scott@vtx-cpd.com

Replying to Francesca W. 10/01/2023 - 15:44

Hello Francesca.

I hope you are safe and well. I have no idea how I missed this question! I am so sorry for the delay!

I would normally use the 100mg dose as you mention. You could absolutely increase this dose if needed. The recommended dose is 5-10mg/kg PO q8-12 hours.

Interestingly, I was speaking to a colleague in the USA yesterday who works in a high volume spay and neuter clinic. They will use routinely ahead of elective procedures.

Hope that helps.

Scott

Replying to Holly U. 06/02/2023 - 20:53

Hello Holly!

Welcome to the course. Thank you so much for learning with us!

I am pleased to hear that your heart lies in internal medicine… mine too!

I really hope you get lots out of the course. Let us know if you have any questions.

Scott 🙂

Replying to Kathryn B. 13/12/2022 - 12:04

Hey Kathryn.

I missed the second part of your questions! I am so sorry!!!!! I hope you are safe and well. I have popped some thoughts under your comments below:

Just finished watching the section on gastroprotectants and my mind has indeed been blown 🙂 Especially by the realisation that giving omeprazole to regurging brachys is increasing their risk of aspiration pneumonia! I’m thinking about some patients I’ve given/not given gastroprotectants to recently and wondering whether this may have been incorrect:

“I think brachys are really tricky. I think there are some examples on when thet do need PPI’s and they definitely regurgitate. I think it is important to remember that the PPI’s are not benign and there can be negative effects too. I have organised a roundtable discussion on this exact to pic with a surgeon and anaesthesia specialist later in the year that I will send you a link to.”

– suspected portal hypertension (based on ascites rather than measuring portal pressures) with no melaena/haematemesis

“I think there is a good justification for PPI’s in some portal hypertension cases, despite the lack of haematemesis or melena. There is not lots of evidence for this, but I would consider in these situations. The one liver situation that I probably consider longer term PPI’s in would be intrahepatic portosystemic shunts. These are cases that are at higher risk of GI bleeding.”

– a dog who developed severe vomiting after neutering and was on NSAIDs post-op; stopped the NSAIDs and treated with anti-emetics alone, no haematemesis but should I have given PPI?

Honestly, in this situation I would not give a PPI. This is the approach in human medicine, even with NSAID over doses. I would treat with antiemetics but only reach for PPI’s if there are sustained GI signs or evidence of bleeding.”

– patients on immunosuppressive doses of pred e.g. IMHA

“I would definitely not use PPIs as routein in cases that I was starting on immunosuppressive doses of steroids. There is no evidence that prophylactic use will help. They might even do more harm with the negative effect on the microbiome. Having said that, if there is any evidence of GI haemorrhage then I would not hesitate to use them.”

– brachys having a GA – if metoclop is better as a CRI than a one off, and we don’t have a means of administering a CRI, what would be the best medication for reducing the risk of reflux in these guys?

“If I was using metoclopramide, I would always use a CRI if possible. This will definitely be more effective than intermittent boluses. I think cisepride is a medication to consider in these cases, I often use this drug in brachy patients:

https://pubmed.ncbi.nlm.nih.gov/22489656/
https://pubmed.ncbi.nlm.nih.gov/30387153/
https://pubmed.ncbi.nlm.nih.gov/24669921/”

And on a different note – is there any benefit to supplementing folate when low in GI patients, and if so what formulation/dose would you use?

“There is a lot of debate about good old folate! I would supplement when low in GI patients. The easiest way to do this is with Cobalaple, the Protexin product. This also contains cobalamin:

https://www.protexinvet.com/cobalaplex/p6222

I hope that helps! I am glad you enjoyed it!

Scott 🙂

Replying to Ashley Wemple 31/01/2023 - 15:11

Ashley!

So excited you are here and so grateful that you have shared your knowledge with us!

I worked with Ashley when I first graduated… taught me all I know!

Scott 🙂