scott@vtx-cpd.com
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Replying to Sarah Keir 16/10/2023 - 17:01
Hey Sarah.
Yes, maropitant does seem to have a number of mystical and undetermined properties.
The data seems to vary regarding visceral analgesic properties etc. I must admit I do use it in these very chronically congested cats with some positive effect. Could simply be the positive effect of flushing the nasal cavity!
I was thinking of setting up a panel discussion on the topic:
“Maropitant… magic or not?”
Other title suggestions on a postcard please?! 🙂
Scott
One more thing!
My perception of euthanasia rates in DM patients is different from what the literature says. My primary care colleagues in the USA report much higher euthanasia rates due to DM and owners not willing to treat (due to a variety of reasons).
Scott 🙂
Hello Sarah.
Thanks for sharing. It is a potentially interesting drug, but clearly not perfect regarding the spectrum of use and the side effect profile.
The published data on this drug is also limited:
https://pubmed.ncbi.nlm.nih.gov/29139146/
A lot of the ‘data’ that has been discussed is unpublished data from the drug company. I attended a round table discussion regarding this drug at ECVIM Congress recently. The opinion was mixed. Some people have some positive experience of using the drug. Others feel very strongly that there is not a place for it and the side effects are rather undesirable. I suppose the other side of the discussion is the owners perception of treatment and the euthanasia of some DM patients:
https://pubmed.ncbi.nlm.nih.gov/29139146/
The argument being that some patients would not be euthanised if there were alternatives to insulin injection. I am in no way suggesting that this is an alternative to insulin treatment, but may be another option in the tool kit for some patients.
As with most things endocrinology based, there is very rarely a right or wrong answer, just a lot of different (often very strong) opinions!
Would be interested to hear what others think.
Have a great weekend.
Scott 🙂
Replying to Rebecca P. 14/10/2023 - 22:28
Hey Rebecca.
Thank you so much for your comments. Lots of brilliant points. The paper I posted looks at gabapentin and trazodone in cats. To be perfectly honest, I do not really use trazodone in cats. I tend to use gabapentin in cats and trazodone in dogs:
https://pubmed.ncbi.nlm.nih.gov/35333743/
Would love to hear others experience though. I have never been in a situation where either drug has been requested when I have not physically seen the patient in the last 6 months. I am also not as up to speed as I probably should be with new guidance, so am probably not the best person to ask regarding that side of things. Again, I would love to pull on the knowledge of others in the group.
This article might also help as a general overview:
https://pubmed.ncbi.nlm.nih.gov/34475580/
Overall, I think these are both brilliant drugs and have massive benefit on patients. I have administered trazadone in a couple of dogs this week in hospital dogs that were stressed out and it worked a treat!
The prescription for fireworks is a good point. I have used trazadone for this purpose in my mum’s dogs, but not sure what the current thinking is regarding this.
Hope that helps a little.
Scott 🙂
Replying to Anna H. 10/10/2023 - 20:14
Hello Anna!
Welcome! Life does get in the way a bit! Remember you have a year to access the material, so hopefully that will help!
Let me know if you have any questions. Have a lovely weekend.
Scott 🙂
Thank you Liz!
Great course as always!
Scott x
Replying to Vicki Cooper 04/10/2023 - 11:46
Hello!
Hope you are well. These rounds are not recorded. We want to make sure people feel OK interacting on the call.
Really sorry!
Scott 🙂
Replying to Nadine S. 02/10/2023 - 20:59
Hello!
Yes, you are totally right!
This is my mistake. Really sorry.
I have edited the post.
Scott 🙂
Hey.
Interesting! I agree with Steph regarding our lack of understanding about the exact histopathology in most of these cases.
Are you finding this in a particular CKD stage?
Scott 🙂
Replying to Sybil Dryburgh 20/09/2023 - 21:13
If all else fails… steroids is hardly ever the wrong answer… right?!
Scott 🙂
Replying to Steph Sorrell 02/10/2023 - 13:00
I knew I was not going mad!
Thanks for sharing Steph.
Scott x
Replying to Loren S. 19/09/2023 - 20:53
Hello Loren.
I agree with your concern about the diaphragm. It was the concern of the referring vets too. I often end up doing CT in these cases if there is any question over what the radiographs are telling us. Once I got the radiography report back I felt confident skipping CT on this occasion. We did indeed carry out bronchoscopy and BAL next!
The bronchoscopy revealed lots of white/yellow mucus in the airways. We performed a BAL. The cytology was consistent with significant neutrophilic inflammation and no bacteria were seen. Culture was nagative.
Only problem was… the dog has some antibiotics prior to these investigations.
My dilemma… lots of things pointing towards an infection but negative culture and persistence of clinical signs despite 5 days of antibiotics.
Any thoughts on treatment options?
Scott 🙂
Replying to Idris Vandekinderen 17/09/2023 - 20:02
Hello Idris!
This is really rare in cats… hence my excitement! Most cats diagnosed with Cushing’s have concurrent DM. Depending on the study, the majority, if not all. This is a tricky combination as it does mean that cats with concurrent Cushing’s and DM are often insulin resistant and require higher doses on insulin to control DM related clinical signs.
It was a cool case to see, but they don’t pop up that often!
Scott 🙂
Replying to Nadia C. 10/09/2023 - 23:06
Hey!
We also have a brilliant webinar on feline probiotics if that is of interest!
Scott 🙂
Replying to Nadia C. 10/09/2023 - 23:06
Hey Nadia.
It is a great question. I think we are probably only really scraping the surface regarding what we know about probiotics. As with lots of things, the evidence is limited in our small animal patients. There is one paper regarding ProKolin specifically:
https://pubmed.ncbi.nlm.nih.gov/30882953/
There are a couple of studies looking at FortiFlora:
https://pubmed.ncbi.nlm.nih.gov/29291771/
I had a funny feeling that our very own Steph did a study in cats with Tritrichomonas foetus and FortiFlora… but I can’t find it. I will get Steph to comment.
In summary, I think FortiFlora and ProKolin are fine! Both very safe! I just think we don’t have loads of evidence for them specifically.
Hope that helps.
Scott 🙂
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