scott@vtx-cpd.com
Forum Replies Created
-
AuthorPosts
-
Replying to Raquel M. 14/01/2025 - 11:04
You’re very welcome! I’m so glad to hear that Purina HA is available on the island—that should be a great option for Lloyd. Repeating the Panacur is an excellent plan, and hopefully, it helps resolve any potential parasitic contributors. It’s also great that the owner has been using the Purina fecal scoring chart; it’s such a helpful tool for tracking progress. Following up on compliance after your holiday will be key to ensuring we’re getting the full picture.
Let me know how things go with the owner and Lloyd.
Speak soon.
Scott
Replying to Rosanna Vaughan 13/01/2025 - 11:53
Thank you again Rosanna for all of the brilliant forum interaction.
I hope you enjoyed the course.
Any feedback welcome!
Scott 🙂
Hi Raquel,
Based on the information provided, I’d recommend considering Purina Pro Plan Veterinary Diets HA Hydrolyzed as an alternative diet option. This diet is formulated to support growth in puppies and is a great choice for managing GI issues like Lloyd’s chronic large intestinal diarrhoea. It’s often well-tolerated by puppies and can provide the nutritional support he needs for proper growth while addressing his GI concerns. If Purina HA is accessible on the island, I’d suggest transitioning him to it for at least 6–8 weeks while monitoring his stool consistency and overall development.
In terms of deworming, given Lloyd’s persistent symptoms and environmental exposure, I’d recommend repeating fenbendazole (Panacur) for a further 5 days at 50 mg/kg SID. This extended treatment will ensure that any occult parasite burdens, particularly Giardia or whipworms that might have been missed or shed intermittently, are effectively addressed. While faecal testing has been negative, parasite infections can sometimes be tricky to detect, and a full treatment course is warranted given the history.
1. Dietary Management
Switch Lloyd to Purina HA as a primary diet, feeding him small, frequent meals (3–4 times daily). Avoid treats, table scraps, or other additions to minimize dietary variability. Consider adding psyllium fibre to his diet. Start with a small dose (e.g., 0.5–1 tsp of unflavoured psyllium husk mixed into meals twice daily) and adjust based on stool consistency. Psyllium can help regulate bowel movements by increasing stool bulk and binding excess water. Pumpkin can also be incorporated into his meals in small amounts (1–2 tsp per meal). It’s a good source of soluble fibre and may help with mild diarrhoea. If pumpkin doesn’t seem effective or causes any adverse effects, it can be discontinued.2. Deworming Protocol
Administer an additional 5-day course of fenbendazole (50 mg/kg SID) to address any potential residual or undiagnosed parasitic infections. Confirm that no environmental reinfections are occurring by advising the owner to maintain strict hygiene, including cleaning up stools promptly and disinfecting areas where Lloyd has defecated.3. Probiotics and Gut Support
Continue using Proviable DC if it has been well-tolerated, but I’d also recommend considering a switch to Visbiome Vet. This high-potency probiotic is specifically formulated for GI support in dogs and may provide better outcomes for chronic large intestinal diarrhoea. Ensure consistent dosing for at least 4–6 weeks. If possible, introduce a prebiotic supplement to further support gut health (e.g., FOS or MOS-based prebiotics, available in some veterinary GI supplements).4. Other Diagnostics and Preventatives
Given the chronicity of Lloyd’s symptoms, consider repeating faecal diagnostics. it might also be worth considering TLI, folate, cobalamin and basal cortisol.5. Monitoring and Long-Term Approach
Track Lloyd’s response to the diet, psyllium, pumpkin, and deworming over the next 2–4 weeks. Evaluate stool quality using a faecal scoring chart and document weight gain and BCS regularly. If diarrhoea persists despite these measures, consider referral or advanced diagnostics such as abdominal imaging or endoscopy to assess for inflammatory bowel disease (IBD), food-responsive enteropathy, or other chronic GI diseases.Summary of Recommendations
Transition Lloyd to Purina HA, as it is a diet labelled for growth and suitable for managing GI disorders. Supplement his meals with psyllium fibre and small amounts of pumpkin as tolerated to help regulate stool consistency. Use Visbiome Vet as a high-potency probiotic for improved GI support. Administer an extended 5-day fenbendazole treatment and ensure strict environmental hygiene.A faecal transplant might also be a consideration. Please let me know how Lloyd progresses or if you have any additional questions.
Kind regards,
Scott 🙂
Replying to Rachel C. 06/01/2025 - 20:49
No problem Rachel!
Happy New Year. Wishing you all the best for 2025.
Let me know if there is anything else I can help with.
Scott 🙂
Rosanna!
Thank you for all of your brilliant contribution to the forum!
Happy new year when it comes.
Scott
Replying to sara marella 30/12/2024 - 23:05
Hey Sara!
Thank you for all of your brilliant contribution to the forum.
Happy new year!
Scott
Replying to Felipe M. 29/12/2024 - 20:43
Thank you again for everything!
Scott 🙂
Replying to Georgina F. 29/12/2024 - 23:22
Thank you again and all the best for 2025!
Scott 🙂
Replying to Samantha T. 23/12/2024 - 11:01
Thank you!
I hope you had a lovely Christmas and Happy New Year!
Scott 🙂
Replying to Lara Brunori 16/12/2024 - 11:09
Hi Lara,
Thanks so much for your reply!
I completely agree with your point about idiopathic renal haematuria being an interesting differential, but like you, I’ve never personally seen it in a cat. I do wonder whether the mineralized material within the urinary tract, particularly at the ureterovesical junction, is enough to be causing persistent irritation and haematuria. When there’s known mineralized material or stones present, it’s challenging to rule them out as the primary cause, especially with their potential to cause localized trauma or inflammation.
Speak soon,
Scott 🙂
Replying to Lara Brunori 16/12/2024 - 11:16
Good news!
Hope you are managing some time off over the festive period!
Scott 🙂
Replying to Talia C. 17/12/2024 - 06:45
Dear Talia,
Thank you for continuing to share your thoughts on Joplin’s case. Reflecting on the initial presentation, I think it’s important to go back to the starting point of why this dog was investigated in the first place. As far as I can see, Joplin initially presented asymptomatically, with incidental increases in liver enzymes prompting further investigation. Given this, even if she were in an early stage of Cushing’s disease, I feel there aren’t enough clinical signs at this time to justify starting treatment.
The current major concerns appear to be the adrenal gland changes and how best to monitor those moving forward. I think you are absolutely sensible to continue supporting the liver and gallbladder with ursodeoxycholic acid and SAM-e-type products, as these address the specific changes seen on ultrasound.
When it comes to adrenal gland changes, the primary goal is to determine functionality. While the LDDS test results lean toward a diagnosis of Cushing’s, I believe the overall findings remain equivocal. At this stage, it may be prudent to repeat the abdominal ultrasound in about three months to monitor for progression of the adrenal nodules. The key risk to watch for is the potential extension of the adrenal mass and invasion into surrounding structures, including the caudal vena cava.
In terms of further testing, you could consider urine normetanephrine/metanephrine analysis for pheochromocytoma, but as you noted, this is a costly option. Instead, serial blood pressure measurements would be a more cost-effective and practical approach for monitoring. Regularly tracking Joplin’s clinical signs and biochemical parameters will also help guide future decision-making.
I agree that testing 17-hydroxyprogesterone may not be particularly helpful at this stage. For now, repeating the scan and reassessing in three months feels like the most logical next step. This will allow you to observe any changes in clinical signs or adrenal size, at which point further diagnostic testing or treatment decisions can be revisited.
In summary, I wouldn’t pursue treatment for Cushing’s at this time, as the evidence remains inconclusive. I would focus on monitoring Joplin with regular reassessments and supporting her liver and gallbladder health, as you are already doing. Please don’t hesitate to reach out if there are any updates or additional questions as this case evolves.
Best regards,
Scott 🙂
Replying to Talia C. 17/12/2024 - 07:04
Hi Talia,
I completely agree that urine cultures in these cases can be tricky. I wouldn’t recommend routinely culturing these patients every time. Instead, my decision to reculture would usually depend on clinical signs and the presence of comorbidities. For example, in asymptomatic patients with conditions like chronic kidney disease or diabetes, I might consider reculturing, but there’s certainly a lot of debate around this.
Unless the patient is systemically unwell or showing specific symptoms that warrant further investigation, I don’t think routine reculturing is necessary. I’d focus more on clinical indicators and ongoing monitoring strategies like creatinine, SAA, and ultrasound, which you’re already doing. This targeted approach helps balance the need for thorough care with cost considerations and avoids unnecessary interventions.
Best,
Scott 🙂
Replying to Steph Sorrell 21/12/2024 - 17:12
Thank you Steph.
Have a wonderful Christmas!
Scott 🙂
Replying to Georgina F. 21/12/2024 - 08:44
So interesting!
Thank you for sharing… I am off to educate myself!
Scott 🙂
-
AuthorPosts