scott@vtx-cpd.com
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Replying to Becky Cartwright 11/04/2024 - 19:44
Becky!
It is so wonderful to see you here! Thank you for joining the course.
Please let us know if you have any questions.
Scott 🙂
Replying to Talia C. 04/04/2024 - 08:38
Hello Talia!
Canada is great! We only moved here in February, so I still feel like I am on holiday!
1. I agree that the faecal transplantation is harder to justify when there is no diarrhoea. There can still be quite significant small intestinal disease and a lack of diarrhoea if the colon maintains a resorptive capacity. There could still be significant dysbiosis, so there may still be justification for the faecal transplant. This might be a case that you could consider performing a faecal dysbiosis index in? If lymphangiectasia is the main concern, prednisolone and a low-fat diet will also be really appropriate.
2. The zoonotic element of the Salmonella is really interesting. I will often be quite quick to point them in the direction of their doctor for advice. I often get calls asking for advice on the zoonotic implications, but I tend to be quite generic in my advice!
3. Thank you for sharing the link to these guidelines. These are really helpful. I will have a look through the rest of them.
Thank you again for your brilliant questions.
Scott 🙂
Replying to Lesley T. 04/04/2024 - 13:42
Hello Lesley.
It is really lovely to hear from you. I am really glad to hear you are enjoying the course!
Really interesting to consider the age of these patients. This recent study is helpful to have a look at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7096654/
The following is a snippet from the results section of the paper:
“Signalment, laboratory findings, ultrasonographic findings, and endoscopic scores were compared between the FR‐PLE and IR/NR‐PLE groups (Table (Table1).1). The FR‐PLE group was significantly younger (mean age, 7.5 versus 10.4 years old; P < .001) and had lower CIBDAI scores (median score, 3 versus 10; P < .001) and CCECAI scores (median score, 5 versus 11; P < .001) than those found in the IR/NR‐PLE group." In short, the food responsive dogs do seem to be a bit younger. Regardless of age, I would still consider a diet trial if it were suitable for the case. Remember, if they have not responded to a diet in a couple of weeks, it is probably not going to be effective. If possible (particularly in younger dogs), I would always try another diet trial, and even a third! It is also important to remember that hydrolyzed is not the only option. I would consider novel protein and carbohydrate as well as low fat in some cases. May of the diet responsive dogs will also respond to steroids; I suppose the diet avoids all the steroid side effects if it is effective. I hope that answers that question, I feel I rambled a bit. I think it is fine to reach for steroids sooner in some cases, I certainly do! Owner compliance with diet is often an issue. I would still try all of the 'easy' low risk strategies if possible. I would try diet, worming and probiotics where possible. There is also an argument with intervening with a faecal transplant earlier. I would persist with diet, if possible, even if older animals, when they are clinically well. We chatted through a lot of this at the round table discussion too. I will make sure that recording is available. I hope that was helpful. Scott 🙂
Replying to Mahmoud M. 08/04/2024 - 14:39
Hello Mahmoud.
Sound like a really tricky case. I will make sure Neus and Kerry see this.
I look forward to hearing their thoughts.
Thanks again.
Scott 🙂
Replying to Felipe M. 04/04/2024 - 15:24
Thanks so much for this.
Regarding noradrenaline, you said:
“Very predictable in its effects, however bear in mind that increasing BP by mostly vasoconstriction gives a lovely MAP with poor peripheral perfusion, and that’s why I do not use it as first instance.”
Can I check specifically what cases you would avoid in. I thought this was your go to in most cases, so I am getting myself confused.
Hope all is well.
Scott 🙂
Replying to Felipe M. 04/04/2024 - 15:38
Thanks for sharing all of this brilliant information.
Scott 🙂
Replying to Kristin Herstad 04/04/2024 - 18:06
Well spotted!
Interesting. I would think that they are suggesting that a persistent USG below 1.010 would warrant investigating for possible PUPD. Many animals with PUPD will have a higher USG than that for sure.
I will reach out to one of the authors and see if we can get more clarification. Will keep you posted.
Scott 🙂
Replying to Helen S. 04/04/2024 - 18:55
HAHAHAHAHAH!
Being human indeed. I wonder if being human would actually have been easier if we did not have all the technology we had today!
We could at least get rid of social media, right!?
Scott 🙂
Replying to Neus E. 05/04/2024 - 14:24
This is soooooooooooooo interesting!
Thank you so much for sharing.
Scott 🙂
Replying to Neus E. 05/04/2024 - 14:26
Hey Neus.
I think we often forget that we can continue to use these drugs in hospitalised patients. The dose reduction tip is also really helpful:
https://pubmed.ncbi.nlm.nih.gov/35195476/
Thanks again for sharing.
Scott 🙂
Replying to Sarah Clements 05/04/2024 - 17:36
This is really interesting Sarah!
I a, glad you are leading the fight in this area!
I could not find anything specific regarding digital palpation and examination, but it will definitely feel different in some cases. I will keep looking.
Scott 🙂
Replying to Josep B. 06/04/2024 - 04:36
Thanks Josep.
This is so helpful. Thank you so much for sharing.
I did not mean to pit you against the anaesthetist! 🙂
Scott
Replying to Mónica P. 06/04/2024 - 08:00
No problem Monica.
Thank you for sharing this. I think you make a really interesting point regarding the size of your practice. Often it is just physically impossible to have cats away from dogs.
I know a nurse that sprays small cotton wool balls in the morning with pheromone spray and then gives them to clients to pop in the cat carriers.
Thanks again.
Scott
Replying to Sarah Clements 03/04/2024 - 19:21
I only answered half of your questions! Sorry!
2. I would recommend a GI diet in raw fed dogs. But you ask a good question! I am not 100% sure if that is the right thing or not. The GI diets are easily digestible and balanced for that sort of situation, so I still think they are appropriate. I might have to double check with a nutrition colleague.
3. You can absolutely do FMT in cats. I think we underuse it! We talked a little about it at the GI roundtable discussion. There are not that many studies, but it is a yes from me:
https://pubmed.ncbi.nlm.nih.gov/37756083/
Hope that helps.
Scott 🙂
Replying to Sarah Clements 03/04/2024 - 19:21
Sarah,
Great to hear from you. I am glad you are enjoying the course. Great questions.
1. I would absolutely focus on the giardia in these cases. I can’t think of a case where the isospora has been significant. Isospora oocysts are found on direct examination of a fecal smear or by flotation. The infection often is self-limiting, but sulfadimethoxine or trimethoprim-sulfa can be used when clinical signs warrant treatment. Coccidiostats, such as toltrazuril and diclazuril, when available, are preferred. The prognosis for recovery is good. You make a really good comment regarding the concurrent enteropathy with these cases, that also has to be supported (diet, probiotics).
Scott 🙂
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