Scottie's Pacemaker Implantation at CUVS

Scottie is a very special male 7-year-old Pembroke Welsh Corgi who has previously enjoyed Championships in multiple US and Canadian dog shows. He has also received titles for herding ducks and sheep. Unfortunately, Scottie's owner, Mari Carroll, noticed over the past few weeks that he had become exercise intolerant and less interested in playing with the other dogs in the household. Scottie was brought to his regular vet for an exam. While at the vet's office, he suffered four fainting episodes (syncope). The results of an electrocardiogram (ECG) were cause for concern and Scottie's veterinarian immediately referred him to the Emergency and Critical Care service of Cornell University Veterinary Specialists (CUVS) for a consultation with cardiologist Dr. Mandi Kleman, DVM, DACVIM (Cardiology).

Upon arriving at CUVS, Scottie experienced another episode of fainting and collapse, and he was immediately brought into the Emergency service for stabilization under the care of Dr. Sergi Serrano, LV, DVM, DACVECC. A repeat ECG showed complete heart block. After discussing all of the options with the owners, Dr. Serrano admitted Scottie for a diagnostic workup with the intention of Dr. Kleman implanting a pacemaker.

Scottie's initial diagnostic workup included bloodwork, a urinalysis and an echocardiogram. Due to the additional findings during Scottie's physical exam, an abdominal ultrasound was performed by CUVS board certified internist Dr. Forman DVM, DACVIM (Internal Medicine) prior to pacemaker implantation.

Dr. Kleman implanting Scottie's pacemaker.

At this point,  Scottie was a good candidate for emergency pacemaker implantation, and Dr. Kleman was prepared for the procedure. The 75-minute implantation procedure went smoothly and Scottie was kept overnight for post-surgical monitoring. The next day, Dr. Kleman performed a chest x-ray, another ECG, and programmed the pacemaker to optimize the settings. Programming the pacemaker, as well as periodic evaluations of the pacemaker's function, can be achieved with no sedation and absolutely no discomfort for the animal. Scottie laid down on a bed in ICU and enjoyed a head scratching (care of our technicians) as Dr. Kleman programmed the pacemaker with her laptop computer and a remote control. 

 

Scottie's x-ray (radiograph) taken the day after surgery showing the pacemaker's location.

It should be noted that the total amount of time that elapsed between Scottie's arrival at CUVS and the end of Dr. Kleman's pacemaker implantation procedure was only about 7 hours- a testament to the speed, accuracy and flexibility that is only possible at a state-of-the-art animal hospital such as CUVS.

Dr. Kleman, DVM, DACVIM (Cardiology) and Nicole VanSant, BS, LVT, VTS (ECC) examine Scottie the day after his pacemaker implantation.

“Pacemaker implantation in dogs and cats is not uncommon. Hundreds of pacemakers are implanted in the U.S. each year by veterinary cardiologists,” says Dr. Kleman. “Pacemaker implantation in dogs and cats is also not as expensive as one might think.” The cost of the procedure is comparable to an orthopedic surgery on a dog’s knee or back. Additionally, the procedure is minimally invasive, with the pacemaker implanted through a superficial vein.

Scottie, bright, alert and happy the day after his pacemaker implantation.

The patient recovers from the procedure with instant clinical improvement. The heart rate is restored to normal and the heart can provide enough oxygen-rich blood to the pet's body. The rechecks are not difficult for the pet or the owner. It can be expected that the typical pacemaker only needs to be programmed two to three times in the first year, and once per year after that.

 Please click on the image above to see an enlarged version.

We were thrilled that we could provide the necessary care to another dog with complete heart block. Scottie was a remarkable patient and our affection for him was trumped only by the joy on Mari's face as he was discharged from CUVS the following day.

 Dr. Kleman, DVM, DACVIM (Cardiology) Nicole VanSant, BS, LVT, VTS (ECC), Scottie & Scottie's mom Mari at discharge.

 Nicole, Dr. Kleman, Scottie & Scottie's mom Mari at discharge.

To learn more about pacemakers, click here.

Sherman Gets a Pacemaker at CUVS

Sherman Tank is an 8-year-old, 66-pound male bulldog who was brought into CUVS in need of help. Sherman needed a pacemaker. Sherman’s owners brought him to their family veterinarian for an exam after noticing that sometimes he lacked his usual energy and was reluctant to climb stairs. Sherman’s veterinarian performed an electrocardiogram (diagnostic tool that measures the electrical activity of the heart) and found that Sherman had 3^rd degree atrioventricular block with a ventricular escape rhythm. In layman’s terms, this diagnosis means the normal electrical impulse which stimulates the heart to contract is blocked. Fortunately, the muscular portion of the heart has a back-up system which allows it to continue to beat in the absence of a normal electrical impulse. Unfortunately, this back-up system often fails over time, despite various medical therapies.  Previous veterinary studies have shown that dogs such as Sherman may experience episodes of collapse or even pass away suddenly at home. Sherman was then referred by his family veterinarian to Cornell University Veterinary Specialists to see our cardiologist, Dr. Mandi Kleman, for an evaluation for a pacemaker.

Upon examining Sherman, Dr. Kleman found Sherman to be bradycardic (possessing a heart rate that is too slow), consistent with his previous exam. In preparation for potential pacemaker implantation, she obtained a repeat ECG, an echocardiogram (an ultrasound of the heart), bloodwork, and a urinalysis. The ECG confirmed the continued presence of the 3^rd degree AV block and the echocardiogram showed mild volume overload of the left heart. After discussing the plan at length with the owners, Dr. Kleman scheduled a pacemaker implantation procedure for the following day.

Dr. Kleman surgically implanting Sherman's pacemaker

Sherman stayed at CUVS overnight for monitoring and at noon the following day, Dr. Kleman prepared and scrubbed for the surgery. During a short 90-minute procedure, Dr. Kleman implanted a Medtronic pacemaker device into Sherman’s heart via two small incisions in his neck.  The surgery was a complete success with no complications. The pacemaker was ideally working to control Sherman’s electrical heart rhythm. Sherman recovered in ICU overnight with attentive pain management and monitoring. 

 

Dr. Kleman evaluating Sherman's pacemaker with ECG the next day.

Dr. Kleman programming Sherman's pacemaker the next day.

The morning after the procedure, the pacemaker was functioning properly, Sherman was energetic, and he ate a can of dog food for breakfast. That day, Dr. Kleman performed a chest x-ray, another ECG, and programmed the pacemaker to optimize the settings.  To program the pacemaker, Dr. Kleman uses a specialized computer to evaluate the pacemaker’s function and if necessary, to adjust the settings of the pacemaker. Sherman was prescribed oral antibiotics and a mild tranquilizer to keep him calm and to allow him to heal properly. He was discharged to his owners at 4PM that day with a normal heart rate and a short little wagging tail.

Sherman at discharge with Dr. Kleman,DVM, DACVIM (Cardiology), Carrie Maskley BS, CVT, Sherman and his owners

–      Dr. Mandi Kleman, DVM, DACVIM (Cardiology)
–      Stephanie Phillips, BA, A.A.S, LVT                       

Learn more about pacemakers by clicking here.

Human pain relievers are toxic to dogs and cats

This past week we saw a couple cases of ibuprofen toxicity in dogs- one was an intentional dosing of the dog by the owner, and the other was a case of the dog finding the bottle of pills and ingesting them. While these are two very different situations, the end result is the same: two very sick animals. Cats and dogs that ingest ibuprofen (the active ingredient in Advil), acetaminophen (Tylenol) or aspirin experience a wide range of negative effects such as severe vomiting, gastric ulcers, kidney failure, liver failure and, if the animal is not treated medically, death.

The dog we treated that accidentally ingested the ibuprofen pills arrived at CUVS comatose, with constricted pupils. She was unresponsive but trembling. Our team sprang into action by administering fluids and the appropriate drugs, placing a nasogastric tube, suctioning her stomach and giving her charcoal and gastroprotectants. Her blood values were closely monitored overnight and by the morning she was awake and aware, although she did stay in the intensive care unit for three more days. Despite the severity of this case, both dog and owner are very lucky: the attentive owner figured out something was wrong and rushed his dog to the vet. This quick thinking saved the dog's life.

The case described above provides two valuable lessons for pet owners:

#1: Make absolutely sure that all of your pills at home are locked away securely.

#2: Do not give any pills to your dog or cat without seeing your vet first.

We all know that dogs like to jump up and see what's on the counter or table, and cats have a truly remarkable ability to jump onto the highest shelves. A bottle of pills left out on a flat surface is a tempting target for both dogs and cats.

If you feel like your pet is in pain, always bring her in to see your vet. The vet will advise you on the proper care for whatever is causing the pain, and you can be certain that the prescription he writes for you will be safe.

Here is the rule of thumb we'd like you remember: dogs and cats cannot take the same pain relieving pills as humans.

Casey's Abdominal Surgery at CUVS

   Casey is a mixed-breed spayed female dog owned by Suzanne, who is the Senior Client Service Representative at Bull's Head Pet Hospital. Casey was referred to CUVS from Bull’s Head after Dr. Nolan Zeide diagnosed her with a large abdominal mass, hemo-abdomen and a fever.  Casey was admitted to CUVS for observation, supportive care and a further work up under the care of Dr. Rousseau, DVM, DACVIM, DACVECC.

An ultrasound at CUVS revealed a large mass potentially originating from the liver, an abnormal spleen and a probable left adrenal mass. Casey underwent abdominal exploratory surgery with Dr. Alon Kramer, DVM, DACVS, during which a large, ruptured splenic mass and a ruptured liver mass were found. A splenectomy, a liver lobectomy and an adrenal biopsy were performed. (Her spleen and part of her liver were removed.) Casey also received a blood transfusion during surgery, a routine part of splenectomies as it combats anemia.

Post surgery, Casey stayed in our ICU for four days for pain relief and continuous monitoring. Attentive post-surgical monitoring is important for splenectomy patients to make sure that there are no complications. Lab results came back showing liposarcoma of the intermediate grade in the spleen, hepatoma in the liver and suspected pheochromocytoma in the adrenal gland.

Once Casey was stable enough for travel, she was sent back to Bull’s Head so her regular veterinarian could continue caring for her. Casey was a lovely patient for us and although we are happy she was discharged from CUVS, we were sad to see her go!

CUVS Featured on Channel 12 CT's Pet Talk TV Show

Dr. Susan Hackner (CMO) and Dr. Mandi Kleman (Cardiology) are interviewed by Lauren Collier on Channel 12 CT's "Pet Talk" TV show about the opening of Cornell University Veterinary Specialists.