scott@vtx-cpd.com
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Replying to Kathryn B. 05/09/2022 - 14:43
Hello Kathryn.
Thank you so much for joining the course. I had my first job in the North East. PDSA in Gateshead… it is still the favourite job of my career!
I hope the course helps with your confidence. Please let me know if you have any questions at any time.
Scott 🙂
Replying to Mariska H. 05/09/2022 - 10:26
Hello Mariska!
Thank you so much for joining the course all the way from Tasmania! Please let me know if you have any questions at any time!
Scott 🙂
Replying to Georgina F. 05/09/2022 - 14:07
Georgie!
Thank you so much for being part of the vtx crew for this course! Such an honour to have you work for us!
Scott 🙂
Replying to Ursula Lanigan 27/08/2022 - 10:54
Hey.
Great questions. I am not sue we know exactly which antibiotic is best. I would try and use an antibiotic with as narrow as spectrum as possible. To be honest amox/clav or metronidazole would be fine. I would try and give these antibiotics orally if possible in these cases. I would only use IV if they had significantly altered conciousness.
There are some other options. The goal of oral antibiotic treatments is to reduce the mass of ammonia-producing bacteria in the colon. Neomycin, an aminoglycoside antibiotic, alters the composition of the bacterial flora in the colon, thus decreasing the number of ammonia-producing bacteria. Neomycin (20 mg/kg PO q12h) should be considered in patients intolerant of lactulose. Neomycin can also be administered via a retention enema (15 mg/kg diluted in water q6h after cleansing enema). Neomycin, although poorly absorbed from the intestines when given orally, is highly nephrotoxic and should never be given parenterally.
Studies on the use of oral metronidazole in treatment of HE are limited in human medicine and lacking in veterinary medicine. Metronidazole undergoes extensive hepatic metabolism; therefore, the dose must be reduced in patients with HE (7.5 mg/kg PO q8-12h) to avoid toxic effects. Advantages of using metronidazole over lactulose or neomycin include decreased risk of diarrhea and nephrotoxicity. Maintenance therapy at high doses has been associated with a central vestibular syndrome characterized by ataxia and nystagmus.
I hope that helps.
Scott 🙂
Replying to Ursula Lanigan 27/08/2022 - 08:47
Hello!
It was indeed PFK!!! This is the report from the genetic testing in the dog:
PFKD/ PFKD (Genetically Affected)
Interpretation:
The examined animal is homozygous for the causative mutation for PFKD in the PFKM-gene.
Trait of inheritance: autosomal-recessive
Scientific studies found correlation between the mutation and symptoms of the disease in the following breeds: American Cocker Spaniel, English Springer Spaniel, WhippetCool right!
Scott 🙂
Hello!
Just a wee welcome from me too! My name is Scott and I am one of the founders of vtx and a specialist in small animal internal medicine.
I am not directly involved with the course delivery, we leave that to the incredible Helen!
Thank you so much for chosing vtx and I really hope you enjoy the course!
Scott 🙂
Replying to Ursula Lanigan 27/08/2022 - 08:47
Hello!
These are all brilliant questions and all things I would evaluate!
Bleeding or IMHA would definitely immediately pop to the top of my DDX list. There were no spherocytes present, slide agglutination was negative and Coombs was also negative. POCUS was performed chest and abdomen and no free fluid was seen… always a good shout! No melena was reported in this case, but I always do a rectal as owners will not always notice this!
These were all really important parts of the investigation here… good work!
Scott 🙂
Replying to Lacey Pitcher 30/08/2022 - 08:28
Hello my lovely friend!
We are so lucky to have you as part of the course!
Have a great week.
Scott 🙂
Replying to Charlotte Anne Jarman 29/08/2022 - 09:01
Hello Charlotte!
Welcome. I am so glad you enjoyed the first lesson.
Let me know if you have any questions at anytime!
Scott 🙂
Replying to Amy Arbuthnott 28/08/2022 - 11:20
Great team at Edinburgh!
So glad you are enjoying the course.
Scott 🙂
Hello.
Hope you are well. I agree with Emma! I would go with the HA too in growing animals!
Scott 🙂
Replying to Gergana G. 18/08/2022 - 21:34
Hello.
Hope you are well. I think speed wise it is OK to use a normal centrifuge but you need a special attachment to allow the micro haematocrit tubes to fit in.
Hope that helps.
Scott 🙂
Replying to Harry S. 21/08/2022 - 14:39
Hello Harry.
Thank you so much for being a part of this course. You really are my fluid therapy hero.
Looking forward to your lesson.
Scott 🙂
Replying to Kathryn B. 23/08/2022 - 09:54
Hey.
Hope you are well. UA was looked at on a few occasions. The urine was persistently positive for bilirubin (4+), but also intermittently contained large amounts of free haemoglobin (4+, negative sediment).
Hope that helps.
Scott 🙂
Hello Gergana.
I hope you are safe and well. Thank you for your kind words, I am glad you are enjoying the course.
These are tricky cases. I think with the albumin at this level, I would wait and see what effect the nutrition has on the albumin levels. Does the dog have a feeding tube in now? There are a few other things I would consider:
1. Ileus can be a really big issue in parvovirus cases. Often fluid can accumulate in the stomach and cause them to feel really rubbish. I would consider a metoclopramide CRI (2mg/kg/day). If the dog has a nasogastric tube in you can also consider placing it in the stomach so it allows you to suction off some of the residual gastric fluid and replace with electrolyte solution/food.
2. Have you tried an appetite stimulant? I would try mirtazapine and capromorelin if you can get it.
3. Normally fluid will not third space until albumin is below 15g/dl, so I would hold off colloids and plasma for now. I would be hopeful the nutrition will sort things out!
Hope that helps.
Scott 🙂
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