Christopher Saul's Activities

Oral ondansetron anyone?

Christopher Saul — Fri, 23 Jan 2026 16:04:03 GMT

Hello everyone, I was just wondering if anyone has any experience in using oral ondansetron to manage chemotherapy-related nausea in an out-patient setting. It is generally accepted that oral bioavailability is poor, though one paper (Burke et al, JAVMA, 2022) seemed to suggest that orally administered ondansetron reduced the incidence and severity of nausea in dogs administered hydromorphone, ACP and glycopyrrolate.

Does anyone have any real world experience of the drug given orally?

Many thanks indeed

Chris :-)

Chemotherapy choices for multicentric B cell canine lymphoma

Christopher Saul — Tue, 08 Oct 2024 15:39:58 GMT

Dear all and a happy Tuesday!

I was wondering if that, given the overall economic climate we find ourselves in, anyone is doing the 15 week version of CHOP as their first line protocol? This version, published about 10 years ago by Burton et al, essentially omits the second vincristine from each of the 4 cycles. I have always personally used the 19 or 25 week versions but increasingly I find clients struggling with the cost of all 16 treatments.

It has made me think that maybe this is something we could do to lower costs for our clients and made me wonder; is anyone doing this as a routine? If so, what are your experiences??

Thank you all,

Chris :-)

Any UK laboratories recommended for investigation of a possible muscular dystrophy?

Christopher Saul — Fri, 05 Apr 2024 16:12:28 GMT

Hello all,

I have an 11 month old miniature poodle cross in whom I'd developing an increasing index of suspicion for some kind of muscular dystrophy. I haven't seen a case in such a long time and I was wondering - are we best sending muscle biopsy samples to Dianne Shelton in San Diego or are there any UK based laboratories with a similar reputation?

Many thanks indeed.

Have a good weekend everyone!!

Pancreatitis and Cocker Spaniels

Joshua Bleakley — Fri, 08 Dec 2023 19:20:59 GMT

I apologise if this has been covered before and in advance I have not actually met this dog yet!

I have a part referral (friend of a friend) coming to me for an ultrasound for possible pancreatitis. It is a 4yr FN Cocker Spaniel that regularly competes at agility. She presented with abdominal pain, not quite inappetence but less interested in food and lethargy. There was no inflammatory marker on the bloods and the only abnormalities were the lipase and spec cpli being raised (both around 550 with ref range being less than 200). Triglycerides and cholesterol were slightly raised.

Obviously, from many previous discussions, if it is pancreatitis I am concerned about a possible immune component with a Cocker spaniel. Other than looking for dry eye would anyone recommend anything else that I should look for other than the usual abdominal scan for other causes and for pancreatitis. Would you automatically go for steroids (and if so what dosage) in Cocker Spaniels or treat as a normal case for now if signs are mild.

Thanks for any help as usual!

Joshua Bleakley

Dexcom G6

Christopher Saul — Thu, 18 Jan 2024 10:30:21 GMT

Hello all and happy new year!!!!

Just a random thought I've been having, not attached to any particular case .... does anyone use Dexcom G6 for continuous glucose monitoring of diabetics? I just wondered if anyone uses it and if so, how does it compare with Freestyle Libre 2?

Many thanks, best wishes,

Chris :-)

Semintra vs generic telmisartan in dogs

Christopher Saul — Thu, 09 Nov 2023 18:50:00 GMT

Hello all,

I'd like to ask a quick question about what form of telmisartan most people use in dogs (e.g. for the treatment of renal proteinuria).

My interpretation of the cascade is that, as we have telmisartan licensed for cats, we should - at least where the volume is practical - use Semintra as a step 3 product over a generic form. However, the volume can be impractical, especially for anything larger than a small dog. Also the cost can be prohibitive.

Do you all tend to reach for the Semintra or generic telmisartan for dogs?

If you use Semintra for small dogs and telmisartan for large, what size do you tend to use as a cutoff?

Or, do you ever use other ARBs (e.g. losartan?)

I'd be interested to hear what people's opinions are.

Many thanks

Chris :-)

Pyridostigmine supply

Fiona Allsop — Wed, 05 Jan 2022 21:04:14 GMT

A colleague is trying to source some pyridostigmine but is finding that BVOA are unable to supply it. Does anyone have any advice on where else to obtain it?

Thank you

Arterioportal fistula in a young adult labrador retriever

Christopher Saul — Tue, 01 Nov 2022 10:24:02 GMT

Dear all, I’d be really grateful of any thoughts on this unusual case.

Sandy is a 1year 2m female (entire) Labrador retriever who initially presented to her referring vet around 2 months ago with watery diarrhoea and vomiting; they treated her with anti-parasitic treatments then a series of empirical antibiotics (co amoxiclav > MTZ > enrofloxacin); the diarrhoea improved somewhat (but faecal quality never completely resolved. There was a period of resolution of clinical signs but she was referred to me recently with marked intermittent dullness, lethargy, watery diarrhoea and vomiting.

Physical examination abnormalities included:

-slightly altered mentation – she was initially bright but unless stimulated would randomly ‘zone out’ and appear mildly obtunded until roused again by normal stimuli. There was a mild but noticeable head tremor.

-Mild cranial abdominal discomfort on palpation.

-Evidence of mild dehydration.

The remainder of the exam was unremarkable.

Investigations

Venous blood gasses / electrolytes were unremarkable except for a borderline/marginal hypokalaemia.

Biochemistry was unremarkable except for a low urea.

Haematology was unremarkable except for a mild (Hct 37% after rehydration) non regenerative anaemia.

Basal cortisol was low but ACTH stim revealed normal adrenal reserve.

B12 and folate were both very low; TLI excluded EPI.

BAST was essentially normal with only a very borderline increase in post prandial BA ( 0.4 and 25 umol/l)

She was treated supportively with anti emetics, IV fluid therapy (including potassium supplementation) and analgesia; the following day she was somewhat brighter with the head twitch being slightly less noticeable.

Given the low urea and neuro signs, a PSS was suspected and a CT scan performed. Changes included an arteriovenous malformation with an intrahepatic left medial-divisional conformation, with multiple acquired portal collateral circulation, including oesophageal, gastric and colonic varices. There was mild- to moderate peritoneal effusion, secondary to portal hypertension. Gastric wall thickening consistent with gastric oedema. Mild pancreatic changes suggesting pancreatic oedema. Mild to moderate abdominal lymphadenopathy, likely secondary to ascites.

My questions:-

There is a small case series describing coil embolisation of the mesenteric arterioportal fistule in two corgis. Does anyone have any experience with this procedure, or know if there are any centres in the UK that might offer it?

Regarding medical management – I have already commenced treatment with cobalamin supplementation and the use of a highly digestible diet, gastroprotectants, low dose MTZ, lactulose (to be used once the diarrhoea is controlled) and I plan to use spironolactone to control the ascites.

What do you think about the possibility of HE in this patient… The post prandial bile acids do not support hepatic functional loss but is HE still possible with a normal BAST or is it likely I’ve missed peak GB contraction here? Should I continue with treatment for HE?

I believe that losartan has been used in humans to lower PVP without causing significant systemic hypotension – do you think telamisartan might be worth a try?

Can you think of any other treatments that might be helpful?

Any thoughts would be gratefully received,

Thank you in advance,

Chris

Medicine Locum Help

Christopher Saul — Fri, 10 Dec 2021 18:42:29 GMT

Dear friends,

Due to one of our much loved colleagues being on longish term (we hope this is temporary as we wish her well for a full recovery) sick leave, an opportunity has arisen in the medicine department of our multidisciplinary referral hospital in the north west of England. Our medicine department is busy with a varied caseload and our hospital is well equipped with a 1.5T MRI and a 64 slice CT scanner, and we have certificate and diploma holding colleagues in Dermatology, exotics, medicine, cardiology, imaging and surgery.

We would love to talk to applicants for part or full time work – anything would help! The position may suit someone who is preparing for residency exams; but we would very much welcome applicants with any level of referral experience working in small animal medicine / oncology.

If you would like any more information please DM me via this site or email

chris.saul@rutlandhousevets.co.uk

I would love to hear from any potential colleagues.

Happy weekend everyone!!

Freestyle Libre

Christopher Saul — Fri, 25 Jan 2019 12:51:09 GMT

Does anyone have a reliable source for freestyle libre at present? I understand the sensors are available at pharmacies (though out of stock at the moment near here) but my owner doesn't have a smartphone. I need to get hold of a reader; does anyone know where I can get these? thank you so much

Ursofalk

Christopher Saul — Thu, 27 Sep 2018 16:02:50 GMT

Hello all,

I was wondering what people's thoughts were on the use of the liquid suspension of UDA for the treatment of very small animals. I have an owner of a 4Kg dog who is receiving UDA in the form of destolit tablets. She has asked me if there is a liquid version available as she struggles with tablets.

Ursofalk, the liquid preparation, contains xylitol as an excipient. By my calculation if you give 10mg/kg UDA, you would end up giving around 0.05g/Kg xylitol, which though is well below the hepatotoxic dose is close to the dose expected to be at risk of causing hypoglycaemia.

I am reluctant to use this preparation for this reason. Does anyone have any experience of Ursofalk?

Many thanks in anticipation of your thoughts

best wishes,

Chris

Revisiting an old conversation - trilostane initiation

Christopher Saul — Sat, 12 May 2018 13:41:06 GMT

Hello all,

I thought it might be interesting to revisit an old thread from a few years ago on here...

https://www.vetsurgeon.org/associations/samsoc/f/64/t/1397.aspx

In view of more recent evidence (e.g. the Arenas paper), I got wondering what people are doing these days. The advice in Ettinger has been revised for the 8th edition and is as follows:-

"An initial dose of 0.5-1mg/kg PO twice a day is recommended. Once-daily protocols (1-2mg/kg) should be reserved for owners who refuse the q 12h alternative."

Of course there are potentially cost and owner compliance implications to twice daily dosing, so - I got to wondering what folks are doing on induction nowadays - is twice daily the norm? Or do you attempt once daily first and move to twice daily if there is insufficient control on once?

thanks for your opinions,

Chris

Some more food for thought; how about another conversation thread?

Christopher Saul — Mon, 19 Feb 2018 23:45:25 GMT

Dear all,

Having seen the rather excellent recent discussion on IMHA, I thought I’d have a go at starting a conversation myself - again just with the purpose of stimulating some conversation.

I was wondering what are people’s opinions regarding the use of different dosing regimes for large vs small dogs when giving cytotoxic or immunosuppressive drugs.

The most obvious example is doxo/epirubicin. Some clinicians dose dogs under 15Kg at 25mg/m^2 whereas others use 1mg/Kg. However with other similarly or more myelosupressive drugs there are no well documented protocols for smaller dogs (I’m thinking particularly about mitoxantrone and carboplatin here).

To me it seems very arbitrary and there is little consensus on what we are doing wth these drugs.

What do people think about this?

When dosing a small dog with doxo- or epirubicin, do you use 25mg/m^2 or do you use 1mg/Kg?

Do you use lower dose rates for smaller patients when giving carboplatin or mitoxantrone? What dose rates do you use?

And what about immunosuppressives? do you use prednisolone at 40mg/m^2 or do you use 2mg/Kg?

Should we be trying to come to some sort of consensus with these - should we dose all dogs <15kg according to bodyweight and dogs >15Kg on a BSA basis?

anyway just food for thought; I’d be interested to see what folk think on this.

Chris

Job opportunity: Referral clinician in Internal medicine and oncology at Rutland House Referrals in St Helens.

Christopher Saul — Thu, 11 May 2017 16:55:02 GMT

Due to ongoing expansion of our service, an exciting opportunity has arisen for a third colleague to join our medicine and oncology department. Although the ideal candidate would hold a diploma in internal medicine or oncology, we also would be keen to hear from experienced certificate holders , board eligible clinicians or someone wanting to work towards a medicine/oncology qualification in referral practice.

You will be working alongside an ECVIM-CA diploma holder in oncology and an experienced RCVS advanced practitioner in internal medicine. Your duties will include seeing cases in both general internal medicine and oncology. You will be given complete clinical freedom and not be bound by strict corporate rules on prescribing or laboratory choices. Our busy caseload is very wide and varied and you will never be bored!

Our hospital is already well equipped with in house CT, video endoscopy, digital radiography, Doppler ultrasound, a dedicated chemotherapy suite and visiting MRI, but we are about to have an extension that will include in house MRI and an ICU. Other departments include cardiology, soft tissue surgery, orthopedics,ophthalmology, dermatology and exotics as well as visiting diagnostic imaging and anesthesia.

We have an exceptionally friendly and welcoming team of nurses, auxiliary nurses, interns and other support staff. You can expect a generous salary and CPD allowance.

Rutland House Referrals is well situated on the motorway network, with very easy connections to the vibrant cities of Liverpool and Manchester, the typically British countryside of Lancashire and Cheshire as well as the stunning mountains of the Lake District and North Wales. Two international airports are within half an hour’s travelling time, and London is less than two and one-quarter hours by train.

For informal inquiries or to apply for the position please email our practice manager Janie Clare on janie.clare@rutlandhousevets.co.uk.

Oral cobalamin supplementation

Christopher Saul — Tue, 02 Aug 2016 13:22:30 GMT

Hello everyone,

I was wondering what people's experiences are with oral cobalamin supplementation in dogs. I have a hypocobalaminaemic GSD (suspected to be secondary to a chronic inflammatory enteropathy) who is aggressively needle shy; I was hoping to use an oral alternative for him.

The Torreson et al paper in January's JVIM suggests doses of 1mg cyanocobalamin orally once daily for larger dogs; as far as I can see cyocobalamin tablets are only readily available in 50ug tablets; hence 20 tablets per day which seems a little impractical.

Does anyone else supplement with cobalamin orally? What preparations do you use?

Many thanks everyone

Chris