Liz Bode

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

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

Hi all

Welcome to this course, I’m really looking forward to working with you and answering any cardiology-related questions. Feel free to ask whatever you like!

I’m one of the Directors of vtx and a cardiology specialist working out of Chestergates Veterinary Specialists in the NW of England. I did my residency with Jenny and Scott and I’m delighted to be working with them both again!

Liz x

Replying to scott@vtx-cpd.com 19/11/2023 - 11:48

Hi Amanda,

I hope your dad is doing better now?

This is a great question and one that I am not sure I can answer easily. We often see AKIs following initiation of diuretics in our feline and canine populations. However, we know much less in these patients with respect the cardiorenal axis and how we should be managing them.

Ultimately, it is a fine balance between managing the heart failure and the AKI and, for me, it depends on the scale of the AKI. If it is mild I will usually withhold diuretics for a time, whilst monitoring the respiratory rate closely, or I will at least reduce the dose of diuretics the patient is receiving. Often this is enough to bring the creatinine down to more acceptable levels. However, when the AKI is more severe (and in my head I guess I have values of >300 even though I know this isn’t necessarily how an AKI is classified) I might start cautious IVFT. I say cautious because a patient in CHF doesn’t need a significant amount of volume, so usually I am looking at around. 2-4ml/kg/hr depending on the case. Again monitoring respiratory rate and ins and outs closely.

I will be very interested to know what Kerry thinks about managing AKIs in the context of CHF but also when CHF is not a concern.

Liz

Hi everyone,

I’d also like to welcome you all to this brand new course, it will be fantastic! I’m Liz, one of the other Director’s of vtx and a cardiologist. I’m available to answer any questions that you might have with regards cardiology!

Enjoy the course, and as always, we welcome feedback about other content you might want to see on here.

Liz