scott@vtx-cpd.com

Forum Replies Created

Viewing 15 posts - 721 through 735 (of 1,929 total)

← 1 2 3 … 48 49 50 … 127 128 129 →

Author

Posts
scott@vtx-cpd.com
Keymaster

08:10 28/07/23

Replying to Talia C. 25/07/2023 - 11:25

I know these are just small case series, but still important to keep these possible complications in mind!

It would never cross my mind that the colon might perforate in this way!

Scott 🙂

scott@vtx-cpd.com
Keymaster

08:07 28/07/23

Replying to Talia C. 25/07/2023 - 11:20

Talia.

These are really good points. I agree, you want to give yourself the best chance of getting the best sample. I would say that for this reason it is probably best to go for a long bone (humerus) when you can. The sternum is good for a quick sample, which might be helpful for things like leishmaniasis and some neoplastic problems. I did a bone marrow yesterday and only managed to get an aspirate, I totally failed getting a core sample. I still sent the sample off and you can often still get good information from the core.

Hopefully you will get a case soon that you can take a sample from!

Scott 🙂

scott@vtx-cpd.com
Keymaster

08:03 28/07/23

Replying to Nadia C. 26/07/2023 - 23:14

Will keep you posted!

Scott 🙂

scott@vtx-cpd.com
Keymaster

14:55 21/07/23

Just as a bit of a fun fact!

The enrofloxacin issue is not thought to be as much of a problem in lions and tigers!

Scott 🙂

INVESTIGATION OF ENROFLOXACIN-ASSOCIATED RETINAL TOXICITY IN NONDOMESTIC FELIDS

Kim M Newkirk, L Kathryn Beard, Xiaocun Sun, Edward C Ramsay

Abstract
Enrofloxacin is known to cause retinal toxicity in domestic cats. The hallmark lesion of enrofloxacin-associated retinal toxicity in domestic cats is thinning of the outer nuclear layer of the retina. Enrofloxacin is commonly used to treat bacterial infections in nondomestic felids because of its action against a wide spectrum of bacteria and the ability for it to be given orally. No previous studies have investigated the potential retinal toxicity of enrofloxacin in nondomestic felids. This retrospective study evaluated 81 eyes from 14 lions ( Panthera leo ) and 33 tigers ( Panthera tigris ) that had been enucleated or collected postmortem. The thickness of the outer nuclear retina was assessed in two separate sites in each eye by counting the rows of nuclei and by using digital image analysis software to determine the area of the nuclei at each site. Medical records were reviewed to determine the enrofloxacin dose for each cat. Cats that had not received enrofloxacin (n = 11) were compared with treated animals (n = 36). The outer nuclear layer thickness or area in treated versus untreated cats was not significantly different. Additionally, no clinical blindness was reported in any of the cats. This study showed no evidence of enrofloxacin-associated thinning of the outer nuclear layer in the lions and tigers evaluated, suggesting that enrofloxacin can be used safely in these animals.

scott@vtx-cpd.com
Keymaster

14:53 21/07/23

Just as a bit of a fun fact!

The enrofloxacin issue is not thought to be as much of a problem in lions and tigers!

Scott 🙂

INVESTIGATION OF ENROFLOXACIN-ASSOCIATED RETINAL TOXICITY IN NONDOMESTIC FELIDS

Kim M Newkirk, L Kathryn Beard, Xiaocun Sun, Edward C Ramsay

Abstract
Enrofloxacin is known to cause retinal toxicity in domestic cats. The hallmark lesion of enrofloxacin-associated retinal toxicity in domestic cats is thinning of the outer nuclear layer of the retina. Enrofloxacin is commonly used to treat bacterial infections in nondomestic felids because of its action against a wide spectrum of bacteria and the ability for it to be given orally. No previous studies have investigated the potential retinal toxicity of enrofloxacin in nondomestic felids. This retrospective study evaluated 81 eyes from 14 lions ( Panthera leo ) and 33 tigers ( Panthera tigris ) that had been enucleated or collected postmortem. The thickness of the outer nuclear retina was assessed in two separate sites in each eye by counting the rows of nuclei and by using digital image analysis software to determine the area of the nuclei at each site. Medical records were reviewed to determine the enrofloxacin dose for each cat. Cats that had not received enrofloxacin (n = 11) were compared with treated animals (n = 36). The outer nuclear layer thickness or area in treated versus untreated cats was not significantly different. Additionally, no clinical blindness was reported in any of the cats. This study showed no evidence of enrofloxacin-associated thinning of the outer nuclear layer in the lions and tigers evaluated, suggesting that enrofloxacin can be used safely in these animals.

scott@vtx-cpd.com
Keymaster

13:01 21/07/23

Replying to Nadia C. 16/07/2023 - 21:17

It does sound great.

I really like that veterinary medicine is moving in this way. I think we need to be flexible in the way we create roles for vet. If they want to do consult only, we should be OK with that!

Sound like the perfect role for you.

Scott 🙂

scott@vtx-cpd.com
Keymaster

12:35 21/07/23

Replying to Nadia C. 16/07/2023 - 21:13

Hello!

Great question. You are correct! A high RDW indicates that the red blood cells are more variable in volume than normal. This may be due to the presence of smaller or larger red blood cells or a combination of either scenario. For example, increased numbers of immature red blood cells during a regenerative response to an anaemia will increase the RDW, because immature anucleated red blood cells are typically larger than normal.

You could also use the MCV and MCHC for this purpose.

Really interesting that you use methylene blue stain, not many people do this. That is very cool!

Scott 🙂

scott@vtx-cpd.com
Keymaster

10:11 21/07/23

Replying to Nadia C. 20/07/2023 - 20:05

Hello.

I am glad the recording was helpful.

Yes, there did seem to be a protective benefit of L4 over L2, so generally L4 would be recommended for that reason:

“In conclusion, being vaccinated with L4 was strongly associated with decreased odds to be diagnosed with leptospirosis compared to unvaccinated dogs, suggesting a protective effect against the disease. This finding is in contrast to the lack of association observed for L2-vaccinated dogs. Considering the level of evidence available at this time, results of our study support use of quadrivalent antileptospiral vaccines as core vaccines for dogs living in areas with a high incidence of leptospirosis caused by the included serogroups”.

Interesting question regarding the FISH. Yes, it can be run on samples in formalin. Most of the time FISH would be requested after the histopathology had been assessed, so normally it would be a test that is added later.

Hope that helps.

Scott 🙂

scott@vtx-cpd.com
Keymaster

09:54 21/07/23

Replying to Nadia C. 20/07/2023 - 20:33

Hello Nadia.

I agree, it is much better to do it with someone/watch someone for your first one.

I was lucky with BM biopsies during my residency and got lots of support. We are actually currently discussing doing some practical days next year and this might be something we could try and do in person. Watch this space!

Scott 🙂

scott@vtx-cpd.com
Keymaster

09:43 21/07/23

Replying to Nadia C. 20/07/2023 - 21:06

Hello Nadia.

Thank you so much for these brilliant comments. I love the case summary. This is exactly what we should be doing with these challenging cases, always go back to the initial problem list!

I think the red blood cell fragmentation changes are the really interesting part of this case. There are smaller number of spherocytes and ghost cells which would be consistent with IMHA. However, the other fragmentation changes are more prevalent and would not be consistent with IMHA. There are some boxes being ticked here for IMHA, but it would not be a confident diagnosis of IMHA in my opinion.

I think faecal occult blood testing would be a very reasonable test to run. Low albumin and globulin would be consistent with bleeding, but we do not see this in every case. The lack of low albumin and globulin does not rule out GI bleeding. Faecal occult blood testing was negative.

The 4DX would also be a good idea. None of the infectious disease organism that would be detected on this test would cause direct haemolysis, but could be part of a secondary IMHA type situation.

We did carry out chest radiography, which was unremarkable.

I agree, the PK deficiency is really unlikely.

SO… I think we have 2 main questions:

1. The splenic FNA’s are ‘normal’. Does this give you enough confidence to move on from the spleen?
2. Would you be confident enough based on the information you have to treat for IMHA?

Thank you again for all of your brilliant thoughts.

Scott 🙂

scott@vtx-cpd.com
Keymaster

09:21 21/07/23

Replying to Siriol B. 20/07/2023 - 22:05

Hey Siriol.

Lovely to hear from you!!! I am so glad you have enjoyed the course.

This is an interesting case. To my knowledge, most of the congenital cases have undetectably low levels of cobalamin:

https://pubmed.ncbi.nlm.nih.gov/23535754/

However, I would absolutely supplement cobalamin in this case. Honestly, the folate is probably less significant, but also worth supplementing in this case.

Would you be able to attach/send me the full blood results? You can attach here or email them to me scott@vtx-cpd.com.

Has the dog had any imaging? Thanks again for sharing this interesting case!

Scott 🙂

scott@vtx-cpd.com
Keymaster

17:33 20/07/23

Replying to Nadia C. 16/07/2023 - 21:18

I think so!

FeLV is a really interesting topic… I find it super confusing too! I always have to review the diagnostic options and what they mean.

If you end up watching the webinar, let me know what you think!

Scott 🙂

scott@vtx-cpd.com
Keymaster

17:23 20/07/23

Replying to Rosie Marshall 16/07/2023 - 21:32

Hey Rosie.

Thank you again for your brilliant questions. I do not think we have definitive guidelines regarding when to use CRP to stop antibiotics in pneumonia cases. I am happy stopping when the CRP is normal, but I would be understanding that other may err on the side of caution and continue a little longer.

HAHA, I agree regarding your comment regarding SRMA… a few year ago, that was the only condition I used CRP to monitor!

The use of CRP for ‘wellness’ is a really interesting discussion. They definitely use CRP in a much more sophisticated way in human medicine. They use it much more for decision making and also for antibiotic decision making. We have less evidence:

https://pubmed.ncbi.nlm.nih.gov/36713872/
https://pubmed.ncbi.nlm.nih.gov/32434519/

I hope that helps.

Scott 🙂

scott@vtx-cpd.com
Keymaster

16:48 20/07/23

Hello Talia.

Thank you so much for the brilliant questions.

1. Great question. I agree, any patient presenting with azotaemia and anaemia could be a possible hypoadrenocorticism. I think the electrolytes are less suggestive in this case. A basal cortisol would have been a reasonable screening tool. I would have been less inclined to think about cobalamin. Cobalamin can cause haematological issues, but normally these are the patients with congenital cobalamin problems. The link between anaemia and low cobalamin in dogs and cats is actually not strong, it is much stronger in human medicine:

https://pubmed.ncbi.nlm.nih.gov/30499147/

2. Your approach to darbepoietin sounds good to me. The exact starting point is not definitively determined. I would consider it with a PCV of 25% and under. It also depends a little on the patient. If I strongly think the anaemia is contributing to the clinical signs, I will intervene sooner. I will indeed give iron injections in these cases without measuring iron status if I am giving regular darbopoietin cases.

3. Great question. In renal disease patients there is evidence to support reducing the proteinuria as it will improve survival. I agree, we have to be careful with these drugs and if you are seeing more than a 30% increase in your creatinine level then I would be reducing the dose of drug. There is quite a bit of evidence to support the use of telmisartan now and many people are using that first line. I would still use these drugs in renal patient with proteinuria, but I would continue with your understandable caution.

Thanks again. I hope that helps.

Scott 🙂

scott@vtx-cpd.com
Keymaster

16:11 20/07/23

Replying to Talia C. 18/07/2023 - 15:46

Hello Talia!

Thank you so much for your reply. Really appreciate it, I know how busy life in practice must be!

I completely agree that blood smear is the next steps here. I have shared the blood smear images on the thread and would love to hear your thoughts.

The occult blood is a good shout. I would probably make the decision about whether to run this test based on whether my investigations revealed any other cause for bleeding. It is very uncommon for B12 deficiency to cause problems with anaemia in dogs and cats. This is much more common in humans, but still not wrong to measure B12.

Completely understand your comment regarding the Na:K ratio and lack of stress leukogram. Based on the lymphopenia, hypoadrenocorticism is very unlikely.

Ultrasound is a really important step and there was a mass in the spleen!

Thank you so much for your brilliant contribution. I have popped more information about the case in the tread.

Looking forward to hearing your thoughts.

Scott 🙂
Author

Posts

Viewing 15 posts - 721 through 735 (of 1,929 total)

← 1 2 3 … 48 49 50 … 127 128 129 →

scott@vtx-cpd.com

Forum Replies Created

edit profile