Posts in Category: For The Dogs

As your primary care veterinarians, we often have a lot of first-line tools and therapies to manage conditions that affect the skin, from allergies and ear infections to lumps and bumps, common types of skin infections, and metabolic conditions (like thyroid disease).

When these conditions are chronic, such as allergies and metabolic conditions, they can be super arduous for veterinarian, pet owner, and pet alike to manage. Nothing saddens me more than when a pet owner comes in and says their pet has been up all night itching, and in their distress, waking everyone else up!

One Thing Leads to Another

Allergies, in particular, can be very complex to control. Not only are there several different types (flea bite sensitivity, seasonal or environmental allergy, food allergies, etc.), but the allergies can also cause secondary problems, like ear or skin infections.

We typically recommend testing for and treating all secondary infections and treating the underlying allergy at the same time to get things under control. (Pro tip: Make sure you keep your pet on a monthly, year-round flea prevention, even if you don’t see any signs of fleas! It just takes one flea bite to send an immune system into a frenzy).

If you don’t control the underlying allergy, you will have difficulty resolving those secondary skin and ear infections, and they will be more persistent and recurrent. Allergies are a pain!

And if this weren’t complex enough, now throw in the factor of time and chronicity in trying to manage allergies, and things can get hard to manage really quickly.

Call in the Specialist

Here comes the good part. We have another tool! When we have tried these first-line workups and treatments and are still having trouble controlling itchiness or infections, we will often suggest seeing a specialist for all things skin, ears, and nails: a veterinary dermatologist.

Yes, pets have (and need!) dermatologists too. And guess what? You now have access to a veterinary dermatologist on site at the primary care clinic you know and love. No extra travelling to a new clinic required!

Dr. Clarissa Souza is one of the amazing veterinary dermatologists at the College of Veterinary Medicine Veterinary Teaching Hospital in Urbana. She sees patients at the Medical District Veterinary Clinic on a part-time schedule. And, just like having our cardiologists on site, having specialty dermatology expertise at our fingertips has really elevated the level of care we are able to provide for your pets.

As your primary veterinarians, we have your (and your pet’s) back for all your primary care needs. But when we get those chronic, complex cases and are feeling stuck, now we can get specialty-led answers sooner and pet comfort faster. We love directly collaborating with our specialists to advance the health of our patients. If you have a pet that has unusual lumps or bumps or has chronic skin, nail, or ear issues that have been hard to control, ask your primary care veterinarian if it is worth a trip to see Dr. Souza. (I bet it will be!)

— Amanda Hampton, DVM (she/her/hers)

As a veterinarian, I get asked quite a few questions, and a handful of them are in competition for the title of “least favorite question.”

What’s the best breed of dog? Why does tick prevention cost more than heartworm prevention?  Do I really need that vaccine?  Can you look at my dog’s poop? (This one is often accompanied by a photo.) Can you smell this? 

And the one I get asked the most: What’s the best food that I can feed my dog?

For most of these questions there is no simple answer, but the one about the best diet may be the hardest to answer. There are so many pet food options and so little regulation of how pet food companies can make and market their diets.

So, what can you trust?

We at Medical District Veterinary Clinic want to facilitate our clients picking a diet that works for their pets and their family as a whole. That means we understand that the cost, type, and how often you feed your pet varies by family. With so many choices available, we often rely on AAFCO standards to know if the diet you select for your pet is adequate.

Who or What Is AAFCO?

AAFCO (which stands for Association of American Feed Control Officials) is a non-profit organization that has been guiding government officials for over 100 years in determining nutritional standards for all pet foods.

Here is their mission statement: AAFCO is a collaborative association that supports members and stakeholders and promotes a safe feed supply through unified system-based regulation, feed ingredients standards, and laboratory operations.

This organization ensures that a diet has the essential nutrients for your pet, with different standards for all types and life stages of pets. That means the AAFCO label will tell you what kind of animal this diet is appropriate for, from a growing puppy to a senior cat.

With the ever-growing number of pet food options out there, you can rely on these standards to know whether the food that you picked for your pet will have the nutrients they need. If the diet you picked for your pup has the AAFCO label, then you won’t hear many concerns from me.

So, you may be asking yourself, what has Dr. Kritzman fed her dog? Well, Miss Emerald Brown Aria Stark Kritzman has been on everything from Iams to Kirkland to Hills Prescription Renal Diet, and now Purina Bright Minds for Senior Dogs, as she enters her twelfth year. (Not including the countless meals from my children that she’s gotten through counter surfing.)

— Dr. Alyssa Kritzman

When your allergic pet gnaws on her haunch or licks his feet incessantly, the habit might annoy you just as much as it does the pet. Some furry friends go their entire lives without suffering from allergies. But those of us who have had pets with allergies know the problem can take a big toll on quality of life.

Dr. Stephanie Bruner is a veterinary dermatologist at the University of Illinois College of Veterinary Medicine. She sees patients at the Veterinary Teaching Hospital and offers insights into what’s going on with all that scratching and shaking.

---

---

What Are Allergies?

“Allergies occur when the patient’s immune system experiences an over-the-top response to any of a wide variety of triggers,” Dr. Bruner explains. “Offending stimuli may range from fleas, foods, pollens, and mold spores to dust mites or even medications. The result is an adverse reaction somewhere in the body.”

Currently, science does not have an answer for why allergies occur in one individual but not another. However, we do know that certain breeds are more susceptible to allergies.

“Genetics plays a role,” Dr. Bruner says. “Various breeds of retrievers, spaniels, and terriers, to name a few, are at a higher risk of developing clinical signs associated with environmental allergens.”

Other factors besides genetics include geography, seasonal fluctuations in pollen counts, the animal’s indoor and outdoor habits, air quality, diet, and the health of the patient’s skin barriers.

“This exceedingly lengthy list explains, at least in part, why no two allergy patients can be treated the same way,” says Dr. Bruner. For this reason, veterinary dermatologists must take a tailored approach to treating each allergy patient.

Allergy Symptoms

In humans, allergies tend to manifest as itchy eyes, sneezing, or runny noses. They can appear as rashes or even result in inflammation and difficulty breathing. In dogs and cats, however, allergies trend toward a different list of symptoms entirely.

In dogs, symptoms include scratching, licking, and rubbing in areas such as the ears, face, feet, belly, and rear end.

“I refer to these as my ‘Big Five’ patients,” Dr. Bruner explains. “These are the head shakers, face rubbers, foot lickers, belly scratchers, and bottom scooters.” Other signs include ear or skin infections that just keep coming back, no matter how often you treat them.

Our feline friends are better at hiding symptoms, and therefore cat allergies tend to look more like excessive grooming. “Cat allergies can also become more obvious if itchy crusts develop on the skin or large areas of swelling arise, possibly resembling ulcers or growths,” says Dr. Bruner.

Identifying the Allergy Culprit

When diagnosing an animal with allergies, veterinarians start by determining what is not causing the reaction.

“First, allergies are diagnosed by ruling out other disorders that can mimic them, such as external parasites, fungal infections, or autoimmune disorders,” Dr. Bruner explains. “Then, the real work begins.”

Pets, like people, suffer from many different types of allergies, such as environmental allergies and food allergies. The first type of allergy to rule out is flea allergy dermatitis.

“Flea allergy dermatitis patients are not typically horribly infested with fleas, but a small number of fleas can cause big problems,” says Dr. Bruner. “Routine flea prevention, prescribed by a veterinarian, can be a real game changer.”

If fleas aren’t to blame, then doctors move on to environmental allergies. “In this case, the patient’s medical history can help answer this question. For example, a dog that only scratches and experiences ear infections in the summer is less likely to be reactive to foods.”

For those patients who do not have a seasonal aspect to their allergy symptoms, a diet trial is the next step. “A highly restricted diet trial, using a prescription-grade food under the guidance of a veterinarian, may be the next diagnostic test performed,” Dr. Bruner states.

During the diet trial, which lasts at least eight weeks, the pet cannot have any treats, table food, or dog food other than the special diet food prescribed. “If the patient does not improve by the end of the trial, environmental allergens are likely to be at fault.”

Finding Relief from Allergies

For those pets with food allergies, treatment means staying away from the foods that have been found to cause the reaction. For those with environmental allergies, treatments can range from medicated shampoos, sprays, lotions, and wipes to oral medications or injections.

Dr. Bruner adds, “Most patients will achieve their best outcomes when a veterinarian or veterinary dermatologist works with the whole family and puts together a highly personalized care plan that includes several of these treatment modalities to attack the problem from multiple angles.”

Unfortunately, no “cure” for pet allergies exists. Treatments are meant to ease symptoms so the patient can be more comfortable throughout the rest of their life. “My goal as a veterinary dermatologist is to develop a safe and effective care plan for every allergy sufferer. The plan should be sustainable—both in terms of time and financial investment—for their humans,” Dr. Bruner explains. “Perhaps the best thing that pet owners can do is be aware of the possible early signs of allergies—remember the Big Five!—and consult with a veterinarian before secondary ear and skin infections take the problem to the next level.”

Pets may be plagued with allergies at any time of the year, according to Dr. Jennifer Clegg, a veterinarian who is completing a residency in dermatology at the University of Illinois Veterinary Teaching Hospital in Urbana. If you suspect allergies are bugging your pet, Dr. Clegg recommends that you see your local veterinarian.

What are the signs that your pet may have an allergy?

“Licking and chewing paws or limbs, scratching ears, shaking the head or face, rubbing the body on rugs or carpets or furniture, and rubbing the hind end on rugs or carpets are all common signs of allergies,” says Dr. Clegg. “You may notice that the excessive licking or scratching has led to hair loss, or even that your pet is pulling out its hair, which happens mainly in cats.”

---

Narrowing the Diagnosis

Your veterinarian will eliminate the most common possible allergies first. Parasites that live outside the body, such as fleas and mites, frequently cause allergies in pets. A flea and tick preventive medication prescribed by your veterinarian should stop this problem. However, if this medication does not get rid of the itchiness, the next step is to consider whether your pet’s food is the cause.

“Some allergies arise when the pet develops hypersensitivity to the protein in their diet,” explains Dr. Clegg. “In these cases, we implement a diet trial, replacing the protein source in the diet with either a prescription hydrolyzed protein diet or a novel protein diet for 8 to 12 weeks.

“By the end of the diet trial, the pet should be symptom free if the protein was the culprit. If the previous diet is then restored and the symptoms return, a food allergy diagnosis is confirmed.”

A successful diet trial requires strict adherence by pet and client. No flavored medications, supplements, toothpastes, snacks, or other food should be given during the trial period.

“Even oral heartworm or flea and tick preventatives must be avoided and a topical product used instead while the pet is on the diet trial,” says Dr. Clegg.

If the diet trial doesn’t eliminate the allergy symptoms, then the pet probably has an environmental allergy.

Outdoor Vs. Indoor Allergens

Unfortunately, in most cases the source of an environmental allergy cannot be eliminated. After all, Dr. Clegg says, “You can’t remove all your trees from your yard or remove all your neighbor’s trees.”

In these cases, the pet’s symptoms must be managed instead. Outdoor allergens vary with the season, if you live in a part of the world that goes through seasonal changes.

Both dogs and cats suffer from springtime allergies, most commonly when trees begin to pollinate. (Although cats are mainly indoor, pollen from trees is in the air and can enter the home.)

In the summer, the main pollen comes from grasses. “Kentucky blue, timothy, orchard, and rye grasses commonly contribute to grass pollen allergies in the Midwest,” notes Dr. Clegg. “And in central Illinois, corn pollen presents a problem for allergic pets during harvest time.”

During fall, weed pollination and ragweed are the main sources of allergens. Additionally, mold spores tend to rise in the fall due to falling leaves and dying plants. Molds thrive on decomposing plant matter and their spores can float in the air.

“For some pets, wiping the paws clean after they come inside may help, but this alone will not be curative,” she says. “However, veterinarians have a variety of prescription medications at their disposal to help manage allergy symptoms. Treatment is tailored to the individual pet.”

Winter typically puts an end to outdoor environmental allergens, but mold spores may continue to be an issue. Indoor environmental allergens are a problem year-round. Veterinarians most commonly see allergies to dust or storage mites.

“Unfortunately, even if you vacuum your house every day and are the most immaculate housekeeper on earth, you will never entirely rid your house of dust mites,” says Dr. Clegg.

Parting Advice

So, what can you do for your itchy pet with an environmental allergy?

Dr. Clegg recommends keeping your pet on year-round flea and tick preventatives. “Even just one flea bite can exacerbate allergy symptoms,” she says.

She also advises against giving over-the-counter medication to pets without a veterinarian’s approval. Over-the-counter antihistamines may not be effective on allergic pets, and certain decongestants can be toxic to pets.

Because most environmental allergens cannot be avoided, the best way to keep allergic pets comfortable is to stay in close communication with your local veterinarian.

Skin issues are one of the most common reasons pets end up at the vet. For many itchy dogs and cats, the underlying problem is pyoderma, a bacterial infection of the skin.

According to Dr. Clarissa Souza, a board-certified veterinary dermatologist at the University of Illinois Veterinary Teaching Hospital, understanding what causes pyoderma is the key to treating it effectively – and preventing it from returning.

“Pyoderma is always secondary to an underlying disease,” Dr. Souza explains. “In dogs and cats, the most common primary disease is allergies.”

---

---

Signs of Pyoderma

Unlike people, who often show their allergies through sneezing or watery eyes, allergic animals primarily have their skin affected and secondary bacterial infections aggravate the problem. And for owners, the signs are usually hard to miss.

“Most animals with skin infections are itchy,” Dr. Souza points out. “Sometimes they are already itchy because of allergies, and they get markedly itchier because of the pyoderma.” Owners may also notice visible changes. “If owners see some scaling, small pink lesions resembling mosquito bites, or yellowish crusts, they should bring their animal to the veterinarian.”

While many owners worry that certain breeds are more prone to pyoderma, Dr. Souza stresses that the bigger issue is allergy prevalence. “I personally don’t think there is one breed of dog that is more predisposed than others,” she notes. “All allergic dogs can have pyoderma.”

Diagnosing Pyoderma

One of the most important messages Dr. Souza hopes to convey to pet owners is that pyoderma must be properly diagnosed.

“Cytology is essential to confirm pyoderma,” she says. “Without cytology, we can suspect, but we will not have a definitive diagnosis.” For cytology, veterinarians collect samples from the skin and examine them under a microscope.

Sometimes veterinarians will culture the bacteria found on the pet’s skin to identify which antibiotics the bacteria respond to. “Culture is recommended when we suspect resistant infections,” Dr. Souza explains. Classic candidates for culture tests include pets that have had multiple antibiotic courses, infections that don’t resolve with treatment, or new pyoderma lesions that appear despite antibiotics administration.

Treating Pyoderma

Dr. Souza supervised a clinical trial at the University of Illinois evaluating how long dogs need antibiotics for superficial pyoderma, the most common form of the disease.

“The main goal of this study was to determine the ideal duration of antibiotic prescriptions,” she says. “At the end, we saw that two weeks of systemic antibiotic treatment should be enough for the great majority of superficial pyoderma cases. We may even be able to use it for a shorter period if topical antibacterial treatment is prescribed together.”

Additionally, and of importance, Dr. Souza notes: “That’s the idea nowadays: to try to use as little as possible of antibiotics so that we are not allowing bacteria to develop resistance.”

She also warns owners against using leftover antibiotics or stopping treatment early. “Failing to complete the full course of antibiotics or using antibiotics prescribed for something else could contribute to bacterial resistance,” she says.

Finally, rechecks are essential so veterinarians can re-assess the skin infection and determine whether it has resolved.

Treating Early, Addressing the Cause

The longer pyoderma goes untreated, the more uncomfortable pets become – and the more likely the infection is to spread, recur, or require aggressive treatment later. Early diagnosis and proper management of the underlying allergy, endocrine issue, or other skin disorders are essential to prevent these infection cycles from repeating.

For owners frustrated by their pet’s repeated pyoderma, Dr. Souza stresses the need to address the underlying problem, which is often allergies.

Most current research focuses on allergy control to get at the root of the problem. “We’ve been seeing companies developing more options for allergy treatment,” Dr. Souza says. “That’s been the focus. Not specifically pyoderma, but controlling the underlying disease.”

With advances in allergy care, dermatologists hope future patients will experience fewer bacterial infections overall.

A puppy born with a rare heart condition—Tetralogy of Fallot—got a second chance at life, thanks to a collaboration involving a visiting veterinary heart surgeon and the cardiology and surgery teams at the University of Illinois Veterinary Teaching Hospital.

Odyssey, an Australian shepherd, was only three months old and newly placed in a foster home when he started showing signs of a problem. After exercising, he began breathing heavily and had trouble standing up on his own. He would lean up against the fence just to stay standing and was having uncontrollable tremors. (article continues below)

---

---

Dr. Todd Sumerfield, a veterinarian pursuing specialization in veterinary cardiology at the College of Veterinary Medicine, explains how the Illinois team diagnosed Odyssey’s condition and arranged for his surgical intervention—a modified Blalock-Taussig shunt—that had never before been performed at the university hospital.

Diagnosing Tetralogy of Fallot

Noticing Odyssey’s post-exercise behaviors, his foster owners took him to their veterinarian, who identified a loud heart murmur and referred the case to the cardiology team at Illinois in August 2023.

“An echocardiogram was performed, as well as a packed cell volume,” Dr. Sumerfield says.

An echocardiogram allows doctors to visualize the heart as it beats within the patient. In Odyssey’s case, the echocardiogram identified all the defects associated with a condition known as Tetralogy of Fallot.

Packed cell volume measures the amount of red blood cells within the blood of the patient. When an animal has a heart condition leading to decreased oxygen in the blood, as in Tetralogy of Fallot, the body produces more red blood cells in an attempt to deliver more oxygen to the body’s tissues. Although the echocardiographic signs of Odyssey’s condition were severe, his packed cell volume was within the normal range, at 44%.

Dr. Sumerfield points out this normal finding “underlines that Odyssey was doing better than most dogs with this condition at the time of his diagnosis.”

What Is Tetralogy of Fallot?

“Tetralogy of Fallot is an uncommon, congenital heart disease,” Dr. Sumerfield says. “It occurs when the patient has four (thus ‘tetralogy’) concurrent abnormalities.”

To understand these abnormalities, it helps to recall how blood flows through the body. Blood is pumped from the heart’s right atrium to its right ventricle and then, via the pulmonary artery, to the lungs. After receiving oxygen from the lungs, the blood then travels back to the heart into the left atrium. From there it is pumped to the left ventricle, which pushes the blood into the large blood vessel called the aorta and on to the rest of the body.

After delivering its oxygen to tissues and organs, the deoxygenated blood travels back to the right atrium, where the cycle begins again.

In a Tetralogy of Fallot case, the animal is born with a narrowing of the pulmonary valve, which controls blood flow from the right side of the heart to the lungs. The animal also has a ventricular septal defect, which is an inappropriate opening in the septum, or wall, that separates the left and right ventricles. Additionally, the aorta, instead of being positioned over the left ventricle, sits over the left and right ventricular outflow tracts. In that location, the aorta accepts blood from both the left and right ventricles, sending a mixture of oxygenated and deoxygenated blood to the body’s tissues. Lastly, the right ventricle of the heart is abnormally thickened.

Heart Defects Lead to Low Oxygen

Dr. Sumerfield continues, “The narrowing of the pulmonary valve obstructs the outflow of the blood to the lungs. As a consequence, the right ventricle must pump harder to force the same volume of blood through a narrowed orifice.” Because the right ventricle functions just like any other muscle, as it “works out” harder, the muscle grows and thickens.

The ventricular septal defect means deoxygenated blood found in the right ventricle can flow into the left ventricle, where it is pushed into the body without having passed by the lungs to take on oxygen.

All four abnormalities are interrelated and contribute to the problem of low oxygen levels in circulating blood. Abnormally low circulating oxygen led to Odyssey’s exercise intolerance: he was unable to oxygenate his body properly while playing in the yard, making him easily tired.

In response to low oxygen in the body, the bone marrow receives instructions to produce more red blood cells. “When there are inappropriately high numbers of red blood cells in circulation, the blood can become more viscous, or thick. This change, in turn, can impair blood flow to the brain and lead to neurologic signs and even seizures.” Or, in Odyssey’s case, tremors.

Surgery: Modified Blalock-Taussig Shunt

Once Odyssey had a diagnosis, the next step was to determine a treatment approach. It is not typical to treat a patient with Tetralogy of Fallot with medications until there is evidence of heart failure. Phlebotomy (physical reduction of the number of red blood cells) and balloon valvuloplasty (a minimally invasive procedure to widen the pulmonary valve) were considered but both approaches had limitations.

Another option was surgical intervention using the modified Blalock-Taussig shunt. “This surgery involves redirecting mixed arterial blood flow back to the lungs for another pass at oxygenating the red blood cells,” explains Dr. Sumerfield. “The procedure is performed under general anesthesia via a left thoracotomy. A synthetic tube is placed to allow arterial blood to flow to the lungs. The goals of the procedure would be to improve forward flow through the lungs and have a higher percentage of oxygenated blood circulating at any one time.”

A shunt can be thought of as an alternate path, or a turn in the road. It provides the blood with somewhere else to go. Shunts that arise naturally may be present at birth or may be “acquired” by the body after certain stressors. However, in this surgery, an artificial shunt is placed to redirect blood from where it was going into the body (with no oxygen supply) back to the pulmonary artery (which feeds into the lungs) so it can receive its oxygen load.

Odyssey Still Going Strong

Although Odyssey’s clinical signs were not severe, they were getting progressively worse. After his fosters decided to pursue the modified Blalock-Taussig shunt surgery, the University of Illinois cardiology service conferred with surgeons across the country, and Dr. Brian Sutherland, a veterinary cardiothoracic surgeon from the University of Georgia, agreed to perform the surgery. The modified Blalock-Taussig shunt surgery was performed at the Veterinary Teaching Hospital in September 2024, when Odyssey was 1 year, 4 months old. The surgery was successful and Odyssey recovered well. 

After two days in the hospital, Odyssey was sent home with pain relievers, sedation, and a strict exercise restriction for two weeks. He was also given six months of blood thinners to decrease the risk of a clot forming in the newly implanted synthetic shunt.

“If left untreated, most dogs with Tetralogy of Fallot will die before reaching one year of age,” says Dr. Sumerfield. “There is limited information regarding life expectancy in dogs who have had the modified Blalock-Taussig shunt procedure, but one journal article found that patients lived for an average of 7 years after the procedure.”

Odyssey is currently more than two years old and continuing to improve. His ability to exercise has improved significantly and his tremors have resolved. Recent rechecks have shown that Odyssey’s shunt is still working.

His fosters have formally adopted Odyssey and are hoping Odyssey lives a long and happy life.

Disclaimer: The following is merely surmised from my professional knowledge and opinion on grape toxicity in the field of veterinary medicine, and not my fealty to the Kritzman family creed:
“No raisin shall reside in a baked good where a chocolate chip may be instead.”

The cookie trays and Grandma Sally’s dessert grab bag at the Kritzman family Chanukah party have been a time-honored tradition since before I was born. Now, as a mother myself, I help make the dozen different types of cookies that are needed to provide dessert to the Kritzman clan.

But there is one ingredient I will not bake with in my home, and that’s raisins. We almost never have grapes in the house either. Not because of the Kritzman creed, but because of my dog Emmie. She is our little hoover. As much as I appreciate her cleaning up after my two-year-old’s attempts to make her own taco with shredded cheese, Emmie will not hesitate to eat a grape or raisin if she gets the opportunity.

What’s the big deal about dogs and grape ingestion? Why are they toxic? For much of my career, the veterinary community didn’t really know. We were taught that grapes could be toxic, and even one could put a dog in kidney failure, but we don’t know which dogs or type of grape would cause this.

This lack of knowledge made me loathe grape toxicity as an emergency veterinarian. Not only because of the potential harm it could cause my patients, but it made me feel like a fearmonger to my clients. I had to give people the worst-case scenario for something that might never happen. Although for most dogs the ingestion of one grape won’t cause any problems, for some dogs it could be fatal. And we didn’t know why.

Today, we have more insight. Starting in 2022, tartaric acid (cream of tartar, for us bakers) was seen to cause the same type of kidney damage in dogs as caused by grape toxicity. The problem usually manifests as lethargy, vomiting, diarrhea, and an increase in thirst initially.

Grapes contain tartaric acid, but the concentration of tartaric acid varies wildly between grape varietals and how ripe they are, which makes it quite difficult to calculate an ingested dose. This is why any grape ingestion can be of concern.

So grape toxicity is not a myth or means to rack up the bill at an emergency clinic. If your dog only gets one grape or raisin, you may be in the clear, but you should still reach out to your veterinarian to determine if medical care is needed.

If you’re like me and live with your dog and two semi-feral racoons (a.k.a., small children), you may find it’s just safest to keep grapes and raisins out of the house. Which is not a grave sacrifice for me (see family creed above). I will happily go about baking with chocolate chips, for which I can easily calculate the amount my dog will need to ingest to result in any problems (3 ounces of semi-sweet chocolate). But that is for another blog.

Happy holidays to you all, and best of luck with all the baking!

—Dr. Alyssa Kritzman

This one’s for all the gentle giants, dashing Danes, and persnickety pinschers.

Owners frequently tell others about their dog’s “big heart.” But what if that is not a reference to the dog’s lovable personality? Boarded cardiologists at the University of Illinois College of Veterinary Medicine explain dilated cardiomyopathy, a situation where a “big heart” is not a good thing. (article continues below)

---

---

Dilated cardiomyopathy (DCM) affects the muscles of the heart so that they no longer contract forcefully enough to adequately pump blood. This results in an enlargement of the heart, which in turn further impairs the heart’s ability to contract. As this negative cycle continues, the patient becomes increasingly likely to develop congestive heart failure. If congestive heart failure develops, patients will require daily medication and frequent veterinary appointments to monitor their disease.

Who Gets DCM?

Large breed dogs, such as Doberman pinschers, great Danes, and boxers, that are middle-aged or older are predisposed to developing DCM. It may be advisable to screen dogs for the disease if they have a family history of DCM or a predisposition due to their breed.

Factors other than breed may play a role in dogs developing DCM. Over the past few decades, veterinary researchers have published data supporting a link between certain diets and DCM.

These diets are often labeled “grain-free” since they use peas, lentils, other legumes, and potatoes as the main ingredient. It is recommended that dog owners avoid feeding “grain-free” and other diets containing legumes.

What Does DCM Look Like?

DCM is different from other cardiac diseases because it may be present for a long time before the patient shows clinical signs. Even though the patient appears healthy, the disease is present and progressing.

Clinical signs can vary widely between patients with DCM. The first symptoms may be exercise intolerance or lethargy. Patients who have progressed to congestive heart failure can suffer from coughing, collapse, and respiratory distress.

Unfortunately, in some dogs, sudden collapse and even death could be the first sign that anything is wrong. For this reason, screening for DCM and monitoring for progression of the disease are vitally important.

Because DCM affects the heart muscle, it can also cause abnormal heart rhythms, called arrhythmias. Arrhythmias originate in the ventricles, the parts of the heart that pump blood to our lungs and throughout our bodies. In DCM, arrhythmias can occur at the same time or even before changes in the shape and musculature of the heart.

Managing DCM

DCM cannot be cured, but the disease can be managed. The goals of therapy are to improve the heart’s ability to contract, improve clinical signs such as being tired and out of breath, and delay onset of congestive heart failure.

Oral medications are used to improve the efficiency of the heart’s contractions and promote forward flow of blood. Patients with congestive heart failure require additional oral medications to decrease fluid accumulation.

The long-term prognosis for canine DCM can be extremely variable, with some patients rapidly progressing to congestive heart failure and requiring therapy while others remain stable for years. Once congestive heart failure develops, however, patients usually have a poor prognosis. Doberman pinschers also seem to deteriorate more rapidly than other breeds.

Hope for the Future

Having an animal with dilated cardiomyopathy can be scary, but researchers are working on a better treatment. The cardiology service at the University of Illinois participated in a study that evaluates the use of a drug called rapamycin in patients with DCM. Called the REPAIR study, this multi-clinic clinical trial sought to determine if rapamycin will reduce cardiac size and improve contractility in dogs with DCM.

Rapamycin treatment has been shown to reverse age-related declines in cardiac function in both laboratory animals and client-owned dogs, without significant adverse effects.

Maple’s owners noticed a problem. Their nine-year-old Chihuahua started to have a dry, hacking cough three to four times a day, mainly in the morning. After coughing for 5 to 10 seconds, Maple would make a retching sound, lick her lips, and then return to normal.

Years earlier, Maple’s primary veterinarian had detected a heart murmur. But because Maple was asymptomatic and the murmur was quiet at that time, they had decided to monitor for changes rather than starting medications or performing other diagnostics. (article continues below)

---

---

Now the murmur could be heard on both sides of the chest with a stethoscope. Maple had also developed a mild tracheal (windpipe) sensitivity, seen as a soft cough when her veterinarian touched her throat. The rest of her physical exam was within normal limits. Given Maple’s breed, age, and history of progressive heart murmur, her veterinarian suspected she had developed chronic valve disease and suggested that Maple see a veterinary cardiologist.

Dr. Todd Sumerfield, a veterinarian pursuing specialization in cardiology at the University of Illinois College of Veterinary Medicine who cared for Maple, shares the signs and treatments for heart murmurs and chronic valve disease in dogs.

What Are Heart Murmurs?

A heart murmur is a physical exam finding that indicates rapid or turbulent blood flow in the heart or nearby large blood vessels. Murmurs can vary in volume, sound, location, and phase of the cardiac cycle. Even low-grade murmurs can be detected by listening to the heart with a stethoscope.

Murmurs are graded on a scale of 1 to 6, commonly written in Roman numerals (I-VI) in the medical record, with grades given for each side of the chest. Murmurs receive a higher grade as they get louder. A grade V or VI murmur, which can feel like buzzing in a pet’s chest, can even be felt through the skin or heard without a stethoscope.

“While the grade of murmur is helpful to confirm suspicion of heart disease, the grade of murmur does not necessarily correspond with the severity of heart disease,” says Dr. Sumerfield. Additionally, a louder murmur does not always mean worse heart disease than a quiet murmur, and murmur grade cannot be used to monitor disease progression. 

Sometimes murmurs are not a sign of disease. These so-called “innocent” heart murmurs are caused by normal blood flow through the heart and are usually harmless.

Pathologic murmurs can be from acquired or congenital disease. Congenital murmurs are present from birth. As in Maple’s case, a veterinarian may hear a heart murmur on physical exam and inform owners that their pet has an underlying heart disease before clinical signs, such as coughing or exercise intolerance, develop. Dr. Sumerfield says small-breed dogs, especially Cavalier King Charles spaniels and toy poodles, have a genetic predisposition to developing chronic valve disease when they are middle-aged or older.

What Is Chronic Valve Disease?

Chronic valve disease (also referred to as degenerative valve disease or myxomatous mitral valve disease) is the most common acquired heart disease in dogs. It typically affects the mitral valve that separates the left atrium and the left ventricle, although other valves may also be affected.

Myxomatous mitral valve disease describes a condition in which a scar-like substance builds up inside the mitral valve, causing it to lose function.

“Myxomatous changes cause the valve to become thickened and irregular, which allows blood to flow backwards across the valve when the heart contracts. This turbulent regurgitation of blood is what causes a heart murmur,” says Dr. Sumerfield.

Maple’s Visit with the Cardiologist

When Dr. Sumerfield examined Maple, he confirmed the presence of a heart murmur and performed an echocardiogram to identify the cause of the murmur. An echocardiogram is a non-invasive ultrasound exam of the heart. It involves shaving small patches of fur on the dog’s chest and may require mild sedation, depending on the temperament of the dog.

Maple’s echocardiogram showed thickened mitral valve leaflets with an enlarged left atrium and ventricle. The mitral valve leaflets are the flaps of tissue that open and close with each heartbeat to control blood flow between the left chambers of the heart.

A technique called color Doppler, which allows for the visualization of blood flow, revealed severe mitral regurgitation as the cause of Maple’s heart murmur.

The echocardiogram confirmed a diagnosis of chronic valve disease in Maple. As this disease progresses, the heart begins to enlarge, which puts the dog at risk of congestive heart failure. That means it is time to intervene medically.

Treatment of Heart Disease

“There are a variety of diseases that cause murmurs, and each is treated differently,” says Dr. Sumerfield. The treatment depends on the underlying cause of the murmur, so proper evaluation is very important. Referral to a veterinary cardiologist may be needed to guide appropriate therapies. 

“Most heart diseases may be treated medically. Animals who require medical management will be on oral medications lifelong,” explains Dr. Sumerfield.

Some congenital heart diseases can be cured surgically. Puppies with loud heart murmurs should be evaluated at a young age to determine if they are a candidate for surgery. 

In recent years, veterinarians have developed surgical treatment for some forms of acquired heart diseases such as chronic valve disease.  

Managing Maple’s Heart Murmur

Maple was sent home on a medication called pimobendan that will help to delay the progression of her heart disease. Before she left, X-rays were taken of her chest so that doctors can monitor the size of her heart and monitor for fluid accumulation in her lungs over time.

Dr. Sumerfield recommends new chest X-rays be performed every six months so her medication can be adjusted to delay congestive heart failure for as long as possible. He also told Maple’s owners that if she experiences difficulty breathing, she would need to see a veterinarian immediately as this may indicate the onset of congestive heart failure. The goal is to keep Maple as happy and healthy for as long as possible without experiencing clinical signs from her heart disease.

This information was originally published on the University of Illinois College of Veterinary Medicine website.

The Fourth of July is a time for celebration—but for our pets, it can be a source of stress, fear, and potential danger.

At Medical District Veterinary Clinic, we want to make sure your four-legged family members stay safe, calm, and healthy during the holiday festivities. Here are some essential safety tips to help your pet enjoy the holiday as much as you do.

1. Keep Pets Indoors During Fireworks

Even the most confident pets can become terrified by the loud, unpredictable booms of fireworks. To prevent your pet from running away or becoming injured:

• Keep pets indoors well before the fireworks begin.
• Close windows and curtains to reduce noise and flashes of light.
• Play calming music or turn on a TV to help muffle outside sounds.

2. Update Microchip and ID Tags

• Ensure your pet’s microchip is registered and up to date with your current contact information. A microchip greatly increases the chances of being reunited with your pet if they’re found.
• Make sure your pet is wearing a collar with an ID tag that includes your phone number.

3. Create a Safe, Quiet Space

Pets need a place to retreat when they feel overwhelmed. Set up a calm, cozy area in your home where they feel secure:

• Use a crate, a closet, or a quiet room with their favorite toys, bedding, and treats.
• Consider using a white noise machine or fan to drown out external sounds.
• Try a calming pheromone diffuser (like Adaptil for dogs or Feliway for cats).

4. Reduce Stress with Supplements or Medications

Some pets experience severe anxiety during fireworks. Talk to your veterinarian in advance about safe options to ease your pet’s stress:

• Natural calming supplements (such as L-theanine, or calming chews) may help mild anxiety. Some common brand names include Zylkene, Composure, and Solliquin.
• For moderate to severe cases, veterinarian-prescribed anti-anxiety medications can offer effective relief.
• Never give your pet human medications, many of which are toxic to animals.

Plan ahead: Medications often work best when started before the fireworks begin.

5. Outdoor Safety Tips If Your Pet Joins the Celebration

If your pet will be outside during any part of your Independence Day celebration, be mindful of these hazards:

• Keep them far away from fireworks, both used and unused. Fireworks can cause burns, trauma, or poisoning.
• Prevent overheating—make sure pets have access to shade and fresh water, especially during midday heat.
• Secure grills and food—fatty meats, skewers, and aluminum foil can be tempting but dangerous if ingested.
• Watch for citronella candles, sparklers, and glow sticks, all of which can be harmful if chewed or swallowed.

Even social pets can become overwhelmed at parties—always supervise them closely and provide a quiet space to retreat if needed.

Final Thought: Prepare Ahead for a Pet-Friendly Fourth

The Fourth of July doesn’t have to be scary for your pet. With preparation, patience, and a few safety precautions, you can make the holiday fun and stress-free for everyone in your household. If you have any concerns about how your pet may handle the festivities—or need help with medications or supplements—contact us at Medical District Veterinary Clinic today. We’re here to help your pet feel safe, calm, and loved.

Wishing you and your furry friends a happy and safe Fourth of July!

– Dr. Jeanette Barragan