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scott@vtx-cpd.com

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  • scott@vtx-cpd.com
    Keymaster

    Thank you so much everyone for your answers. I summarised the imaging findings below.

    The cardiac comments were really interesting. My thoughts about enlargement too. We did echo this dog and found the cardiovascular structures to be normal. No heart disease noted. I obviously had the benefit of that information!:

    1. Diffusely within all of the lungs there is severe poorly defined increased opacity, forming ill-defined micro-nodular/miliary-like pattern with peribronchial cuffing.
    2. The cardiovascular structures are wnl.
    3. The mediastinal and pleural structures are wnl.
    4. The visible cranial abdomen is unremarkable.

    Conclusions:

    1. Severe diffuse predominantly unstructured interstitial to miliary/micronodular lung pattern Ddx pulmonary haemorrhage, haemangiosarcoma metastases (no obvious splenic mass/peritoneal effusion in cranial abdomen), non-cardiogenic pulmonary oedema (neurogenic cause), less likely lymphoma/granulomatous disease with absence of regional lymphadenomegaly, less likely parasitic such as angiostrongylus/eosinophilic bronchopneumopathy/pulmonary fibrosis with absence of lower airway signs.

    So the cardiac size may have been a normal variant for this dog.

    Hope this all helps.

    Scott xxx

    scott@vtx-cpd.com
    Keymaster

    Hey.

    I would totally agree, I think a longer-acting insulin is the way to go in this case. I wonder whether ProZinc may be the next choice (due to licensing and ease of dosing)? If ProZinc, I would start with 0.25IU/kg BID. If considering the insulin analogs glargine (0.3IU/kg BID) or detimir (0.1IU/kg BID) the main challenges are going to be dosing (less of an issue in dogs compared to cats). Main thing is not to dilute the insulin in any way. The nadir will still vary (especially in this patient). I would monitor as you are doing with BG curves and be super aware of the possibility of hypoglycaemia in the initial stages.

    Hope that helps.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Thank you Magda and Michael.

    I will see if we have any more thoughts before revealing the next bit!

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Really interesting case!

    Could you send the timings of the most recent BG curve results. When is the dog fed?

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    I knew that is what you meant!

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Hey.

    Yes, it is the Freestyle Libre 2.

    Scott x

    scott@vtx-cpd.com
    Keymaster

    Hello.

    Using the single value to increase dose can be challenging. A single blood glucose measurement is rarely useful in monitoring DM with the exception of finding a low result, always indicative of an overdose. Single glucose measurements may be sufficient when an owner believes the dog is virtually asymptomatic, the PE is unremarkable and serum fructosamine levels are between 360 to 450 mcmol/L. In such cases, glucose concentrations between 10 and 14 mmol/l around the time of the insulin injection are consistent with good glycemic control and additional blood glucose measurements are not usually necessary.

    Hope you are having a lovely weekend.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Kerida,

    Thank you so much for your kind words.

    We really appreciate the support.

    Have a lovely weekend.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Hello.

    Hope you are well. Sorry for the delay in getting back to you. Overall, the pre insulin glucose and clinical signs might be a better way to go. The problem with the 6h post insulin, is that this one result can be very variable. Remember, the main issue normally in the initial stages of treatment is avoiding hypoglycaemia.

    In the more stable patients, I would be happy to rely on the fructosamine and clinical signs. Again, there may be some use in the pre-insulin BG value if other monitoring is not possible. Ultimately, a BG curse will give you more information.

    Overall, clinical signs really are the most important part of this. There is definitely not a one size fits all!

    Hope that helps.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Kerida!

    I am so excited that this all went well with the sensor!!!

    I am really happy to help with the interpretation of the results too, let me know.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Hey Alice.

    So sorry for the delay. I normally place BG sensors in cats behind the head at the back of the neck. Is that what you would normally do? I would then cover it with a bit of dressing around the neck like when we bandage in an oesophageal feeding tube. Does that make sense? I have popped a picture below:

    BG Sensor Cat

    Hope that helps.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Kerida…

    There are many benefits of being a vintage vet! I too need to brush up on my cardiology knowledge.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    It is a really good question.

    In this situation, particularly of the renal parameters are normal and there is not an ‘obvious’ other problem from basic bloods then I probably would be treating the calcium, even without a definitive diagnosis. The reason for running the PTH and PTHrp is often as part of the exclusion process in the diagnosis of idiopathic hypercalcemia.

    So, in this case, where cash is limited, it would not be ridiculous to start aledronate.

    Hope that helps.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Really good question!

    What was the ionised calcium value?
    Were the renal parameters normal?

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Hello!

    My name is Scott, I am one of the other directors of vtx. I am a specialist in internal medicine and had the great joy of doing my residency with Liz. I am often the one delivering the lectures, so it is going to be lovely to be the one listening! Cardiology is definitely a weak area for me! I am excited to learn.

    Scott

Viewing 15 posts - 1,936 through 1,950 (of 2,238 total)