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veterinarian

What Do Heart Murmurs Sound Like?

January 19, 2018

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!

medicine versus mom

What Pet Parents Have a Right to at the Vet’s Office

July 19, 2016

A visit to the veterinary hospital can be overwhelming.

You walk in confident and ready to discuss the list of items you brought to your pet’s annual exam, and then you are completely thrown off the second your vet says something like, “What’s this we found here?”.

Suddenly, your mind starts racing.

“What do you mean?”

“What did you find?”

“What’s wrong with my baby?” (this is the first thought I would have).

Amongst all of your emotions you hear your veterinarian say, “I want to take a closer look at this lump”. And, now you are wondering…

…”Why? Is it cancerous?”…and then panic ensues.

While even the best veterinarians provide the most thorough explanations intended to ease your worrying and provide you with sound reason, you can’t help but feel overwhelmed and agree to their recommendations immediately. Your hope is that there are more answers than questions provided by their initial tests.

After your pet is back in your arms and you have been reassured that everything is okay, you have been hit with a larger than expected bill. And your only thought is, “…wait, what’s happening?”

While many veterinary offices have no intention of overwhelming you, most days they are a place of well-organized chaos. Which can leave you feeling overwhelmed with perhaps more questions than you have answers.

Today, I would like to share with you some of the things you can keep in mind while at the veterinary hospital. Specifically, things I believe you have a right to:

A right to ask questions:

As a former veterinary professional I can tell you that we don’t mean to seem like we are in a hurry or that we don’t want to explain things further, it’s just that we do this for a living, so sometimes we forget to slow down and explain. Therefore, don’t forget that you can stop us at any time and ask questions!

Questions are important and your veterinary staff wants you to leave the hospital with all of your questions answered. Veterinary staffs are often on a very tight schedule, so you may have to wait a few moments to have a chance to speak with a member of the veterinary staff, but take your time and get all the info you need while you are there.

What Pet Parents Have a Right to at the Vet

A right to an estimate:

Always ask for an estimate! Estimates are particularly useful anytime your pet receives more treatment than you planned, i.e. when your veterinarian makes a discovery during their annual exam.

When I worked at the veterinary hospital we wrote an estimate anytime we treated a pet (ex. they needed more than just vaccines). We understood that everyone’s financial position is different and we wanted people to feel prepared when they went to pay their bill.

A right to alternative treatment plans:

Often, we would provide both a low & high estimate. The low end of the estimate would include any treatments deemed absolutely necessary to protect the health of your pet by the veterinarian. The high end would include some additional tests that would make the veterinarians diagnosis more accurate and might save money in the long run.

As a technician, I went over these estimates with our clients regularly and explained each item one by one. Specifically, I explained why the veterinarian wanted it and how the test was going to improve the health of their pet. If you aren’t sure about any of the items on your estimate, don’t forget to ask questions and ask for alternatives.

A right to the whole appointment time:

This point relates back to asking questions. While veterinarians may have very busy schedules, you did pay for their time so you have a right to use that time to ask questions.

Additionally, sometimes veterinarians have to be pulled away from appointments to assist in emergency cases. If this ever happens to you, be patient. If it was your pet having the emergency, you would want all veterinarians helping them too. However, you still have a right to your full appointment, even if you have to reschedule you should get the 20-30 minutes you paid for.

A right to purchase medications at a different pharmacy:

Some of the medications used to treat animals are also used to treat humans. Which means they might be available at your local Walgreens or Costco. Sometimes you can save money by picking up medications at these other pharmacies. Keep in mind this isn’t an option for every prescription.

Further, veterinarians might be willing to price match, so you might save yourself a trip by bringing up pharmacy alternatives.

A right to ask for a take-home guide:

At the last hospital I worked, many of the veterinarians provided take-home guides. The guide included a description of your pet’s condition, a summary of their medications, next steps for treatment, and follow-up care instructions.

While your veterinarian might not have take-home guides as a standard practice in their hospital, you can ask them to write things down for you if you know you are going to have a hard time remembering the course of treatment when you get home (remember the overwhelm we described above?). Many veterinarians are happy to provide you with this information especially if this means you are going to follow their treatment plan thoroughly.

A right to a demonstration:

There were 3 main training sessions (or demos) I gave pet parents while working at the hospital:

  1. Subcutaneous fluids
  2. Nail Trim
  3. Insulin injections

Each of these tasks can be daunting for a non-medical professional. If you know you need to perform these treatments at home, don’t hesitate to ask the staff to show you how to do it or at least, give you some pointers.

The above list represents my opinions, but I have been on the side of both client and veterinary professional and I can tell you that it is really important to advocate for yourself and your pet!

For Carol’s mom perspective on this topic, please visit her at Fidose of Reality.

medicine versus mom

The Importance of a Cancer Screen for Your Dog

January 18, 2016

Recently, I was contacted by a reader named Gabrielle, who is determined to press upon pet parents the importance of early cancer detection. Gabrielle reached out to me via my Facebook page and shared with me that she just lost her dog Zoey to cancer. Zoey was diagnosed with a tumor on her spleen. Unfortunately, it is very common for these tumors to grow unbeknownst to the pet parent, and often the detection is too late. Gabrielle reached out to me hoping that I would write a blog post about early cancer detection and cancer screening. So in honor of Zoey, here is my take on cancer screening:

Cancer is one of those things we just don’t want to think about. I’m almost positive that cancer has affected everyone reading this blog post in one way or another. It’s terrible, and sadly, cancer only seems to be increasing in the lives of our friends and family members.

My family has a strong history of cancer. As a result, I seek frequent preventative testing to ensure early detection should I have to fight such a terrible disease. While many of us know our genetic history, or have an opportunity to know if our family is likely to have cancer, for our pets it’s unusual for pet parents to know their exact genetic history.

This is where breed information and cancer screening can help.

Breed Information:

As a pet parent, it is important to know what diseases are common for your dog’s breed. Why? So you can keep an eye out for symptoms, and possibly cure the disease with the appropriate treatments. For example, if you have a Boxer, it is important to know that Boxers are at an increased risk for cancers such as lymphoma, hemangiosarcoma, and mast cell tumors (Vetstreet). Therefore, as a Boxer parent, you would want to keep an eye out for changes in their usual behavior, appetite, and bowel movements, in addition to checking them regularly for unusual bumps and swollen lymph nodes. Any of these signs or symptoms would then be treated immediately.

If you are unsure of your dog’s risks, ask your veterinarian.

I realize that not all pet parents have breed information. More often than not, we guess at the breeds of our mixed dogs. In these cases, there are two things that you can do:

  1. Ask your veterinarian what breed they think your dog is. Industry professionals see an incredible number of dogs every year. Therefore, it is easy for us to spot certain characteristics of breeds to help you better determine your dog’s breed.
  2. Canine HealthCheck: Rooney and I tried Canine HealthCheck this past summer. This at home DNA test screens your dog for a number of inherited diseases and genetic mutations. This type of genetic testing can provide you with very valuable information about your dog’s health. For example, while I know that Corgis, in general, are prone to Degenerative Myelopathy, I now know that Rooney actually carries the gene for this disease. Meaning, my knowledge of symptoms is crucial for early detection and the quality of Rooney’s life.

The Importance of a Cancer Screen for Your Dog

Cancer Screen: 

Whether or not you know you dog’s breed, it is worth your time and effort to invest in a cancer screen. What do I mean when I say cancer screen? Specifically, I am referring to a number of basic tests that your veterinarian can run on an annual or bi-annual basis for your dog. Depending on your veterinarian’s recommendations this may include the following tests:

Abdominal/Thoracic X-ray

Ultrasound

Bloodwork

Urinalysis

How often should you do the cancer screens?

This all depends on your dog’s age, breed risks, and size.

Age: While young dogs typically see their veterinarian once a year for their annual exam (these are very important), when your dog becomes a senior it is worth it to increase your veterinary visits to bi-annual exams.

Breed Risks: As mentioned previously, some breeds are at much higher risks for cancer than others. So your veterinarian may recommend more frequent screenings for individual dogs.

Size: The size of your dog can determine when they are classified as a senior. For example, giant breeds tend to be considered seniors around 6.5-7.5 years old. While large breeds may be considered seniors at 8-10 years old, and small breeds at 9-11 years old, or even later. It all depends on the average life span of the breed. Therefore, if you have a household with one giant breed dog and one medium size dog, you are going to need to adjust their healthcare accordingly.

Why wouldn’t my veterinarian recommend this to me in the first place?

Due to backlash throughout the years regarding client’s financial hardship, veterinarians may not suggest preventative tests, but rather only suggest the tests that are absolutely necessary in order to save you money.

If you want to begin cancer screens for your dog, you need to open those lines of communication with your veterinarian and make the request.

What is my plan?

Rooney has yet to have an ultrasound, but I do have baseline chest x-ray on file for him, and I do request annual bloodwork just in case. When he turns 8 (he is 5.5-years-old now), I will conduct a cancer screen, and will do so every year moving forward. When Rooney’s veterinarian recommends we increase to bi-annual screens, I will abide.

What has been your past experience with preventative testing? In Zoey’s memory, are you willing to have a cancer screen for your dog?

What Should You Do When You See a Stray Dog?

November 23, 2015

What should you do when you see a stray dog?

Stop, drop, and roll.

Just kidding, that’s for fires of course. However, like emergency or unexpected situations, spotting a stray dog can make many people freeze and panic. So, we need to establish a plan that is clear and easy to remember.

I have encountered this situation many times. Some of these instances have occurred while Rooney was with me, and others occurred while I was by myself. Some have occurred while I was driving, and other times I have been out for a run and vulnerable to the situation. In an effort to be helpful, I am going to describe my “tips & tricks” for several different types of situations you might encounter with a stray dog.

If you are driving:

I would love to say that I have never seen a dog on the road, but I have. In fact, a few months ago I saw a cow getting on the freeway. In an area where we have a high volume of cars, animals on the road could spell disaster. So these are the steps I recommend for handling this particular situation.

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9 Things to Look for in a New Veterinarian

January 12, 2015

MVMNewVet

Once again, Carol Bryant from Fidose of Reality and myself, have decided to bring together our experiences in order to give you two sides to the same story. If you missed our inaugural post of Medicine versus Mom, you can check it out here.

 If you aren’t familiar with Carol Bryant, she is a good friend and fellow pet blogger. She is the founder and CEO of Fidose of Reality. If you haven’t checked out her blog, you really should! As a seasoned blogger and writer she brings her dedicated pet parent perspective to share will all “Dog Lovers of the Highest Order”. Her posts are always a must read for me, and for any other pet parent out there. As we progress through our Medicine versus Mom series, I hope to share with you even more reasons why Carol is awesome! 

MedicineVsMom

How do you know when it is time to find a new veterinarian and what do you look for in your new doctor?

Personally, I think the #1 reason anyone should look for a new veterinarian, is if the veterinarian’s practices aren’t in line with their needs as a client.

From my experience, there are several different aspects that clients look for in their veterinarian:

1. Medicinal Practices: How generous or conservative is this veterinarian when it comes to pain management and anesthetic protocol? Don’t be afraid to ask how they monitor anesthesia and control pain during surgeries and procedures. It is important that they provide a level of transparency with you and your pet’s health.

2. Difference Makers: What does this veterinarian provide that another veterinary hospital couldn’t? Do they have exceptional experience? Unmatched equipment? Find out why they will be able to provide your pet with the best treatment available in your area.

3. Ability and Willingness to Answer Questions: Have you ever been in the room with your doctor, or veterinarian, and felt like they weren’t willing to explain? Or even worse, that they were patronizing you during their explanation? This is enough to make anyone change their doctor or veterinarian. Definitely take the time to look for someone who will do their best to help you understand, and doesn’t make you feel unintelligent when doing so.

4. Understanding Finances: Everyone has a different budget and disposable income when it comes to their pets. A veterinarian should be as understanding and flexible as possible when it comes to your pet’s treatment. They should be willing to explain to you the difference between the absolutely necessary treatments, and the treatments that could wait for another day (if applicable).

5. Diversity of Medicine: Look for a veterinarian who is highly educated and accredited. Veterinarians often seek additional education and certification after attending veterinary school, which furthers their knowledge and ability to treat your pet. All veterinarians and veterinarian technicians are required to keep up with their states CE or Continuing Education requirements, but some professionals in this industry go above and beyond the required education.

For example, Dr. Summer Godfrey who works at Pleasanton Veterinary Hospital not only graduated from UC Davis with her DVM (Doctor of Veterinary Medicine), she also graduated from the Chi Institute of Traditional Chinese medicine in 2008, which allows her to treat patients with a combination of eastern and western medicine. She provides her patients (Rooney) with more tools to improve their health.

6. Location: Let’s face it, location matters when it comes to a veterinarian. Not only is it more convenient to have your veterinarian near by, it is also better for your pet’s health and safety if you ever experience an emergency situation. The area that we live in also supports 24 hour veterinary emergency, and it just so happens that Rooney’s doctor mentioned above, works there also.

7. Willingness to Make Adjustments: Sometimes, your pet needs adjustments to their treatment plan. For example, we had this one patient who would lose her mind the second we brought her in the hospital. However, if we examined her, and did most necessary treatments outside by the grass, she felt totally fine and very comfortable. Obviously, if this patient needed a procedure or some major treatment, we would have to bring her inside, but for her annual exam and vaccines, why not leave her where she is most comfortable?

Now that I think about it, we had a few patients like that, and we were always willing to make adjustments for our patients, and I think this was important to our clients.

8. Relationship with Specialists: If your veterinarian is unable to perform a specialty surgery or procedure, are they able to put you in contact with the right doctor? If your veterinarian isn’t available 24 hours, can they put you in contact with an emergency or other 24 hour hospital? These are important things to consider when evaluating a veterinarian.

9. Bedside Manner: this is a fancy term for how much tact a doctor has when dealing with you and your pet. I have worked with veterinarians who are very friendly and have excellent bedside manner, and I have worked with veterinarians who are a little on the quirky side. Regardless, the initial first impression of a veterinarian is something that usually gets burned in a client’s brain.

Most important, is whether or not your pet likes your veterinarian’s personality and disposition. Sometimes, certain pet’s tend to gravitate toward one gender or another, and it is important that they feel comfortable.

If your veterinarian isn’t meeting your expectations, how do you go about finding another doctor?

1. The American Animal Hospital Association (AHAA) provides pet parents with a list of accredited veterinary hospitals. Each AHAA accredited veterinary hospital meets AHAA standards on 900 different measures of veterinary excellence.

2. Be weary of local review sites and forums. Although some reviews provide some truth, people are motivated to write reviews when they are upset, so take what people say with a grain of salt.

3. Don’t forget to ask your pet parent friend’s who live in the area, but make sure your questions are specific to exactly what it is that they like about their veterinarian.

Have you ever made a veterinary switch? What motivated this move?

For Carol’s Mom perspective on this subject, please hop over to her blog here.

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