scott@vtx-cpd.com

Replying to Ellen T. 18/09/2024 - 11:54

Hi Ellen,

It sounds like you’re seeing a lot of these cases, and your rationale for withholding antibiotics unless there is evidence of neutrophilia or pyrexia makes sense, especially given the focus on judicious antibiotic use. Neutrophilia or fever tends to indicate a more systemic infection, which could justify antibiotic therapy. In the absence of these signs, withholding antibiotics helps avoid unnecessary use and the potential for resistance.

Regarding cases transferred to you already on antibiotics like metronidazole or co-amoxiclav, I agree that unless there are signs of systemic illness, stopping the antibiotics—especially if the patient is on a combination like metronidazole and amoxicillin/clavulanic acid—would be reasonable. There is no good evidence to suggest that finishing the course of antibiotics is always necessary. If the patient is systemically unwell, sticking with amoxicillin/clavulanic acid alone should usually be sufficient, as it provides broad coverage for most common pathogens. Each case might warrant reassessment, with diagnostics guiding whether to continue or discontinue antibiotics.

Hope this helps, and thanks again for the great question!

Best,

Scott

Replying to Laura S. 17/09/2024 - 11:08

Hey Laura.

Great points! I totally get where you’re coming from. Telephone calls can definitely feel more efficient—you get the conversation done in real time, and it feels like there’s a clear start and end. With email, things can drag on, and it does sometimes turn into a back-and-forth that feels endless.

I think you’re spot on about the risk of making ourselves too available. Clients can see email as a way to bypass the system, and managing expectations becomes tricky. I like your idea of having an admin email specifically for photos and videos—that could be a good way to keep things organized and still benefit from the visuals without it becoming overwhelming.

Another major advantage of email for me is that it provides a record of the conversation without needing to manually document it, which is a big plus. I’ve been using dictation software lately to help record phone conversations into clinical records, and that’s been a real game-changer for staying on top of things.

Thanks again for your response.

Scott 🙂

Replying to Steph Sorrell 14/09/2024 - 07:24

Hey!

While in-house analyzers are improving in terms of accuracy, it’s wise to exercise caution when diagnosing thyroid disease solely based on in-house results. A convincingly high T4 level that matches the clinical signs can usually be trusted, but for borderline or unclear cases, sending the sample to an external lab is always a good practice. Consistency is indeed key—using the same method regularly helps in monitoring trends over time.

Hope that helps.

Scott 🙂

Replying to Rachel R. 12/09/2024 - 14:00

Hey Rachel.

Thanks for your brilliant questions.

I have some thoughts, but I will let Steph wade in first!

I hope you are enjoying the course!

Scott 🙂

Replying to Kerida Shook 04/09/2024 - 20:57

Hi Keri,

Thank you again for your insights! I completely agree that these cases with haemoperitoneum and splenic masses are difficult to manage, especially when immediate access to advanced diagnostics like MRI or CT isn’t feasible in actively bleeding dogs. Stabilization is always the priority, and more advanced imaging often becomes secondary due to the urgency of the situation.

Regarding tranexamic acid, while it’s being explored in veterinary trauma settings, there’s no substantial evidence showing it could slow bleeding effectively enough in a case of a ruptured splenic mass. It’s generally more beneficial in perioperative care than in acute hemorrhage.

You’re absolutely right about the poor survival statistics for hemangiosarcoma (HSA) post-splenectomy. Traditionally, we follow the “double two-thirds rule,” which indicates that approximately two-thirds of dogs with splenic masses will have a malignant tumor, and two-thirds of those malignancies will be HSA, meaning around 43% of all splenic masses are diagnosed as HSA. However, these numbers evolve when you factor in haemoperitoneum. Studies show that around 21.7%–37.5% of dogs with haemoperitoneum have benign masses, and that number increases to 63.1%–70.5% without haemoperitoneum.

The recent systematic review published in J Am Vet Med Assoc (2022) by Schick and Grimes sheds more light on this. They evaluated 1,150 dogs with nontraumatic haemoperitoneum due to ruptured splenic masses and found that 73% had malignant splenic lesions, with a higher 87.3% of those malignancies diagnosed as HSA. This study highlights that more dogs than previously thought are diagnosed with malignant splenic masses and specifically HSA, suggesting that the “double two-thirds rule” may underestimate the likelihood of HSA in cases of haemoperitoneum. While these findings add valuable context in emergency settings, it’s essential to remember that a portion of these dogs still have benign conditions or non-HSA malignancies that might have a better prognosis.

In addition, the 2020 study published in Vet Comp Oncol by Owen Davies and Angela Taylor added another dimension by identifying genotype-based breed groupings and the presence of haemoperitoneum as significant predictors for malignancy and HSA. This study, which included 288 dogs, found that German Shepherds were the most commonly affected breed, and that genotype-based breed grouping was a superior predictor compared to traditional phenotype groupings. This could help refine our approach to breed-specific risk and guide decision-making.

Diagnostics, such as thoracic and abdominal imaging, are critical for assessing metastases, but definitive diagnosis only comes from histopathology post-splenectomy. Stabilizing the patient with fluids, oxygen, and transfusions is essential if bleeding is ongoing, and if the dog responds, surgery might be a valid option. Importantly, 95% of dogs with haemoperitoneum survive to discharge after splenectomy.

Finally, a study noted that clients who chose surgery were more satisfied with their decision compared to those who opted for palliation or euthanasia, with higher post-operative quality of life for the dogs. While we must remain realistic about HSA’s prognosis, surgery might still be worth considering, especially for those rare benign masses or motivated clients looking to extend their pet’s life.

Best,

Scott

Replying to Ariane N. 01/09/2024 - 07:55

Really helpful!

Thank you!

Scott 🙂