scott@vtx-cpd.com

Replying to Ornella R. 26/04/2023 - 13:31

I will let you know when I confirm with Purina!

Scott 🙂

Hello Veronika.

Thank you so much for sharing this… really helpful!

I must admit I have not completed this lesson yet, I hope to get around to it this week! I have many examples of this sort of clinical scenario that I find impossible to get out of my head at home.

1. I spend a lot of time worrying about what clients think of me. Worrying that they come and see a specialist and are somehow disappointed by seeing me. These are mostly unfounded thoughts and narratives that I create in my head. I constantly have to remind myself that thoughts are not facts!

2. I also find it useful to run through the scenario in my head and tell myself what I would tell others if it was happening to them and they were asking me for advice… why are we kind to others and not to ourselves!!!!

I look forward to watching the lesson.

Scott 🙂

Hey Ornella.

I have spoken to Hilary and she has answered below:

1-In a dog with chronic diarrhoea, I usually use highly digestible/low residue diet as the first diet. In what cases would you use a fibre-enhanced diet? What would make you suspicious of the dog needing more fibre?

There are certainly multiple approaches for chronic enteropathy dogs, depending on the root cause of their chronic diarrhoea. Digestibility is important, as is supporting the gastrointestinal microbiome to replenish populations of beneficial bacteria if they have been disturbed. Rather than just recommending a high-fibre food, we recommend a food with a specific prebiotic fibre blend. It’s as much about fibre type and quality as quantity. Because it has proven to be quite successful in many dogs with chronic diarrhoea, I do tend to reach for a prebiotic fibre-bundle enhanced diet (e.g. Hill’s Gastrointestinal Biome) first unless I am suspicious that the pet may have an adverse food reaction at the root of their clinical signs.

2-In what cases would you choose i/d sensitive over normal i/d? Maybe in dogs that have had chicken previously and still having diarrhoea?

I would reach for i/d Sensitive in dogs that I am suspicious of an adverse food reaction to one of the ingredients in i/d, or in dogs who have tried i/d without resolution.

3-Just to make sure I understood this correctly.You mentioned that probiotics work well for acute disease but not so much for chronic disease? How many days would you give probioticts for acute cases? Do you use probiotics at all in chonic cases?

How long to give probiotics will depend on the case and specific brand of probiotics used and their manufacturer recommendations. There is not a hard and fast rule, and giving them long term is unlikely to cause harm. It’s more that we have growing evidence that exogenous probiotic supplements may not lead to longer term colonisation of the GI tract in dogs and cats, as they seem to be species and even individual-specific. Giving a prebiotic-fibre enhanced diet can help the pet build and nourish its own native population of beneficial bacteria more effectively in the long term. It may also be easier for the owner to comply with, as they are feeding their pet daily anyway, and don’t have to give an additional administration of anything.

4-What is the % of true food allergy in dogs and cats, I remember you mentioning is not that common.

That is correct. According to this study, “Among dogs and cats with any disease, skin disease, pruritus or allergic skin disease, the median prevalence of CAFR is less than 1%, about 5%, between 15 to 20% and 10 to 25%, respectively; it is also estimated to be around one third of dogs with atopic dermatitis.” For this reason, if a pet has only cutaneous signs and not GI signs, we recommend assuming atopic dermatitis rather than adverse food reaction first and choosing nutrition designed to manage that (e.g. Hill’s Derm Complete).
https://link.springer.com/article/10.1186/s12917-017-0973-z
Olivry, Thierry, and Ralf S. Mueller. “Critically appraised topic on adverse food reactions of companion animals (3): prevalence of cutaneous adverse food reactions in dogs and cats.” BMC Veterinary Research 13 (2016): 1-4. https://link.springer.com/article/10.1186/s12917-017-0973-z

5-I would like to understand this. Insoluble fibre help to softens the stools (makes them more moist), which would help with constipation; and soluble fibre help to solidy the stools (so less watery/more formed) which would help with diarrhoea?

Fibre is complex! Solubility relates to how well the fibre dissolves in water. Fermentability is another important consideration, and relates to how fermentable that fibre is by the native microbiota in the GI tract. Both of these factors can impact stool texture and quality. Usually a balanced blend of both soluble and insoluble fibre, with moderate fermentability, is recommended to maintain stool quality and nourish the microbiome. A great article explaining fibre types can be found here: https://vetnutrition.tufts.edu/2019/11/fiber-frustrations/
Hill’s Gastrointestional Biome food has both types of fibre and has been clinically proven to resolve diarrhoea and constipation in cats in as little as 24 hours.

Hope that helps!

Scott 🙂

Replying to Rachael Porter 21/04/2023 - 19:11

No problem!

I hope it helped, let me know if you have any other questions.

Scott 🙂

Replying to Ornella R. 17/04/2023 - 22:20

Hey Ornella.

This is great news about the cat. My understanding is that the protein in Fortiflora is hydrolysed. I will double-check this with Purin though!

I think with chronic disease, even if just vomiting, there is indication for biopsies. There could still be small intestinal disease with a normal cobalamin.

Thanks for sharing the paper! I think if we all had TEG in our lives decision-making would be much easier! I would say that in cases of PLE with lower than reference albumin, there would be a rationale for clopidogrel. Thankfully we do not see too many cases that develop clinically significant thromboembolic disease.

Hope that helps.

Scott 🙂