scott@vtx-cpd.com
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Replying to Rosemary S. 01/11/2021 - 11:31
Hello Rosemary.
I hope you have had a wonderful Christmas!
I have no idea how I have missed this question… I am so sorry! Probiotics is a great question. I find the following article is a good review:
https://drive.google.com/file/d/1GitsWnXb92Fs3Gk_Km3i4agw19Ff3qJj/view?usp=sharing
I think the summary points for this article are really useful and helpful from a clinical point of view:
1. When considering treatment for acute uncomplicated diarrhoea, probiotics are likely a better choice (unlikely to cause harm, possible shortening of recovery time) than antibiotics (can cause significant and long standing gut dysbiosis).
2. When considering probiotics as adjunctive treatment to infectious disease, there is so far only some evidence for the benefit of Enterococcus faecium for Tritrichomonas foetus infection in cats.
3. Saccharomyces boulardii is an interesting potential probiotic, that has shown promising results in reducing antibiotic-induced diarrhoea in dogs as well as improve clinical scores in dogs with chronic enteropathy and PLE.
4. Specific probiotic blends can be as efficient in treating canine chronic enteropathy than antibiotic and glucocorticoid treatment combined.
5. When treating feline chronic constipation, a specific probiotic blend can be considered as adjunctive treatment.
Overall, there is still a huge amount for us to learn about probiotic. The main benefit of their use is that they do no harm. So, I would pretty much use them whenever there may be any benefit. I tend to use the following products:
With the VSL, I would base it on the study that demonstrated a benefit. The VSL#3 group (D-VSL#3; nā=ā10) received between 112 and 225 billion (112 to 225Ć109) lyophilized bacteria per 10 kg daily for 60 consecutive days. The amount will depend on the exact product (they vary in bacteria concentration). There is a mixture of capsules or powder.
With the other would be Sivomixx:
https://www.sivomixx.net/en/author/sivoy/
Obviously there are lots of other veterinary probiotics in practice. For these, I would follow the individual manufacturer guidelines.
I hope that helps.
Scott š
Replying to Josie B. 22/12/2021 - 12:40
Hello.
Thank you for your amazing comments. Let me share the pathologists report:
Site Liver
Microscopic Description
Liver: Preservation is moderate and nucleated cellularity is low to moderate. Slide no4 contains
predominantly dense blood. The remaining scans contain variable amounts of fresh blood and small lipid
spaces. There are low to moderate numbers of well-differentiated hepatocytes arranged in sheets and clusters. Low numbers of erythrocytes and focal clusters contain low numbers of small clear punctate
vacuoles. There is rare focal moderate intracanalicullar bile stasis (bile casts). There are rare isolated
slender fusiform mesenchymal cells (presumed to be fibroblasts). Streaked nuclear material is frequently
associated with a parasite clusters and, in these areas, neutrophils and small lymphocytes occasionally
appear overrepresented. Infectious agents and atypical cells are not identified.Microscopic Interpretation
Moderate focal cholestasis. Mild focal discrete vacuolar change.
Comments
Aspirates have harvested predominantly fresh blood however, within the hepatocytes there is evidence to
support cholestasis and although this is focal, it is moderate. The mild indiscrete vacuolar change is
non-specific and may be associated with elevated metabolic stress associated with inflammation of
varying aetiologies (hepatic and nonhepatic), as well as metabolic disease (e.g. pancreatitis).
Overt inflammation and infectious agents are not identified however this is a relatively small sample. The
fibroblast presence may be compatible with fibrosis however, this requires histopathology for definitive
diagnosis. Given the slightly increased numbers of leukocytes associated with hepatocytes, although overall
leukocyte numbers do not appear elevated mild inflammation cannot be excluded. Biopsy with
histopathology for evaluation of tissue architecture and tissue culture may be of value should changes
persist.I was interested with your pancreatitis comments, what made you suggest that?
Thanks again for your brilliant comments.
Scott š
Replying to Josie B. 22/12/2021 - 17:06
Josie.
I am so blown away by your comments. It really is so kind of you to share that. I am so honoured to have a played a small part in keeping you in the veterinary loop. I honestly forget people listen and am so blown away when they say they do.
Truly, thank you. I hope you and yours have had the most wonderful Christmas.
Scott x
Replying to Josie B. 22/12/2021 - 16:36
Hello!
Another brilliant question. Really there can be many extra hepatic causes of increased liver parameters. I think it all has to be taken in the context of the case. There can definitely be increases in liver parameters with more severe dental disease. Mild/moderate increases in ALP in these cases would not stop me from going ahead with the GA in these cases. It is when the increases in ALT become more significant that I start to worry a little more.
With the mild increases in ALT and ALP, it is most likely to be a reactive hepatopathy. I would consider UDCA/sAME as support but would still go ahead with procedure.
Hope that helps.
Scott š
Replying to Josie B. 22/12/2021 - 13:08
Hello!
Hope you are well. Really lovely to hear from you. I am in awe that you have found the time to listen to the lectures and have such a young child in the house!
It is a really good question. I definitely a belt and braces approach to leptospirosis diagnosis if possible. I would try and get blood and urine for PCR as well as sending off the MAT serology. The antibiotics will definitely affect the PCR results quite quickly but you will still get a rising antibody despite antibiotic therapy. How much this will dampen/affect the titre is difficult to determine and poorly documented. I am not able to find a huge amount in the literature. Basically, it would never be a reason to hold off the antibiotics and you should still see a rise in the titre.
Hope that makes sense!
Scott š
Replying to Gabriela Gonzalez-Ormerod 07/12/2021 - 18:33
Hey Gabriela.
Hope you are well. It is a really interesting drug! I think we will see more and more data over the next few years to support its use!
Scott š
Replying to Alice L 14/12/2021 - 21:22
I feel your pain!
Let me know if there were any questions we did not answer.
Scott š
Replying to Alice L 09/12/2021 - 14:11
Hey.
I have spoken to Andy (who works at a dermatology only practice) and they are struggling too.
I will try other places and keep you updated.
Scott š
Replying to Roy Spigelman 10/12/2021 - 16:41
Great!
Hope you are safe and well.
Scott š
Replying to Elizabeth D. 13/12/2021 - 16:44
Great.
The only thing that the bile might help with is possible presence of infection.
Good luck with the case.
Scott š
Replying to Elizabeth D. 12/12/2021 - 09:33
Hello Elizabeth.
Hope you are well. These are always more tricky cases when they are closer to work and home! Is the ALKP the only value that is increased related to the liver? If this is the case, then I would honestly worry about it a huge amount less. I think it is most likely to be reactive and this could easily be explained if there is more going on systemically. It would involve more FNA/biopsy type investigation to be looked in to further.
I would definitely continue the UDCA and consider also using something with sAME (Denamarin is my favourite). The other options sampling wise would be to FNA a bit of liver that you could access or also consider cholecystocentesis. Both may or may not give you information.
I hope that helps.
Scott š
Replying to Doireann C. 12/12/2021 - 13:19
Doireanne,
I hope you are safe and well. Thank you so much for the feedback. It is really appreciated.
I am so glad you are enjoying the course.
Scott š
Replying to Alice L 09/12/2021 - 14:11
Hello!
I will do some digging and get back to you!
Scott š
Replying to Alice L 09/12/2021 - 14:29
Alice!
Sad not to see you at the Q&A last night. I hope we answered all of your questions.
Will get the recording up ASAP.
Scott š
Replying to Lindsay W. 09/12/2021 - 22:38
Hello.
We can definitely try and make this available.
Scott š
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