scott@vtx-cpd.com

Replying to Mihai R. 05/10/2025 - 17:25

Hello!

Thank you for your question!

Thank you so much for joining the course. I will make sure to pass on your question, and we will get it answered ASAP!

Have a great week.

Scott

Replying to Julia Biernat 01/10/2025 - 19:16

Thanks Julia.

I must admit that I do not find myself reaching for the blood culture bottles that often, but it is important to remember we have the option for certain cases.

Scott 🙂

Replying to Raquel M. 28/09/2025 - 15:30

Really interesting!

You’re right, there is some support in the literature for lameness being linked with systemic inflammatory disease like pyometra.

In dogs, immune-mediated polyarthritis (IMPA) can occur as a “reactive” phenomenon, where an inflammatory focus elsewhere in the body (e.g. infection, neoplasia, or pyometra) triggers sterile synovitis via circulating immune complexes. This can present as shifting-leg lameness, stiffness, or reluctance to move, sometimes without obvious joint swelling (Clements et al. 2004; McCarthy et al. 1996). Exacerbation of pre-existing osteoarthritis by systemic cytokines is also a plausible mechanism.

There are even case reports where anterior uveitis and IMPA co-occurred, likely through the same immune-mediated pathways (e.g. Yoon et al. 2024, zonisamide-induced IMPA with uveitis). So while the pyometra-uveitis link is better established (Jitpean et al. 2014; Fortuny-Clanchet et al. 2025), I think your observation of lameness could well fit into this broader “reactive inflammation” picture.

Clinically, it makes me think: if a pyometra case presents with unexplained limb pain or stiffness, it might be worth a quick joint palpation and even synovial fluid sampling if there’s effusion, especially if lameness improves as the systemic disease resolves.

Thanks for raising it!

Scott 🙂

References:

Clements DN, et al. Diagnosis of canine immune-mediated polyarthritis: a review of 40 cases. J Small Anim Pract. 2004;45:336–342.

McCarthy G, et al. Immune-mediated polyarthritis in the dog: clinical and laboratory findings in 31 cases. J Small Anim Pract. 1996;37:103–110.

Yoon J, et al. Presumed zonisamide-induced, immune-mediated polyarthritis and anterior uveitis in a dog. Front Vet Sci. 2024;11:1352217.

Jitpean S, et al. Outcome of pyometra in female dogs and predictors of peritonitis and prolonged postoperative hospitalization in surgically treated cases. BMC Vet Res. 2014;10:6.

Fortuny-Clanchet M, et al. Prevalence of anterior uveitis in dogs diagnosed with pyometra. J Small Anim Pract. 2025.

Replying to Raquel M. 27/09/2025 - 17:29

Interesting!

I wonder what caused the lameness? I am trying to find some good images of uveitis to share too.

Scott 🙂

Replying to Pauline Brauckmann 22/09/2025 - 18:55

Hi Pauline,

I couldn’t agree more, Denamarin tablets are a real compliance challenge. They’re bulky, unpalatable, and the formulation makes them particularly unforgiving. The key issue is that S-adenosylmethionine (SAMe) is highly sensitive to gastric pH and handling. That’s why the Denamarin tablets are enteric coated, to protect the SAMe from degradation in the stomach and allow absorption in the small intestine. Crushing the tablets destroys that coating and essentially wipes out the bioavailability.

On top of that, they’re supposed to be given on an empty stomach, because food can significantly reduce absorption. That’s easier said than done, especially in cats (who rarely tolerate tablets at the best of times), and in dogs where owners struggle to withhold food beforehand.

There are some formulation differences across products:

Dogs: Denamarin chewable tablets exist in some markets, but even those are often large and not much more palatable. SAMe-only formulations (e.g. Denosyl) can be an option if you don’t need the silybin component.

Cats: The standard tablets are particularly difficult to administer. Compounding pharmacies can prepare SAMe suspensions or smaller capsules, but stability and bioavailability are less predictable compared to the proprietary coated tablets.

Bioavailability: Studies have shown that SAMe bioavailability in dogs and cats is variable, depending on the salt form used (tosylate vs disulfate) and whether the product is properly protected with enteric coating. Even small changes in formulation can dramatically affect how much active SAMe reaches circulation.

So we’re stuck with a product that’s clinically useful, but difficult to administer exactly as intended. In practice, I’ve had to either coach owners through creative administration strategies (often with limited success). It still amazes me that, given how widely prescribed these products are, no one has produced a reliably smaller, more palatable, cat-friendly format.

I hope you are enjoying the course!

Scott 🙂