Terrier with ?emphysema (mine!)

Re: Terrier with ?emphysema (mine!)

Michael Woodhouse — Fri, 18 Jan 2013 23:14:11 GMT

Wren is a horse vet - I imagine she is very familiar with horizontal beam radiography!

When it is your own dog the rules go out the window. If it was my terrier sick then I'd hold the dog - whatever the rules say. (we sometimes hold pets)

From our rules from our RPA:

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An exception to general practice is allowable if it is considered necessary to radiograph an animal undergoing a special procedure. In addition to wearing protective aprons, gloves or hand and forearm drapes, any person in close proximity to the animal should be positioned as far as is practical from the path of the useful beam. No part of their person, even if covered by protective clothing, should be within the area of the beam. When such procedures are unavoidable they should be carried out by the veterinary surgeon requesting the examination, or by another member of staff trained in the techniques involved.

Re: Terrier with ?emphysema (mine!)

Joyce Whitehead — Fri, 18 Jan 2013 22:40:17 GMT

[quote user="james herriot lied"]

[quote user="Joyce Whitehead"]

and this was pre visit onion but I'd second that as it has worked for a little Scottie I was treating for fibrosis too.

[/quote]

Vivitonin? It took a while.

[/quote] Oops. Sorry blinking iPad spell check. It was indeed meant to be vivitonin.

Re: Terrier with ?emphysema (mine!)

David Mills — Fri, 18 Jan 2013 22:05:05 GMT

You need an X-ray. For the seconds it will take to capture one, it'll give a wealth of information. Otherwise this is an exercise in guesswork. Pulmonary auscultation is phenomenally insensitive as a diagnostic tool (there's about a 30% agreement with definitive diagnosis). Crackles only tell you its fluid popping or the dog moving too much.

The misunderstanding with xrays I think comes from a misinterpretation of BVA guidelines which states that manual restraint can only be used when chemical and non-manual restraint has been exhausted or in exceptional circumstances - a statement written by some old boys in a committee room if ever I heard one. In my previous employ, manual restraint of RTAs, dyspnoeic animals was the norm. Certainly nothing in law disallowing it. There was an interesting discussion on here a while ago where Mike Martin produced with HPA figures for exposure limits and every day exposures which was illuminating.

Corvental can be effective but it needs to be given BID 10mg/kg minimum in advanced disease. It's hellish expensive for questionable benefit in most cases. Terbutaline has beta2 effects so works in a different way. Both are misunderstood - they don't dilate the bronchial tree, but just makes it less likely to collapse, or, mainly, spasm, by relaxing bronchiolar smooth muscle. Whether bronchiolar spasm has much of a role in pulmonary fibrosis or chronic bronchitis is open to question.

Re: Terrier with ?emphysema (mine!)

james herriot lied — Fri, 18 Jan 2013 21:45:26 GMT

[quote user="Joyce Whitehead"]

and this was pre visit onion but I'd second that as it has worked for a little Scottie I was treating for fibrosis too.

[/quote]

Vivitonin? It took a while.

Re: Terrier with ?emphysema (mine!)

Joyce Whitehead — Fri, 18 Jan 2013 20:28:45 GMT

I'd also be suggesting pulmonary fibrosis if she sounds crackly, generally the crackles seem to be all over the lung fields and not so much just ventrally as you would hear with oedema. My old border terrier (no longer with is) had this and sadly didn't make 12 years old. She got to the stage where she couldn't get her head down to sleep. However she had the problem for at least 2 years prior to this and had a happy time, still enjoying her walks. Cornpvental did nothing for her, and this was pre visit onion but I'd second that as it has worked for a little Scottie I was treating for fibrosis too. Inhalers didn't work for my border, but then neither did systemic steroids ...

Re: Terrier with ?emphysema (mine!)

Evelyn Barbour-Hill — Fri, 18 Jan 2013 18:21:29 GMT

[quote user="Rajat"] envisaged no personnel in the room when a horizontal beam view is taken..if shooting at a wall behind which there are no people, and no one is in the room, is this unsafe? Or more unsafe than lead protection + holding the pet? Just curious..[/quote]

Yes of course you can do horizontal beams but as you've already worked out it needs extra precautions. Partly because of all the scatter bouncing about in directions not perhaps catered for by your regular precautions, partly because you might be shooting someone with the main beam who is all unprotected, unbadged, maybe unaware. Whereas with a vertical beam, lead table, someone experienced and trained standing out of the beam to hold the dog all togged up with the lead armour and fingertip or wrist monitors....... very little risk.

Re: Terrier with ?emphysema (mine!)

Rajat — Fri, 18 Jan 2013 18:01:16 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Rajat"] meant its not permitted to hold them down while shooting the radiograph like they do in the US[/quote]

That's a statement you often see made but as far as I know it's not true.

If we are truly considering radiation safety I'd be far more bothered about using a horizontal beam.

[/quote]

Thanks Bob and Evelyn - I have heard it often so yeah seems like its a commonly held belief- certainly says so in the document given to us by our RPA!

I envisaged no personnel in the room when a horizontal beam view is taken..if shooting at a wall behind which there are no people, and no one is in the room, is this unsafe? Or more unsafe than lead protection + holding the pet? Just curious..

Re: Terrier with ?emphysema (mine!)

Bob Russell — Fri, 18 Jan 2013 17:51:12 GMT

Conscious X-rays, held by staff member (suitably attired) are quite acceptable where clinical grounds justify it. I don't expect my staff to hold them but I do where required.

Re: Terrier with ?emphysema (mine!)

Evelyn Barbour-Hill — Fri, 18 Jan 2013 17:46:49 GMT

[quote user="Rajat"] meant its not permitted to hold them down while shooting the radiograph like they do in the US[/quote]

That's a statement you often see made but as far as I know it's not true.

If we are truly considering radiation safety I'd be far more bothered about using a horizontal beam.

Re: Terrier with ?emphysema (mine!)

james herriot lied — Fri, 18 Jan 2013 17:37:32 GMT

[quote user="Rajat"]

[quote user="Wren"]I do conscious rads sometimes. I didn't think it was banned? [/quote]

No sorry I assumed you'd have to hold her for it, or anaesthetise her and henceyou did not want to do it..I meant its not permitted to hold them down while shooting the radiograph like they do in the US

[/quote]

Shurely shome mishtake? I thought we were allowed to do it, but had to have clinical grounds not to sedate/anaesthetise, no gloves in the picture and a dosimeter stuffed up each sleeve.

As in our practice

Plus one for inhalers, as an asthmatic I can attest to the relief given - always worth a punt, and you can pick up paediatric chambers for literally nowt from the doctors, and a small face mask from work for ditto.

Re: Terrier with ?emphysema (mine!)

Dagmar Steele — Fri, 18 Jan 2013 17:25:41 GMT

[quote user="Rajat"]

[quote user="Wren"]I do conscious rads sometimes. I didn't think it was banned? [/quote]

[/quote] As in Germany for that matter. Surprisingly we don't drop dead, all of us :-) But then, if you're not allowed to hold the animal, it will be very difficult to do.

Re: Terrier with ?emphysema (mine!)

Rajat — Fri, 18 Jan 2013 17:17:17 GMT

[quote user="Wren"]I might try her with codeine tablets (cheap, cheerful and easy)[/quote]

Yup, much nicer than the syrup!

Re: Terrier with ?emphysema (mine!)

Rajat — Fri, 18 Jan 2013 17:16:45 GMT

[quote user="Wren"]I do conscious rads sometimes. I didn't think it was banned? [/quote]

Re: Terrier with ?emphysema (mine!)

Bob Russell — Fri, 18 Jan 2013 16:52:25 GMT

Full surgery and operating list yesterday to bu**er all in a few hours! Don't you love a little bit of snow!!!

Re: Terrier with ?emphysema (mine!)

Wren — Fri, 18 Jan 2013 16:37:26 GMT

I don't know if this is allowed in a serious clinical debate, but this is the dog in question, with her partner in crime.

I might try her with codeine tablets (cheap, cheerful and easy) before embarking on the inhaler but I'll bookmark this thread so I can retrieve your helpful advice wheneer I need it.

I do conscious rads sometimes. I didn't think it was banned? Obviously precautions for the people restrainng the animals but if I've chosen to do them conscious it's usually because the animal needs little/no restraint. We do horses conscious all the time, with a lateral beam...

With reference to the snow - I'm waiting for evening surgery to start (the one small animal surgery I do) but we have NO appointments booked. Hence recourse to t'internet.

Re: Terrier with ?emphysema (mine!)

Bob Russell — Fri, 18 Jan 2013 16:37:23 GMT

Perhaps a frusemide therapeutic trial? If everything else has failed and you are not going to investigate worth a go if she is otherwise OK.

I have no concerns with gowning up and holding one of my own pets but will only do conscious X-rays on patients I feel sedation or g/a is going to be particularly hazardous to the patient.

Re: Terrier with ?emphysema (mine!)

Andrew Kent — Fri, 18 Jan 2013 16:28:10 GMT

[quote user="Wren"]

That's helpful too thanks. Butorphanol tablets are definitely discontinued (used to use them a bit for KC in my SA days). There's something on our wholesaler list called 'codeine linctus' which is about £15 for 2l. Does that sound about right? I've taken a lot of codeine tablets in my time and they are the most foul-tasting drugs known to man. I hope the syrup is better!

She's definitely got a good quality of life, I'd just like to breathe more easily and cough less. And be 5 again...

[/quote] She's a terrier so I'm sure she still thinks she is 5! :-)

I'm afraid the codein linctus is pretty disgusting tasting as well so tablets may be easier!

Re: Terrier with ?emphysema (mine!)

Anthony Dennison — Fri, 18 Jan 2013 16:13:20 GMT

[quote user="Rajat"]I am assuming everyone is as quiet as I am with all this snow, eh? [/quote]

Got excited when we had a real flurry of snow here in St. Annes (near the golf course)... but it stopped at lunchtime and is almost all gone now :(

Re: Terrier with ?emphysema (mine!)

Rajat — Fri, 18 Jan 2013 16:10:35 GMT

[quote user="Dagmar Steele"]

I know in the UK x-rays are mainly taken under GA, in Germany we do lots of conscious x-rays, if the dog is ok to handle. Maybe there's no GA needed for a little overview ? It would be better than nothing and is quickly done.

[/quote]

I believe this is not permitted in the UK...one way though of getting around this is to get a standing lateral horizontal beam view with a regular xray plate and a dental xray head. Does need the pet to stand still in front of the plate...and it is a terrier... not sure it will be successful!!!

Re: Terrier with ?emphysema (mine!)

Dagmar Steele — Fri, 18 Jan 2013 16:06:45 GMT

Re: Terrier with ?emphysema (mine!)

Kate Richardson — Fri, 18 Jan 2013 16:06:26 GMT

[quote user="Wren"]And be 5 again...[/quote]

I know what you mean But she is a terrier and they are sooooo resilient!

Re: Terrier with ?emphysema (mine!)

Rajat — Fri, 18 Jan 2013 16:05:55 GMT

[quote user="Kate Richardson"]

Do you think there is any point trying inhaled corticosteroids/bronchodilators if oral ones haven't really worked? (assuming adequate doseage)

[/quote]

I'm also not a fan of oral bronchodilators but when I do use them I use Terbutaline. Corvental has failed me several times and a swap to Terbutaline has worked so I am not sure why. And it sounds from the description there was a response to medrone so I think inhaled CS will work. I like your idea of PF if there are crackles on auscultation :)

FWIW Furosemide is a bronchodilator too and positive responses in older coughing small breed dogs without other strong supportive signs of CHF are often false positives.

A flurry of responses and postings here so I am assuming everyone is as quiet as I am with all this snow, eh?

Re: Terrier with ?emphysema (mine!)

Wren — Fri, 18 Jan 2013 16:03:04 GMT

She's definitely got a good quality of life, I'd just like to breathe more easily and cough less. And be 5 again...

Re: Terrier with ?emphysema (mine!)

Kate Richardson — Fri, 18 Jan 2013 15:59:42 GMT

Do you think there is any point trying inhaled corticosteroids/bronchodilators if oral ones haven't really worked? (assuming adequate doseage)

Re: Terrier with ?emphysema (mine!)

Rajat — Fri, 18 Jan 2013 15:55:54 GMT

[quote user="Rajat"]I find sometimes you can wean these pups off the steroids, but often not poss esp if there is irreversible chronic change like BE[/quote]

To clarify, I meant wean off oral steroids after a while of being on both oral and inhaled Corticosteroids...