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SIERRA VISTA — Zack is one lucky little dog.
He’s lucky because he has owners like Jan and David Guy. Lucky because Pam Drake is his veterinarian. And he’s lucky because Jan has a best friend with a private plane, willing to fly a sick Yorkshire terrier to a heart specialist in San Marcos, Calif.
On May 9, Jan took Zack to see his veterinarian at New Frontier Animal Medical Center for what she thought was an upset stomach. But when his physical exam revealed an extremely slow heart rate — 40 beats per minute instead of the normal 80 to 120 for a dog his size — it immediately raised a red flag with Drake, who recommended more diagnostic tests.
 Veterinarian Pam Drake, left, looks over X-rays of Zack, a dog that has a pacemaker implanted in him to help regulate his heart. Zack is being held by his owner, Jan Guy. The pacemaker was implanted in San Diego. (Ed Honda-Herald/Review) |
“This brings up a good point in terms of why we do thorough exams on every patient that walks in the door, every time,” Drake said. “When Zack came here, he presented with a tummy upset. But after we saw the slow heart rate, we ran more tests that led me to believe he was suffering from third-degree heart block, which is a conduction disturbance.”
Heart block occurs when the top chambers of the heart, or the atria, receive an electrical charge but the impulse fails to reach the lower half of the heart, or ventricles, because of a blockage. While potentially fatal if left untreated, it’s a problem that can be corrected with a pacemaker.
After a daylong hospitalization at New Frontier, Zack seemed to have improved enough to go home. Drake went over some of her concerns with Jan and told her what kinds of things to watch for.
The Guys, who have 12 dogs — of which 11 are ones they’ve rescued — have tremendous experience in dealing with medical issues when they come up.
“I was pleased to see how good he looked and was glad to hear he could go home,” Jan recalled. “I thought he looked much more comfortable.”
But Zack’s improvement was short-lived.
Dog has ‘medical crisis’
The next morning the 7-pound Yorkshire wasn’t doing well. Jan called it “a medical crisis.”
“His heart rate had dropped to 36 and his temperature was down to 97, when 101 is normal,” Jan said, recounting that morning. “His tongue and gums were a dusky blue color and his breathing was very labored, what I call bellows breathing.”
It was obvious Zack was dying.
Jan and David swooped him up and raced to New Frontier, where an animal health technician placed the struggling dog on oxygen. The hospital’s two veterinarians were away that day, so the technician called an emergency facility in Tucson, one staffed with a team of specialists. The technician rigged up a portable oxygen tank with a mask for Zack and the Guys raced to Southwest Veterinary Specialty Center. David drove while a fearful Jan held Zack on her lap with an oxygen mask to his face.
“It was the most frightful trip,” Jan said. “I remember thinking, ‘This little guy is going to be the death of me.’ ”
Upon their arrival, they were ushered into a critical care unit.
For the second time that day, Zack was placed in an oxygen chamber while the veterinarian and technicians began more evaluations, keeping a watchful eye on his status.
“Two vets, Annalisa Prahl and Rhonda Schulman, worked with Zack through his entire stay there,” Jan said. “They were excellent. We’re so fortunate to have specialty practices like this one, with 24-hour emergency and critical care.”
Zack remained at Southwest for three days, where veterinarians confirmed Drake’s diagnosis of an electrical conduction disturbance.
The problem had spiraled to acute heart failure, which meant Zack’s heart was overworking, causing fluid accumulation in his chest, making it difficult for him to breathe.
“He was put on diuretics to clear the fluid in his lungs, was placed on oxygen and was started on a heart medication to help ease the work that his heart was doing,” Drake said.
Through Zack’s hospitalization at Southwest, the veterinarians communicated with Drake, keeping the dog’s primary care veterinarian apprised of his status.
It had become clear that Zack’s survival depended on a pacemaker, a procedure that required a veterinary cardiologist.
“And that’s where it gets interesting,” Drake said. “There are no board certified veterinary cardiologists in the state of Arizona.”
Help in California
Prahl and Schulman got on the phone and networked with a cardiologist in Texas and one in California. Ultimately, it would be William Herndon a veterinary cardiologist in San Marcos, Calif. — near northern San Diego — who would perform Zack’s procedure.
Then came the next obstacle.
“Transporting him to San Diego was problematic because of the logistics involved,” Jan said. “You can’t carry supplemental oxygen on a commercial plane. Zack had to be on oxygen. The trip by car is a six-hour drive across the desert. I suppose that would have been possible, but not the best answer, given his fragile condition.”
After hearing their dilemma, a good friend with a twin engine plane and a pilot’s license offered to fly Jan and Zack to California.
“I can’t tell you how relieved I was when he stepped up and offered to do that for us,” Jan said. “It was just a tremendous relief.”
So on May 14 — Mother’s Day — Jan and Zack lifted out of the Sierra Vista Municipal Airport, on their way to California to see Herndon.
“I had the supplemental oxygen on board, a portable oxygen tank with a mask, as well as injectable medication in case he went into another crisis,” Jan said, recalling the two-hour flight. “We made the trip just fine. He was a calm little traveler.”
On May 15, Zack was presented to Herndon at California Veterinary Specialists in San Marcos. Hailed as the only dog to arrive at their clinic in a privately-owned air ambulance, Zack was treated as a minor celebrity.
After a full evaluation, Herndon determined Zack would make a good candidate for a pacemaker.
“Initially, I want to ensure the main clinical problem is a critically slow heart rate, where the heart is beating very slowly or even stops for awhile,” Herndon said. “Those are the symptoms that I can fix with a pacemaker.”
During the evaluation, Herndon also looks for underlying medical problems that could affect the dog’s longevity.
“I check for cancer in the body and other serious, chronic or terminal conditions,” Herndon said. “If I find something like that, the owner needs to know. It’s because if there are any systemic illnesses that could shorten the dog’s life span, the owner may not want to go through with the procedure.”
Zack gets a pacemaker
Pacemakers used in dogs are the same as the ones used in people. Herndon, who performs about 10 implants a year, prefers those that are manufactured by Medtronics Inc.
While some dogs receive a secondhand pacemaker from deceased people, it’s also common to use new ones that have a partially-expired shelf-life. The practice is not recommended for humans, but those pacemakers work well for dogs.
“I use the new pacemakers that have been sitting on the shelf for awhile,” Herndon said. “After several months have gone by, there are concerns about the shelf-life of the power source for humans, and those pacemakers are no longer suitable for people.”
Pacemakers are comprised of a pulse generator and leads. About the size of a silver dollar, but thicker, the pulse generator, which is a battery pack and tiny computer, is implanted in the dog, somewhere beneath the skin. The exact location depends on the dog’s size and which procedure is used. In Zack’s case, the pacemaker is on his back, just behind his withers in his scapula area.
A lead is threaded through the dog’s jugular vein to the heart, where it is attached to the heart muscle.
“As I’m placing the lead into the heart muscle, I’m using a device that secures the lead to the heart muscle,” Herndon said. Similar to a tiny wrench, the device allows the veterinarian to turn the other end of the lead which is outside of the dog’s body.
The lead is what transmits electrical impulses between the power source and the heart. When the pacemaker’s monitor detects problems in the heart’s electrical activity, it sends out a signal to correct the rate.
“A pacemaker is sophisticated enough that the rate can change with the dog’s activity,” Herndon said. Veterinarians program the pulse generator to best suit the individual dog.
Zack’s is set for 80 beats per minute.
“Older dogs like Zack do real well with a pacemaker,” Herndon said. “As with any medical procedure, a certain percentage will have complications. But we really do have a good success rate with this. These dogs don’t have a chance without this procedure.”
Herndon performed Zack’s implant on May 16, the day after he conducted his evaluation.
Zack improves
after surgery
Zack’s improvement was immediate.
“On May 17, exactly one week from the day Zack went into heart failure, my friend picked us up at the airport and we flew home,” Jan said. “From the moment I saw him, I was amazed. His tongue was pink again, his breathing was normal, he was back to his old perky self. It was miraculous.”
The life expectancy of Zack’s battery pack is between 5 and 6 years. Now 10, Zack will be 15 when his pacemaker battery is due to be changed. If his quality of life is still good when that time comes, Jan says she will likely have the battery replaced.
“The great thing about this procedure is that the dog is cured,” Herndon said. “Owners don’t need to worry about medicating or injections. It’s a positive outcome for everyone — the dogs and the owners.”
Cost for a pacemaker varies. Depending on a number of factors, the cost ranges between $2,000 and $3,000.
There are about 135 veterinary cardiologists throughout the United States. Anyone considering a pacemaker for their dog should seek a board certified cardiologist. Herndon sees appointments on a referral basis only.
In her 24 years of practice, Drake said that Zack is the second dog she’s seen with this particular electrical conduction problem. The first case was a dog that she treated while practicing in Maryland. That dog, she said, also received a pacemaker and responded well.
As for Zack, he’s doing great.
The Guys are finding their greatest challenge is keeping him inactive during the recommended four to six weeks healing time.
“He’s like the little energizer bunny now,” Jan said with a laugh. “He truly is a little miracle man. He just goes and goes and goes.”
HERALD/REVIEW reporter Dana Cole can be reached at 515-4618 or by e-mail at dana.cole@svherald.com.
TheSilverRose wrote on Jun 27, 2009 10:22 PM:
Thank You! "