scott@vtx-cpd.com

Replying to Felipe M. 08/03/2025 - 11:48

Hey Felipe!

Really interesting that you mention tramadol and oral buprenorphine!

Thanks again for sharing.

Scott 🙂

Thank you again for another brilliant video!

Scott 🙂

Replying to Bethany Deadman 02/03/2025 - 17:17

Hi Bethany,

Thanks for your message. I completely agree that at-home analgesia for patients with liver disease can be a real challenge, especially when options like opioids aren’t feasible outside of a hospital setting.

Gabapentin could be an option in this case, particularly as part of a multimodal approach. Given its primary renal excretion and minimal hepatic metabolism, it is generally a safer choice in liver-compromised patients compared to NSAIDs or paracetamol. That being said, I’d be really interested to hear Felipe’s thoughts on its role in visceral pain.

Regarding NSAIDs, I would be quite hesitant in a dog with a liver mass, particularly if synthetic function is compromised or there is concurrent portal hypertension, coagulopathy, or gastrointestinal fragility. NSAID-induced hepatopathy is rare but can occur idiosyncratically, and as you mentioned, the risk of GI ulceration is always a concern.

It’s great to hear that you have had good success with IV paracetamol in-hospital, particularly in pancreatitis, post-op GI cases, and painful autoimmune conditions like IMPA. It does seem to be underutilized in some settings, despite its potential benefits in those scenarios.

Let me know your thoughts, and I’d love to hear Felipe’s perspective as well.

Best,

Scott 🙂

Replying to Georgia 03/03/2025 - 10:14

This is so interesting!

There is so much to consider. I would never have considered looking at all of these elements of a diet and company.

So helpful!

Scott 🙂

Replying to Rachel L. 01/03/2025 - 16:12

Thanks Rachel,

I hope you have enjoyed the ophthalmology course too. Your approach to nutritional management in diabetic pets is really interesting, and I completely agree that diet plays a major role in both stabilizing and achieving remission, particularly in cats.

Your experiences with Katkin and prescription diabetic diets align with a lot of the research on macronutrient management in diabetic patients. While high-protein, low-carb diets have been shown to increase remission rates in cats, the broader literature also emphasizes that each diabetic patient should be managed individually, taking into account body condition, comorbidities, and feeding preferences. The work by Parker and Hill (2023) highlights this well, noting that while diet modification can help glycaemic control, many animals don’t necessarily require a diet change, especially if they’re already on a complete and balanced diet with controlled feeding schedules. However, in cases like your Sheba-fed cat, where remission was achieved but later lost, it raises the question of how much dietary composition shifts over time and whether that might impact long-term glucose control.

I also appreciate your approach to diabetic dogs. While the literature suggests that prescription diabetic diets don’t always provide a clear advantage over a balanced adult maintenance diet, your success in stabilizing patients quickly supports the idea that a higher-fibre approach can improve glycaemic control. The study emphasizes that fibre can help regulate postprandial glucose spikes, though it also notes that calorie intake and body condition score are just as critical. Your shift towards immediate prescription diet use rather than modifying the existing diet over time makes a lot of sense, especially from a cost-effectiveness and clinical stability perspective.

Another key takeaway from the research is that meal timing relative to insulin administration is less rigid than traditionally thought. While twice-daily meal feeding is often recommended with intermediate-acting insulins, newer approaches with basal insulins may not require such strict meal-insulin pairing. Given that some of your cats have responded to diet alone, it also reinforces that metabolic control isn’t solely about insulin, it’s about the broader picture of energy intake, weight management, and overall consistency.

It sounds like your recent cases have gone exceptionally well, whether that’s luck or refined management strategies, it’s fantastic to see such positive outcomes. Thanks for sharing your insights, really enjoyed hearing about your experiences! Would love to hear if you’ve noticed any trends in long-term dietary adherence among owners, do they stick with the recommendations or do they revert to old habits over time?

Thanks again!

Scott 🙂