Wednesday, April 13, 2016

Patient of the Month- Max!!!!

The first days of our pets lives are full of joy. Then comes the potty training and the behavior training and then the long life (we all hope) of mutual love and general spoilage. This month’s Patient of the Month started out life with a little more struggle as he fought off the Parvo virus at just 8 weeks old. This is where the VCAHAH came in. 

Under the medical supervision of Dr. Sessa, Max was watched 24/7 in our isolation ward. After a week of care he, was on the mend and heading home. However, this little mastiff puppy stole our hearts and for the next 8 years has trusted us with his care.

Then about a month ago Max was brought into the hospital in acute distress. Before anyone could even take the time to snuggle with our old friend, Dr. Herrington and our staff worked quickly to evaluate and relieve his distress.

Max’s blood pressure was low, his heart sounds were muffled, his pulses were weak and he was showing signs of shock. An ECG as immediately performed and a quick X-ray revealed fluid around Max’s heart that was filling up the space needed to allow his heart to beat. Dr. Fishkin, our Board Certified Criticalist & Boarded Internist worked quickly to perform a pericardiocentesis. This procedure took only moments but immediately changed Max’s state by removing the fluid that filled the sack around his heart via a catheter. Immediately Max's heart was allowed the space to beat, unobstructed.

Now stable, the reason for the fluid could be evaluated. Max was hospitalized. He was monitored intensity throughout the night for fluid build up around his heart and underwent
pericardiocentesis as needed. An appointment was made for a ‘5-point’ inspection by our Board Certified Cardiology, Dr. Carpenter.

The following day Dr. Carpenter met with Max and his mother. Through a cardiac ultrasound , an in-depth look at Max’s heart, valves, chambers, pressures and walls was performed to see exactly what the heart was up against. The prognosis was clear, Max had pericardial effusion caused by a mass on his heart. Pericardial effusion is when an abnormal amount of fluid accumulates in the pericardial sac- the pericardium. This normally paper-thin, translucent membrane attaches at the  based of the heart and provides a sac-like protective compartment filled with a relatively small amount of fluid which acts as a lubricant for the heart. If the sac fills with too much liquid the internal pressure impedes the hearts ability to expand thus obstructing the flow of blood throughout the body.

Our Board Certified Surgeon, Dr. Danielson was called in to preform a pericardiectomy. A pericardiectomy is the surgical removal of part or most of the pericardium to relieve the pressure built up by the increase fluid. The ultimate goal was to remove the cause of the fluid- the mass- but evaluation of that would have to wait until it could be was fully visualized in surgery.

During surgery, Max was monitored critically by our team of technicians under the supervision of both our Surgeon and Criticalist to ensure any variable in his vital signs would be addressed immediately. Anesthesia went smoothly and while removing the mass was not an option, based on it’s location, the pericardiectomy successfully performed.  

Max is now home. The fluid from the mass will continue to be produced but the sack around his heart will no longer be strained. His heart will be able to beat feeling as his body will work to absorb the excess fluid.

We at the HAH hold Max and his family in a very special place in our hearts. Now home, he gets to enjoy life again and all of the cuddles that come with it. To us and to his family, we certainly see this as a success story. One that shows times and again that Max is a fighter and given that chance he will not be kept down.

A very special thank you to Max’s family for letting us share this story and for trusting us with his care!

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