scott@vtx-cpd.com
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Replying to Pauline Brauckmann 20/10/2025 - 19:42
Hi Pauline,
That makes perfect sense, sounds like you get plenty of real-world experience with envenomations there! I think your plan to reserve Denamarin for cases that develop liver changes is absolutely the right approach.
Thanks so much for being part of the course and for contributing to the discussion!
Best,
Scott š
Replying to Anna M. 29/10/2025 - 11:46
Hi Anna,
Iām really glad youāre enjoying the course, thatās great to hear!
Youāre absolutely right that thereās some nuance in how we approach screening for acromegaly in diabetic cats. The newer data suggest itās more common than we used to think. The recent German cross-sectional study by Guse et al. (J Feline Med Surg 2025; 27[1]:1098612X241303303) reported increased IGF-1 (>746 ng/mL) in 17.5% of 97 diabetic cats tested, and a positive correlation between IGF-1 and insulin dose (median 1.63 U/kg/day vs 0.86 U/kg/day, P = 0.018). That aligns with earlier findings from the RVC and elsewhere suggesting that 15ā25% of diabetic cats may have hypersomatotropism, even though only a subset show overt clinical acromegalic features.
In practice, I donāt test every diabetic cat, I reserve IGF-1 screening for those showing insulin resistance (typically >1.5 U/kg/injection or poor glycaemic control despite good technique, diet, and concurrent disease management). Testing all diabetics will certainly detect mild or subclinical cases, but these often donāt alter management unless thereās genuine insulin resistance or poor control. The review by Scudder & Church (J Feline Med Surg 2024; PMID 38323402) reinforces this selective approach, emphasizing that hypersomatotropism-induced diabetes typically manifests as highly variable or refractory hyperglycaemia.
Regarding comorbidities, pancreatitis remains very common, depending on criteria and assays, around 30ā50% of diabetic cats show either historical or concurrent evidence of pancreatitis. Many of these fall under the ātriaditisā umbrella (IBD, cholangitis, pancreatitis), and we often suspect at least low-grade pancreatic inflammation in poorly controlled or relapsing diabetics.
Your practical advice for inappetent diabetics is exactly what I suggest:
If theyāve eaten ā„ 50% of their normal meal, itās generally safe to give the usual insulin dose (or modestly reduce it if thereās concern).
If theyāve eaten < 50%, skip that dose and monitor. Safety always outweighs perfect glycaemic control in these situations, especially if owners donāt have home glucose monitoring. Hope that helps, and Iām delighted youāre finding the material useful. Best, Scott
Replying to Rachel C. 24/10/2025 - 16:45
Thanks again for the great questions and forum interaction Rachel!
I hope you are having a lovely weekend.
Scott š
Replying to Mihai R. 12/10/2025 - 18:29
Thatās a really great question!
Iāll make sure Ingrid sees your message, as I know sheāll have some excellent insights to share regarding post-op radiography, case efficiency, and workflow management!
Scott š
Replying to Jo T. 13/10/2025 - 15:14
Hey Jo!
So glad it was helpful!!!!!!!!!!
I hope you have a lovely week.
Scott š
Replying to Mihai R. 13/10/2025 - 19:48
Hello!
‘Quite generous with my osteotomy’… you should get that on a t-shirt! HAHAHA! There us a whole line of dentistry merchandise right there!
Thanks again for the question. I will make sure Ingrid sees this.
Have a great week.
Scott š
Replying to Elizabeth G. 12/10/2025 - 19:42
No problem!
I hope you are enjoying the course.
Scott š
Replying to Mihai R. 12/10/2025 - 17:07
I use it for all my bleeding noses now!
Most of the bleeding noses I see I have cause the bleeding by performing nasal biopsies!
I hope you are having a lovely weekend.
Scott š
Replying to Rosie Webster 09/10/2025 - 19:40
Thanks so much, Rosie! š Itās brilliant to have you with us, and Iām really glad youāre enjoying the lectures so far. Wishing you all the best as you make the move into primary practice! We really appreciate your ongoing support!
Scott š
Replying to Victoria R. 12/10/2025 - 07:24
Sadly, I do not!
Interestingly this week we had a client send us their gym progress pictures by mistake… which as you can imagine was followed by another rather frantic email!
Scott š
Replying to Victoria R. 12/10/2025 - 07:25
If I am being honest…
When I look at the image of the hair all glued together… it all looks like a bit of a mess! Hhaha!
It also seems like a bit of a faff to me!
Scott š
Hello again!
I have popped a reply from Hilary and Tori below:
“Oh, great questions, and firstly, I hope youāre feeling better soon! There seem to be far too many colds going around for this time of year!
Youāre absolutely right that exposure and sensitisation are central to the development of atopic dermatitis (AD), but we donāt necessarily need patients to be over a year of age before we can make a diagnosis. While the typical age of onset is between 6 months and 4 years, we do occasionally see very young dogs, even as early as 14ā16 weeks, presenting with clear clinical signs of AD, sometimes quite severely affected.
Itās all about pattern recognition and ruling out other causes of pruritus, particularly ectoparasites. Using Favrotās criteria can really help guide your reasoning in younger patients. When youāre confident thereās no ectoparasitic burden, an atopic process should remain high on your list, especially with classic signs such as itchy ears, face, paws, axillae, or ventrum.
As for your question on brachycephaly and conformation, there isnāt evidence that these features directly reduce the age of onset or cause AD. However, we do see AD more frequently in these breeds, likely due to a combination of genetic restriction (small breeding pools) and environmental influences. Conformational issues can certainly exacerbate AD by worsening secondary factors like skin barrier disruption or chronic inflammation, but they donāt inherently cause immune sensitisation earlier in life.
Now, onto diets, and yes, itās a real minefield! Owners often want to āadd a little somethingā for flavour, but unfortunately, that completely defeats the purpose of a diet trial. I often explain it with a simple analogy: giving a dog on a strict elimination diet ājust a little treatā is like giving someone with a peanut allergy a fun-sized Snickers every day, theyāll never improve! That usually gets the message across.
When possible, I prefer clear, controlled diets with known ingredients, either home-prepared single protein diets (e.g. kangaroo, rabbit, ostrich, with butternut squash or sweet potato if tolerated) or a commercial hydrolysed diet. Hydrolysed diets are generally best for practical use, but they must be fed with absolutely no additional treats or toppers. For clients struggling with palatability, making a simple meat gravy or puree from the chosen protein and freezing it in small portions can help, just make sure the pet actually likes it before committing to a full batch!
Cats, of course, tend to be less cooperative in this process, but thatās another discussion altogether!”
I hope that helps!
Scott š
Replying to Victoria R. 12/10/2025 - 07:45
Thank you so much Tori for this brilliant answer!
Scott š
Hey Jo.
I hope you are well!
Thank you so much for sending through this question! I will make sure Hilary sees this and will get back to you ASAP.
I hope you are feeling a bit better and enjoying the course!
Scott š
Replying to Shona McTaggart 29/09/2025 - 11:54
Haha!
I think that is all what we secretly wish!
I hope your trip is going well.
Scott š
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