scott@vtx-cpd.com

Replying to Laura Jones 27/09/2024 - 10:04

Hey.

I have only used in twice in real life! I did some practical session last week when we practiced with it a bit more. You have to have the right size tunnelling device and it only fits on to the MILA tubes.

https://www.milainternational.com/products/esophagostomy-feeding/tunneler-for-length-adjustable-esophagostomy-feeding-tubes.html

So I suppose a limitation is that you have to have the kits sitting there ready to go, which may be more challenging for practices that are looking to keep more limited stick. I found it a little bit of a fiddly with larger dogs, but generally it works well.

You should try them!

Scott 🙂

Hi Keri,

Sounds like you’ve got a challenging case—Cushing’s in Boxers can be quite complex, especially with the complicating factor of prednisolone affecting the UCCR ratio. The elevated UCCR is likely related to the pred, so it’s smart to wait for the washout before conducting the LDDT to avoid false positives.

Regarding supportive supplements:

1) Melatonin
Melatonin is sometimes used in treating canine Cushing’s, especially with alopecia. It’s cost-effective, has minimal side effects, and is widely available in health food stores or online. Typical dosing:

3 mg q12h (BID) for dogs <13.6 kg
6 mg q12h (BID) for dogs >13.6 kg
Regular melatonin (not rapid or extended-release) is preferred. It has anti-gonadotropic activity, inhibiting aromatase (reduces androstenedione and testosterone to estradiol conversion) and 21-hydroxylase (lowers cortisol). It may take up to 4 months to see clinical effects, and monitoring includes clinical signs, biochemistry, or steroid profile testing.

2) Lignan
Lignan has phytoestrogenic activity, competing with estradiol for receptors with reduced biological effects. It also inhibits aromatase, further lowering estradiol. Dosing recommendations:

SDG lignan: 1 mg/kg body weight/day
HMR lignan: 10-40 mg/day, depending on dog size
Melatonin and lignans are sometimes used together when estradiol is elevated, helping reduce cortisol and androstenedione as well.

3) Myos (Fortetropin)
Myos can be useful for preserving muscle mass and promoting growth in dogs with muscle atrophy from Cushing’s or chronic steroid use. Though evidence is more anecdotal, some vets have seen good results with its use.

Please note that while these therapies can be helpful in managing Cushing’s, there isn’t a huge amount of evidence to support their efficacy, so responses can vary from dog to dog.

Hope this helps guide your next steps. Keep us posted on the LDDT results and any treatment adjustments!

Cheers,

Scott

Thank you for a great session.

I’m looking forward to hearing people’s thoughts.

Scott 🙂

Hi Felipe,

Great topic! Managing second or third-degree heart block in animals can be quite challenging, especially without access to permanent pacing. In primary care, if pacing capabilities are unavailable, management typically focuses on stabilizing the patient until they can be referred to a specialty center for permanent pacemaker implantation.

How accessible is temporary pacing? I only ever remember having it at the vet school. For drug intervention, supportive measures like anticholinergic drugs (e.g., atropine or glycopyrrolate) or sympathomimetic agents (e.g., dopamine) can be helpful in increasing the heart rate, albeit with variable success. However, they often only provide temporary relief, and patients still need urgent evaluation by a cardiologist.

Looking forward to hearing your thoughts!

Best,

Scott