Weighing Heavy on the Hearts of the Tiny

It’s the fifth month of a global pandemic, and you have finally decided to bring your super not-sick cat into the clinic for what will only be a regular annual exam, because nothing will ever happen to her and she is perfect and actually named after a minor character in a science fiction mini-series from the ’70s whose reference you will always be surprised is picked up by your vet who tends to type and talk in run-on sentences.

So all is going well.

You are sure of it.

You are waiting a tiny bit too long and you start to remember how your last sick cat once came to the vet and you had to wait 15 minutes extra and then got bad news. But then I come to your car and say that everything looks good [exhale], the annual blood work is normal on Meow Lamba [exhale], but …

BUT BUT BUT!!!!!! [heart sinks because this is not how the day was supposed to go and–what will it be?]

… but your sweet little cat has a very mild but notable heart murmur. You then hear nothing but a funeral march played on Moog synthesizers because Meow Lamba would want it that way.

As I say “heart murmur,” I see everyone’s face do one of two things: Eyes dilate and widen, mouth slowly goes agape and you are about to fall apart, or the muscles form the physical equivalent of “OK, Doc, be straight with me: how many months do I have left with her?”

I have to intervene immediately and dilute the words a bit, allowing you to fall back to earth and be able to talk out the rest. 

And so: heart murmurs. Why do we often say not to worry, and then sometimes tell you to worry? Why do we send you to the cardiologist immediately sometimes, and more often tell you to monitor? Why did your last vet say you can never do a dental on her, and now I am telling you we can?

Let me help you. As with everything, each doctor has her own protocol, but I will give you some basics to consider. Each individual case may be different.

What is a murmur?

Lub Dub-Lub Dub-Lub Dub is the sound of the valves of the heart taking turns to close and effectively push blood through the heart. It’s not the only thing doing so, but gets most of the credit. Occasionally there will be some form of pathology to the valves causing them not to shut properly. Like a rattling screen door that doesn’t fit in the frame after years of humid summers and dry winters, the valves sometimes become misshapen or inflamed, causing the beautiful tell-tale lub-dub of the heart to sound more like lub-a-swish-dub-lub-a-swish-dub.

I liken it to someone turning up the reverb on a snare drum, but this analogy nails it for about none of my patients. So don’t worry when that means nothing to you.

To avoid making this into a veterinary textbook, I am not going to go into the pathophysiology of every reason a cat could get a heart murmur, but there are many: from congenital disorders (cats are born that way), to innocent ones caused by nothing at all, to underlying diseases (hyperthyroidism, etc.), to metabolic status (anemia, dehydration, high pressures, etc.).

The important thing to remember is that a heart murmur can be the result of something very serious, but in itself is not an emergency or an actual indication that a cat’s heart is progressing toward failure. I say this to a lot of clients, but my last cat (who was not named after a minor science fiction character) lived to be about a billion years old and had a Grade 3 heart murmur for all of those years with no clinical signs or progression.

This is not the same for every cat, though.

And then here is my first question: Is this a new murmur, or this is an old murmur that was either very hard to hear or the circumstance today (like being sick) is making the murmur sound more noticeable? Being dehydrated, sometimes being sedated or under anesthesia, being calmer or more excited can make a hard-to-hear murmur easier to hear.

If this is genuinely a new murmur, my next question is to understand if there are clinical signs of heart disease going on at home. These include coughing, wheezing, congestion, fluid from the nose, exercise intolerance, lethargy, or any type of respiratory noise. Now generally what happens is that when you hear about the murmur, you start to remember every single sneeze, wheeze, and cough that the cat (which was previously doing fine, with no issues) has had over the past year. It’s not that I discount the amended history, but heart disease is not the primary rule-out for any of the above clinical signs, so I take reports of these issues in context.

And if these things are not going on and the cat is still doing fine, then comes the choice of what to do. The most aggressive thing is to take x-rays to look at the size of the heart, to assess if the murmur is associated with other issues. Then sometimes, regardless, we discuss going to see a cardiologist where an ultrasound of the heart can evaluate those valves very specifically and make sure there is nothing going on.

Certain breeds of cats are more prone to issues, including the tragic and lovable Maine coons, Ragdolls, British shorthairs, Sphynxes, Norwegian forest cats, and Siamese. With these breeds, I generally err on the side of caution, but generally a happy healthy domestic short-haired cat that has a mild murmur and nothing else I will monitor and watch. I think it’s good to come back in a few months to recheck the murmur to make sure it is not progressing.

We do dentals and other anesthetic procedures all the time on cats with murmurs. It’s not that we don’t have to worry about it; it’s that we do. We take many precautions and monitor closely for any issues that are occurring during anesthesia. I think that sometimes cats with mild heart murmurs suffer much more from things like severe dental disease that goes unchecked because of the fear of putting them under anesthesia.

To be clear, you want to avoid anesthesia if possible, but it is not something that has to be avoided at all costs. Sometimes, again, going to a cardiologist before is recommended (and the safest things you can do).

I should say that despite my assurance that a heart murmur doesn’t always mean the worst, it can be. I don’t want anyone who is still reading this to think that I think that heart murmurs are a scam. There are animals that acquire heart murmurs and it is an early indication of heart disease that is serious. What you need to remember, though, is that there is a subtlety to it that is not so simple. Part of why annual exams on your cats are so important is so we can catch things like first-time heart murmurs and make sure that we are preventing any possible disease before it gets bad.

Thanks,

Shop local, love your cats, watch ’70s Canadian sci-fi,

Brett Grossman, DVM
Medical District Veterinary Clinic

Keeping Pets Happy in the COVID Era

[dog playing outside]
It might be too soon to return to a crowded dog park.

We have now been living with COVID-19, the disease caused by the novel SARS-CoV-2 virus, for four months (officially) here in Illinois. Chicago and much of Illinois have moved into Phase 4 of the Restore Illinois response plan, and summer is in full swing.

It has been a strange and distressing time for us and for our pets.

My dog Emmie fits in perfectly with social distancing, due to her long-standing leash aggression and dislike of other dogs! (We’ve been working on those issues for a long time, but maybe not as seriously as we should have.) On the downside, the pandemic also means that we probably won’t be taking Emmie to any of her favorite spots, like the dog beach, for a while.

Current COVID Recommendations

Here are some current facts and recommendations from the American Veterinary Medical Association (AVMA) about COVID in cats and dogs. Remember, though, that there is still a lot we don’t know.

  • Routine testing of animals is not recommended by most regulating and professional groups, including the AVMA, the Centers for Disease Control and Prevention, and the USDA.
  • Testing can be done when an animal appears to be showing clinical signs and has had prolonged close contact with a person that is COVID positive or in a facility that is high-risk (nursing home, etc.).
  • There is no evidence that animals play a significant role in spreading COVID to people. This disease is overwhelmingly transmitted person-to-person, but it is always recommended to wash your hands after interacting with animals.
  • In rare instances, there is evidence that people can transmit COVD to animals, and in those cases, fever, lethargy, and respiratory signs have been noted. Most animals responded well to supportive care.
  • If you are positive for COVID, you should minimize contact with your pets as much as possible.

Consider Your Pet’s Stressors

While disease prevention and management for us and our pets is important, it’s also important to think about how the many changes in routine are affecting the lives of our pets. You might think having their owners working at home would be the best thing that ever happened to our pets, but that’s not necessarily the case. Here are some points to consider:

  • Even though most animals may be glad you’re home more, it’s still a major change in their routines, which can be very stressful. Try creating a new routine that gives your pet some time away from you. For example, take a walk or drive on your own or participate in a safe social distancing visit outside so your pets are still used to you being away at times.
  • Be sure that your pets have a space, even if small, that is their own. No one should be allowed to bother them when they are in that crate, on that certain dog bed, or in “their” room.
  • Try not to reinforce attention-seeking behaviors. Even negative attention is attention. Instead try to redirect and focus your pet on another activity if you need them out of your space while you’re working or if they are doing something, you’d rather they not do.

Play It Safe

Finally, how to we manage socialization with other dogs? The city of Chicago has not yet reopened their dog parks. Even after the parks reopen, we recommend minimizing their use as much as possible.

Lots of dogs present means more people around, which can make it harder to social distance. Although there is no evidence that COVID can be transmitted dog-to-dog or dog-to-person, the less contact with other family units the better.

Just a few weeks ago, I witnessed a dog fight in a local park where dogs were off leash playing. Luckily, no animal or person was significantly injured, but the owners had to physically separate the dogs, which meant close contact—and they were not all wearing masks when this happened, because it happened so suddenly.

I get it, though. Some dogs need the socialization, and at some point, our pets and our own mental health are important to consider. Some dogs would go bonkers without a good play session.

If possible, try to find a small group of dogs and people that you know and stick to a private area, like a friend’s backyard. But if you must go to a public area, try to go at non-peak hours, wear a mask that covers your mouth and nose, social distance, carry hand sanitizer with you, and be sure to wash your hands after interacting with your pets.

Stay safe everyone!

-Dr. Alyssa Kritzman

Could COVID Worries Be Bothering Your Pet?

Care for Yourself So You Can Care for Your Pet

Like many of you, I never expected to experience the pandemic we are currently facing. Social distancing, quarantine, virtual gatherings, and isolation have become part of our daily lives due to COVID-19.

Adjusting to this new normal has been challenging for many people. Pets can often sense an owner’s stress and anxiety, which in turn the pets can absorb. Signs of stress in pets can be very subtle, and these behaviors can mimic pets’ normal behavior, so identifying stress can be difficult for owners.

Indicators of stress in dogs include pacing and shaking, whining and barking, trembling, changes in eyes and ears, shedding, panting, changes in bodily functions, hiding, and acting more withdrawn. While cats can exhibit the signs above, they also commonly overgroom (which can lead to sores on the skin) and fail to use the litter box. Cats in particular, are prone to developing urinary symptoms when they are stressed, so it is important that owners keep a close eye on their cat’s litter box habits. It is clear that our mental health impacts our pets, which is one more reason to be mindful of self-care.

Self-care Strategies

In honor of Mental Health Month, here are some strategies to help deal with COVID-related stress:

  • Separate what is in your control from what is not. Focus on the things you can do, such as washing your hands, drinking water, and limiting your news consumption (including social media).
  • Get outside in nature; fresh air and exercise is beneficial for not only mental health but physical health.
  • Challenge yourself to stay in the present. When you find yourself worrying about something that hasn’t happened, gently bring yourself back to the present moment. Try to focus on the positive things happening in your life.
  • Stay connected to the people in your life. Reach out to trusted friends and family members when you need support.
  • Use meditation and relaxation exercises to promote a sense of calm.
  • Eat healthy, well-balanced meals, exercise regularly, and get plenty of sleep.

Enjoy Time with Pets

While many people have transitioned to working from home, pets are enjoying the extra time they get to spend with their owners. You can still enjoy the outdoors with your pets in a safe way by finding quieter and less populated areas. The time outdoors and exercise helps reduce stress and anxiety and is also an opportunity for your dog to have fun and burn off some of their energy.

For your cats, you can find new ways to play with them at home. There are many different types of cat toys available (online shopping is a great way to find some exciting new toys), or you can find some items around the house for the cat to play with. It’s incredible how something as simple as a cotton ball or piece of paper can keep them entertained for hours. This is also a good way to bond with your cat, which is beneficial for mental health.

By taking care of yourself, you will be better able to care for others, including your pets. Although these are uncertain times, we’re in this together!

Amber Slaughter, DVM

Reduced Service: Seeing Sick Patients Only

The situation is very fluid. Please check this post or our Facebook page for updates.

Last updated March 17.

With recent developments in COVID-19, Medical District Veterinary Clinic is implementing reduced service in order to keep our staff, clients, and community safe. (Remember, your pets are not at risk from COVID-19, but having people bringing their pets to a public place increases the risks for people.)

We will continue to see SICK patients only; wellness and routine procedures will be postponed.

If your pet is due for a crucial vaccine, such as rabies, and your pet goes to daycare or boarding, please contact us to find out if an exception can be made.
If you have a fever, cough, sore throat, or possible exposure to COVID-19, please do not come to the clinic. Arrange for someone else to bring your sick pet to see us.
Stay safe! We all need to work together—but at least 6 feet apart—to implement these public health measures.

Thank you for your understanding and cooperation! We have the best clients in Chicago! ♥