Raquel M.

Replying to scott@vtx-cpd.com 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

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 3 years, 5 months ago by Raquel M..

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 3 years, 5 months ago by Raquel M..

Replying to scott@vtx-cpd.com 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

Replying to scott@vtx-cpd.com 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

Joined a bit late due to some technical issues with registering. Really looking forward to learning more!
In terms of checking cobalamin and folate in vomiting cases. Is this something you would do routinely as part of the minimum database in both acute and chronic vomiting cases?
Just curious as to when in the diagnostic process, would you recommend this? Is it after ruling out surgical disease? Is it when the vomiting is recurrent or chronic? Is it when there’s relapse of clinical signs of vomiting whilst on a treatment plan that worked before. Or relapse of clinical signs as soon as treatment ends?
And what criteria do you use to define when a case moves from an acute onset vomiting to chronic?
Hope that makes sense. Thanks!