Pruritic Cocker Spaniel

Re: Pruritic Cocker Spaniel

Anthony Todd — Thu, 06 Sep 2012 19:48:08 GMT

How's the dog??

Re: Pruritic Cocker Spaniel

Anthony Todd — Sun, 02 Sep 2012 11:13:36 GMT

[quote user="Anthony Todd"]Surely that was a wind up?[/quote]

This summarises the argument well!

http://www.youtube.com/watch?v=1VuMdLm0ccU

Re: Pruritic Cocker Spaniel

Gareth Dowdeswell — Sat, 01 Sep 2012 16:53:33 GMT

[quote user="Martin Atkinson"]

immunotherapy as it is not without its problems [/quote]

What problems? I'm aware there's a low risk of anaphylatic reactions and there's the bigger chance it may not work but are there any other reasons to avoid immunotherapy?

Re: Pruritic Cocker Spaniel

James Laidlaw — Sat, 01 Sep 2012 11:02:52 GMT

I use steroids for skin cases with puritis when required, but I try to avoid them not as much for fear of side effects, but for the fact that they cover up the clinical signs and symptoms and make an actual diagnosis of the skin condition difficult or impossible.

How many of the cases on steroids do you have a primary diagnosis for? And if you only start working them up after not responding to steroid, do you not think it's reasonable that some of the clinical diagnostic features may have been reduced or eliminated and make diagnosis more difficult?

Used judiciously all medications are fine, but may have side effects even at standard doses. To assume that no medication at normal use will ever cause problems is at best ignorant, at worst dangerously close to (or within the realms of) malpractice. In my humble opinion of course...

Re: Pruritic Cocker Spaniel

Anthony Todd — Sat, 01 Sep 2012 08:51:05 GMT

[quote user="Evelyn Barbour-Hill"]

I can remember a corticosteroid (prednisolone, I think) making a German Shepherd significantly ill in a short time. Administered at the dose recommended by the dermatologist.

[/quote]

See what I mean about corticosteroids and their reputation; could only have been the corticosteroid, German Shepherds get ill only after corticosteroids.

Surely that was a wind up?

I'll get my coat.

Re: Pruritic Cocker Spaniel

Evelyn Barbour-Hill — Sat, 01 Sep 2012 00:54:54 GMT

[quote user="Anthony Todd"]

[quote user="Evelyn Barbour-Hill"]A progestogen is a steroid.[/quote]

No but "progesterone" had that different connotation; it was a "hormone" and they are good....

and,er, I certainly didn't make the connection.

[/quote]

And, er, glucocorticoids are hormones.

Re: Pruritic Cocker Spaniel

Anthony Todd — Fri, 31 Aug 2012 21:30:01 GMT

[quote user="Simon Neuhoff"]after implying you look for demodex if they don't respond to steroids?[/quote]

Yeah, all my demodex cases got a month or two of high dose Bets ....[not].

So you've never mistaken demodex for something else?

I think I have. Did you scrape every dermatitis, I certainly didn't? If that's you're best criticism of my argument then I'll stop too.

And then I found this:

Use of certain drugs can predispose to pancreatitis (sulfa containing antibiotics such as trimethoprim sulfa, chemotherapy agents such as azathioprine or L-asparaginase, and the anti-seizure medication potassium bromide). Exposure to organophosphate insecticides has also been implicated as a cause of pancreatitis. Exposure to steroid hormones have traditionally been thought to be involved as a potential cause of pancreatitis but this appears not to be true, though steroids are able to cause an increase in lipase blood tests.

from [www.marvistavet.com/html/body_canine_pancreatitis.html Sept 2011] But I'm sure there are other conflicting quotes.

Yet your post adds more fuel to the bonfire of the steroids but doesn't sound like a cast iron cause and effect to me.

I'll be happy if a few more animals stop itching while the diagnosis is reached, or not, and other less effective treatments are gone through and the thing finally ends up non-pruritic at last,even if on those lethal steroids.

Re: Pruritic Cocker Spaniel

Anthony Todd — Fri, 31 Aug 2012 21:03:47 GMT

[quote user="Evelyn Barbour-Hill"]A progestogen is a steroid.[/quote]

No but "progesterone" had that different connotation; it was a "hormone" and they are good....

and,er, I certainly didn't make the connection.

Re: Pruritic Cocker Spaniel

Simon Neuhoff — Fri, 31 Aug 2012 20:54:46 GMT

[quote user="Anthony Todd"]

[quote user="Simon Neuhoff"]Your statement that steroids provide "instant relief". Always." is incorrect,.[/quote]

Oh sure, hyperbole, but 95% or more of the time; if it doesn't then look again viz: demodex.

[quote user="Simon Neuhoff"]Your statement that steroids "never killed anything." is also incorrect.[/quote]

Never, to my knowledge, and in my hands, but then I used them judiciously. Give examples please of death caused by judicious steroid use.

[quote user="Simon Neuhoff"]This is blatantly obvious to anyone who has worked in private practice and used steroids [/quote]

Not even slightly obvious to me and I worked in intensive private practice before the days of spot-ons when flea derm. in dogs and cats was the commonest condition treated, at certain times of the year.

I wonder what I was doing right [or wrong or differently]?

[/quote]

Anthony do you read what you post? You talk of judicious use - after implying you look for demodex if they don't respond to steroids?

I have euthanased at least two animals following intractable side effects of steroid use- one was diabetic, the other pancreatitis. I have managed severe side effects in scores of others. If you aren't seeing iatrogenic cushings in your animals then you simply aren't recognising them.

To forestall your next post - I am getting tired of this - I am not a "steroid hater". I use them frequently - more often than I would ideally like in fact. But I DO use them as judiciously as I can - I don't just pay lip service to that word.

Re: Pruritic Cocker Spaniel

Evelyn Barbour-Hill — Fri, 31 Aug 2012 20:18:45 GMT

I can remember a corticosteroid (prednisolone, I think) making a German Shepherd significantly ill in a short time. Administered at the dose recommended by the dermatologist.

Re: Pruritic Cocker Spaniel

Anthony Todd — Fri, 31 Aug 2012 19:29:51 GMT

[quote user="Simon Neuhoff"]Your statement that steroids provide "instant relief". Always." is incorrect,.[/quote]

Oh sure, hyperbole, but 95% or more of the time; if it doesn't then look again viz: demodex.

[quote user="Simon Neuhoff"]Your statement that steroids "never killed anything." is also incorrect.[/quote]

Never, to my knowledge, and in my hands, but then I used them judiciously. Give examples please of death caused by judicious steroid use.

[quote user="Simon Neuhoff"]This is blatantly obvious to anyone who has worked in private practice and used steroids [/quote]

I wonder what I was doing right [or wrong or differently]?

Re: Pruritic Cocker Spaniel

Simon Neuhoff — Fri, 31 Aug 2012 19:03:56 GMT

Ok Anthony I shall spell it out.

Your statement that steroids provide "instant relief". Always." is incorrect,.

Your statement that steroids "never killed anything." is also incorrect.

This is blatantly obvious to anyone who has worked in private practice and used steroids - you certainly know this as well as anyone.

Re: Pruritic Cocker Spaniel

Evelyn Barbour-Hill — Fri, 31 Aug 2012 18:55:30 GMT

I've been watching this debate from a neutral position although my sympathies are leaning Todd-wards, however

[quote user="Anthony Todd"]'cos it was a progestogen and not a steroid....[/quote]

A progestogen is a steroid.

Or was that irony?

Re: Pruritic Cocker Spaniel

Anthony Todd — Fri, 31 Aug 2012 18:47:09 GMT

[quote user="Simon Neuhoff"]If you can't see why it is rubbish[/quote]

Nah, can't see it at all.

Mind you having my statement described as "rubbish, just rubbish" makes it difficult for me to work out where I'm wrong.

Sometimes think that "rubbish" is a word used when you feel that someone is wrong but don't know why, just not what you think or feel?

The only HAC I recall was in the early days of Ovarid when all cats with FAD were put on massive doses of the drug because it was the result of desexing , and we all accepted it 'cos it was a progestogen and not a steroid and that sort of tied in with desexing so it made sense, at least that's what the advertising implied....

Mind you I reckon loads of cats had HAC 'cos loads were given massive continuous doses for long periods.

Never seen another, nor any other chronic side effects that I know of but then I used steroids intermittently and to effect, which people seem not to do, if they use them at all, these days.

Re: Pruritic Cocker Spaniel

Simon Neuhoff — Fri, 31 Aug 2012 18:27:53 GMT

Anthony re read your post. If you can't see why it is rubbish then there is no point in me trying to explain it. Though I rather suspect you were just trolling - as you continue to do.

Re: Pruritic Cocker Spaniel

Simon Neuhoff — Fri, 31 Aug 2012 18:27:52 GMT

Anthony re read your post. If you can't see why it is rubbish then there is no point in me trying to explain it. Though I rather suspect you were just trolling - as you continue to do.

Re: Pruritic Cocker Spaniel

Anthony Todd — Fri, 31 Aug 2012 17:57:19 GMT

[quote user="Simon Neuhoff"]Sorry Anthony -but rubbish. Just rubbish.[/quote]

Sorry, just noticed this.

How, why is it rubbish?

Re: Pruritic Cocker Spaniel

Anthony Todd — Fri, 31 Aug 2012 17:54:28 GMT

As a total, but relevant, aside a friend of mine, with vague back pain was referred recently to a Prof. specialising in spinal neurology.

His report, of nearly two A4 sheets on very nice yellowish bond contained about a page of symptoms, half a page of "diagnosis" including "enthesitis" [look it up!] based on very little, not even the scans, and concluding with: yes, wait for it....

A jab of Depomedrone in the buttock resulting in a large bruise, two days of comparative relief and a fee of £250.00.

So steroids are alive and well in private medicine at least.

Hope the vets catch up soon.....

Oh, and another private specialist offered me a series of Depomedrone injections for my facet joint inflammation for £2500.00.

I asked if I could bring my own Depomed and he said "No, that's how the clinic makes its money".....

Re: Pruritic Cocker Spaniel

Simon Neuhoff — Fri, 31 Aug 2012 17:54:07 GMT

Anthony you must have been a politician in a previous life. You continually twist and wriggle your argument and misrepresent what others are trying to say and reduce grays into black and white.

For what its worth I have seen plenty of iatrogenic HAC - some of them caused by me.

Re: Pruritic Cocker Spaniel

Anthony Todd — Fri, 31 Aug 2012 17:40:37 GMT

[quote user="Martin Atkinson"]So there's another reason not to use 'em[/quote]

See what I mean, and you can't even get an a therapeutic exemption certificate from most of the veterinary profession....

B*gg*r, was hoping this would keep bubbling 'til the Belgian GP.....

Re: Pruritic Cocker Spaniel

Martin Atkinson — Fri, 31 Aug 2012 17:13:05 GMT

[quote user="Anthony Todd"]Must be the Tour de France influence I reckon.[/quote] Funny you should mention it: the only blood test His Lanceness failed was one for cortico-steroids but the UCI hastily obtained a backdated therapeutic exemption certificate to cover it up if you believe the conspiracy theorists. So there's another reason not to use 'em - thanks for reminding me Anthony.

Re: Pruritic Cocker Spaniel

Anthony Todd — Fri, 31 Aug 2012 17:05:30 GMT

[quote user="Martin Atkinson"]Yes my approach is expensive but I've seen enough iatrogenic HAC and a fulminating case of Demodex from other vets misuse of corticosteroids to convince me not to use them unless absolutely necessary.[/quote]

I would reverse that and I say Iwould use them unless it is absolutely necessary not to. [er, like demodecosis]

The steroid phobics [can't think of a better word] always cite these extreme examples, which hardly any vet would be guilty of, and applies them to correct steroid used correctly.

How many of we steroid philics have ever misdiagnosed demodex [and used steroids on them] or produced iatrogenic HAC?

And was the use of steroids in the iatrogenic HAC justicious, sensible and managed? I'll bet not. [I'm sure someone will cite a horrifying reference]

I've seen more animals on inadequate continuous doses than I've seen or heard of "overdoses" for want of a better word.

[not to mention the boxer on 1 bets tab daily in East London that they reckon had consumed 5000 tablets at the rate of 30 a month or something].

And whilst this almost religious argument goes on you've got these dogs tearing themselves to bits because many vets have this almost hypothalmic abhorrence of steroids in any shape or form and try to get a diagnosis with, sure, some success, but at what cost, what delay, and what irritation while the dog or cat waits?

And I always smile quietly to myself when the case is referred and comes back on steroids

Must be the Tour de France influence I reckon.

Re: Pruritic Cocker Spaniel

Mark Hedberg — Fri, 31 Aug 2012 16:22:53 GMT

[quote user="Mark Holmes"]

[quote user="Mark Hedberg"]an NSAID was thus contraindicated[/quote]

So is steroid for that matter... but I would have used them myself.[/quote]

I suppose you're right about being contraindicated, but damned if you do, damned if you don't - I love being a vet

Re: Pruritic Cocker Spaniel

Mark Holmes — Fri, 31 Aug 2012 16:17:49 GMT

[quote user="Mark Hedberg"]an NSAID was thus contraindicated[/quote]

So is steroid for that matter... but I would have used them myself.

Re: Pruritic Cocker Spaniel

Martin Atkinson — Fri, 31 Aug 2012 16:10:42 GMT

[quote user="Lorna McHardy"]I favour an approach somewhere between the Anthony and Martin extremes, myself... they're a very useful tool for instant relief and I certainly wouldn't avoid them on principle. [/quote] I don't avoid them on principle, indeed in my first post in this thread I suggested they may have their place and I agree as a means of short term relief from an acute problem they are very useful, It is just that there are some who use them as a short cut to spending effort on a meaningful diagnosis or a more difficult treatment plan. And on your point re recurrent otitis externa: given a lot are undiagnosed atopics, they can have their use there but so can many of the things I'm doing. I've had clients who like Anthony think my approach is too expensive and have gone to Mr Depomed up the road but in truth that is their loss not mine. Here endeth the lesson before this discussion gets put in the sin bin or I have to post the picture of Pandora's box as well as the can of worms.