scott@vtx-cpd.com

Hi Raquel,

Thanks for sharing this! Yes, I’m familiar with the WASAVA guidelines and the ENOVAT recommendations for antimicrobial use in canine acute diarrhea. I think they provide a strong evidence-based approach to antimicrobial stewardship, particularly in reinforcing that antibiotics should be avoided in mild to moderate cases unless there are indicators of significant systemic inflammation.

One area where I diverge slightly is their stance on probiotics. While the guidelines remain neutral due to the evidence balance, I still strongly recommend their use in practice. Even if the magnitude of benefit isn’t always substantial, probiotics are generally safe and contribute to gut microbiome support, so I continue to advocate for their inclusion in treatment plans.

Additionally, I think it’s important to consider other adjunctive therapies, such as fecal microbiota transplantation (FMT) and clay-based products, both of which can be highly beneficial in acute diarrhea management. There’s growing literature supporting their roles, and I’ve included a couple of references below:

ENOVAT Guidelines on Antimicrobial Use in Canine Acute Diarrhea: https://www.sciencedirect.com/science/article/pii/S1090023324001473?via%3Dihub
Probiotics and Gut Microbiome in Acute Diarrhea: https://pubmed.ncbi.nlm.nih.gov/32562450/
Clay-Based Therapy for Gastrointestinal Disorders: https://pubmed.ncbi.nlm.nih.gov/39094622/
Would love to hear your thoughts on this as well!

Best,

Scott

Hello!

What a great question! This is not something I have direct experience with, but I spoke to some collegues and pulled together some information I hope is useful:

Platelet-rich plasma (PRP) is an emerging regenerative therapy in veterinary medicine, particularly in orthopedic conditions such as osteoarthritis and tendon injuries. It has been widely used in human medicine, but its efficacy in dogs remains an area of ongoing research and debate.

What is PRP?

PRP is a concentrated portion of blood rich in platelets, which contain growth factors that promote tissue healing and reduce inflammation. It can be injected into joints, soft tissues, or used as a platelet-rich fibrin clot (PRFC) to enhance tissue regeneration.

Mechanism of Action

Platelets contain transforming growth factor beta (TGF-β1) and platelet-derived growth factor (PDGF), which modulate inflammation by reducing pro-inflammatory cytokines (IL-1, TNF-α) and inhibiting destructive enzymes such as matrix metalloproteinases (MMPs). The goal is to enhance the body’s natural healing response at the site of injury.

PRP Preparation

PRP is typically prepared by centrifugation of whole blood, separating platelets from red blood cells and white blood cells. The final composition varies between commercial systems, individual patients, and species, affecting treatment outcomes.

Higher platelet concentrations provide more growth factors but may not always be beneficial.
White blood cell content influences inflammatory response, with leukocyte-poor PRP potentially being more effective for chronic conditions.

Current Evidence in Veterinary Medicine

1. PRP in Canine Osteoarthritis (OA)

Bergström et al. (2024, Vet Sci) investigated PRP with stromal vascular fraction (SVF) in dogs with elbow OA. Improvement in gait symmetry was observed, but overall efficacy was inconclusive.
Full paper: https://www.mdpi.com/2306-7381/11/7/296
Bland (2015) suggested PRP as a promising treatment for hip osteoarthritis, with some dogs showing reduced pain and improved mobility.

2. PRP in Cruciate Ligament Disease & Post-Surgical Recovery

Volz et al. (2024, J Small Anim Pract) conducted a randomized controlled trial comparing PRP, hyaluronic acid, and no injection post-TPLO for cranial cruciate ligament rupture.
No significant improvement in recovery, osteoarthritis progression, or limb function was observed.
Full paper: https://onlinelibrary.wiley.com/doi/10.1111/jsap.13704

3. PRP vs. NSAIDs in Joint Disease

Raulinaitė et al. (2023, Vet Sci) compared PRP to NSAIDs in dogs with CCLR and patellar luxation.
PRP reduced inflammation and improved muscle strength more effectively than NSAIDs.
Full paper: https://www.mdpi.com/2306-7381/10/9/555

4. PRP & Photobiomodulation Therapy (PBMT) in Osteoarthritis

Alves et al. (2023, Animals Basel) found that PRP combined with PBMT (laser therapy) led to greater and longer-lasting pain relief and improved mobility compared to PRP alone.
Full paper: https://www.mdpi.com/2076-2615/13/20/3247
Comparison with Human Medicine

The debate over PRP’s efficacy is not unique to veterinary medicine.

Campbell et al. (2015, Arthroscopy) reviewed PRP for knee osteoarthritis in humans and found symptomatic relief for up to 12 months, especially in early-stage OA. However, variability in PRP preparations made conclusions difficult.
Full paper: https://www.arthroscopyjournal.org/article/S0749-8063(15)00395-8/fulltext
Clinical Considerations

PRP appears safe but its effectiveness varies depending on platelet concentration, white blood cell content, and patient factors.

No clear superiority over traditional treatments such as NSAIDs, hyaluronic acid, or corticosteroids has been consistently demonstrated.

PRP may have a role in multimodal therapy, especially when combined with laser therapy or other regenerative treatments.

Conclusion

The jury is still out on PRP’s efficacy in veterinary medicine. While some studies show promising results, others indicate no clear benefit over conventional therapies. Given the variability in PRP preparations and patient response, more high-quality, controlled trials are needed.

I hope thus helps! I would love to hear how you get on with this! I would also love to hear if any others have more direct experience!

This also seems like a useful resource: https://www.aaha.org/wp-content/uploads/globalassets/05-pet-health-resources/pain-management/aaha-arthrex-poster-front-small-booklet-trends-nov-2022-web.pdf

Scott 🙂

Hello everyone,

I went down a bit of a ketamine rabbit hole after you started this discussion—I didn’t realize people were using ketamine in such a sporadic subcutaneous way, and I think that’s really interesting.

I also came across this case report that I thought was worth sharing. A dog accidentally received an extreme ketamine overdose—338 times the intended dose—due to a misinterpretation of an electronic treatment sheet. The dog was on a 67.6 mg/kg/hr CRI for four hours, receiving 270 mg/kg total, and developed tachycardia, hyperthermia, anisocoria, and hypoglycemia. Fortunately, with aggressive supportive care, he made a full recovery within 18 hours without lasting effects.

The case is published in Can Vet J. 2023 Mar;64(3):235–238 (PMC9979721, PMID: 36874544) and highlights both the potential resilience of patients in extreme circumstances and the importance of clear doctor-technician communication when using electronic treatment sheets.

Scott

Replying to Raquel M. 25/02/2025 - 16:03

Hi Raquel,

Glad you found the information helpful!

Regarding the potential link between chronic paracetamol use and splenic tumours in dogs, I am not aware of any strong evidence supporting this association. While chronic paracetamol use in humans has been scrutinized for various long-term effects, including potential renal, cardiovascular, and hepatic impacts, there is no well-documented link to tumorigenesis in the spleen. In veterinary medicine, there is similarly no widely recognized data suggesting an increased risk of splenic neoplasia with chronic use.

If your colleague has seen a study or case series suggesting this link, I would be really interested to read more about it. Until there is more substantial evidence, I would consider this more of a theoretical concern rather than a proven risk?

Let me know if you come across anything on this; I’d be happy to discuss further.

Best,

Scott 🙂

Replying to Josep B. 24/02/2025 - 10:11

Thank you!

Scott 🙂

Replying to Josep B. 24/02/2025 - 10:05

Thanks for sharing this, Josep—great summary of CK and its clinical relevance!

I’ve always been a bit unsure about how to use CK effectively, so it was really interesting to explore this further in your recent journal club. The Jones & Harcourt-Brown study was particularly insightful, showing how CK (alongside AST) can serve as a rapid screening tool for Neospora-associated meningoencephalitis. The high sensitivity and specificity at the 485 U/L cutoff make it a useful early marker, though I still wonder about its reliability in milder cases.

In practice, I find CK elevations are often non-specific, especially in medicine cases!

Thanks again.

Scott 🙂