Dogs with Colitis

Re: Dogs with Colitis

Anthony Todd — Wed, 26 Nov 2014 14:46:43 GMT

[quote user="Neil Wheadon"]The second line is the killer quote. You may have meant it differently but it suggests that we're poor vets if we don't.[/quote]

As one who has "diagnosed" a tibial fracture by examination in the wrong leg and made more mistakes than I care to reveal I think I'm pretty sympathetic to new or recent graduates.

Having been asked "What took you so long?" with my first few calvings I'm well aware of inexperience.

Then Kara says this "Straining/tenesmus can be a sign of large bowel diarrhoea " which was what I was getting at.

So after all I 'm now clear, and others maybe, that if you've got a patient with some diarrhoea, mucus and some blood and non-productive straining you've either got a colitis or something else and a rectal sounds as if it might be a very good idea.

Whereas if you've got voluminous D++, not too much straining and always productive it's small bowel and a rectal is less necessary.

So the signs are different and should be recognisable.

Sorry if I offended but I don't think what I have said should upset anyone. If others can learn from my upsetting utterances I'm happy.

I just wish forums were around when I started!!

Re: Dogs with Colitis

Kara Gibson — Wed, 26 Nov 2014 10:58:59 GMT

[quote user="Anthony Todd"]

Too true, but "straining" would be the clue, as I was trying to get at whereas with a D++ usually it just all rushes out without any straining

Or sometimes you'd call it "productive" straining I guess.

I'd hope I would do a rectal on a "non-productive" strainer.

[/quote]

Straining/tenesmus can be a sign of large bowel diarrhoea not just rectal masses but in actual fact both cases with rectal masses were not showing much signs of straining but had produced slightly loose stool with flecks of fresh blood. I just though I'd make the point that not all of us are going to rectal every dog with signs of colitis every time but if they are not settling or recurring it is always a good idea!

Re: Dogs with Colitis

Neil Wheadon — Wed, 26 Nov 2014 10:09:54 GMT

Hi Anthony

Read this, you've written it in this thread :-

'Weren't the presenting signs different?

Can't think anyone wouldn't recognise a difference??'

The second line is the killer quote. You may have meant it differently but it suggests that we're poor vets if we don't.

I replied 10 minute appointments, we're human. Add to that, few clinical signs and we are relying on trying to interrogate an owner on what exactly the dog is doing and producing - not easy.

I really like this forum, but there is a problem in that vets and especially our younger colleagues are simply afraid to post anything because a comment like this will appear. I know this as fact. I don't use red stars but do like and use the 5 stars as I think that a degree of positivitity is really important.

My favourite posts are the clinical ones and especially the quick fire, fast points one like the one I started on the London Vet show. I'd love to see more 'basic questions' (If there is one) but feel that new graduates are simply afraid of asking these as they will questioned as to their competance.

So instead of red starring, I replied as you have asked in the past. Your experience as a dinovet is invaluable, but also needs to be supportive.

Neil

Re: Dogs with Colitis

Anthony Todd — Tue, 25 Nov 2014 23:53:58 GMT

[quote user="robloxley"]

[quote user="Neil Wheadon"]10 minute appointments, and we're all human[/quote]

sadly some on here are clearly superhuman and clearly have a poor opinion of the majority of the rest of us

[/quote]

Dunno who that's a pop at, I suppose it's me, but it helps if I [or the popee] knows why the pop.

Re: Dogs with Colitis

Rob Loxley — Tue, 25 Nov 2014 20:10:22 GMT

[quote user="Neil Wheadon"]10 minute appointments, and we're all human[/quote]

sadly some on here are clearly superhuman and clearly have a poor opinion of the majority of the rest of us

Re: Dogs with Colitis

Anthony Todd — Tue, 25 Nov 2014 15:17:11 GMT

[quote user="Neil Wheadon"]Rectalling sounds a good point and was the point of the post - to pick up a few good ideas[/quote]

Too true, but "straining" would be the clue, as I was trying to get at whereas with a D++ usually it just all rushes out without any straining

Or sometimes you'd call it "productive" straining I guess.

I'd hope I would do a rectal on a "non-productive" strainer.

Re: Dogs with Colitis

Neil Wheadon — Tue, 25 Nov 2014 12:50:17 GMT

[quote user="Anthony Todd"]

Weren't the presenting signs different?

Can't think anyone wouldn't recognise a difference??

[/quote]

Getting sidetracked here.

10 minute appointments, and we're all human.

Saw a dog a few weeks ago that had presented with straining and passing flecks of fresh blood, treated for colitis on 2 previous occasions. In fact had a bladder full of stones

Rectalling sounds a good point and was the point of the post - to pick up a few good ideas

Neil

Re: Dogs with Colitis

Anthony Todd — Tue, 25 Nov 2014 12:00:26 GMT

[quote user="Neil Wheadon"]Which is the situation that many of us find ourselves in too, where a client has already starved and provided a bland diet[/quote]

See my answer above re "Highgate Housewives" and, I suspect most clients......

It's the exact definition of "starved" and "bland"......

Oh, and I forget, keep them indoors, or they'll get milk and tinned food four doors down 'cos "it's a starving stray we've been feeding for months".....

Re: Dogs with Colitis

Neil Wheadon — Tue, 25 Nov 2014 11:45:45 GMT

[quote user="Richard Carter"]

1. they are aware that starving is the first line for g/ent and have tried it.

2. they are also aware bland diet is the next stage of trying to get it to settle and they have tried that as well so when they finally reach for the phone 3-4 days later to make the appointment, for me to pat them on the head and tell them to 'starve/bland diet and it will all be fine, here have some magic powder' would be extremely arrogant and thoughtless and not worth the consultation fee they have just been charged.

[/quote]

Which is the situation that many of us find ourselves in too, where a client has already starved and provided a bland diet

So what do you do in these cases?

Neil

Re: Dogs with Colitis

Anthony Todd — Tue, 25 Nov 2014 09:31:46 GMT

[quote user="Kara Gibson"]

Just a point to remember - I have twice seen a dog treated for previous 'colitis' with recurrence of signs a while after treatment which turned out to have rectal masses so always performing a rectal if not on the first occasion, definitely on the second!

[/quote]

Weren't the presenting signs different?

Can't think anyone wouldn't recognise a difference??

Re: Dogs with Colitis

Kara Gibson — Tue, 25 Nov 2014 07:20:58 GMT

Re: Dogs with Colitis

Sara Ramsey — Mon, 24 Nov 2014 23:47:18 GMT

Following this thread as have a tricky colitis case at the moment. I just wondered, as owners often just want the d+ to stop occurring (in the house!), is loperamide used by anyone? I have had people ask about using immodium but I tend feel that it may be "better out than in"

Currently trialling sulphasalazine in my case after diet trial/dexadreson/pro-kolin.

Re: Dogs with Colitis

Anthony Todd — Mon, 24 Nov 2014 22:06:14 GMT

[quote user="Richard Carter"]

1. they are aware that starving is the first line for g/ent and have tried it.

2. they are also aware bland diet is the next stage of trying to get it to settle and they have tried that as well

[/quote]

Trouble is, if they're like the Highgate Housewives I used to deal with they aren't "aware" at all and:

1. "starving" doesn't include no buttered toast ,nor just a saucer of milk ,nor a bit of last Sunday's roast.

2. "bland" certainly means milk and plenty of it..

Re: Dogs with Colitis

Richard Carter — Mon, 24 Nov 2014 18:05:45 GMT

Obviously have a different set of clients to the rest of you but generally my clients watch a lot of vets on TV so:

1. they are aware that starving is the first line for g/ent and have tried it.

re tylosan - is freely available in USA in a variety of forms not available here so our equivalent of non-sterilising git antimicrobial are metronidazole or oxytets

Re: Dogs with Colitis

Miriam Lodewyks — Mon, 24 Nov 2014 13:51:33 GMT

Stan Marks from California, gave a great talk at London Vet show recently. He also advised caution with "blind" antibiotic use, as many "pathogens" are often not as pathogenic as we might believe (Campy etc.) He did seem to be a big fan of Tylosin though, and rates it well above Metronidazole. Not an AB I would have considered using, but will look into it.

Re: Dogs with Colitis

Miriam Lodewyks — Mon, 24 Nov 2014 13:46:39 GMT

I normally suggest 12 hour starve to reduce the on-going unpleasantness. Assuming it's large-intestinal (increased frequency, decreased volume, mucoid, haemochezia) I will use a single Buscopan injection, perhaps even a low-dose dex. Encourage fluid uptake and feed bland food, little and often. Pro-biotics may or may not help but they do no harm and clients generally like to feel you've given them "something". I would use it if my dog had soft stools. I always ask clients to return within 3-5 days, unless completely resolved, sooner if becomes lethargic, or begins to vomit.

Re: Dogs with Colitis

Glenn Hodgson — Mon, 24 Nov 2014 13:14:45 GMT

I've seen a few cases of dry eye post TMPS but never salaz. Don't use much salaz though, use plenty TMPS

Re: Dogs with Colitis

ChrisBVSc — Mon, 24 Nov 2014 13:05:26 GMT

Bland diet, prokolin paste (not convinced how effective this is, but I see it as 'won't do harm & may do some good', also gives the owners something to do), possibly dex injection if a lot of discomfort from tenesmus. I'm actively cutting back on antibiotic use so this most likely wouldn't get metronidazole at this stage.

Michael - I've had success with salazopyrin for more chronic cases, never bothered in a more acute case. Apparently it can cause dry eye, has anyone seen this?

Re: Dogs with Colitis

Anthony Todd — Sun, 23 Nov 2014 13:40:34 GMT

[quote user="David Mills"]I'm sure you appreciate the pathophysiological, and therefore therapeutic, difference?[/quote]

TBH I don't , not at least based on the owners description of the signs, so there must be some easy diagnostic features. The animal doesn't seem in anyway distressed in the cases we're talking about.

What are they 'cos I've never bothered to make the distinction in a happy dog with the squits which is what, I think, we're talking about?

Is it the mucus with a bit of blood, if so then I'd probably look at the dog a bit more closely.

[quote user="David Mills"]Colitis in the vast majority of cases is an inflammatory condition.[/quote]

I'm sure it is hence the steroids, my point was why the difference is therapeutics with an inflamed skin, which you've sidestepped?

[quote user="David Mills"] I think, anthropomorphising, that I would want medication if I was straining to s**t every hour. [/quote]

True, but steroids??? that was my point

[quote user="David Mills"]Or are you from the Kiwi school of 'pain is nature's splint [/quote]

Sadly that was the attitude when I first started practice in NZ, fortunately it has changed.

I'm not sure that perioperative analgesia for a sympathetically performed B/S is so necessary, judging by observations of the chaos ensuing when they weren't on the lead...

But why not give it just in case, can't do anything but good as far as the dog is concerned?

Even more necessary to keep them on the lead! then!

Re: Dogs with Colitis

Neil Wheadon — Sun, 23 Nov 2014 13:19:32 GMT

[quote user="David Mills"]

[quote user="Neil Wheadon"]2) Pro-biotics.[/quote]

Don't get me started on these. A complete, expensive, unsupported, load of crap (pardon the pun).

[/quote]

Yes I eluded to this in my reply that in people not a lot of evidence and don't get me started on Yakult. We'll be digging up those little pots from landfill for ever!

Neil

Re: Dogs with Colitis

David Mills — Sun, 23 Nov 2014 13:11:26 GMT

[quote user="Anthony Todd"]Yet with a simple D++[/quote]

We're on about colitis here. Not any diarrhoea. I'm sure you appreciate the pathophysiological, and therefore therapeutic, difference?

[quote user="Anthony Todd"]when they'd get better on water and boiled something....[/quote]

Complete logical fallacy. A broken leg will, in a lot of cases, 'get better' without intervention. With treatment, colitis will get better quicker with appropriate medication. Colitis in the vast majority of cases is an inflammatory condition. Therefore anti-inflammatories (dex/mdz/sulphaslazine) are indicated.

Now, you can make an ethical point about whether medication is strictly 'required'. I think, anthropomorphising, that I would want medication if I was straining to s**t every hour. Or are you from the Kiwi school of 'pain is nature's splint - it stops the dog from moving around and allows it to heal' as I recently heard from a Wellingtonian dinovet regarding preoperative analgesia for bitch spays?

[quote user="Neil Wheadon"]2) Pro-biotics.[/quote]

Don't get me started on these. A complete, expensive, unsupported, load of crap (pardon the pun).

Re: Dogs with Colitis

Anthony Dennison — Sun, 23 Nov 2014 12:54:40 GMT

[quote user="Anthony Todd"]Yet with a simple D++ ,which will almost certainly settle with dietary control alone, steroids have been given at the first consult.[/quote]

Not always at the first consult. Bear in mind sometimes by the time the animal is presented to the vet with diarrhoea it might have been going on for up to a week.

[quote user="Anthony Todd"]When humans get D++ do they ever ever get steroids without a lot of pre-examination and diagnosis?[/quote]

Of course not. They get antibiotics.

Re: Dogs with Colitis

Anthony Todd — Sun, 23 Nov 2014 12:04:29 GMT

[quote user="Anthony Dennison"]the steroid reduces inflammation and lowers the dog's urge to empty it's bowels[/quote]

It just strikes me as illogical when, steroids get totally banned by most ,even when an animal is tearing itself apart with skin irritation, and diagnosis [if ever] is the sole goal and steroids are only used by those who can't be bothered or who want to give the animal relief.

Yet with a simple D++ ,which will almost certainly settle with dietary control alone, steroids have been given at the first consult. I don't think dinovets would dream of jabbing a dog or cat with a simple dietary D++, certainly not on the first presentation, based on very little evidence.

One good thing with steroids; it'll increase appetite for the bland diet, and, if this was given as the rather unscientific reason fair enough, but it seems to be indicated on pathological grounds.

Of course a jab of a short acting dex won't do much harm so why is it so frowned upon when there is a real need in a very itchy dog or cat?

Where's the logic or the good practice or is it "Gold Standard"?

When humans get D++ do they ever ever get steroids without a lot of pre-examination and diagnosis?

Re: Dogs with Colitis

Anthony Dennison — Sun, 23 Nov 2014 11:30:52 GMT

Generally follow everything that's been said already. Bland diet (I've been using RC Gastrointestinal a bit recently if they come back a second time), pro-kolin, if there is blood usually go for Voren. And yes Anthony, I know it is usually only a dietary intolerance but often the owners want the dog to stop crapping brown water on the carpet sooner rather than later; the steroid reduces inflammation and lowers the dog's urge to empty it's bowels as soon as there's anything there.

Metronidazole only in repeat offenders with a temperature. They'll often get a week of 50mg/kg fenbendazole at this point too. I used to send off loads of faecal samples, but nothing ever comes back, so I don't tend to do it until my normal approach isn't working.

Re: Dogs with Colitis

Stigen — Sun, 23 Nov 2014 09:53:05 GMT

I used to follow a rule that i learned from more experienced veterinarians; if there is blood in the feces then use antibiotics...but I stopped doing that some time ago as I was told on some cpd courses that it was`nt really indicated. Yesterday I went to the lecture "The 2nd consult: Persistent diarrhoea - should I try another antibiotic?" by Edward Hall.
His Message was Clear - NO .
A retrospective study showed that 71% of dogs that was referred With diarrhoea had been on antibiotic trial and 19% had been treated With steroids.
Justification was given as; "suspected Campylobacter infection" , but even in the cases where cultures had been made, it is believed that the majority of isolates were non-pathogenic species - C.upsaliensis. There was no PCR test for C.Jejuni at the time of the study(2010).

His conclusion mirrored what I have been thinking the last few years; that most acute diarrhoea is self limiting, and will pass on its own With a bit of time. Fluid theraphy and early Return to enteral nutrition are the only treatments that have been showed to have any effect on outcome.
I usually see these dogs, conclude that they are fairly healthy as they look happy,wagging the tail,eating and drinking well etc. Then I give the owners something to make them feel that they are getting some treatment...some probiotics, some boxes of intestinal Food W/d or I/d, and some advice about feeding patterns or starvation etc, and maybe some worming tablets. Most times that seems to work,maybe because of the treatment, or maybe because I`m buying some time for the dog to get better on its own