scott@vtx-cpd.com
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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 🙂
Replying to Junwei Föhr 04/03/2024 - 21:36
Here is the full radiography report:
Skeleton:
There are no skeletal abnormalitiesThorax:
There is a an alveolar pattern with air bronchograms affecting predominently the right middle lung lobe. The other lung lobes are unremarkable.
The cardiac silhouette is within normal limits. There are no abnormalities in the cranial mediastinum, the oesophagus is mildly dilated with air on the left lateral view. The diaphragmatic line is clear on the right lateral view but obscured on the left lateral view.Abdomen:
There is moderate ingesta and a small structure of bone opacity in the stomach. There is mild gas in the colon as expected. The remaining abdominal organs are unremarkableDDx aspiration pneumonia, bronchopneumonia, haemorrhage, less likely oedema, torsion or neoplastic infiltrate
Replying to Neus E. 05/03/2024 - 11:54
Thanks for sharing Neus.
I think you raise a good point… determining whether there is GI bleeding/ulceration is not always easy.
Unless there is obvious melena or haematemesis in these cases, it can be tricky!
Scott 🙂
Replying to scott@vtx-cpd.com 15/03/2024 - 09:23
Here are couple of papers looking that the ‘atypical’ hypoadrenocorticism cases we were discussing:
https://pubmed.ncbi.nlm.nih.gov/17501661/
https://pubmed.ncbi.nlm.nih.gov/8960190/Some of them progress and others seem not to!
Scott 🙂
Replying to Talia C. 05/03/2024 - 15:49
Hello Talia.
I am really pleased you enjoyed the lesson. The link between megaoesophagus and hypothyroidism is not a strong one. There are a few older papers and case reports:
https://pubmed.ncbi.nlm.nih.gov/21498218/
There is one recent survey paper that 8.8% of megaoesophagus cases had hypothyroidism. I will need to look at this paper in more detail as that seems like a lot! In many of these studies I would go back to the diagnosis of hypothyroidism as that is commonly misdiagnosed.
The hypoadrenocorticism link is also rare and based on case reports:
https://pubmed.ncbi.nlm.nih.gov/7783439/
Although hypothyroidism and hypoadrenocorticism are less likely, I would still consider screening for them in older dogs with megaoesophagus.
Hope that helps.
Scott 🙂
Replying to Lesley T. 10/03/2024 - 15:54
Lesley!
So great to see you here! I am somewhat humbled by your impressive experience. I am sure you will have a lot to share with us.
Happy to help with your own cat or any other challenging cases you might have!
Scott 🙂
This is a great discussion topic!
I love a bit of gastrointestinal motility support!
I am looking forward to hearing people’s thoughts! I might have a few opinions of my own!
Scott 🙂
Replying to Talia C. 12/03/2024 - 08:25
We have a great webinar on anti-thrombotics that is worth checking out too!
Scott 🙂
Replying to Talia C. 12/03/2024 - 08:25
Hello Talia.
Thank you for the brilliant questions. I hope you are enjoying the course.
Regarding the alpha-1-antitrypsin. There are a few papers looking at the use of it in dogs. Most of them are quite old, but I found this more recent one:
https://pubmed.ncbi.nlm.nih.gov/26631946/
Honestly, I am just not sure how useful it is in a practical clinical setting. I have never been in a situation where I thought it would be useful. I am not sure that it would change what I did treatment wise? I would be interested to hear other peoples thoughts. Maybe I am not using it right!
I would consider clopidogrel in cases of protein losing enteropathy, particularly the more severe cases.
This is a great question regarding ‘atypical hypoadrenocorticism’. The thinking is that these patients have preferential destruction of the adrenal gland and this will progress with time. I would be doing exactly what you are doing and monitor these cases carefully for progression to mineralocorticoid deficiency. The timescale is poorly determined, so difficult to predict.
Really interesting regarding the helicobacter! Could the strange smell have been digested blood? Would you be able to share the histopathology results from this case? The way they report the helicobacter can sometimes help decide whether to treat or not.
Thanks again for the great questions.
Scott 🙂
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