scott@vtx-cpd.com
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Replying to Josep B. 29/04/2024 - 10:13
“Decoding the supercomputer”
We should get t-shirts made with that on!
Scott 🙂
For me the biggest challenge is actually determining which patients have SIRS or are septic!
Scott 🙂
Hey Kath.
I thought this recent review was helpful, but not one for the faint hearted! Might be the ultimate bedtime reading?!
Defining Sepsis in Small Animals: A Veterinary Perspective
https://onlinelibrary.wiley.com/doi/10.1111/vec.13359
Sepsis is a life-threatening condition that occurs when the body’s response to an infection causes widespread inflammation. While the definition of sepsis in human medicine has been well-established through consensus definitions, the same cannot be said for veterinary medicine. In a recent review by Robert Goggs and colleagues, the need for a consensus definition of sepsis in veterinary medicine was highlighted.
Background
In human medicine, sepsis has been defined by consensus three times, with the most recent definition established in 2016. However, in veterinary medicine, there is a lack of uniformity in how sepsis is defined, and there is no consensus on how to clinically identify it. Most publications in veterinary medicine rely on modified criteria derived from the 1991 and 2001 human consensus definitions. This divergence between human and veterinary descriptions of sepsis hampers research, limits our ability to translate pathophysiology insights into clinical practice, and restricts our ability to optimize patient care.The Need for Consensus
Given these challenges, there is a growing recognition of the need to formally define sepsis in veterinary medicine. Establishing a consensus definition would not only help advance the field but also improve our ability to diagnose and treat septic patients. In their review, Goggs and colleagues present a synopsis of prior attempts to define sepsis in both human and veterinary medicine. They also discuss developments in our understanding of sepsis and highlight some criticisms and shortcomings of existing schemes.Moving Forward
The review serves as the foundation for current efforts to establish a consensus definition for sepsis in small animals. By generating evidence-based criteria for recognizing sepsis in veterinary clinical practice, we can improve patient outcomes and enhance our understanding of this complex condition.In conclusion, defining sepsis in small animals is crucial for advancing veterinary medicine. By aligning our understanding with human medicine and establishing consensus definitions, we can improve the diagnosis and management of septic patients, ultimately saving lives.
Replying to Katherine Howie 29/04/2024 - 09:38
Hey.
Thanks so much for sharing this. I was really interested in your comment about not having access to an ECG and monitoring CV status.
Would you be able to elaborate on this? Very interested!
Have a lovely weekend.
Scott 🙂
Replying to Helen S. 28/04/2024 - 11:33
Thank you for sharing these Helen.
Scott x
Replying to Amanda-Jane Rogers 27/04/2024 - 17:53
Thank you so much for sharing this!
Hope you are well.
Scott 🙂
Replying to Yvonne McGrotty 29/04/2024 - 12:38
Hi Yvonne,
Thank you so much for your detailed and informative reply. Your insights into monitoring trilostane therapy for hyperadrenocorticism are incredibly valuable, and I appreciate you taking the time to share your expertise.
Your explanation regarding the use of pre-pill cortisol and the considerations for when it may not be suitable, as well as the importance of clinical signs in dose adjustment, were particularly enlightening. I will certainly keep these points in mind when managing cases in the future.
Your advice on the use of ACTH stim tests and the considerations for twice-daily dosing will undoubtedly help me make more informed decisions in my practice.
Thank you once again for your thorough response.
Best regards,
Scott x
Replying to Suzi Bailey 26/04/2024 - 20:48
Hey Suzi!
I hope you are well and enjoying the course. I hope Yvonne’s response helped. If you have any other questions let me know!
Have a great weekend.
Scott 🙂
Replying to Jackie L. 25/04/2024 - 14:39
Hi there,
Thank you so much for your kind words! We’re thrilled to hear that you found the neurology course interesting and informative. It’s fantastic to hear that you’ve learned a lot and that you’re keen to continue your learning journey in neurology. We’ll definitely keep you updated on any future neurology courses on this site, and we encourage you to explore other courses that might pique your interest.
If you have any specific topics or areas within neurology that you’d like to delve deeper into, feel free to let us know. We’re here to support your learning and growth in any way we can.
Thanks again for being a part of the course, and we look forward to having you join us in future learning opportunities!
Best regards,
Scott 🙂
Replying to Talia C. 23/04/2024 - 07:10
Hello!
I utilize a treatment protocol that involves measuring a baseline Spec cPL concentration, then administering prednisone to the dog for 5 days at a dose of 2 mg/kg PO q 12 h, followed by 1 mg/kg PO q 12 h for another 5-7 days. A recheck of clinical signs and another Spec cPL concentration is then conducted. If there is any improvement in clinical signs or the Spec cPL is significantly decreased, I continue prednisone therapy at a slowly decreasing dosage. Additionally, successful treatment of a canine patient with chronic pancreatitis with cyclosporine has been reported in one case, and a clinical trial is underway. I measure a baseline serum Spec cPL concentration and then administer 5 mg/kg of Atopica PO q 24 h for 3 weeks, after which another recheck is performed to evaluate the patient clinically and measure another Spec cPL concentration. Treatment continues long-term based on the above-mentioned criteria. However, further studies are needed before these treatment strategies can be recommended for more routine use in dogs. This protocol is not heavily evidence-based. There are some occasions when people will start with up to 4 mg/kg for the management of some immune-mediated conditions for a short time. I do not often go for this high dose but will stick to 2 mg/kg/day initially in most cases.
I hope that helps!
Scott 🙂
Replying to Sarah H. 02/05/2024 - 14:01
Hello Sarah!
Really great to have you join us! I really hope you enjoy the first lesson.
Let us know if you have any questions.
Scott 🙂
Replying to adele smart 01/05/2024 - 18:15
Adele!
What a joy to have you here! Please let me know if you have any questions!
Scott x
Replying to Felipe M. 01/05/2024 - 17:52
Welcome Felipe!
Thank you so much for being part of our team!
Scott 🙂
Replying to Talia C. 30/04/2024 - 12:26
I was actually speaking to some of the RC reps in the clinic the other week and they informed me that these liquid preparations are great for going down feeding tubes but are not able to be offered orally. They are not palatable!
https://www.royalcanin.com/rs/dogs/products/vet-products/renal-liquid-dog
Scott 🙂
Replying to Mónica P. 22/04/2024 - 14:58
Hello!
Thank you for sharing all of this information.
It sounds like Sofia’s case has been quite challenging, but you’ve been thorough in your approach to her care. Given the complexity of her presentation and the fluctuations in her thyroid hormone levels despite treatment, it may be beneficial to consider a few additional steps:
Confirm Medication Compliance: Ensure that the owner is administering the medication as prescribed, ideally without food, as food can interfere with levothyroxine absorption. It might also be helpful to ask about any changes in the medication brand or formulation.
Review Diagnosis: Revisit the initial diagnosis of hypothyroidism. Given Sofia’s breed and the presence of other conditions, such as severe skin infection and ovarian cyst/tumour, it’s possible that these factors are affecting her thyroid function tests. It may be worth consulting with an internal medicine specialist for a second opinion.
Further Testing: Considering Sofia’s weight gain and persistent otitis and facial dermatitis, additional tests such as a complete blood count (CBC) and a more comprehensive blood chemistry panel could provide valuable insights into her overall health and potential underlying conditions contributing to her symptoms.
Discuss Histopathology: While the owner chose not to pursue histopathology on the ovarian mass, it may be worth discussing the benefits of obtaining a definitive diagnosis, especially if there are concerns about the mass potentially affecting Sofia’s health or hormone levels.
Lab Results Clarification: Follow up with the lab to confirm the type of TSH (cTSH) and the method used for fT4 measurement (ED). This will help ensure the accuracy of the thyroid function tests.
Long-Term Management: Consider a long-term management plan for Sofia’s hypothyroidism, which may include regular monitoring of thyroid hormone levels, adjusting medication dosage as needed, and addressing any concurrent conditions that may be influencing her health.
If Sofia is doing well now, I would consider weaning her off all thyroid medication and monitoring her clinical signs closely. If clinical signs of hypothyroidism persist, then testing could be undertaken again. It’s worth noting that thyroid hormones can have a general effect on metabolism, so even if a patient is not hypothyroid, thyroid supplementation can lead to an improvement in mood and overall well-being. Owners often report a lift in mood and energy levels in their pets after starting thyroid supplementation, highlighting the broad impact of thyroid hormones on the body, including effects on energy levels, appetite, and skin and coat condition.
In Sofia’s case, total T4 is generally fine for monitoring, but free T4 might be helpful in future assessments about the possibility of hypothyroidism, especially if there are concerns about the accuracy of the total T4 measurements. However, TSH and free T4 would not be used for monitoring.
If you are experiencing any issues uploading images, please feel free to email them to me at scott@vtx-cpd.com. I’ll be happy to assist you further.
Hope that helps.
Scott 🙂
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