Alex Gough's Activities

When in Rome ...

Arlo Guthrie — Mon, 24 Feb 2020 14:21:07 GMT

[quote user="Gillian Mostyn"] Anyway...what did you think of Rome Arlo Guthrie? Any recommendations?[/quote]

Tangent of: RE: Coronavirus

Indeedy ...

All visits to Rome start with the Coliseum and the Arch of Constantine (click photos for better quality):

Hypopituitarism in a young cat

Alex Gough — Mon, 04 Mar 2019 14:32:14 GMT

Interesting case - any input/experience that anyone has had would be welcome.

8mo DSH cat, history of possible head trauma when a few weeks old (left alone with a young child who started screaming and crying, kitten was found recumbent, stupurous, blood around nostrils GCS10). Made a good recovery, but clinically was PUPD and had circling episodes - seizures or compulsive behaviour. Stunted growth.

Clin path - persistent mild elevation in ICa, phos normal 2.45,urea 16.3, SDMA 14, USG 1.020. low PTH and PTHrP, low normal Vit D. Basal cortisol 111. T4 6, TSH 0.044 (15-50). IGF low 22 (50-1000). MRI showed small pituitary with missing neurohypophysis. Good response to PUPD with a desmopressin trial.

So working diagnosis is pan (poly?) hypopituitarism, with partial central DI and pituitary dwarfism. With a normal TSH I'm presuming the T4 is non-thyroidal illness. Head trauma a red herring or a separate cause of the seizure like behaviour.

Plan is to check for hypoadrenocorticism with ACTH stim test, maybe think about alendronate for the persistent hypercalcaemia if not hypoadrenocorticim as the owner's last cat died of renal disease secondary to nephroliths from idiopathic hypercalcaemia.

Any other tests to run? Other treatments to consider? Specifically, porcine GH isn't available in the UK (we tried to import it but it seems to be available for research only). Human GH is reported to cause antibody formation in dogs - would the same apply to cats?

Any thoughts welcome, if not hope you enjoyed the interesting case.
Alex

Metrobactin dose

Alex Gough — Mon, 02 Jul 2018 16:15:12 GMT

What do people think about the licensed dose of metronidazole? we've got case in at the moment with severe neuro signs after several weeks of metrobactin at just under 50mg/kg SID. The data sheet reads: "The recommended dose is 50 mg metronidazole per kg body weight per day, for 5 to 7 days. The daily dose may be divided equally for twice daily administration (i.e. 25 mg/kg body weight twice daily)."

This is obviously off licence because of the duration of treatment, but I think a lot of vets are looking up the dose of metronidazole based on the licensed dose. 8th edition of BSAVA formulary says 15-25mg/kg q12 hours, but 9th edition follows the data sheet guidelines and says 25mg/kg q12 hours or 50mg/kg q 24 hours, but doesn't discuss duration.

I also saw another case which didn't have neurological signs, but had been treated with 50mg/kg BID based on a misreading of the data sheet - as the text mentions the drug being twice daily but then gives the daily dose in the weight tables.

We've reported the adverse reaction to the VMD.

If I've seen two problems in the last month, I wonder how many other cases are out there? Personally I never go above 15mg/kg q 12 hours

Cheers

Alex

Odd bicytopenia

Alex Gough — Tue, 19 Jun 2018 10:09:42 GMT

Any ideas about a 6yo FN cocker with non-regenerative anaemia and severe neutropenia.

Bone marrow comment is as follows:

INTERPRETATION
1. Megakaryocytes - No abnormalities detected
2. Myeloid series - Relative myeloid hyperplasia
3. Erythroid series - Relative erythroid hypoplasia with some support for
immunological destruction of late stage precursors.

We have found no evidence for a septic focus or neoplasms after a full body CT, and the dog was originally pyrexic but is normothermic on broad spectrum antbiotics. Dog is also extremeley well in herself, especially post blood transfusion (initial PCV was 13).

Coombs negative. No history of toxins or drugs.

Working diagnosis is immune mediated destruction of red cell precursors with concurrent immune mediated neutropenia. Any other ideas? Being treated with steroids and antibiotics, just like I was taught not to do at vet school!

Alex

Internal medicine job opportunity at Bath Veterinary Referrals

Alex Gough — Thu, 18 Jan 2018 16:14:04 GMT

We have a vacancy at Bath Veterinary Referrals for an internal medicine clinician. The job advert is as below. Please feel free to contact me informally on 01225 832521 or alex.gough@bathvetreferrals.co.uk to chat about the opportunity.

Alex

A vacancy for an internal medicine clinician has arisen at Bath Veterinary Referrals, to join the medical referral team. The position could be full or part time. The package includes 6 weeks holiday pro rata and competitive remuneration. Bath Veterinary Referrals is a well-established multi-disciplinary referral centre, and you will be working alongside an experienced team of colleagues taking referrals in internal medicine, cardiology, neurology, soft tissue and orthopaedic surgery and ophthalmology. Bath Veterinary Referrals is based at Rosemary Lodge Hospital in the World Heritage City of Bath, and boasts the equipment you would expect from an advanced referral centre such as on-site CT and MRI, video endoscopy and same day reference laboratory testing. The ideal candidate would hold a Diploma or equivalent qualification, but a residency trained or experienced certificate holding internist would also be considered.

Diet for hepatic encephalopathy

Alex Gough — Fri, 18 Aug 2017 14:43:16 GMT

What diet are people using now for hepatic encephalopathy, either prior to shunt surgery or as chronic medical therapy? I was aware it was controversial, and that in humans recommendations have changed, but the issue came to mind as my father has been in hospital with recurrent episodes of hepatic encephalopathy. I found a consensus statement of human hepatologists from 2009 that said that restricted protein diet was appropriate in certain cases of recurrent HE to reduce the severity and frequency of episodes, but my father's liver specialist said that thinking was outdated, and they recommend high protein diets now.

I suspect the answer is going to be, it's complicated...

Alex

methylmalonic aciduria

Alex Gough — Mon, 26 Jun 2017 14:29:01 GMT

Does anyone have any information about this condition? I have a 10 month Shih Tzu with a chronic history of intracranial signs, sky gazing and circling to the left as well as nystagmus. Ophthalomological examination was unremarkable. MRI of brain and CSF cytology were normal. Csf protein was mildly elevated. Routine bloods, toxo, neospora, distemper and thiamine levels were all normal. urine organic acid screening showed methlmalonic acid was 125 (0-9) and malonic acid was was 4 (0-1). I'm assuming this is sufficient to make the diagnosis of methylmalonic aciduria? If so, does anyone know anything about prognosis or treatment. There is very little in the peer-reviewed literature and virtually nothing on the VIN boards. It looks like in people low protein diets may be helpful.

Thanks for any help

Alex

Blind versus bronchoscopic BALs

Alex Gough — Fri, 25 Nov 2016 12:34:09 GMT

Interesting discussion yesterday on how to perform BALs in radiographically diffuse lung disease. For a probably asthmatic cat or a dog with probably chronic bronchitis (bearing in mind these may be different answers) are you more likely to a. perform blind BAL without bronchoscopy, b. perform bronchoscopy then blind BAL OR c. perform a bronchoscopic guided BAL.

Alex

Checklists

Alex Gough — Tue, 31 May 2016 14:23:12 GMT

Hi all,

Ive just read the rather inspirational Checklist Manifesto by Atul Gawande, which discusses the use of checklists in human medicine to reduce avoidable complications, and I want to introduce some into my practice. I'm sure we all have a number already, like admission forms, but things like the WHO safe surgery checklist have had massive effects on morbidity and mortality in human settings. Looking on VIN, it seems that some places use them, but there is little evidence for their use in Vet medicine.

If you arent familiar with the concept (and I recommend the book), checklists are not clinical guidelines, or attempts to enforce a standard of care, but cognitive aids to make sure the obvious but criticial tasks aren't missed (pre op bloods checked? Patient correctly identified? Appropriate pre-anaesthetic antibiotics given at the right time?).

I have found some helpful surgical and anaesthesia checklists adapted for vet use from the WHO guidelines on VIN. I wondered if people are commonly using checklists in their own practices, and if so, which ones, and would you share with the group?

I was intending to produce checklists for pre-medical procedures involving anaesthesia eg endoscopy, one for chemotherapy and one for euthanasia. These would be Do-Confirm style checklists. I might try to make a simplified CPR one which would be Read-Do style. Does anyone have any other ideas for checklists?

Alex

Veterinary Homeopathy

Alex Gough — Thu, 26 Nov 2015 15:35:17 GMT

You may be aware that (by coincidence) two petitions to the RCVS on the subject of veterinary homeopathy have been launched simultaneously. One of these, the Campaign for Rational Veterinary Medicine, has had input and support from two SamSoc members, myself and Martin Whitehead. This petition calls for the RCVS to give a position statement on homeopathy, to require homeopaths to abide by ASA regulations, and to require veterinary homeopaths to get owners to sign consent forms that outline the RCVS' views on the ineffectiveness of homeopathy. This petition can be found here

The other petition, which is open to the public and calls for a full ban on veterinary homeopathy can be found here

The petitions are not mutually exclusive and you can sign one, both or neither. Hopefully most SAMSoc members are evidence based medicine proponents, hence why I thought I would bring this to your attention.

Alex

Word of the day: Iatrotropism

Alex Gough — Thu, 29 Oct 2015 17:28:32 GMT

Iatrotropism, or the degree to which individuals are inclined to seek medical attention, is quite obviously one of the most important determinants of outcome in patients with treatable medical problems.

http://www.medicalmediareview.com/iatrotropism-and-related-neologisms/

Dentistry - good for your bottom?

Alex Gough — Fri, 31 Jul 2015 09:33:59 GMT

Sorry, couldn't resist while waiting for next appointment to arrive:

VetSurgeon.org

Fri, 26 Sep 2008 08:06:51 GMT