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Liz Bode

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Viewing 15 posts - 106 through 120 (of 249 total)
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  • Liz Bode
    Keymaster

    Replying to Nicholas K. 16/11/2022 - 10:48

    Hi Nick,

    So sorry that this slipped form my radar too! In answer to your echo related questions:

    For fractious cats I would use gabapentin initially – it takes the edge off them and has little effect on echo parameters so is fine to use. It will only allow you to echo those cats that are anxious and not the ones that are very aggressive – in my experience you still need something stronger for this. In cases where gaba is not enough I would use butorphanol and alfaxalone – IV if you can get access with gaba but if not IM – only issue is that IM does seem less reliable but it is only a small number of cats where you would need something other than IM butorphanol and alfaxalone.

    Liz

    Liz Bode
    Keymaster

    Replying to Thaleia M. 27/11/2022 - 19:55

    Hello Thaleia,

    This is a good question. Cats are so tricky – we always joke that we should echo EVERY cat (or perform NTproBNP) as you never know which one has heart disease and which doesn’t. However, if you have no abnormalities on auscultation at all, and the cat is otherwise healthy, then I wouldn’t be inclined to do anything further. Then if things change later in the cats life you could always perform NT-proBNP at that point (or echo if you can).

    Liz šŸ™‚

    Liz Bode
    Keymaster

    Hi both,

    Great to see you guys on here too šŸ™‚ I hope you get something from it. Last year we had another ESAVS candidate and she really enjoyed it, so fingers crossed!!

    Absolutely, ask about other certificates in the UK. I am module coordinator for the Improve Distance learning Cardio Cert and for the Liverpool CertAVP but I have limited knowledge of any others. Sadly, none combine theory with practical echo as far as I am aware.

    Liz

    Liz Bode
    Keymaster

    Replying to Laura T. 14/11/2022 - 16:07

    Hi Laura

    Great to have you joining us. I hope that you find the course useful and I look forward to working with you over the coming weeks.

    Liz

    Liz Bode
    Keymaster

    Replying to Kathryn B. 01/11/2022 - 11:59

    Hi Kathryn (and everyone)

    I made this little video running through the x-rays, so here it is. Let me know if you have any questions šŸ™‚

    Liz

    https://drive.google.com/file/d/18AKFZw4OHuoMYZbtNyW7fUjuPaa4ID6o/view?usp=sharing

    Liz Bode
    Keymaster

    Replying to Kathryn B. 26/10/2022 - 08:18

    In that case it’s this one! Sorry I couldn’t spot where I’d mentioned it.

    https://onlinelibrary.wiley.com/doi/10.1111/jvim.15854

    Liz

    Liz Bode
    Keymaster

    Replying to Kathryn B. 23/10/2022 - 20:25

    Hi Kathryn,

    Sorry for the delay and it was nice to ‘meet’ you last night. I’ve looked through my slides and my recording and I cannot see where I mention VHS and a paper, sorry! I do mention the VLAS score in association with a paper. It is:

    https://avmajournals.avma.org/view/journals/javma/253/8/javma.253.8.1038.xml

    It says you can tell if there is LA enlargement with a VLAS of >2.3 in the abstract but in the paper it is more accurate at >3.

    In terms of osteomata/ vessels and neoplasia. This can be tricky. Osteomata tend to have a ventral distribution and are mineral opacity whereas vessels and neoplasia are usually soft tissue opacity. Ostemoata are also very small and there tends to be multiple of them. With vessels you can usually trace back to the origin or they overly a vessel as they turn the corner and come towards you. I guess the real solution is that if you are not sure to repeat the radiographs again in 3-4 weeks to see if there are any changes.

    Liz

    Liz Bode
    Keymaster

    Replying to Sybil Dryburgh 23/10/2022 - 23:14

    Hi both

    Yes, this group originally did a retrospective study on this (although I’m not sure how you do a retrospective study about applying pressure and the presence or absence of a murmur!). They then went on to prove the concept with this prospective study.

    In some cats, usually older and thinner cats, it is possible to place your stethoscope on the right parasternum and cause a low grade systolic murmur. The same goes with echo in some cats. When looking at the right ventricular outflow tract from the right side you can cause a dynamic obstruction due to the pressure of the probe. Another study (before we knew that some of these could be iatrogenic) back in 2004 showed that cats with dynamic right ventricular outflow tract obstruction didn’t have associated pathology or heart disease that would cause it. So, putting two and two together (and hopefully making 4) I think it would be safe to say that these cats probably don’t have pathology but due to their chest conformation you can push the heart against the opposite wall of the chest and deform the right outflow tract resulting in a murmur. When you release the pressure the murmur should disappear. Obviously, if it doesn’t disappear then another cause of the murmur might be present and if you’re not sure then echo is indicated.

    I don’t think we know about dogs but I think the majority of dogs have too big a chest for this to be an issue (think how narrow cat chests are compared to a chihuahua even!)

    Hopefully this answers your question but let me know if there are any others.

    Liz

    Liz Bode
    Keymaster

    Replying to Kathryn B. 17/10/2022 - 18:15

    That’s so sad! The last Golden I saw was a 3year old with pericardial lymphoma presenting as pericardial effusion, took me completely by surprise and had a similar outcome as they do very badly šŸ™ I hope your run of sad cases changes soon.

    Liz Bode
    Keymaster

    Replying to Kathryn B. 17/10/2022 - 16:19

    Hi Kathryn,
    Ooh drainage of big dogs like this can take AGES!!! I’d use a Mila chest drain in these cases as you’ll find them much faster and should reach further into the chest cavity as it probably was the length of your needle that was the limiting factor. You can suture them in for a few days. However, if you’ve drained the chest and it keeps recurring for longer term management I’d use a pleural port ideally (depending on the source of the effusion). A haemorrhagic effusion in a golden retriever doesn’t sound great šŸ™

    Liz Bode
    Keymaster

    Replying to scott@vtx-cpd.com 17/10/2022 - 13:52

    Hi Scott

    Thanks for this and providing the hydrocodone dose.
    I was at a stenting course recently and the course leader used lofenoxal @ 0.2-0.5mg total dose BID as a cough suppressant. Have you used this before? I believe it’s very effective but now needs an import licence?

    Liz

    Liz Bode
    Keymaster

    Replying to Emma Holt 06/10/2022 - 15:49

    Hi Emma,

    The cut-off for myocarditis is unclear, but I would be more suspicious if the cTNI was >1. I think most cardiologists go by this too. Generally they are well above this in the acute stages. It is good to be mindful that chronic myocarditis (at least in people) may have normal or only mildly elevated cTnI, but they usually have a DCM phenotype.

    Liz

    Liz Bode
    Keymaster

    Replying to leonique v. 05/10/2022 - 15:33

    Hi Leo,

    Sure no problem (probably my accent and slurring the words). What we want in pulmonary hypertension is a PDE5 inhibitor as this increases level of nitric oxide resulting in vasodilation of the arteries. This is what sildenafil does in particular within the pulmonary vasculature. Pimobendan is a PDE3 inhibitor and cause arterial dilation via changes to calcium levels in systemic and probably pulmonary vessels. The recent consensus statement on pulmonary hypertension states that pimobendan should be used in cases of post-capillary pulmonary hypertension, ie that caused by left heart disease, but it’s use in pre-capillary hypertension (pul hypertension due to airway disease) has not been studied so it’s use in this situation is unclear. I was referring to cor pulmonale in the lecture – where pulmonary hypertension causes right sided cardiac remodelling and in this instance pimobendan is likely indicated, especially when systolic dysfunction of the right ventricle is present.
    Does that make sense?
    Liz šŸ™‚

    Liz Bode
    Keymaster

    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 ā€˜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 šŸ™‚

    Liz

    Liz Bode
    Keymaster

    Hi Louise,

    Poor little guy! Do you think it could be associated with small thromboembolic events? ATE is quite common in these cats sadly and micro-infarcts could be common and cause angina or pain elsewhere. It might be worth giving him rivoroxaban or apixaban alongside frusemide and clopidogrel if the LA is huge and there is smoke (if owner can manage etc). For pain I’m not aware of any great analgesic for this particular problem. Atenolol would only help if there was an arrhythmia or HOCM and as you said is contraindicated in CHF.
    Gabapentin might help a little. I checked with an anaesthesia colleague of mine too and that is what he suggested as minimal
    Cardiovascular side effects. Although how good it would be for visceral pain in a case like this is debatable. Might be worth a shot though?

    Liz

Viewing 15 posts - 106 through 120 (of 249 total)