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scott@vtx-cpd.com

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Viewing 15 posts - 1,351 through 1,365 (of 2,028 total)
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  • scott@vtx-cpd.com
    Keymaster

    Replying to Katie Swords 06/06/2022 - 13:55

    Hello Katie.

    Welcome to the course. Thank you so much for your support.

    There is nothing like a ‘near miss’to make us stop and have a wee think! We are always learning, right?

    Have a great week.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Hello everyone.

    I hope you are all safe and well. My name is Scott, I am a specialist in small animal internal medicine and one of the founder of vtx. I am so excited that Felipe has joined us to deliver this exciting course.

    I really hope you enjoy the course. If you have any (non anaesthesia related) then please let me know. Keep any anesthesia related ones for Filipe! 🙂

    Have a brilliant week.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Hello.

    This is not something I have heard of. My understanding was the follows:

    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.

    As far as I am aware this is the same for the IV preparation.

    But I stand corrected if you have other information!

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Replying to Raquel M. 27/05/2022 - 20:16

    Hello Raquel.

    Great to hear from you. I would definitely consider vitamin D in these cases to help with the hypocalcaemia.

    The clopidogrel is a great shout. I would indeed use that in these cases. The standard tablets only come as the 75mg. I would normally use a compounding pharmacy to get different sizes. I normally use BOVA. They have a liquid version too:

    https://drive.google.com/file/d/1bL4sa0V_ApBT7UpQBtZorV4ZCyxL5w5d/view?usp=sharing

    They might ship to you?

    I hope that helps.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Replying to Kathryn B. 30/05/2022 - 08:10

    Hello.

    Thank you for the answer! I love that we now know what the weird pink things are!

    I have popped the pathology report below:

    Microscopic Description

    The images depict highly cellular smears with good cell preservation. There is a variable quantity of
    background blood and a large nucleated cell harvest dominated by large lymphocytes approximately two
    erythrocytes in diameter. These have moderately thick, deep basophilic cytoplasmic rims and occasionally
    contain small, ill-defined pale staining Golgi zones. Nuclei are round or plump oval and paracentric with
    stippled chromatin and up to 5 variably sized dispersed pale nucleoli. There are frequent mitoses. There are
    numerous spherical lymphoglandular bodies in the background, occasional neutrophils proportionate to
    the quantity of background blood and low numbers of tangible body macrophages.

    Microscopic Interpretation

    Lymphoma

    Comments

    Given the large size of this mass and its apparently rapid onset, the cellular harvest is
    consistent with large cell lymphoma. Cytomorphology suggests diffuse large B-cell subtype. Definitive phenotyping will require some form of immunocytochemistry or immunohistochemistry. It would be unusual for this type of lymphoma to present with just one lesion and a thorough assessment for enlarged nodes and organs as well as a haematology
    are suggested before considering treatment options. If disease is restricted to this single location I suggest
    that the diagnosis is confirmed histologically on biopsied or excised tissue.

    Hope that helps.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Replying to Jen Williams 31/05/2022 - 17:18

    Haha!!!

    All the good guys do seem to be in there! Thank you for sharing!

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Hello Austeja.

    I hope you are well. Theses are really tricky cases, so don’t beat yourself up about the outcome. You did a great job.

    I have popped some thoughts under your questions:

    1. How long do you have to wait after discontinuing pred so you can take biopsies?

    This is a great question. In an ideal world I would wait as long as possible, at least a couple of weeks. Longer if possible. Endoscopy would have maybe been a good option in this case. You could have considered endoscopic biopsies even when the albumin was lower.

    2. I gave metronidazole as immunomodulatory drug, however, now I think it was unjustified. Was it wrong to prescribe it in this case?

    The dog had very severe signs, so I understand your reasoning. I would probably not be rushing to use antibiotics in this case. I would have considered diet, probiotics and steroids before antibiotics.

    3. Was the shaking fit similar to eclampsia, because of low calcium secondary to low albumin? I assume low glucose was secondary to long standing diarrhea and not eating?

    Sounds like the shaking was due to the low calcium and I would suspect moist of this is due to the albumin. The severity of the GI disease will also contribute to issues with calcium absorption. When exactly was the low glucose documented? This could be post seizure/neurological; activity. The other possible concern for low glucose could be sepsis?

    4. Could extreme liver enzymes be caused by diazepam and other drugs being more toxic with such low albumin.

    I think there are lots of reasons for the liver to take a hit in this case (drugs/GI disease/hypoxia). I would suspect this was a secondary hepatopathy.

    5. How would you approach hypoalbuminemic crisis like this?

    These are very challenging. Treating the cause as aggressively as possible. I would also be aggressive regarding calcium supplementation (IV in a crisis) as well as considering vitamin D supplementation to help longer term. Plasma and human albumin are the only option for albumin replacement, but both options have their limitations.

    6. Do you have any more comments on how would you manage this case?

    I think the main thing I would have pushed for earlier on would have been endoscopic biopsies. I would also have considered vitamin D supplementation to help with calcium.

    I hope that helps.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Hey Julie.

    Great points. I think overall the association with Helicobacter and disease is much better determined in human medicine.

    I have definitely been in a position where I have ‘treated’ the helicobacter before. I would only consider treatment if there was histopathological evidence of Helicobacter. I would tend to supplement vitamin B and change diet first and see what kind of response there was. If there was associated inflammatory change it might even be worth considering a trial of steroids too. But in some cases, more direct treatment of Helicobacter may be warranted.

    Hope that helps.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Replying to Jen Williams 13/05/2022 - 15:30

    Hey Jen.

    Lovely to hear from you! I always keep my PDSA in mind. I still think they were the happies days of my career to date!

    Thanks for supporting the course.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Replying to Hannah R. 11/05/2022 - 09:47

    Hello Hannah.

    Really lovely to hear from you. Thank you so much for supporting the course, we are so glad to have you on board!

    Let me know if you have any questions at anytime!

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Replying to Alison Lambert 11/05/2022 - 08:13

    Hello Alison.

    I hope you are well. Thank you so much for your kind words.

    Yes, there is no evidence to say that prophylactic use of a PPI is necessary when administering higher doses of steroids.

    Hope that helps.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Replying to Alison Lambert 11/05/2022 - 08:13

    Hello Alison.

    I hope you are well. Thank you so much for your kind words.

    Yes, there is no evidence to say that prophylactic use of a PPI is necessary when administering higher doses of steroids.

    Hope that helps.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Replying to Rosemary S. 10/05/2022 - 09:33

    HAHA!

    Please do not get up at 5am for journal club.

    We will record this and make available.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Replying to Gillian Gordon 07/05/2022 - 13:44

    Thank you so much Gillian.

    We are so pleased you have enjoyed the course and really appreciate your support.

    Much love.

    Scott 🙂

    scott@vtx-cpd.com
    Keymaster

    Hello.

    Lovely to hear from you. I normally use this product:

    https://www.protexinvet.com/pro-enzorb/p6243

    This would normally be a capsule a day for cats. I hope that helps.

    Scott 🙂

Viewing 15 posts - 1,351 through 1,365 (of 2,028 total)