scott@vtx-cpd.com

Hey Emma.

I hope you are having a wonderful time away in Scotland!

This is a nice review and raises some good points:

1. I would still use endoscopy in cats with diffuse disease. I have experienced ‘missing’ a diagnosis of lymphoma in both dogs and cats with endoscopy, so this can definitely still happen. I always warn owners of this possibility. I think the key think with feline endoscopy particularly is aiming to get to all areas. I would always biopsy from ilium and duodenum. If there was any concern about not achieving this, I would consider surgical biopsies.

2. I would actively avoid endoscopy if US demonstrated lesions beyond my reach… mid jejunum!

3. I would always consider surgical biopsies if there was questions regarding disease in other organs (liver and pancreas).

There are pros and cons to both endoscopy and surgery, but I will still consider endoscopy due to the less invasive nature.

Hope that helps.

Scott 🙂

Replying to Raquel M. 14/04/2022 - 14:09

Hello again.

The chemotherapy induced diarrhoea is a great question. Generally I would indeed treat as uncomplicated diarrhoea. There is not a uniform consensus on exactly how to deal with these cases. Generally, I would not be reaching for metronidazole, but I know some will in these cases. There is not not evidence to support the use of metronidazole in acute cases of diarrhoea. The following study actually demonstrated good results when treating these cases with medical clay:

Chemotherapy-induced diarrhoea in dogs and its management with smectite: Results of a monocentric open-label randomized clinical trial

Abstract
Chemotherapy-induced diarrhoea (CID) is a frequent chemotherapy adverse event in dogs. Yet, there is currently no consensus regarding its management. Smectite is a natural medical clay, widely used in the treatment of acute diarrhoea in humans. The objectives of this study were to assess the efficacy of smectite in the management of CID in dogs, and to collect epidemiological data on CID. For each episode of diarrhoea, dogs were randomized into two management groups: Smectite group, receiving smectite at 0.5 g/kg PO per day divided in two to three doses initiated at the start of CID; control group, without initial medication. In both groups, rescue metronidazole was prescribed if CID progressed or was not improved within 48 hours. Sixty dogs were recruited and received 426 chemotherapy administrations between June 2017 and March 2019. The incidence rate of CID was 110/426 (25.8%, 95% CI: 21.7%-30.2%), and significantly differed between the chemotherapeutic drugs administered (P < .001). Metronidazole was administered in 5/54 events (9.3%, 95% CI: 3.1%-20.3%) in the smectite group and in 40/56 events (71.4%, 95% CI: 57.5%-82.3%) in the control group (P < .001). The time to resolution of diarrhoea was shorter (P < .001) in the smectite group (median: 19.5 hours, interquartile range [IQR]: 13.5-32 hours) compared with the control group (median: 53 hours, IQR: 31.5-113.5 hours). The results of this study support the administration of smectite in the first-line management of CID in dogs. Often, the cases that do require antibiotics would be those that become significantly neutropenic. We have Katie (oncology specialist) joining us for later session and I will make sure to ask this question to her during the second live Q&A. Hope that helps. Scott 🙂

Replying to Rachel O. 09/04/2022 - 07:05

Hello.

Lovely to hear from you. Things have been so crazy in the veterinary world, we totally understand.

You should have access to the material for one year from the start date of the course.

If you have any problems accessing the material let me know.

I hope you are enjoying the course so far.

Scott 🙂

Replying to Raquel M. 12/04/2022 - 22:44

Hello.

Hope you are well. Really interesting questions!

Do you have a link to the lesson so I can have a look. Would be good to look at the references.

Scott 🙂