Liz Bode
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Replying to scott@vtx-cpd.com 09/11/2024 - 01:33
Hi Sarah
Yes, that’s quite a tricky one. Generally though you want to ensure that you don’t volume load them too much so cautious with the fluids, even though you might have a stage B1 cat you could still induce CHF with over judicious use of fluids. You can give medetomidine to cats with HCM, lower doses, as they have diastolic dysfunction not systolic dysfunction it is safer to use and they don’t mind a slight increase in afterload. Usually though, opioids and alfaxalone induction with inhalational is going to be fine. More fractious cats you can use low dose alpha-2. I don’t know doses off the top of my head I’m afraid as I always defer to our anaesthesia colleagues!
Hope that is somewhat helpful
Liz
Replying to scott@vtx-cpd.com 06/09/2024 - 23:54
Hi both,
I would agree with Scott’s comments above. The only time I’d consider performing this procedure is in a dyspnoeic dog and then the owners have to be aware that coughing will continue. I was working with Scott last year and he was referred a case for stent placement and when the dog walked through the door I think Scott and I were both thinking it would be a great candidate. However, the dog did very well on medical management and never (this far at least) required a stent.
The dogs that we have performed stents in don’t have further dyspnoeic episodes and the coughing can be relatively well managed with medications. At the time off stent placement we will scope and BAL them to make sure we haven’t got any infectious component to the cough. We tend to try and do everything under one GA (scope, BAL and stent) as recovery is risky in these patients if work up is done in a staged approach.
Liz
Hi all,
Welcome to this fab course, covering a wide range of topics.
I am Liz Bode, one of the Directors of vtx but I am also a Specialist in Cardiology working out of Chestergates Veterinary Specialists near Chester in the UK. I also have two small boys, 2 and 4 years old who keep me busy and very entertained!
I look forward to working with you all over the next few weeks and I will ‘see’ you for coughing and the ECG lesson at the end of the course. We really hope you enjoy it and it gives you more confidence in your every day clinical practice.
Any questions, please ask as always.
Liz
Replying to Laura Jones 31/08/2024 - 19:24
Massive thanks to you all. We hope you enjoyed the course and learnt things that you can take in to your every day practice. I’m going to post an ECG for your thoughts over the course of the next couple of weeks too, so feel free to have a look at that and let me know what you think 🙂
Liz
Replying to scott@vtx-cpd.com 20/08/2024 - 23:55
Hi Maria,
This is a good question. We do need to be more cautious in cats with steroids generally. There is a link (or possible link) between giving a cat steroids and them developing heart failure. A study on healthy cats a few years ago found that a dose of steroids caused significant changes in glucose levels and vascular volume in some cats, not all, studied. We think that in cats with heart disease these fluid shifts can then precipitate heart failure as cats with HCM and diastolic dysfunction are less able to cope with fluid changes and can develop heart failure as a result. Some people, however, question whether it is the steroids that cause heart failure or whether it is the stress of going to the vets in the first place!
However, until we can better define the risk I would always be cautious giving a cat steroids without certain clinical need (like acute asthma episode), especially if they have signs of heart disease such as a murmur, gallop sound or arrhythmia. We don’t worry in dogs as they tolerate steroids and changes in vascular volume better as their underlying heart diseases don’t tend to cause diastolic dysfunction.
Hope that makes sense!
Liz
Hi all
Just to finish this case;
We performed a thoracic POCUS and there were diffuse B-lines together with a dilated RA and RV with very prominent PA. Therefore we treated Millie for pulmonary hypertension, put her in oxygen and left her alone for 24 hours with monitoring only. She responded very well and we were able to take her out of oxygen 48hours later – a miracle! A CT showed changes consistent with fibrosis and echo moderate PHT. The acute onset didn’t quite fit this picture and my differentials were PTE or non-cardiogenic pulmonary oedema. She is currently on sildenafil, clopidogrel and had a course of fenbendazole too. She’s doing well!!
Liz
Replying to Spela Bavcar 03/08/2024 - 05:33
Hi everyone
Thanks from me too, I hope you enjoyed it and find it useful in your clinical practice.
See you soon 🙂
Liz
Hi all,
I have just noticed a mistake in the date for this event. It is actually tomorrow 30th July at 8pm. The link above should work and the papers are the same.
See you then,
Liz
Hi all,
I have just noticed a mistake in the date for this event. It is actually tomorrow 30th July at 8pm. The link above should work and the papers are the same.
See you then,
Liz
Hi all,
I have just noticed a mistake in the date for this event. It is actually tomorrow 30th July at 8pm. The link above should work and the papers are the same.
See you then,
Liz
Replying to Carmen P. 08/07/2024 - 11:55
Hi,
Great question and always a tricky one. I think if the cat is a stage B2 and is asymptomatic then it is best to go ahead with the dental procedure. You will need to be very cautious with any fluids you give, if any, and monitor blood pressure closely. That being said these cats will manage with even a low dose of medetomidine. I’d probably use methadone if the cat is calm as a pre-med then induce with alfaxalone and maintain with whatever gas you use. You could also perform nerve blocks if confident with those which will help with analgesia but also reduce the amount of anaesthetic you use.
Hope that is useful?
LizReplying to Laura Jones 23/06/2024 - 11:26
Hi all,
I’m Liz, one of the Directors of vtx and also a specialist cardiologist working out of Chestergates Veterinary Specialists near Chester in UK. We can’t wait to have you on board for this course, please don’t hesitate to ask me any cardiology or ECG related questions 🙂
Liz
Replying to scott@vtx-cpd.com 07/05/2024 - 22:10
Hi Laura
Thanks for the great questions.
In terms of bronchodilators, we don’t really think or know that they’re very effective in dogs and cats so I wouldn’t use them prior to performing a BAL for this reason. The only time we might use them is in cats (terbutaline) to try and prevent bronchospasm prior to scope/BAL. This is really clinician dependent though.
For steroids – I don’t worry about them so much in dogs, their heart disease and the physiology of it (thinking mainly MMVD) means they can cope better with fluid shifts. We need to be more cautious in cats and certainly prior to any depot steroids we should assess a cat’s risk of heart disease e.g murmur, gallop, arrhythmia and if we have concerns then advise echo before going ahead. That being said some cats have significant heart disease without a murmur! We don’t know exactly if it’s the steroids themselves that result in some cats developing CHF though, or if it’s the stress of coming to the vets!
Hope that helps.
Liz
Hi all,
I’m Liz, a Cardiologist working from Chestergates Veterinary Specialists in the UK and I’m also one of the Directors of vtx alongside Scott. I’m excited to be part of this course, respiratory disease is such a common problem that can be tricky to manage for all of us!
I hope you find the course applicable to your everyday practice and I look forward to supporting you over the coming weeks.
All the best,
Liz
Replying to scott@vtx-cpd.com 04/04/2024 - 00:06
Hi Rachel
I’m not surprised you’re not looking forward to it!
It would be unusual for a dog this age to have both PS and PHT so I would bet that it just has PS, most likely moderate to severe with those changes and that kind of murmur. It would likely be a candidate for balloon valvuloplasty/stent placement if it did have this so I’d be pushing for referral where possible (although I know this is tricky when they don’t necessarily perceive a problem). PHT would be lower in my list if the dog doesn’t have any respiratory issues. I don’t have any words of wisdom regarding anaesthesia – Felipe will be better placed obviously, but I guess without a diagnosis it will be tricky to advise very well.
Liz
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