scott@vtx-cpd.com

Replying to Shona McTaggart 29/09/2025 - 11:45

Hi Shona!

So lovely to see you on here, I’m absolutely thrilled you’ve joined the course. Sounds like you bring a wealth of experience, and I think you’ll find the sessions really helpful for those trickier feline views and interpretation. Great that you’ve already got the dental radiography in place.

Enjoy your holiday in Oz, and fantastic that you’re planning to get stuck into the first couple of weeks while you’re away. Looking forward to learning alongside you!

Scott 🙂

Replying to Julia Biernat 30/09/2025 - 08:51

Hi Julia,

Informing owners about the uncertainty but also the low risk is exactly how I tend to frame it too. In many cases, especially when emesis isn’t an option, it feels reassuring to have something we can do in the moment, even if the evidence base is thin.

And you’re absolutely right, these kinds of discussions are valuable!

I hope you are having a lovely week.

Scott 🙂

Replying to Julia Biernat 22/09/2025 - 09:31

Hi Julia,

That’s a really good question and not tedious at all! I hope you are enjoying the course! Any feedback is always appreciated!

Sorbitol is the cathartic most often included in veterinary activated charcoal products. Its role is to increase osmotic draw into the gut lumen, which in turn speeds up intestinal transit. That’s the intended effect, to help move the charcoal–toxin complex through the GI tract faster and reduce reabsorption.

Where it sometimes gets phrased differently is in the context of what happens if you give multiple doses: repeated cathartic administration can lead to significant fluid and electrolyte shifts, ileus, and dehydration. That clinical consequence can look like delayed gut motility, but pharmacologically the mechanism is increased transit time. So, to be clear for your slides, cathartics like sorbitol speed up gut transit.

On your second point, you’re right about the ongoing debate around activated charcoal in grape/tartaric acid toxicity. The data is still very limited:

The ASPCA/APCC (and more recently the ASPCA Pro guidelines) generally advise against charcoal in grape/raisin/tartaric acid cases, mainly due to lack of proven efficacy and the fact that the toxin responsible seems to act via renal tubular mechanisms rather than an enteric-absorbed pathway.

That said, many clinicians (myself included) would still consider charcoal in certain situations, especially if emesis isn’t safe, as in your geriatric pug with CHF. It’s unlikely to harm if given as a single dose, and could theoretically help if some fraction of toxin is still unabsorbed.

The cost issue with Carbodote is very real, especially in larger dogs. Owners should absolutely be part of that discussion, we need to balance uncertain benefit against a fairly high cost.

I’m really sorry if there was any inaccuracy in what I presented, and I’ll make sure the material is updated so it’s clear and accurate going forward.

And I agree, it’s sad not to have more concrete options, sometimes charcoal is all you’ve got in the moment, even if the evidence base is thin.

Scott 🙂

Replying to Jo T. 22/09/2025 - 22:46

Hi Jo,

It’s so lovely to hear from you, I’m really glad to hear you’re still enjoying your time at the hospital! I can imagine it’s a great environment for keeping skills fresh, especially with all the ophthalmology you’re seeing.

Sorry to hear you’ve been unwell, I hope you’re feeling much more like yourself now. Don’t worry at all about catching up; that’s the beauty of this course format, and I know you’ll slot right back in. Let me know if I can help in any way as you’re getting back into it!

Take care and speak soon,

Scott 🙂

Hi Raquel,

Apologies for the delay in replying, and how exciting that you’re stepping into your first FMT case! I’d love to hear how it all went, did you go ahead with the procedure? How did the patient tolerate it?

Based on your summary, this sounds like a solid candidate, a well dog with chronic mixed-bowel diarrhea, chronic enteropathy confirmed on SI biopsies, and a long-standing history. It’s also great that he’s no longer on antimicrobials or steroids, which simplifies the interpretation of response to FMT and helps avoid confounding effects on engraftment. Given the months-long history and prolonged hospitalization, this seems like a great opportunity to trial microbial-directed therapy.

If you haven’t done the FMT yet, or if you’re considering repeating it, here are some thoughts and steps you might find helpful:

Before the FMT

Deworming: Definitely worth repeating if there’s any uncertainty about timing or coverage, especially with chronic GI signs. Fenbendazole 50 mg/kg PO q24h for 5 days would be my go-to.

Cobalamin: If it hasn’t been checked recently, I’d strongly recommend it. Even subclinical hypocobalaminemia can affect mucosal healing and response to therapy, and supplementing (either oral or SC) is easy and low risk.

Fasting: A short fast (8–12 hours) beforehand can help reduce interference from residual stool and improve retention time post-enema.

Probiotics: I usually advise stopping probiotics 48–72 hours before and after FMT to reduce microbial competition, although this is based more on consensus than data.

Diet & Timing

You mentioned he’s on a z/d trial arranged by a colleague, that’s absolutely fine, and it makes sense to stick with it during the FMT window. I’d recommend avoiding any diet changes for at least 2 weeks after FMT so you can assess its impact in isolation. If you’re not seeing improvement, you can consider a novel protein or hydrolyzed protein switch later, but try to change only one variable at a time.

FMT Dosing & Technique

If you opted for rectal enema (still the most common method in dogs):

Dose: I’d suggest 10–20 mL/kg of filtered slurry (based on recipient BW), for the first treatment, closer to 10 mL/kg may be easier to tolerate.

Retention: The target is ≥30–45 minutes, but don’t consider it a failure if they defecate earlier, many dogs retain for hours, but some will pass it sooner, and still show benefit.

Sedation: Case-by-case. I sedate most of mine but some centres will perform conscious! If the patient is anxious or hard to handle, mild sedation can help ensure safe and effective delivery, though there’s no evidence it improves outcome.

Donor screening: Ideally a healthy adult dog with no GI disease, no antibiotics in the last 90 days, and recent clear fecal tests (including Giardia, ideally PCR or antigen).

Monitoring & Repeat Plans

Most dogs with chronic enteropathy benefit from more than one FMT, with treatments spaced roughly 10–20 days apart.

In one retrospective study, a median of 3 FMTs was associated with improved outcomes, and about 75% of dogs who responded showed further gains after the second dose.

Use clinical signs (stool frequency/consistency, tenesmus, appetite, energy) to guide repeat timing.

Outcome Tracking & Owner Guidance

Make sure owners know that FMT is an adjunct, not a standalone cure, and that improvements may be incremental.

Mild, transient side effects like flatulence, softer stool, or nausea can occur, but serious adverse effects are rare.

Key goals include improved stool quality, reduced urgency, improved QoL, and potentially reduced reliance on immunosuppressants down the line.

If you’ve already performed the FMT, I’d be really keen to hear how the dog responded, was there any change in stool quality or frequency? Did you consider a repeat, or are you waiting until the z/d trial has run its course?

Hope it went smoothly and look forward to hearing an update!

Very best,

Scott