scott@vtx-cpd.com
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Replying to Jennifer M. 15/05/2023 - 14:00
Welcome Jennifer!
I hope you are safe and well. Glad you enjoyed the first lesson!
Scott 🙂
Hello!
Glad you are enjoying the course! Some useful information from a DVM 360 article below:
Treatment options for hyperlipidemia include treatment of inciting diseases, diet modification, and pharmacologic intervention.
Dietary modification. In some patients, switching the patient to a low-fat diet may be the only therapy needed. It is generally recommended that diets should contain less than 20% fat on a metabolizable energy basis for dogs and less than 25% for cats. However, obtaining a good diet history to estimate the level of consumed fat is important before deciding the degree of fat restriction. The patient should be fed a diet with a fat level lower than the previous diet. Treats should be restricted to 5% of the daily caloric intake and changed to low-fat varieties. When low-fat diets are not adequate, lipid-reducing pharmacologic agents can be considered.
Pharmacologic intervention. Lipid-lowering agents used in people include chitosan, omega-3 fatty acids, niacin, fibric acid derivatives, and statins. Evidence for their effectiveness and safety in veterinary medicine is lacking. Chitosan is a calorie-free, animal-derived fiber supplement that not only passes through the intestines without being digested but also absorbs and removes fat. There are no clinical trials reporting the benefit or side effects of chitosan. Diets rich in omega-3 fatty acids can lower hypertriglyceridemia in people by decreasing the production of VLDLs. Menhaden oil can be used in dogs at a dosage of 200 mg/kg/day.
Niacin (100 mg/day in dogs) may also reduce hypertriglyceridemia by decreasing fatty acid release from adipocytes and reducing VLDL production. Potential side effects of niacin include erythema, pruritus, abnormal hepatic function test results, vomiting, and diarrhea. In my experience, these side effects and the lack of convincing evidence of efficacy limit niacin use in dogs and cats.
Fibric acid derivatives lower triglycerides by stimulating lipoprotein lipase, which decreases the production of fatty acids and, in turn, reduces VLDL concentrations. I commonly use gemfibrozil (Lopid—Pfizer) at a dosage of 200 mg/day in dogs and 10 mg/kg every 12 hours in cats. Potential side effects include abdominal pain, vomiting, diarrhea, myositis, and abnormal hepatic function test results.
This article is also helpful:
https://pubmed.ncbi.nlm.nih.gov/33137654/
Hope that helps!
Scott 🙂
Replying to Sarah Noponen 15/05/2023 - 00:11
Hey.
I agree, thyronorm does tend to be the go-to drug now. Do you find it difficult to convince owners to go for radioactive iodine treatment? Do you find the cost and length of hospitalisation varies a lot?
Scott 🙂
Replying to Sarah Noponen 15/05/2023 - 00:15
Hey.
Really interesting. Thanks for sharing. Is there a maximum dose you will use? Do you think some cats are more sensitive to the effects than others?
Scott 🙂
Replying to Rosanna Vaughan 11/05/2023 - 14:51
Rosanna,
I am really pleased to hear you are enjoying the course so far!
1) Basically an allergic type reaction! This is an example of a non-dose-dependent, idiosyncratic drug reaction; this type of reaction to methimazole and propylthiouracil is uncommon. Drug reactions, or “allergies,” can manifest as cutaneous lesions (facial erythema), haematologic abnormalities (neutropenia and thrombocytopenia), or liver disease (cholangiohepatitis). All of the abnormalities in this patient could be attributed to an idiosyncratic reaction to methimazole. Therapy requires discontinuation of the drug because the reaction is non-dose-dependent, or “allergic.” There is a good picture in this article:
https://www.cliniciansbrief.com/article/pruritus-hyperthyroid-cat
2) The post radioactive iodine therapy renal issue is similar to that of other therapies. It is thought that these cats have pre-existing renal disease that is ‘unmasked’.
3) Yes, you would orally supplement with thyroid supplementation just as you would with dogs.
Hope that helps! Great questions!
Scott 🙂
Replying to Rosanna Vaughan 11/05/2023 - 15:00
Hello!
Great question. The dose for pre-visit anxiety/stress does seem to vary quite a bit.
https://pubmed.ncbi.nlm.nih.gov/34727056/
This study looks at 100mg/cat. I think lots of people are using this standard dose. So yes, it is often higher than the analgesia dose in the formulary.
Is this a drug you have used a lot for this purpose?
Hope that helps.
Scott 🙂
Replying to Magda Upton 10/05/2023 - 14:09
Hey Magda.
The FDA thing is interesting. It does seem that many drugs get approval without loads of evidence behind them. I get the feeling they just need to be relatively confident the drug is safe. The FDA stuff is not something I am so familar with either.
In other news… Sybil is a very strong name!
Scott 🙂
Replying to Sarah Noponen 25/04/2023 - 19:17
Hello Sarah!
It is so lively to have you here. I appreciate your support. I started my career in the Newcastle area… I have lots of fond memories. I am glad the locum work is working well for you.
Hi!I agree that these endocrinology can be super challenging especially if you are picking them up in the middle!
The client’s expectation point is a brilliant one… there is no perfect test, that is how most of my client chats start!
Scott 🙂
Replying to Rosanna Vaughan 03/05/2023 - 10:48
Hello Rosanna!
Lovely to have you here. Thank you so much for joining the course and supporting vtx.
I really hope the course helps to get you back to work with confidence!
Please let me know if you have any questions.
Scott 🙂
Replying to Liz Bode 03/05/2023 - 21:28
Thank you so much Liz.
Really helpful!
Scott 🙂
Replying to Liz Bode 03/05/2023 - 21:28
Thank you so much Liz.
Really helpful!
Scott 🙂
Replying to Sophie Ponter 04/05/2023 - 17:09
Sophie!
It really is wonderful to have you here.
It sounds like you are busy!!! What kind of referral practice are you working in at the moment? Very exciting that you are considering an ECC residency. Let me know if I can support in any way.
Please let me know if you have ny questions. I really hope you enjoy the course.
Scott 🙂
Replying to Anya W. 03/05/2023 - 21:43
Hello Anya!
Lovely to have you on the course. I hope you are enjoying it so far! Very excited to hear you are doing a rotating internship. What are your plans after that? Would you consider a residency?
Let me know if you have any questions at any time.
Scott 🙂
Replying to Sophie Ponter 04/05/2023 - 17:16
Hello Sophie.
I hope you are well and enjoying the course.
It is a really good question! I delivered a variation of Lesson One with a focus on this exact question. I will make this available to the delegates on the liver course and hopefully, this will answer your questions!
I agree that the first thing to do when liver enzyme increases are incidental is to show that they are repeatable. This is the first thing I would do. Assessment of concurrent disease is the other main thing as we know so many different things can cause liver enzyme increases.
I will let you know when the other webinar is available.
Scott 🙂
Replying to Sarah Noponen 25/04/2023 - 19:30
Thanks, Sarah.
I agree, I think a lot of clients like to see how things go with the medication first!
Many of them do very well and improve without the need for lots more testing.
What medication do you reach for first in your hyperthyroid cats?
Scott 🙂
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