scott@vtx-cpd.com
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Replying to Kaloyan K. 16/03/2022 - 14:22
Kaloyan!
What a brilliant question! I am not able to find anything in dogs but this paper in the human literature:
https://pubmed.ncbi.nlm.nih.gov/30956473/
Seems that it was used in this study topically in the abdomen. I am not sure how extensively this is practiced. In Greyhounds that are bleeding I would probably still use IV in most cases.
I will ask some colleagues and see if they have ever used it topically in this way!
Replying to Ursula Lanigan 06/03/2022 - 22:54
Hello.
I think in any cases like this where there is heavy bleeding from the abdomen, there may indeed be an indication for TXA. The only possible contraindication would possibly be bleeding that was coming directly from a kidney (e.g. idiopathic renal haematuria). The issue here might be that if there is bleeding directly from the kidneys and we encourage clot formation with TXA, blot clots could get stuck in the ureters and cause a ureteric obstruction.
Hope that helps.
Scott 🙂
Replying to Laura B. 17/03/2022 - 12:35
Hey Laura.
I think this would be a perfect way of using it topically, especially in such tricky cases!
Scott 🙂
Replying to Raquel M. 17/03/2022 - 12:39
Hello Raquel.
I hope you are safe and well. Thank you so much for your question. I have popped your question below so I did not miss anything!
”Just curious as to when in the diagnostic process, would you recommend this? Is it after ruling out surgical disease? Is it when the vomiting is recurrent or chronic? Is it when there’s relapse of clinical signs of vomiting whilst on a treatment plan that worked before. Or relapse of clinical signs as soon as treatment ends?
And what criteria do you use to define when a case moves from an acute onset vomiting to chronic?”Folate and cobalamin is probably not that helpful in cases of acute vomiting and diarrhoea. Even in cases where you have ruled our surgical disease, if the symptoms are still quite acute ( a few days) then I would not consider folate and cobalamin. Cobalamin may be of use in cases of relapsing or recurrent signs as some patients with GI disease will not respond so well to treatment when folate is low. Cases of vomiting and diarrhoea become truly chronic after about 2-3 weeks and all chronic cases would benefit from folate and cobalamin.
Hope that helps.
Scott 🙂
Replying to Hannah B. 15/03/2022 - 16:20
Hello again Hannah!
Really interesting comments regarding the omeprazole. Hopefully we unlock this even more in lesson three. It really is one of my favourite topics. I think the first thing would be to consider whether the patient needs the omeprazole dispensed in oral form. If there is evidence of melena/haematemesis/confirmed ulcer then I would, but otherwise I would not. Your comments regarding tablet size for omeprazole are brilliant. I would really try not to go higher with the dose as I think we can see side effects with omeprazole, not to mention the dysbiosis! I love BOVA for this reason. I have popped the product list here… lots of lovely tablet sizes and formulations:
https://drive.google.com/file/d/1bL4sa0V_ApBT7UpQBtZorV4ZCyxL5w5d/view?usp=sharing
Hope that helps.
Scott 🙂
Replying to Hannah B. 15/03/2022 - 16:20
Hello Hannah.
I hope you are safe and well and enjoying the course. Regarding the maropitant; I am really happy using this longer-term if necessary. In the majority of cases the need for antiemetic therapy is less when the underlying problem is sorted out. If I am sending patients home with oral maropitant, it is normally not for more than 7 days. I must admit I often do 4 days as that suits the box sizes. The box size definitely does not indicate maximum length of dosing. Below is some data from Zoetis. I have the feeling this is unpublished data, but I have contacted a pal at Zoetis to see if I can get more information:
https://www.zoetisus.com/products/pages/cerenia/extended-therapy.aspx
I am really happy using oral maropitant longer term in cases that need it. I think the best example of this is chronic renal disease patients. Sometimes I will do every other day dosing, but if they need it, they need it!
Hope that helps!
Scott 🙂
Replying to Emma Holt 14/03/2022 - 10:59
Hello Emma.
Hope you are well.
I will pop all of the diet literature in the next couple of sessions (diarrhoea), including a good review I recently came across. I can feel your anticipation from here! 🙂
Metoclopramide is a interesting one. I have heard people talk about not wanting to use it because of fear that it might increase the chance of intestinal dehiscence. I must admit that post operative ileus is a much bigger issue. I think we are significantly over estimating the power of metoclopramide… I would be surprised if it broke down a wound! All we are really trying to do is promote movement it guts that are not moving very much, so I feel very comfortable using it. Normal gut movements should be tolerated.
Hope that helps.
Scott 🙂
Replying to Raquel M. 17/03/2022 - 14:50
No problem!
I am just so happy you find it useful. I love it when we have lots of good discussion!
Scott 🙂
Replying to Raquel M. 17/03/2022 - 13:11
Hello Raquel.
Really lovely to hear from you. This is a brilliant question. I think it all depends on the case. The main thing is not having fully ruled out a FB. There is some concern that the maropitant would ‘mask’the vomiting and the FB would go untreated and could compromise the patient. I would say it is fine to use in patients that you are confident does not have a FB and patients that are in the process of being investigated.
If the patient is undergoing the investigation process, fine to give! Very safe drug generally, the only worry is the masking of clinical signs in undiagnosed cases.
Hope that helps.
Scott 🙂
Replying to Vicki B. 15/03/2022 - 08:22
Hello Vicki.
Hope you are safe and well and enjoying the course.
If you look at the top left of each of the videos for the lesson you will see a clickable link that will take you to the notes for the lesson.
Let me know if you have any problems.
Scott 🙂
Replying to austeja Zykute 11/03/2022 - 19:52
Hello Austeja.
Thank you so much for your kind words. We are so happy to have you as part of our community.
These are really tricky cases. The patient clearly needs the medication you have prescribed for the underlying condition. The ulceration is most likely to be due to the prednisolone. With the secondary immunosuppression on board, is there any option to reduce the prednisolone more quickly? I would absolutely start omeprazole at 1mg/kg 2x daily and monitor very carefully. The melena may not always be obvious, so I would also keep a close eye on what the haematology is doing.
Hope that helps.
Scott 🙂
Replying to Emma S. 09/03/2022 - 14:57
No problem!
Let me know if I can do anything to help!
Scott 🙂
Replying to Nathalie Cunha 10/03/2022 - 05:36
Cool!
Keep us posted with the final diagnosis!
Scott 🙂
Replying to Nathalie Cunha 09/03/2022 - 12:38
Hello again!
This is another interesting paper. Basically, the time to ulcer formation can vary, but can be quite quick. Again, it depends a bit on the comorbidities:
https://pubmed.ncbi.nlm.nih.gov/34596276/
Regarding the spinal patients… we will crack that open in lesson three!
Scott 🙂
Replying to Ursula Lanigan 01/03/2022 - 16:06
Hello Ursula.
Thank you for this brilliant thoughts. I think you are right, totally depends on the case. If there are persistent symptoms then it would definitely move forward your decision to do to surgery.
I often see cases that have eaten a variety of chicken bones (that are asymptomatic) for endoscopic retrieval. I think many of them could be left alone and would dissolve just fine.
Scott 🙂
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