scott@vtx-cpd.com
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Replying to Raquel M. 04/02/2025 - 15:29
Hi Raquel,
I’m glad you found the ideas helpful! It’s great to hear that email works well for you, especially in providing both clients and yourself with a clear record of communication. I completely agree that it allows clients time to process information before following up with any questions, which can make discussions more productive.
It’s interesting that your clinic also incorporates text messaging. Have you found it to be an effective tool, or do clients tend to overuse it? I can see how it might be useful for quick updates but could also present challenges in setting boundaries.
I really like your approach of giving clients multiple options—email, phone, or in-person consultations—so they can choose what works best for them. It’s a great balance between accessibility and efficiency while keeping phone lines free for more urgent matters.
Thanks for sharing your experience!
Best,
Scott 🙂
Hello!
Thank you so much for working with us Felipe and for delivering such a brilliant course!
Scott 🙂
Replying to Gemma B. 06/02/2025 - 12:42
Hello Gemma!
Thank you for joining the course.
Feel free to ask questions at any time!
Scott 🙂
Replying to Charlotte H. 04/02/2025 - 17:54
Hello Charlotte.
Thank you so much for joining the course, it is wonderful to see you here.
Let us know how you get on with the first lesson.
Scott 🙂
Replying to Georgia 03/02/2025 - 13:57
Georgia!
Thank you so much again for being brilliant!
We are very lucky to be working with you.
Scott 🙂
Replying to Josep B. 27/01/2025 - 12:22
Really interesting!
Scott 🙂
Really interesting videos!
Thank you for sharing.
Scott 🙂
Replying to Rachel C. 29/01/2025 - 10:52
Hi Rachel,
I really appreciate the update, and I’m glad my response was helpful, especially given the timing with your case. It sounds like you’ve taken a great approach, and it’s good to hear that the azotemia resolved with IVFT, making a pre-renal cause the most likely explanation. If it had persisted, immune-mediated glomerulopathy would have certainly been a consideration, but it’s reassuring that renal function improved so quickly.
Starting ciclosporin following the relapse was a solid decision, and I hope the patient stabilizes well on the combination therapy. Hopefully, the Leishmania results come back soon and provide further clarity, but it’s excellent that you’ve been proactive in covering all bases.
I had a very tricky IMPA case this week and had to add in ciclosporin quite quickly as well. Keep me posted with the Leishmaniasis results, I’d love to hear how things progress.
Wishing you and your patient the best outcome and I’m always happy to discuss further if anything else comes up.
Kind regards,
Scott
Replying to Sarah Clements 31/01/2025 - 11:42
No problem!
Hope all is well with you otherwise!
Scott 🙂
Replying to Felipe M. 31/01/2025 - 00:41
Thank you again for being brilliant!
Scott 🙂
Replying to Talia C. 12/01/2025 - 17:28
Dear Talia,
Happy New Year to you as well, and thank you for the update! It’s excellent to see that the desmopressin trial has provided some meaningful data, even though the challenges of snow and multiple dogs have made it tricky to fully assess water intake.
From the data you’ve shared, there does appear to be a significant improvement in USG during the day compared to pre-treatment values. Before desmopressin, her afternoon and evening USG values were consistently dilute (1.006 and 1.005), whereas now, these readings are markedly higher (e.g., 1.029, 1.027, 1.030). This suggests that the desmopressin is having an effect and supports a diagnosis of central diabetes insipidus (CDI), particularly given the consistent improvement in her ability to concentrate urine.
The similarity in her morning USG before (1.028) and during treatment (1.033) may be due to the fact that her baseline morning USG was already reasonably concentrated, which can occasionally happen in partial CDI cases. It’s also worth noting that psychogenic polydipsia (PD) would be less likely to show such a clear improvement in daytime USG following desmopressin administration. If it were primary PD, the effect on urine concentration would typically be minimal, as plasma osmolality in these cases already suppresses ADH production.
While there is still some overlap in the presentation of partial CDI and primary PD, the overall improvement during the day, combined with the owner’s observation of reduced water intake, strongly points toward CDI as the most likely diagnosis.
I would recommend continuing desmopressin treatment and monitoring her long-term response. If possible, getting a few more morning USG readings once the snow clears may help confirm whether this improvement remains consistent across all times of the day.
How are you enjoying the lectures?
Best regards,
Scott 🙂
Replying to shimin cheong 04/01/2025 - 05:57
Shimin,
Thank you so much for your thoughts and questions—it’s great to hear your perspective, and you’ve brought up some excellent points to consider!
Siichba’s Case Details
He’s a domestic shorthair kitten with no known genetic predisposition. His adoption history is limited, but there haven’t been any obvious breed-related concerns.
He’s in a single-cat household, entirely indoors, and while his environment seems low-stress overall, stress as a contributing factor is still something we’re mindful of. Adding environmental enrichment and ensuring hydration (wet food with added water, fresh water sources) has been part of the plan.Congenital Concerns
You’re absolutely right that congenital anomalies, such as ectopic ureters, could predispose him to recurrent infections or stone formation. While the initial ultrasound and imaging didn’t highlight any obvious structural abnormalities apart from the calculi, further investigation could be warranted if he develops recurrent infections or persistent haematuria despite resolution of the current stones.
Your example of the kitten with portal vein agenesis and a bladder stone is fascinating—thank you for sharing! Congenital liver disease does seem less likely in Siichba.
Current Approach
At the moment, Siichba is doing reasonably well, though he’s had intermittent setbacks, including lethargy and reduced appetite, which we’re managing supportively. His urine is bacteria-free, and we’re closely monitoring for any signs of blockage, especially given the risk associated with ureteral stones.
We do have the option of lithotripsy here, though I haven’t considered it yet for this case. It could certainly be an option in the future if his condition changes or the stones become problematic.
Regarding prazosin, it’s an interesting topic with quite a bit of debate about its effectiveness in managing lower urinary tract disease. I haven’t used it for Siichba yet, but I suppose it could be considered if there were signs of more acute obstruction.
Thank you again for sharing your insights and questions—it’s such an interesting case, and I appreciate the discussion. Let me know if you have any further thoughts or ideas!
Interestingly, I had my first case of ectopic ureters in a cat this week! It is the first one I have diagnosed in a cat!
All the best,
Scott 🙂
Replying to Rosanna Vaughan 25/01/2025 - 11:30
No problem!
Keep us posted!
Scott 🙂
Hi Sarah! 😊
Great questions, pancreatitis in Miniature Schnauzers can definitely be a tricky topic!
1. Predisposition to Pancreatitis in Miniature Schnauzers:
Miniature Schnauzers do have a known predisposition to pancreatitis, primarily related to their increased incidence of idiopathic hypertriglyceridemia. Elevated triglyceride levels can directly contribute to pancreatic injury through lipotoxicity and the formation of toxic byproducts during lipid metabolism, which damage pancreatic tissue and initiate inflammation.That said, it is worth noting that Miniature Schnauzers may also have an independent predisposition to pancreatitis unrelated to hypertriglyceridemia. Genetic studies have not conclusively linked specific mutations (e.g., SPINK1 variants) to pancreatitis in Schnauzers, but their breed-specific metabolic and pancreatic characteristics likely play a role. Additionally, dietary factors, obesity, and concurrent conditions like hypothyroidism or diabetes mellitus can exacerbate their risk.
2. CRP in Chronic Pancreatitis:
C-reactive protein (CRP) is a well-established marker for systemic inflammation and is typically elevated in acute pancreatitis (AP), correlating with disease severity. However, its role in chronic pancreatitis (CP) is less clear. Chronic pancreatitis often involves low-grade, ongoing inflammation and fibrosis, which might not provoke as significant a CRP response as acute inflammation.That said, CRP could still be mildly elevated in cases of active or acute-on-chronic pancreatitis episodes, where there is a surge in inflammation. Studies have shown a correlation between CRP levels and clinical disease activity, so it can be a useful adjunct marker to assess disease progression or flare-ups, particularly when paired with cPLI and imaging findings.
It sounds like you’re managing a complex case. If hypertriglyceridemia is a factor, managing lipid levels (e.g., through diet or omega-3 supplementation) might help reduce pancreatic stress. Let me know if you’d like to discuss further!
Cheers,
Scott 🙂
Replying to Rosanna Vaughan 24/01/2025 - 13:01
No problem!
Let me know if you try it!
Scott 🙂
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