Raquel M.
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Replying to Raquel M. 27/05/2025 - 14:31
Oh and yes I would still use it. I offer it as an option to client in cases where I can see it being beneficial.
This is great timing Scott. I’ve been thinking about the safety and use of Librela as I’m back in clinical practice again soon.
It’s become a polarizing drug on island. Some love it and use it frequently. I’ve met vets who are extremely cautious with I and avoid even offering it as an option to clients. I think your nuanced approach is very important. I’ve already started to really improve educating clients on it when I offer the option and having them make an informed decision. I’m trying to balance not* being overly cautious with being honest about potential side effects.
At least on island, I think many GPs are more comfortable with Librela because it’s perceived to be safer than NSAIDs. I do think we need to get better at getting baseline imaging done to confirm the arthritis and better at monitoring. I’ve seen Librela prescribed for long term use but I’ve had questions in my mind about whether there was truly clinical improvement in some cases where it continued to be used. I thinking imaging would help and having more conversations with the owner to determine whether it is really beneficial to continue long term use if there isn’t really improvement in clinical signs. I haven’t seen it cause worsening of orthopedic signs but I’ll be more conscious to monitor for that. I’ve not used it in younger dogs yet. Is there any research on neurological side effects or using in animals with concurrent neurological disease? I ask because a visiting neurologist from the vet school I used to work at had concerns that Librela can cross the blood brain barrier. He cautioned with using it in cases with neurological disease. On island, I think that’s done in cases where the clincial signs are misdiagnosed as OA when they’re probably more neurological. We don’t have MRI or CT so I can see the risk of misdiagnosis o occurring in those cases if a good neurological exam isn’t done.Replying to scott@vtx-cpd.com 18/05/2025 - 15:44
I think you worked with one of my old colleagues Ellie there or maybe it was in an emergency practice. I can’t remember her last name she always had great things to say about you. I was telling her about this platform then I found out that she worked with you in the past.
Replying to Jane Sedgewick 20/05/2025 - 18:06
That is great! I would love to start doing something like that on island(Cayman Islands) for the vets here.
Replying to scott@vtx-cpd.com 18/05/2025 - 15:44
Hi Scott,
Yes it’s the humane society here in Cayman Islands(CIHS). My last job was in Barbados at the Barbados RSPCA. They keep the R in RSPCA 😆. Which is even more amusing now that Barbados is also a republic so officially there is no more “Royal” that is used for anything Barbadian owned. They have a new ultrasound machine that I’ll have use of. I just came back from a course in Orlando on cardiology. Unfortunately no ECG but I’ll still be doing the webinars here on ECG. The Orlando course showed all of GPs in attendance that we’ve not used ECG enough. I’ll then be looking to ownership at a clinic on island. Unfortunately the work environment on island has work to do! Had my experience of it and I’ve found my current goals for upward movement to be ownership. Your platform has been great! I don’t know what I would do without online CE. I would love to attend the in person events if it’s feasible for me to visit the UK again. But if you ever have any in North America then I would happily attend. Or make a trip to the Caribbean if you want some fun in the sun 😉
Let us know how it goes Jane. I think is great that your practice holds meetings and discussions on topics like this. I’ll be venturing back into charity practice soon as well so this would be interesting. Last time I did charity full time was back just after I had graduated in 2013-2018. Things have changed a lot since then
Replying to scott@vtx-cpd.com 11/04/2025 - 18:00
Thanks for the kind words 🙂. Ok that’s all good advice and yes please let me know if you ever come upon any concrete evidence. Would be an interesting retrospective study.
Replying to scott@vtx-cpd.com 28/03/2025 - 20:08
Thanks Scott! That’s very helpful to know and I’ll certainly work on educating clients with high risk dogs on this more 🙂
Do you know of any other evidence based advice that can be helpful for clients? I’ve seen a client drill holes into balls that their dog plays with in the hope that if it gets stuck that air can still pass through it. Definitely not fool proof but I can see some do the reasoning behind it.
Replying to scott@vtx-cpd.com 02/04/2025 - 13:26
Yes I did ! It was amazing and I can’t wait to do more. I need to rewatch and write my notes. I’m so grateful you have this option for us foreign vets! 🙂
Replying to scott@vtx-cpd.com 28/03/2025 - 20:16
Thanks very much as always! I’ll keep you updated : )
Replying to scott@vtx-cpd.com 25/03/2025 - 11:56
Is it also helpful to have the owner monitor pH at home? I’ve had some owners do that so I can tell what the average pH is throughout the day.
Also would you recommend screening radiographs also? I recommend that because she’s an older dog also so added bonus to help catch other changes in organs earlier. Let me know what you think because I like to offer spectrum of care approaches also if owners need it. Especially because we don’t have pet insurance on island. Also gives the owner more buy-in I find if they have an input in decision making : )
Replying to scott@vtx-cpd.com 25/03/2025 - 11:56
Thanks as always Scott! This canine patient I have did have infection induced struvite. The lab cultures a staph (aureus from memory) as the predominant bacteria.
She presented with a history of dysuria for 2 years prior! So I would consider her high risk for forming more struvite.
She has her cystotomy a few weeks ago and has been on Hill’s CD wet food since.
Thanks for the advice as always! To manage costs better we have the option to use a human lab(on island)to culture and run the sensitivity. I counsel the owners that the antibiotics choices would be limited to human versions.
Can you foresee any other limitations using the human lab on island to culture? Could they potentially miss certain types of bacteria that aren’t common in people?
I’ve not had any issues but was curious on your thoughts about this.
Replying to scott@vtx-cpd.com 22/03/2025 - 16:54
You’re welcome! Yes it’s been the journey in my career for sure working in different countries. I’ve worked in the UK also 🙂 I went from a country where parvovirus, e. Canis and leptospirosis were diseases I encountered all the time to never seeing a case of them when I spent a year at a practice in South London and a 5 week locum stint in South Yorkshire.
Yes it would be due to the thrombocytopenia so that is great advice.
I have had cases where the 4dx snap test gives a postive to e. Canid but the animal is non-clinical and no changes on cbc so that’s really good advice.
Replying to scott@vtx-cpd.com 20/03/2025 - 20:55
Thank you 🙂
Replying to scott@vtx-cpd.com 20/03/2025 - 12:22
That’s a great idea! Does your clinic or have you seen clincis charge for that or not? And is it with a nurse or vet and does that change whether it’s charged for?
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