scott@vtx-cpd.com
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Replying to Natalie H. 06/04/2022 - 10:01
Hey.
The most evidence is actually for budesonide foam. It is used mostly in humans for ulcerative colitis:
https://pubmed.ncbi.nlm.nih.gov/32189103/
There is not data in dogs. I would consider this as an option in very refractory cases of colitis and proctitis. The biggest issue with this treatment is the tolerance of the patient!
Replying to Hannah B. 23/03/2022 - 17:25
Hello.
Thank you for your question. I hope you are having a lovely week. I popped the following information on our members forum and I thought it might be helpful:
”Cats with chronic upper respiratory disease/rhinitis can sometimes be really challenging to treat and become very congested. There are no scientific studies to support and describe the use of intranasal maropitant citrate, and this would be off-label use. The described use is done by diluting 1ml of maropitant to 9ml of saline (10% dilution) and using this as an intranasal drop. Most individuals that report anecdotal response are using 1-2 drops daily or every other day.
The use of intranasal maropitant for cats is generally reserved for those with severe rhinitis (nasal congestion/inflammation), as maropitant is thought to directly target inflammation. Maropitant is a neurokinin-1 (NK1) receptor antagonist that acts in the central nervous system by inhibiting Substance P. Though maropitant is labeled for use to control vomiting, substance P has been documented to be released in the respiratory tract following inflammation or irritation.”
Hope that helps.
Scott 🙂
Replying to Sybil Dryburgh 23/03/2022 - 13:34
Hey.
Great question. I will try and find some supporting literature. Furosemide certainly has more than just its diuretic effects.
I will also ask Liz to comment as she has lots more experience with this drug.
Scott x
Hello
For the chronic cases I currently use Vivomixx, as it is the same composition as what used to be VSL#3, which has the most evidence attached. This is also, as Sivomixx is currently not available for shipping to the UK, they have some licensing issues. Also, Vivomixx can be at room temperature for up to 7 days, which makes posting easier, but then it should go back in the fridge. Dosing is a bit arbitrary, but I’ve attached the dosing guide for Sivomixx, which I use as a guide for Vivomixx as well.
Hope that helps.
Scott 🙂
Replying to Lesley M. 10/03/2022 - 23:02
Hello.
Did this one ever come back and see you?
Scott 🙂
Replying to Raquel M. 24/03/2022 - 16:32
Hey again!
I have shared this paper before, but I think it also supports the chat we have having about prophylactic omeprazole use:
https://pubmed.ncbi.nlm.nih.gov/34337965/
Hope that helps.
Scott 🙂
Replying to Raquel M. 24/03/2022 - 16:32
Hey.
This is a slightly tricky one. I would definitely never use omeprazole in this prophylactic way and I would not start omeprazole so that NSAIDs could be started again.
However, as always, if a NSAID causes an ulcer, then omeprazole is totally appropriate and the NSAID discontinued.
I think in this case it is not clear that there was an ulcer. I would definitely not stop start the NSAID with omeprazole in-between.
Could you consider an alternative in this case for the OA pain:
https://www2.zoetis.co.uk/products-solutions/dogs/oa-pain/librela
Have you used a lot of Librela?
I am sorry that is not a very definitive answer, it is a tricky one.
Scott 🙂
Replying to Raquel M. 24/03/2022 - 16:32
Hello.
I hope you are well. I have popped the first part of your question below so I do not miss anything:
”A colleague had discontinued NSAIDs in a dog on long term nsaid use for arthritis throughout his elbows and hips. He had discontinued it because after questioning the owner had reported that the dog had been eating grass for the last few months. The dog had been doing really well on multimodal pain management along with the NSAIDs. I wasn’t aware that eating grass was a clinical sign of nausea or indication of GI ulceration from NSAID use. Are you able to shed some light on this? Is this something I should questioning owners about or is this something unproven?”
Eating grass can indeed be a clinical sign of nausea, but it is really non specific. They can obviously eat grass for lots of other reasons. Again, you could see this with ulceration from NSAIDs secondary to nausea. It is a fine line to walk as you would obviously not want to continue NSAIDs in a dog that was developing ulcers. I would have considered a couple of days of anti-emetic therapy first and see what kind of response there was. Abdominal ultrasound may also be useful for ulceration, although small ulcers are difficult to detect. You could possibly consider faecal occult blood testing as another way of looking for ulceration/bleeding.
Overall, this is not something I would routinely be asking owners about but could flag up the possibility of nausea.
Scott 🙂
Replying to Katerina N. 10/03/2022 - 11:42
Hello Katerina!
I hope you are safe and well and enjoying the course.
Sound like a brilliant approach to me!
Scott 🙂
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 🙂
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