On today's episode of Twin Trees Vet Talk, we welcome our very special guest, Dr. Mark Harmon. Dr. Harmon is a Veterinary Cardiology Specialist at Boundary Bay Veterinary Specialty Hospital in Vancouver, BC (Canada).
In this video we discuss what it is like to be a veterinary cardiologist. Dr. Harmon tells us about his training after vet school (including 2 year-long internships and a 3 year residency). He talks to us about recent advances in the treatment of heart disease in pets, including pacemakers, balloon valvuloplasty, a new minimally-invasive method for treating mitral valve disease, and open heart surgery. Finally, he tells us about some of his most inspiring cases, including a labrador with atrial standstill and a cat with aortic thromboembolism (also called ATE or saddle thrombus).We hope you enjoy this episode! Please leave your questions and comments below!
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[TEASER/INTRO] Pacemakers, balloon valvuloplasty.
Balloon valvioplasty was first performed in an English bulldog before it was ever performed in a child, and it was only because it went well that they were like- we should try this in children.
It's a really rapidly changing field, there's even cases that get open heart surgery. Really remarkable things that are out there. It's definitely worth talking to a Cardiologist because we have to stay up on this- it's part of staying boarded as a cardiologist.
You guys are always right on the forefront of all the ne advances.
It's hard to get the most updated information if you can't go right to the source [Music]
Dr. Lopez: Today we have a very special guest Dr Mark Harmon he is a board certified Veterinary cardiologist at Boundary Bay Veterinary Specialty Hospital. The amazing world of Cardiology has advanced so much over the last 10 to 20 years; a lot of people don't realize that a lot of the same procedures that humans need for their hearts, like pacemakers and balloon valvuloplasties, many of those procedures are now available in pets if you see a Cardiology specialist.
Dr. Harmon: I would say those are some of the most rewarding things for us to be able to do, are some of these procedures. And some of it even started with us. Balloon valvuloplasty was first performed in an English bulldog before it was ever performed in a child, and it was only because it went well that they're like- we should try this in children and see how it works. And so veterinary medicine and human medicines are more alike than a lot of people realize. There's been a constant sharing of information back and forth across this group, and things like the PDA occlusions (so putting these plugs into these vessels that should have gone away to help these animals basically be cured of heart disease), pacemakers (that we put in animals that to ensure that they have great quality lives). It's a really rapidly changing field too, because there's things coming down the pipeline that were not previously accessible to us.
In older dogs, changes to their mitral valve on the left side of their heart (that make it very leaky) are the leading cause of heart disease by far in dogs. There's a newer device where they can actually do a very small procedure and they shove a catheter across the heart and they can clamp the valve together so that it can't leak very much, and that can actually be super super helpful for these animals in some situations. And then there's even cases in a couple of places in the world that get open heart surgery on dogs these days too. And actually they can repair the valves, and I've seen some pretty remarkable sort of outcomes from that as well. We've had dogs that, you know I don't know that they would have lived another month, we were kind of maxing out everything we could do for medications, and these dogs come in for rechecks and they're like off all of their medications and they're like back to being normal again. So really remarkable things that are out there and that are kind of changing the face of what we can do in vet medicine.
And so it's definitely worth talking to a Cardiologist, because we have to stay up on this- it's part of staying boarded as a cardiologist, is we have to be tested on this stuff and we have to maintain our credentials with continuing education specifically related to Cardiology to be able to keep calling ourselves a cardiologist. It's hard to get the most updated information if you can't go right to the source.
Dr. Lopez: Yeah, so you guys are always right on the Forefront of all the new advances all the technology.
Dr. Harmon: Yeah frankly in this situation, it's nice that Veterinary Cardiology is such a small field. I mean the last numbers from 2018 there were 308 total in North America, and so you end up knowing a lot of people by the end of it . So it's a very small field , o people can talk to each other really easily about things and keep each other updated on what's going on and and what directions may be happening, so in that regard. It's actually kind of helpful to keep everybody on the same page.
Dr. Lopez: That's so cool. So your journey to becoming a Veterinary cardiologist- what does that entail?
Dr. Harmon: So my journey started off a little bit funny. My undergraduate degree was actually in chemical engineering, and I decided really early on that I didn't want to be a typical engineer, that that probably wasn't where I wanted to go with it. And it was actually just kind of a freak comment from my brother about: " you should become a veterinarian so I could pay you to do this instead of something else..."
And so I started in my second year doing all the prerequisites for veterinary school. I ended up getting accepted into the University of Missouri, graduated from there, did a rotating internship at the University of Pennsylvania in Philadelphia , spent a year as an ER doctor in Michigan. My wife was a criticalist at Michigan State and I was just working down in Ann Arbor. And then after that was accepted into a Cardiology specialty internship where I just did Cardiology and did some Urgent Care things on the side. And then was accepted into the Cardiology residency of Missouri.
Dr. Lopez: Oh that is so interesting, I never knew that.
Dr. Harmon: Yeah.
Dr. Lopez: Cool. So all in all it was like another what like six years after graduating from school before you became board certified?
Dr. Harmon: After vet school, it was a one-year internship, one year as an Urgent Care Vet, one year as a specialty intern, three years as a resident, and then two sets of boards that we have to pass to become a cardiologist and be board certified. So there were a lot of extra years added on beyond the vet school side, which was hard enough on its own.
Dr. Lopez: That is a long journey. So much respect for putting in all the hard work and all those years.
Dr. Harmon: Yeah exactly. It was a long arduous sort of journey. Unfortunately, there's just not many training programs in the world for cardiology on the veterinary side of things, and so it's pretty typical that you're at least in limbo for a couple of years before you go into a Residency program these days .
Dr. Lopez: Well that is amazing. What does a typical caseload look like on an average day?
Dr. Harmon: Every day is a little bit different. So you would think being a cardiologist that we kind of just see the same cases over and over again, and some days that is true, but we tend to see more dogs than cats I think probably 60 to 70 percent dogs and 30 to 40 percent cats. The number of cases can be pretty variable. Some days we only have about six cases; some days we're seeing 15 cases and have extra emergencies and things that we have to do as well.
So a normal evaluation would be doing things like an examination, doing an ECG to look at the heart rhythm, doing an echocardiogram to actually get an idea of what the actual diagnosis is and where we are as far as the stage of the heart disease, and then compiling all that information together and figuring out a plan that will work for this pet and this owner. And then every couple weeks we block off days where we get to do surgeries (if we can plan them out and they don't have to be emergency surgery). So we can do minimally invasive surgeries where we can correct some congenital things that dogs are born with or place pacemakers or things like that so we get a lot of variety.
Dr. Lopez: That is so cool. Do you have a couple cases that kind of stand out in your memory as being the most inspiring ones?
Dr. Harmon Yeah I have a couple. So one was when I was a resident- so there was a dog named Lucy. The dog was diagnosed with a condition called atrial standstill, which is an ER medicine that can be due to things like a high potassium, but in the Cardiology world if they don't have high potassium they can just have a primary heart disease that causes it and that can cause replacement of the muscle within the atria by scar tissue. And that can eventually lead to things like collapsing, and heart failure, and very low heart rates. So Lucy came in actually before I was even a vet student when she was only about like a year and a half old- two years of agem as a Labrador. And she was collapsing and they found that she had this condition. They put a pacemaker in when I was a student - I was actually checking her when I was doing my clinical rotations and then when I came back to Missouri she was still alive and still doing really well and she was in her older years by that point. She eventually went into starting having more episodes of heart failure and then the last week of my residency she passed away.
So I was there for a big part of Lucy's Journey. But she had such a really good quality of life, and that was one of the cases I feel that was pretty instrumental for me and seeing like what we can do.
I've said that with my own dog too. When I was a student we had a dog that was brought into my wife who was on the Cardiology rotation- she's also a veterinarian-- she had a congenital heart murmur we thought she was probably going to be something that could only live for a couple years. And we were able to fix her and we had her for 10 years. I have personal experience on multiple levels of being able to see what we can do and the quality of life that we can give some of these animals as well.
And then there's one that's more recent, there's a cat that I've been managing for several years- her name's Angel. And angel had come down to see me because she had had a saddle thrombus- its a complication of heart disease. So she had thrown a clot to her back her legs, but she was able to be nursed through it. The criticalist Dr jagadich that was at Boundary Bay at the time did a really fantastic job getting her through that, which is a trial in and of itself to get get them through one of them. Yeah we got her through it, She eventually started to develop more signs of heart failure. She had a total of three saddle thrombus events that happened, and every single time she just pushed through it like a champ and did remarkably well. Never really had any sort of the huge complications that we sometimes can see. She had owners that were just the most amazing at caring for her, and the most perceptive people I've ever seen at picking up problems. And so she was honestly a testament to me as far as what animals can do if you give them a chance and if they have the right sort of environment and the proper care. And she was really phenomenal - how well she did. And she actually lived three years after her initial saddle thrombus event, despite all these little hiccups that we had along the way. And actually only fairly recently did we have to put her to sleep finally because she was starting to decline, but just an unbelievable case as far as how she did from where we had a pretty bad conversation at the beginning in pretty dire prognosis of what we could be looking at to where she ended up was pretty phenomenal.
Dr. Lopez: Yeah even for me that's very inspiring.. all the years of saddle thrombus I wouldn't be able to count any good outcomes to be honest.
Dr. Harmon: So yeah that is a complication in cats of heart disease, and certainly there's cases that are just way too far gone and we're not going to be able to help them. But certainly her owners were like : "we're willing to give her a chance and if she decides that she can't do it then we'll make that decision if we have to." Every time they'd give her a chance, and she'd just rock straight through it, and she be like: "all right, Angel's back to being normal again." s
Dr. Lopez. So inspiring. Wow. Well thank you for sharing this with us.
0:43 Intro, advances in veterinary cardiology
3:45 Dr. Harmon's journey to becoming a veterinary cardiologist
5:41 typical day in the cardiology department
06:44 inspiring case #1: Lucy the dog with a pacemaker
08:04 Inspiring case #2 Harmon's own dog had congenital heart disease
08:27 Inspiring case #3 Angel, a cat with saddle thrombus , aortic thromboembolism
FULL BLOG POST: https://twintreesvet.com/blogs/vet-talk/the-amazing-world-of-veterinary-cardiology
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3 BEST PIECES OF ADVICE FROM THE EMERGENCY VET THAT COULD SAVE YOUR PET'S LIFE
1) DON'T WAIT TOO LONG TO GET HELP! If you wait too long, it could be too late. This is especially true for concerns such as laboured breathing, pale gums and weakness. You know your pet best, so if you are worried or concerned, "when in doubt, check it out!"
2) PREVENT THE PREVENTABLE. Learn as much as possible about dangers that face your pet, such as household poisons, seemingly harmless objects (like toys, clothing, garbage and rocks), other animals, and vehicles. Pets are like toddlers and they need a responsible adult/babysitter to protect them from danger.
3) BE PREPARED FOR THE WORST CASE SCENARIO. Have a plan in place, know your nearest emergency clinic, have the ASPCA phone number on speed dial. Know basic first aid training and CPR. But MOST IMPORTANTLY, BE FINANCIALLY PREPARED. The cost of medical treatment in an emergency, and the owners' ability to pay for it, is probably the most important factor that determines whether a pet will receive the medical care it needs. The best way to protect yourself is to have good medical insurance for your pet. Do your research.
The medical information on this site is provided as an educational resource only, and is not to be used or relied on for any diagnostic or treatment purposes.
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