scott@vtx-cpd.com
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Replying to Nathalie Cunha 09/03/2022 - 12:32
No guilt needed!
I spent 10 years of my career advising the approach. The hope is that with the acute cases, things get back to normal quite quickly. I agree with Hilary that the GI diets are the way to go, but each case is individual and if you are really challenged with what the pet and owners will do, then a little bit of home cooked short term will be fine.
Scott 🙂
Replying to Nathalie Cunha 09/03/2022 - 12:27
Haha!
FeLV and FIV were negative!
Scott 🙂
Replying to scott@vtx-cpd.com 05/04/2022 - 12:31
Hey.
Thoracic radiography was unremarkable!
Abdominal ultrasound
Lymph Nodes: A single peri-gastric lymph node is large and hypoechoic. All other lymph nodes are normal.
Stomach: The gastric wall at the level of the body and pyloric antrum is diffusely, severely thickened with loss of the normal wall layer architecture.
No other abnormalities were noted in the abdomen
Next steps?
Scott 🙂
Replying to austeja Zykute 13/03/2022 - 15:57
Thanks Austeja.
I hope you are well. I would definitely be considering some sort of hypereosinophilic syndrome… cats love to do things with eosinophils!
I think ultrasound and radiography sound great! I will pop the results of these tests below! Would love to hear your comments.
Scott 🙂
Replying to Nathalie Cunha 09/03/2022 - 12:27
Hello Nathalie.
Thank you for your response! Differentials for the eosinophilia would include:
Gastrointestinal disease – eosinophilic inflammatory bowel disease, gastrointestinal eosinophilic sclerosing fibroplasia
Parasitism – gastrointestinal helminths, ectoparasites
Asthma
Allergic dermatitis
Eosinophilic granuloma complex
Hypereosinophilic syndrome
Neoplastic – paraneoplastic e.g. lymphoma, mast cell tumour, squamous cell carcinoma, thymoma
Fungal infections e.g cryptococcus
HypoadrenocorticismI would indeed consider faecal analysis. The other option would be to repeat a course of parasitic treatment. Normally a 7 day course of fenbendazole!
Scott 🙂
Replying to Rosie Webster 04/04/2022 - 18:07
Welcome!
I hope you are well. I hope you also like the less ECC parts of the course too! You never know… you might see a hypothyroid case OOH!?
Scott 🙂
Replying to Hillary N. 04/04/2022 - 12:25
Really helpful.
Thank you.
Scott 🙂
Replying to Julie S. 23/03/2022 - 14:51
Hello Julie.
I am so sorry for the delay in getting back to you. No idea how I missed this! I hope you have had a lovely weekend and you are enjoying the course.
One of the natural products that has some evidence regarding nausea in people is ginger. I could find one paper (quite old) that used it in dogs for chemotherapy induced nausea:
https://pubmed.ncbi.nlm.nih.gov/9254112/
There does seem to be quite a bit of evidence in the human literature:
https://pubmed.ncbi.nlm.nih.gov/23638927/
Ginger is not something I have experience of giving as a stand alone supplement. The other option for GI cases would be to use a probiotic. Less evidence for vomiting, nausea, reflux, but not likely to do any harm.
I know some veterinary diets will contain ginger, which might be interesting to discuss more.
I would be interested to hear the experience of others?
Hope that helps.
Scott 🙂
Replying to Emma Holt 01/04/2022 - 14:21
Hello again.
I am going to look in to the Fortifolra a bit more and speak to Silke too. I would agree with that approach regarding probiotic then diet. I would also be comfortable trying Vivomixx more in cats. Danielle was concerned about the palatability issue compared to Fortiflora.
Scott 🙂
I have had the following back from Danielle:
”Hi Scott,
Good Qs.
As far as I know, still no NP wet – unless Steph can correct me.
I would usually try a pro-biotic or symbiotic course before a hydrolysed diet trial for this reason. I don’t know about VSL#3 instead – but I know a lady who will know…
Dxx”
I will speak to Silke at Edinburgh regarding the Forti flora too.
Scott 🙂
This is a brilliant question!
The main evidence for Fortiflora is regarding Tritrichomonas foetus. So my recommendation is extrapolated a bit from this.
I have forwarded your question to Danielle Gunn Moore and Stephanie Lalor! Feline goddesses! I want to make sure I give you the correct answer… I will let you know what they say!
Scott 🙂
Replying to Natalie H. 01/04/2022 - 12:23
Hello Natalie.
I hope you are safe and well.
Regarding diet with chronic enteropathy. Generally if there is no response after 2 weeks I would recommend trying a different diet. Generally if there is going to be a positive response you will see this quite quickly. The longer diet trials are more appropriate for dermatological conditions.
Hope that helps. Have a lovely weekend!
Scott 🙂
Replying to Richard Todd 27/03/2022 - 16:54
Hello Richard.
Lovely to hear from you. I have just popped some comments on regarding NSAIDs and similar comments apply to steroids. There is no evidence to say that starting omeprazole to prevent issues with immunosuppressive doses of steroids. I would not routinely use these in cases when I am using immunosuppressive doses of dugs.
If any patient taking steroids or NSAIDs develops signs of ulceration, they would still be the right drugs to use. It is the prophylactic use that can be problematic.
Hope that helps.
Scott 🙂
Replying to konstantinos C. 11/03/2022 - 18:09
Konstantinos,
I hope you are well. Thank you for your great question. Overall, it is probably not helpful to give omeprazole/gastroprotectants before giving NSAIDS. There was actually a recent study looking at this in patients with neoplasia:
https://pubmed.ncbi.nlm.nih.gov/34337965/
Bacterial overgrowth can have deleterious consequences when PPIs are administered with other drugs that can injure the small intestinal (SI) mucosa. It is common to prescribe PPIs in patients at risk for upper GI injury from nonsteroidal anti-inflammatory drugs (NSAIDs), but PPIs can alter the SI microbiome, increasing the risk of injury to the intestinal epithelium caused by NSAIDs. This effect is acid-independent and unrelated to gastric mucosa injury caused by NSAIDs. Inhibition of intestinal cyclooxygenase 1 and 2 (COX-1, COX-2) enzymes injures the SI mucosa. Enterohepatic recycling of NSAIDs likely plays a role whereby high concentrations of NSAIDs in bile are secreted into the duodenum in close proximity to the major duodenal papilla. Some of the most serious intestinal lesions in dogs caused by NSAIDs occur in this region. Small intestinal injury may be caused by increased numbers of gram-negative facultative anaerobic bacteria that flourish in the SI of patients treated with PPIs. Lesions are characterized by loss of villi, erosions, and multifocal ulcers distributed throughout the small bowel. Anaemia also may occur. Whereas some bacteria play a protective role against intestinal mucosal injury by NSAIDs, the intestinal dysbiosis arising from PPI administration increases the risk of NSAID-induced intestinal injury.
I hope that helps!
Scott 🙂
Replying to Raquel M. 24/03/2022 - 12:15
Hello Raquel!
Hope you are safe and well. Did the NSAIDs get discontinued just because of the grass eating? Has the dog had any GI signs. Any change in appetite?
Scott 🙂
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