scott@vtx-cpd.com

This is so interesting!

I never thought we would be discussing a Chinchilla, but very excited we are!

Thanks for sharing.

Scott 🙂

Replying to Rosanna Vaughan 20/01/2025 - 13:17

Let us know how you get on!

Scott 🙂

Hey Rosanna.

Definitely not my are of expertise! I have reached out to some surgeon pals to comment too!

Thanks again for the great question!

Scott 🙂

Hi Josep,

Thank you for your contribution to the neurology course! Neurology is always such a challenge, and I truly appreciate the effort you’ve put into making it approachable. Along with ophthalmology, it’s one of those topics I’ve always found particularly tricky—but I’m excited to dive in and learn from the cases and insights you’ve prepared. I’m sure your guidance will make all the difference.

Looking forward to this journey!

Scott 🙂

Replying to Raquel M. 17/01/2025 - 12:37

Hi Raquel,

That’s fantastic news about Lloyd’s progress! It’s great to hear his stool is normal now. Since he’s currently on a grain-free diet, transitioning him to a more nutritionally balanced option, such as Purina HA, is an excellent next step. This will help him regain weight, improve his body condition score (BCS), and avoid potential long-term effects associated with grain-free diets. For the transition, given his GI history, I’d recommend a 10- to 14-day gradual change to minimize the risk of GI upset. Start by replacing 25% of his current diet with the new food for 3–4 days, then increase to 50% for another 3–4 days, followed by 75%, and finally 100% of the new diet. During the transition, monitor his stool consistency and adjust the timeline if needed.

I also wanted to address your concern about introducing the idea of reducing metronidazole as the first-line treatment for acute uncomplicated diarrhoea, which I completely understand is a sensitive topic as you’ve recently joined the clinic. Evidence increasingly suggests that metronidazole may not be the best option for such cases. Studies show it does not significantly decrease the duration of diarrhoea compared to probiotics or placebo, and it has been associated with disruptions to the gastrointestinal microbiome that can persist for weeks, particularly affecting bile acid metabolism. These microbiome changes can have longer-term implications for canine gut health.

Probiotics or synbiotics, on the other hand, appear to offer comparable or slightly better reductions in diarrhoea duration without the adverse effects on the microbiome. Studies like those by Shmalberg et al. (2019) and Kelley et al. (2009) suggest probiotics can reduce diarrhoea duration by up to 2.5 days in some cases. Moreover, probiotics are generally safe and provide a tangible treatment option for owners who expect medication. Products like Visbiome Vet or FortiFlora could be used to meet these expectations while aligning with evidence-based medicine.

To encourage a shift in clinic practice, you might consider a few strategies. First, sharing educational materials or presenting a brief overview of the evidence could help highlight the risks of overusing metronidazole and the benefits of probiotics as a first-line treatment. Proposing a standard clinic protocol for managing acute uncomplicated diarrhoea could provide a clear and structured alternative. This could include dietary management with GI support diets, probiotics like Visbiome Vet, and deworming with fenbendazole if indicated, reserving metronidazole or other antimicrobials for cases with clear evidence of bacterial overgrowth or systemic involvement.

The available evidence supports probiotics as a safe, effective alternative to metronidazole for uncomplicated diarrhoea and shows that dietary changes and supportive care are sufficient for most cases. If you’d like, I’d be happy to help draft a specific protocol or provide materials to assist in discussions with your colleagues. Let me know how I can support you further with this or Lloyd’s ongoing care!

Kind regards,

Scott

Hi Rachel,

Thank you for the great questions!

For your PUO patient on 5mg prednisolone daily for chronic bronchitis, this dose (approximately 0.3mg/kg for a 16kg dog) is a low anti-inflammatory level. While it may partially mask pyrexia, it’s unlikely to fully suppress a febrile response. Chronic steroid use can, however, blunt the immune system and complicate diagnostic clarity. If the bronchitis is stable, consider tapering the steroid dose gradually, especially if empirical treatments fail and no underlying cause is identified. Alternatively, you can maintain the current dose and pursue further diagnostics (e.g., bone marrow aspirate, infectious disease panels).

If you suspect an immune-mediated disease, I recommend starting 2mg/kg/day of prednisolone for at least 7 days. Most immune-mediated diseases tend to respond quite quickly to this therapy. For your 16kg patient, this would equate to 32mg/day, ideally split into two doses for better stability. If there’s no response after 7 days, reassess the diagnosis and consider adding adjunctive immunosuppressants such as cyclosporine or azathioprine rather than further increasing the steroid dose. In older patients, immune-mediated disease remains a strong possibility, but I would also actively investigate for underlying causes such as neoplasia, infectious diseases, or paraneoplastic syndromes. When financial constraints limit diagnostics, a short course of antibiotics to rule out a treatable infectious process is not unreasonable, especially when infection cannot be entirely excluded.

In an ideal world, I would allow for a 3-day washout period between NSAIDs and steroids to minimize risks like gastrointestinal ulceration. However, in cases of severe immune-mediated disease, waiting may not be feasible. In these situations, I would start steroids sooner if necessary, while clearly warning owners about the potential risks. While a washout is a good practice, it’s not a hard-and-fast rule in emergencies or severely affected cases.

For your patient diagnosed with polyarthritis and azotaemia, I would recommend starting 2mg/kg/day of prednisolone while investigating potential infectious causes like Leishmania. Polyarthritis and azotaemia may be linked through an immune-mediated mechanism, such as concurrent immune-mediated glomerulonephritis. However, they could also represent separate conditions, particularly given the patient’s geographic history (e.g., Trinidad). Azotaemia warrants close monitoring of renal function, hydration, and blood pressure while managing the polyarthritis with immunosuppressive therapy. Infectious causes must be ruled out or treated appropriately, as some mimic immune-mediated disease presentations.

Ultimately, even if there is an infectious trigger, the immune system still needs modulated.

I hope that helps.

Best regards,

Scott 🙂

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