HMC's Activities

Amoxyclav in neonatal puppies

HMC — Tue, 29 Dec 2020 17:50:32 GMT

Hi,

Just wondering if anyone has experience of using Synulox in pups the day they are born as a course of the palatable drops in the event of some of the litter being stillborn.

This is not something I have prescribed, just reading a history.

Thanks,

Hannah

Guine pig abscesses

HMC — Wed, 11 Nov 2020 13:37:48 GMT

Hi,

I have been treating a guinea pig that has now had 2 abscesses of unknown cause. I just wondered if anyone is aware of it being possible for the cause of dermal abscessation in a gpig being ingrown hairs in a whorl?

The first abscess was present for months and grew huge (10cm diameter) and was treated surgically by debriding as much as possible then manuka and baytril. This was on the rump, with a large whorl around it.

The second abscess I have just removed today by en-bloc excision (it was much smaller at 10-15mm). This abscess was slightly more cranial than the first and does not appear to be attached to the original. And interestingly, this abscess was sited right where the hairs change direction. Of course this may be a coincidental finding in that gpigs have many places where the hairs change direction. But I was thinking along the lines of Rhodesian Ridgebacks having infected dermal cysts along the dorsal midline. With neither abscess was there any known skin trauma.

I have kept the abscess in formalin (with part of it removed and stored in the freezer for capsule culture) but the owner's finances will not stretch to sending these off.

Just wondering!

Thanks,

Hannah

Oral ranitidine alternative for rabbits

charlievelyn — Wed, 15 Jan 2020 15:29:49 GMT

The oral ranitidine we use for bunnies is currently in a supply shortage and I am tasked to find an alternative that we could easily dispense (e.g. for owners to give at home). We still have injectable ranitidine available.

Oral metoclopramide was my next choice. Unfortunately, I've been told that for our level of use it would be uneconomical for my practice to keep it as a stock item and we would need to order a whole bottle for individual clients (£76 + VAT).

Does anyone have any good suggestions for an alternative or know where I could source oral ranitidine/cheaper oral metoclopramide? I have emailed and asked Richard Saunders this week via our RWAF membership but no reply yet (will update when I do have one!). I was even wondering whether we could use the SC ranitidine PO, if anyone has any opinion or knowledge on this? Alternatively does anyone have any experience with cimetidine or others?

Many thanks in advance for any help!

Ethanol as a diluent in medicines

HMC — Wed, 15 Jan 2020 16:24:52 GMT

Hello,

I have just ordered in a paracetamol suspension and found that it has 3.7% v/v ethanol. Seeing as this dog is very sensitive to buprenorphine (owner very upset at seeing the dog ataxic) and she is already on pregabalin, and the very reason I wanted to prescribe paracetamol is that it is generally very well tolerated... I feel a bit doubtful.

It needs to be a suspension rather than a tablet as the dog weighs <3kg.

Does anyone have any thoughts on this? The starting dose would be 0.6mls of 3.7% ethanol in a 2.9kg dog.

I'll see if there are any preparations without ethanol available.

Thanks,

Hannah

Odd rabbit case with seizures and periocular alopecia

HMC — Mon, 05 Aug 2019 14:02:31 GMT

he full

Hello,

I have an odd case and I just wanted to see if anyone has come across similar or who has any other ideas!

4 month old Lionhead rabbit ME. Had a seizure a month ago so prescribed fenbendazole 28 day course for E. cuniculi. Unfortunately prescribed Panacur rabbit at 1 syringe graduation per day ie 2.5kg dose when weighed <1kg. Had another seizure 1 week ago and bloods taken. Only able to run biochem as not enough blood obtained: and liver parameters slightly deranged:

Total Protein

59.6

g/l

50.0 - 71.0

Albumin

42.5

g/l

27.0 - 36.0

Total Globulin

17.1

g/l

20.0 - 33.0

Urea

6.3

mmol/l

9.0 - 22.0

Creatinine

umol/l

54 - 150

1271

U/l@37C

140 - 372

Triglycerides

1.47

mmol/l

1.40 - 1.80

AST

U/l@37C

5 - 50

Gamma GT

6.0

U/l@37C

0.0 - 5.0

My opinion is that the liver derangements are more likely to be due to the fenbendazole rather than intrinsic liver disease as the rabbit was perfectly well in between seizures (ie I would expect more signs if truly liver dz). And this makes me concerned as (from my reading) fenbendazole can suppress the bone marrow to a fatal degree and it can take 30 days from cessation of treatment to manifestation [Graham et al. (2014)] ie things can still be getting worse for him.

He then developed a periocular alopecia and my ddx list for this is:

1) previously latent dermatophytosis causing clinical disease due to stress on the body caused by the seizures/fenbendazole.

2) idiosyncratic drug reaction

3) fenbendazole affects rapidly dividing cells, so whilst periocular alopecia has not been reported [that I could find] with fenbendazole, and whilst the distribution is odd, consider fenbendazole toxicity.

So, concerned re option 3, I repeated the haematology thinking an anaemia should be developing if this were the case. Manual PCV was 38% (essentially wnl) and the full haematology is pending.

Regarding the ongoing seizures despite fenbendazole, my DDx list is:

1) persistent granulomas from E. cuniculi causing c/s.

2) not E. cuniculi

3) fenbendazole not 100% effective.

It is unlikely that he was reinfected by Ec spores as the owner has been disinfecting the environment repeatedly.

In case the seizures were due to microabscesses, I prescribed sulfatrim at the standard dose. He had a white nasal discharge when the owner first bought him, which was treated with a 5 day course of enrofloxacin, and appeared fully resolved. So there seemed adequate reasoning to prescribe antibiotics.

Now, he is lethargic and sleeping a lot. I have not seen him back since the owner described him as lethargic but my colleague has and was happy with him clinically (this was the point we did the manual PCV). The owner did describe him binkying at the weekend ie when he was lethargic, so for me that may introduce an element of doubt as to how lethargic he is.

I discussed doing E. cuniculi antibody titres with the owner and decided that: if it were positive, we cannot tell if the treatment has been effective or not, just that he has come into contact with Ec; if negative then he is a young rabbit so may not have had adequate opportunity to develop sufficient titres. So... I decided that the best use of serology would be paired titres. I have not yet managed to persuade the owner to pay the £220 for this so this has not yet been done.

My plan going forward is:

- await haematology

- monitor clinical condition closely

- call Virbac re the sulfatrim and see if lethargy has been reported before

- continue to hope the owner will let be do paired serology (or MSD may pay; this is pending also).

- repeat biochem/haem in a fortnight.

E. cuniculi is a pet topic of mine and I hope you can see I have put a lot of thought into this case !! However I have never seen periocular alopecia in a rabbit.

Any thoughts?

Thanks,

Hannah

Umbrella companies

HMC — Thu, 16 May 2019 13:13:53 GMT

Hi,

Can anyone recommend an umbrella company for locum work? I know that this is not a very financially efficient way for me to get paid but the practice does not want me to be self-employed, nor zero hours and I'm only doing a few shifts for them so I don't want to set up a limited company.

Thanks.

VetSurgeon.org

Sat, 20 Feb 2010 11:05:41 GMT