April is National Heartworm Awareness Month!

Heartworm Awareness and a Very Special Update

April is National Heartworm Awareness month, and our cardiologist, Dr. Gretchen Singletary, DVM, DACVIM (Cardiology), has some information for all dog and cat owners about this dangerous, but highly preventable disease:

"Heartworm disease affects increasing numbers of dogs and cats in the US every year. The disease is transmitted by mosquitoes and is most prevalent in warm and humid climates. Peak transmission usually occurs during July and August, although pets in certain areas such as the Southeastern US may be at risk year-round. Heartworm disease is a serious, sometimes fatal condition which can be safely and easily prevented using a monthly heartworm preventative medication. Yearly testing for heartworm is recommended for all dogs.

Pets infected with heartworm can develop damage to their blood vessels, lungs and heart. Symptoms include coughing, difficulty breathing, decreased ability to exercise and weakness. Severe infections can result in heart failure or death. There are approved treatments for infected dogs - including injections of a medication to kill the worms and removal of the worms using a minimally-invasive surgical procedure. There are no approved treatments for heartworm infections in cats. Prevention is key when it comes to heartworm disease!"

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 Dr. Gretchen Singletary, DVM, DACVIM (Cardiology)

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We at CUVS can't think of heartworm without also remembering Lucky. In 2011, we posted about Lucky, the mixed breed dog who was rescued in Los Angeles, and brought to CUVS by a New York rescue organization. When he was first brought to us, Lucky had suffered gunshot wounds to his legs, and needed several surgeries. While his injuries were already certainly enough for the scrappy dog to handle, it was discovered that Lucky was also suffering from a severe heartworm infection of his pulmonary artery. Fortunate for Lucky, our cardiologist was able to expertly remove the heartworms using flouroscopy and an incredibly steady hand. While heartworm extraction is a complex procedure with many risks involved, Lucky sailed through the procedure and after a night of recovery in CUVS' Intensive Care unit, went home heartworm free.




When Lucky was brought to CUVS, his injuries were severe.

 

Cardiologist Dr. Kleman was able to remove a sizable group of heartworms from Lucky's pulmonary artery.


Lucky then underwent surgery to repair the damage to his front and rear legs, caused by serious abuse before he was rescued. Thanks to the skill and care of CUVS' surgery department, Lucky's limbs were skillfully repaired and Lucky was able to regain full use of all his legs. At the end of Lucky's journey here, one of our staff members adopted him and provided Lucky with a happy ending in his new forever home. 

Lucky with Dr. Kleman, members of the nursing staff and his rescuers on his way home.


Lucky attended our Courageous Companions event in April, and CUVS staff had the opportunity to reunite with him and his supportive family. We're happy to say that he looks incredible, and along with his supportive family, enjoyed the spotlight with his colleagues.

Lucky attended the reunion looking better than ever!

Lucky was fortunate that his heartworm was discovered before it had progressed any further, and he serves as an example of why heartworm prevention is so vital to a pet's well-being. Speak to your primary care veterinarian about the prevention options available to you and take care of all those hearts that are so dear to yours!

Zolty's Heart Surgery at CUVS

Zolty is an amazingly sweet 9-year-old Golden Retriever who was born on Valentine's Day in 2002. Zolty's owners recently noticed an acute onset of extreme weakness, prompting them to take Zolty to see Dr. Nolan Zeide, their regular vet at Bull's Head Pet Hospital. After a thorough examination, Dr. Zeide found that Zolty suffered from pericardial effusion and a condition called cardiac tamponade. In layman's terms, pericardial effusion is the accumulation of excess fluid around the heart. Cardiac tamponade is the compression of the heart that occurs when blood or fluid builds up between the heart and the outer covering of the heart. Dr. Zeide referred Zolty to Cornell University Veterinary Specialists for further evaluation and treatment.

When Zolty arrived at CUVS, he was extremely weak with a fast heart rate and weak pulses. His heart sounds were barely audible with a stethoscope. One of the first diagnostic tests run on Zolty at CUVS was an echocardiogram, which confirmed Dr. Zeide's findings of pericardial effusion and cardiac tamponade. Additionally, a mass was located on the right side of Zolty's heart.

In order to alleviate the stress created by fluid buildup on the outside of Zolty's heart, criticalist Dr. Sergi Serrano, LV, DVM, DECC performed an ultrasound-guided pericardiocentesis. In other words, Dr. Serrano used ultrasound as a means of guidance to insert a needle into the sac surrounding Zolty's heart and remove the excess fluid that was trapped there. After Dr. Serrano removed 100mls of fluid, Zolty's tampanade resolved on its own and his heartrate returned to normal. While this remarkable turnaround sounds exciting, it was simply a temporary fix for the symptoms associated with a larger problem: the mass on Zolty's heart. It should be noted that Zolty still had arrhythmias, or abnormal electrical patterns within his heart, and that the fluid would have continued to fill up within the outer covering surrounding Zolty's heart if no further action was taken.

After a consultation with Dr. Serrano, Zolty's owners decided that they wanted to have the mass removed from Zolty's heart. A second consultation with Dr. Mandi Kleman, DVM, DACVIM (Cardiology) involved more detailed and extensive analysis of Zolty’s heart and the mass. Using echocardiogram, Dr. Kleman found that the pumping function of Zolty's heart was moderately depressed. Additionally, she described the location, size, and appearance of the mass within the edge of the right atrium. Based on these findings, she suspected to be a malignant type of cancer called hemangiosarcoma.

Zolty's large run allowed him to stretch out and relax post-surgery.

After the values of a full blood test were found to be favorable, and no metastatic disease was discovered on abdominal ultrasound, Dr. Alon Kramer, DVM , DACVS scrubbed in to perform Zolty's heart surgery. Zolty’s surgery involved a thoracotomy (open chest surgery) to allow exposure, and careful excision of his heart’s right atrial mass. Dr. Kramer also removed part of Zolty’s pericardial sac (the outer covering of the heart) to prevent any future fluid accumulation. The surgery went very well, despite being a technically difficult procedure. Zolty recovered recovered uneventfully and was comfortable in our ICU shortly afterwards. After the surgery, the mass was sent out to the lab for a histopathology and analysis.

Zolty relaxes in his run in ICU while we monitor his heart functions post-surgery.

Zolty stayed in the ICU for four days after surgery for close monitoring and pain and arrhythmia management, during which time he successfully won over every single employee that participated in his care.

Zolty and critical care technician Stephanie Phillips, BA, AAS, LVT

After his stay in ICU was over, Zolty was discharged to his owners with a Holter Monitor, which is an ambulatory device that measures heart rate and rhythm for 24 hours. The beauty of these devices is that they can be worn by the patient while resting in the comfort of their home. The dog can relax while the Holter monitor acts like a portable ECG, recording information about the heart that can be downloaded later for analysis. Heart rhythm abnormalities can vary from hour to hour, so without a portable device like the Holter monitor, the animal could experience abnormalities while away from the animal clinic that would otherwise be missed by the doctor. Zolty stayed at home resting for 24 hours while wearing the Holter monitor, and then he was brought back to CUVS to have the monitor removed. The data was then downloaded and analyzed. We were all pleased to find that the Holter monitor showed no evidence of concerning arrhythmias post-surgery.

The histopathology report on the heart mass did reveal cells consistent with hemangiosarcoma, confirming Dr. Serrano and Dr. Kleman’s pre-surgical suspicions. Hemangiosarcoma is a form of malignant cancer. Zolty is currently being seen by CUVS oncologist Dr. Edwin Brodsky, DVM, DACVIM (Oncology) who has begun treating him with chemotherapy. Chemotherapy does not usually make animals feel ill like it can do to humans. The use of chemotherapy in animals is not meant to absolutely cure the cancer; rather, it is a way to prolong a good quality of life. As such, we are very happy that we were able to give this wonderful dog more time with his owners. Zolty is an amazing animal who deserves to live a comfortable life, and we all feel blessed to be able to help with that.

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.