scott@vtx-cpd.com

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 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 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 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
Hypoadrenocorticism

I 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 🙂