Liz Bode

Replying to Kelly M. 27/09/2022 - 09:17

Hi

Thanks for the great questions and sorry for the delay in replying.

I think mediastinal disease is very difficult to identify too. If there’s fluid you get the Christmas tree appearance but solid masses either cause distortion of the mediastinum in specific regions or move things like the trachea (big lymph nodes for example). I’m afraid I don’t have any examples, I rarely encounter this probably because we CT most chests.

When laryngeal paralysis is secondary to hypothyroidism the signs may improve slightly with treatment but would rarely resolve completely. I don’t think we know enough about the mechanism of the disease to understand the relationship. I’d treat the hypothyroidism and monitor the laryngeal paralysis (unless very severe) but warn the owner it’s unlikely to resolve and may still get worse.

Historically we would have chosen metronidazole as part of a ‘four quadrant’ approach to severe AP. These days covering with co-amox will be sufficient for most pathogens and if severe cases or very poorly we would add in a fluoroquinolone. We rarely see pure anaerobes infecting the airways hence the lack of need for metro.

Hope that helps 🙂

Liz

Fab question!

There is no confirmed link in dogs but it is suspected and there are large scale studies in the USA currently.

The thoughts at the moment are that, for unknown reasons, some dogs on grain free diets that are high in peas, pulses or legumes may cause a DCM-phenotype. This is obviously not in all dogs that are consuming these diets, and we probably aren’t encountering it as frequently in the UK and Europe. However, if we are diagnosing a DCM phenotype in a dog that is on a grain free diet then one of our first recommendations is that the diet is changed to non grain free and a diet like Hill’s, RC or Purina etc that we know are complete and high quality. We would then expect to see improvements in systolic function over 3-6months.
If dogs are a breed predisposed to DCM that are on one of these diets then I’d still change the diet but the DCM phenotype is more likely genetic.

Liz

Replying to Kathryn B. 20/09/2022 - 13:21

Hi Kathryn,
Thanks for the lovely questions, I’ll do my best to answer but some of the areas are probably better answered by Scott, a gastroprotectant knowledge king! Sorry also for the delay, I’ve been away and just getting chance to answer now.

– in terms of antibiotic choice this isn’t a combination that I would be familiar with. In uncomplicated aspirations I would tend to stick to co-amox and then consider adding a fluoroquinolone if not as straightforward. Doxycycline does penetrate the airways really well and perhaps they were concerned about Mycoplasma as it is effective for that? Scott might also be able to shed some light here.

– In terms of omeprazole in brachys to reduce aspiration pneumonia I wouldn’t generally use it for this. However, I don’t think it’s straight forward at all and again Scott said he would put his thoughts here and might use it at the Q and A session.

– my preferred choice initially in dogs, if I knew they could be fidgety or slightly aggressive would be trazadone. In cats it would be gabapentin as you suggest. Then, for dogs it would be butorphanol IV or IM at 0.3mg/kg. This can work quite well. If wanting to do rads you’ll like need to add in alfaxalone IV. Cats don’t tend to respond as well to butorphanol so if use butorphanol and alfaxalone IV if possible but if not IM. See my answer to Viktoria for doses. Our anaesthetists tend to avoid midazolam for the reason you give, recovery can be bad and it isn’t very reliable. I think alfaxan has taken its place now and is much more reliable.

– I rarely perform inflated radiographs, I think we can see quite a bit of detail on digital images BUT there is often always interstitial pattern in under inflated rads so if the disease process is mild we might miss it. That being said if possible I would always follow a radiograph with a BAL and cytology which would pick up mild disease better than radiographs. If I were to use anaesthetic in this case for either a well or unwell dog I’d still choose butorphanol and alfaxalone. Although if you have to extubate for a BAL I would use propofol to maintain anaesthesia and so would then not use alfaxalone. We

Hope that helps 🙂 I’ll look forward to hearing Scott’s point of view too.

Liz

Replying to Mariska H. 15/09/2022 - 05:47

Hi,

This is a great question! Heart failure can be defined by the presence of fluid (as this is when the heart can no longer meet the requirements of the body), whether that’s pulmonary oedema or effusion. When an animal has heart failure they usually (with a few exceptions) have survival times less than a year and will have elevated respiratory rates in association with a cough.
Heart disease is progressive so over years the heart can have heart disease but mechanisms in the body, such as RAAS, are upregulated to maintain the efficiency of the heart and in reality it is only a very small percentage of animals that develop heart failure. So I would only ever use the term heart failure when there is fluid present.
In terms of the coughing dog, as I mentioned in the lecture furosemide might improve the cough as it has anti-tussive properties and may even shrink the left atrium by reducing blood volume and therefore left atrial pressure for some time (pimobendan will do the same). If owners finances would stretch to a point of care ultrasound to assess heart size and lungs then this would be preferable before starting furosemide ot pimobendan. If not, and the dog is coughing without an increase in respiratory rate, you could trial a course (10 days) of doxycycline. This is obviously antibacterial but also anti-inflammatory. If no improvement, or cough recurs, then again diagnostics are warranted but if not a short course of prednisolone at 1mg/kg for 2-3weeks could be initiated. Then inhaled steroids if an improvement to that.
Hope that clarifies things and helps.
Liz

Replying to Laura W. 09/08/2022 - 22:40

Hi everyone,

I’m Liz, I make a brief appearance in this course when I discuss feline heart disease. I’m one of the Director’s of vtx along with Scott and Andy. I’m also a Specialist in Cardiology working out of Chestergates Vet Specialists (although I’m currently on maternity leave).

We are really lucky to have Steph present this course. What she doesn’t know about cats is probably not worth knowing 😊

I’m looking forward to answering your questions about heart disease so please post away. I will also include a case or two later down the line.

Liz

Hi Nichola,

Thanks for the question and I’ll reply to this one 🙂 a one off dose of furosemide is fine to give. It would be safe together with steroids or NSAIDs but, in people, NSAIDs result in furosemide resistance and presumably the same is true in dogs and possibly cats (we don’t know for sure). Also, in cats steroids can cause heart failure so I’d be careful in this species (we don’t seem to see the same in dogs).

So yes, in theory, you could give furosemide with these drugs. However, if you suspect heart failure a dose of furosemide on its own followed up with diagnostic tests to confirm or otherwise your diagnosis is better. Otherwise it can be tricky to know which drug is being effective.

Hope that’s helpful!

Liz

Hi all,

These are great questions.

Thyroid hormone and interaction with the cardiovascular system is super interesting. Thyroid hormones play an integral role in many features of the CV system, not just the heart. In people we know that severe hypothyroidism can cause heart failure and that it can also result in arrhythmias, increases in diastolic blood pressure and reductions in cardiac output. In dogs the cardiac affect of hypothyroidism are less well defined.

There are single case reports of dogs with atrial fibrillation and hypothyroidism converting to sinus rhythm with thyroid supplementation and reversal of DCM-phenotypes. However, these cases are few and far between. Scott rightly points out that a study looking at dobermans showed that, although they had hypothyroidism and DCM, there was no causative link, that both diseases probably occurred coincidentally.

Therefore, to answer Scotts question; I would not routinely look for cardiac disease in a dog with hypothyroidism. However, in a dog with a DCM-phenotype, especially in a breed that is not known for DCM, I would check thyroid levels to exclude this, not necessarily as an underlying cause of the DCM-phenotype but as a contributing factor to reduced cardiac output.

Hope that helps,

Liz

Replying to Kerry Doolin 12/03/2022 - 00:43

Me again!

This is a really great case and one that displays how you approach these cases in practice fantastically! I love the practical approach in respect to cost constraints and how much info you can get from a few, relatively simple (although some require confidence/ practice) tests.

I will be intrigued to see what happens (and obviously the cause of the murmur!!).

Liz