scott@vtx-cpd.com
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Replying to Jessica Wilson 18/10/2022 - 01:58
Welcome Jessica!
Where did you work overseas? Thank you so much for joining the course.
Please let me know if you have any questions.
Scott 🙂
Replying to Steph Sorrell 16/10/2022 - 11:36
Really interesting and really helpful!
Thanks.
Scott 🙂
Replying to Holly D. 16/10/2022 - 21:26
Hey.
I thought I would share my thoughts regarding the management of tracheal collapse. Long-term treatment mainly aims to decrease all potential promoting factors and the level of inflammation of the tracheal mucosa. Weight reduction in the obese animal is essential. Weight loss alone can be curative of clinical signs. Likewise, replacement of neck collars with harnesses can be effective. Removing the dog from respiratory irritants such as noxious gases, smoke, and dust is common sense and should be explained clearly to the owner. It is also important to detect and treat other diseases, including chronic airway disease, cardiac disease, and hyperadrenocorticism.
Long-term therapy consists of very low-dosage corticosteroids (prednisone 0.2 mg/kg PO q 24 h × 1-2 weeks, at 3-month intervals, for instance), or by inhalation (fluticasone, one 120 mcg puff q 12 h using a face mask and spacer), often in combination with a sedative-antihistamine. Oversedation must be avoided, since the animal must keep moving to avoid gaining weight and to promote clearance of tracheal secretions. Oral antitussive agents that are effective in controlling cough include hydrocodone (0.22 mg/kg PO q 12 h) and butorphanol (0.55 mg/kg PO q 12 h). I must admit that I most routinely use codeine as an antitussive. I would also consider antibiotics in some cases. I tent to think doxycycline is a good choice!
Hope that is helpful.
Scott 🙂
Replying to Samanta A. 16/10/2022 - 22:17
Hello.
I was on a live Q&A with feline specialist Steph Sorrell last week and she was discussing some of the possible side effects of alendronate treatment. This is not something I have seen clinically, but will definitely make owners more aware of:
https://pubmed.ncbi.nlm.nih.gov/30663796/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5580850/Hope that helps too!
Scott 🙂
Replying to Dani B. 17/10/2022 - 09:18
Dani!
Never too late! So nice to see you here!
You sound very busy indeed! Please let me know if you have any questions.
Scott 🙂
Welcome everyone,
Thank you for joining our toxicities course, we really hope you enjoy the course and are so thrilled to be joined by the amazing Kerry! My name is Scott and I am one of the founders of vtx and a specialist in small animal internal medicine. Please introduce yourself in the thread below. We would love to know a bit more about you!
This course is a safe place to ask questions, discuss cases/situations, to start discussions with your fellow veterinary colleagues and mostly importantly to share your experiences (if you want to, that is).
I would also love to know what you hope to get out of the course?
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Best wishes
Scott
Replying to Holly D. 15/10/2022 - 17:16
Hello!
I am not stepping in Liz’s toes with this one and am really interested to hear what she has to say. I do not have direct experience of using this drug. Can I ask what other therapy you have tried in this case?
Scott 🙂
Replying to Lynne F. 12/10/2022 - 12:39
Lynne!
How lovely to hear from you and how lovely to see you on here.
I hope all is well with you! We are all just about surviving I think!
Thank you so much for supporting the course, let me know if you have any questions at any time.
Scott 🙂
Thanks for sharing Liz.
All still very confusing to me. I wish I had paid more attention in cardiology!
Scott 🙂
Hey Lorna.
I hope you are well. Thank you for the great question. It is a not a drug I use. There is always a bit of a debate about a couple of human GI drugs that intermittently get used in small animal medicine, notably loperamide and buscopan.
Anticholinergics and opiates or opioids (loperamide, diphenoxylate) often are used for the nonspecific management of acute diarrhea, but anticholinergic agents can potentiate ileus and are not recommended. Opioid analgesics were thought to exert their effects by stimulating segmental motility, thereby slowing transit, but they actually act mainly by decreasing intestinal secretion and promoting absorption. They are indicated in short-term supportive management of acute diarrhea in dogs; they are contraindicated in cases involving obstruction or an infectious aetiology. Loperamide can have central nervous system side effects in collies and other dogs with the multidrug resistance (MDR-1) gene mutation. Antimuscarinic drugs such as hyoscine (buscopan) (butylscopolamine) generally are not recommended, as they can produce a paralysed, nonfunctional SI, can predispose to intussusception, and can cause intoxication. However, in mild cases of acute gastroenteritis, their antispasmodic effect could help relieve colic-type pain.
I did have a look for any dog specific literature, but could not find a lot:
https://pubmed.ncbi.nlm.nih.gov/31140850/
It did seem to be helpful and well tolerated in this context. Would love to hear other thoughts.
Scott 🙂
Replying to Ilse v. 15/10/2022 - 07:59
Hey.
Sounds like you did a great job with this! Well done on picking up the cardiomyopathy too!
Scott 🙂
Replying to Kathryn B. 11/10/2022 - 21:02
Hello.
Great to hear from you. Thanks for the great question, I agree, these can be really frustrating cases!
Despite the normal total calcium in this case, I would still measure an ionised calcium, especially in cases when you are not finding anything else. An SDMA would be a good shout. I am less convinced these early cases present so much with obvious signs of PUPD, but again, in cases where you are not finding anything else, I would.
You are right about the USG. When the urine is hyposthenuric, the urine is more dilute than plasma and therefore there must be renal tubular function. Central and nephrogenic diabetes insipidus are differentials as are conditions that interfere with the concentration of urine such as hypercalcemia, sepsis (e.g., pyometra, pyelonephritis), hepatic disorders, hypoadrenocorticism, hyperadrenocorticism and psychogenic polydipsia.
Nothing is totally ruled out by the level of USG that a patient falls in to.
1. I would want to see multiple morning urine samples from this dog to assess ability to concentrate.
2. I would defiantly get the owners to quantify intake.
3. Ionised calcium and SDMA as mentioned.
4. I have seen some weird cases of cPSS present in later life just with PUPD. A bile acid stimulation test would not be a ridiculous shout.
5. I would tend to them image these patients next. There are some other weird things that could be to blame like splenic haemangiosarcoma and pheochromocytoma.
6. If all else fails then you could then consider DDAVP trial.I hope that helps. Let me know how you get on with this one.
Scott 🙂
Replying to Ilse v. 11/10/2022 - 01:05
Hello.
Great question. I will make sure we ask this at the live Q&A tomorrow night!
Scott 🙂
Replying to leonique v. 11/10/2022 - 10:22
Hey Leo.
Thank you for the question.
I will make sure Felipe gets this one!
Scott 🙂
Replying to Catarina S. 11/10/2022 - 16:24
Hello Catarina!
Thank you so much for joining the course and thank you so much for your kind words. I am really pleased you are enjoying the course.
Scott 🙂
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