scott@vtx-cpd.com
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Replying to Yvonne McGrotty 03/04/2024 - 21:36
Yvonne!
What a joy to have you join us! Thank you so much for being a part of the course.
What you don’t know about ACTH stimulation tests is not worth knowing!
Thanks again pal.
Scott 🙂
Replying to Aaron H. 04/04/2024 - 06:29
This is really interesting Aaron.
Are you more likely to use a histamine type 2 receptor blocker like famotidine, or are you happy using omeprazole (PPI) as they are going to be more effective for ulcer treatment?
Thanks again!
Scott 🙂
Replying to Steph Sorrell 02/04/2024 - 16:07
This is so helpful Steph!
Thank you for sharing! I hope you had a wonderful holiday.
Scott 🙂
Replying to Talia C. 02/04/2024 - 11:56
Hello Talia.
Thank you for sharing such an interesting case. I have shared a few thoughts:
I am glad we share the Vivomixx love! I have just moved to Canada and am having to change what I am using again. It seems availability and cost does depend on where you are in the world. That is a really interesting point that you raise regarding Fortiflora. I feel like I have looked in to the chicken flavour before and whether it is OK when undergoing a hydrolysed diet trial. I must try and find out the answer to that!
1. Regarding the dog with chronic enteropathy. I agree with your approach. The question of diet is really tricky in this case. It is always a balancing act. If the dermatologist is really keen to change the diet, then I would go with that. If the dog is relapsing and ultrasound changes are persistent then surgical or endoscopic biopsies would be indicated. You could consider increasing the prednisolone dose? I would give this dog Vivomixx. I think this dog would be an excellent candidate for a faecal transplant!
2. Regarding the salmonella cases. Are you testing for the salmonella in the faeces? If these cats are sick then I would definitely treat them. I would be more reluctant to repeatedly culture faeces for salmonella after treatment. The salmonella can persist and I would not be treating to achieve negative culture in faeces. I would be treating to achieve clinical improvement. If salmonella is isolated from faeces and the patient is not systemically unwell, I would not treat, despite it being a zoonosis.
3. I agree that giardia can be really tricky. Again, I would be treating to achieve clinical resolution of clinical signs/diarrhoea and not always re-testing. In cases that have persistent clinical signs and positive results with faecal analysis (not antigen positive) then I would focus on owner hygiene. I would be getting owners to clean perineum after passage of faeces etc. I would be considering other interventions for enteropathy too. I would try hydrolysed diet and Vivomixx.
I hope that helps.
Scott 🙂
This is an excellent topic!
A few things that have come up on different forums in the last couple of weeks:
1. Recovering these patients with owners to reduce stress.
2. Don you always give omeprazole?
3. When do you give maropitant. Is it given with the premed or should it be given before?I look forward to hearing your thoughts.
Scott 🙂
This is a brilliant question and decision making that I ALWAYS find confusing!
I look forward to hearing your thoughts.
Generally, I have seen a trend toward norepinephrine in the last 5 years.
Scott 🙂
Replying to Felipe M. 02/04/2024 - 10:57
This is an excellent review of what our options are.
Thank you for sharing.
Scott 🙂
Hey.
So it would seem like they are pretty equivalent. What do you tend to use in practice? Is one easier to dose than the other? Is one more available?
Scott 🙂
Replying to Hayley O. 02/04/2024 - 21:39
Hello Hayley!
It is great to have you join us for another course. Thank you so much for your support.
Endocrine cases are definitely some of the most challenging. Please let me know if there are any specific cases you would like to discuss.
I really hope you enjoy the course.
Scott 🙂
Thank you so much to everyone for your understanding with this!
Scott 🙂
Replying to Kristin Herstad 30/03/2024 - 19:23
Hey Kristen.
I hope you are well. Thank you for your comments. I think I might be losing my mind. I am not able to find the part in the document where they mention this USG cut-off, can you remind me where it is. I am so sorry!
Generally speaking, urine specific gravity values in apparently healthy small animals vary markedly, ranging from 1.006 to 1.050 in dogs and 1.005 to 1.090 in cats. In general, urine specific gravity is higher in healthy cats compared to dogs (mean 1.050 in cats versus 1.033 in dogs). In dogs, the specific gravity of morning samples is typically higher than evening samples. I often recommend that an owner collect multiple urine samples at home over several days to determine the ranges of urine specific gravity. In most cases, maintenance of a urine specific gravity greater than 1.030 in dogs and greater than 1.035 in cats is not supportive of polyuria unless due to marked glycosuria, or intermittent polyuria (primary polydipsia or disorders of the regulation of AVP secretion).
I agree with your comments regarding the combination of PUPD and incontinence. I think that often the PUPD will tip the incontinence over the edge. I think it is valuable to investigate and treat both problems.
Scott 🙂
Replying to Felipe M. 02/04/2024 - 13:29
Really interesting Felipe.
I was really interested regarding your mention of robenacoxib. This is a drug I do not often consider, but should probably think of it more.
Thank you again.
Scott 🙂
Replying to Natalie Niven 28/03/2024 - 22:09
Hey Natalie.
Some interesting comments. I have zero experience of using Librela. Osteoarthritis is often the least of my patients worries when they come to see me! 🙂
It did get me thinking. Do they market the drug for anything else? Anything to your knowledge that would indicate it would be useful for pain in other clinical situations.
Paracetamol is really a godsend. I like it as we can use it with steroids. Which covers most of my patients!
Scott 🙂
Replying to Natalie Niven 28/03/2024 - 21:58
Natalie!
Great to hear from you. Thank you for sharing your thoughts. Your plan sounds great. I have shared a bit more about the PE above that might help. I would agree with your problem list:
Coughing
Anisocoria
Muffled heart sounds
Pale pink mm
Weight loss
Partial anorexia
DehydrationAs with all DDX lists, they can end up being quite extensive and unnecessary! I think you have mentioned many of the most important differentials:
Affected pupil smaller (miosis)
a. Anterior uveitis
b. Corneal ulceration/trauma
c. Other intraocular disease
d. Synechiae
e. Horner syndromeAffected pupil larger (mydriasis)
a. Glaucoma
b. Pharmacologically induced
c. Afferent lesion with anterior segment inflammation
d. Retinal detachment/ degeneration
e. Chorioretinitis
f. Optic neuritis
g. Optic nerve atrophy
h. Retrobulbar lesion
i. Optic tract lesion
j. Retinal dysplasia (severe)
k. Optic nerve hypoplasia
l. Optic nerve coloboma
m. Iris atrophy
n. Oculomotor nerve (CN III) palsy
o. Iris hypoplasia
p. Iris coloboma
q. Posterior synechiaeI will share the results of some of the tests you have mentioned too!
Scott 🙂
Hello everyone.
I wanted to give a bit more information about the physical examination too:
Orthopaedic evaluation – No obvious orthopaedic abnormalities, however there was discomfort reported when the quadriceps muscles were palpated.
Femoral and peripheral pulses were palpable.Ocular Examination: Anisocoria was observed with the right pupil larger than the left. No direct PLR was present in the right eye; however a consensual response was present when light was shone in the left eye. Large wedges of grey/black discoloured areas of fundus extending out from the optic disc. Consistent with chorioretinitis.
Neurological examination: No gross neurological deficits observed. No spinal cord or neck pain.
Blood pressure: 145 mmHg systolic (Doppler).
Hope that helps!
Scott 🙂
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