Dog with CHF maxed out on meds

RE: Dog with CHF maxed out on meds

Martin Atkinson — Tue, 14 Nov 2017 19:03:00 GMT

To bring some order back to this thread: the dog in my OP came back in tonight and reports isn't coughing and is bright and happy. We've taken blood for TT4 in case the cervical mass is a functional thyroid mass but they have balked at biopsy because they won't have surgery. I'm also doing a profile to check renal function in case it is a case of 'never let anything die without the benefit of the 'roids'!

RE: Dog with CHF maxed out on meds

Roland Bulkyn-Rackowe — Tue, 14 Nov 2017 17:59:09 GMT

[quote user="Anthony Todd"]

[quote user="roland bulkyn-rackowe"]Both were cats diagnosed with restrictive cardiomyopathy[/quote]

Why ever use a long-acting Csteroid in a condition that responds to a short acting Csteroid particularly when the allergen is identified and modern flea treatment gives such good control and quickly?

[/quote]Good question. I didn't make that particular decision in either case.

RE: Dog with CHF maxed out on meds

Anthony Todd — Tue, 14 Nov 2017 15:45:54 GMT

[quote user="Sarah Keir"]

I am choosing not to reply as I don't feel like getting trolled this week. For those interested in the cases they can talk to me in a reasonable fashion. Otherwise lets just leave it at that

[/quote]

Come on, I'm on your side FHS!

Now you're not helping either, and are in a justifiable one-star situation.

RE: Dog with CHF maxed out on meds

Sarah Keir — Tue, 14 Nov 2017 14:41:25 GMT

I am choosing not to reply as I don't feel like getting trolled this week. For those interested in the cases they can talk to me in a reasonable fashion. Otherwise lets just leave it at that.

RE: Dog with CHF maxed out on meds

Anthony Todd — Tue, 14 Nov 2017 14:26:26 GMT

[quote user="Sarah Keir"]I have definitely seen it[/quote]

One star is just stupid as it helps nobody, but the history and the c-steroid dose etc. would be helpful.

I doubt if single jab of a short-acting one would produce any side effects?? [perhaps a bit of polydipsia?]

RE: Dog with CHF maxed out on meds

Anthony Todd — Tue, 14 Nov 2017 14:22:44 GMT

[quote user="roland bulkyn-rackowe"]Both were cats diagnosed with restrictive cardiomyopathy[/quote]

Why ever use a long-acting Csteroid in a condition that responds to a short acting Csteroid particularly when the allergen is identified and modern flea treatment gives such good control and quickly?

RE: Dog with CHF maxed out on meds

niall morton — Mon, 13 Nov 2017 22:21:52 GMT

I’ve definitely seen it a few times but only ever in cats and I’ve worked with vets that use ALOT of steroids

RE: Dog with CHF maxed out on meds

Roland Bulkyn-Rackowe — Mon, 13 Nov 2017 21:45:56 GMT

Both were cats diagnosed with restrictive cardiomyopathy (by a cardiology diplomate), both had been relatively stable on heart meds for some months. They had both previously (some years before) had depo medrone injections for FAD. The same vet gave this to each of them immediately before their decompensation. One I remember particularly well as I would count the owner as a friend. His notes would be straightforward to find. The other not so much as I didn't have much to do with him other than presiding over his deterioration / demise.

RE: Dog with CHF maxed out on meds

Anthony Todd — Mon, 13 Nov 2017 17:34:26 GMT

[quote user="roland bulkyn-rackowe"]

Re steroids in CHF. I have seen 2 cats in the last 18 months who have practically "dropped off the needle" within a day of a depo injection (I saw them on the following day unfortunately). I've not had any dogs suddenly decompensate after a trial dexamethasone injection (at <0.15mg/kg) and plenty seem to benefit.

[/quote]

I'd love to see the case notes... bit like saying "my friend rode a bicycle and died on day one".....

Why would anyone give a long-acting steroid to an animal straight off. This sounds like a complex condition with all sorts of serious therapeutic possibilities so treat with caution and very short term initially.

Treatment like this is usually dogmatically quoted, and with other gross mis-use, as the main reasons why steroids, on here, and by modvets, are so denigrated.

I'm confident saying that any Csteroid injection that I have given has never caused anything nasty because I use that group of drugs sensibly and with consideration.

RE: Dog with CHF maxed out on meds

Roland Bulkyn-Rackowe — Mon, 13 Nov 2017 16:45:47 GMT

RE: Dog with CHF maxed out on meds

Martin Atkinson — Mon, 13 Nov 2017 09:09:55 GMT

The medics refer to sinus rhythm as a normal heart beat i.e. P/QRS/T. Somehow we have bastardised it to refer to a steady heart rate as opposed to sinus arrhythmia which as I understand is the variance of a normal heart rate with breathing under vagal control which is a normal state in a normal dog. To clarify: under that definition, this patient has loss of sinus arrhythmia.

RE: Dog with CHF maxed out on meds

Jill Butterworth — Sun, 12 Nov 2017 12:06:32 GMT

Attempt a standing radiograph if your local rules and dog training abilities would allow it? ;)

RE: Dog with CHF maxed out on meds

Rob Loxley — Sun, 12 Nov 2017 10:20:25 GMT

[quote user="David Mills"]Atko mentions sinus rhythm, I assume he means variance with breathing.[/quote]

I assumed sinus rhythmn was as opposed to some pathological dysrhythmia/prematur complexes/AF etc., rather than a sinus arrhythmia?

RE: Dog with CHF maxed out on meds

Judith Archbold — Sat, 11 Nov 2017 20:30:23 GMT

I think any vet ( mentioning no names...) who won't use / trial steroids in a case like this " because they don't use steroids" shows a complete arrogance and lack of clinical judgement.

Just walk around a geriatric ward in a hospital and look at human patients. Most of them will have lung pathology such as bronchitis or COPD as part of their cardio-respiratory deterioration.

Who gives a fat rat's arse if the steroids shorten this dog's life by a week or so....it'll have a less crappy end if it doesn't have to cough all the time .

RE: Dog with CHF maxed out on meds

David Mills — Sat, 11 Nov 2017 20:22:37 GMT

[quote user="Sarah Keir"]

I have definitely seen it.

[/quote]

How did you diagnose it?

RE: Dog with CHF maxed out on meds

Sarah Keir — Sat, 11 Nov 2017 19:48:25 GMT

I have definitely seen it.

RE: Dog with CHF maxed out on meds

David Mills — Sat, 11 Nov 2017 19:20:42 GMT

[quote user="Sarah Keir"]

I would be very careful about using corticosteroids in a patient that sounds like is already struggling with fluid load - this could definitely tip into volume overload.

[/quote]

I think the steroids and fluid build up dogma has largely been found to be theoretical rather than clinical in humans. Ive never seen it.

Atko mentions sinus rhythm, I assume he means variance with breathing. Therefore there is significant respiratory disease which causes vagal irritation - pure chf would be sinus tachycardia.

Likewise I think pretty much the enlarged LA/cough stuff has largely been disproved. They only cough with enlarged LA if underlying resp disease. Cardiac cough is very different to resp cough.

So in this dog treat the resp disease too. That means preds for bronchitis, being an inflammatory disease and all that. I've found lomotil and methylxanthines to be almost uniformly useless, and codeine moderately OK in some patients. Time to bite the bullet Atko! How delicious.

RE: Dog with CHF maxed out on meds

Sarah Keir — Sat, 11 Nov 2017 15:09:18 GMT

I would be very careful about using corticosteroids in a patient that sounds like is already struggling with fluid load - this could definitely tip into volume overload.

RE: Dog with CHF maxed out on meds

Rob Loxley — Fri, 10 Nov 2017 13:40:49 GMT

[quote user="Thomas Johnson"]

I would have pulmonary oedema higher on my list of differentials than emphysema for crackly lungs in a dog with cardiac disease.

My other bid concern would be that thyroid tumours metastasise to the lungs.

[/quote]

I think a chest xray would be very useful - if metastatic thyroid tumor then maybe the end, if no pulmonary oedema/congestion then less worry about more diuresis and maybe some steroids?

[quote user="George Cooper"]Let the poor bugger go and be at peace. Jeez.......[/quote]

I guess that Martin is able to decide when this is the right answer. The more general discussion on where to go with cases is otherwise interesting, no?

RE: Dog with CHF maxed out on meds

ChrisBVSc — Fri, 10 Nov 2017 13:10:53 GMT

Got a similar case in a JRT at the moment on totally maxed-out oral meds (the dog is on everything possible including moduret). Referral cardiologist I spoke to recommended trying additional frusemide injections at weekly intervals, potentially increasing to every 3-4 days. The rationale being, despite being on maxed out oral frusemide already, the effects of CHF on circulation can mean absorption of oral meds is less effective. Therefore giving intermittent parenteral frusemide may bypass this issue, firstly with the aim of improving pulmonary oedema, and second by potentially improving the GI circulation issues that may be limiting oral drug uptake - therefore oral drugs may become even more effective short term too.

Anyway, I've tried it (currently giving the dog 1mg/kg frus IM once a week), and although the lungs are still crackling, the owner is convinced clinical signs at home have improved. Plus the dog has been fine - ideally you should be monitoring renal values & lytes as you're giving way more frus than recommended, however in this situation the owner & I are in agreement that we've got nothing to lose so if the kidneys pack up then so be it, if the dog gets to be a happy a while longer in the meantime.

RE: Dog with CHF maxed out on meds

Thomas Johnson — Fri, 10 Nov 2017 09:32:59 GMT

[quote user="Martin Atkinson"][quote user="robloxley"]what do you mean by 'emphysema' in this dog? how much of the dog's cough and tachypnoea is primary lung rather than cardiac disease? [/quote]My definition of emphysema is breakdown of alveolar walls I can hear crackling which is suggestive of this.[/quote]

I would have pulmonary oedema higher on my list of differentials than emphysema for crackly lungs in a dog with cardiac disease.

My other bid concern would be that thyroid tumours metastasise to the lungs.

RE: Dog with CHF maxed out on meds

Michael Woodhouse — Fri, 10 Nov 2017 00:47:52 GMT

Was also going to suggest steroids. Make them feel better, reduce inflammation and potentiate the diuretics.

RE: Dog with CHF maxed out on meds

George Cooper — Thu, 09 Nov 2017 19:25:00 GMT

Let the poor bugger go and be at peace. Jeez.......

(But try a dose of short acting steroid first, to be sure you have tried everything.) ( AND - what happened to the much-criticised so-called poly-pharma situation......)

RE: Dog with CHF maxed out on meds

Anthony Todd — Thu, 09 Nov 2017 18:28:11 GMT

This is a very recent development and with a 6/6 systolic murmur its pretty certain cardiac failure is the main factor.

Surely with "cardiac failure" exercise tolerance would surely be reduced and that is a more reliable indicator than the volume of a murmur?

Back in the day, some of the fastest greyhounds in Glasgow had massive cardiac murmurs. it's just a noise after all....

Don't look at the cause search the effect.

RE: Dog with CHF maxed out on meds

Rob Loxley — Thu, 09 Nov 2017 17:41:17 GMT

[quote user="Martin Atkinson"]It is difficult to assess how much of the progression the disease is cardiac and how much lung disease as they won't let me X-ray it in case it gets distressed yet they're prepared to pay £100's for medication.[/quote]

Are you sure it's in congestive heart failure; a thought given previous poor response to frusemide?

[quote user="Martin Atkinson"][quote user="Thomas Johnson"]A little bit of codeine might be helpful as an anti-tussive?[/quote]Most opioids are effective so butorphanol and Lomotil are better,[/quote]

AFAIK Torbutrol tablets are discontinued and Lomotil (both the branded and generic) is currently unavailable?