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They did an xray and it did not show fluid, just slight cloudiness throughout the lungs fields bilat. His heart is slightly enlarged as well, displacing the trachea slightly, but they felt it was not heart failure at that time. I guess my question is can he be seen in the morning (it is 4:30 am here). We had our vet for 30 years and it is hard to trust someone else, do you think they misdiagnosed him and are not treating properly? Our vets funeral is tomorrow (he was a good friend) but I am concerned for time. How long can he maintain this HR and respirations?
Thank you, XXXXX XXXXX me make an informed decision. Have a wonderful day on The Big Island.
I took him to the emergency vet at 5:00 am. By the time I got there his respirations had improved some and his HR was down a little. They felt like I could wait until the next day but he did say Toby had a large mass in his abdomen.
After the funeral on Monday I took him back to the same vet hospital (different vet) because I had already spent so much money on labs/x-rays. She said she did not feel a mass and I agreed to another x-ray to be sure. The x-ray came back normal except he had a slightly enlarged liver and spleen. She determined he had a "twisted spleen" which "fixed itself" and would have caused all of the symptoms. She said this could have felt like a mass.
They are trying to get me to agree to a cardiac ultrasound, which I think is silly. He is an older dog, we know he has a murmur that is progressing, so I asked if they could start him on heart meds when it is time without an ultrasound. She started him on enalapril and lasix. I have had him on the new meds for a few days and he does not do well during the day after he has had the meds (faster HR and lethargic) but by the next morning when it is time for his next dose he is active and happy. I held the lasix today to see how he did, and when I picked him up he was very active, alert, and exited to see me, basically back to his normal self. I am not sure if it was because I held the lasix or because he is just getting better.
I do not agree with the vet clinic I have taken him to so I am taking Toby to a new clinic next Tuesday. If our vet was still alive we would have answers by now, even if it was not what I wanted to hear, but I feel like we do not have any answers, and they only want me to spend endless amounts of money.
To answer your question directly, Toby is much better but something was wrong and he still has a cough at times. I want to make sure the meds he has been placed on are appropriate for his condition and necessary at this time. I also would like another vet to review his records and symptoms. I would like to have Toby a few more years, but if that is not possible, I want to make sure I am not adding to the problem.
Hope this answer is not too long, I am frustrated. We lost a good friend and a Veterinarian who loved animals and someone we trusted care for our 4 legged family members. It seems like the people we have to go to now only care about money and not the animals they are treating.
Hi Dr. Salkin,
Toby is doing so much better and we had a great visit to the new vet. today. They reviewed his x-rays, meds, and symptoms. They determined his cough was caused by his enlarged heart irritating his esophagus/trachea. They kept him on the enalapril, lasix, and pepcid and started thyroid meds because his thyroid was low (he has a hx of hypothyroidism).
Toby is so much better he is like a new animal (I mean human, he does not know he is a dog). I am so glad we have someone we can trust with Toby now. The new Dr. is a lot like our other vet. He explains everything and is very thorough, he does not try to sell unnecessary tests.
He thinks the enlarged liver and spleen is secondary to heart failure and he is not concerned at this time.
Thank you so much for your help. I appreciate your concern and your knowledge on the subject even though you have ever seen the patient. You helped me through a very tough time with a sick dog, and losing our good friend and the only vet we had ever known/used. Thanks again.
Hi, I am back. I think Toby is dying. We took him to a specialist yesterday and she said Toby had a pericardial effusion and she increased his lasix dose from 6.25 mg daily to 25 mg twice a day. He was doing better yesterday before we started the new lasix dose but today he can barely walk and he is not eating. He began fainting about 2 weeks ago and is has gotten more frequent. When this happens his gums turn pale or purple, he moans, and he is incontinent. Today he can barely stand without collapsing. Te Dr.'s have not been good at follow up, I feel like they just throw new meds at him without checking to see how they are working. He has not had labs checked since I talked to you last. If we have done all we can do for him I wish they would tell me that, but they act like this treatment should be working and it is not. He is currently taking enalapril, vetmedin, lasix, pepcid, and thyroid. He seems comfortable, he is not restless or in distress, but he is weak and not eating. His heart rate is still between 150 and 170 at rest. Do you have any recommendations? I do not want to extend his life unnecessarily but would like to know if we are doing everything we can to improve his quality of life. If something is not done I do not think he will live much longer. Do you think he is in pain?
Thank you so much for you help.
I'm sorry to hear of this, Natalie. Without knowing what's causing the pericardial effusion, I can't know if you're already doing everything you can. We have to differentiate effusion due to neoplasia (hemangiosarcoma, heart base tumors), idiopathic (unknown cause), and congestive heart failure. Whatever the cause, Toby's repeated syncopal (fainting) episodes are life-threatening. It's likely that he needs removal of the pericardial effusion by aspiration (pericardiocentesis).While removal would undoubtedly improve Toby's quality of life, if there's an underlying tumor causing the effusion I can't in good faith subject Toby to the repeated pericardiocentesis necessary. Did the specialist conjecture what the cause of his effusion was; was anything seen on ultrasound other than the fluid surrounding his heart?
No, nothing else was seen. They think it is CHF but the x-rays do not show fluid on his lungs. His bronchioles were "dilated" so they think he may have some underlying lung disease as well. Do dogs his age (14) do well with pericardiocentesis? I am not sure he will be here many more days and I cannot get anyone to take me seriously. They just keep saying watch him.
Can he get too much lasix? His episodes have worsened today after he is receiving the higher dose of lasix. Is that coincidence? He was just having 1 or less syncopal episodes per day but now he cannot stand, he seems very dizzy. We have to carry him outside and help him stand to go to the bathroom.
I did forget to say he has mitral and tricuspid regurg. I will try to talk to his vet tomorrow to see if he will consider the procedure. If he makes it through the procedure, what kind of life will he have. Is the treatment for tamponade the pericardiocentesis?
If we were to leave him untreated is this a painful way to die?
I took Toby back to his specilaist today and she said she would not do a pericardiocentesis because the effusion is not large enough. She noticed his abdomen has been swelling, as did we, so she did an ultrasound to check for ascites. She found a liver mass measuring 4.5 X 6.2 cm. She thinks some of his symptoms could be caused by pan so she gave him ultram. He has improved some today but he did not receive his arsenal of meds last night. She wants us to continue to give him the high dose of lasix because she thinks we can remove get him out of heart failure and possibley operate on the tumor next week.
I do not know what to do. Are his symptoms improved today because he did not have the meds, or because he had the ultram? I do not want to have another day like yesterday where he could not stand up because he was so dizzy and week. She did say she could have caused his pressure to drop so she changed his enalapril to 1/2 tab BID but still wants us to give the lasix 25 mg twice a day. I do not think he will tolerate that.
Does he need to be on enalapril and vetmedin since they are similar in action?
His sodium and potassium were normal today but his BUN was elevated at 59 with normal creatinine.
If, by some miracle, he were to come out of heart failure, should we even consider this type of surgery at his age? What if it has metastasized? I am not ready for Tobee to leave us but I do not want to keep him here for our selfish purposes. He walks around with his tail down all the time now. I feel so helpless.
If we did not treat the mass how long will he live? Should we consider euthanizing him soon?
That is reasonable, my husband and I feel the same way, but we struggle with making the choice to kill him. He is our family and we would never put a family member down.
Toby does everything with us, if we go somewhere in the car he goes, too. He has comforted me through three of my husbands deployments, he sits at my daughters door every morning and will not get in the car until I have gotten her, he goes on every vacation with us. We feel like we are saying none of that mattered and we are just going to get rid of you in your time of need.
We do not want him to suffer, but how can we take his life?
Toby died tonight. Thank you for all your help.