scott@vtx-cpd.com
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Replying to Rachel H. 06/10/2024 - 14:40
Hello!
Thank you for your excellent question! During a bile acid stimulation test, it’s crucial to offer a meal that stimulates gallbladder contraction effectively. While plain chicken can provide some stimulation, it may not be sufficient for all dogs. A meal with higher fat content generally triggers a stronger contraction, which is necessary for accurate post-prandial bile acid measurement.
You could try mixing a small amount of fat-rich food (e.g., canned food or cooked egg yolk) with the chicken to increase the fat content without making the meal too large. If dogs remain reluctant, adding a small amount of a favorite treat can encourage them to eat.
As far as I’m aware, there aren’t any specific studies in dogs that examine the impact of different food types on gallbladder contraction during BAST, so recommendations are based on clinical experience. Sometimes, you really only understand what’s happening once you have the test results!
I hope this helps clarify things! How are you finding the course so far?
Best,
Scott 🙂
Replying to Jo C. 03/10/2024 - 21:00
Hello Jo!
Thank you for your great question! When addressing liver disease in dogs, it’s vital to identify the specific type of liver disease, as this determines the nutritional approach. In cases of copper-associated hepatitis, managing copper intake is critical. Copper accumulation can occur due to a hereditary defect in biliary excretion (e.g., in Bedlington Terriers or Labrador Retrievers), cirrhosis, or excessive dietary copper intake.
Current guidelines suggest dietary copper levels be below 7.5 mg/kg dry matter and ideally around 3 mg/kg dry matter for copper-sensitive breeds. The National Research Council and the Association of American Feed Control Officials do not specify an upper limit for copper intake due to a lack of data. Safe intake is likely to be breed- and individual-dependent.
Dietary management focuses on a low-copper diet combined with zinc supplementation, as zinc reduces copper absorption and helps maintain liver function. For some dogs, a diet with 1.2 mg Cu and 25.5 mg Zn/Mcal has effectively reduced hepatic copper levels below 400 mg/kg dry weight. In patients with <800 mg/kg of hepatic copper, a low-copper diet alone may suffice, while higher levels often require copper chelation therapy alongside dietary adjustments.
For liver disease in general, requirements for many minerals and trace elements remain uncertain. It’s assumed they should at least match those of healthy dogs, with sodium restriction recommended for ascites or portal hypertension. Hypokalaemia is common due to poor intake, vomiting, or diarrhoea, necessitating potassium supplementation when diet alone isn't sufficient.
Another consideration is manganese, which can accumulate in dogs with advanced liver disease or portosystemic shunts (PSS), potentially contributing to hepatic encephalopathy. Zinc supplementation is crucial, not only for its effect on copper but also to prevent zinc deficiency, which is common in human liver disease and likely relevant in dogs too.
I hope this is helpful! By the way, how are you enjoying the course?
Best regards,
Scott 🙂
Replying to Hilary J. 18/10/2024 - 14:55
Hello Hilary!
We are so lucky to have you as part of our course,
Thank you so much for your contribution.
Scott 🙂
Replying to Nikki McLeod 18/10/2024 - 09:32
Hey!
Not sure what is happening with the code!
I tried to sign up again and it came up with the same thing! I have email Helen now and will let you know when she gets back to me! Sorry about that!
Let me see what I can do regarding the LVS ticket too!
Scott 🙂
Replying to Megan S. 16/10/2024 - 17:04
Hi Megan,
Thank you for your kind words! I’m glad you’re finding the course helpful and interesting.
To answer your question, differentiating between adrenal-dependent hyperadrenocorticism (ADH) and pituitary-dependent hyperadrenocorticism (PDH) can be important, but it’s not always essential, especially if the treatment plan may not change. Here’s a breakdown:
Clinical Importance of Differentiation:
PDH is more common (about 80-85% of cases), and medical therapy like trilostane or mitotane can effectively manage both PDH and ADH.
ADH can be more aggressive, particularly if there is a functional adrenal tumor. In these cases, surgery (adrenalectomy) may be curative. Differentiating ADH from PDH helps identify whether surgery should be considered as a more definitive option.
When to Differentiate:If imaging or clinical signs suggest an adrenal mass, it may be worth investigating further, as adrenal tumors could require more specific management. I suppose that it is good to know if there is an adrenal mass as it may be something that needs careful monitoring with ultrasound and could even be an indication for surgical removal.
The other indication would be if there is a growing pituitary mass, which could require intervention. In cases of macroadenomas, there may be indications for radiation therapy or even surgical removal of the pituitary. This can be more of a concern if neurological signs develop or the tumor is compressing nearby structures. What are your thoughts on this?
Investigating:Differentiation tests (such as endogenous ACTH or imaging) can sometimes give unclear results, which is frustrating.
In straightforward cases where medical therapy is working well, it may not always be necessary to push for a definitive diagnosis, especially if there’s no suspicion of an adrenal or pituitary mass.
In summary, while it’s not always necessary to differentiate between ADH and PDH when clinical signs are well controlled with medical therapy, there are situations—like with adrenal masses or growing pituitary tumors—where knowing which form is present becomes more important. Monitoring with imaging and considering interventions such as surgery or radiation might be key in such cases.Let me know if you have any further questions!
Best regards,
Scott 🙂
Replying to Steph Sorrell 16/10/2024 - 19:20
Really helpful Steph!
Thank you!
Scott 🙂
Replying to Laura Jones 16/10/2024 - 16:47
Thank you for sharing!
Scott 🙂
This is a SUPER interesting topic!
Owner involvement can be really helpful… until its not, if you know what I mean!
Stress is obviously one of the main issues here, and if owner involvement reduces this, I am a fan!
Scott 🙂
Hey Sarah!
Great to hear from you. Thank you for the questions.
I will make sure Steph sees this.
Scott 🙂
Replying to Laura Jones 15/10/2024 - 12:58
Thanks for sharing!
Scott 🙂
Replying to Louise L. 14/10/2024 - 13:18
Hey Louise.
So glad you are enjoying the course!
Laura is a pretty brilliant speaker!
Scott 🙂
Hi Lara,
Not a stupid question at all—it’s a really practical one, especially when it comes to optimizing DOCP dosing intervals! I hope you are enjoying the course. Let me know if you have any feedback!
For this case, the hypernatremia is an indicator that we may be slightly over-supplementing with DOCP, which can cause electrolyte imbalance. Waiting a week to retest the electrolytes allows us to assess if the sodium normalizes without the influence of a fresh DOCP dose, which would provide a clearer picture of whether the decrease to 1.5 mg/kg SC is appropriate long-term.
If we were to give the dose immediately, we’d miss the opportunity to observe if the dog’s electrolyte balance can sustain at a lower DOCP dose over a longer period. This way, we avoid the risk of overtreatment and allow for adjustments that may help the dog maintain better electrolyte stability over time.
Regarding the frequency of monitoring once at 30-day intervals, for a clinically well patient, electrolytes are generally rechecked every 3-6 months. This can vary slightly based on individual cases, particularly if there’s a history of fluctuations or any new clinical concerns.
Hope this clears things up! Let me know if you have any other questions.
Best,
Scott
Replying to Laura Jones 15/10/2024 - 13:00
Thanks Laura.
Do you have a link for the Dechra food you are talking about?
Scott 🙂
Replying to Louise L. 14/10/2024 - 13:13
Thanks Louise!
What is this witchcraft with the HA dust?! Does that work well?
The HA does not come in a wet form for cats? DO you find the wet HA for dogs blends well?
I learned recently that the RC liquid diets are not actually palatable. Great for going down NG tubes but not great for offering orally.
Scott 🙂
Replying to Laura Jones 16/10/2024 - 14:00
Thanks pal!
Scott 🙂
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