#health tests

[themiscyradobermans]

Myxomatous Mitral Valve Disease vs Dilated Cardiomyopathy (Part 1)

Hope you are ready to do some learning today! I didn't want to bog down Nadia's post too much so I figured I'd do something a little more in depth, separately. I also hope that the information here might help anyone seeking information about either disease. Might want to go and make yourself a drink and/or a snack because this will be a long read.

What is MMVD? Myxomatous Mitral Valve Disease also called Degenerative Mitral Valve Disease is the most common cardiac disease affecting dogs. It is an acquired disease (aka "adult onset") that is most typically seen in small breed geriatric dogs. It is characterized by a progressive thickening of the Mitral valve, which is the valve on the left side of the heart - in other words, the valve that connects the left ventricle (LV) to the Left Atrium (LA). The thickening results in it becoming more rigid and overtime it loses the ability to close properly, causing a leak (or regurgitation) from the left ventricle to the left atrium. Over time, the valve has a tendency to become so fibrinous that the leak becomes more important with time, and for some dogs with very advanced MMVD the valve may not even really close much at all anymore.

Because of the leak, over time the left ventricle and the left atrium will enlarge. When the left atrium becomes severely enlarged the patient will progress to congestive heart failure. Because of the stiffening of the valve the chordae tendineae that hold it together are also at risk of rupturing as the disease progresses. When a dog ruptures a major chord, they are at risk of an acute episode of CHF without dilation of the left atrium (because the left atrium does not have a chance to adjust or adapt to the sudden backflow) and patients in this situation will often require critical hospitalization care for 24-48 hours before normalizing. In some very uncommon or rare cases the disease can be self limiting. We have seen it in one or two patients where the dog actually improved after being in B2, with the heart reducing in size because the mitral valve thickened so much it started plugging the leak again. What causes MMVD? It is unknown what exactly causes this process. In certain breeds there is a very strong genetic, hereditary and familial component like in Cavalier King Charles Spaniels, Dachshunds, Cocker Spaniels, Yorkies, Pomeranians and others. It mostly affects small breeds, but any dog breed can get MMVD. How is it diagnosed? MMVD can only truly be diagnosed exclusively via cardiac ultrasound (echocardiography) by a cardiologist. It can be listed as a differential with the help of other diagnostic tools like x-ray, auscultation (presence of a heart murmur on the left side), age/breed of the patient and clinical symptoms (late stages). There are other diagnostic, clinical tests but they are non-specific blood tests that can merely serve to further refer out to a Cardiologist. Can you treat it? Yes. The primary treatment for MMVD will be the administration of Pimobendan once the disease progresses to moderate stage MMVD classified as ACVIM B2. Because it is so prevalent in dogs there is empirical data on it, and one in particular the groundbreaking EPIC study has helped establish very specific guidelines for the classification of Moderate Stage MMVD and the early (pre-clinical) administration of pimobendan. In order to be classified as B2 and qualify for early administration of pimobendan the dog must meet 4 criteria:

Grade III heart murmur or higher

Left Atrium/Aortic (LA/Ao) ratio of 1.6 or higher

Left Ventricle Internal Diameter in Diastole Normalized for weight (LVIDDN) of 1.7 or higher

VHS (Vertebral Heart Score) of 10.5 or higher on xray

Where an echo is not possible, in order to qualify for pimobendan, it is recommended to wait until the the VHS is equal to 11.5 or higher. What is miraculous about the EPIC study is that it offers proof that administering Pimobendan to a dog in B2/moderate MMVD will slow down significantly the progression of the disease. The median time it takes for a B2 moderate MMVD to progress to a Stage C heart failure is 766 days without the administration of Pimobendan. With pimobendan that median increases by 60% 1228 days. Once a dog reaches CHF typically the prognosis is 6-12 months post diagnosis of CHF. With pimobendan it adds about 10% overall time without clinical signs or quality of life issues. Some Cardiologists will also prescribe an ACE Inhibitor (Angiotensin-converting-enzyme inhibitors) alongside Pimobendan even while still in Moderate/B2 stage, while others will prescribe it rather only once the dog progresses to a Stage C (aka severe stage with congestive heart failure). Once the dog reaches Stage C, typically a diuretic will be added to the treatment. Management can include adjusting dosage of the medication and on occasion adding in additional diuretics, or if exhibiting new cardiac symptoms, adding additional medication. For example in large breed dogs you can see Atrial fibrillation, and in some individuals you'll also see Ventricular Premature Contractions (VPCs or PVCs which doberman people will be familiar with due to its role in DCM) so medications can be added to control these aspects too. Now what is interesting with MMVD is that there are currently two surgical procedures/interventions with very limited availability. One is an open heart surgery that is curative and consists in repairing the Mitral Valve. There is the JASMINE Animal Referral Hospital in Japan where the procedure was developed by Dr Uechi Masami, who has then gone on to train teams in the UK at the Queen Mother Hospital Royal Veterinary College as well as a team in France at HOPIA. Currently Dr Uechi is performing mitral valve repair procedures at the University of Florida in the USA, with the goal to try and train as many teams in the USA and around the world. The likelihood of this surgery ever becoming widespread or common place or even accessible to most people is fairly low, given the high demand, and how resource intensive it is both in equipment and specialized teams. The other very recent intervention is the TEER mitral valve repair, a minimally invasive procedure that consists in installing a clamp on the mitral valve to bring it back closer together and thus reduce or eliminate the leak. Can I do anything to prevent it? While there's nothing you can do to prevent MMVD from occurring, if you intend to purchase a puppy from a small breed or medium breed, especially one of the breeds known to have high prevalence of the disease, it is imperative to ask the breeder if the parents have been screened and are being monitored for cardiac disease by a cardiologist, whether that's with a yearly auscultation or a yearly echocardiogram (because MMVD is always associated with a murmur, for regular owner it is acceptable to auscultate yearly, and only do an echo if/once a murmur is heard). Ask about the pedigree also. I strongly encourage you to start screening/monitoring for it when your dog reaches 4-5 years for at risk breeds. Breeding animals should be screened before being bred and then yearly thereafter. If you are unsure whether your breed is considered at risk, you can check the recommended tests for your breed on the OFA website. If you adopt a pup from a rescue or shelter with an unknown genetic background, I would strongly encourage you to ask your vet to properly auscultate during your yearly vet visits and physical exams, and I would request a referral to a cardiologist (if required in your area, our cardiology department doesn't per se require a referral anyone can call and book) even if your dog only has a Grade I-II murmur.

[nancykhemchandani]

Stay Healthy This Monsoon: The Importance of Health Checkups

Discover how regular health checkups and maintaining a healthy lifestyle can protect you from monsoon-related illnesses. 

[facts1590]

Stay Healthy This Monsoon: The Importance of Health Checkups

Discover how regular health checkups and maintaining a healthy lifestyle can protect you from monsoon-related illnesses. Learn tips to stay healthy .

[pangur-and-grim]

here are Belphie's x-rays from a couple weeks ago! I'm not a vet, so I don't know what to zero in on here, but they show a "dilated right sided heart with moderate amount of pericardial effusion".

in other words, the right side of his heart is too big, and there's fluid all around it. which is bad! we don't want fluid!

it's very possible that FIP has messed with his heart (and there is precedence of the virus doing this exact thing), which means that it should improve with more time on the medication. but it's also possible that this is an underlying structural problem. I'm hoping it's the former, because if it's the latter, he'll likely have a shortened lifespan.

the only way to find out is to let him recover from FIP, and then check all his insides again. and in the meantime, he'll be getting plenty of medically prescribed kisses to the forehead!

[kaijutegu]

Today I was talking with my mom about why seeing an alligator is fundamental to my mental health. At first she laughed but I got her to listen and she gets it now. My psychiatrist and I call this the alligator litmus test, and it works really well for making decisions about my treatment. I bring this up because perhaps there is something in your life that you can use in a similar fashion.

I have severe major depressive disorder, and I treat this depression with medication. I've been on meds for about... seven years now, and sometimes we have to mess with them. But sometimes the emotional part of the depression is just super bad and there's something underneath that needs to be addressed. When we are figuring this out, my psychiatrist says to take one alligator and call her in the morning.

See, no matter how bad I'm feeling, seeing an alligator almost always cheers me up in the moment. (This works with other large crocodilians, too- they gotta be big, it doesn't work with caimans. I don't know why.) I can't look at their goofy toofers and beautiful eyes and bumpy hides and not be a little wowed by them. Millions of years of evolution have led to this amazing creature and they are completely unbothered by me. Almost all of the time, they make me feel happy. Or maybe I'll feel sad for some unspecified reason. Maybe I'll get worried about the ecosystem or something- but invariably, I will FEEL.

Unless, of course, it's my brain chemistry. If I can experience an alligator and not feel anything- not happy, not sad, just numb- there's something wrong and we should talk about adjusting my meds. Usually with a little tweaking I'm back to my very functional medicated baseline in quick order- instead of wasting time with coping skills and such alone when what I really need is brain chemicals, it's a much quicker way to communicate what's going on with me. At the same time, it also helps me know when the coping skills ARE likely to work without changing up my meds, or when there's something I need to work through with some help.

It's a pretty solid test. Might not work for anyone else on the planet, but it works great for me!

[harmeet-saggi]

https://www.secondmedic.com/blogs/what-are-the-top-8-health-tests-you-should-consider-after-turning-40

[teachworkoutlove]

A List of 4 Crucial Health Tests to Get Before You Reach Your 50s

It’s only natural that we start worrying more about our health as we age. Yet, by attending regular health check-ups and screenings, you can identify any issues before they become more significant and more challenging to treat.   Attending regular health appointments improves your chances of remaining in optimal health even as you approach your golden years. There are many ways to maintain your…

[thebibliosphere]

I’m assuming my period skipped this month because two medical emergencies that put your body into crisis will do that to you but damned if the Christian trauma of the virgin birth doesn’t linger in the back of my head going “but what if…”

[puppetmaster13u]

Prompt 167

Honestly, Danny is having such a good time right now. He gets to travel with Ellie, explore space, just have fun. Plus his secondary protector-instincts are having soothed despite him not technically doing any hero-ing anymore. Really his sister had the right idea when she decided she wanted to become a doctor, this is honestly a blast.

And if someone does end up passing away, well, Ellie is always happy to help soothe their spirit and guide them to the Realms where they can reach their respective afterlife. Or become a ghost. 

They are completely oblivious to the fact that there are now legends and entire temples dedicated to them now. Apparently accidental ascension is in fact a thing, as Dan later laughs at them about. 

[acecroft]

DINA MEYER as Detective Allison Kerry in Saw III (2006)

[jackshiccup]

Omg, you bound a fanfic? Can we see the finished project? It must be beautiful!

hello hehe yes i did :) i was only going to show friends but i guess this is a good excuse to post pictures of it 🫶🏽

it’s my first ever hardcover bind so i was prepared to make a lot of silly little mistakes and this one definitely does, but i love how it turned out still, i think she’s so cute .. i’m also just happy to finish a personal project that took up so much time to make 🥹

anyways, enjoy the pics and most importantly: stream otnwas on ao3 and youtube teehee🤞🏽❄️!

[blueskittlesart]

hey has anyone tried to buy a covid test lately. because i just had to buy one for a friend at my local walgreens and the cashier very seriously asked me if i was sure i wanted it because. a 2-pack of tests currently costs $23.99. do we not think that it's a little insane that the only reliable diagnostic tool for a very much ongoing pandemic costs over $20 for a single package. what if I didn't have that kind of money to burn??? Especially if you're already facing potentially losing at least a weeks worth of pay if you DO test positive and can't work. How many people are going to see that price point and decide they can't justify the expense??? literally insane. remember that brief moment of sanity this country had when we all got these for free

[mindblowingscience]

The average glioblastoma patient survives 12-18 months after diagnosis. The crux of the diagnostic is a biochip that uses electrokinetic technology to detect biomarkers, or active Epidermal Growth Factor Receptors (EGFRs), which are overexpressed in certain cancers such as glioblastoma and found in extracellular vesicles. “Extracellular vesicles or exosomes are unique nanoparticles secreted by cells. They are big—10 to 50 times bigger than a molecule—and they have a weak charge. Our technology was specifically designed for these nanoparticles, using their features to our advantage,” says Hsueh-Chia Chang, a professor of chemical and biomolecular engineering at the University of Notre Dame and lead author of the study about the diagnostic published in Communications Biology.

Continue Reading.

[inniave]

US Americans, please visit the link below to write your representatives & urge them to push back against mask bans!

We all deserve to have the basic freedom to protect ourselves from airborne diseases. If the government won't protect us, we must protect ourselves.

[incognitopolls]

We ask your questions so you don’t have to! Submit your questions to have them posted anonymously as polls.

[choccy-milky]

Finally had time to catch up on the raven and the snake. I am just in awe of everything.

Also, I kinda like Clora hanging out with Garreth and Leander. (don't kill me 🤐)

aw thank you!!🥹💖💖im happy to hear it! and NO i wont kill you, you are so right. the garreth/leander/clora hangout was my fav part of the chapter and also the most fun part to write, and it gave me an appreciation for the leander and garreth dynamic, which is amazing

i now headcanon their relationship like brothers LMAO, garreth constantly badgering leander and getting on his nerves, while leander is just exasperated in dealing with him (BUT IN A FRIENDLY WAY) theyre like characters in a sitcom tbh BAHAHA (and to anyone wondering, im gonna TRY to have the next chap up within the first week of feb!🙏 ive just been busy with the dark relic comic + work + and now i feel a bit under the weather. ive been sleeping almost nonstop for the past 2 days LOL oop)