scott@vtx-cpd.com
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Replying to Helen S. 28/04/2024 - 11:33
Thank you for sharing these Helen.
Scott x
Replying to Amanda-Jane Rogers 27/04/2024 - 17:53
Thank you so much for sharing this!
Hope you are well.
Scott ๐
Replying to Yvonne McGrotty 29/04/2024 - 12:38
Hi Yvonne,
Thank you so much for your detailed and informative reply. Your insights into monitoring trilostane therapy for hyperadrenocorticism are incredibly valuable, and I appreciate you taking the time to share your expertise.
Your explanation regarding the use of pre-pill cortisol and the considerations for when it may not be suitable, as well as the importance of clinical signs in dose adjustment, were particularly enlightening. I will certainly keep these points in mind when managing cases in the future.
Your advice on the use of ACTH stim tests and the considerations for twice-daily dosing will undoubtedly help me make more informed decisions in my practice.
Thank you once again for your thorough response.
Best regards,
Scott x
Replying to Suzi Bailey 26/04/2024 - 20:48
Hey Suzi!
I hope you are well and enjoying the course. I hope Yvonne’s response helped. If you have any other questions let me know!
Have a great weekend.
Scott ๐
Replying to Jackie L. 25/04/2024 - 14:39
Hi there,
Thank you so much for your kind words! We’re thrilled to hear that you found the neurology course interesting and informative. It’s fantastic to hear that you’ve learned a lot and that you’re keen to continue your learning journey in neurology. We’ll definitely keep you updated on any future neurology courses on this site, and we encourage you to explore other courses that might pique your interest.
If you have any specific topics or areas within neurology that you’d like to delve deeper into, feel free to let us know. We’re here to support your learning and growth in any way we can.
Thanks again for being a part of the course, and we look forward to having you join us in future learning opportunities!
Best regards,
Scott ๐
Replying to Talia C. 23/04/2024 - 07:10
Hello!
I utilize a treatment protocol that involves measuring a baseline Spec cPL concentration, then administering prednisone to the dog for 5 days at a dose of 2โฏmg/kg PO q 12โฏh, followed by 1โฏmg/kg PO q 12โฏh for another 5-7 days. A recheck of clinical signs and another Spec cPL concentration is then conducted. If there is any improvement in clinical signs or the Spec cPL is significantly decreased, I continue prednisone therapy at a slowly decreasing dosage. Additionally, successful treatment of a canine patient with chronic pancreatitis with cyclosporine has been reported in one case, and a clinical trial is underway. I measure a baseline serum Spec cPL concentration and then administer 5โฏmg/kg of Atopica PO q 24โฏh for 3 weeks, after which another recheck is performed to evaluate the patient clinically and measure another Spec cPL concentration. Treatment continues long-term based on the above-mentioned criteria. However, further studies are needed before these treatment strategies can be recommended for more routine use in dogs. This protocol is not heavily evidence-based. There are some occasions when people will start with up to 4 mg/kg for the management of some immune-mediated conditions for a short time. I do not often go for this high dose but will stick to 2โฏmg/kg/day initially in most cases.
I hope that helps!
Scott ๐
Replying to Sarah H. 02/05/2024 - 14:01
Hello Sarah!
Really great to have you join us! I really hope you enjoy the first lesson.
Let us know if you have any questions.
Scott ๐
Replying to adele smart 01/05/2024 - 18:15
Adele!
What a joy to have you here! Please let me know if you have any questions!
Scott x
Replying to Felipe M. 01/05/2024 - 17:52
Welcome Felipe!
Thank you so much for being part of our team!
Scott ๐
Replying to Talia C. 30/04/2024 - 12:26
I was actually speaking to some of the RC reps in the clinic the other week and they informed me that these liquid preparations are great for going down feeding tubes but are not able to be offered orally. They are not palatable!
https://www.royalcanin.com/rs/dogs/products/vet-products/renal-liquid-dog
Scott ๐
Replying to Mรณnica P. 22/04/2024 - 14:58
Hello!
Thank you for sharing all of this information.
It sounds like Sofia’s case has been quite challenging, but you’ve been thorough in your approach to her care. Given the complexity of her presentation and the fluctuations in her thyroid hormone levels despite treatment, it may be beneficial to consider a few additional steps:
Confirm Medication Compliance: Ensure that the owner is administering the medication as prescribed, ideally without food, as food can interfere with levothyroxine absorption. It might also be helpful to ask about any changes in the medication brand or formulation.
Review Diagnosis: Revisit the initial diagnosis of hypothyroidism. Given Sofia’s breed and the presence of other conditions, such as severe skin infection and ovarian cyst/tumour, it’s possible that these factors are affecting her thyroid function tests. It may be worth consulting with an internal medicine specialist for a second opinion.
Further Testing: Considering Sofia’s weight gain and persistent otitis and facial dermatitis, additional tests such as a complete blood count (CBC) and a more comprehensive blood chemistry panel could provide valuable insights into her overall health and potential underlying conditions contributing to her symptoms.
Discuss Histopathology: While the owner chose not to pursue histopathology on the ovarian mass, it may be worth discussing the benefits of obtaining a definitive diagnosis, especially if there are concerns about the mass potentially affecting Sofia’s health or hormone levels.
Lab Results Clarification: Follow up with the lab to confirm the type of TSH (cTSH) and the method used for fT4 measurement (ED). This will help ensure the accuracy of the thyroid function tests.
Long-Term Management: Consider a long-term management plan for Sofia’s hypothyroidism, which may include regular monitoring of thyroid hormone levels, adjusting medication dosage as needed, and addressing any concurrent conditions that may be influencing her health.
If Sofia is doing well now, I would consider weaning her off all thyroid medication and monitoring her clinical signs closely. If clinical signs of hypothyroidism persist, then testing could be undertaken again. It’s worth noting that thyroid hormones can have a general effect on metabolism, so even if a patient is not hypothyroid, thyroid supplementation can lead to an improvement in mood and overall well-being. Owners often report a lift in mood and energy levels in their pets after starting thyroid supplementation, highlighting the broad impact of thyroid hormones on the body, including effects on energy levels, appetite, and skin and coat condition.
In Sofia’s case, total T4 is generally fine for monitoring, but free T4 might be helpful in future assessments about the possibility of hypothyroidism, especially if there are concerns about the accuracy of the total T4 measurements. However, TSH and free T4 would not be used for monitoring.
If you are experiencing any issues uploading images, please feel free to email them to me at scott@vtx-cpd.com. I’ll be happy to assist you further.
Hope that helps.
Scott ๐
Replying to Nikki McLeod 24/04/2024 - 10:07
HAHAHAHAHAHAHA!
Scott ๐
Replying to Talia C. 23/04/2024 - 09:53
Hi Talia,
We are on the same page!
Thank you for sharing your experience with OFT tubes. It’s great to hear that you find them effective for managing patients, especially for administering medications. It’s interesting to hear about the use of NFT tubes in Sweden and the differences in tolerance and potential issues compared to OFT tubes.
Your preference for OFT tubes seems well-founded, especially considering the ease of administration of medications and the lower likelihood of blockage compared to NFT tubes. I was speaking to the Royal Canin reps. this week about their liquid diets for feeding tubes. Have you used them?
Best regards,
Scott ๐
Replying to Talia C. 23/04/2024 - 09:41
Hi Talia,
10 โ 30 ฮผg/kg (0.01 โ 0.03 mg/kg) standard buprenorphine IM, IV, or buccal/OTM every 4 to 8 hours. Dosages at the high end of the dosing range may be required for more severe pain. NOTE: If using buccal/OTM, suggest using upper end of dosing range or higher (up to 0.05 mg/kg). Use of high-concentration buprenorphine (Simbadolยฎ) 0.12 โ 0.24 mg/kg buccal/OTM provided analgesia under experimental conditions with a duration of 8 to 12 hours (not 24 hours as provided by SC administration).
I would go high end when giving orally. What formulation are you using?
Regarding the case of cortisone and chronic pancreatitis in your 13-year-old DSH, it’s a complex situation. Given the chronic nature of the pancreatitis and the presence of steatitis and dilatation of the pancreatic duct on ultrasound, chronic pancreatitis is a strong possibility. The intermittent vomiting and reluctance to eat can be consistent with this diagnosis. The bloods certainly are!
I would always be worried about the GI tract and liver in these cases. What are the liver parameters doing? Is there an option for cholecystocentesis, cobalamin, folate and TLI bloods? Would hydrolysed be a diet consideration option?
Considering the response to maropitant and the presence of abdominal discomfort, it may be beneficial to consider adding prednisolone to the treatment plan. Prednisolone can help reduce inflammation in the pancreas and may improve clinical signs. However, as you mentioned, the potential for weight gain and development of diabetes mellitus should be considered. It might also help if there is GI disease. I think it sounds like the next step to me.
Regarding the difficulty with tabletting, you could consider using a compounding pharmacy to prepare a liquid formulation of prednisolone, which may be easier to administer.
Ondansetron might be another helpful option.
It’s also important to continue monitoring the cat’s weight, appetite, and overall condition closely, and to address any new or worsening clinical signs promptly. Regular rechecks and monitoring of bloodwork, including renal function, are important in managing this case. What is the USG in this case?
Best regards and thanks for sharing such an interesting case!
Scott ๐
Replying to Talia C. 23/04/2024 - 09:41
Hey!
Really interesting case. Would you be able to share the fully bloods for this case?
What are the liver parameters doing?
Scott ๐
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