Cardiac Disease

Cardiac or heart disease can take many forms, and have many causes (etiologies).

Congenital  is  when a problem is present at birth, usually as a result of an anatomical anomaly. Examples are patent ductus arteriosus which occurs when there is a shunt around the major arteries that supply the heart that does not close at birth. This is usually detected by a veterinarian at the pet’s first visit and is manifested by a very loud and pronounced murmur. Treatment is the surgical ligation of the shunt, reestablishing proper blood flow dynamics to the heart.

 The other congenital anomalies are septal defects of the heart. The septum is the wall that separates the 4 chambers of the heart. If a hole is present between the chambers, blood leaks through and causes the other chambers of the heart to enlarge due to an increased blood volume. Eventually heart failure occurs. The murmurs present in these cases are not as pronounced as the patent ductus arteriosus. Surgical correction is much more difficult because it involves in open heart surgery versus  ligating vessels outside the heart.

Valvular defects can be congenital or acquired. Acquired cases usually occur in older patients, usually smaller breeds. Predisposing factors include chronic dental disease that seeds the valves with bacteria setting up placque deposits, not allowing the valves to close properly, causing an audible murmur, and eventually causing other chambers of the heart to enlarge.

Cardiomyopathies are syndromes where the the heart muscle is affected and the heart gets larger. Certain breeds are predisposed, ie Doberman Pinschers, Boxers, and Great Danes.
Heartworm disease can cause permanent damage to the heart.  The severity of the infection and length of time with the disease before treatment, will contribute to the severity of damage to the heart.

Diagnosis is usually made during a routine physical exam.  Ideally the pet is not showing any clinical signs and a murmur is detected.  As heart disease progresses, the pet owner may notice coughing, especially at night and early morning. Exercise intolerance, weight loss, lethargy, and bloating may be seen as the disease progresses into heart failure.  We are very aggressive in promoting diagnostic tests when a cardiac abnormality is detected. We can do chest radiographs, electro cardiograms, blood pressures, and ideally, we refer to a cardiologist for an echocardiogram.

Dr. Patrick Kelly and his dog Ellie (Ellie was a rescue dog with heartworm and has residual heart disease controlled with medications)

 

 

 

 

Cardiac disease, as in most disease processes, responds best when diagnosed early. There are many drugs available that help manage and slow down the progression of the disease. We do not ascribe to the commonly held suggestion that “ just watch him/her. If he/she starts coughing, or has exercise intolerance, we will pursue it further.” What you are then telling a client is we will wait until their pet is in congestive heart failure before we treat. If we had received the same suggestion from one of our physicians, I am sure most of us would seek a second opinion. Pets can lead long and productive lives with heart disease if they are diagnosed early and monitored routinely.

Herd helps baby elephant caught in snare - GrindTV.com

Herd helps baby elephant caught in snare - GrindTV.com

Housecalls

We at Kelly's Animal Hospital are now offering housecalls upon request. We realized there is an unmet need for our senior clients who are no longer able to drive and need help from others when their beloved pets need veterinary care.

My mother in law lives in an assisted facility that allows pets. She is very fortunate she has us to help with her dog and cat, but many others simply do not, and their pets go without much needed veterinary care.

We will begin accepting requests for housecall veterinary care. If your pet needs more than can be provided at home, we will transport them to our veterinary hospital for further evaluation, diagnostics, or hospitalization.

We hope this new service will improve the lives of our senior clients and their beloved pets.

Call us at (772) 336-8111 for further details.

                                          Patrick Kelly, DVM and Jessica Khodadad, DVM

Canine Lymphoma

Lymphoma is a cancer of the lymphatic system, which is part of the immune system. It is the most common type of cancer in humans and pets. Lymphoma can affect almost any part of the body. Dogs typically are presented with enlarged lymph nodes or glands. The ones that are usually the first to enlarge are the sub mandibular lymph nodes which are just below the jawline. Dogs that are brought in for “enlarged glands” are usually totally normal, eating, and active, but have generalized lymph node enlargement. Cats rarely present with enlarged lymph nodes. Their disease is usually manifested with gastro intestinal signs, kidney signs, or respiratory signs. Cats usually present thin, with chronic diarrhea, lethargic, and a lack of appetite. Palpable lymph nodes are more likely to be internal, with the lymph nodes that drain the intestines being enlarged. Diarrhea, and weight loss that is not responsive to treatment should alert the clinician and pet owner that lymphoma is a possibility.

Diagnosis is made with fine needle aspirates, or biopsies. Sometimes special stains have to be used to confirm the diagnosis. Lymphoma usually is very responsive to chemotherapeutic drugs. Lymphoma has been studied extensively in humans and effective chemotherapy protocols are readily available. Remission can usually be achieved in 93% of dogs using a combination drug protocol. Length of remission varies, but the usual first remission length is 12-13 months. Smaller dogs tend to stay in remission longer than their larger counterparts. Once dogs come out of remission, they have a reduced chance of going into a second remission, and the length of remission is usually half of the first remission.

The usual protocol is weekly chemo treatments for 4 treatments, then every other week for 20 weeks with a week off between cycles. Weekly CBC’s (complete blood counts) have to be done before chemotherapy treatments. The white count should be above 5000. If the levels are lower, the treatment is postponed. These drugs tend to suppress the bone marrow/immune system and make the patient susceptible to infection. Treatment is usually tolerated very well and the quality of life is excellent. I can attest to this. My dog Candi had lymphoma and survived 22 months with chemotherapy. My cat Charlie had nasal lymphoma, but did not respond well to chemotherapy and lived 3 months from the initial diagnosis.
Radiation therapy has shown promise in lymphoma patients especially those affecting the head and sinuses and is now available in several institutions in the state.

Gertjie and Lammie playing together

Canine Influenza

Canine influenza is a highly contagious respiratory virus. 80% of dogs that are exposed to the virus contract the disease. The virus is similar to the human influenza virus. It is the H3N8 strain that only affects dogs. There have been many outbreaks around the country. Texas is currently having an epidemic. Locally there have been cases reported in Palm Beach and Highlands counties.

Clinical signs of canine influenza include persistent, occasional ly moist productive cough, low grade fever, nasal discharge, lethargy, inappetance, and in severe cases, pneumonia, and even death.  The cough can persist up to a month and can be confused with the less virulent kennel cough. Kennel cough is caused by the bacteria Bordetella bronchiseptica and is treated with antibiotics. Canine influenza should be suspected in a dog that does not respond quickly to antibiotics.

Dogs that are at highest risk are ones that are kenneled in boarding facilities, go to grooming salons, doggie parks, and areas where they are exposed to other dogs. Canine influenza is generally spread through aerosol contact through coughing, direct contact like kissing, licking, and nuzzling . Transmission can also occur through contact with contaminated surfaces and clothing. A person can transmit the virus when they get the virus on their hands and touch things like doorknobs exposing other people to the virus.

There is no specific treatment for canine influenza. Treatment is supportive with antibiotics, hospitalization, iv fluids, and good nutritional support. Infected patients sometimes need to be hospitalized for many days on oxygen support.

Prevention and minimizing exposure is the key to controlling the disease. A well cared for dog, that is up to date on its vaccines, on a good plane of nutrition, and is current on heartworm prevention will be much more likely to have a good immune system, and more capable of fighting the disease. There is an effective, safe vaccine to prevent the canine influenza virus. It is given twice the first year, 2 weeks apart, and then yearly after that. Dogs that are boarded or groomed regularly should be vaccinated and pet owners should select those establishments that require dogs to be vaccinated against canine influenza over those that do not. Dog owners should avoid areas where dogs congregate like stores, doggie parks, kennels, and grooming shops when news that the virus is present in a particular area.

Ringworm

Ringworm is a skin disease caused by a group of fungi called dermatophytes. In humans it causes a red ring-like lesion that is itchy and was therefore misnamed a worm. The more proper terminology is not ringworm, but dermatophytosis. Ringworm fungi are soil borne organisms that affect many species of animals including humans. They are highly contagious, and spores from infected individuals can fall off the host and contaminate the environment. Some individuals can be carriers without showing any clinical signs.

Cats tend to be affected more readily than dogs, and kittens are the most easily infected because of their immature immune systems.

Clinical signs in pets tend to be non-specific and can look like most any other form of skin disease. Scabs appear on the skin that may or may not have the red ring around them. Most cases are diagnosed when a pet has not responded to an appropriate course of antibiotics to treat the much more common staph infection.

Diagnosis is made definitively with fungal cultures. Screening tests include fluorescence under a Wood’s lamp and looking at hair samples microscopically. Most ringworm cases will fluoresce under a Wood’s lamp, but not everything that fluoresces is ringworm. Microscopic identification can be difficult, so most veterinarians do ringworm culture tests when ringworm is suspected.

Treatment is aimed at minimizing shedding of the spores into the environment while treating the patient. Some cases require shaving to facilitate topical treatment with antifungal shampoos. Oral antifungal medication: itraconazole and griseofulvin are the mainstays of successful treatment but it can be expensive and typically must be given for at least 6 weeks. Infected animals should be segregated from other pets and human family members to reduce the risk of infection and to prevent shedding of infective spores throughout the environment. Lime sulfur dips can be effective, but are very foul smelling (rotten eggs), and can stain clothes and carpets. Some pets fight off the infection without treatment, but those cases are rare. The environment can be disinfected by using dilute bleach to disinfect animal bedding and carpets.