Rhinitis in dog

Re: Rhinitis in dog

Anthony Todd — Fri, 07 Nov 2014 03:35:30 GMT

[quote user="Sean Henney"]I was giving the equivalency so that the dexamethasone dose could be converted to prednisolone.[/quote]

Sorry, misunderstood, thought you were suggesting oral dexameth, but there isn't a licensed vet one. It'd probably work better if there was.

If you can't get a diagnosis, which often happens, but steroids control the symptoms surely you don't just withhold relief?

Re: Rhinitis in dog

Sean Henney — Thu, 06 Nov 2014 18:22:30 GMT

I was giving the equivalency so that the dexamethasone dose could be converted to prednisolone. Oral dexamethasone is a human product. I am really not sure why you would not just use prednisolone, as there is no reason not to-but obviously it relies on getting a diagnosis, not just as a trial

Re: Rhinitis in dog

Anthony Todd — Wed, 05 Nov 2014 19:21:01 GMT

[quote user="Sean Henney"]

Yes there is and is that relevant?

[/quote]

Yes, because if it's steroid response it'll go onto owner medication at home.

What's the oral form called 'cos I can't find it in NOAH?

Re: Rhinitis in dog

Sean Henney — Wed, 05 Nov 2014 19:05:35 GMT

Yes there is and is that relevant?

Re: Rhinitis in dog

Anthony Todd — Wed, 05 Nov 2014 13:32:09 GMT

[quote user="Sean Henney"]

FYI

Dex is roughly 5-6 times (depends on the reference) more potent than pred on mg/kg basis

[/quote]

But I don't think there is an oral formulation?

Re: Rhinitis in dog

Sean Henney — Tue, 04 Nov 2014 22:29:15 GMT

FYI

Dex is roughly 5-6 times (depends on the reference) more potent than pred on mg/kg basis

Re: Rhinitis in dog

Anthony Todd — Tue, 04 Nov 2014 14:33:44 GMT

[quote user="Stigen"]something like 0,25mg/kg dexamethasone IM. [/quote]

Er, can't remember the dose but no response to your dose doesn't sound convincing or helpful. I'd say one more shot at a high dose rate and then give up on the allergic/immune aetiology.

Steroid response is always within 24 hours, that's not a cure, just an obvious improvement ,before the steroidophobes leap on me.

And, of course, I forgot you've got two cases on the go so I'm talking about the serous one.

Re: Rhinitis in dog

Stigen — Tue, 04 Nov 2014 09:39:12 GMT

[quote user="Anthony Todd"]

[quote user="Stigen"]I`m thinking about a steroid trial[/quote]

I hope I'm not telling you what you would do anyway but very often, I would say always, steroids get discredited based on an excessive, inadequate inappropriate or prolonged dose.

One jab of a short acting steroid will always give a favourable response, even if for 24 hours only, if steroids are ever going to, in this sort of case.

I would suggest doing just that first; if there is no appreciable response then I'd be very surprised if steroids will help ever.

If a adequate and obvious response then titrate an intermittent one single dose [tabs work fine] of pred only when and if symptoms return.

Owners take some time to understand the idea; they're looking for a "cure"!

No continuous dosage and no taper [a single dose tapers anyway.....].

Keep me. at least, posted.

[/quote]I did actually give it a jab of dexamethasone a week ago, without much response to the serous discharge...but I was thinking I`ve been to conservative on the dosage, and maybe would see a better response on an immune-suppressive dose. I think I gave it something like 0,25mg/kg dexamethasone IM.
Right now just crossing my fingers for the environmental changes to make some difference...but suspect this will go for CT eventually.
Same thing with my mucopurrulent case, which is actually much worse as it causes nasal congestion and discomfort for the dog.

Re: Rhinitis in dog

Anthony Todd — Tue, 04 Nov 2014 09:31:29 GMT

PS. Of course you can do your allergy testing and other measures concurrently [waiting a while after the last steroid dose if needed] as you're only using the steroids when you have to thus relieving the dog's distress which everyone seems to think is bottom of the diagnostic and treatment regime.

This way you can do both.....

Re: Rhinitis in dog

Anthony Todd — Tue, 04 Nov 2014 06:47:32 GMT

[quote user="Stigen"]I`m thinking about a steroid trial[/quote]

I hope I'm not telling you what you would do anyway but very often, I would say always, steroids get discredited based on an excessive, inadequate inappropriate or prolonged dose.

One jab of a short acting steroid will always give a favourable response, even if for 24 hours only, if steroids are ever going to, in this sort of case.

I would suggest doing just that first; if there is no appreciable response then I'd be very surprised if steroids will help ever.

If a adequate and obvious response then titrate an intermittent one single dose [tabs work fine] of pred only when and if symptoms return.

Owners take some time to understand the idea; they're looking for a "cure"!

No continuous dosage and no taper [a single dose tapers anyway.....].

Keep me. at least, posted.

Re: Rhinitis in dog

Stigen — Sun, 02 Nov 2014 12:19:02 GMT

The extended panel did show a 5/5 reaction on s few kinds of storage mites as well as house dust mites. I`m still not entirely sure if it`s the causing agent for the serous discharge, but feel it worthwhile trying some things that might help. I`ve told her we`ll try for a week now with her minimizing the contact with allergens at home...she`s changed all the shhets, and bought some anallergenic bedding. She`s also taking care about the storing of the food, and minimizing dust from the dry food. If that does`nt work, I`m thinking about a steroid trial, for a short while. I`m not sure about ordering the immunotheraphy...It`ll be a lot of work with questionable benefit it it does`nt respond on the steroids.

At that point I`ll be more likely to refer it to Ct and endoscopy/mucosal biopsy. I Did take a blind culture from the nares that showed a variety of bacteria and some Malasezzia...but as has been pointed out here,and in the litterature, it is unlikely to be of significance. It did also have antibiotics to cover for the bacteria found, but made no difference.

About the discussion of whether or not to do the advanced diagnostics earlier....I probably would have done it earlier if we had it in our surgery, but I guess as we don`t have it I would like to try to do what I can to help this patient before sending it onwards. During this time the dog is not suffering or in pain, it`s only got a serous discharge.

The aspergillosis treatment regime seems like a real challenge. would`nt the discharge have been getitng worse when the dog had antibiotics and steroids if it was fungal rhinitis?

Re: Rhinitis in dog

Anthony Todd — Sun, 02 Nov 2014 01:07:47 GMT

Is this a fair summary of aspergillosis treatment?

http://www.aspergillus.org.uk/indexhome.htm?secure/veterinary/canine.html~main

Re: Rhinitis in dog

Anthony Todd — Sun, 02 Nov 2014 00:51:07 GMT

[quote user="Evelyn Barbour-Hill"]what if it is likely to affect the outcome; and how would you know until you've got it?[/quote]

True, and unarguable, but how likely versus the cost and procedural effect on the patient, let alone the prognosis?

Re: Rhinitis in dog

Anthony Todd — Sun, 02 Nov 2014 00:33:09 GMT

[quote user="villagevet"]Got complete resolution of a ongoing 'dental'/oral saga in a cavalier after last ditch cytology scrapings of chronic stomatitis and faucitis was reported as eosinophilic pharyngitis and serum test pointed to mite and pollen sensitivities. Immunotherapy finally eliminated all oral signs and chronic low grade ears, as well as saljva staining put down to poor oral hygiene.[/quote]

But I would have given it steroids early on, after having a good look, and got a great 100% response [the animal and owner would have been delighted] for much less cost and time.

They act as a pretty reliable diagnostic tool incidentally too.

What are the comparative success rates of immunotherapy versus judicious steroids,and the comparative costs 'cos I reckon the response to steroids is 100% and almost immediate?

But I know I'll get the usual flack and criticism usually citing inappropriate choice of cases and ridiculous dosage regimes.

Having said all that I'd also look at the possibility of contact oral allergens and the mythical [?] plastic food bowl oral reaction???

There was a big hoo-ha in humans when a certain toothpaste was causing exactly the same signs as our discussed case.

Re: Rhinitis in dog

Lindsey Edwards — Sat, 01 Nov 2014 21:16:09 GMT

Immunotherapy for non-skin cases...if the extended panel support specific mites I'd consider it, or a trial on atopica? Eosinophilic bias on flush would definitely persuade me if all other avenues drawing a blank. If you hear footsteps think horse, remember though one day it might be a zebra! Got complete resolution of a ongoing 'dental'/oral saga in a cavalier after last ditch cytology scrapings of chronic stomatitis and faucitis was reported as eosinophilic pharyngitis and serum test pointed to mite and pollen sensitivities. Immunotherapy finally eliminated all oral signs and chronic low grade ears, as well as saljva staining put down to poor oral hygiene.

Re: Rhinitis in dog

Evelyn Barbour-Hill — Fri, 31 Oct 2014 14:40:48 GMT

[quote user="Andrew Kent"]

But, even without that, there is an argument that advanced imaging techniques are justified early on in the course of investigation. The only downside of them is cost, in most other ways - sensitivity, speed (CT anyway) they are superior. So, again, it comes down to owner preference - I will discuss all the potential diagnostic tests with the owner and they can decide whether they want to go straight to CT/MRI or whether they would like to start with x-rays/rhinoscopy - most go for advanced imaging.

In many cases advanced imaging gives us a diagnosis without then needing to do rhinoscopy. We may still do it to get targeted samples, remove a FB etc, but often we don't to reduce costs to the owner.

The other factor is that we plan to do everything under one general anaesthetic - if we performed rhinoscopy before advanced imaging then we would complicate the findings by introducing water, damaging mucosa etc.

[/quote]

Wow. You go to CT or MRI before even plain radiographs?

This is really interesting.

I'm a little unhappy at the suggestion that my rhinoscopy would damage mucosa, though.

[quote user="Anthony Todd"]Sorry, yes, forgot aspergillosis, or an infection, should have suggested a swab.[/quote]

Blind swabbing is generally unhelpful.

[quote user="Anthony Todd"]I'm just anti this pursuit of a diagnosis, at considerable expense, when it is very unlikely to affect the ultimate outcome,[/quote]

But – assuming we are still talking about nasal disease (because I agree there is definitely a case for empirical treatment in other areas) – what if it is likely to affect the outcome; and how would you know until you've got it?

Re: Rhinitis in dog

Anthony Todd — Fri, 31 Oct 2014 12:29:01 GMT

[quote user="Evelyn Barbour-Hill"]maybe an aspergillosis,[/quote]

Sorry, yes, forgot aspergillosis, or an infection, should have suggested a swab.

I'm just anti this pursuit of a diagnosis, at considerable expense, when it is very unlikely to affect the ultimate outcome, if it is not available by the simpler methods I, and others have suggested.

Some case histories might persuade me to change my mind.

Re: Rhinitis in dog

Andrew Kent — Fri, 31 Oct 2014 11:55:20 GMT

[quote user="Evelyn Barbour-Hill"]Interesting to see that Andrew and Tim, because they have the facilities, go straight to CT or MRI without even lifting an endoscope first, whereas for me rhinoscopy is an essential part of the investigation.[/quote]

Many of the cases that we see will have already had radiographs +/- some kind of rhinoscopy at their primary vet which probably makes us more likely to pursue advanced imaging sooner.

Re: Rhinitis in dog

Evelyn Barbour-Hill — Fri, 31 Oct 2014 02:23:12 GMT

[quote user="Anthony Todd"]Assuming that you should be able to diagnose the things you can obviously and/or successfully do something about without sophisticated diagnostic techniques, by which I mean FBs, dental and tumours[/quote]

You are wrong for once, Anthony.

Some of the things you really couldn't diagnose without "sophisticated" techniques might still be neoplasia or a foreign body or maybe an aspergillosis, that for some reason hid well from the endoscope and wouldn't deliver up biopsies by violent flushing. They might even be dental – not in small animals, no, but certainly in the horse.

[quote user="Anthony Todd"]The diagnosis is surely just a pointer to treatment and not an end in itself which is, IMHO, the difference between modern vet. practice and the good 'ol days.[/quote]

Actually, I think in modern practice it's unchanged, except that instead of saying "I don't know" one now pronounces a diagnosis of idiopathic something-or-other.............. No, really, we want a diagnosis in order to decide best treatment, and also to give a prognosis, and that's why we proceed to sophisticated stuff like MRI or CT if we've got the facilities......... wish I had.

Interesting to see that Andrew and Tim, because they have the facilities, go straight to CT or MRI without even lifting an endoscope first, whereas for me rhinoscopy is an essential part of the investigation.

Re: Rhinitis in dog

Andrew Kent — Fri, 31 Oct 2014 00:42:06 GMT

I don't think we really need to make every thread descend into this same argument but in this case I couldn't not respond

What diseases are you suggesting that you are treating with those drug choices?

Very few nasal diseases are caused by a primary bacterial problem and so the indication for antibiotics is usually in addition to other things. And almost no nasal diseases are steroid responsive. And if the dog does have a steroid responsive disease (e.g. lymphoma) then you will probably destroy any possibility of making a diagnosis in the future and reduce the treatment options. If it has nasal aspergillosis then you will almost certainly make it worse.

Even you can't really think that what you suggest is a good idea?!

As always there are some clients who don't want any investigations - in those cases then some NSAIDs are probably as good as anything. But we can do a lot better than that and that's what clients want to at least be offered these days. It's not for us to make a decision not to investigate things.

Re: Rhinitis in dog

Anthony Todd — Fri, 31 Oct 2014 00:29:15 GMT

[quote user="Hannah Wynne Richards"]

There's no doubt the diagnosis rate is correlated to the sophistication of imaging available.

Wynne

[/quote]

Assuming that you should be able to diagnose the things you can obviously and/or successfully do something about without sophisticated diagnostic techniques, by which I mean FBs, dental and tumours why not try antibiotics or steroids rather than these advanced diagnostics?

Apart from the three possibilities above nothing else will be gained, as far as the relief of symptoms are concerned, by an "accurate" diagnosis and treatment, without "diagnosis" may relieve the symptoms, even permanently.

The diagnosis is surely just a pointer to treatment and not an end in itself which is, IMHO, the difference between modern vet. practice and the good 'ol days.

[cowers behind sofa]

Re: Rhinitis in dog

Andrew Kent — Thu, 30 Oct 2014 19:28:47 GMT

Whether or not allergic rhinitis really exists in our patients is a point of some controversy, personally I am sceptical. In any event, as far as I am aware there is no evidence that immunotherapy is likely to be useful. I am equally sceptical that a positive in-vitro allergy test is helpful in these cases (I am sure you would find positive in lots of normal dogs).

I think an irritant rhinitis is much more likely to be a real thing - i.e. a reaction to airborne irritants like cigarette smoke and so I would definitely speak to the owners about the air quality that the dog is exposed to.

Many nasal diseases start serous and then progress.

Is the disease bilateral? Is there normal airflow through both nostrils? And is there any nasal pigment changes?

Re: Rhinitis in dog

Stigen — Thu, 30 Oct 2014 11:45:24 GMT

I ran an allergy screen on the dog with serous discharge, and came back at 5/5 for mites, so have asked the owner to take car in her home...mite proof bedding,clean and wash more than before..change sheets...freeze the dry food to kill storage mites,and vacum pack it...some drops of water on dry food to avoid dust entering the nares when eating etc...
Also doing a further differentiation panel on the mites...but do`t really know the significance of these findings. The dog is not pruritic,and not had any ear problems or any other sign of allergy. Could serous nasal discharge be a sole symptom of mite allergy? I`m hoping that to decrease the amount of dust in the house and from the dry food will give some decrease in the discharge...I`m not sure about ordering immunotheraphy for this one, never tried that for a case like this before.

The mucopurrulent case is on antibiotics, slighlty better, but not significantly so. I`m hoping to do further diagnostics ,mainly CT and endoscopy on that one.

Re: Rhinitis in dog

Hannah Wynne Richards — Thu, 30 Oct 2014 11:18:06 GMT

There's no doubt the diagnosis rate is correlated to the sophistication of imaging available.

Wynne

Re: Rhinitis in dog

Andrew Kent — Wed, 29 Oct 2014 15:51:02 GMT

[quote user="Evelyn Barbour-Hill"]

Andrew, as you have the facilities, I believe, at Cambridge, do you go to MRI first, or CT, or both? How do you like to work it?

[/quote]

there is very little between them in terms of diagnostic rate so it comes down to personal preference. I like MRI as it's what I'm most comfortable with but it takes a little longer.