scott@vtx-cpd.com
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Replying to Lucy Morley 11/08/2022 - 10:27
Lucy!
Lovely to have you here again. What took you to Australia? I hope life is treating you well.
Thank you again for supporting vtx.
Scott 🙂
Replying to Kirsty C. 11/08/2022 - 11:00
Looking forward to meeting people in person!
I am speaking in the IDEXX stream too.
Thank you again Kirsty for all of your support with the nurse leadership course.
Scott 🙂
Replying to Emma Holt 10/08/2022 - 15:17
Emma!
Fancy seeing you here!!! Thank you as always for your support.
Hope you enjoy the course.
Scott x
Replying to Raquel M. 09/08/2022 - 22:00
Hello.
If you are using a human product I recommend a dose of 200 mcg for cats and smaller dogs (<20 kg BW) and 400 mcg for larger dogs (20 kg BW) PO once daily for 4 weeks ( or as long as needed).
I think that most EPI cases can have quite severe deficiencies, which is why people will often use injectable therapy. There is a recent paper that would suggest oral may also be OK in EPI cases:
https://pubmed.ncbi.nlm.nih.gov/33593499/
Hope that helps.
Scott 🙂
Replying to Laura W. 09/08/2022 - 22:40
Hello Laura.
We are beyond excited to have you on the course.
Looking forward to you sharing your wealth of knowledge with us too.
Thanks you so much for supporting vtx.
Scott 🙂
Replying to Raquel M. 08/08/2022 - 14:25
So…
You can get Cobalaplex on amazon… how are your amazon deliveries??? 🙂
- This reply was modified 2 years, 3 months ago by scott@vtx-cpd.com.
Replying to Raquel M. 08/08/2022 - 14:25
Hey.
Injections are fine too. There are studies looking at the difference between oral and injectable therapy and it seems both cause cobalamin levels to get to the same point in the end:
Comparison of efficacy of oral and parenteral cobalamin supplementation in normalising low cobalamin concentrations in dogs: A randomised controlled study
Abstract
The aim of this study was to compare the efficacies of parenteral and oral cobalamin supplementation protocols in dogs with chronic enteropathies and low cobalamin concentrations. It was hypothesised that both treatments would increase serum cobalamin concentrations significantly. Fifty-three dogs with chronic enteropathies and serum cobalamin concentrations<285ng/L (reference interval 244-959ng/L) were enrolled. Dogs were randomised to treatment with either daily oral cobalamin tablets (0.25-1.0mg cyanocobalamin daily according to body weight) or parenteral cobalamin (0.4-1.2mg hydroxycobalamin according to body weight). Serum cobalamin concentrations were analysed 28±5days and 90±15days after initiation of supplementation. After 28 days, all dogs had serum cobalamin concentrations within the reference interval or above. In the parenteral group (n=26), median (range) cobalamin concentrations were 228 (150-285) ng/L at inclusion, 2107 (725-10,009) ng/L after 28days and 877 (188-1267) ng/L after 90 days. In the oral group (n=27), median (range) serum cobalamin concentrations were 245 (150-285) ng/L at inclusion, 975 (564-2385) ng/L after 28days and 1244 (738-4999) ng/L after 90 days. In both groups, there were significant differences in serum cobalamin concentrations between baseline and 28 days, and between 28days and 90days (P<0.001). In conclusion, both parenteral and oral cobalamin supplementation effectively increase serum cobalamin concentrations in dogs with chronic enteropathies and low cobalamin concentrations.Hello.
Hope you are well. This is a great question. There is real debate regarding the significance of folate. Honestly, it is much less often significantly decreased compared with cobalamin. What was the cobabalamin level in this case? Many of the problems associated with low folate and cobalamin come from human literature. An equivalent relationship between hypocobalaminemia or hypofolatemia and hematologic changes in small animal veterinary species has not been established, although reports of anisocytosis, macrocytosis, anemia, or pancytopenia in association with hypocobalaminemia do exist.
Honestly, I would supplement folate if low in most GI cases. It is a very safe thing to do. I would normally use the oral Cobalaplex product from Protein as it will supplement folate and cobalamin.
How are you supplementing the cobalamin in this case?
Scott 🙂
Replying to Gergana G. 27/07/2022 - 20:50
Hello.
I would not consider a blood transfusion in this case. I would only consider the transfusion if the dog decompensates or is cardiovascular unstable. I would probably not increase the steroid dose if the dog is already on 2mg/kg/day and is having GI signs.
There are some cases that require a 3rd immunosuppressive drug. If the dog is doing better then I would maybe hold off for a bit and repeat haematology in 7 days.
The spleen is most likely to be extramedullary haematopoesis but you could consider FNA’s to make sure not something like lymphoma.
Hope that helps.
Scott 🙂
Replying to Victoria T. 29/07/2022 - 09:33
Hello Victoria.
I am so pleased you have enjoyed the course!
Thank you so much for your support.
Scott 🙂
Hello Gergana.
I hope you are well. Tricky case!!!!
Has the dog had any other investigations? Any imaging? Have you tested for any other infectious disease?
It is odd that you are not getting a better response with the medication. I would worry that the dog is ill despite the PCV not being that bad and there could be more going on.
I look forward to hearing from you!
Scott 🙂
Replying to Grigory Brodetsky 27/07/2022 - 13:29
Thank you so much Grigory!
Thank you for supporting this course, I am so pleased you enjoyed it.
Please let me know if I can do anything more to help.
Scott 🙂
Replying to Sybil Dryburgh 21/07/2022 - 22:21
Hello.
Some really good points. I have contacted VPIS to ask them what their evidence is for recommending PPI’s routinely with NSAID toxicity.
It seems like the standard of care with acute toxicity in human medicine is not to give PPI’s unless evidence of GI signs. It would seem like the incidence of GI signs is actually quite low.
I will let you know what VPIS say.
Scott 🙂
Replying to Nathalie Cunha 17/07/2022 - 18:25
Hello.
Great question. There is not really any time restriction on this. Most of the situations when you are faced with the decision to perform auto transfusion will be more acute situations. Blood is unlikely to be in a body cavity for a long time. If there is a bleed that then stops, the peritoneum will reabsorb that blood.
In short, I would not worry how long it has been there.
Scott 🙂
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