scott@vtx-cpd.com
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Hello Raquel!
Great to hear from you. Exciting regarding the change in job! Are you working at a vet school?
I will make sure Steph sees this. I will share some thoughts too.
Scott
Replying to Kerry Doolin 22/03/2024 - 13:17
So helpful Kerry.
Thank you for sharing your thoughts.
Scott 🙂
Hello again.
The following reply is from Zoetis:
“As per the data sheet for use of Cerenia use in dogs ‘neurological disorders such as ataxia, convulsions/seizures or muscle tremor have been reported in very rare cases’, as Cerenia is not licensed for use in cats we have no studies on this and therefore no data regarding the possible adverse events from this. Sorry I don’t have any more information to give you on this.”
Seems like it might be a rare side effect. I would contact they directly to report these adverse side effects, particularly if yoy have had a few of them.
Scott 🙂
Replying to Junwei Föhr 16/03/2024 - 10:29
Hello again.
It seems like CRP may also have a possible role to play on the diagnosis of lung disease. A number of studies have shown that CRP seems to be higher in cases with bacterial pneumonia when compared to other inflammatory lung disease:
https://pubmed.ncbi.nlm.nih.gov/24351049/
Scott 🙂
Replying to Junwei Föhr 16/03/2024 - 10:29
Hello.
I hope you are well. I do indeed use CRP as a way of monitoring aspiration pneumonia cases. It can be a helpful tool to help determine when to stop antibiotics as you mention. This paper looked at CRP use in dogs with aspiration pneumonia and whether it is a reliable indicator of when to stop antibiotics. They found that in dogs where CRP normalised and clinical signs resolved that antibiotics were discontinued in as little as 1 week! This is much shorter than the traditional length of time, or 2 weeks past resolution on radiographs/ thoracic ultrasound (remembering imaging improvement often lags behind clinical).
CRP is gaining more and more attention as a marker for when to stop antimicrobial treatment, and although this cohort was small I think it shows some useful findings. Here is the abstract, and the paper is open access through JVIM.
https://pubmed.ncbi.nlm.nih.gov/35348224/
Abstract
BackgroundEvidence regarding optimal treatment duration in dogs with aspiration pneumonia (AP) and the role of thoracic radiographs (TXR) and lung ultrasonography (LUS) in the long-term follow-up of affected dogs is lacking. C-reactive protein (CRP) is a reliable acute phase protein to monitor bacterial pneumonia in dogs.
Hypothesis
Investigate the safety of antimicrobial discontinuation based on clinical improvement and serum CRP normalization, as well as the usefulness of TXR and LUS for follow-up.
Animals
Dogs diagnosed with AP and treated with antimicrobials.
Methods
Prospective observational study. Antimicrobials were discontinued based on clinical improvement and serum CRP normalization after 1, 3, or 5 weeks. At each consultation, a quality-of-life questionnaire, physical examination, serum CRP, TXR, and LUS were assessed. Short- (2 weeks) and long-term (>1 month) follow-ups after treatment discontinuation were performed to monitor for possible relapses.
Results
Seventeen dogs were included. Antimicrobials were discontinued after 1 week in 12 dogs (70.6%) and 3 weeks in the remaining 5 dogs (29.4%). Short-term relapse was not observed in any dog and long-term relapse was diagnosed in 3 dogs. Thoracic radiographs and LUS were useful for diagnosis, but did not add additional information during follow-up, because image normalization lagged behind clinical improvement and serum CRP normalization.
Conclusion and Clinical Importance
Dogs with AP can be safely and effectively treated using a short-term antimicrobial regimen discontinued after clinical improvement and serum CRP normalization. Imaging might still be useful for complicated cases with a less favorable response to treatment.
Scott 🙂
Replying to Marit Veeber 18/03/2024 - 09:15
Hello Marit!
Welcome. Great to see you here, thank you so much for joining the course.
I am sorry to hear you are at home unwell. I also love that you are taking advantage of being ill and catching up on CPD!
I hope you feel better soon. Let me know if you have any questions.
Scott
Replying to Jackie L. 19/03/2024 - 10:02
Hello Jackie.
Great to see you hear. We have never had a Chiropractor join us before, so it will be exciting to hear things from your perspective.
What made you move from humans to animals?
I hope you enjoy the course, please let me know if you have any questions.
Scott 🙂
Replying to Talia C. 19/03/2024 - 19:01
I think your plan sounds great.
If the dog is doing well with supportive care/omeprazole, then most of the changes your are seeing histopathologically could be due to ulceration. I would keep a close eye on the dog and repeat the ultrasound at some stage if possible.
If the clinical signs persist, then you could consider taking another biopsy at that stage.
Scott 🙂
Replying to Felipe M. 16/03/2024 - 13:11
Hello Felipe.
Thank you for sharing. This is all really interesting and really helpful.
Do you think the type of pulse oximeter matters? Are there some that are more reliable in our dogs and cats than others?
Scott 🙂
Replying to Felipe M. 16/03/2024 - 12:56
This is so interesting!
I could talk about omeprazole all day! I think it is a really important and useful drug, but often very over prescribed in the veterinary sector. I think Felipe has made an excellent job of summarising its use in this context, based on the evidence we do have. In cases that have more significant regurgitation, I will often consider using cisapride too:
https://pubmed.ncbi.nlm.nih.gov/22489656/
If anyone ever wants to chat about omeprazole more, give me a shout! 🙂
Scott 🙂
Replying to Talia C. 15/03/2024 - 12:11
Hello.
These results are really interesting:
1. Is there a visible mass on ultrasound or endoscopy? Did you visualise ulcerated areas?
2. The inflammation in these sections is more significant than we normally see with typical gastritis. I would be concerned that there is a significant inflammatory enteropathy. The other concern would be that this more significant inflammation with that neutrophilic component, could be secondary to neoplasia or part of the ulcerative process.
3. I would be worried that you are missing a neoplastic process. I have had this happen with some gastric masses/thickening, where the biopsies only represent superficial/surface inflammation. If the clinical signs persist, full thickness biopsies could be considered.
4. I think it is less likely that the Helicobacter are significant here. The numbers are quite high, but they are superficially distributed. I would treat everything else before considering treating the Helicobacter.
I hope that helps.
Scott 🙂
Hello Talia.
Super interesting! Thank you for sharing. I have not experienced this side effect and have not heard of this being reported. Are you experiencing this with the oral medication?
I am recording some podcast episodes with Zoetis (who make Cerenia) in a few weeks, so I will reach out to them with your question and see if they have any reports of this. I will keep you posted.
Scott 🙂
Hello Talia!
Was sorry not to see you live. I hope you are well.
Let me know if you have any problems accessing the recording.
Speak soon.
Scott 🙂
Replying to Neus E. 05/03/2024 - 12:00
My worry too!
Bleeding or IMHA would definitely immediately pop to the top of my DDX list. There were no spherocytes present, slide agglutination was negative and Coombs was also negative. POCUS was performed chest and abdomen and no free fluid was seen… always a good shout! No melena was reported in this case, but I always do a rectal as owners will not always notice this!
I will pop the outcome soon!
Scott 🙂
Replying to Junwei Föhr 04/03/2024 - 21:36
Thank you so much for your brilliant comments!
Interestingly, the referring vets were worried about a defect in the diaphragm.
Haematology was unremarkable. Echocardiography was not carried out.
I LOVE your suggestion of CRP! Do you think that would help diagnostically… or more therapeutically?
Thank you again!
Scott 🙂
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