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Feature, General

Tracheal stents – a management option for tracheal collapse

By admin On May 4, 2012 - Comments

Tracheal (windpipe) collapse is characterised by the dorsoventral (top to bottom) flattening of the tracheal rings with a laxity of the dorsal tracheal membrane. It is thought there is an intrinsic weakness of the tracheal rings, resulting from a reduction in glycoprotein and glycosaminoglycan content of the hyaline cartilage of the tracheal rings. There is a reduced capacity of the cartilage to retain water and this consequently diminishes the rigidity of the rings. The syndrome causes dogs to cough with varying degrees of breathing difficulty. Clinical signs of this condition can be seen in young adults through to older toy or miniature breeds, with the Yorkshire Terrier the commonest breed seen with this problem. Any section of the trachea can collapse, a common region being the thoracic inlet, where the neck meets the thorax (chest). Once signs of coughing have developed, the syndrome of tracheal collapse is perpetuated by the cycle of chronic inflammation of the tracheal mucosa (lining).

Treatment should always start with medical therapies used singularly or in combination, such as the use of anti-inflammatories, anti-tussive (cough suppressants), short courses of antibiotics or bronchodilators. Patients should always be exercised using a harness and dogs carrying excess weight should be encouraged to reduce their body condition. For the majority of dogs the medical management alone is enough to control their clinical signs. However, tracheal collapse is a progressive condition and for some dogs their breathing difficulty is severe and quality of life poor even with all the medical treatments on board.

Is there any other option of management?

YES – for those dogs that have exhausted medical managements, at Northwest Surgeons we have the ‘know-how’ and technology to place self expanding tracheal stents. The stents are made of nickel and titanium and are delivered by a thin catheter system directly into the trachea using fluoroscopy (real-time x-ray imaging). Measurements are taken prior to stent placement to determine the tracheal lumen size and length of collapse. The stents are made by Infinti Medical in the US and are shipped to Northwest Surgeons within a week. So, no surgery required, very short anaesthesia time and often home the same day.

A stent immediately restores an open lumen to the collapsed section of the trachea. The patient can breath easily. Some patients will still have a cough as there are irreversible changes within the tracheal lining and some do require more long term medications to reduce inflammation. However, most patients with stents placed can partake again in the day to day activities they have not be able to do for years and can cope with situations that stimulate excitement without the constant worry to owners of a life threatening respiratory crisis.

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Feature

Pushing the boundaries of science

By admin On April 12, 2012 - Comments

Presentation of an abstract gives authors of scientific research the opportunity to present their findings to the scientific community. At Northwest Surgeons we are actively involved in research in order to advance our knowledge in all of the areas in which we specialise.

At this week’s meeting of the British Veterinary Orthopaedic Association one of our interns Tom Dutton presented his work investigating the use of local anaesthetics in dogs. The study was well received by the highly respected audience and Tom was commended by many specialists for producing a sound scientific study.

The study documented the use of local anaesthetic injected into the elbow joint prior to arthroscopic surgery. Arthroscopy is a minimally invasive procedure which involves using a camera to examine the inside of the joint whilst the dog is under anaesthesia. Like any type of surgery the procedure produces a degree of pain. The outcome of the study showed that by injecting local anaesthetic into the joint before surgery starts, we can minimise the pain to the dog.

Every year at Northwest Surgeons we carry out well over 100 arthroscopic procedures, mostly for the investigating of elbow lameness in dogs, so we are very keen to make sure we do our very best to minimise any pain or discomfort this may cause to the animal. We can do this thanks to our combination of specialists in orthopaedics and anaesthesia as well as round the clock care provided by our on site vets.

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General

Veterinary Nursing in focus

By admin On March 26, 2012 - Comments

A common comment when I explain to people that I am a Qualified Registered Veterinary Nurse (RVN), is, “that’s amazing”, and then I listen to the perception that I play with puppies and kittens for the majority of my working day!  I would love to say an element of that is true however there is much more involvement in my daily role as a RVN.  It is very common for clients to know how long the Veterinary Surgeons’ training is.  It is however uncommon for clients to understand the content and length of the Veterinary Nursing qualification including our options for further qualifications.

The Veterinary Nursing qualification currently involves two years of difficult studying with practical examinations, oral examinations and written examinations to qualify as a RVN.  It is then common for newly qualified nurses to work alongside the Veterinary Surgeon normally in first opinion veterinary practices to gain experience and become more confident as a newly qualified nurse.

Another option that Veterinary Nurses can undertake is specialising in certain subject areas such as Medical Nursing, Radiography or Anaesthesia.  The nurse would have to ideally work alongside specialist Veterinary Surgeons and partake in research and submit case reports to the Royal College of Veterinary Surgeons (RCVS) to obtain the Higher Education Clinical Veterinary Nursing and Advanced Veterinary Nursing Diploma.

This involves two and a half years of intensive study, submitting case studies, oral examinations, practical examinations, written examinations and a final written dissertation with an additional examination.  This qualification is recommended and recognised by the RCVS and results in the Veterinary Nurse achieving a specialist qualification.  It is considered by the RCVS the highest clinical nursing qualification available to Veterinary Nurses at this current time and is a great achievement to gain.

In the past Veterinary Nurses were never accountable for their actions or negligence if such occurred – this always fell with the Veterinary Surgeon. However recent improvements to the Veterinary Nursing profession has included Veterinary Nurses having their very own governing body and as a result RVN’s are now accountable for their actions, similar to that of Veterinary Surgeons.  An addition to the title Veterinary Nurse has been established and newly qualified nurses are now titled Registered Veterinary Nurse (RVN) and must perform continuing professional development (CPD) regularly to remain on the RVN register which is monitored by the RCVS.

There are a wide range of CPD courses for RVNs to keep up to date and learn new techniques from anaesthesia to surgical nursing and oncology to dermatology so you can rest assured we never stop learning!

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General

Airway obstruction, can surgery help?

By admin On March 8, 2012 - Comments

Bulldogs and Pugs are two brachycephalic (short nosed) breeds that unfortunately suffer with breathing problems due to excessive soft tissue in their mouths and a narrowing of various components of their airways. Bulldogs and Pugs are usually very friendly in nature and are lovely to have as pets but they are often unable to engage in  normal family activities due to the compromise of their upper airways. Exertion, particularly in hot weather can result in extreme difficulty in breathing ( dyspnoea) and collapse.

The usual problem areas are :

The nasal apertures (openings)  are often stenotic ( narrowed). So the patient’s initial ability to draw air into the nostrils is reduced. Currently in the soft tissue surgery department at Northwest Surgeons, we would advise that a lateral wedge resection is performed to widen the nasal apertures. A triangular wedge is removed from the side of the each nostril. The wound bed created is sutured to create a wider opening. The sutures placed are small, soft and dissolvable.

The soft palate is often over long and dangles over the top of the epiglottis and into the airway, obstructing airflow. The soft palate is a muscular structure that should contract and shorten, allowing the epiglottis to flip upwards and protect the opening of the airway (glottis). Surgery is advised to shorten an overlong soft palate so that the ‘new’ edge is level with the back end of the tonsils. At Northwest Surgeons we perform a staged cutting of the excess soft palate tissue and meticulously over sow the cut edge using a dissolvable suture material.

The laryngeal saccules are two fleshy balloons of airway lining near the vocal chords that evert and obstruct the opening of the airway (glottis) if there is excessive friction in air movement. In the brachycephalic breeds there is often a lot of constant airway friction, a high pressure gradient as the patient tries to draw the air past the larynx into the windpipe. The saccules can spend most of their time everted and swell with oedema (fluid), which for some individuals means that the aperture of their airway is reduced in size by 50%. We would recommend that the everted saccules are removed surgically.

Hypoplasia of the trachea is yet another additional condition that can hamper the breathing efforts, particularly in bulldogs. This is a congenital condition and is characterized by a significant narrowing along the entire length of the trachea. This causes yet more resistance to airflow when the dogs breathe in and out. This condition cannot be corrected surgically.

Recovery from airway surgery is a time for vigilance and careful preparation by our specialist in anaesthesia, Matthew Gurney. Our patients have a smooth transition from the endotracheal tube delivering oxygen to a laryngeal mask. This enables oxygen delivery for a longer period during recovery and can be safely removed as the patient becomes more conscious. Surgery to the upper airway, not matter how meticulous can cause localised swelling which could lead to temporary airway obstruction . It is therefore vital that provision is always made for an emergency tracheostomy, though it is very rarely required. Airway patients at Northwest Surgeons, always stay hospitalised the night of the surgery so that they can be regularly monitored and the surgeon is on hand should a problem arise.

What happens if patients do not have surgical correction of the above problem areas?

The constant increased respiratory effort and low airway pressures may cause the laryngeal ( voice box) cartilages to tire and lose their rigidity. The cartilages become floppy and scroll inwards, the patient can develop a progressive collapse of their larynx.

At Northwest Surgeons we feel that the vast majority of our brachycephalic patients do benefit from  corrective surgical procedures. They will always have excessive upper airway noise despite surgery but we hope  that the removal of some of the obstructive  tissues enables these lovely pets to enjoy  a more full and active life style.

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Feature, General

My cat cannot wee!

By admin On February 24, 2012 - Comments

Does your cat sit on the litter tray for ages but not actually pass any urine?

Does your cat make frequent trips to the litter tray but only pass a small amount?

Does your cat vocalise whilst urinating?

Does your cat have blood in its urine?

If your cat is showing any of these signs then he or she may be struggling to urinate.

This can be a life threatening situation and veterinary attention should always be sought. The main reason for an inability to urinate normally is a blocked or partially blocked urethra – the tube that links the bladder to the outside. Cats with complete urethral blockage require urgent treatment to relieve the blockage – this is one of the big feline emergencies to be aware of as a cat owner.

For more information on medical management of feline lower urinary tract disease (FLUTD) click here to link to the next blog.

Despite medical management some cats still form enough crystals to make a ‘plug/stone’ which blocks the urethra, causing ongoing misery to the cat in their attempts to pass urine. For those cats with stones stuck in their urethra, further investigation and possibly surgery is necessary.

Often under sedation the lodged stone can be dislodged back into the bladder with flushing via a catheter which is inserted into the urethra. Sometimes the catheter is left in place for a few days for the urethral inflammation to settle. In the meantime the urine is analysed to see if there is infection and /or crystals present.

The dislodged stone that is now back in the bladder may be dissolved slowly with the use of the correct prescription die. Not all cats require a cystostomy (surgical opening of the bladder) to remove the offending stones but in some cases this is essential. For any stones that cannot be dislodged from the urethra or in cats with frequent reoccurrence of obstruction, surgery is required.

A perineal urethrostomy (removal of the penis and part of the urethra) would be the procedure of choice for obstructive episodes affecting the penile urethra. The aim of this surgery is to remove the penile urethra, which is a very narrow tube in order to prevent any stones becoming lodged and to make a new opening for urine to pass through. A new aperture, a much wider opening to the urethra is created surgically.This allows any debris/crystals/stones to pass without obstructing the urethra and also enables a good flow of urine to be voided.The patients do not require indwelling urethral catheters following surgery and they do not experience urinary incontinence. A perineal urethrostomy can be an extremely successful procedure, giving a large number of cats long lasting relief from their obstructed urethra.

 

Important points in the treatment of FLUTD

  • Observe your cats urination
  • Feed the correct prescription diet
  • Promote water intake
  • Administer GAG supplements
  • Reduce stress

Remember if you see your cat struggling to urinate then seek veterinary attention immediately.

 

 

 

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General

My cat still can’t wee! (part 2!)

By admin On February 24, 2012 - Comments

FLUTD (Feline lower urinary tract disease) is a common problem which can cause distress and misery in cats if not treated correctly. For the first blog on this theme, click here.

Uroliths (crystals) can be found in any age of cat. It is more common with overweight male neutered cats that are kept indoors but can occur in females too. Some cats such as Burmese, Himalayan and Persian breeds can be very prone to having uroliths. The common forms of crystals found in the bladder are struvite and calcium oxalate.

The majority of cats can be controlled on a special diet and medication to help prevent crystal formation in the bladder. The diets available are specially formulated and designed to produce moderately acidic urine, control the content of minerals in the urine and increase the amount or urine produced. These foods are available in a wet and dry form.

There are also medications available called (GAG) supplements (Glycosaminoglycan) which aim to restore the protective mucosal layer (thin layer of mucus) within the bladder wall. Cats with FLUTD can often have chronic cystitis and haematuria (blood in the urine) which can lead to the breakdown of the bladder’s mucosal barrier resulting in inflammation, dysuria (difficulty urinating) and increased permeability of the bladder lining. GAG supplements can be very useful and of huge benefit to cats with FLUTD and are part of the long term management of FLUTD.

Stress can also be an important factor and can influence the recurrence of FLUTD signs in cats so should also be considered when treating FLUTD.

Cats don’t like:

  • Overcrowding
  • Changes in diet
  • Changes in environment
  • Changes in weather
  • Owner stress
  • Introduction of new pets or people.

All these points should be considered when treating a cat with FLUTD. Certain points to remember are:

  • Provide a secluded place for the litter tray
  • Place litter trays away from feeding areas
  • Provide extra litter trays with different types of litter
  • Ensure the litter trays are cleaned regularly
  • Provide escape/hiding zones around the house so the cats can get away from other cats or people
  • Provide play time and owner interaction time
  • Use pheromone sprays

For cats with FLUTD it is important to promote water intake. This can be difficult with cats especially if they go outside a lot as it can be hard to observe their drinking habits.

Some other things to try to promote and encourage drinking are:

  • Cat water fountains
  • Prawn water/stock
  • Ice cubes with fish in etc
  • Water bowls with a wide diameter as cats don’t like getting their whiskers wet!
  • Extra bowls of water around the house

 

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Feature, General

Choosing an insurance policy

By admin On February 7, 2012 - Comments

Of the cases we see at Northwest Surgeons, 95% of these are insured for veterinary fees. Like everything in life, you get what you pay for. Even the insurance companies say this! So how do you know which insurance policy to choose for your dog or cat?

NEWSFLASH

Lloyds TSB and Halifax have pulled out of the pet insurance market. This has left many consumers stranded. If your pet has an on going condition covered which has already been subject to an insurance claim you probably will not be able to get cover for this on a new policy. 

The best insurance policies will of course be more expensive, but choosing a cheaper policy could leave you with inadequate cover or no cover at all. So where do you start?

The question how much can you afford can be viewed many ways! Firstly, work out how much can you afford per month for an insurance policy. Then check the policy limit. Consider what happens if you reach the limit on your insurance policy. Many people don’t realise that there may be a gap between what the insurance will pay out and the vet bill, and because there is no NHS for pets it will be you left to pick up this amount.

How much cover do you need?

Insurance policy limits vary from £500 to £12000. The days of limitless policies are gone.

Bills for specialist veterinary treatment can be somewhere between £2000-5000 so this gives you an idea of where to start, but bear in mind that certain conditions can be more than this.

In recent years there has been an increase in cheaper insurance policies and of course, at the same time veterinary fees are increasing. In many cases this is leaving a bigger gap between what the insurance covers and what the client has to pay. If your cover limit is £2000 and your vet bill is £4500 you need to find £2500 out of your own pocket.

What is an excess?

Most policies will have an excess. This is an amount, usually around £70-£100 which you have to pay yourself when you make a claim – so really it is not worth claiming on your insurance unless the bill is over this amount. The older the pet, the higher the excess will be. Some policies also require that you pay a percentage of the claim, usually 10-20%, although this is more common with older animals. Beware on a £3000 bill this will be £300.

How long will the insurance pay out for a condition?

Dogs and cats diagnosed with diabetes will need lifelong insulin treatment, to pick an example. The cheaper policies will only pay out for a year, so if you need the reassurance of lifelong cover make sure you get the right policy. Don’t make the mistake of picking the cheapest online policy. Phone the company and discuss your needs to make sure you fully understand what you are buying. And read the small print.

What is pre-authorisation?

Many private medical insurers insist on pre-authorising claims. This is a slick process whereby you are assured that your insurance will pay for your private healthcare. Some pet insurers request pre-authorisation for certain claims but the process is rarely a well-oiled one and can delay your pet’s treatment. It is not uncommon for our clients to have to wait several hours for this. Check when you buy a policy whether the company ask for pre-authorisations.

What not to do!

Cancel your policy – all of us have seen clients who, having never claimed on their policy decided to cancel it, only for the worse to happen and the pet become ill. Only do this if you can afford to pick up any subsequent bills!

How we can help you

If you are referred to Northwest Surgeons for specialist treatment, for certain insurance companies we will process the claim for you and the insurance company will pay us direct (known as a direct claim). This saves you having to pay us first and then claim back the money yourself. We do not do this for all companies because some have poor reputations for paying claims. (Although we would like to tell you which companies to avoid this is not particularly professional!) We have a dedicated Claims Manager to process claims and communicate with the insurers which is why we levy a small fee for doing so. You must provide us with your certificate of insurance and sign a direct claim agreement which allows us to act on your behalf to make the claim.

So think carefully when buying pet insurance and check exactly what you are paying for and what is not covered. If in doubt, ask your vet.

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Feature

Dogs give blood too!

By admin On January 31, 2012 - Comments

**Next donation day Sunday 21st April – to register contact Pet Blood Bank.

Did you know that just like the NHS we perform blood transfusions in veterinary medicine?  Blood transfusions for dogs and cats are common practice here at NWS for our sick patients requiring blood.

We are able to source the blood we need from two places – calling upon staff pets or from the Pet Blood Bank (PBB). Dogs have two main blood types – negative and positive. We keep a stock of both types of canine blood in at NWS ready for emergencies, but just like the NHS our supplies can run out, meaning we do not have blood readily available for our critical cases. Click here for our blog on cat blood donation. We made the decision to help out by hosting our own blood collecting session with the Pet Blood Bank, to ensure there is always blood available should your dog require it.

Firstly we had to find some volunteer donors – the dogs must be between 1 & 8 years old, have never been abroad, on no medication and in good health, be fully vaccinated and be over 25kg body weight. The first session was held on Sunday January 8th 2012 and we had 18 dogs come along to donate. So how did the session run? Click here to see our photos!

On arrival at NWS each dog was weighed to ensure they were over the required 25kg. Each dog first had a full clinical examination by one of the Pet Blood Bank’s vets; this also included a blood test to ensure they were able to donate. The PBB also send away a blood sample once a year for a full analysis to ensure donors are healthy, and to potentially pick up any changes. Two small patches were clipped from each dog’s neck – one for the blood test and one for the donation. They also checked the donor’s microchip – all donations are linked to the dog’s microchip number. Any dog wanting to donate needs to be microchipped and the PBB with do this free of charge at the time of donation.

Once the donors had passed through the pre-donation check, they were then taken through to the donation room. They were then lifted up on to a table with a padded mattress and laid on their left side.   Here a fully qualified phlebotomist collected about 450ml of blood. The actual donation took between 5-10 minutes.  The needle was then removed from the vein and a dressing was applied to the site of venipuncture to help reduce the risk of bruising.

After donation every dog was encouraged to stay at NWS for a short while to have a drink, lots of treats and fuss and to be observed by the PBB staff. Each dog received a Goodie Bag which included an “I’m a Lifesaver” Bandana and Tag to thank them. Owners received a call from one of the PBB staff within a few days of their dog donating and paperwork relating to the donation was sent to them and their veterinary practice.

All of the 18 dogs that attended were first time donors and of the 18, 7 dogs successfully went through to donation. Each donation will go to help save the life of up to 4 dogs!

Dogs that didn’t donate this time were a little anxious about the clippers needed to clip away the fur.  For these dogs we used this session as training for them, the PBB are happy to do lots of training with donors to ensure they are happy to donate – the PBB will not muzzle or sedate dogs

Want to help other dogs? Register now with Pet Blood Bank!

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Feature

Laryngeal Paralysis in dogs

By admin On January 9, 2012 - Comments

What is Laryngeal Paralysis?

For most older dogs, Laryngeal Paralysis (LP) occurs due to an aging process of the nerves that supply the laryngeal muscles and cartilages. The larynx (voice box) is the first part of the upper airway and is made up of 5 cartilages. The epiglottis cartilage flips upwards and protects the entrance of the airway (the glottis) during swallowing and the paired arytenoid cartilages function to open and close like a pair of curtains as the patient breathes in and out. If the arytenoid cartilages are paralysed or partially paralysed, they will hang in the entrance of the airway (the glottis) and obstruct airflow. The patients develop a raspy breathing noise and over time, usually months they become less able to cope with exercise. Any slight exertion or excitement can potentially leave these dogs in a very compromised state, they struggle to breathe, it can be a life threatening situation.

Who is affected?

Laryngeal Paralysis of the older dog can occur in any breed but at Northwest Surgeons, we tend to see this condition mostly in large breed dogs. The most common breeds to present are Labradors and Golden Retrievers but we have seen the Greyhound, Rhodhesian Ridgeback, Hungarian Visla, Leonberger and a Bouvier de Flanders breeds during the past year.

What should we look for?

A gradual onset of noisy breathing, not coping with exercise , having to excessively pant, tongue and gums turning a purple colour (cyanosis)  during periods of stress, throat clearing and the pitch of the bark may also alter with time.

How do we confirm the diagnosis?

Laryngeal function cannot be assessed in the conscious patient, so we have to try and view the larynx moving at a point which most represents its function in real life. We do this by viewing the larynx moving as the patient is given a small amount of intravenous anaesthetic, just enough to slacken the jaw tone but to minimally affect the patients attempts to move their arytenoid cartilages. At Northwest Surgeons we usually record these images to demonstrate to the patient’s owners the degree of LP.

How do we treat Laryngeal Paralysis?

A non surgical / conservative approach can be taken for those patients who may have a number of medical conditions, are too debilitated to undergo anaesthesia or where finance precludes a surgical treatment. We would normally advise that these dogs use a harness for exercise restraint and are only walked in cooler weather. It is worth considering the purchase of a mobile air conditioning unit, so that one area of the house can be made very cool on humid and hot days – we find this is a very useful aid to cool and reduce the stress that hot weather can cause to patients with LP. Medications such as anti-inflammatories can be useful to reduce the inflammation that surrounds the larynx.

The aims of surgery

  • Increase the size of the aperture leading into the airway (the glottis) allowing easier breathing
  • Preserve airway protection

 The larynx is approached surgically from the left side of the neck. Careful dissection between the muscles of the neck and larynx gives access to the paralysed left arytenoid cartilage. This cartilage is then carefully mobilised from the surrounding chassis of the larynx and re positioned so that it sits to one side – it has been ‘tied-back’ (lateralised). This cartilage is secured into its new position by two small but very strong sutures that do not dissolve.

Following surgery, owners are advised to make sure their dog eats slowly by hand feeding or incrementally feeding small amounts at any one time. This limits the patients bolting their food, coughing during eating and hence reduces the risk of sucking back food particles into the airway. Aspiration pneumonia is an uncommon complication for LP surgery providing the feeding protocol is adhered too for at least 4 weeks post surgery.

Future advances in the treatment of laryngeal paralysis include the use of lasers to partially ablate one side of the paralysed cartilage and the use of stents to fortify the weakened cartilage of the larynx.

Laryngeal paralysis in the older dog is a common condition that we see at Northwest Surgeons. For most patients, surgical intervention results in a significant improvement in their ability to breathe. These older patients can then resume the activities they enjoy without the constant concern of an ensuing respiratory crisis.

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General

My puppy has a heart murmur – should I worry?

By admin On December 21, 2011 - Comments

All of us would be worried if we are told at the first vaccinations that our puppy has a murmur. A murmur could represent a serious congenital heart defect – (congenital means a defect the puppy is born with).  The chances depend on the breed of the pup and the loudness of the murmur.  To put things into perspective, the incidence of congenital heart disease is about 7 cases per 1000 puppies, so the chances that your puppy is affected are slim.

 A murmur represents turbulent blood flow through the heart.  This is usually the result of high velocity flow caused by either blood flowing through a narrowing under pressure or the leakage of one of the main valves within the heart.  Murmurs are scored out of 6 with 1 being the quietest, audible after listening carefully for a few minutes in a quiet room.  Grade 6 murmurs are audible with the stethoscope lifted off the chest!

 Almost all puppies with congenital heart disease have a murmur and the louder the murmur, the more serious the problem.  If we can feel a vibration or “thrill”, on the side of the chest wall representing grade 5 or 6, then there is likely to be significant disease and further investigation is needed. 

 Some murmurs have a characteristic sound and the majority occur when the heart is contracting, during systole. If the murmur is continuous, then the likely diagnosis is a congenital heart defect called patent ductus arteriosus (PDA). This is one of the three most common congenital heart defects in dogs.  The other two involve narrowing or “stenosis” at the base of the main aorta (from the left ventricle) or pulmonary artery (from the right ventricle).

 Indecision often exists about the significance of a murmur at a young age because we also see innocent flow murmurs in puppies.  These are murmurs that have no underlying disease and get quieter as the puppy grows.  They have often disappeared by maturity.

 Unfortunately, some breeds that are prone to congenital heart diseases such as the Boxer also commonly have innocent flow murmurs as puppies.  Innocent flow murmurs are usually quieter and have soft blowing character.  Indeed about 50% of all boxer puppies have detectable murmurs.  This does not mean that they will need treatment for heart disease as many are innocent flow murmurs or mild sub-aortic stenosis.  The significance may also depend on the future of the dog.  Mild sub-aortic stenosis that would not affect a pet would be catastrophic for the breeding potential of a dog.  Unfortunately it is usually impossible to differentiate between an innocent flow murmur and mild to moderate sub-aortic stenosis without further investigations, such as echocardiography (heart scan).

 If the murmur persists and further evaluation is required, a non-invasive technique using ultrasound can confirm the diagnosis and give guidelines regarding severity.  This can usually be performed with the puppy lying on its side being gently restrained.  Sedation is rarely required although we usually have to shave a small patch of fur behind the elbow on the chest wall.

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