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HOME MONITORING OF HEART FAILURE

by admin on April 3rd, 2018

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This article provides key aspects of monitoring your pet with heart failure at home and explains the parameters to record. These need to be monitored frequently (daily) in the few weeks after initial diagnosis and commencement of medications, or at any time when things are unstable, such as a relapse or progression in symptoms. The frequency of recording can be less (weekly) when everything is stable and your pet is happy. You can record all of these using a diary or computer database. Remember to always bring your record back with you to every visit.

Sleeping Respiratory Rate (SRR)
This should be recorded when your pet has had a period of rest and is asleep. This might be by your feet or in bed. It is best to record this when your pet falls asleep when you are in the room, as opposed to going into the room where your pet is already asleep – as they usually wake up when you enter.
Breathing is often best seen when your pet is lying on the side and the chest and flank can be seen to rise and fall. A breath in and then out is recorded as one breath. The rate is given as the number of breaths in 1 minute.

Heart rate (HR) at rest:
This is more difficult to record, but it is possible to do and it provides very useful information. The heart rate when ‘in the vets’ is always somewhat elevated because of excitement or nervousness, so does not represent the real heart rate at home.
The heartbeat can be felt by placing your hand on the chest over the heart, just inside the ‘armpits’ on the left side, but can be either side of the chest. You could purchase a cheap stethoscope and learn to listen to the heart rate. Feeling the pulse in the leg does not always represent the heart rate, as some abnormal or weak heartbeats might not produce a palpable pulse, so we prefer that you do not use this method.
You could purchase a heart rate monitor, and whilst these are a little more expensive, over the course of your pet’s life, often represent good value for money. The rate is given as the number of heartbeats in 1 minute.

Weight
One of the effects of heart failure is the accumulation of excess fluid in the lungs (oedema), chest cavity (pleural fluid) or abdomen (ascites). One litre of fluid is equivalent to 1 kg in weight. Thus monitoring your pet’s body weight is a useful means to track the loss or gain in fluid accumulation.
We recommend weighing your pet weekly. It is often best to use the scales at your own vets for consistency and accuracy.

Appetite
Your pet’s appetite may reflect his/her well-being. It is a simple scoring system, comparing appetite to when your pet was well prior to this illness and is as follows:

Appetite Scores:

1 Ate hardly anything
2 Ate much less than normal
3 Ate a little less than normal
4 Normal
5 Ate very well

Exercise
Once any congestion has resolved with treatment, a return to some exercise is good for the well-being of your pet and for the circulation. The ability to exercise also reflects the ability of the heart to function and circulate blood, so it can be a useful indication of how well your pet is doing. Again this is a simple scoring system, comparing the ability to exercise to when your pet was well prior to this illness and is as follows:

Exercise Scores:

1 Can hardly exercise at all
2 Is exercising much less than normal
3 Is exercising a little less than normal
4 Normal
5 Exercises very well

Cough
Coughing is a common symptom in dogs (it is rare in cats). This can occur for a few reasons. One is that an enlarged heart presses on the windpipe, compressing it and this triggers a cough; it probably feels like something is stuck in the throat. Another is the accumulation of fluid in the lungs (oedema), this needs to be moderately severe to trig, of course,h. Then of course a dog (or cat) can be coughing secondary to various lung conditions such as bronchitis (or asthma in cats). Monitoring the frequency and severity of a cough can therefore be useful.

Cough Scores:

1 Very often, daily
2 Often, daily
3 Often, weekly
4 Occasionally, weekly
5 None

The Happiness Factor
This is a surprisingly useful overall score of how well your pet is. It is a simple scoring system, comparing how happy your pet is compared to when your pet was well, prior to this illness and is as follows:

Happiness Scores:

1 Very unhappy
2 Much less happy than normal
3 A little less happy than normal
4 Happy, back to normal
5 Really happy

AUSCULTATE DOG HEART

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Special Offer – April – Tackling Ticks

by admin on April 3rd, 2018

Category: Special Offers, Tags:

Apr Tackling Ticks

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Pet of the month – April – Hank

by admin on April 3rd, 2018

Category: Pet of the Month, Tags:

Pet of the Month this April is Hank, a handsome 7 year old Labrador. We are delighted to report that he has recovered extremely well following recent surgery for Gastric Dilatation.

In his owners words:

“Hank, my 7 year old black Labrador had been competing in a working test on Sunday and wasn’t his usual self.  He seemed reluctant to jump and just wasn’t as obedient as he normally is. I have no idea if he was already feeling a little off colour that day, and guess I will never know.    Within 45 minutes of eating his dinner that evening he started to try and vomit, but nothing was coming up. He was stretching, lying in the praying position and just generally not looking very happy.  I was immediately suspicious that this could be a torsion and so I rang Lisa and Kate who agreed to see him.  By the time I got to the surgery at 6.30 pm he was clearly becoming distressed, so we x-rayed his abdomen and it was showing that indeed he had a twisted stomach. By then was pale and shocked and his abdomen was getting larger by the minute.  Hank was put on fluids and prepped for surgery.  His surgery lasted over 3 hours, but was thankfully successful.

Only 48 hours after surgery, Hank was allowed home, and has made an amazing recovery.  He is now training once again and exercising normally.  I guess after all the years working at Fitzalan House I have learnt a thing or two as I managed to spot the signs of what was happening but without the prompt veterinary care he received I could have easily lost him.  I am so very grateful for Lisa and Kate’s attention to him that night, they undoubtedly saved his life, and I cant thank them enough.”

What is gastric-dilatation and volvulus (GDV)? Is my dog at risk?  Gastric dilatation and volvulus, or GDV as it is commonly abbreviated, is a relatively common clinical syndrome seen in large / giant breeds of dog. Dilatation refers to bloating of the stomach with gas, and volvulus refers to twisting of the stomach about its axis. The cause of this syndrome is not completely understood. In fact it is quite controversial which occurs first; the bloat or the volvulus (twisting). Indeed both components do not have to occur together and some patients will develop relatively simple bloat alone. GDV is a potentially life threatening condition and emergency veterinary attention should be sought immediately if it is suspected.

Why is GDV potentially life-threatening to dogs?
There are a number of serious and potentially fatal consequences that occur as a result of GDV. Initially the severe distension of the stomach stretches the blood vessels over its surface reducing the blood supply to the stomach walls. This is made worse by the twisting of the stomach which also twists the blood vessels, effectively shutting off blood supply to the stomach. A lack of blood flow means there is a lack of oxygen and nutrients delivered to the stomach and waste products are not removed. As with any organ this will result in parts of it dying. This process happens very quickly and in severe cases could result in part of the stomach wall rupturing and releasing its contents into the abdomen.

The large distended stomach occupies much more space inside the abdominal cavity and compresses surrounding structures. Severe distension puts pressure on the diaphragm and interferes with the patient’s ability to breath. It also applies pressure to a large blood vessel in the abdomen (the vena cava) that normally returns blood from the back half of the body to the heart. Pressure on this vessel obstructs flow therefore reducing the amount of blood returned. If blood can’t be returned to the heart, then it in turn can’t pump it out to the rest of the body. If there is insufficient blood being pumped, the blood pressure falls dramatically making the patient weak and potentially leading to collapse.

To add insult to injury, other organs in the body such as the lungs, kidneys, liver and intestines do not receive a blood supply and begin to fail. The lack of a functional circulation also means that toxic products build up in these organs that further compromise the patient. These changes can happen in a matter of hours, emphasizing the importance of early veterinary attention.

What are the symptoms of GDV in dogs?
The symptoms generally include obvious distension or enlargement of the abdomen with unproductive vomiting or retching. The patient may drool excessively and appear restless or agitated. As the condition progresses the patient may become increasingly weak or even develop shock and collapse.

What is the treatment for GDV?
The age and breed of the patient coupled with the clinical signs of a severely bloated abdomen will make your vet highly suspicious of this condition. They will immediately place one or more an intra-venous catheters to allow administration of fluids to support the circulation and dilute toxins in the blood. They may also analyse the patient’s blood to assess the severity of organ damage.

The next stage involves attempts to decompress the stomach. This is usually accomplished by passage of a specially designed tube through the mouth down into the stomach. There is a gag that can be used to assist in this process but many patients will require sedation or anaesthesia to complete the task. It can be very challenging or sometimes impossible to perform stomach tubing. This is particularly the case when the stomach is twisted 360 degrees or more. In this instance a cannula (tube) may have to be inserted through the body wall and into the stomach to allow deflation. Deflation is clearly an imperative step because it will relieve pressure on the diaphragm and help restore blood flow back to the heart through the vena cava.

Radiographs of the abdomen are often required to help distinguish between simple dilatation and dilatation with volvulus. In the latter case surgery will be required as soon as the patient is stabilised. The aim of the surgery is to de-rotate the stomach and assess it for areas of devitalisation. If there are areas of the stomach that have undergone necrosis (died), these need to be removed surgically.

It is vital that the stomach is attached to the inside of the body wall. This is called a gastropexy and it will prevent volvulus in the future. This is essential as up to three quarters of the patients that do not have this performed will have another episode in the future. This also applies to those patients suffering with bloat alone as they have the same risk.

What are the risk factors for GDV in dogs?
There are several factors that have been clearly demonstrated to increase an individual’s risk of developing this condition. These include:

  • Being a purebred large / giant breed
  • Having a deep and narrow chest conformation
  • Having a history of previous bloat
  • Having a history of bloat or GDV in a first degree relative (parent or sibling)
  • Increasing age
  • Having an aggressive or fearful temperament
  • Eating fewer meals per day
  • Eating rapidly
  • Being fed a food with small particle size
  • Exercising or stress after a meal

What breeds are predisposed to this condition?
The breeds most commonly affected are large purebred dogs that have a narrow deep chest confirmation. Those at most risk include:

  • Great Danes
  • Gordon setters
  • Irish setters
  • Weimaraners
  • St. Bernard’s
  • Standard poodles
  • Bassett hounds

Although these are the breeds we typically see GDV in, it is worthy to remember that it can happen in any patient.

What is the prognosis?
With improved understanding of the secondary consequences of GDV and excellent anaesthesia, surgical and post-operative care now available for veterinary patients a good prognosis can be achieved for this condition. Survival rates of 73-90% would be typical. There will always be a range quoted for survival because individual patient’s circumstances in terms of severity, age, general health and treatment received will have an impact on the outcome. One important factor that has been shown to decrease the survival is the presence of clinical signs for greater than six hours. This emphasizes the importance of prompt veterinary attention in all cases.

If you are in any doubt that your dog is suffering from bloat or GDV, please call your vet immediately.

Hank 2

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