KCS firstline treatment

Re: KCS firstline treatment

Hannah Wynne Richards — Mon, 23 Jun 2014 14:39:51 GMT

You're 100% in the right. Your colleauges(?) are 100% in the wrong.

Good luck.

Wynne

Re: KCS firstline treatment

Utlendigur — Mon, 23 Jun 2014 14:37:35 GMT

Thanks for the replies. The last case I saw, last week, was even insured! I'm not sure why the practice has this approach but since I seemed to be the one out of step, I started to question whether I was being OTT!

Re: KCS firstline treatment

Hannah Wynne Richards — Mon, 23 Jun 2014 14:36:48 GMT

That's fine if the Optimune has been offered and refused - you're still then doing your best for the animal. It's not offering that's compleyely unforgivable.

Wynne

Re: KCS firstline treatment

ChrisBVSc — Mon, 23 Jun 2014 12:59:33 GMT

Don't always start immediate optimmune if it's a very borderline/mild case & cost is a concern, but it should definitely be mentioned as a possible requirement in the near future. Only used the Remend drops in 1 case so far - borderline 10-11mm/min case, conjunctiva just mildly inflammed, owner wanted to keep it cheap for now. Haven't seen the dog back yet but the eyes looked amazingly bright & shiny after the 1st drop went in! It will be interesting to see what happens.

Re: KCS firstline treatment

Hannah Wynne Richards — Mon, 23 Jun 2014 09:54:32 GMT

I would say not advising Optimune at initial consult was negligent - not merely borderline. It's not and never will be the veterinary surgeon's business to decide on behalf of the owner how much they can spend.

Wynne

Re: KCS firstline treatment

Ana Santos — Sun, 22 Jun 2014 16:50:02 GMT

I got a very strong and wriggly dog owned by an eldery couple. Owners were unable to put any drops in. Referral place prescribed tacrolimus as in some cases you get a quicker and better response than with optimune. As the issue was mainly the dog's behaviour, he went through a bilateral parotid duct transposition and he's very happy. Owners are also over the moon.

Re: KCS firstline treatment

emma_j — Sun, 22 Jun 2014 12:42:46 GMT

Same approach as Linda - initially lubricants + optimmune (+abs if 2ary ulcers etc) and once STT values are improved, discontinue lubricants, keep on optimmune and monitor STT.

I have known some clients openly obtaining cheap ciclosporin ointment over the internet without prescription, it is shipped from South Africa I believe, clearly not legally. There was one who at least came regularly for checks, and the STT were good for at least a year or so (lost to follow up after that).

I am aware of a colleague's KCS case coming back from a ophtho referral with tacrolimus drops, I think as an adjunct to optimmune? I haven't had one recently at the point of optimmune not being effective but tacrolimus may be an alternative/adjunct if that is the case - anyone else have experience with that?

Re: KCS firstline treatment

Linda Filshie — Sun, 22 Jun 2014 10:57:40 GMT

I use optimmune first line if there's still some tear production unless the owner really can't afford it. I use lubricants alongside initially and then drop these off if I'm getting good STT values.

I think it's borderline negligent not to even discuss why preserving the natural tear production is a better option for the dog - in my mind it's like seeing a dog with itchy skin and throwing steroids at it without even thinking about flea control etc.

Slightly O/T but I was wondering whether anyone had tried the Remend lubricating eye drops. I've heard good things about the corneal repair gel.