scott@vtx-cpd.com

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 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 Neus E. 05/04/2024 - 14:24

This is soooooooooooooo interesting!

Thank you so much 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 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

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 🙂

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 🙂