalent case‑to‑case. Both stressed that addressing perfusion, electrolytes (potassium flagged), and the underlying cause remains central.

7.Faecal microbiota transplantation (FMT) in chronic enteropathy: one enema didn’t beat diet change

A blinded RCT in dogs with chronic enteropathy compared:

versus

Findings discussed:

Chronic diarrhoea >3 weeks? This RCT didn’t show a clear win for a single FMT enema over diet change. Consider reserving FMT enthusiasm for acute situations until stronger chronic data emerge.

  • Single retention enema FMT using fresh donor faeces
  • Diet change alone
  • No clear clinical benefit of adjunctive single‑enema FMT over diet change in that sample. Small numbers mean caution about over‑interpreting.
  • Acute GI scenarios may be a different story; older work (e.g. parvo) is often cited, but practical uptake in GP remains limited without a simple product.

8.Commission‑based pay: culture, ethics and the day job

A brief detour into practice culture:

If you’re shaping incentives, reward teamwork and care quality (peer‑recognised hard work, positive reviews, reliability) rather than revenue generated. It protects culture and patient‑centred decisions.

  • Commission/production pay is not commonplace in the UK teams we work with. Concerns include over‑testing, owner cost pressure, and skewed case selection—especially on OOH shifts.
  • Alternative rewards the team liked: bonuses for hard work, teamwork, staying late when needed, missed‑break cover, great client feedback, and “no‑complaints” streaks—rather than tying pay to how much you bill.

9.TAKE‑HOME POINTS

  • Xenotransfusion with canine FFP in coagulopathic cats can temporarily correct clotting times; reactions can occur and it’s a one‑off bridge. Use with owner consent and pair with definitive therapy.
  • Sepsis now needs infection + dysregulated host response + organ dysfunction. That clarifies triage, records and owner discussions.
  • Librela’s SPC now lists very rare joint‑related adverse effects. Communicate the risk clearly but proportionately. A three‑monthly feline anti‑NGF injection has been approved in the UK.
  • A May paper suggested metoclopramide CRIs reach steady state ~3.25 hours without a loading dose; loading may help earlier effect in selected ileus cases.
  • In a controlled trial, a single FMT enema didn’t outperform diet change in chronic enteropathy; sample size was small.

10.THE LAST WORD

We love referral‑grade ideals, but most of our breakthroughs live in GP reality: a freezer with dog plasma, a crotchety cat that can’t wait, owners communication that will benefit from clear thresholds for the word “sepsis”, and honest counselling when a great drug has a very rare but real risk. Add one or two Monday‑morning moves to your toolkit and you’ll feel the difference.

11.Useful links from this episode

Keep the conversation going

Listen to the full episode for the discussion, context and the bits that made Charlotte and Brendan laugh.

Listen to Episode 29
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