Strange Parvo case?

Re: Strange Parvo case?

Kate Richardson — Wed, 18 Apr 2012 12:07:58 GMT

[quote user="Anthony Todd"]

[quote user="Kate Richardson"]I have seen a lot of dogs recently with mild to moderate gastroenteritis which seem to improve with symptomatic treatment but won't eat, and when scanned to asses further have had moderate to marked gastric dilation due to fluid build up and poor motility, no evidence for FBs, so started metoclopramide to stimulate motility and they have all recovered well. If there is reduced motility then obviously need to give meds by injection until motility restored so may need to stay in hosp unless owners happy to bring back and forth regularly.[/quote]

Don't want to prolong this but the above early post seems at odds with the last few??. Another post suggested Cerenia.

[/quote]

These cases all had gastroenteritis- vomiting and diarrhoea typical of a viral infection. Completely different cases. Gut motility needed stimulating in these cases to aid return to normal function.

So please don't quote me out of context and criticise a case where you don't know all the details. I was just simply trying to illustrate a point about the motility effects of metoclopramide.

Re: Strange Parvo case?

Anthony Todd — Wed, 18 Apr 2012 01:03:50 GMT

Don't want to prolong this but the above early post seems at odds with the last few??. Another post suggested Cerenia.

It looks as if the FB [what was it by the way?] was not detectable by any imaging or palpation. [KFC corn cobs are the classic, very palatable but undigestible; can they be picked up with ultrasound cos I could never see them for sure on Xray or by palpation??]

All I will add, finally, is that an early ex lap, if metoclopramide hasn't resolved the vomiting in 24 hours, should be urgently considered in the absence of other definitive diagnoses and, in that scenario, metoclopramide acts as a diagnostic prompt.

"Mmmm, there may be more to this, We'd better open it up sooner rather than later"

Do all the imaging you like; there'll be ones that slip through if you don't, and this one shows it.

Thank goodness an ex-lap was finally performed and the outcome was good.

Re: Strange Parvo case?

Kate Richardson — Tue, 17 Apr 2012 19:55:08 GMT

[quote user="Anthony Todd"]Ok then, the motility effects of metoclopramide caused the claimed complication ie if metoclopramide hadn't been given the FB would have, by this logic, stayed in the stomach [and the intermittent vomiting continued?.....][/quote]

And like I said, an ex lap was lined up for this dog anyway as the next step in investigating the problem and would have led to a gastrotomy rather than an enterectomy. And for the record I am NOT claiming the motility effects of metoclopramide as a complication!

Re: Strange Parvo case?

Anthony Todd — Tue, 17 Apr 2012 15:37:15 GMT

[quote user="Kate Richardson"]To be fair it wasn't a case of a claimed complication, it was an illustration of the motility effects of metoclopramide.[/quote]

Ok then, the motility effects of metoclopramide caused the claimed complication ie if metoclopramide hadn't been given the FB would have, by this logic, stayed in the stomach [and the intermittent vomiting continued?.....]

As for the "diagnostic" use of metoclopramide I say, and one other has agreed, that if a dog vomits after 24 hours of the drug then it indicates that further investigation is needed and an exlap, in the absence of other signs,even if negative, may be the most definitive next step and should be done earlier rather than later.

"Diagnosis" is too final, but it separates the harmless vomiting from the ones that are potentially more serious so helps the diagnostic process.

I'd rather do an ex lap on a dog vomiting intermittently for 13 days and find nothing, than wait longer and end up with an enterectomy.

Re: Strange Parvo case?

Kate Richardson — Tue, 17 Apr 2012 14:11:51 GMT

[quote user="Anthony Todd"]

In the claimed complication following from metoclopramide the dog had been vomiting on and off for a fortnight [!!] surely some warning bells should have rung earlier.

To blame it on a shot of metoclopramide is stretching it a bit, I think.

[/quote]

To be fair it wasn't a case of a claimed complication, it was an illustration of the motility effects of metoclopramide. There are plenty of causes other than foreign bodies of intermittent vomiting for periods of a fortnight or longer- I am sure many of us have performed an ex lap on a dog with a strong suspicion of a FB only to find nothing and I don't think that an ex lap should be used as a diagnostic tool without good evidence to suggest it is warranted. " Warning bells" started ringing when signs of an obstruction developed- post metoclopramide. It was just too much of a coincidence that it obstructed when it did.

Re: Strange Parvo case?

Martin Atkinson — Tue, 17 Apr 2012 13:25:40 GMT

OK so this is me playing Devil's advocate a little but on the vaccine argument: were these dogs reported with mild symptoms of CPV vaccinated against Coronovirus? It is known that CoV exacerbates CPV infection - maybe the CoV vaccine worked better than the CPV vaccine!! I wonder if the really nasty cases we used to see years ago also had CoV (we didn't/couldn't test for CoV then) and that is what made them so nasty whereas perhaps dogs that don't get CoV concurrently - would the symptoms of CPV be less serious? Who also tests for CoV when doing a test for CPV? I have sent faecal samples away for PCR tests in chronically squity dogs and a number have come back positive for CPV even though I've not suspected it as a causal agent in those cases. With that in mind maybe the case in the OP was a false positive or maybe less-virulent strains of CPV are present. Food for thought.

Re: Strange Parvo case?

Simon Neuhoff — Tue, 17 Apr 2012 10:07:24 GMT

Having used Cerenia in confirmed parvo cases I can tell you that it does not eliminate vomiting completely - some will vomit quite frequently still. I do think it works much better than metoclop for these cases though.

As an aside - this dog with parvo - do we consider that a vaccine "failure"? It has had very mild symptoms and bounced back quickly. No vaccine is 100% protective - I would consider this dog to have been reasonably well protected myself!

Re: Strange Parvo case?

Martin Atkinson — Tue, 17 Apr 2012 09:51:11 GMT

I've not seen a case of (diagnosed) CPV for years but back in the day when they were very common I never found metoclopramide worked as an anti-emetic anyway. I seem to recall phenothiazine derivatives like Phenergan or even ACP were more effective but nothing really worked. Will be interesting when I get my next one to see if Cerenia works.

Re: Strange Parvo case?

Simon Neuhoff — Tue, 17 Apr 2012 09:45:09 GMT

[quote user="Anthony Todd"]

[quote user="Simon Neuhoff"]There are certainly better ways to diagnose an FB than response to Metoclopramide! Not to mention the risks.[/quote]

Oh, for sure, but we were talking about an initial consult with a vomiting dog with no other signs. If metoclopramide and diet advice didn't fix it in 24 hours then it was time to look further and more metoclopramide wouldn't be something we [back then, not the current "we" ie vetsurgers] would continue.

In the claimed complication following from metoclopramide the dog had been vomiting on and off for a fortnight [!!] surely some warning bells should have rung earlier.

To blame it on a shot of metoclopramide is stretching it a bit, I think.

[/quote]

Anthony I can quite agreee with you there - in a dog managed appropriately for gastritis that is not responding, further investigation is indicated. Fine. With respect however this is not the same as previous posts calling it "a diagnostic aid" and "almost a diagnosis in itself" and alluding to it as a shortcut through "the umms and errs of equivocal blood tests" etc.

Now I know this is not exactly what you meant but to some more impressionable readers this could be taken as literal.

Re: Strange Parvo case?

Julie Innes — Tue, 17 Apr 2012 08:47:42 GMT

It is interesting (and a bit worrying) to hear of vaccinated dogs with symptoms of parvo. I currently vaccinate at 8 and 10 weeks, as per the data sheet, but also offer a parvo booster at 16 wks (optional, but explain to the owner why) I seem to remember reading that around 1 in 10 puppies were found to still have maternal immunity at u[p to 15wks, which prevented the vaccine from being fully protective, but then dropped off. I'm sure this was discovered after an outbreak a few years ago??

I don't enforce it, but give owners the choice, and tell them the stats. That way, I have given them all the info so they can make an informed decision, but I can't be accused of merely trying to "get money" (aargh!) or "overvaccinating"

Re: Strange Parvo case?

Anthony Todd — Tue, 17 Apr 2012 00:58:40 GMT

[quote user="Simon Neuhoff"]There are certainly better ways to diagnose an FB than response to Metoclopramide! Not to mention the risks.[/quote]

In the claimed complication following from metoclopramide the dog had been vomiting on and off for a fortnight [!!] surely some warning bells should have rung earlier.

To blame it on a shot of metoclopramide is stretching it a bit, I think.

Re: Strange Parvo case?

Simon Neuhoff — Mon, 16 Apr 2012 18:19:47 GMT

There are certainly better ways to diagnose an FB than response to Metoclopramide! Not to mention the risks. I have certainly seen NON fb dogs continue vomiting on metoclopramide too - I really think any kind of reliance on this as a "diagnostic test" is fraught with difficulty.

Re: Strange Parvo case?

Acrobat77 — Mon, 16 Apr 2012 17:26:43 GMT

I think it boils down to use of metoclopramide should be extremely cautious (if at all) if a FB is suspected. If it is used and V+ persists, be afraid! We have strayed somewhat OT though.

Re: Strange Parvo case?

Kate Richardson — Mon, 16 Apr 2012 17:11:25 GMT

[quote user="Anthony Todd"]Are you sure the foreign body hadn't been expelled from the stomach some time earlier to make an enterectomy necessary; takes a while for the gut to necrose?[/quote]

I'm not at work so haven't got the details to hand but the FB was of a size and shape that once in the duodenum it wasn't going to go far. And I wasn't present at the surgery, but as far as I know the intestine wasn't necrotic but it wasn't looking healthy so a decision was made to perform an enterectomy. The dog was bright and had no abdominal discomfort prior to the metoclopramide and of course the FB could have passed through into the duodenum at any point in time, but it seemed too much of a coincidence. Don't get me wrong, I'm not anti metoclopramide, I think it's a great drug, but this case just made us more cautious, especially about warning the owners of this possibility.

Re: Strange Parvo case?

Anthony Todd — Mon, 16 Apr 2012 15:07:15 GMT

[quote user="Kate Richardson"]metoclopramide's motility effects caused a bad problem to get worse[/quote]

A couple of weeks of intermittent vomiting is not one I'd use metoclopramide on; if the vomiting didn't stop and all signs normalise within 24 hours of the start of vomiting and one shot of metoclo. I'd be thinking of an exlap, particularly in a bull terrier that eats anything, usually with impunity.

Are you sure the foreign body hadn't been expelled from the stomach some time earlier to make an enterectomy necessary; takes a while for the gut to necrose?

I have to say that 2 weeks intermittent vomiting has to be a classic for an ex lap, particularly as there was nothing positive, and I'll bet it had had all the in-conclusive tests etc. too.

Re: Strange Parvo case?

Kate Richardson — Mon, 16 Apr 2012 14:36:45 GMT

I can recall one case where the use of metoclopramide's motility effects caused a bad problem to get worse. Low grade intermittent vomiting for a couple of weeks in a bull terrier where a foreign body was on the list still despite diagnostics thus far not being conclusive- just one of those ones where you just don't want to take a FB off the list, but you don't quite have enough to warrant an ex lap at that point in time. The vet whose case it was had specifically said for the dog not to have metoclopramide as she was still concerned about a FB, however a colleague saw the dog and chose to give it metoclopramide. Within the next 24hours dog had an emergency ex lap and part of duodenum removed as a foreign body had been expelled from the stomach into the duodenum. Ex lap was on the cards for this dog anyway, but a gastrotomy in an otherwise well dog would have been preferable to an emergency enterectomy in a toxic patient.

Re: Strange Parvo case?

Anthony Todd — Mon, 16 Apr 2012 13:25:44 GMT

[quote user="Michael Woodhouse"] The response was almost a diagnosis in itself.[/quote]

Sorry, Michael I just repeated what you had already said...

Re: Strange Parvo case?

Bob Russell — Mon, 16 Apr 2012 10:34:03 GMT

The symptoms look consistent with parvo in a vaccinated dog IMHO. I have seen it a few times in the past. They tend to be very miserable for about 24 hours then bounce back quickly!

We have been recommending 8 & 12 week vaccs for over a year but have decided to go for 8, 12 (or 10 if owner wants to start puppy classes) & 16wks. If the owner demands 8 & 10 wks so be it but that is their decision.

Re: Strange Parvo case?

Andrew Kent — Mon, 16 Apr 2012 10:05:39 GMT

Very much agree with Martin on this one and think the vaccine manufacturer would be interested in looking into these cases further if they are vaccinated animals. Andy

Re: Strange Parvo case?

Martin Atkinson — Mon, 16 Apr 2012 09:24:59 GMT

My thoughts on this are not whether the treatment of this individual case is correct but why had several other dogs in the same area contracted CPV? Its not surprising there would be an outbreak in an area if the virus is around but it questions the effectiveness of the vaccination. Were the others vaccinated? And when was this case vaccinated? I've seen more than one case of CPV in dogs at 5 months of age when they were given their second vaccination at 10 weeks. Sorry to start sounding like our RMB friend from the land of Oz banging on about the same thing but this raises the thorny question of the effectiveness of vaccination more than anything else.

Re: Strange Parvo case?

Acrobat77 — Mon, 16 Apr 2012 06:18:38 GMT

Not all, as it's something I never did. Each to their own though.

Re: Strange Parvo case?

Anthony Todd — Mon, 16 Apr 2012 03:57:50 GMT

[quote user="Acrobat77"]metoclopramide without ruling out FB[/quote]

I/we all found it a very good diagnostic aid in that if the vomiting continued then a quick ex. lap without all the delays and ers and ums whilst equivocal bloods and xrays, not to mention ultrasounds, were occasionally, and always now, mulled over ad nauseum [sic] [sorryx2] whilst tempus and the animals condition fugits.

Certainly ignore or discount vomiting after metoclopramide at your, and the patient's, peril

Re: Strange Parvo case?

Acrobat77 — Sun, 15 Apr 2012 21:00:19 GMT

[quote user="Michael Woodhouse"]

[quote user="Acrobat77"]Surely metoclopramide without ruling out FB is asking for a lawsuit when the bowel necroses around the corn on the cob and peritonitis results? [/quote]

In a 7 month old pup you could feel a corn on the cob! Before we had Cerenia (which stops everything being sick) most vets I know would investigate for FB if the dog continued to vomit through metoclopromide. The response was almost a diagnosis in itself.

[/quote] Obviously I meant the corn as an example, not a literal in this case. Seeing as metoclopramide is specifically contraindicated in GI obstruction AND is a prokinetic, the old strategy strikes me as extremely risky. Certainly not something I'd advocate now nor did I use prior to Cerenia coming on the scene. Fortunately, this all appears hypothetical in this instance.

Re: Strange Parvo case?

Michael Woodhouse — Sun, 15 Apr 2012 20:40:33 GMT

[quote user="Acrobat77"]Surely metoclopramide without ruling out FB is asking for a lawsuit when the bowel necroses around the corn on the cob and peritonitis results? [/quote]

Re: Strange Parvo case?

Acrobat77 — Sun, 15 Apr 2012 18:52:37 GMT

[quote user="Michael Woodhouse"]

In this case the diagnostic tests have muddied the water. I think you are trying to treat a lab result rather than the puppy! To be fair without haemorrhagic GE I wouldn't even have tested this dog.

I'd give a shot of metoclopramide and send it home. Actually I wouldn't have even kept it in. Have another look on Monday and it will be eating.

[/quote]Surely metoclopramide without ruling out FB is asking for a lawsuit when the bowel necroses around the corn on the cob and peritonitis results? Cerenia would be safer, whilst I appreciate it doesn't have the motility benefits. Zantac could be used for that.