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What Do Heart Murmurs Sound Like?

This post was originally published on 12/22/2014, but has been updated to provide you with even more information. Welcome to another edition of Medicine Versus Mom where Carol Bryant from Fidose of Reality and I discuss veterinary medical issues experienced by pets and their families.

Today, I want to discuss heart murmurs. Heart murmurs can occur for a variety of reasons, in both dogs and cats, and can be a long term issue for your pet.

While working at the veterinary hospital I met quite a few pets who had heart murmurs. Some of which were so severe that you could even feel them once you knew what you were looking for. However, most heart murmurs are detected with a stethoscope. Today our goal is to provide you with clarity on heart murmurs and what you can do for your pet if they have been diagnosed with a heart murmur.

What is a Heart Mumur?

During my undergraduate degree, I was fortunate enough to take a physiology course. During that course, I learned that a heartbeat is actually the sound of two valves closing. When you hear a heartbeat, you may not actually distinguish that what you are hearing is not one sound, but two different sounds occurring within milliseconds of each other. The heartbeat is a lub-dub, not just a dub.

A murmur is an abnormal extra sound (which can sometimes drown out the normal sounds).  Murmurs most commonly occur between the “lub” and the “dub” and have a “shooshing” or “whooshing” quality. – Dr. Mark Rishniw, ACVIM

Understanding that a heartbeat is a series of sounds rather than one, will really help you understand what a heart murmur is, and what exactly you are hearing. The two separate sounds are the result of multiple valves closing as blood flows through the heart.

What Do Heart Murmurs Sound Like?

Photo Courtesy of http://philosophyofdog.com

The picture above provides a visual example of how blood flows through the heart.

Blood initially enters the heart in the right atrium.  The blood then passes through the tricuspid valve into the right ventricle which pumps the blood through the pulmonic valve into the lungs to pick up oxygen (among other things).  The oxygenated blood then enters the left atrium.  Blood in the left atrium passes through the mitral valve to reach the left ventricle, which then pumps the blood through the aortic valve out to the rest of the body.  (Veterinary Partner).

These valves exist to keep blood flowing forward, and prevent it from flowing backward. When the valve is not opening or closing properly, this disturbs the blood flow and creates turbulence, which causes a murmur (Veterinary Partner).

A heart murmur is an extra heart vibration that occurs when there is disturbance in the blood flow (PetMD).

It is imperative to understand that a murmur is not an arrhythmia. An arrhythmia is defined by irregularity and possibly erratic rate of the heartbeat (Merck). Basically, if the flow of the blood is not disrupted, but the rhythm (lub-dub) sounds irregular, than you are dealing with an arrhythmia, not a murmur.

What causes a heart murmur?

According to PetMD, murmurs are caused by the following:

  • Disturbed blood flow caused by high blood flow through a normal or abnormal valve.
  • Flow disturbances identified by forward flow through abnormal valves.
  • Flow disturbances identified by regurgitant blood flow due to an abnormal valve.

According to Veterinary Partner, the most common murmurs in dogs are associated with leaky mitral valves. Sometimes, murmurs are caused by holes between two of the chambers in the heart, or narrowing of a chamber or vessel, or anemic blood.

What are the different kinds of murmurs?

  • There are benign (non-harmful) murmurs in which the cause of the murmur is not associated with a known heart disease. These kinds of murmurs are not usually found in adult dogs, but can be found in puppies and cats of all ages. Characteristically, they have a soft sound and tend to be intermittent. Heart murmurs brought on by anemia or excitement often fall into this category (Veterinary Partner).
  • Congenital Murmurs are present from birth. The defect that is causing the murmur is always there, but may not be heard until later than life (Veterinary Partner).
  • Acquired Murmurs are brought on throughout the course of the pet’s life, but they are often associated with a heart or valve disease (Veterinary Partner).

Grading Scale

Murmurs are classified on a grading scale. Grade of a murmur is determined by sound (time and intensity), configuration, and location (PetMD).

HeartMurmurs

What do they sounds like?

A veterinarian that I worked for at Acorn Veterinary Clinic in Davis, California explained it to me the best. Dr. Jackman said that a heart murmur sounds like a washing machine as opposed to a lub-dub, this analogy would help me identify murmurs very well in the future.

The following videos are a series of audio clips, that show a view of the valves and how they are working with each type of murmur. Make sure to have your volume on, but I promise you this is very interesting. (I also want to thank Steven Farmer, DO for creating these videos).

First, this is the sound of a normal heart.

This second video is an Aortic Stenosis Murmur, which is defined but the AKC Canine Health Foundation as the narrowing of the aortic valve, or just above it. Listen for the “washing machine sound”.

This video is an Aortic Regurgitation Murmur, defined by Merck Manuals as back flow of blood from the aorta into the left ventricle.

This last video is a Mitral Regurgitation Murmur (the most common in dogs) , which can be defined by VCA Hospitals as back flow from the left ventricle to the left atrium.

If you were able to hear subtle differences between these videos, then you have a great ear for heart murmurs. These are very challenging to distinguish, but will give you an idea of what your veterinarian is listening for.

Symtoms

If your pet’s murmur is due to a structural heart diseases, they may display signs of congestive heart failure, which according to (PetMD) includes: coughing, exercise intolerance, or general weakness.

What should I do if my pet has a murmur?

The short answer is, work with your veterinarian. There are so many different classifications and underlying causes for murmurs, that your veterinarian will need to help you determine if treatment is necessary, if there are any structural issues you should be worried about, and what you can do to help your pet.

Our dog Maui (who passed away in 2015) had a murmur since 2010, and lived a healthy and full life (she had epilepsy, but that wasn’t related to our knowledge). Maui was not on medication for any heart issues until she was diagnosed with heart failure in the fall of 2014. We miss you Mau Mau <3!

Maui

Have you ever had a pet with a murmur?

To learn more about heart murmurs, please visit Carol’s Fidose of Reality to hear her Mom perspective on this same topic!

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How to Administer Medication to Your Pet

Whether you are giving your dog medication temporarily or giving a pill for long-term treatment, administering medication to your dog is not an easy task. Not to mention, some dogs have become masters at avoiding medication and/or spitting it out when you aren’t looking.

As you can imagine, I have a lot of experience getting dogs (and cats) to take medication and there are a few things you can do to make administering medication just a little bit easier on you and your pet.

Food is your friend

If your dog is at all food motivated, the very first thing you need to know is that food is your friend when it comes to administering medication.

High Value Treat

If you have any experience training your dog, you may already know what they consider to be a high-value treat. For Rooney, it’s anything we are eating (he even gets excited about lettuce). However, for some dogs you might have to put in a little more effort to determine what they consider to be high-value.

Once you have determined your dog’s favorite high-value treat, you can use that information to help administer medication. For example, you could hide your dog’s medication in chicken or even some cheese. I prefer to use string cheese for small pills since you can stuff the pill into an already formed cheese stick. The more you coat the pill in the food you are giving, the more likely they are to eat the entire thing and the pill.

Make sure that you check ingredients before giving your dog medication in any non-pet food. I would avoid “diet” or “light” foods as they tend to use alternative (and sometimes unreadable) ingredients.

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Dog Safe Peanut Butter

Dog safe peanut butter is also a high value treat, and my go-to for feeding pets their medications. I mentioned dog safe peanut butter on my Facebook page a few months back and someone commented and asked what I meant by “dog-safe”. As it turns out, there are several peanut butter brands that contain xylitol, which is a very toxic ingredient for dogs (most often found in sugar-free gum). So make sure to check that your peanut butter doesn’t contain xylitol before giving it to your dog. Additionally, you can opt for an even healthier peanut butter option by switching to unsalted or homemade peanut butter (AKC).

The reason I like to use peanut butter to administer medication is because of the texture. It’s so sticky that dogs very rarely eat the peanut butter and spit out the pill because the peanut butter adheres together.

The Spoon Method

This recommendation is based on nothing but my experience. When I give Rooney a pill in peanut butter or cheese, I put it into a spoon. I find that when he has to bite down to get the food, which he does when I give it to him in a spoon, he tends to eat the pill a lot faster, and easier, because he isn’t licking the peanut butter or cheese out of a bowl for example, and carefully leaving the pill behind.

Pill Pockets

Pill pockets are designed to put a pill into the “pocket” of food and then easily close the food around the pill to make it more palatable for your dog. While I have never used these for Rooney, I had many clients who swore by their effectiveness and ease of giving their pet medication.

Make it Fun

If anyone has given their pet pills over a long period of time, they know many dogs will find a way to eventually leave the pill behind. Even when the most high-value treats are involved. Rather than handing your dog a random treat (with a hidden pill), and then moving on, you could make a training session or game out of it, which takes your dog’s concentration off of the treat and hidden pill.

Animal Behavioralist Patricia B McConnell suggests making the process of giving your dog medication fun. She suggests the 1, 2, 3 game outlined below.

The One Two Three Game: First, encase the pill in some highly palatable food, perhaps a piece of chicken or some peanut butter. Put it aside and give the dog a treat with no pill. Then give the dog a second treat. Next, pick up the treat-encased pill and put it right next to your dog’s nose, but don’t let him eat it! Pull it away, as if to tease him. Move it within an inch of your dog’s nose/mouth again and snatch it away a second time. Move it a third time toward your dog’s mouth and let him eat it. Follow it up with a fourth treat, this time with no pill. Unless the pill is truly noxious, this works really well and makes the entire exercise great fun.

I love the idea of getting your dog to play with you as part of administering medication rather than making it a forced situation. She also suggests using natural competition to your advantage if that motivates your dog, and is an available option for you. Dr. McConnell further outlines that process in her blog post here.

Opting for Liquid or Chewable Medication

A lot of medications can be compounded these days which allows you to give your dog flavored medication on top of their food (this is also a great option for cats), or as a treat. Unfortunately, not all medications can be administered in liquid form, so this isn’t an option for every one, but definitely something you can ask your veterinarian about.

Other Methods

Manually Giving the Pill

You can give your dog a pill by placing it as far back in their mouth as you can. I wouldn’t recommend this unless you have taken the time to try other methods, none of which have worked for you, and you are now in a situation where the medication is imperative to your dog’s health and well being and, therefore, you need to give the pill manually. If you are going to do this, make sure that you get a demonstration and further instruction from your veterinarian or veterinary technician. They will be able to show you exactly how you should administer the pill to your pet, so that you can avoid some common mistakes that pet parents make.

Stay Positive

If you can, try to stay positive about the experience. While giving your pet medication can be difficult, and at times, frustrating, rely on your veterinarian and their team to help you develop a solution. If you are going to give your pet a pill often, you don’t want them to have a negative experience. Adding food and positive reinforcement wherever possible will definitely help.

For more info on how to give your pet their medication, hop on over to Fidose of Reality for Carol’s Dog Mom perspective.

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The Difference Between Obesity and Hypothyroidism

Welcome back for another edition of Medicine Versus Mom. While working at the veterinary hospital, I can’t tell you how many overweight pets we had as patients. Statistics would tell you that at least 50% of our patients were overweight and had a poor body condition score. While some pet parents seemed oblivious that their pet’s weight was not ideal, others knew that their dog was gaining weight, but felt that they were doing all the right things (not overfeeding, and providing regular exercise). This issue among pet parents is so common that Carol Bryant from Fidose of Reality and myself thought we would discuss it here today.

Specifically, we want to talk about understanding the difference between canine obesity and hypothyroidism. While both of these diseases are highly treatable in dogs, they do have similar symptoms which could lead to misdiagnosis or assumptions from pet parents about how to improve their dog’s health. I believe that by understanding hypothyroidism and it’s symptoms, you will be able to better understand when your dog needs to have endocrine testing versus needing diet and exercise changes.

What is Hypothyroidism?

According to PetMD: 

“Hypothyroidism is a clinical condition resulting from a lowered production and release of T4 and T3 hormones by the thyroid gland. It is common in medium to large-sized dogs, with some being more predisposed than others. “ 

When the production of the T3 and T4 hormones decreases, it causes the processes and the functions of all organ systems in the body to slow down. Including, your dog’s metabolism. Hypothyroidism is commonly diagnosed between the ages of 4 and 10 years old, and some breeds (listed below) are more prone to the disease than others:

  • Golden Retriever
  • Doberman Pinscher
  • Irish Setter
  • Miniature Schnauzer
  • Dachshund
  • Cocker Spanial
  • Airedale Terrier

What are the symptoms associated with Hypothyroidism?

According to the Merck/Merial Manual for Pet Health, the symptoms associated with hypothyroidism include:

  • Lethargy
  • Unwillingness or inability to exercise
  • Weight gain
  • Dry coat or skin
  • Excessive shedding
  • Hair thinning or hair loss
  • Reoccuring skin infections

What causes Hypothyroidism to occur?

According to PetMD, hypothyroidism usually occurs because the thyroid gland has been destroyed by an abnormal immune reaction. In most cases (95%) hypothyroidism is due to the destruction of the gland itself, however, in a small number of cases it is due to a tumor of the pituitary gland (Merck/Merial Manual for Pet Health).

How is Hypothyroidism diagnosed?

Traditional diagnosis requires endocrine testing (measuring the amount of thyroid hormone your dog has available) of the T3 and T4 hormones.

What is the treatment for Hypothyroidism?

Traditional treatment for hypothyroidism requires providing your dog’s body with the synthetic version of the hormone they are lacking.

The deficient hormones are given in synthetic form, with the dosage adjusted occasionally based on your dog’s individual physical condition and progress. Most clinical symptoms will resolve after a few months, but only your veterinarian can determine whether your dog’s medicine dosage should be adjusted or changed. To avoid complicating the condition, do not change the type or dosage of the drug yourself, and never give anything new to your dog without first consulting with your veterinarian. This caution includes the use of herbal remedies.- PetMD

How to know when its just weight gain…

When I was studying Animal Science at UC Davis, I specifically remember learning that Hypothyroidism, while not a rare disease, was being over diagnosed in veterinary medicine. In an article written by Dr. Patty Khuly in 2008, she alluded to the over-diagnosis of this disease mostly based on the idea that people didn’t want to admit that their pets were simply gaining weight.

Not only do I find this disease of slow-metabolism to be one many of us humans wish we had (especially when at a loss to explain why we gained so much weight over the holidays)—hypothyroidism is an illness pet owners increasingly want their overweight pets tested for.

I can’t blame pet parents for wanting their dogs to be tested for hypothyroidism, especially when they feel that they have done all of the right things to care for their dogs. But, if your dog’s hormones are balanced, we don’t want to give them medication they don’t need.

So, how can you be sure that your dog is receiving the right diagnosis?

According to Dr. Jennifer Coates, if your dog has symptoms associated with hypothyroidism, and bloodwork has revealed low thyroid levels, and all other clinical signs have been ruled out, then it is appropriate to tentatively diagnose your dog with hypothyroidism. The true test will be your dog’s responsiveness to the medication. If repeat testing shows that your dog’s hormone levels have returned to normal, than your dog is truly hypothyroid and should continue on the medication per your veterinarian’s recommendations.

Misdiagnosis can occur for a variety of reasons:

Because dogs that are sick with diseases completely unrelated to the thyroid gland often develop low thyroid hormone levels. The condition is called euthyroid sick syndrome, and it does not require thyroid hormone replacement therapy. What is really needed is an accurate diagnosis and treatment aimed at the underlying problem, but this is sometimes easier said than done!

In conclusion, it is important for pet parents to be honest with themselves. Is your dog gaining weight? Or are there other symptoms on this list your dog is experiencing? Have you tried adjusting their diet and exercise? Is someone else in your house overfeeding your dog (you would be surprised how often this happens)?

If you truly feel that your dog is experiencing symptoms of Hypothryoidism, definitely take them to visit your veterinarian and be prepared for bloodwork testing.

I highly recommend visiting Fidose of Reality to hear Carol’s Dog Mom perspective on this topic!

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Trupanion Summer Safety Series: Pool Safety for Pets!

A few weeks ago we kicked off the Trupanion Summer Safety Series by discussing Beach Safety for Pets.

Today, we want to continue that series by discussing Pool Safety for Pets! Although we have discussed pool safety a few times on the blog so far, I am always looking for new insights and tips for keepings our pets safe. Therefore, we are relying on the wonderful Dr. Sarah Nold, DVM & the Trupanion team to share with us their insights to help make the pool a safer place for our pets! Below you will see our Q&A:

1) Pools can be a great way to keep pets cool in the summer, but what precautions can pet parents with backyard pools take to keep their pets safe?

Make sure your pet doesn’t have access to your pool unless they are supervised, especially if your pool does not allow your pet to easily get out of the pool on their own.  If you don’t know if your pet swims well or are concerned they are a poor swimmer, consider having your pet wear a life jacket while in the pool.

If it’s their first time with a pool,  let your pet approach the water at their own pace. Swimming can be intimidating to some dogs—especially when their paws can’t touch the floor. Don’t force your dog into the water—instead start at the shallow end and create plenty of positive experiences.

Rooney wears a lifejacket while in the pool. He usually knows where the stairs are or can pick up on that quickly, but much of the time Rooney is trying to keep up with dogs that are naturally much stronger swimmers. (I think Rooney thinks his legs are much longer than they actually are.) To prevent him from becoming exhausted or panicked, I keep a lifejacket on him.

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2) Are there any common pool toys that can be particularly dangerous for pets?

Soft pool covers are dangerous, as a pet can easily become trapped and drown. Avoid toys that are small enough for your pet to swallow or have small parts that can come off.

We do not have a pool, but if I did I would make sure it had a fence around it to add an additional layer of safety for Rooney. As of now, Rooney gets to swim with one of his friends at a nearby pool. As far as pool toys go, Rooney and I are big fans of PrideBites toys because they can float in the pool, and are machine washable.

3) Swimming can be a great physical therapy activity for dogs with joint injuries, are there any specific activities or exercises pet parents can do with their pets in the pool?

Many dogs enjoy retrieving their favorite toy (preferably one that floats).

Why is swimming such a great exercise for dogs? As outlined by the Water4Dogs Canine Rehabilitation Center in New York, hydrotherapy is aerobic, but low impact on the joints and bones. Due to the low impact, the aerobic component, and the resistance from the water, swimming is an ideal exercise for keeping your dog in shape.

As you mentioned, swimming is a great low-impact exercise. If your dog is a hesitant swimmer, you can encourage them to walk through shallow water. This alternative provides some of the same low-impact exercise benefits as swimming and can be a great option for older dogs or dogs who aren’t as confident in the water.

Additionally, for Corgis, swimming is a great exercise for building muscles that support their back while keeping the exercise low impact.

4) At Trupanion what kinds of claims are commonly associated with pools?

This is very similar to the beach-related claims. Dehydration and heat stroke are always a concern on hot days. Pets, just like humans, need plenty of water and a place in the shade to cool down.

For dogs like Rooney who have a fear of missing out (FOMO). It’s difficult to get him to take a break while other dogs are playing in the pool. I know that swimming is much more challenging for him than a Lab, for example, so I have to schedule breaks when he is swimming. Last week, Rooney was swimming with his friend Grayson who is a Cattle Dog Border Collie Mix, who swims every day. Rooney wouldn’t rest while Grayson was still swimming, so I did have to take him for a leisurely walk so that he could use the bathroom, and take a much needed break from swimming.

Does your dog like to swim? What precautions do you take to help keep your dog safe around the pool?

Stay tuned for the next installment in the Trupanion Summer Safety Series: Car & Travel Safety

Disclaimer: Trupanion is the pet insurance that we have for Rooney. My Kid Has Paws is working with Trupanion to provide pet parents with valuable information to help keep their pets safe. Also, I am a PrideBites affiliate. However, My Kid Has Paws only shares information we think our readers would find to be valuable. 

Apoquel is Rooney’s Best Friend

Disclaimer: What works for us may not work for you, but I did want to share our experience with Apoquel. I think it’s important to note that I am not a Veterinarian and, therefore, can’t recommend or prescribe Apoquel for any individual dog (Apoquel is not FDA approved to be used for cats). This post was created simply to provide our experience and give pet parents some additional information. Apoquel didn’t sponsor this post. Additionally, all thoughts and experiences are my own.

I don’t know if I have mentioned this already, but allergies in California this year have been fierce! Mostly due to all the rain we had (and needed) this past winter. The only bummer is that when our allergies are bad, so are our dogs allergies.

Therefore, Rooney has been one itchy dog this year. Most years his allergies will peak sometime in the Spring and again in the Fall, but this year Rooney has been constantly fighting allergies. Luckily, these days we have a medication that works well and fast, it’s called Apoquel.

Signs of Allergies

Before I start talking about Apoquel and its benefits, it’s important that you know the signs and symptoms associated with dog allergies. According to Apoquel’s guide, the signs and symptoms of canine allergies include:

  • Excessive Licking, Chewing, Biting or Scratching
  • Excessive Rolling, Rubbing, or Scooting
  • Foot Chewing (Rooney’s number 1 symptom)
  • Hair Loss
  • Ear Infections and Head Shaking
  • Red or Itchy Skin
  • Changes in the skin, including sores, darkened colors, or scabs

If your dog is exhibiting any of the above symptoms, its imperative that you learn what type of allergy your dog has (inhaled, flea, or food). In order to accurately determine what kind of allergies your dog is experiencing, and how you can best help your dog, you will need to work with your veterinarian.

Rooney has inhaled (or environmental) allergies. Apoquel helps control his itching and secondary symptoms associated with his allergies.

Apoquel, A History

Shortly after Apoquel debuted on the market, it went on backorder due to high demand, and according to Veterinary Practice News, “undisclosed production problems”. Before Apoquel was available on the market, and during it’s shortage, there are few other medications available that are somewhat cost effective, and don’t include steroids. While steroids are used to treat severe allergies in the short term, they are tough on the body’s kidney and liver, therefore, I want to avoid giving Rooney steroids as much as possible. We had tried quite a few medications, since Rooney’s allergies arrive every year, and cannot be left untreated or he will develop hotspots. However, once Apoquel was back on the market, we talked to Rooney’s vet and began using it to tame his allergies once again.

What exactly is Apoquel?

APOQUEL is used for the control of itch associated with allergic skin disease and for control of atopic skin disease in dogs at least 1 year of age. APOQUEL significantly reduces itching, and also decreases the associated inflammation, redness or swelling of the skin.

How Does Apoquel work?

Unlike other treatments, APOQUEL targets a key itch signal in the nervous system and has minimal negative impact on the immune system. APOQUEL also allows your veterinarian to continue to diagnose the underlying cause of itch while providing your dog with relief.

Why I Like Apoquel

As Needed. Rooney gets Apoquel once a day as needed to relieve itching due to allergies. I like this type of dosage because Rooney doesn’t need the medication 365 days a year. However, he will need allergy medication several times throughout the year to keep his allergies in control.

Works Fast. Apoquel can start to relieve your pet from itching in 4 hours. I know when I give Rooney his Apoquel he quickly goes from being very itchy to only slightly itchy within a few hours.

Apoquel is mostly cost effective for our budget. It’s not the cheapest allergy medication available, but it is so effective. And because you can give it to your pet on an as needed basis, it helps you save as compared to some other medications.

Work With Your Veterinarian

Do you think that your dog could benefit from a medication like Apoquel? If so, you should discuss this possibility with your veterinarian if your dog is over 1 year of age. Please keep in mind that like all medications, Apoquel can have side effects. I highly recommend doing your research and consulting a veterinarian before starting your pet on any medication.

Would you like us to bring back Medical Mondays (even though it’s Wednesday — I’m trying lol)? I think these posts have provided pet parents with important information over the years. Therefore, I would like to add them back to the blogging rotation (and post more frequently again – sorry friends!). What do you think?

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