scott@vtx-cpd.com

Great question!

Persistent fasting hyperlipidemia is abnormal and can be either primary or secondary to other diseases or drug administration. Secondary hyperlipidemia is the most common form of hyperlipidemia in dogs. Most commonly, secondary canine hyperlipidemia is the result of an endocrine disorders. Primary lipid abnormalities are usually, but not always, associated with certain breeds. Depending on the breed, the prevalence of a primary lipid abnormality can vary widely. Primary hyperlipidemia is very common in Miniature Schnauzers. Primary hyperlipidemia in the Miniature Schnauzer is typically characterized by hypertriglyceridemia with or without hypercholesterolemia. Primary hyperlipidemias have also been reported in Shetland Sheepdogs (in Japan and possibly other countries), Beagles, Briards, a family of rough-coated Collies from the United Kingdom,18 and anecdotally in Doberman Pinschers and Rottweilers.

Hyperlipidemia itself does not seem to lead directly to the development of major clinical signs, it has been shown to be associated with the development of other diseases that are clinically important and potentially life-threatening. Hyperlipidemia, and more specifically hypertriglyceridemia, has long been suspected as a risk factor for canine pancreatitis. The results of two recent clinical studies provided stronger evidence that hypertriglyceridemia, especially when severe (>900 mg/dL), is a risk factor for pancreatitis in Miniature Schnauzers. Therefore, severe hypertriglyceridemia in Miniature Schnauzers should be treated even when clinical signs are not present, due to the risk of developing pancreatitis. In summary, I would treat (mostly with low-fat diet) in Miniature Schnauzers.

In other breeds, a more general and wide selection of tests might be necessary for patients that have vague or no clinical signs. It should be noted that dogs with hyperlipidemia are often clinically healthy. It is likely that at least some of these dogs have some form of primary hyperlipidemia. If it is mild or moderate, there may be no need for detailed diagnostic investigations. If hypercholesterolemia is the main abnormality (without or with only mild hypertriglyceridemia), then it is more likely that the dog has some form of secondary hyperlipidemia, warranting recommendations for further diagnostic investigation.

I hope that helps a little bit. Let me know if that makes sense.

Scott 🙂

Hello!

Can you send me the bloods? How high was the blood glucose?

I would still attempt to reduce the steroids. It might be good too do an even more gradual reduction in steroids on this occasion and see if you can get to a dose that does not cause DM but does control the signs.

The main this would be to consider alternative management while reducing the steroids. I would consider cyclosporine, azathioprine, chlorambucil, budesonide.

The other option would be to introduce an antibiotic like metronidazole, as some of these IBD cases will be antibiotic responsive.

If the dog requires the steroids to control the disease, there are some circumstances when you will have to continue the lowest dose of steroids possible and start insulin as you would a normal diabetic.

Hope that helps.

Scott 🙂

Hey.

In these cases, I think it is fine just to taper the steroid. With long-term use, I would normally taper relatively slowly. I would possibly consider a 25% dose reduction on a weekly basis. If the dog had very severe clinical signs, you could do this quicker.

If there is a need to reduce quicker, I would reduce to physiological doses over a period of 7 days.

An inhaler would be an option, but it is important to remember that this steroid will still be absorbed, so you will not be able to completely avoid side effects. Overall, the side effects will normally be fewer.

Hope that helps.

Scott 🙂

Hey.

The owner should be able to buy one online without not too much trouble.

I am quite happy to pop into the practice and help with placement if that would help.

I am also happy to help looking at curves if that would help keep costs down.

Scott 🙂

Hello.

Sorry for my delay in reply. I hope you are safe and well.

The optimum dosage and frequency of administration of T4 for hypothyroid dogs remain somewhat controversial. Total daily doses ranging from 0.02 to 0.04 mg/kg BW and given once, twice or three times daily have been recommended. Most published studies have evaluated the use of 0.02 mg/kg administered once daily, on the premise that the serum half-life of T4 does not necessarily reflect its biological effect. This regimen has been successful, although an increase in dosage is required by about 35% of dogs. This percentage can be lowered depending on the T4 preparation used and by ensuring consistency with feeding times. The number of dogs requiring a dosage reduction with this protocol is about 6-10%. Twice-daily dosing is associated with lower peak concentrations and less fluctuation in circulating TT4. Twice-daily dosing of 20 mcg/kg has also been used successfully but may not be superior to once daily. There are no reports evaluating the number of dogs in which dosage adjustments are required using twice-daily dosing. It is important to note that the effect of a given dose of T4 varies with each individual. Thus, clinical, clinicopathological and hormonal monitoring is critically important in determining each dog’s T4 dosage and frequency. This may require several adjustments.

Gradual introduction of supplementation (25-50% of starting dose) has been recommended in dogs with concurrent illnesses such as cardiac disease, hypoadrenocorticism and diabetes mellitus. However, using a once-daily dose of 20 mcg/kg was not associated with adverse effects in dogs with such disorders, conferring another advantage to this regimen in patients with these conditions.

Hope that helps.

Scott 🙂

Hey.

The oral Thyronorm has not been evaluated with food. Difficult to say how much of an effect this has. I would give with food is necessary, but try and limit this as much as possible.

Hope that helps.

Scott x