scott@vtx-cpd.com
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Replying to Lynne F. 12/10/2022 - 12:39
Lynne!
How lovely to hear from you and how lovely to see you on here.
I hope all is well with you! We are all just about surviving I think!
Thank you so much for supporting the course, let me know if you have any questions at any time.
Scott 🙂
Thanks for sharing Liz.
All still very confusing to me. I wish I had paid more attention in cardiology!
Scott 🙂
Hey Lorna.
I hope you are well. Thank you for the great question. It is a not a drug I use. There is always a bit of a debate about a couple of human GI drugs that intermittently get used in small animal medicine, notably loperamide and buscopan.
Anticholinergics and opiates or opioids (loperamide, diphenoxylate) often are used for the nonspecific management of acute diarrhea, but anticholinergic agents can potentiate ileus and are not recommended. Opioid analgesics were thought to exert their effects by stimulating segmental motility, thereby slowing transit, but they actually act mainly by decreasing intestinal secretion and promoting absorption. They are indicated in short-term supportive management of acute diarrhea in dogs; they are contraindicated in cases involving obstruction or an infectious aetiology. Loperamide can have central nervous system side effects in collies and other dogs with the multidrug resistance (MDR-1) gene mutation. Antimuscarinic drugs such as hyoscine (buscopan) (butylscopolamine) generally are not recommended, as they can produce a paralysed, nonfunctional SI, can predispose to intussusception, and can cause intoxication. However, in mild cases of acute gastroenteritis, their antispasmodic effect could help relieve colic-type pain.
I did have a look for any dog specific literature, but could not find a lot:
https://pubmed.ncbi.nlm.nih.gov/31140850/
It did seem to be helpful and well tolerated in this context. Would love to hear other thoughts.
Scott 🙂
Replying to Ilse v. 15/10/2022 - 07:59
Hey.
Sounds like you did a great job with this! Well done on picking up the cardiomyopathy too!
Scott 🙂
Replying to Kathryn B. 11/10/2022 - 21:02
Hello.
Great to hear from you. Thanks for the great question, I agree, these can be really frustrating cases!
Despite the normal total calcium in this case, I would still measure an ionised calcium, especially in cases when you are not finding anything else. An SDMA would be a good shout. I am less convinced these early cases present so much with obvious signs of PUPD, but again, in cases where you are not finding anything else, I would.
You are right about the USG. When the urine is hyposthenuric, the urine is more dilute than plasma and therefore there must be renal tubular function. Central and nephrogenic diabetes insipidus are differentials as are conditions that interfere with the concentration of urine such as hypercalcemia, sepsis (e.g., pyometra, pyelonephritis), hepatic disorders, hypoadrenocorticism, hyperadrenocorticism and psychogenic polydipsia.
Nothing is totally ruled out by the level of USG that a patient falls in to.
1. I would want to see multiple morning urine samples from this dog to assess ability to concentrate.
2. I would defiantly get the owners to quantify intake.
3. Ionised calcium and SDMA as mentioned.
4. I have seen some weird cases of cPSS present in later life just with PUPD. A bile acid stimulation test would not be a ridiculous shout.
5. I would tend to them image these patients next. There are some other weird things that could be to blame like splenic haemangiosarcoma and pheochromocytoma.
6. If all else fails then you could then consider DDAVP trial.I hope that helps. Let me know how you get on with this one.
Scott 🙂
Replying to Ilse v. 11/10/2022 - 01:05
Hello.
Great question. I will make sure we ask this at the live Q&A tomorrow night!
Scott 🙂
Replying to leonique v. 11/10/2022 - 10:22
Hey Leo.
Thank you for the question.
I will make sure Felipe gets this one!
Scott 🙂
Replying to Catarina S. 11/10/2022 - 16:24
Hello Catarina!
Thank you so much for joining the course and thank you so much for your kind words. I am really pleased you are enjoying the course.
Scott 🙂
Replying to Neus E. 11/10/2022 - 13:38
Neus!
What an absolute joy to see you here! So excited that you have joined us!
Scott 🙂
Replying to Hannah L. 10/10/2022 - 16:06
Hello Hannah!
Welcome. Thank you so much for joining the course. I worked in the medicine department at Wear until late 2021! What a lovely team there is there! We have had the privilege of Jon, Felipe and Janette working with us at vtx!
Really glad to have you on board.
Scott 🙂
Replying to Natalie N. 10/10/2022 - 10:35
Natalie!
It is so lovely to hear from so many familiar faces on here!
I really hope you enjoy the course, thank you so much for joining.
Scott 🙂
Replying to Samanta A. 06/10/2022 - 13:51
Hello Samantha!
I hope you are well. Great question. Most cats with idiopathic hypercalcemia will respond to oral alendronate, at a dose range of 10-40 mg once weekly. I start with an initial oral dose of 10 mg per week, and then gradually increase the dose based on ionized calcium concentrations monitored at 4-6 week intervals. What does are you on at the moment? Is there room for increase?
This treatment protocol will restore normocalcemia in over two-thirds of the hypercalcemic cats treated with an average weekly dose of 15 mg. The other options would be dietary therapy (high fibre) and the possible addition of steroids.
The oral bioavailability of alendronate in cats is poor. In one study, the percentage of the drug that was actually absorbed when administered to cats was found be only 3%. This percentage fell about 10-fold when alendronate was formulated in tuna juice.
To maximize intestinal absorption of this drug, I recommend that the cats be fasted overnight (12-18 hour fast) prior to the administration of the alendronate. The medication should then be given with 6-ml of plain water (to ensure passage of the tablet into the stomach), and the fast continued for at least 2-4 additional hours.
Then if all else fails… Chia seeds!
https://pubmed.ncbi.nlm.nih.gov/32793647/
Hope that helps.
Scott 🙂
Replying to Sophie Ashworth 06/10/2022 - 14:35
Thanks for letting us know Sophie.
I am sorry again we had to re-schedule this.
Hope you can make the next one.
Scott 🙂
Replying to leonique v. 07/10/2022 - 11:10
Hello again Leonique.
I will make sure we get Hilary to answer these questions at the Q&A session.
Thank you again for your contribution and brilliant questions.
Scott 🙂
Replying to leonique v. 07/10/2022 - 11:25
Hello Leonique!
Another brilliant question. I will add it to the list!
Have a brilliant week.
Scott 🙂
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