scott@vtx-cpd.com
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Lovely to hear from you all!!!!
Also lovely to hear what a small veterinary world it is!
Let me know if you have any questions at any time.
Scott 🙂
Hey.
I think the bottom line is that there is probably not a universal gold standard.
If the PDSA are recommending, I would honestly go with that. They are very careful and considered about the information they give to clients. I would consider this good information.
Do you have a website for your business? I would love to check it out.
Scott 🙂
What an interesting question!
Thank you so much Amy. I hope you are safe and well and enjoying the course.
I have looked in the literature and I am not able to find any actual peer-reviewed data. This genuinely may be because there is none. I will ask some ECC specialist colleagues to see if they know of any.
I did find some information on the Hills website which was helpful:
https://www.hillspet.com/dog-care/healthcare/how-to-help-a-choking-dog
I will ask our friends at Hills if they know any more.
Sorry not to be more helpful!
Scott
Emma,
We did do imaging. I will try and upload that today.
Scott
No problem.
Yes, I think if haematuria problematic I would trial treatment.
The human literature supports this.
Let me know how the dog gets on.
Scott 🙂
Thanks again for sharing Ashley.
I have popped images of the skin lesions below:
Let us know how the dog gets on. Great shout regarding RVC referral.
Scott x
Interesting!
Would be interested to hear the comments on the post result… that is still quite a stonker!
Scott 🙂
Hey Inga.
Really sorry about delay!
Really interesting question and one of my favorite drugs!
What other drugs is the dog on?
Tranexamic acid is an antifibrinolytic drug. It therefore reduces bleeding but, in certain situations, it may expose patients to a risk of thrombosis. It is used for the treatment of various types of bleeding, including menorrhagia, haematuria, certain surgical procedures and trauma. Its harm-benefit balance is favorable in certain situations associated with serious bleeding. The harm-benefit balance is different in minor bleeding: the expected benefits are smaller because the condition is not serious, and the risk of thromboembolism may be higher without the haemodilution associated with severe bleeding.
Clinical trials (human) conducted in serious haemorrhage or in patients undergoing surgery with a high risk of bleeding have not shown an increased risk of thrombosis with tranexamic acid. In practice, as of early 2013, the harm-benefit balance of tranexamic acid is favorable in severe traumatic bleeding. But when bleeding is not life-threatening, the thrombotic risk is too poorly documented to justify exposing patients to a plausible and inadequately evaluated risk.
I could find one specific human haematuria paper that overall did not represent a massive benefit (https://pubmed.ncbi.nlm.nih.gov/28916142/).
It has also been suggested that there may be a specific contraindication with bleeding in the urinary tract as tranexamic acid prolongs the dissolution of fibrin deposits already formed. Macroscopic haematuria is therefore
regarded as a contraindication for the use of tranexamic acid because this may lead to clots in the urinary tract with possible obstruction. I am not able to find any reports of this in the animal literature.So, in summary! I would probably only use it if the bleeding was severe and causing more severe side effects like a drop in PCV.
Hope that helps.
Scott 🙂
Hey.
Both pre and post results are often increased in cPSS but they do not have to be. Most of the time the post prandial is the most elevated value and is most helpful/diagnostic.
Hope that helps.
Scott x
Hey.
Really interesting question but really frustrating cases! I have seen a couple and not had any survive sadly. Anderson Moores are currently the leading centre for research and have some useful information:
https://www.andersonmoores.com/vet/CRGV.php
Anderson Moores will also offer a type of free PM service if the dog is PTS. THe main components of treatment are supportive:
1. IVFT to maintain perfusion/hydration. Be careful not to fluid overload if AKI. It is helpful to place urinary catheter and measure urine output. If anuric then furosemide could be considered but must be used with care.
2. I would administer antibiotics (amox/clav) IV is unwell and hospitalised.
3. other supportive care would include anagesia and maropitant.
4. I would be careful with doing too much topically with the skin wounds. I am a massive fan of Vetericyn spray for these sorts of situations.
5. Keep a close eye on electrolytes and obviously manage deficiencies appropriately.
6. There have been reports of the use of therapeutic plasma exchange (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060235/). This procedure is only available in the UK at the RVC and Vets Now Glasgow.
Can you send some pictures of the skin lesions?
Hope that helps.
Scott 🙂
Thank you so much for sharing the radiographs.
I would agree with Liz’s comments.
You mentioned harsh lung sounds. Is there a crackle or a wheeze to be heard? 🙂
Scott
Great thoughts everyone!
I know the megaoesophagus was the easier one, but I wanted to share as it was a good example! I think they can sometimes be quite tricky to spot! We did manage to get this radiograph conscious. Sedation and GA can in themselves cause megaoesophagus, so I always try and get conscious when I can. We found no underlying cause, so I think idiopathic.
The pneumomediastinum was a real surprise in the other case! We really struggled to understand. The CT did not give us an answer… could it have been the blood sample!??! This dog presented with significant vitamin D toxicity. Hypercalcaemia resolved but respiration worsened. Severe interstitial pattern on CT. Sadlt we put dog to sleep, we got consent for PM, so will keep you posted. Still no explanation for the pneumomediastinum…
Pneumomediastinum is the abnormal accumulation of air within the mediastinum and it can be caused by a variety of mechanisms. Tracheal disruption can leak air into the mediastinum, and has been reported with cervical trauma, mechanical ventilation, transtracheal aspiration, tracheostomy, tracheal intubation and overinflation, or central venous catheter placement. Similar to tracheal trauma, oesophageal or pharyngeal rupture can result in pneumomediastinum. Subcutaneous emphysema from any location can eventually enter the mediastinum via the cervical soft tissues and thoracic inlet. Less commonly, air can enter the mediastinum from gas accumulation in the retroperitoneal space. In some cases, the cause of pneumomediastinum is not determined (spontaneous pneumomediastinum).
The presence of air in the mediastinum creates enhanced contrast and detail, allowing radiographic visualization of individual mediastinal structures (best seen on lateral images), including cranial vena cava, brachiocephalic trunk and left subclavian artery, oesophagus, and azygos vein. Visualization of the tracheal wall is enhanced due to the presence of both intraluminal and extraluminal air.
Scott x
Really interesting Gail.
Thank you for sharing your experience of gabapentin!
Scott 🙂
The trazodone/gabapentin in blocked cats is a brilliant idea Jack.
I am going hunting for literature now… if it is not there then this might be the first official vtx study!
Is the liquid gabapentin Bova?
Scott x
Could not agree more Emma.
Immune-mediated disease is definitely when I use it the most. I agree that clinical signs often guide us, but it is a useful marker to measure, especially when we start to wean the steroid dose. The main thing as you say is that it is really non-specific. There are a couple of interesting papers that also suggest it may be useful in the management of respiratory disease:
The Utility of Acute-Phase Proteins in the Assessment of Treatment Response in Dogs With Bacterial Pneumonia
Background: Acute-phase proteins (APPs) are sensitive markers of inflammation, and serum C-reactive protein (CRP) recently has been shown to be a useful diagnostic marker in dogs with bacterial pneumonia (BP). In humans with community-acquired pneumonia, APPs also have great utility as follow-up markers aiding in the assessment of treatment response.
Objectives: The aim of our study was to investigate the applicability of APPs as markers of treatment response in dogs with BP.
Animals: Nineteen dogs diagnosed with BP and 64 healthy dogs.
Methods: The study was conducted as a prospective longitudinal observational study. Serum CRP, serum amyloid A (SAA), and haptoglobin concentrations were followed during a natural course of BP. Normalization of serum CRP was used to guide the duration of antibiotic treatment (treatment was stopped 5-7 days after CRP normalized) in 8 of 17 dogs surviving to discharge; 9 of 17 dogs were treated according to conventional recommendations.
Results: All measured APPs initially were significantly increased, but the magnitude of increase was not correlated to disease severity. C-reactive protein and SAA concentrations decreased rapidly after initiation of antimicrobial treatment. When normalization of serum CRP was used to guide the duration of antibiotic treatment, treatment duration was significantly (P = .015) decreased without increasing the number of relapses.
Conclusions and clinical importance: Serum CRP and SAA reflected the recovery process well and therefore may be used as markers of treatment response. According to the results, the normalization of serum CRP may be used to guide the duration of antibiotic treatment in dogs with BP.
Serum C-reactive protein as a diagnostic biomarker in dogs with bacterial respiratory diseases
Background: C-reactive protein (CRP) is a major acute-phase protein in dogs. Serum concentrations are low in healthy animals, but increase rapidly after inflammatory stimuli.
Objective: The aim of the study was to investigate CRP concentrations in various respiratory diseases of dogs and to determine if CRP can be used as a biomarker in the diagnosis of bacterial respiratory diseases.
Animals: A total of 106 privately owned dogs with respiratory diseases (17 with bacterial tracheobronchitis [BTB], 20 with chronic bronchitis [CB], 20 with eosinophilic bronchopneumopathy [EBP], 12 with canine idiopathic pulmonary fibrosis [CIPF], 15 with cardiogenic pulmonary edema [CPE], and 22 with bacterial pneumonia [BP]) and 72 healthy controls.
Methods: The study was conducted as a prospective cross-sectional observational study. CRP was measured in serum samples. Diagnosis was confirmed by clinical and laboratory findings, diagnostic imaging, and selected diagnostic methods such as cytological and microbiological analysis of respiratory samples, echocardiography, and histopathology.
Results: Dogs with BP had significantly higher CRP concentrations (median, 121 mg/L; interquartile range, 68-178 mg/L) than dogs with BTB (23, 15-38, P = .0003), CB (13, 8-14, P < .0001), EBP (5, 5-15, P < .0001), CIPF (17, 10-20, P < .0001), or CPE (19, 13-32, P < .0001) and healthy controls (14, 8-20, P < .0001). Dogs with BTB had significantly higher CRP concentrations than dogs with CB (P = .001) or EBP (P < .0001) and healthy controls (P = .029). Conclusion and clinical importance: These results indicate that CRP has potential for use as an additional biomarker, especially in the diagnostics of BP. All very interesting! Have just set up a live journal club on this exact topic! Scott 🙂
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