scott@vtx-cpd.com
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Replying to Ornella R. 06/03/2023 - 21:41
Hello Ornella.
I am really glad that you enjoyed the first lesson. I have popped some thoughts under your questions below:
1-OE tube with incorporated balloon. Do you place it like a normal OE tube? Do we need to to do endoscopy to check that the balloon is at the level of the stricture? If the stricture is at the distal oesophagus would it be OK to use this method and leave the OE tube in that position?
This is a great question. It is placed like a normal oesophageal feeding tube. I would recommend doing an endoscopy to confirm/check placement. I would be a little careful at the very distal oesophagus. I would avoid having the balloon dilating the lower oesophageal sphincter if possible. There is always the risk that this could cause gastro-oesophageal reflux.
2-the x-ray with the dog that had a massive knife in the oesophagus How did it happen? How do you deal with that? Do you remove it through the mouth or the stomach? High risk of perforation there.
Crazy cases indeed! The case I was involved with was all over the news. The knife in this case was removed via gastrotomy. We used the endoscope to assess the degree of mucosal damage. The oesophagus is surprisingly tough!
https://www.bbc.co.uk/news/uk-scotland-glasgow-west-38649586
3-the dog with dysphagia that had fluoroscopy showed a narrowing of the oesophagus at the level of the heart. What was the cause? PRAA?
Yes. This dog had a PRAA. Sady, this dog went for surgery but continued to have some problems with regurgitation.
Hope that helps/
Scott
Hello Gosia!
I hope you are safe and well. Great to hear from you. I am so pleased you are still enjoying the course!
I will forward your question to Felipe now.
Have a graet week.
Scott
Replying to Neus E. 02/03/2023 - 13:31
This is really interesting Neus!
Thank you for sharing! Just a quick question… would you use in HGE case? I can see it might be useful in hypoalbuminaemic GI patients, but what about ones with normal albumin? Do you think plasma would be a good shout?
In hypoalbuminaemic GI patients. How low is too low for albumin? Would you use albumin below a certain value, or just when you start to see third spacing?
Hope that makes sense?
Scott
Replying to Neus E. 02/03/2023 - 13:33
Hey Neus!
The TXA tampon is a great idea!
Thanks for sharing.
Scott
Replying to Neus E. 02/03/2023 - 13:40
Thank you Neus!
Really helpful!
Scott x
Hey Lesley.
This sound like a very frustrating case. I would say from your description that the most likley thing is USMI.
Did you ever try the Propalin and Incurin in combination.
Scott
Replying to Jennifer Cartwright 20/02/2023 - 16:03
Hey.
Thanks everyone for the great suggestions!
Hope you are well. UA was looked at on a few occasions. The urine was persistently positive for bilirubin (4+), but also intermittently contained large amounts of free haemoglobin (4+, negative sediment).
Bleeding or IMHA would definitely immediately pop to the top of my DDX list. Blood smear demonstarted signs of regeneration. There were no spherocytes present, slide agglutination was negative and Coombs was also negative. POCUS was performed chest and abdomen and no free fluid was seen… always a good shout! No melena was reported in this case, but I always do a rectal as owners will not always notice this!
Scott
Replying to Kerry Doolin 22/02/2023 - 10:34
Thanks Kerry!
Another really interesting use!
Scott
Replying to Kerry Doolin 22/02/2023 - 10:38
Hey Kerry.
Really interesting. Thank you for sharing.
Scott
Replying to Kerry Doolin 25/02/2023 - 01:27
Thanks for this pal!
Really helpful!
Scott
Replying to Lauren W. 23/02/2023 - 12:39
Hello Lauren!
It is so lovely to have you join us!
Please let us know if you have any questions at any time!
Scott
Hey Lesley.
I will share my thoughts. Would be interesting to hear Jenny’s thoughts too!
You are right… Male dogs with urinary incontinence pose a more difficult challenge. Although a less common problem in males, less than 50% of male dogs respond to medical therapy, and the most successful treatment is phenylpropanolamine. One possible reason for this is a misdiagnosis of dogs with USMI when in fact they have overflow incontinence from urethral sphincter dyssynergia or functional urethral obstruction. Testosterone cypionate has had some anecdotal use in males with USMI and may provide some improvement. Urethral bulking agents may be placed antegrade through a cystotomy incision; however, there has not been a formal evaluation of this procedure and its overall success rate is unknown. Surgical placement of an artificial urethral sphincter appears to have some success in male dogs that fail medical therapy.
I think it is important to work up these male incontinent dogs as much as possible. I would definantely consider urine analysis and possible culture. An abdominal ultrasound would be helpful. The problem in male dogs is a visualisation of the lower part of the urinary tract. If clinical signs are suggestive of any urethral disease I would consider a retrograde urethrogram or possibly CT.
In short, the first line medication trial would be phenylpropanolamine.
Hope that helps.
Scott
Hello Ornella.
I hope you are well and enjoying the course.
I would normally use NAC when patients are hospitalised and I would normally give more than one dose. I normally use the following:
N-acetylcysteine (140 mg/kg loading IV, then 70 mg/kg q 6 h for 7 treatments)
I will then transition them on to oral sAME when they are tolerating food.
Will be interested to see what Kerry thinks!
Scott
Hello Helen.
I would agree that we are seeing more and more evidence that antibiotics are often not needed in these cases:
https://pubmed.ncbi.nlm.nih.gov/36191142/
https://pubmed.ncbi.nlm.nih.gov/31742807/I think they summarise really well here too:
https://bvajournals.onlinelibrary.wiley.com/doi/10.1002/vetr.44
Can you share a little more about the plasma? What is the trigger for giving this?
Scott
Replying to Lesley M. 14/02/2023 - 23:02
Hey Lesley.
Thanks for your thoughts. I will give the others a wee bit longer and then I can share what happened next.
The clinical discussions part of the forum section of the website is where we share cases and some other useful stuff!
Scott
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