Good evening, everybody, and welcome to tonight's webinar. My name is Bruce Stevenson, and I have the honour and privilege of chairing tonight's webinar, which you're in for a treat of ultrasound tonight. Just a quick thank you to Eric and his company SonoPath for sponsoring this evening.
We do appreciate your sponsorship and If it wasn't for the generous sponsorship, we wouldn't be able to bring you this webinar. So, thanks, Eric, and thanks to Sonoath. For those of you that are new to us, if you have any questions during the, webinar, please just, move your mouse over the screen.
You'll see that the control bar pops up. It's normally a black bar across the bottom and you'll see, a, Q and A box. If you just click on that, you'll be able to pop your questions in there.
They'll come through to us and we will hold those over until the end. And we'll get through as many of those as we can. Now, there's lots of videos and I'm sure there's gonna be, oh, can you just go back and show this again?
Short version, though, we can't. But the good news is, is we are recording the webinar, so in the next 24 or 36 hours, it will be up on the webinar vet website. And then you can go and watch and pause and rewind and look at it over and over again.
So please don't worry if you missed something on a webinar. On a video, you will be able to see it on the webinar vet. So from about 24 to 36 hours.
Our speaker tonight is Doctor Eric Lindquist, and he's a veterinary clinical sonography innovator and founder, CEO of Sonoath. With 3 decades of clinical experience, he created SDEP, a veterinary ultrasound protocol used globally to brief efficiency, accurately and repeatability of diagnostic imaging. Eric is board certified since 2003.
He has lectured worldwide, including ACVIM, ECVIM, and EVDI. He's published in top journals and authored The Curbside Guide to Clinical Sonography, Volumes 1 and 2. Leading Soopaths, 20 plus specialists, six North American mobile teams, and the Sonopath Education and Imaging centre in Andover.
Doctor Lindquist strives to raise the bar in veterinary clinical sonography. We are very pleased to have Eric here. Eric, welcome to the webinar vet, and it's over to you.
Thank you, Bruce. Thank you. I appreciate you having me and thank you everybody for spending some time with me this evening.
I hope you're, you, you found a beverage to accompany this next hour. I am speaking to you from Rome and of course I have an appelspritz to accompany. So, .
So tonight's objective is essentially to give you an overview of what ultrasound can do and what I prefer to use the term clinical sonography, which is a combination of utilising ultrasound and combining with your, your medical and general practise and internal medicine. And surgical, history and experience and putting that all together and we call that clinical sonography. So it's a matter of put a probe on it if it isn't doing right, if he's sick, if you have a lump, whatever an ultrasound beam can.
Power through is something that you should be investigating with ultrasound. And, none of us are in veterinary school or maybe some of you still are, but if you, if, if you likely don't have a professor over your shoulder, making sure that you soap everything. And do everything like you were taught in school.
Once you're out, what, what really matters is getting to the bottom of the case and getting that animal in the right direction as soon as possible and as accurately and as efficiently as possible. And that's where ultrasound comes in. And we have this adage, and I've been doing this for, for essentially all of my career right out of school.
And I was a GP and a surgeon, and, and, and then I picked up a probe and never looked back. And if I had the practise without a probe, I'd open up my wine bar in Maui because I just really couldn't practise the way I know that I can practise and, and get to the bottom of cases, and that's through clinical sonography. And, and so what we're going to do tonight is show you the things that clinical sonography can do.
And what I'm going to show you are cases that run across my computer screen or in clinics every day. These are not, uncommon pathologies to put a double negative out there. This is something that we See as clinical sonographers every day.
This is why we use the, the kind of the, the, the cropped up image of an ultrasound machine in the hand of a scuba diver, because we're down looking at the fish. We're not on, we're not on the shore. We're not on a boat in the water trying to figure things out, and that's kind of what you do and, and what I used to do as a clinic, as a, as a general practitioners go from the outside in.
You do your physical exam, you then, which is all great information, but when an animal is sick. He needs a probe and you know, so you can go and scuba dive and figure out what's going on from the inside out. So we also coined a phrase and trademarked it called medicine from the inside out.
And so tonight we're going to show you medicine from the inside out, clinical sonography from somebody who's been doing a very long time, and I'm not unique in this. We have a very wide community that at Soopath that presents or that approaches case in this fashion. Who are soopaths, we do everything around the probe from making sure that you have a solid machine to work from, which it starts there.
We educate on how to utilise it and how to optimise it because we're all clinical sonographers, we're using the machines every day and we Support, support, support, like you've never been supportive before. We interpret through telemedicine of every modality that you can think of. And then we go back to the ultrasound machine, case by case by case, this is who we are.
Our company is built around this concept. I invite you to take a look at it. We created this, protocol.
It's actually the first, presented and published abdominal protocol called the SE or sonographic diagnostic efficiency protocol. And what this does, it proactively, even if you've never scanned before, proactively gets you every nook and cranny of that abdomen or every part of. At heart and a protocol, even if you don't know what you're looking at, a specialist will know what you're looking at as long as you follow those structures, follow the protocol over and over again.
It's a 17 point in the abdomen. It's a 7 point in the chest, and it allows you to do all the Doppler and all the approaches that you would want to do to be able to make sure you don't miss. A lesion, which is the bottom line of what we're trying to do.
We're supporting our people and, to not miss a lesion, everything from the deep pelvic urethra to the gastroesophageal inlet to the portal hylus. You may not know what a shunt looks like, but we do. You just have to get the images and save it on a hard drive and you learn over and over and over again on how to approach.
How to skin, you know, it's image acquisition and it's very, very straightforward if you utilise this protocol. And we do that hands on in your facility or at our facility. We do it live virtual, we have online downloadable courses you can do on your own, and of course in hospital training.
And we're gonna bump on this again, but we, we do a summit every year this next year in 26, it's in Vienna with John Bonnagura in cardiology, Dominic Penic on abdominal sonography and GI Nele Ele on, on thoracic imaging and myself, and we're gonna be, it's gonna be a lot of fun. So I'd like to take a look at that and it's limited on, we're about 120 people. It's always a great time.
So. Regarding the probe and your sick patient. So think about the last and and as you go, as you go through this, I want you to think of the last number of cases that you had this week.
That were sick and what may be really going on, you know, because something may look like a pancreatitis when it's actually a perforating gallbladder mucoussele or a distal small intestinal foreign body or neoplasia that's masking as pancreatitis. So if you're just going by your serum enzymes and clinical exam, chances are you're missing the whole picture because, yeah, a lot of times you have comorbidities. So we always say if it's.
It needs a probe today. If you're emitting that animal for a CBCEMUA and radiographs, it needs a probe while you're doing those things. Get the ultrasound done first, move it up in your workup because you're going to get so much more information right at the beginning, and you're going to find that over time you're going to see over and over and over again that your other diagnostics that you've been utilising are just filling in the blanks because you're going to come up with so much.
So much information on what actually is going on in that patient, and we strive to be the first day diagnostician. You want to get to the answer to that patient within the 1st 12 hours because the more it sits and the more it suffers with whatever pathology is going on, the more that animal is compromised. Think of that last lymphoma case, think of that.
Perforating hemangiosarcoma, think of that perforating intestinal mass. Think of that gallbladder mucous cele that's perforating. All of those things show up over and over again.
If you don't have an answer within the first day, that's just a, it's a, it's a problem in the process, you know, because you, you need to get to that. If you're not getting it to the first day, the, the vet down. The road probably is, you know, if they're using ultrasound first.
So I invite you guys to start utilising ultrasound right in the workup and time out how much time it takes you to get the definitive diagnosis compared to what you were doing before. And it's a study that we want to do. We've been organising to do it, but I already know the answers.
So, but we're gonna work on that. So think of the, your typical quote unquote pancreatitis case, right? Think of your inflammatory bowel case, your hepatitis case, your UTI case, your Cushing's case, your renal failure, everything that comes in that's sick.
Most of the time, I can tell you, it's never just this. It's never just that. It's never just this.
There's always something more. Going on. And the more information you can get about that patient, the more you're going to deliver the therapy that it needs or the information to the owner so they can make a complete layered decision on what they're going to do with that patient.
Now I use the analogy of Forrest Gump. I'm sure everybody's seen this movie. Ultrasound, clinical sonography, it's like a box of chocolates.
You never know what you're To find, you know, it's gonna be the caramel chocolate on one moment. There's gonna, you're gonna have a cherry in another one. You know, you really don't know what you're going to get, even if I, I've been doing this for a long time, about almost 300,000 cases in my career, and I still get surprised by stuff, you know.
So you may be looking for pancreatitis and you have an invasive pheochromocytoma going on, you know, and you're not really, you're not really going to know that until you put a probe on it and see what's actually going on. So I'm gonna give you a little insight to my life. A number of years ago, I was toodling down the road on my, on my mobile day.
And, don't tell the, the, the police in New Jersey, but my client sent me this radiograph on the phone, so you could see that it's like, hey, does this guy have a foreign body? It's like, well, it's an abnormal gas pattern. Let's put a probe on it.
Had a technician 10 minutes down the road. Went over there, scanned it. My next clinic, I picked this up and read the case within about an hour, and he had an obstructive pattern, and off he went to, off he went to surgery and pulled it out, you know.
And so we're, that's, that's, that's my life, you know. And, and so I, we don't know what the CBCAMUA. Is, what, you know, what else was going on, but, you know, immediately that animal needed to go to surgery and got it done, and this sort of thing happens all the time.
So if we look at the, look at the urinary tract here, and just think of your last dysuria, pola PUPD case, you're gonna find all kinds of things going on. You know, you put a probe on a cat that has 3 kidneys. Which are fused together, you know, so you never know what you're gonna find.
Or maybe you have a pyelonephritis going on in this cat that had a, had a renal transplant, you know. If you have a renal failure, you want to know if the animal's producing urine. Well, I don't have to collect urine.
I could just look at the ureters and you can see the ureteral jets here. He's pumping out urine for both jets. I know he's producing urine, so it's not an aneuric urine, urinary failure.
Or you have a chronic cystitis pattern, or you put the probe on it and you have a wicked cystitis and emphysematous cystitis and bladder calculi that are going down into the into the pelvic urethra, you know, you need to know all that. You just throw antibiotics at something like this, it's never going to resolve, right? So you want to get the whole story first before you take A shot at what's actually going on, you know, and this, this is another example of a chronic cystitis with a bunch of stones, you know, and they may be radiolucent, you may not see them on a, on, on a radiograph, but you will see them on ultrasound.
Or you put a probe on the bladder and you see a tumour, you know, and you don't want to put a needle in this tumour, unless the owner is prepared for potential trailing. This is a classic carcinoma that will trail right through the body wall. So you don't want to do a blind cysto anymore because you could be.
Sticking a needle right into right into a bladder mass, right? Or the SE protocol gets into the pelvic urethra every time. The bladder was fairly normal, but he's got this polyploid expansive mass into the pelvic urethra.
Or we have another one. Here, the bladder was fine, his urethra junction's fine, pelvic urethra has a mass in it, or a very subtle mass over here in this deep pelvic urethra and this cat, right? Or this one over here, pelvic urethra and carcinoma go together.
So, and it gets missed all the time if you're not scanning the pelvic urethra. And there are things like this procedure that we developed. Dr.
Dean Surf and I back in the late 2000s, published in Jab and you take a look at that. This is ultrasound guided laser ablation. We don't do this anymore here, but a few facilities in the United States does.
This is a scope. This is a diode laser, and we laser away the obstructive tumour that, that was non-resectable for this patient. So this and.
And chemotherapy and here's the tumour on scope. So the scope comes in, it can't see where it's going to laser or where it's going to go into the wall here. So we just laser away and the ultra sonographer is the guide dog for this and it kind of guides them in the direction they need to go.
It's very effective procedure. There are a few facilities in this, including Texas A&M in the United States that does it. Emphysema to cystitis, you want to know if you have that, or if you have a young animal that has a bunch of bladder stones, you ask yourself, well, why does this 2 year old Maltese have a bunch of bladder stones?
You know, and you may run into, and then for the bright stones like this, you may run into a port of systemic shunt, right? And you're gonna get that image set in the SE protocol every time, even if you don't know what it looks like, you'll be covering the areas to where it can be interpreted remotely. And then you have other things like this chronic cystitis and this, intact pit bull in the BPH prostate.
And you may think, well, is this cystitis that's obstructing this, this ureter here? Or is this something more? Is this a carcinoma?
So you can do an ultrasound-guided traumatic catheterization where you get tissue back without invading the bladder wall, because this is transitional cell carcinoma. It will trail, right? So you can go in with a catheter and get pieces and chunks there.
And this came back chronic cystitis. The dog was neutered, treated for UTI for 4 to 5 weeks, and it did just fine, right? And there was no neoplasia.
So think about how important that is from a, from a perspective of an owner, right? Now, this here is a prostatic abscess, right? Intact male, the bladder is way out of view here.
Here's a cystourethro junction, and you have this big viscous here and a little lot of inflammation. That's what this fuzzy fat is around it. So we put a needle in it and we drain it, 16 gauge IV catheter in this case, drain it all the way out as much as we can, leave a little bit of a cavity and shoot antibiotic right back into it.
Betrol in this case, and neuter them at the same time. This is what it looks like and it looks really cool on ultrasound. You show that to the owner and they're gonna Their eyes are gonna get really big.
And they're not gonna have a problem paying the bill, right? It looks really, it looks really cool. And then this was this dog after 3 weeks post a procedure, that's abscess drainage, antibiotic injection and neuter.
That's the name of the, the procedure. And this was the prostate regressing adequately without any marsupialization or expensive surgery like that. Prostatic carcinomas, this is what they look like, and they invade into the urethra.
So imagine the dysuria, polyuria, and so forth. This is what they look like on cytology. You can tell a cytology that out and get your answer right away.
And you can see this is just a matter of putting a probe. On it, that's not right. You can do a traumatic catheterization, get your sample, or if you can do ultrasound guided, you can have trailing on these, but we still do it.
You send out the cytology within an hour or two, you have your answer. So imagine that next tourapolauria case that you're running into. Or you may run into something a little more, a little more dramatic and less frequent like this prostatic lymphoma, right?
Put a needle in it, there's your sample, your answer, it's not supposed to be there. We put a needle in 25 gauge. It's pretty tough to do any damage with a 25 gauge needle.
And you can get your answer. And pyometras, for example, you know, you look at it on a radiograph, yeah, it looks like a pyometra. Well, it jumps out on the probe on ultrasound and you can see how this big monster pyometra is here if you have a, uterine remnant or a py .
You know remnant, stump pyometra, sometimes you get these ovarian remnants. It's what they look like on ultrasound. Pretty straightforward for those of you who've been utilising the probe, and I'm trying to, for those of you who have been utilised ultrasound, I'm trying to provide it for the enough material for you tonight as well as those that have been utilising ultrasound.
These are some things that you can, you can do. And last, last couple of things on the urinary tract, you have that hit by car, you want to see if the bladder is intact, you pass the catheter, shoot saline right through it, and if it doesn't fill and you have little bubbles going out the apex, you know, you got a quick and easy. Surgical repair to, to happen.
Your your ale diverticulum, that's what that looks like, you know, very easy to see on ultrasound. So you have that chronic recurrent UTI case that has that le diverticulum, you know, right away that you have to go to surgery on that and take care of it. This is what an ectopic ureter looks like on ultrasound.
Again, you're going to get multiple views on this in the STE protocol. It's an extra tube that isn't supposed to be there and it's colour flow negative, and it usually contracts and you follow it, usually into the urethra, but sometimes it'll, it'll land elsewhere, and bypass the ureter. Now, renomegaly in cats.
So these are the things that do renomegaly in cats, polycystic kidney disease, lymphoma in friends, hydronephrosis, FIP perirenal pseudosis, and pyelonephritis. And of course, polycystic kidney disease looks like this, a bunch of cysts in the kidney where it should be. The cool thing about all of these, they all look different, except for maybe pyelonephritis on an advanced phase and a lymphoma in an early phase can look very similar.
That's what a 22 gauge needle takes care of, and then we're, we're in good shape. So over here, we have, a typical renal lymphoma scenario and, with the needle, needle coming in here into the cortex. That's what we wanna do.
We wanna hit that cortex with a little bit of irregularities. And then we get this little subcaps or halo here. And we want to hit the hypochoic areas when we're suspecting lymphoma because that's where your diagnostic yield is.
So again, a probe and a 25 gauge needle can go a very long way from a clinical sonographer perspective. Now, here, you know, if you have a renal dysplasia, you're suspecting renal dysplasia in a dog or a cat, they typically look very, very abnormal. So let's say you have a 2 year old boxer that's in renal failure and want to find out why.
Well, when you put a probe on it, it looks like a flattened rugby ball or a flattened football with these nodular changes to it, or . That's pretty much what a, what a renal dysplasia looks like. And sometimes you run into these scenarios in cats where you have 33 kidneys or a fused kidney scenario.
This is an older image, same sort of thing. These tend to actually function pretty well. So this cat wouldn't have 9 lives.
He'd probably have 12 or 15 because he has 3 kidneys, you know, and, and so you see some pretty Crazy stuff from a clinical sonography perspective. I don't know how many, how many books in college we ran into and said, Yeah, cats can have fused kidneys and they can have 3 of them without a transplant. You know, this, this, this is not that uncommon.
I have about 10 of these in the archive, you know, they, they, but they don't tend to have renal failure unless there's something going on acutely, you know. So they, they tend to do just fine with fused kidneys, twin, Siamese twins of kidneys. So, if you have a patient that's an ain't doing right patient, what we call in the states, you know, he's just not himself, right?
And, and so, if you have that history, that is definitely something you want to put a probe on because you're going to find a lot of things or maybe you'd find. Nothing, which is great because he may be not doing right, because he has referred back pain. He has, he has a back spasm going on and, and that's disguising as an acute abdomen.
And you go through the abdomen, you find absolutely normal abdomen. That's a good thing because now you know where to direct your therapy, and it's gonna be more of an orthopaedic or pain-related one, or maybe the problems in the, in the chest or in the CNS, you know, so. I have a, I have a saying that if whatever's making the animal sick isn't in the abdomen, it's not in the chest, then it must be metabolic, orthopaedic, or in the CNS.
And so, obviously, you can't put, put a probe on too many orthopaedic things. There are a few things that you can, but you, you know that there's nothing viscerally going on in the abdomen. Put a probe on the heart.
And if Starling's laws are in good shape and the heart is beating like it should, It's not volume overloaded and it doesn't have any arrhythmia, you know, those two problems are gone. So, you know, what else could be, you know, you just eliminate whatever else could be causing the problem, you know. And so I'll sneak up on some neuro cases that way.
We have a, we have a CT that will run into, run into brain tumours and the animals didn't have any dramatic neuroscience, but, you know, we just keep fish and then sooner or later you're going to catch what you're looking for. But things that cause ain't doing right from a pathological perspective is for us clinical sonographers is obviously biliary disease, neoplasia, GI foreign bodies, especially the distal ones. As opposed to the pyloric ones, intestinal necrosis, thrombosis, abscessation, all of this stuff comes up very quickly, when you're doing abdominal sonograms all the time, like this perforating gallbladder mucous seal, for example, that may have been masking as a pancreatitis.
Obviously, you're gonna treat it completely differently when you have a perforating mucous cell, that needs to go to surgery right away. And you want to see the common bile duct and common bile duct should be. Very small, about 4 millimetres, and when it jumps out on the probe and it's about 1 centimetre wide, you know, that's a problem.
So you follow it down and see what's causing the obstruction and where the plumbing problem is. And literally, this is, I don't need to know. Obviously, I want to know completely what the CBC CEMOAs, you know, the liver enzymes are up, whatever.
That's all, that's all secondary because I already know this is a perforating meek seal. I already know where I'm going with that case by just putting a probe on it. And then I'm going to fill in the blanks with everything else.
Or adrenal tumours or adrenal pathology. That's a classic ain't doing right patient. When you have an invasive pheochromocytoma or carcinoma coming off the cranial pole, the right adrenal gland, this is the right adrenal, this is the aorta, this is the vena cava.
Adrenal tumours love to go into the vena cava right through the frantic vein. We see this every time. Time in our protocol.
And we have a saying, every adrenal every time, because if you miss this, you're gonna miss the boat on what's actually causing the patient to be, to have a problem, right? Or maybe as a thrombus on this old beat up adrenal that's been, you know, treated with lysedrin for many years, or maybe it's a flattened adrenal gland like you get in an Addisonian. You know, so if we know what in a normal adrenal looks like every time, then we know what an Addisonian adrenal looks like, because we should see a big peanut on the left, and we should see an arrowhead on the right, and if both of those are flattened like this, you stand back and say, oh, could this be Addisonian?
And there are just about as many atypical Addisonians out there as there are typicals with the sodium potassium that are off, right? And so, or you may run into this kind of carcinomatous type adrenal, you know, so adrenals, we don't have really good, we don't have really serum markers that are gonna tell us much about adrenal pathology unless you're run in your. Metanephrine tests.
And that's an expensive test, at least it is in the state. So I want to make sure, I, if I had an adrenal tumour, OK, I'm gonna run a urine metanephrine test if there's hypertension, but I'm not going to go and spend 20 to $300 of the, of the owner's money if the adrenals look fine, right? So we want to see what those adrenals look like first before we jump on the, on the tests that we're going to run.
And this is a typical left adrenal and right adrenal, and you should be getting this sort of thing every time, where you see the frenic vein in the middle, you see the corticome medullary band, you see the nice capsular contour, and this is the right adrenal is what it should look like, the right adrenal cranial pole is bigger. In the caudal pole. So when you know what these, you got the peanut on the left and the arrowhead on, on the right side, you know that, OK, deviations from that could be a problem, and they may be clinically significant, or like these Addisonian adrenals that we're going to see.
So you have the Addisonian adrenal and of course your ultrasound machine comes with arrows to point out where the pathology is by that machine because it really help you out, especially when you have these flattened adrenal glands like this. And then you put a probe on the heart and the heart says, ah, and maybe wanna beat today, you know, I'm not really excited. That's what a shocky heart looks like, where it's not contracting.
Really well, or it's also what an Adisonian heart looks like. And so when we go and measure out the, the adrenal glands, like this small left adrenal, that's about 3 millimetres or this right adrenal that's about 3 to 4 millimetres and it's flat and I have to work at it to find it. Every time that happens, I stand back and ask myself, could this dog be an Andisonian?
You know, and then baseline cortisol or an ACTH stem and and you're off to the races, and, and giving exogenous cortisone will do this as well. It'll make the adrenals look Adisonian. So when you're seeing adrenals every time, you're gonna be surprised, right?
You're gonna be chasing that, you know, liver enzyme, or you're gonna be chasing that, that ain't doing right, and you're gonna get in that right adrenals, oh, he's got a big right adrenal, and then you get to the cranial pole and you see where that invasion happens into the vena cava, and that's when it invades like that, there are two types of tumours in the adrenals that do that. One is a pheochromocytoma and one is an adenocarcinoma. So you can, and they may be functional or non.
So you can chase it that way, and I, I call adrenal pathology sneaky, just like my son here, you know, this was my niece's 18th birthday party in Italy, and if you know anything about birthday party is the 18th and in Italy is like a wedding, so my . My brother-in-law at the time, spent about $4000 5000 dollars on a photo shoot, and my son acted like in a sneaky adrenal tumour and photobombed the bottom of the eight on every one of the photos. So you can imagine how my, former brother-in-law, that may be one of the reasons why he's my former brother.
But I have a sneaky son. He loves when I. Compare them to an invasive adrenal gland.
But that's what you're going to find. You're going to find that they're sneaky. They may look normal on the caudal pole and then they invade in the cranial pole.
But if you're not getting those images, you're going to miss that lesion. And these are not uncommon. We see these all the time, you know, and, and obviously, how are you going to diagnose that from a basic clinical perspective?
You're not. Now, adrenal neoplasia can take a lot of different forms, right? So this is a big ugly tumour moving the right kidney out of the way.
What does that, what lives there? Well, this is what I call elefino lesions. It's like ele I know what that is, right?
And, and what you get with it when you cross an elephant with a rhino, you get an elefino, little little humour from . Oh, that name escapes me. I do.
I was gonna forget it. Ted Lasso, thank you. Little Ted Lasso humour there.
But, you know, we call these, these lesions eopfina where you can't really tell what they're coming from, but there's only one type of tumour that'll move that right kidney out of the way, and that's an adrenal tumour. Same thing on the left side. Kidneys are fixed in a pretty good position.
There's pretty much only one type of tumour that'll move them out of the way, and that's an adrenal tumour. So you can pretty much bet when you have a big tumour like this moving the kiddy out of the way, then Then it's going to be an adrenal tumour, right? And they, they, on the left side, they invade through the phrenic vein and then go down like this snake right into the vena cava, and they tend to be fairly vascular, right?
So this is a, this is a pheochromocytoma on the left. This is a feo over here. This is a carcinoma on this one, you know, so if they're big and ugly and invading, they're going to be one of those too.
So, you want to be the one that gets this tumour. You're the one, you, and then You can work it up from there. You don't want somebody else showing up with a better machine or a better technique and getting the adrenal tumour that, because then the owner comes back to you and says, Hey, why didn't you find it?
Well, now, why not be the one first up, right? It says, Yep, I found it. Let somebody, they want a second opinion.
Let the other person confirm it. Or maybe they're not going to get that adrenal tumour. But you want to be the one that's gonna get that adrenal tumour.
It really sets you on a whole other level as a facility that you're getting every adrenal every time. The pancreatic disease in the ADR patient. This we see quite a bit.
You know, this pancreas, big, ugly nodular pancreas and a cat that's irregular. You know, that could be a carcinoma, that could be pancreatic necrosis, that could be hyperplasia. If you're palpating in a subxiphoid fashion, I strongly suggest that you get pain up around underneath the subxyphoid and underneath the ribs.
That's where the pancreas lives. So you can get, you know, can kind of support your diagnosis of pancreatitis. Or sometimes you have this kind of a blob.
This is an older machine with poor resolution, but I know that I have this blob of elefino lesion here in this, this pancreatic base. We, we can put a needle in that, and I'm gonna show you how to do that in just a second. .
You know, this is a right out of letters from Martha Moon Martin, a radiologist in in the United States and This is a quote from her. It's essentially radiographs are pretty much useless for pancreatitis. And you know, you think about, I, I like radiographs.
They tell me, OK, that's nice, let's put a probe on it. You know, it's if you're talking about orthopaedic disease, great. But other than a GDB, when was the last time you made a definitive diagnosis on a set of radiographs, you know, from a soft tissue standpoint, you's like, oh yeah, there's a splenic mass.
OK, sure, but is it me. To the liver or not. Has it made it to the omentum or not?
You know, is it bleeding or not? You may or may not see that on radiographs, but you're going to get so much more information about all of those questions and so many more by looking at it sonographically from the inside out, right? So I, I like radiographs, but I, it's very rare we're going to make a solid decision and get the whole story off of radiographs.
It's just not the modality for that. It gives you an overview, you know, it's, it's the fishing boat and you See the water, but you're not going to see what's, what fish are under underneath there. Whereas if you jump in a scuba dive, you can see, yeah, that's a blasting pancreatitis in this cat, hypoco and irregular and you have this hyperchoic inflammation of fat.
That's also ponification of fat. This is the edematous pathological pancreas, or here in this cat with this undulating contour of the pancreas and this this pancreatic duct that is dilated. These are all, these Are these are classic pancreatitis cases, but you don't know, one, what type of inflammation is in that pancreas.
Is it lymphoplasmaytic or is it neutrophilic? You're going to treat them differently if that's the case, right? Or is there a neoplastic process going on there?
Is this pancreatic lymphoma that does happen? Or is it pancreatic carcinoma, is it spindle cell tumour? You don't know any of that because they can all look the same.
They can all have all of these runn signs of Pancreatitis, but there may be more going on, or not just pancreatitis, but also pancreatitis with neoplasia, you know, so. We want, we want to follow it out sonographically. So you have the pancreatitis case and you're treating it and so forth.
On day one, you see, OK, it's a blasting pancreatitis. But on day 2, day 3, day 4, what's it look like? Is it getting smaller?
Is the inflammation calming down? Better yet, you can put a needle in the pancreas, 25 gauge FNA into the pancreas. Nice study here on cats, 73 cats.
When they put needles in the pancreas, you know what happened? They got a diagnosis. They got a diagnosis and they knew what what was carcinoma, pancreatic lymphoma, lymphocytic plasmacytic pancreatitis, or if it was neutrophilic, and none of the cats died.
None of the cats had complications and, and that old adage, it's really tough to do any significant damage with a 25 gauge needle. And so, I, I don't know where the phobia came from. It's probably poor technique, but if you can, if you can do a systo, you can do an FNA of the pancreas with ultrasound guidance.
We do it all the time, very straightforward. You can see what happens when the needle goes into the hypochoic portion of the pancreas. You get all that information because otherwise it's just guesswork, even though you know pancreas is a problem, is it just pancreatitis or not, you know, and, and when it's not.
You know, when it, if, if you're treating a cat for pancreatitis, pancreatic carcinoma it's just not going to get better, or if it's pancreatic lymphoma, it's not going to get better. And so you want to know that on day one, not on day 3, not on day 4, not on day 5 when the animal has already spent 5 days not getting better and the owner is calling you every day, why is he not getting better? And they've already had emotional.
And they've already have economic employment. If it's badness, you want to give them the, you want to pull off the band-aid and give them the answer on day one, you know, and they'll, they'll appreciate they will like it, but they'll appreciate it a lot more than they will on day 3 or on day 5. So again, put a probe on it.
If it's not right, if you can get to it with a needle, 25 gauge and get it on a slide, get your answer, so you know where you're going. With the case. And this is a SE 13 position, all of them are numbered, and this gets the pyloris every time, no matter what's in it.
It also gets the common bile duct and the pancreatic duct that come together. And, you know, you wanna see that because you want, you want to see the portal vein for checking on the shunts, you wanna see a hepatic lymph node that's sitting there, right? You wanna see what the common bile duct looks like, if that's, you know, bilirubin's going up, as it supposed to paddock obstruction.
You want to see what it's doing to the pancreatic duct as they come together. So these are all things that you can see on ultrasound and, and I'm not saying if Pick up a probe and start learning to do ultrasound, you're gonna see all these things. But whoever you're seeing is sending it to will, and then you will learn over time what these things look like, right?
This is a classic pancreatitis and the schnauzer, OK, occupational hazard. Of course, it's a schnauzer, of course, it has pancreatitis. But this is what it looks like and it wraps around that duodenum.
And this is one of the reasons they throw up their soul when they get pancreatitis. Especially on the right side. We did a study on that.
Whereas if they get pancreatitis in the left limb, they tend to just be not doing right, and they don't throw up as much. And so there's a, you can monitor that and take a look at that on ultrasound on day one and see how your therapy's doing on day 3 and day 5. Or you can see if they're getting a post hepatic obstruction.
This is a pancreatitis case that got adhesions and pinched off that common bile duct. And you get that bilirubin dog that comes in 4 or 5 days after you've been treating it for pancreatitis, and then you turned yellow. Often this is what's going on, and you can see that on ultrasound, as the, as the adhesions, pinch off the common bile duct.
Sometimes we run into pancreatic abscesses like this one. This is in the right base of the pancreas. This is the portal vein coming through and you have these cavities here.
This is necrosis and this is abscessation, this fluid. Should never have free fluid or coalesced fluid in the abdomen. And if you do, you always want to get a needle in it because you'll, here's the needle going through into the cavity.
And this is antibiotic getting injected right back into that abscess, and this is what we pulled out of there. And this is about a week later after therapy and so forth. He's doing great, no surgery.
So ultrasound guided drainage of the abscess. You don't necessarily have to put antibiotic back into it, but I If I had an abscess in my pancreas and I pulled that out, I would want an antibiotic back in. You know, and sometimes they culture positive, sometimes they've been given antibiotics already.
They may not culture. I'm not a big fan of the, you know, cultures as far as how accurate they are, because there's so many variables and getting false negatives and so forth. But that's me.
I, you know, I make suggestions, you guys make decisions. But when you see a pan, a mass like this, an elaine a lesion in the area of the pancreas, you know, it's probably pancreas because that's what lives there, right? And so this is an S step 8 position that pancreas lives in S step 8.
It's not supposed to be there. We put a needle in it. It, this was a cat that you'd see a map.
Mass on radiographs and you can palpate it. So you immediately think neoplasia, right? Well, this was not.
This was a necrotic mass. It was non-neoplastic. And this cat got treated and did fine over time, you know?
And so mass is not equivalent to neoplasia. It's very important that we, we utilise our, our language correctly on that because you, you can give a death sentence to an animal that can definitely respond. But then you get something like this, same sort of lesion, same position.
This is a spindle-style sarcoma. This is an adenocarcinoma, same position, a little bit different look to it, but these are, you know, the sonographically, these lesions can look the same, which is why we put at least a 25 gauge needle into these things. Same thing with insulinomass, that's what they look like, you know, the profile, what it does clinically, and we're looking for these hypochoic nodules in the pancreas or lymph nodes associated with it, and you'll get the answer on the lymph node or the nodule.
And sometimes these, these insulinomas are very, very small, so I go. Look for the lymph nodes. If I see a lymph node or any nodule in the liver, I'm sticking it in an insulinal case because it may be metastatic and the primary may, may be very small.
But sometimes we get the primaries that are big enough to take a look at, we map them out and say, OK, yeah, you can take that out. That's the left limb, you know, and I don't see any mets anywhere else. So.
So moving on to more things that make animals vomit, the GI disease, foreign bodies, obstructions. So, you know, if it looks like a duck, it probably is. This is a radiograph of the animal ate this duck, you know, you can't make this stuff up, right?
But clinical sonography will, one, will keep you, keep your technicians from, having to utilise barium, so your technicians will love you more. But a GI, GI ultrasound for obstructions is actually quite straightforward. Once you follow the protocol, we're looking for a dilation of intestine.
With concurrent small intestine that's empty, we follow the dilation until we run into something that's not supposed to be there, and it's usually followed by empty small intestines. So that's called an obstructive criteria. So we're going to guess, guess the foreign body here, and this is a rope, dog ate a rope, and these obstructed into the small intestine, you know, and, and so I like to play guess the foreign body, you know, it's gonna kind of fun.
Sometimes it can be. A bit revealing about the owner as well. I'm sure you guys have run into that in clinics or see something similar like that.
And then, you know, then you get, you're imaging the stomach. This is an S 8B position where we see the stomach in its entirely and it's gastric fundus, and then you said, oh, there's this mass here, right? Well, we can put power Doppler on this and see if it's a mass, it's going to be power Doppler positive.
It's a foreign body, it's gonna be negative. But, and if we put a needle on it, if we put a needle in this, you know, we get back. We get mashed potato back.
This is actually what a potato looks like in the gastric fundus, right? So it's very important to get a definitive diagnosis. You don't want to give a give a dog a mass when it's actually a big potato sitting in there, right?
So, and, you know, you put a needle in and you get mashed potato on your slide. I'm sure, you know, the pathologist will have a, have a laugh or two on that one, right? And then you get the GI form bodies, the linear form bodies, which will anchor usually in the pyloris, and then they'll have the accordion pleading and so forth.
And this was an obstructive one that had to go to surgery, right? It's a fabric type foreign body, that has a linear attachment, right? And sometimes they move through, so you can follow this one was empty, but he ended up having Having the foreign body in the colon.
This is a step 3, where we see the colon and there's the foreign body. So, you know, you don't have to go to surgery, you just have to wait for it to come out, right? In both of these cases, this happened to be, ladies' underwear or thong, right?
So you just have to hope that the, that it belonged to the, to the wife or the partner, and it wasn't a surprise to the owners. And, this particular one, happened to be a surprise. It's like, that's not mine.
That's what the owner said. So, you know, it is what it is. This is when you, when you pull one of these out of surgeries, you hand it to the technician, put it up there and you, you're gonna be in surgery for the rest of the day.
You don't want to get caught up in that conversation, right? But you definitely want to have a laugh about it later on. Gastric ulcers, of course, this is what gastric ulcer looks like.
So you have the hematemesis case, you're gonna put a probe on it and you're gonna look for these inclusions, these hyperchoic inclusions that are, that are penetrating into the wall. Protein losing and neuropathy, this is what mucosal fogging looks like. This is all lymphangjectation, the small intestine.
And 1.5 of an albumin on the American side of calculations and measurements, that's what we're looking for because if you have an oncotic pressure or a albumin of 1.5 or less, that will form aci spontaneously.
If you have a An albumin at 1.9 and you have ascites, the ascites is coming from something else, and the low albumin may be contributing to it, but when we see this sort of thing with the mucosal fogging and a low albumin, that's protein losing and neuropathy and rubin otherwise, and of course it's probably a Yorkshire terrier, right? But we call that mucosal fogging, and you have those PLE cases, those low albumin cases, put a probe on.
In cats, low albumin goes with lymphoma and bad inflammatory bowel disease. So you definitely want to put a probe on it. The low albumin, the cat is a big red flag for me.
We did a study on that, but also in dogs, it's either going to be protein losing, nephropathy, protein losing, and neuropathy, or liver failure, which will have a bunch of other parameters to it, or Addison's. So that's the albumin breakdown when it's low in a dog, so you put a probe on it and you see mucosal fogging. OK, great, PLE, but this one opens up into.
Lymphoma. Lymphoma is obstructive mass, right? So you can have perineoplastic protein losing and neuropathy as well.
So you always want to put a probe on it. Again, anything that's not right, put a probe on it, you're gonna find something to talk about, and you may find the actual problem. And cats with GI disease, you know, they know inflammatory bowel, quote unquote, whatever that is.
Times they have hairballs. They don't transit their hairballs, and it may be the hairball's causing the problem right now. This is what a hairball looks like in the stomach, big shadowing looks like a big foreign body, but it's just a hairball, you know, and a good week's worth of laxitone will break that down pretty well.
Sometimes they transit into the small intestine. That's what looks like a soft foreign body, but it's actually a, hairball and those of us that have seen these a lot are pretty straightforward. In the deceptions, of course, you're looking for the sausage in the, in the middle with her sausage or the onion, palpable sausages I was always called, told to to palpate and it looks like an onion on ultrasound pretty straightforward.
Then you get the lesser, the less common things like bowel necrosis, and this is actually a bowel infarction with necrosis. So you have this obstructive mass. And all this inflammation, this was a non-neoplastic bowel infarction.
So you never, again, the box of chocolates things, you know, never know what you're gonna get. GI neoplasia, lymphoma, put a needle in it, get your answer and move on. Very straightforward stuff, intraoperative ultrasound, that's something you can do too if you're interested in that, you can, reach out to us on that.
We can give you some resources. So working through ascites, you may have pericardial effusion. If I have ascites in the abdomen and the paddock veins are dilated, I'm going right to the chest to find out what the problem is cause there's a causing something in the chest that's causing passive congestion.
Like this pericardial effusion, or maybe have ascites from a renal lymphoma, or a ruptured mass, or this is a, this is a pericardial fusion with toponod and toponod is defined by collapse of the right article. So you can have pericardial fusion without collapse of the right article. That's not tompono.
That's just pericardial fusion. But when you have collapse of the right article, you know, this Is a problem, the pressures of the pericardium are higher than that of the right atrium, and therefore, you're gonna get passive congestion. Or maybe have that, that, that, mitral dog that just ruptured its left atrium.
It's got a clot in the pericardium. You'll see that occasionally. On rare occasions, these will seal up, believe it or not, but most of the time, it's not a good thing and they're not long for this world.
Or you have right-sided failure, like the skunk. This is a skunk with a kind of an unclassified cardiomyopathy or myocarditis. It looks like DCM and it, it was failing.
And then when you have that sort of failure, you get the passive congestion on the liver, which I'll show you here just now. You get this dilation of the being a cave and and hepatic veins like that. That's what you want to look for.
When you see that and you see ascites, go cranial to the chest to find the answer. So again, the PLE cases, PLN cases, the kidneys often don't look like much in protein losing nephropathy, but you go by your protein or your clinical parameters. You may have ascites from portal vein thrombosis.
This is what portal vein thrombosis looks like. You have a hypercoagulable state. You can get a thrombus in the portal vein.
You get secondary ascites. You see that sonographically, you know, how else would you diagnose it, right? And so we see that sort of thing all the time.
Neoplasia will cause ascites, hypochoic lymph node, put a needle in it, a mass, and they'll find a lesion, put a needle in it. Maybe even pull the ascites and side to spin it down and slide out the sediment. Anytime you're you're tapping fluid, slide out the sediment after spinning it down.
That's where your answer is. We see target lesions, which are usually neoplastic or fungal if you're in a fungal lesion. I don't think you guys have much in the way of fungal, but we do here in the states.
Telescytology is a great thing to do, you know, with the world that we have today and that you can get your slides read within a couple of hours. It's, it's a great option. And then if you need special staining, you can send it out.
Thrombosis, this is the thing we see on ultrasound all the time is thrombosis, you know, and, and I don't need the dimers and FDPs to tell me there's a thrombus. I can look at it. I can see it, and then I'm looking for a hypercoagulable state.
To go along with it, right? And these are all the things that do that. Essentially, any, any significant sickness will cause a thrombus, right?
And this is a splenic vein thrombus. This is your classic saddle thrombus. This is an intrapatic vascular thrombus.
This is a big aortic thrombus that was completely incidental. This is a, what a phrenic vein thrombus looks like coming off the left adrenal from the right side. And this is of course a ping pong thrombus and a unclassified cardiomyopathy of a cat, you know, you don't, I, I don't need expensive tests other than a probe and and some visual of what's going on in those, in those vessels.
So, obviously, ascites can be caused by splenic masses, and we always want to check the heart to make sure there's not a concurrent mass going on in the right article before we go to that splenectomy. Thoracic disease, it can tell pretty rapidly if the fusion or the, the cough or the respiratory signs are cardiogenic or not, just by seeing if there's volume overload in that left atrium or not, right? So every type of, even if you've never scanned before, if you can get a view of that 4 chamber, right, for perternal four chamber long axis, what we call the brick where you're seeing that left atrium and left ventricle, and that mitral valve, you can tell within seconds if that's a cardiogenic case or not causing that cough or the pleural effusion or not.
And we have a protocol for that. You can get into fancy things like bubble studies and things like that. It's really straightforward as far as getting the image acquisition, whereas the interpretation can get more and more interesting, but if you're following a good protocol, you can send that image set to whoever you trust, and, and that's what we're about.
We have specialists and 24 specialists, all in Europe and South Africa, and the United States, and they're all very, very good specialists. All you have to do is get the image acquisition and, and that is a very quick thing to do, and you continue to refine your pathology or your your image acquisition over time. We're in the last few minutes here, so I'm just gonna go through some other things that we, we put a probe on all the time, that thyroid and parathyroid pathology.
Whether it's a thyroid carcinoma or an adenoma, we can put needles in that with ultrasound guidance. You're looking for that hypercalcemia cause, that parathyroid adenoma, very straightforward. You just need the right probe and the right machine for it.
Aogland pathology, is that an anoland aonitis or is it a aogland carcinoma? Does it look resectable or not? Is it an aogland abscess?
This is a big anal gland carcinoma. That's what it looks like on ultrasound. You know, you have a lump in the abdomen on the body wall.
Put a probe on it because you may have a penetrating foreign body and a big abscess that you can ultrasound guide and pull out, or grass ons, for example, that we have a lot here in the United States. That's what this looks like, that, that fistula, you know, maybe a porcupine quill or something like that that gets in there. You can just ultrasound it, find it, take the alligator forceps and pull it right.
Back out. How many of you have been frustrated by those cases, right? So, the very useful thing to do there.
Orthopaedic ultrasound. We, you want to know if you have a buckle, bucket handle tear, chronic DJD, partial tear. You can do orthopaedic ultrasound with a linear probe.
Very straightforward. This is what the cruciate looks like on ultrasound, and you want it nice intact. It looks like a band right there, the interior cruciate.
This is what a buckle handle tear looks like, this is what a normal meniscus looks like. So I call it the whack a mole. When the whack a mole pops his head out, he looks, that's when you have, you have a ruptured meniscus.
So when it comes down to, guys, is, is, we as practitioners, we have a client base that comes to us on a daily basis to get the answers efficiently and accurately as possible. They don't want to spend 3 days trying to figure, they don't want you spending 34 days trying to figure things out. They want to know right away.
And think of clinical sonography as your bridge. You know, every animal that comes in, he's either going to have surgical disease, he's going to have intensive care disease, he's gonna have outpatient medical disease, or he's going to have nothing, you know, and, and so, or he's gonna have hospice, excuse me, hospice care, you know, for multicentric badness. And, and so it's our job to figure out which one of those doors that.
Needs to go to, right? And as efficiently as possible. So challenge yourself.
I strongly recommend that you adopt ultrasound in your practise if you haven't already. I strongly recommend that you get a proper machine for it unless you have a cat practise, you can spend a lot less. But if you have a full practise where you have Labradors and others, you need a good solid machine and you need to be looking at about 40 to $40,000 3500 to $40,000 American.
To get a machine that's gonna be powerful enough to penetrate into those docs, and otherwise you're gonna misleions because the machine, the hardware is not good enough for you. So, and then technique, so it's the machine, it's the technique, and then you do the numbers and economically it all takes care of itself. It becomes a nice profit centre for you.
And, and so, and we've been doing this over and over and over again for 30 years now, you know, and, and it's we live by the 12 to 24 hour rule to get to the answer what's going on, and get a direction for that patient. And when you get those answers, you know, and, and the friends of, friends of that client are gonna say, wow, it took, you know, let them talk about 2 to 34 days of getting the answer when that animal came into your place and you found that perforating mucous seal when it looked like a pancreatitis or that distal foreign body. That neoplasia and you got to the answer right away.
That owner's going to tell like kind that you guys got it done right. You got it done quickly, and it was, you know, it was a great outcome. It was a bad outcome, but if you get it done in a short time frame and accurately, then it's a win-win for everybody.
Right, so we have a nice suit YouTube channel. If an hour of me is not enough, there's plenty up there along with a lot of good, good friends from around the globe, and I highly recommend coming and seeing us hanging out at the summit in Vienna on May 8th through the 10th of 2026. A lot of talented people here, and I'm just kind of along for the ride, but these guys really know what they're doing.
So we invite you to come there and, and hang out with us and, and enhance your ultrasound skills or even, you know, digging deeper to, hey, is ultrasound right for me? The answer is probably yes, and even if you're not the one with the probe, if you have it in your practise, where you have a probebe, every time you open that door, probes ready to scan, you're gonna win and win and win and get to the answers as as fast as possible. So, finishing up here.
I'd love to take some questions. I thank you for hanging out. I think I sort of stayed with the time frame.
And I know I went through fast on a lot of this stuff. My wife, sent me a picture, sent me a message, she's here in the room with me as I got to slow down. Eric was like, Well, I'm not gonna get through this in 50 minutes if I slow down.
So it's a matter of, but I do listen to my wife and I did slow down. So it's, but I just realised it's about, just getting an overview of what ultrasound can do. And I'm sure there's, there's an application of clinics that patients that came through your clinic this week, that pretty much touches on every page of the slide, because that's what lives out there, you know, and, and maybe you saw it, maybe you didn't, maybe it just saw you, you know, but if you keep looking, you're gonna find stuff over and over again that'll put that animal in the right direction.
So, With that, I'm happy to take some questions, and thank you for hanging with me. Eric, I'm not one who's often short of, of things to say, but I can only come up with one word for this, and that is mind-blowing. Thank you so much.
. It, I, I've never professed to be a, a really good ultra sonographer. In fact, those who know me will know that I often say I know where to switch it off and how to move it out the way. But, you just take it.
A whole new level. So thank you so much for your time and to your company Sonoath, for sponsoring this evening. Thank you very much.
Thanks for having me. And, folks, just a reminder that we have, recorded this. So, although Eric has gone through it very quickly, you can go back onto the website in the next 24 or 36 hours, and you can watch the recording and rewind it and Go through with it.
And then, of course, like me, if you need to know more, want to know more, SonoPath is the place and there is an email address on there for you to get hold of. And Eric and his fantastic team will be able to guide you through all the information that you need. Eric, something that is stirring the pot of questions is about abscesses and prostate abscesses, pancreatic abscesses, needles in and antibiotics in.
What The questions are, you know, how easy, what antibiotics should we use? You mentioned antibiograms, you're not a fan, but people are saying, should we wait for those? What should we put back in, etc.
Sure, sure. That's a, it's a great question and it is It is a, I don't, this is a, you know, the case load of study between my ears and those of my colleagues that do this. There are some people who don't like to do it, but I've yet to see a, a complication from it.
And, and my thought process is, the only place I won't put it is in a renal abscess, OK? But when you're talking about prostatic abscesses, pancreatic abscesses, you know, body wall abscesses, even hepatic abscesses, I typically lean towards a refloxacin. Never had a problem with it.
And, and, you know, the problem is you're right there with a probe and a needle, right? So you can't really wait for your antibiogram to come back. You, you know, you gotta just, you're there, you know, you wanna, you just fill out use about a body weight dose, 5 to 10 makes per kg.
And if it's a, if it's a larger abscess, I mean, that's Some saline to that, and, I've never had a complication. I've only had positive responses and faster cure rates because this is an expensive disease. I mean, just think of how much it costs the owner for a pancreatic abscess to go to surgery or a prosthetic abscess and a and a and a .
The, what do you call it, prosthetic, I'm trying to think of the surgical procedure, but it's, it's a message, the marsupialization. Thank you so much. Yeah, and so I mean those are expensive things in the states you're looking at $300 to 60 to $7000 you know, and whereas with this, you're looking at a, you know, an 18 gauge, 16 gauge, 2 inch needle with an extension set and a 60 cc syringe and a and a shot of Batrol, you know.
So it's, and then just monitoring it. So it, it really gives you a lot more flexibility to do it. I just, just do not do it and I, I do it in the organs I mentioned, but I do not do it in the kidney cause I had a colleague that sent a cat into renal failure doing that.
But at least drain it, you know, if you're not of the type that wants to take antibiotics in, just drain it and, you know, you're gonna need intensive care, you know, intensive care and, and good solid fluid therapy to open up vascular channels. To get your intravenous antibiotics there, right? Cause a lot of times these things are walled off with a granulation bed.
So whatever you put IV sometimes doesn't even get there, right? Because it's just walled off. And you can see that with Power Doppler on the lesion.
You know where the blood flow is, The Power Doppler's gonna tell you. And if it's all walled off, how are you gonna get an antibiotic IV even there, much less an IM or an oral antibiotic, right? So, that's the, that's the reasoning behind it.
And I would love to do it, I love to. I have to do a study on that. I just, you know, in 30 years, I haven't had time, but I can tell you 10,070 cases of those between me and my colleagues, and we've never had a problem injecting antibiotic back in and only had positive results, but I'm knocking on wood right now because it'll, you know, next week I'll be on the road.
You know, I'll probably have a problem with it. But, yeah, so I know it's a long-winded answer, but it, it, it is a great question. If you can do a Cysto, the other thing is the ease of it.
If you can do an ultrasound guided cystocentesis, and you can do it regularly and you can be lined up and watch that needle go in. If you're doing a pancreatic abscess, it's a glorified cysto. It's just a further, further up towards the diaphragm, you know, and same thing with a prostatic abscess, you know, you just point back towards the tail and in front of the pubic bone, and the thing's gonna jump on the probe.
You just find the angle, the closest distance between two points, and, and it's a glorified cystocentesis, yeah. And just a couple of questions coming through about antibiotics and doses, and that's the thing. You're just using standard doses for your, Beryl, your refloxacin.
Yeah, yeah, yeah. That's whatever you, whatever you would give I am. It's very arbitrary, but, you know, you're getting a nice concentration right into that cavity anyway.
So I think it just gives you a really good jumpstart on, on your other therapy. And I like a prostatic abscesses personally. I've always usedbatrol clindamycin, .
To cover the bug spectrum that'll be in a prostatic abscess, but also to get some good penetration by that and refluxus, and it loves to get in the nooks and crannies, from the pharmacodynamics. One last question, Eric, quickly because we are running out of time. Cat fur balls.
You mentioned about the fur ball in the stomach and, using laxatives. How can you decide at what point in the GI tract that it's a fur ball that's gonna move? Yeah, that's a great question.
So, yeah, you know, usually they're in the stomach. We're gonna see them in the stomach most of the time and the density of the of the fur ball. Tells me whether how much I'm going to treat it medically or how much time I'm gonna get it, right?
So if you get a progressive acoustic shadow, where it's been the the ultrasound beam is penetrating through that fur ball for a while and then it attenuates, those are typically medically manageable. You get laxiton or whatever you guys use for it in in the UK for about 1 week or 10 days, put another probe on it, it's probably going to be gone. You know, whereas if it's really dense like a rock, like a bladder stone would be, that's probably a surgical, and if you're gonna go into the stomach to evacuate that, you want to get GI biopsies cause they probably have underlying disease.
If they've had problems with hair balls, they typically have underlying disease, even, you know, inflammatory bowel or even lymphoma sometimes. Excellent, excellent. Yeah, folks, I, I've gone through a lot of the other questions.
I know we have run out of time. There are a lot of them that if you go back and watch the recording, Eric has covered those. For example, the one that says, when do we know to put a probe on?
Go back and watch Eric's, very passionate, stick a probe on when it's walking through the door, entry to this, webinar, and then you'll get the answer to those. I don't think we've missed any questions that you haven't answered, Eric, but if we have, we'll send them through to you and we will get those answers out to the folks. Be happy to answer you guys one last thing, when you're starting to do ultrasound and then just in general employ it into your protocol that you're using, you know, Torbitrol or gabapentin or something like that, just to take the edge off of the patient.
Because it'll be the difference of about 2 to 3 centimetres of penetration of that sound beam into that abdomen, whether they have a tense abdomen or they're relaxed. So you really want to, and, and it'll make your life easier as well. So, sedate, sedate, sedate.
You don't have to sedate heavily, just take the edge off a little doggie Valium, so to speak, and it'll make your life a whole lot easier and make a protocol much more efficient. Excellent, excellent. Eric, once again, to you and your company SonoPath, I say thank you so much for your time.
I, have no doubt we will get you back on again because there is a lot of interest in ultrasounds and especially with, what you guys are doing, making us look like we're holding the probe backwards. But that's what learning. Hey, I can read a backwards probe too.
Just get it on. It's all good. It's all good.
Thank you so much for having me and we love what we do and we love to support people in the process. So that's, that's what we're here for. Thanks, Eric.
To everybody that attended tonight, thank you very much for your time. I hope you enjoyed this as much as I did. And as always, to my controller, Dawn in the background for making everything run smoothly.
Thank you very much. From myself, Bruce Stevenson, it's goodnight. Cheers everybody.
Thank you.
