Which one of us wouldn’t do everything possible for our ailing dog in a time of need?
Being proactive on his/her behalf is only part of our commitment and responsibility. The other segment of the equation is knowledge of every option available and communication with the veterinary team.
From death’s doorstep to a normal life span, Gus, a boxer, is alive today thanks to incredible professional collaboration and owner commitment stretching from Philadelphia to Cincinnati in June 2014.
Owned by Lissa and Gary Brown, of Flourtown, Pa., Gus began exhibiting signs of nausea and subsequent vomiting and was diagnosed with a slight heart murmur at four months of age by Dr. Rebecca Latham in Hilton Head, S.C., while the couple was vacationing there. She urged an immediate follow-up upon their return home with their primary veterinarian, Dr. Andrea Orsher in Fort Washington, Pa., who, in turn, confirmed the murmur and referred the dog to Dr. Beth Bossbaly, in Levittown, Pa., a Veterinary Specialty and Emergency Center cardiologist.
Chest radiographs revealed an enlarged heart but no signs of congestive heart failure. Because of his history, Bossbaly placed a 24-hour Holter monitor on Gus and gave the Browns a diary in which to record his specific activities and corresponding time of day during the monitoring of any events or periods when they saw Gus’s heart pounding at home. The recording monitor revealed rapid heart rates with arrhythmia that landed Gus in VSEC’s ICU immediately.
In the process Gus lost considerable weight. “Looking back,” says Lissa Brown, “it seems the genetically destined arrhythmia was progressive, finally at five months, showed signs (murmur), symptomatic with changes in heart structure (valvular leakage and myopathy), steadily worsening over the next month.”
Brown, an ophthalmologist and a former nurse with experience in cardiac surgery, says,” I understood generally the arrhythmia issue, and my background allowed me to read medical and veterinary literature to fully grasp Gus’s condition and the treatment options available.”
Bossbaly’s team attempted medical therapy with several antiarrhythymics and when one of the non-conventional drugs broke the arrhythmia, they became suspicious of an accessory pathway (“extra” electrical connection) and referred Gus to the University of Pennsylvania School of Veterinary Medicine, where he was seen by Dr. Mark Oyama, also a cardiologist.
Oyama diagnosed Gus’s condition as a unique form supraventricular tachycardia (SVT), a congenital electrical defect that permits electrical impulses to travel between the top and bottom portions of the heart outside of the normal single pathway. This allows the electrical impulse to continuously circulate around the heart, Oyama explains, and results in the accelerated heart rate with which Gus presented.
On four occasions last June, Gus was admitted and discharged from the hospital for recurrent episodes of SVT, and treated with various combinations and doses of oral drugs with limited success.
In his final three-day hospitalization, Gus experienced problems tolerating IV drugs needed to control his SVT. At one point he collapsed due to a critically low heart rate, requiring staffers to revive him.
Because medical management at Penn Vet’s Ryan Hospital was not enough to control the condition, his best hope was an immediate cardiac ablation procedure performed by Dr. Kathy Wright, a Cincinnati ACVIM specialist in cardiology and internal medicine. The hospital (MedVet Medical and Cancer Center for Pets) is recognized as the premier site for clinical ablations in the U.S. and Canada; more than 70 have been conducted.
This meant Lissa needed to drive the ailing dog from Philadelphia to Cincinnati—11 hours and 625 miles—for the surgery.
“Gus preferred to curl up in the passenger seat and put his head next to the gear shift and rest it on my knee or the arm rest and sleep. I had a harness on him but didn’t actually need it. Because I had no way to control his heart rate I stopped checking when we set out on the trip. I knew my job was to drive safely, not get lost and get to the veterinary hospital on time.”
Being in the health field, Brown was asked to describe her feelings through the bulk of Gus’s treatment.
She replied, “They ran the gamut. I used to do cataract surgery; my husband does retinal-detachment surgery, so I believe generally we are relatively cool under pressure. The month of June we both were definitely not cool. We were at each other over the dog. And we raised three children and lived through serious health problems in our family. It didn’t matter. Anxiety and fear of the unknown are powerful emotions.”
Add several late-night 35-minute trips to the Penn ICU and mounting care costs to the challenges faced by the Browns. There were no viable treatment options, so it became a matter of treat or watch a 5-month-old puppy go into heart failure, Brown explains. “We were both surgeons,” she continues, “and used to ‘fixing.’ That’s when frustration set in, not to be able to fix Gus but determined to get him to the right surgeon.”
At home, Brown researched the problem, talked with cardiology colleagues and learned about Gus’s likely problem and the possibility of a cure. “They, of course, were amazed that ablation was available anywhere for dogs,” she says.
So what does ablation operation involve? Wright replies, “An electrophysiologic study is performed, in which special electrode catheters are introduced through veins in the leg and the neck and positioned at key areas within the heart. We do extensive testing in which we pace various parts of the heart through these catheters. Based on electrical responses, we are able to tell where the extra electrical connection, known as the accessory pathway, is generally located within the heart.
“We then have to do fine mapping, in which we determine within a millimeter or so where this accessory pathway lies. Radiofrequency energy is then delivered through a special catheter whose tip is positioned on the accessory pathway.
“If conduction through the pathway is not interrupted within seven seconds we perform additional fine mapping for better positioning. If conduction through the pathway is interrupted within the seven-second period we continue to deliver energy for a full minute. This is followed by an hour-long study to make certain that conduction through the accessory pathway does not return.”
The entire procedure in Gus took four hours 15 minutes. Recovery was quick, allowing the Browns to take him home the following day.
Without the surgery and with the severity of Gus’s rhythms, Wright speculates he would most likely not have survived more than a year or two. And during that span he would have required several hospitalizations to control the rapid heart rhythm.
Twenty one dog breeds have been documented with accessory pathways, according to Wright. It has been most commonly seen in the Labrador retriever (40 percent of the cases).
The Team Gus story is one of three special Animal Survivor stories to be presented at the American College of Veterinary Internal Medicine Forum in Indianapolis June 4, showcasing veterinary and owner teamwork. The annual forum will attract more than 3,200 veterinary specialists.