ARD?

Re: ARD?

Hannah Wynne Richards — Tue, 25 Oct 2011 17:38:33 GMT

Yes Steve I laughed as well at that one

Wynne

Re: ARD?

SteveOwen — Tue, 25 Oct 2011 17:35:16 GMT

[quote user="Hannah Wynne Richards"]

Anyone feel like inventing something round toput beneath sleds to make them run easier ???????????????????

[/quote]

Oh dear. Definitely don't go into engineering. Adding wheels to a sled would not make it "run easier"!

Re: ARD?

Hannah Wynne Richards — Tue, 25 Oct 2011 17:25:12 GMT

Here we go -round again

When I was seeing practice I was told by an experienced and very well regarded veterinary surgeon,that whatever I was treating,togive a shot of multivitamins "a good tonic !"

I qualified and another very experienced veterinary surgeon advised me to give a scouring calf a shot of B12 I was severely criticised by a young SA veterinarian,not much longer qualified than I was, and told it was useless-what business was it of his anyway ?

I later heard of anti-oxidants-we weren't taught about them in the 70s,asked what they were and was told Vits A, D, C,E and thought "Mr John's tonic injection "

Now it seems that the merits of B12 are being rediscovered

Anyone feel like inventing something round toput beneath sleds to make them run easier ????????????????????

Wynne

Re: ARD?

SteveOwen — Tue, 25 Oct 2011 16:44:46 GMT

Sorry. Martin's point...lots of people give a jab of Vitbee to cats, maybe once month as part of their "kidney cocktail"...

How sensible is this....with a water-soluble vitamin? How often does a huge dose of vitbee really last?

Genuinely, I don't know the answer. But I suspect not so longer. I suspect better to increase daily intake in food....

Re: ARD?

SteveOwen — Tue, 25 Oct 2011 16:39:41 GMT

Yes, I'm well 'ard.

Re: ARD?

Martin Atkinson — Tue, 25 Oct 2011 16:22:20 GMT

[quote user="Ian Battersby"]

...there are studies in cats showing that if a B12 def is present they can be less resposnive to diet etc unless the b12 def is corrected

[/quote]

This has gone a bit off thread but I think B12 deficiency occurs a lot more frequently in older animals than we realise. Given the number of older people who suffer from pernicious anaemia and old cats which brighten up a lot with a shot of the pink stuff, perhaps we should be testing them more regularly not just when we're investigating chronic diarrhoea.

Re: ARD?

Ian Battersby — Tue, 25 Oct 2011 14:02:58 GMT

Idiopathic ARD is typically a diagnosis of exclusion and not all need long term Ab some can be weaned off.

What exactly we treat in the True ARD cases we can only speculate ( bacteria flora population composition rather than numbers, an unknown infectious agent , an specific flora intollerance etc etc ). However SIBO is within the group of ARD conditions if that makes sense. So it could be this dog has a secondary SIBO due to IBD , partial obstruction etc.

So even if the owner is reluctent to more investigations - given the low folate and Cb - a diet trail would seem sensible as I would hope you can miminise/eliminate the need for antibiotics. Which i hope is an argument an owner could be amendable to when you outline issues such as selecting for bacteria resistance etc. So ideally you want to avoid it

WRT ARD treatment - tylosin vs MTZ vS OTC. Not aware evidence to say which is best - i think it is personal preference and were you trained.

I would agree with Andy - certainly supplement cobalamin for reasons outlined in his post. there are studies in cats showing that if a B12 def is present they can be less resposnive to diet etc unless the b12 def is corrected

All the best

Ian

Re: ARD?

Andrew Kent — Tue, 25 Oct 2011 10:27:39 GMT

Low folate and cobalamin points to changes the the proximal and distal small intestine, ie malabsorption. It says you have diffuse small intestinal disease rather than focal to one part. This helps in terms of decision making for biopsies etc. you should also supplement cobalamin (and some people would say also folate) as low Vit b causes villus stunting further worsening the malabsorption process. Andy

Re: ARD?

Anthony Todd — Tue, 25 Oct 2011 00:25:50 GMT

[quote user="Mark Hedberg"]Published research says 65% of chronic diarrhea responds to dietary change - in my experience it's considerably more![/quote]

Yeah, me too. Colin Burrows in Florida told me that [I think] 90% of diarrhoea referrals were dietary sensitivity.

Of course these are all in patients that are clinically "well".

Trouble is owners don't stick to an elimination diet and usually give "just a bit of its favourite treat etc."

Other thing is, as well as with skin allergy, the owner or the vet often adds or changes something else to the regime but gives credit to the drug or drugs, classically with flea allergy treated with some wonder drug, but with effective but unmentioned or credited, flea control.

You may find that the owner has stopped the morning milk drink whilst the dog is on the antibiotics for instance??

Re: ARD?

Busybee — Mon, 24 Oct 2011 22:16:54 GMT

Continue with metronidazole for now then? Re-consider diet trial/hypo food once this JW bag has gone? Tell owner may need metronidazole long term but may drop to SID or even EOD? (Can you tell I have to phone the owner tomorrow with the blood results and we need a plan!?)

Re: ARD?

Mark Hedberg — Mon, 24 Oct 2011 22:01:44 GMT

Couldn't tell you (don't know!) but at least this is pointing in a likely direction!

Re: ARD?

Busybee — Mon, 24 Oct 2011 21:23:45 GMT

The pathologist's comment was something along the lines of 'low folate and cobalamin indicate a malabsorptive disease process (eg. IBD, lymphoma)'. So yes, now thinking more IBD but how long would a dog have to have diarrhoea for (for any reason eg. ARD/SIBO) before the folate/cobalamin would decrease anyway?

Re: ARD?

Mark Hedberg — Mon, 24 Oct 2011 20:20:04 GMT

Well, could low cobalamin point towards an IBD?

Re: ARD?

Busybee — Mon, 24 Oct 2011 18:28:42 GMT

Just an update -

Did bloods on the dog - normal TLI, low folate and low cobalamin. Haem and CBC generally nad. Currently on metronidazole alone. So now the options seem to be long term metronidazole or food trial (though the O has just bought a big bag of JWb duck and rice so doesn't want to try a hypo food just yet!).

We are not equipped to do endoscopic biopsies and as I said the before, the owner is very reluctant to do for biopsies at ex-lap.

Re: ARD?

Charlotte Marshall — Thu, 06 Oct 2011 22:08:26 GMT

I may be being thick but why do you need to wait for the dog to get diarrhoea again before starting the food trial? Surely you can start a suitable food straight away and then bring off the tablets and if the food works the dog may not develop the diarrhoea again at all.

Re: ARD?

Rob Loxley — Thu, 06 Oct 2011 18:48:42 GMT

Or Euk Derm FP for another, cheaper option - often my first choice for the squitty GSDs.

For cases that need antibiotics, is there any argument for oxytet vs. metronid vs. tylosin (the US seem keen on this) or is it just the simplest thing that works?

Re: ARD?

Mark Holmes — Thu, 06 Oct 2011 17:22:59 GMT

I have huge success with purina HA, and use a diet trial subsequent to faeces analysis and panacur prior to anything invasive. Results can be dramatic and much sooner than 6 weeks

Re: ARD?

Martin Atkinson — Thu, 06 Oct 2011 09:25:56 GMT

[quote user="Busybee"]

I do want to get it onto a hypoallergenic food but because the owner's seeing good results with tablets, its taking some persuading to wait til the diarrhoea returns then try a 6 week food trial. It's currently on homecooked chicken and rice. I know that research about the 65% too! Might print out the evidence and present it to the owner!

[/quote]

I feel you are going about this the wrong way round and it seems you realise this too so you must be assertive with the owner. ARD/SIBO is almost certainly not a condition in its own right but a response to a failure to digest/absorb food normally causing a change in normal bacterial flora most probably due to IBD, EPI or food intolerance, TLI, B12 & folate test might help in this regard. I would also do the Idexx PCR panel to eliminate or indeed confirm pathological microrganisms. Metronidazole works because of its immunomodulatory properties more than as an antibiotic and a judicious dose of prednisolone will probably work as well. I wouldn't use salozopyrin anymore due to poss. long term side effects. Probiotics don't always work well initially, some dogs need much a longer course over several weeks to recover with 2-3 different types including live yoghurt although this might conflict with an exclusion diet which IMO is the way to go but you may need intestinal biopsies to make the ultimate diagnosis. Chicken and rice is not a good choice these days as they are included in many dog foods, much better white fish or salmon and potato although for sake of convenience I may suggest a commercially available diet first like RCW intestinal support or Hills I/D.

Re: ARD?

Richard Carter — Thu, 06 Oct 2011 08:47:38 GMT

Its a golden retriever - will have infiltrative IBD - trial metron / salaz or metron/ pred. Yes in an ideal world you will chance on the magic food but as it probably finishes off the owners weetabix in the morning, probably not.

Re: ARD?

Mark Hedberg — Thu, 06 Oct 2011 00:09:55 GMT

You don't always need a 6 week trial. Sometimes the results are gratifyingly quick. If the owner sees an improvement in a week or two, then often it's easy to talk them into staying on the food long term.

Re: ARD?

Busybee — Wed, 05 Oct 2011 23:36:57 GMT

Re: ARD?

Mark Hedberg — Wed, 05 Oct 2011 23:29:33 GMT

I will bet you a nickel that a bag of d/d or RC sensitivity will sort it. Published research says 65% of chronic diarrhea responds to dietary change - in my experience it's considerably more!

Food allergies can develop later in life.

Re: ARD?

Busybee — Wed, 05 Oct 2011 22:55:03 GMT

[quote user="Nicola Lawlor"]

Have you tried and if so how does the dog respond to probiotics instead?

[/quote]

Yes, initially the dog responded to probiotics (ProKolin) alone but over the past few months has needed antibiotics to get a response.

The owner is reluctant to go for anything too invasive as she lost her last GR under anesthesia. I was thinking of just sticking to the metronidazole rather than continue with both having read up a bit about ARD recently. Do you think this sounds like a true ARD then (+/- IBD)?

Re: ARD?

Nicola Lawlor — Wed, 05 Oct 2011 20:52:40 GMT

Have you tried and if so how does the dog respond to probiotics instead?

Re: ARD?

Stephen Courtney — Wed, 05 Oct 2011 20:01:33 GMT

I have a few animals with presumed IBD that do well on long term metronidazole - I certainly wouldn't be happy using potentiated amoxycillin long term, asking for scarily resistant enterobacteriacea...

Idexx offer a fecal test looking for DNA of various things like giardia, crytposporidia and campy, worth considering. dietary trials also worth considering, Purina Ha is practially vegetarian as well as hydrolysed, so is pretty much the least allergenic diet you can get for dogs or cats.

also consider endoscopy and biposies etc. if client won't let you do this then try get down to just metronidazole, often this can be given once a day once they are stable.

I've had some success with budesonide and even cyclosporin, but would want a histological diagnosis and food trial first.