scott@vtx-cpd.com
Forum Replies Created
-
AuthorPosts
-
Replying to Raquel M. 11/04/2022 - 19:55
Hello.
Hope you are well. Where is the world are you again?
We recorded the session and it should be available as a video by the end of the week.
Scott 🙂
Replying to Liz Bode 11/04/2022 - 20:18
Thanks Liz.
Really interesting and very helpful.
Scott 🙂
Replying to Liz Bode 11/04/2022 - 20:45
Thanks Liz.
This is really interesting.
Scott 🙂
Replying to Lesley M. 10/04/2022 - 09:43
Hello.
This does seem like a high dose of steroids. I would normally use 2mg/kg/day for most immune mediated conditions. There are some situations where I would consider 4mg/kg/day for the first 3-5 days in more ‘severe; cases but would drop back to 2mg/kg/day after that.
Scott 🙂
Replying to Tzuhan W. 10/04/2022 - 10:04
Hello Joyce.
Really lovely to hear from you. I am so excited that you are joining us all the way from Taiwan.
It is a good question regarding the dosing in patients in cardiac disease with hypothyroidism. I do not alter my approach in these patients, I dose in the same way for almost all hypothyroid patients, with the same targets.
I have asked Liz (our cardiology specialist) to comment too.
Scott 🙂
Replying to Claire L. 10/04/2022 - 11:06
Thank you also for your kind words regarding the course.
Scott 🙂
Replying to Claire L. 10/04/2022 - 11:06
This is a brilliant question.
I am going to chat to some ECC colleagues about this one too.
The role of gastric protection medication in acute toxicity is not clear, even in human medicine as far as I am aware. Significant gastrointestinal hemorrhage secondary to acute overdose is likely to be uncommon. It is thought that upper gastrointestinal symptoms are self-limiting; however antiemetics may be required for those with persistent or severe nausea and vomiting. No studies, to my knowledge, have investigated the role of prophylactic use of antacid or acid-suppressants such as proton pump inhibitors. I might consider a short (7-day course) of a proton pump inhibitor in patients with acute NSAID overdose who have persistent upper gastrointestinal symptoms which do not settle within a few hours of ingestion. I would not be reaching for them routinely.
I would consider misoprostol in these cases, although the evidence for this is also not great.
Hope that helps.
Scott 🙂
Replying to konstantinos C. 10/04/2022 - 16:52
Hello Konstantinos.
Hope you are well. In acute cases I would normally only give short course (up to 7 days). In chronic cases, I would use much longer term. You could even consider life long in some cases. Because so many of the chronic cases are dietary responsive, I would normally do that first. I would be moving quickly to introduce probiotics after this and certainly introducing probiotics in all cases that were receiving steroids. If I was then weaning medications in more chronic cases, I would consider keeping the probiotics going until all other medications had been discontinued.
Hope that helps.
Scott 🙂
Replying to Christina Birks 09/04/2022 - 09:26
Hello Christina.
Thank you so much for joining the course.
Your suggestions are great and I agree that these are definitely the most challenging cases when there is more than one thing is going on!!!
Glad you enjoyed the first lesson.
Scott 🙂
Replying to Emma Holt 05/04/2022 - 13:12
Good shout with the chlorphenamine!
The FNA results were as follows:
Cytology – lymph node
MICROSCOPIC DESCRIPTION. Mildly increased numbers of eosinophils are present with lower numbers of nondegenerate neutrophils. Rare intermediate to large lymphocytes and plasma cells are noted. No infectious organisms or malignant cells seen.MICROSCOPIC INTERPRETATION: Slight eosinophilic to mixed inflammation.
Cytology – gastric wall
MICROSCOPIC DESCRIPTION. Increased numbers of eosinophils are present with lower numbers of nondegenerate neutrophils. No infectious organisms or malignant cells seen.MICROSCOPIC INTERPRETATION: Eosinophilic inflammation.
We did go on to take biopsies:
Histopathology – Gastrointestinal biopsies
Stomach:
Several sections of tissue consist of brightly eosinophilic material surrounding clusters of coccoid bacteria and encased in fibroplasia, epithelioid macrophages, neutrophils, and eosinophils. Special stains show no infectious organisms.
These histologic lesions are most compatible with eosinophilic sclerosing fibroplasia.Duodenum:
No histopathologic abnormalitiesDiagnosis? Treatment?
Scott 🙂
Replying to Sophie I. 07/04/2022 - 16:28
Hello.
I have double checked with Jocep and it is not available in the UK.
Scott 🙂
Hello Nathalie.
I am certainly a big fan. From my perspective, really useful in patient on steroids… and I have a lot of them.
I recorded a podcast on this exact topic with an anaesthesia specialist:
I am sure Kerry and Neus will have lots of insight with their more critical patients.
Scott 🙂
Replying to Julie S. 07/04/2022 - 11:34
Hello!
Lovely to see you here too. You will be busy with GI and endocrine at the same time!
Thank you again for the support.
Scott 🙂
Replying to Sophie I. 07/04/2022 - 16:28
Hello.
Lovely to hear from you. I hope you are well.
I am not 100% sure… but I know a man how will know!
I will speak to Jocep and let you know!
Scott 🙂
Replying to Raquel M. 24/03/2022 - 13:19
Hey Raquel.
I hope you are safe and well and having a lovely week. Thank you again for your brilliant questions. I have popped your questions below and my thoughts underneath. I did not want to miss anything:
Hello,
1) (a) what would you suggest for cases where an animal is reported to have a pinkish color in the vomitus or a few drops of blood as per O?
This is a great question and challenging to give a definitive answer. I would say in acute cases, when patients are well otherwise, I would not jump to use a PPI. If the presence of blood continued despite symptomatic therapy (antiemetic), or there was evidence of melena, then I would consider the use of a PPI.
(b) also if the owner reported the above was a one-off incident(or intermittent) and the other episodes of vomiting didn’t indicate any signs of blood then would you start with a PPi? Or only if the diagnostic workup confirmed GI ulceration?
Again, I would probably not. In there cases when intermittent. Endoscopy/ultrasound would be perfect to confirm ulceration or not.
Was just wondering if there’s not a substantial amount of frank blood in the vomitus and the pinkish color or specks of blood reported by owner aren’t persistent. Then is it appropriate to use PPIs or not? Especially if the owner is unable to complete a full workup to rule out ulceration.
I think for small amounts I would be rushing to use. If this was persistent and the owners were not able to carry out much work up then I would consider a PPI.
I hope that helps/makes sense.
Scott 🙂
-
AuthorPosts