scott@vtx-cpd.com

Replying to Ursula Lanigan 06/03/2022 - 22:54

Hello.

I think in any cases like this where there is heavy bleeding from the abdomen, there may indeed be an indication for TXA. The only possible contraindication would possibly be bleeding that was coming directly from a kidney (e.g. idiopathic renal haematuria). The issue here might be that if there is bleeding directly from the kidneys and we encourage clot formation with TXA, blot clots could get stuck in the ureters and cause a ureteric obstruction.

Hope that helps.

Scott

Replying to Raquel M. 17/03/2022 - 12:39

Hello Raquel.

I hope you are safe and well. Thank you so much for your question. I have popped your question below so I did not miss anything!

”Just curious as to when in the diagnostic process, would you recommend this? Is it after ruling out surgical disease? Is it when the vomiting is recurrent or chronic? Is it when there’s relapse of clinical signs of vomiting whilst on a treatment plan that worked before. Or relapse of clinical signs as soon as treatment ends?
And what criteria do you use to define when a case moves from an acute onset vomiting to chronic?”

Folate and cobalamin is probably not that helpful in cases of acute vomiting and diarrhoea. Even in cases where you have ruled our surgical disease, if the symptoms are still quite acute ( a few days) then I would not consider folate and cobalamin. Cobalamin may be of use in cases of relapsing or recurrent signs as some patients with GI disease will not respond so well to treatment when folate is low. Cases of vomiting and diarrhoea become truly chronic after about 2-3 weeks and all chronic cases would benefit from folate and cobalamin.

Hope that helps.

Scott

Replying to Hannah B. 15/03/2022 - 16:20

Hello Hannah.

I hope you are safe and well and enjoying the course. Regarding the maropitant; I am really happy using this longer-term if necessary. In the majority of cases the need for antiemetic therapy is less when the underlying problem is sorted out. If I am sending patients home with oral maropitant, it is normally not for more than 7 days. I must admit I often do 4 days as that suits the box sizes. The box size definitely does not indicate maximum length of dosing. Below is some data from Zoetis. I have the feeling this is unpublished data, but I have contacted a pal at Zoetis to see if I can get more information:

https://www.zoetisus.com/products/pages/cerenia/extended-therapy.aspx

I am really happy using oral maropitant longer term in cases that need it. I think the best example of this is chronic renal disease patients. Sometimes I will do every other day dosing, but if they need it, they need it!

Hope that helps!

Scott

Replying to Emma S. 09/03/2022 - 14:57

No problem!

Let me know if I can do anything to help!

Scott

Replying to Nathalie Cunha 09/03/2022 - 12:38

Hello again!

This is another interesting paper. Basically, the time to ulcer formation can vary, but can be quite quick. Again, it depends a bit on the comorbidities:

https://pubmed.ncbi.nlm.nih.gov/34596276/

Regarding the spinal patients… we will crack that open in lesson three!

Scott

Replying to Nathalie Cunha 09/03/2022 - 12:38

Hello.

I hope you are well. Thank you so much for the questions. Regarding the NSAIDs. I think I depends a little. It can happy within a few days, and this might be associated with co-morbidities. I actually found this recent case series which I think is really interesting. I never think of colonic perforation as a possibility. In all of these cases the perforation happened quite quickly after starting NSAIDs:

Colonic perforation in 4 dogs following treatment with meloxicam
Mark J Longley 1, Stephen J Baines 2, Guillaume Chanoit 3

Abstract
Objective: To describe the clinical findings and treatment of 4 dogs that developed colonic perforation shortly after meloxicam administration.

Series summary: Three cases were treated with meloxicam for variable nonspecific signs including lethargy and pyrexia. Hemorrhagic diarrhea developed following meloxicam administration in 2 cases. Gastrointestinal perforation was suspected on diagnostic imaging leading to exploratory celiotomy in all 3 cases. Partial colectomy was performed in 2 cases and suture repair with serosal patching in 1 followed by broad spectrum antimicrobials. All 3 dogs recovered from surgery well. One dog that had undergone perineal herniorrhaphy and received meloxicam perioperatively collapsed and died 7 days postsurgery. Postmortem examination revealed ulceration and perforation of the ascending colon with resultant generalized septic peritonitis. Histopathologic findings in all cases showed full thickness infiltration of the colonic wall with inflammatory cells along with ulceration and perforation. Thrombosis of vessels underlying the ulcerated areas was also noted.

New or unique information provided: This report suggests that colonic perforation may be a complication of nonsteroidal anti-inflammatory drug use in some cases. To the authors’ knowledge, this has not previously been described in dogs. Colonic perforation associated with NSAIDs administration may be more commonly identified in dogs with concurrent morbidities. Caution may be warranted when using NSAIDs in dogs with colonic pathology or possible risk factors to develop such pathology. Prompt diagnosis and treatment is essential for a positive outcome.