scott@vtx-cpd.com
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Replying to Kirsty C. 28/04/2022 - 13:51
Hey Kirsty.
Hoper you are well. You should be able to join with this link:
vtx is inviting you to a scheduled Zoom meeting.
Topic: RVN Leadership Live Q&A Session
Time: Apr 28, 2022 20:00 LondonJoin Zoom Meeting
https://us02web.zoom.us/j/82761647407?pwd=ZkRCMVFzK29QTTRoRVpxZzQ3Njk5QT09Looking forward to seeing you tonight.
Scott 🙂
Replying to Hannah B. 27/04/2022 - 14:43
Hello.
In cases like this I would often treat medically as much as possible. I would transition cases on to a hydrolysed diet and consider steroid therapy, especially with these histopathology changes. I have seem enough of an improvement in some cases with steroids.
In more severe cases I would consider more definitive surgical intervention with pyloroplasty.
These are tricky cases though!
Scott 🙂
Replying to Alba Chiara Abbruciati 28/04/2022 - 10:31
Thanks again for all the information.
The only reason I asked about the cobalamin was because it will often appear within reference, but if it is under 400 then I would always supplement.
The giardia antigen will indeed stay positive despite infection being cleared. It can work the other way round too and can be intermittently negative. Best approach is to follow up/confirm with faecal parasitology.
The decision making regarding full thickness biopsies vs endoscopy can be difficult. I totally understand the rational in this case for doing the OVH and biopsies at the same time. I would probably hold back a bit with the GI investigations, especially with the increased complication risk with full thickness biopsies. Generally 2 shorted anaesthetics will not be more dangerous for the patient.
Hope that helps.
Scott 🙂
Replying to Nichola C. 28/04/2022 - 09:46
No problem.
How did the case get on?
Scott 🙂
Replying to Ellie H. 27/04/2022 - 20:31
Hello Ellie.
I hope you are safe and well.
The session will be recorded and we will make this available like the other webinars on the website.
Hope you can join us live though!
Scott 🙂
Replying to Kim Choo L. 26/04/2022 - 21:04
Of course!
Drop me an email with the details or pop it on here and I will help where I can.
Scott 🙂
Hello.
Interesting and tricky case! Thank you so much for sharing.
I had a couple of comments and questions if that is OK?
1. What was the actual value of the cobalamin when you measured it?
2. What testing method did you use for the giardia testing?
3. I completely agree with your comments regarding the diet. I would definitely prioritise a hydrolysed diet trial. I would maybe hold off with the Vivomixx for now and introduce this after a couple of weeks of diet trial.
4. The decision making around the spay and biopsies is tricky. Has this patient had abdominal ultrasound? Is endoscopy an option?
Thanks again for sharing.
Scott 🙂
Replying to Raquel M. 14/04/2022 - 14:09
Hello.
The probiotic question is a great one.
Depending on the type of probiotic, antibiotics will absolutely have an effect on the bacterial load. It seems there is more and more support for using probiotics with antibiotics:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601687/pdf/JFP-62-148.pdf
Hope that helps.
Scott 🙂
Replying to Raquel M. 12/04/2022 - 22:44
Hello.
Thank you again for these brilliant questions. We will definitely chat more about this decision making in the feeding tube lecture. The use of appetite stimulants is very case dependant and feeding tubes will be more appropriate in some cases.
It is important to remember that anorexia is a symptom of disease and not a disease itself and, as such, the primary medical treatment should be aimed at addressing the causes of food refusal. For animals with reduced but not absent
food intakes, those where the duration of anorexia is expected to be less than one week, or for those whose owners are reluctant to place an indwelling feeding tube, short‐term use (i.e., less than one week) of appetite stimulants can be considered. In animals that experience persistent anorexia for more than three days despite medical management of the underlying disease state or those requiring longer‐term nutritional support (i.e., expected anorexia for more than one week), placement of an indwelling feeding tube should be considered.Hope that helps.
Scott 🙂
Replying to konstantinos C. 26/04/2022 - 15:07
Hello.
It is a good question. Honestly, if there is a histopathological diagnosis of hepatitis or enteritis, I would often continue longer with 2mg/kg. It all depends on clinical response too. Once symptoms were better controlled, I would always consider a dose reduction.
Scott 🙂
Hello.
Thank you again for your question. I found the following quite helpful (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4810896/):
The exact mechanism of hypocalcaemia in acute pancreatitis is unknown. Mechanism of hypocalcaemia during early stage (within 1st week) is different from hypocalcaemia developing in late phase of the disease. Several mechanisms proposed for hypocalcaemia seen in early phase are autodigestion of mesenteric fat by pancreatic enzymes and release of free fatty acids, which form calcium salts, transient hypoparathyroidism, and hypomagnesaemia.
Later stages of pancreatitis are frequently complicated by sepsis, which becomes an important contributor to hypocalcaemia. Mechanism of hypocalcaemia in sepsis is not clear. Whitted et al. proposed that increased circulating catecholamines in sepsis cause a shift of circulating calcium into the intracellular compartment leading to relative hypocalcaemia. This causes increased PTH secretion by negative feedback loop leading to further increase in intracellular calcium overload, oxidative stress, and cell death. Hypomagnesaemia-induced impaired PTH secretion and action, relative PTH deficiency, and Vitamin D deficiency, etc., are some of the other plausible causes.
Hope that helps.
Scott 🙂
Hello.
Thank you again for the great questions. Some clinicians feel that prednisolone should only be used in cats that are not hyperglycaemic and only at anti-inflammatory dosages (ie, 0.5-1.0 mg/kg PO q24h on a tapering schedule)
I would tend to use immunosuppressive dosages of prednisolone (eg, 2.0 mg/kg q12h for 5 days and then 1.0 mg/kg q12h for 6 weeks with a decreasing dosing schedule after that time) with close monitoring (ie, clinical re-evaluation and measurement of fPLI after 2-3 weeks).
If hyperglycaemia develops, or is pre-existing, I would consider the use of cyclosporine (5 mg/kg q24h for 6 weeks) with close monitoring (ie, clinical re-evaluation and measurement fPLI after 2-3 weeks).
In cats treated with either prednisolone or cyclosporine in which clinical signs have not improved and pancreatic lipase has not decreased, discontinuation of treatment should be considered. In cats that show a clinical response, continuation of treatment is indicated.
I hope that helps.
Scott 🙂
Hello.
I hope you are well. This is a great question. I would say that we do not have evidence for the routine use of pancreatic enzyme supplementation in cases of acute or chronic pancreatitis. As you mention, I would be keeping an eye out for the development of EPI.
It seems like the data is also mixed in human medicine, but there may be some benefit:
https://gut.bmj.com/content/66/8/1354.1
Hope that helps.
Scott 🙂
Hello.
I hope you are safe and well. Thank you for your question.
The dosage of ILE used varied between the cases and was not always recorded. However, in most cases
standard protocols were followed and included an intravenous bolus of 1.5 ml/kg of a 20% ILE, followed by a
constant rate infusion CRI of 0.25-0.5 ml/kg/min for 30-60 minutes, which was repeated as necessary.Reported dose ranges in the literature include boluses of 1.5 ml/kg-2.0 ml/kg over 2-15 minutes, then as a CRI
0.06 ml/kg/min to 0.5 ml/kg/min for multiple hours (Gwaltney-Brant, 2012). No maximum daily dose has been
determined in veterinary patients (Kuo et al., 2013).I would repeat/continue treatment if clinical signs persisted.
I hope that helps.
Scott 🙂
Replying to Hannah B. 25/04/2022 - 13:31
Hello.
Lovely to hear from you. NAC is usually given as a 10% solution diluted 1 to 2 with saline as an IV bolus over 20 minutes through a 0.25 micron non-pyrogenic in-line filter at a dosage of 140 mg/kg initially followed by dosages of 70 mg/kg q 8-12 h.
I would use this type of filter if possible.
Let me look in to where we get them from!
Scott 🙂
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