"Panring and sits on backside with front legs straight up. Her head tilts upwards with eyes staring," the lady in her 30s said to me today, Hari Raya last day. A bright sunshine day.
On Jun 10, 2015, she boarded the 3-year-old female spayed Chihuahua. On the 7th day of boarding in a home, the chihuahua vomited saliva and had a slight cough. The boarding owner fed her own vegetarian diet and so the owner presumed a change of diet caused this problem. She brought the dog home on Jun 25.
On Jun 25, consulted Vet 1 who diagnosed heart disease based on X-ray (see below) and wanted to prescribe heart medication. The owner rejected this.
On Jun 27, consulted Vet 2. Also another visit on Jul 12. Vet 2 diagnosed a dietary change as the boarder came to give the owner free vegetarian diet for the dog. The boarding operator came on Jul 9 and the dog was fed this vegetarian diet for 3 days. "Could there be toxicity in the diet?" the owner postulated. So Vet 2 diagnosed the problem as dietary based on blood liver enzymes slightly elevated and low white cell count.
But the dog continued with the same behaviour of panting at night and upright front legs.
On Jul 14, consulted Vet 3 who diagnosed heart disease based on X-ray of Vet 1 and prescribed one medication called invoril 5 mg.
On Jul 15, consulted Vet 4 who did an abdominal ultrasound to scan for tumour and wanted to refer her to a French specialist to do ECG test for the heart. The heart murmurs were grade 1.
Today, Jul 17, I was on duty in the morning. I confirmed Vet 1's and Vet 3's diagnosis of heart disease. Left heart enlargement for a 3-year-old dog is rare but does occur. There was throat pain due to the owner force-feeding medicine by grabbing the dog's throat and syringing medication with a 3-ml syringe.
I thought her to use a 1-ml syringe and be gentle. The dog should be placed on a table. Panting at night stresses out the career lady as she has to have a sound sleep. The lady is happy with the final diagnosis from me.
"I am in denial," she said when I asked her why she did not believe the first vet. "It is better than I have more second opinions! Will she be cured and how long will she live?"
"Well, the 3rd vet is an experienced vet with over 30 years of practice," I said. "Yet you do not believe him."
I opened my website and showed her X-rays of a 1-year-Pom with severe heart disease and how heart enlargement look like.
"Your dog has a Grade 1 left mitral murmur on the left heart, the left sided heart enlargement is not too large and is due to congenital origin, that is from birth problem. It is hard to predict how long she will live. Much depends on the control of the heart disease, restriction of strenuous exercise and diet."
The dog went home. The owner phoned. "My dog vomited, peed and her front legs are now stretched out straight!" I asked her to be patient as it was only 1 hour since she left the clinic.
It is very difficult to convince some owners about heart disease in young dogs. I used the previous case of a one-year-old Pomeranian to illustrate the heart enlargement in X-rays as shown above.
As you can see, the left heart occupies more than 1/3 of the pleural cavity and is therefore enlarged. the right heart is normal. The X-rays from Vet 1 are slightly tilted but the clinical signs are the main factors in coming to a correct diagnosis of heart disease. It is just that client education is very important as there is a need to "show and tell" rather than just tell.
The owner just cannot believe that such a young dog can get heart disease during boarding. The boarding operator surprisingly offered more of her home cooked vegetarian diet after boarding, confusing the owner. As to the dog showing improvement after the first visit to Vet 1, I told her that it could be the pain-killer cartophen that temporarily stopped the pain in the heart. But proper heart medication is the solution.
UPDATE ON SAT JUL 18, 2015
Jul 18, 2015. My SMS as I could not contact her by mobile
9.50am "Any front leg being upright in Wawa now?"
1.10 pm Hi doc, sorry I was busy with housework earlier, so missed your call. She is not in upright posture anymore, but kept sleeping and mostly in a daze-like expression.
I phoned her. The dog had the most restful sleep without panting on Jul 17, after treatment. So did the owner. The dog had eaten a little bit of the chicken meat but avoided the H/D diet prescribed for heart-diseased dogs. I advised her to persevere in feeding H/D with 90% of the present diet until H/D replaces the diet. As for the lethargy, it was most llikely that the dog is recuperating for over a week of night panting and deprivation of sleep. I advised a small teaspoonful of honey in case the chihuahua suffered from hypoglycaemia as some do.
"I have researched the internet and saw similar X-rays of left heart enlargement," the lady said. "What is the cause of this heart disease? Will she be cured? Should she have an ECG?"
"The cause is presently unknown. Heart enlargement could be due to infection, heart valve disease or from birth. Wait one month before doing the ECG and to get another review." No blood work was done by me on that day as the other vet had done it.
UPDATE - July 22, 2015
The owner phoned me saying that the French vet who did an ECG on her cat had said that the dog's heart did not have abnormalities as there was no heart murmur or abnormal ECG. "I had told you that the heart disease was due to a slightly enlarged left heart when you had seen the X-ray of a 1-year-old pomeranian with a extremely large heart enlargement. The heart murmur was not serious. I have advised to take the antibiotics and heart disease medication for one month and then review the heart, doing ECG when necessary."
But the owner had the ECG done anyway on this 3-year-old chihuahua and found nothing abnormal from the 5th vet. "It is hard to pinpoint as to cause your dog to have the upright posture, night panting and difficulty in sleeping based on one-time X-ray," I said. "The dog could have a chest or heart infection which leads to a slight enlargement of the left heart. How is he nowadays?"
"He is good and normal," she now can sleep peacefully at night as the dog no longer had nocturnal respiratory distress. She would complete the medication and get the dog X-rayed and reviewed one month later.