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Raquel M.

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  • Raquel M.
    Participant
    21:14 17/08/22

    Replying to [email protected] 10/08/2022 - 09:26

    Thanks again! Super helpful as Always

    Raquel M.
    Participant
    22:00 09/08/22

    Replying to [email protected] 08/08/2022 - 19:40

    Great to know that the oral cobalamin is it’s as effective. I wasn’t sure if it was better to stick with the injectable form or not. I have used the oral form before.
    An Idexx internal medicine specialist had told me once that they wouldn’t use the oral supplementation with a too with pancreatic insufficiency. Do you feel this way also? (Not related to the case I asked about previously)

    Also do you have a dose of the folate if I use a human product? Or should I follow the guidelines on the cobalex packaging? Not sure if I’ll get permission to order some for the clinic. I can ask the client to and see how long that may take.
    Thank again!

    Raquel M.
    Participant
    14:25 08/08/22

    Replying to [email protected] 08/08/2022 - 10:23

    Hi Scott,
    Thanks so much for the quick and super helpful response. Her cobalamin levels were 242 ng/L. Her folate was 3.9 ug/L(normal is 4.8-19). I’ll see if we can order Cobalex in. Might be a while(I’m in the Cayman Islands). Can a human folate product work alternatively? I gave the owner the options for supplementation-oral or weekly injections. She chose the injections.
    Thanks again!

    Raquel M.
    Participant
    19:31 31/05/22

    Replying to [email protected] 31/05/2022 - 19:26

    Thanks so much as always! I’ll see if we can it shipped here. Or I’ll check with the compounding pharmacies we have on islands 🙂

    Raquel M.
    Participant
    20:16 27/05/22

    Replying to [email protected] 24/05/2022 - 14:37

    Really interesting case-thanks for posting! Just reading through now because I also have a Yorkie with suspected PlE. Currently working it up. Scott, would you also use clopidogrel for hypoalbunemia? And when would you consider supplementing the vit d for the hypocalcemja.
    What does of clopidogrel would you use? I’m not sure if I can get it compounded on island so the smallest size of tablet I have available would be 75mg. The yorkie is 7lb but has ascites so her true weight is lighter.

    Raquel M.
    Participant
    03:49 25/04/22

    Hi thanks for asking this.
    I also wanted to find out how long the transmucosal can be used for. I had attended a dentistry cpd day and it was mentioned that if it’s used for more than 3 days in cats that it can cause hyporexia. Interested to hear what Scott would recommend.
    If it helps before Scott answers:-You’ll find some dosages at the very end of the pancreatitis cat lecture. The article Scott mentioned on triaditis had a buprenorphine oral transmucosal dose of 0.02-0.03mg/kg q6-12hr.
    I had see a study on buprenorphine in cats-‘ a review of studies using buprenorphine in cats’ from 2014. Which mentioned that that dosages of 0.04mg/kg provide higher levels of analgesia. Not sure if that’s a dose that can be used routinely in pancreatitis cases? Oral transmucosal or IV/IM.

    Raquel M.
    Participant
    14:09 14/04/22

    Replying to [email protected] 11/04/2022 - 16:02

    Had some other questions:-

    1) At my current clinic, sucralfate is commonly given for animals with diarrhea. Especially dogs. My understanding is that it is used to help prevent the diarrhea by causing constipation as a side effect. I’ve seen the other vets dispense it in the pill form so I’m not sure if it can even cause constipation if it’s not being given as a slurry. Is there ever any indication to treat diarrhea by giving a medication that cause constipation? I’m not comfortable using the sucralfate in this way but there are clients who expect it to be dispensed for diarrhea based on their previous treatments from the other vets.

    2) How would you approach treating mild Diarrhea as side effect of chemotherapy use? Would it be a similar approach to an uncomplicated diarrhea case using dietary support, probiotics? Do you ever consider antibiotics? Another webinar from the a Caribbean conference was describing the use of metronidazole in cases of diarrhea due to chemotherapy.

    3) is there any evidence to state that using antibiotics and probiotics concurrently can reduce the efficacy of the probiotics? I know you had mentioned that using probiotics can the start of an antibiotic course like amox clav, can reduce the likelihood of the GI side effects of the antibiotics.

    I have a few other questions but I’ll not post them all in one go to give you a chance to respond.

    Thanks as always,
    Raquel

    Raquel M.
    Participant
    11:29 13/04/22

    Replying to [email protected] 13/04/2022 - 08:19

    Yes I can email it to you and see if I can get in contact with the speaker to get the references she used 🙂

    Raquel M.
    Participant
    22:44 12/04/22

    Hi Scott,
    Thanks as always for answering our questions. I had recently listened to a recorded webinar from the Caribbean veterinary conference. I didn’t get to attend the live webinar so wasn’t able to ask questions.
    It was mentioned that there is evidence showing:-

    1)The use of appetite stimulants in the acute anorexic patient could prolong the hyporexic state and lead to a longer negative energy balance.

    2)The speaker recommended reserving appetite stimulants for chronically ill patients with hyporexia vs acutely anorexic patients.

    3)I believe she meant that it was better to start with a feeding tube(unless contraindicated) instead of an appetite stimulant, in acutely anorexic patients.

    I would imagine it really depends on the case. How long would you continue to try an appetite stimulant before using a feeding tube in an acutely anorexic patient?

    Thanks,
    Raquel
    P.s. not sure if you may be covering this in the feeding tubes lecture

    • This reply was modified 2 years ago by Raquel M..
    Raquel M.
    Participant
    13:02 12/04/22

    Replying to [email protected] 12/04/2022 - 08:36

    Ok great thanks so much! I’m in the Cayman Islands 🙂. I’ll request an earlier finish work shift so I can attend the next in at the end of May.

    Raquel M.
    Participant
    19:55 11/04/22

    Will this be recorded? With the time difference, London time is 6 hours ahead of where I am. Realized that I missed it!

    • This reply was modified 2 years ago by Raquel M..
    Raquel M.
    Participant
    16:32 24/03/22

    Hi again,
    I’m well thanks 🙂. Hope you are as well. No GI signs, normal appetite. They were discontinued because of the grass eating and omeprazole was started for 1 week or so then to restart the NSAIDs at a lower dose was what the other clinician advised.
    So my concern after your very informative lesson 3. Is that the prophylactic use of the omeprazole without confirmed GI ulceration could have done the opposite and increase the risk of GI ulceration after the NSAIDs were restarted?

    • This reply was modified 2 years, 1 month ago by Raquel M..
    Raquel M.
    Participant
    13:19 24/03/22

    Replying to [email protected] 17/03/2022 - 14:36

    Hello,
    I’m terms of the indication for PPIs in cases of hematoemesis:-

    1) (a) what would you suggest for cases where an animal is reported to have a pinkish color in the vomitus or a few drops of blood as per O?

    (b) also if the owner reported the above was a one-off incident(or intermittent) and the other episodes of vomiting didn’t indicate any signs of blood then would you start with a PPi? Or only if the diagnostic workup confirmed GI ulceration?

    Was just wondering if there’s not a substantial amount of frank blood in the vomitus and the pinkish color or specks of blood reported by owner aren’t persistent. Then is it appropriate to use PPIs or not? Especially if the owner is unable to complete a full workup to rule out ulceration.

    Thanks as always,
    Raquel

    Raquel M.
    Participant
    12:15 24/03/22

    Replying to [email protected] 20/03/2022 - 19:34

    Hi Scott,
    I had another question. A colleaguehad discontinued NSAIDs in a dog on long term nsaid use for arthritis throughout his elbows and hips. He had discontinued it because after questioning the owner had reported that the dog had been eating grass for the last few months. The dog had been doing really well on multimodal pain management along with the NSAIDs. I wasn’t aware that eating grass was a clinical sign of nausea or indication of GI ulceration from NSAID use. Are you able to shed some light on this? Is this something I should questioning owners about or is this something unproven?
    Thanks,
    Raquel

    Raquel M.
    Participant
    14:50 17/03/22

    Replying to [email protected] 17/03/2022 - 14:36

    Thanks for quick reply! Really appreciate the advice. So grateful to have this platform where we can all discuss things that come up often in general practice

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