Exercise and heart murmur

Re: Exercise and heart murmur

Virginia Campbell — Sun, 15 Dec 2013 21:41:07 GMT

[quote user="robloxley"]

[quote user="Ann Holohan"]refusing any workups[/quote]

Interested why this is,

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Could be of the of the "I don't want the lump sent off, I'd rather not know" persuasion aka ostrich.

Re: Exercise and heart murmur

Rob Loxley — Sun, 15 Dec 2013 19:40:10 GMT

[quote user="Ann Holohan"]refusing any workups[/quote]

Interested why this is, as they are obviously concerned re their pet's health. Knowing if the dog has preclinical DCM may have a bearing on whether to use pimobendan which can improve the outlook for the dog http://onlinelibrary.wiley.com/doi/10.1111/j.1939-1676.2012.01026.x/abstract

Re: Exercise and heart murmur

Martin Atkinson — Wed, 11 Dec 2013 15:21:11 GMT

[quote user="Ann Holohan"]Hi, we have a client with a Doberman with a low grade heart murmur diagnosed at least 1 year ago, refusing any workup[/quote] I nearly forgot my pet subject (well one of them!) NT-proBNP. If the client won't let you do any extensive work-ups you may convince them to do this. If you're not familiar you only need 1ml of EDTA blood, test costs you £35 from Idexx. A low result will give you confidence to advise exercising the dog, a high result may convince them to work it up further.

Re: Exercise and heart murmur

Martin Atkinson — Wed, 11 Dec 2013 10:30:46 GMT

[quote user="Ann Holohan"]Hi, It feels like I've opened Pandora's box,[/quote] You are new to this forum Ann. You will very quickly find that compared to most threads, Pandora hasn't even found the key yet on this one!

Re: Exercise and heart murmur

Ann Holohan — Tue, 10 Dec 2013 17:50:37 GMT

Hi, It feels like I've opened Pandora's box, It's a really nice client, last dog was a very overweight retriever, I think they were not very well advised by a colleague, will have a chat to them and get them going with stepping up the exercise and monitoring resting resps. Didn't know about Cardalis App so will recommend that too. Thanks everyone, Ann

Re: Exercise and heart murmur

Martin Atkinson — Tue, 10 Dec 2013 12:49:44 GMT

[quote user="Francisco Gomez"]You put an image of a Devil or something in the post[/quote] That is the Devil's Advocate which I am often playing the challenge is tell when I'm serious or not!

Re: Exercise and heart murmur

Francisco Gomez — Tue, 10 Dec 2013 12:09:45 GMT

... you did a post that I thought was quite funny... I said something to do with changing my opinion of your posts (when I thought David wrote it).. You put an image of a Devil or something in the post... Long time ago. This, of course, being after one of David's attacks on the forum reaching the 10,000 users landmark, which involved attacking me ...

Re: Exercise and heart murmur

Martin Atkinson — Tue, 10 Dec 2013 11:35:25 GMT

[quote user="Francisco Gomez"]It's a 'tongue in cheek' post Martin. [/quote] Yup despite there being a whole row of them I didn't spot the tongue in cheek smilies until I clicked post.

[quote user="Francisco Gomez"] you remember that day that I made the mistake of referring to you when I meant someone else... ?[/quote] Actually I don't!

Re: Exercise and heart murmur

Francisco Gomez — Tue, 10 Dec 2013 11:13:29 GMT

It's a 'tongue in cheek' post Martin. I actually agree with him too. Just wanted to pay him back in the way he always destroys my posts ...

[quote user="Martin Atkinson"]

despite that fact that he is a pain in the rear end some most of the time

[/quote]

... you remember that day that I made the mistake of referring to you when I meant someone else... ?

Re: Exercise and heart murmur

Martin Atkinson — Tue, 10 Dec 2013 11:02:41 GMT

[quote user="Francisco Gomez"]Hurts donnit David?[/quote] I don't often find myself defending David (but we're NBFs now)! I think you're over-reacting Francisco, and despite that fact that he is a pain in the rear end some most of the time I empathise and agree with his attitude entirely on this occasion. That was a bit of an unnecessary personal assault. And don't think it will hurt him, its water off a duck's back.

Re: Exercise and heart murmur

Mark Holmes — Tue, 10 Dec 2013 10:54:12 GMT

I just tell them that in all likelyhood he will be absolutely fine but I won't give 100% guarantee because that would just tempt fate and he won't be.

Re: Exercise and heart murmur

Francisco Gomez — Tue, 10 Dec 2013 10:11:04 GMT

[quote user="David Mills"]

I find owners in this situation want you to give definite answers with no diagnostic information

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Welcome to the trade David, or perhaps you've failed to appropriately educate your client before making this generalist, vilified and unfair to most clients comment.

[quote]

- I had a barrister

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Are you really making a point here? The fact that the owner is barrister doesn't give you the right to accuse her of ignorance about pets or medicine! I'm sure that if you were involved in a legal procedure that is not part of your trade you would ask questions that your lawyer would consider idiotic.

[quote]

last night with a panting old Westie (likely pulm fibrosis) who wouldn't pay for an examination

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So you do accuse her of wanting a diagnosis without examination but you have the cheek of making one, don't you?

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but, over the phone, wanted to know (at least three times) 'If I go to bed now, and leave him, will he definitely be alive in the morning?'.

[/quote]

I'm sure you've the experience of this happening. We all complaint about it daily. Do you think she is asking for reassurance because she loves her animal and she is scared to lose him? Or are you suggesting here that she is planning to sue you if you answer the question and things turn out to be the other way around?

[quote]

After the third time of asking I said I'll just go and find my free crystal ball. She put the phone down at that point.

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And then we complaint of why we are losing the general public trust.

***

Hurts donnit David?

Re: Exercise and heart murmur

Hannah Wynne Richards — Tue, 10 Dec 2013 09:46:36 GMT

David I hope you took her phone number. Next time you have a legal problem,wait till 3 am, then phone and demand advice foc.Bloody cheek.

Wynne

Re: Exercise and heart murmur

David Mills — Mon, 09 Dec 2013 19:29:04 GMT

There is pretty convincing evidence from the human field that exercise even when in CHF is a Good Thing, and certainly a Good Thing pre-failure at improving haemodynamics, myocardial blood flow etc etc. There's nothing in the vet literature but yes I'd get the thing out and running - rather have it die chasing round a field than being hand-fed gourmet meat wheezng in obesity on the sofa.

I find owners in this situation want you to give definite answers with no diagnostic information - I had a barrister last night with a panting old Westie (likely pulm fibrosis) who wouldn't pay for an examination but, over the phone, wanted to know (at least three times) 'If I go to bed now, and leave him, will he definitely be alive in the morning?'. After the third time of asking I said I'll just go and find my free crystal ball. She put the phone down at that point.

Re: Exercise and heart murmur

Martin Atkinson — Mon, 09 Dec 2013 19:18:26 GMT

Wot the other's say. But if they refuse a work-up get them counting the resting respiratory rate - cost them nothing. It is surprisingly constant at around 22/min in all dogs and if it stays there then there is probably little risk. Of course it's obesity may increase this but what they are looking for is a gradually rising rather than steady rate. Gives them something to do and is probably the most reliable DIY/free evaluation there is. They can even download the Cardalis app onto their smartphone to keep a record (I expect they have one of them most people who won't spend money on their pets still buy gadgets)!

Re: Exercise and heart murmur

Robin Grimmer — Mon, 09 Dec 2013 18:52:58 GMT

If this dog had DCM it would be dead by now, so lack of clinical signs in a year means probably not significant. How old is the dog?

Re: Exercise and heart murmur

KMurphy — Mon, 09 Dec 2013 18:27:12 GMT

Maybe point out that the obesity is likely to pose a greater threat to his heart than exercise. Sort out his diet, recommend a gradual build-up of exercise and hopefully all will be well. I'm assuming it's "just" a murmur - no rhythm abnormalities or any associated clinical signs.

Edit - should also say that I tell owners that heart murmur does not equal heart failure. Maybe if this is explained, if it hasn't been already, the owner will be a bit less frightened to exercise the dog.

Re: Exercise and heart murmur

Hannah Wynne Richards — Mon, 09 Dec 2013 18:15:27 GMT

Yes

Wynne