Dave Dickson's Activities

Older coughing dogs.

Claire Godfrey — Wed, 28 Jan 2026 14:12:50 GMT

Just wanted to ask what you all do for older coughing dogs, seem to be having a run recently.

Those dogs that are generally well but old, owners don't want diagnostics but want to make more comfortable.

I have tried codeine, pardale, honey and benyllin. Anything else? Most are already on Nsaids.

Thanks in advance.

What do you think about 91% of vets reporting mental health issues?

Arlo Guthrie — Wed, 11 Dec 2024 14:15:04 GMT

Not sure what to make of this:

https://www.vetsurgeon.org/b/veterinary-news/posts/91-of-vets-reporting-that-the-job-causes-them-mental-health-problems

I mean, that is a huge percentage.

Doesn't define what a mental health issue is, and I think that is a significant problem with this research.

But assuming that it is bad enough to report, then I wonder what is driving it? Changing nature of the job. More demanding clients. Less rewarding. Or is it that the younger generations are simply less resilient than older ones?

Any thoughts?

Sedation for heart work-up in cats

joanne mcallister — Wed, 04 Jan 2023 16:55:18 GMT

Hi,

What is the best sedation protocol to use to xray and echo a middle-aged cat with a heart murmur?

Thanks!

Medetomidine and heart disease.

Miriam Lodewyks — Thu, 15 Sep 2022 21:39:18 GMT

I have a colleague who’s terrified of using Medetomidine in dogs with heart murmurs, sh’s convinced it causes progression into active heart failure.
I’ve used this drug daily over the past 25 years and can’t think of any actual cases that have ended badly, but I’m now worried I’ve unwittingly been causing harm to my patients…

Can anyone advise when I really should NOT be using this drug, and are there any papers I can swat up on to help decide when it is/isn’t appropriate to use Medetomidine for chemical restraint.

Medetomidine and heart disease

Miriam Lodewyks — Wed, 14 Sep 2022 12:59:20 GMT

Can anyone advise when I really should NOT be using this drug, and are there any papers I can swat up on to help decide when it is/isn’t appropriate to use Medetomidine for chemical restraint.

Lung ultrasound in cardiogenic pulmonary oedema

Roger Wilkinson — Tue, 14 Jun 2022 18:26:53 GMT

Second interesting thing to discuss.

I still read authoritative texts and articles by cardiologists recommending that thoracic radiographs are required for confirmation of cardiogenic pulmonary oedema.

In human medicine...

www.ncbi.nlm.nih.gov/.../

'The findings suggest that LUS is more sensitive than CXR in detecting pulmonary edema in acute decompensated heart failure'

This is pretty much in line with most published findings.

As a sonographer it just seems natural to me to do lung and abdominal ultrasound in conjunction with echo as a means of making an assessment of cardiac status (L CHF, R CHF). I never really want to have the hassle and cost of doing CXR as well. Ok we know that lung ultrasound isn't 100% sensitive for CPO but it's probably @80-90% depending on exactly which criteria one uses. Specificity depends a lot on patient population but, on the whole, I find it a lot easier to distinguish pneumonia, fibrosis, interstitial syndrome and pulmonary neoplasia on the basis of LUS.

I'm just interested in why LUS hasn't fully supplanted CXR in the mainstream of vet cardiology. Is it because people are often not very good at separating B lines from other lines? Or it's because we don't have the right set of criteria to define what's positive Vs negative yet?

Again any thoughts much appreciated.

Roger

Subaortic stenosis tx

Roger Wilkinson — Tue, 14 Jun 2022 15:18:00 GMT

Hello heart people,

It's been ages since we discussed any cardiology on here. I have a few things I wouldn't mind talking about if anyone has the energy...

First up...

This RCVS Knowledge vet evidence review

https://doi.org/10.18849/ve.v6i2.368

I really like these generally...but I find this one a bit perplexing.

It's nice to have a precis of relevant publications. The conclusion of the review reads:

'Treatment of some form should be given to a dog diagnosed with aortic stenosis. This will improve clinical signs and there is evidence to say that it will prolong survival as well as improve quality of life'

I wondered whether it's just me who finds this to be a perverse conclusion where the only controlled study directly addressing the issue of survival with/without beta-blocker clearly finds no benefit of treatment.

And I'm not aware of controlled studies showing improved signs. Maybe I've missed something? Eason et al (2014) certainly don't look at clinical signs.

I find it frustrating generally that advice presented in texts and articles frequently doesn't reflect the evidence base. Doubly so with this Vet Evidence series which should be a great chance to sort out the situation objectively.

I'll be completely up front and say that as an AVP i find it a minefield when one witholds treatment according to what seems to be best evidence and then runs the risk of complaints from clients when they do get tablets from elsewhere.

Any thoughts appreciated...tell me I'm wrong, it'll make life easier!

Roger

Sleep apnoea in CKCS with MMVD & CHF

Holly Lee — Sun, 26 Sep 2021 23:18:13 GMT

Hi all,

I would appreciate any cardiology opinions on the following.

10yo CKCS been on pimobendan for 12 months then tipped into CHF. When this happens she developed marked URT noise which settled when furosemide was initiated. Lung ultrasound confirmed she had pulmonary oedema at the time and there is no sign of this now but she is better on TID furosemide (1mg/kg TID).

I had been assuming the URT noise was due to some BOAS type issues with her being CKCS which had been exacerbated by the increased respiratory effort of tipping into CHF, which fitted in with this reducing when we increased her back from BID to TID furosemide.

However the owner has now mentioned to me that she has episodes during sleeping where she will stop breathing for around 15 seconds, and her heart rate slows during this time. The owner is VERY vigilant about monitoring resting RR which are stable around 24-48bpm; HR at home is typically around 130bpm.

My first thought was that it was a sleep apnoea type issue due to some upper respiratory narrowing, probably an overlong soft palate. However I came across one experimental study suggesting that pulmonary hypertension could cause a sleep apnoea or irregularities in breathing during CHF. I don't have the skill to assess pulmonary hypertension on ultrasound and funds for a specialist scan may be limiting.

Has anyone any experience of these signs? Any thoughts as to whether it's cardiac or unrelated trigger?

The complicating factor is that she now needs a dental, which is an anaesthetic concern but allows us to assess her upper airways some more. My thought is how much I need to prioritise getting a specialist echocardiography referral prior to this.

Thanks for any thoughts,

Holly

CHF treatment in first opinion practice

Annie Gleed — Thu, 05 Nov 2020 22:40:17 GMT

I am a first opinion vet trying to come up with some protocols for chf management for my practice. Recent discussions with cardiologists have suggested full bloods followed by initial therapy with pimobendan and furosemide then repeat bloods for renal and electrolytes 2 weeks later before adding in aceinhibitors. Please may I ask if there is an azotaemia at this second bloods and the dog is stable do you reduce frusemide dose if possible and re-blood before adding in ace inhibitor? This is assuming no azotaemia initially.

thank you

Management of CHF in cats

Dave Dickson — Fri, 13 Nov 2020 09:23:22 GMT

[quote user="Kate Richardson"]Definite tangent! Dogs always get priority in discussions about cardiac disease management balancing management of renal disease and cardiac disease is a common scenario for me. Cats seem so much more susceptible to the negative effects of frusemide than dogs so torasemide is interesting although I don’t know enough to know if the side effects are any different- I suspect not. [/quote]

Tangent of: RE: CHF treatment in first opinion practice

OK, let's start a tangent then. I've not done this before so bear with me

With cats, it's both much more complicated and much more simple. Cats get a wide range of cardiomyopathies and we are still only just learning how to describe them, let alone know how to treat them. However, a cat in heart failure has limited treatment options and even less evidence to guide us. This is what I do.

1. A cat in CHF (pulmonary oedema or pleural effusion) gets a loop diuretic. Frusemide works well. Torasemide works well too. Toras is once daily for most cats, so wins for me. We don't have any real safety data on it, but then we don't have any on frusemide either. Don't get me started on controlled trials in cats.

The goal of any diuretic is always to give the minimal effective dose. Because cats get more diastolic problems than dogs (in human medicine this is called heart failure with preserved ejection fraction or HF-PEF), they are more sensitive to diuretics than dogs and generally I give them about half the dose - I'd start a dog with 'standard' CHF (whatever that is) on 2mg/kg frus BID whereas a cat I'd go for 1mg/kg BID.

2. A cat with a big left atrium gets clopidogrel 18.75mg SID, if it will take it. There is some reasonably good evidence that it works and is better than aspirin at preventing secondary ATE. If they won't take clopidogrel I use aspirin.

3. Beyond that, it's a combination of nuance and guesswork. Some cats get more profound systolic dysfunction with their particular flavour of cardiomyopathy so, provided they don't have significant outflow tract obstruction (loud murmur, Doppler evidence of obstruction) I might use pimobendan cautiously. There is some pretty weak evidence it helps but this paper is old now and hasn't been verified prospectively. There is some data (in review still, frustratingly) that shows pimo can be harmful in cats. This should be no surprise to anyone - we need to stop thinking of cats as all getting one 'heart disease' that needs a standard cocktail of drugs. I think pimo can work in some individuals but is harmful in others.

ACEi have no proven benefit on their own. In combination with spironolactone makes more sense, but no data. Occasionally I do use Cardalis in cats but only when I'm convinced the cat can take the 3rd pill.

That's what I do. If you want more specifics, give me some scenarios to work with. And see what the other cardiologists think as there will be other approaches.

Dave

When to start Pimobendan?

Anthony Dennison — Thu, 17 Sep 2020 08:26:05 GMT

Would it be possible to get some advice on a scan I did last week? 10 yr old MN CKCS, grade 4/6 systolic murmur, PMI left apex, thoracic percussion all normal. M mode LVIDd was 2.93cm, which is the upper end of normal according to the JVIM paper on allometric scaling for M mode, and LA:Ao was 1. There was E:A reversal on left sided parasternal view, with the ratio of 1.73.

No clinical signs of CHF currently, no exercise intolerance. ECG was unremarkable as well. Should this dog be started on pimobendan yet or wait and rescan in 3-6 months? It is very borderline, and with the EA reversal being quite significant I didn't know whether it would be advisable (then again my measurements using the Doppler may not be accurate).

Pimobendan as positive chronotrope

Roger Wilkinson — Fri, 07 Aug 2020 09:41:39 GMT

Anyone use pimo in, for example, 2nd degree AVB?

https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=6361644_jvms-81-022-g001.jpg

I realise no proper evidence, just curious if anyone uses it in that scenario and if you think it has any effect.

All the best

Roger

pimobendan....extrapolation from MVD to mitral dysplasia and tricuspid dysplasia???

Roger Wilkinson — Mon, 04 Nov 2019 15:01:01 GMT

I'd like to invite some debate on this. We have EPIC study suggesting that we can use pimo in B2 mitral valve disease to delay onset of CHF. So.....does the same argument apply to mitral dysplasia with L heart enlargement? Immediate pathophysiology is the same but usually younger dogs and less progressive lesion? And if so then what about tricuspid dysplasia? What are your thoughts in theory and what do you do in practice guys?

thank in advance for any feedback

Roger

Right atrial thrombus in dog- do I give Clopridogrel?

Andrew Henfrey — Tue, 09 Jun 2020 12:00:33 GMT

www.vetsurgeon.org/.../3326.Molly_5F00_Foster_5F00_20200609083413_5F00_0932590.avi www.vetsurgeon.org/.../7041.Molly_5F00_Foster_5F00_20200609083413_5F00_0948440.avi11 year old female labrador with ascites, pleural effusion, and small pericardial effusion. Atrial fibrillation - HR200-300. Tricuspid regurgitation identified on CFM. Relatively large thrombus in right atrium, small possible thrombus in left ventricle.

Dog home on frusemide, benazecare, diltiazem. Do I give anything [clopridogrel?] for the thrombi.

Videos posted with owner's permission.

TIA.

Hunting dog coughing up blood

Fable — Tue, 19 May 2020 01:55:12 GMT

Would really appreciate some help with this interesting case.

The patient is a pig hunting dog, who in the past 2 weeks has had episodes of coughing up small amounts foamy blood. This only occurs when he is out hunting and therefore exercising strenuously. The rest of the time according to his owner he seems normal. He has had no recent episodes of trauma and no access to rat bait or other toxins. The cough has persisted since the last episode 4 days ago.

On CE: mm pink and moist, crt<2s, HR fast but regular rhythm and no murmurs, RR normal but slightly increased lung sounds especially caudally, NAD abd palp, T 38.3

I sedated him to take the images attached to this post. He has right sided heart enlargement with enlarged lobar pulmonary arteries suggesting pulmonary hypertension. This could explain the bloody foam he is coughing up.

I have also run full CBC/biochem which came back with only very mild increases in urea and glucose and low normal K+.

In an ideal world I would refer this dog for echocardiography, but if that is not an option in this case what further diagnostics would you recommend that I do with this patient? Is there any benefit to a treatment trial - something like sildenafil or pimobendan? Clinically he is normal most of the time so could we elect for benign neglect or should I act now to slow the progression of disease? Obviously his career as a hunting dog is going to be limited.

Any advice would be gratefully received. Many thanks!