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My dog is a 10 year old bichon frise. His stomach has been…

Hello! My dog is...

Hello! My dog is a 10 year old bichon frise. His stomach has been very hard for the past two days, today he was shivering as well. So I rushed him to the vet clinic and they said he could have an enlarged heart or organ. Further tests and and X-ray are being carried out now. I would like to know your opinion on this matter. Thanks

Veterinarian's Assistant: I'll do all I can to help. What is the dog's name?

His name is muffin

Veterinarian's Assistant: Is there anything else the Veterinarian should be aware of about Muffin?

Nothing else. He was perfectly fine and suddenly this started a couple of days ago

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Answered in 2 minutes by:
1/29/2018
Scott Perry
Scott Perry, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 3,563
Experience: DVM
Verified

Hello. My name is***** and I am a veterinarian that can answer your question. I understand Muffin is at the veterinarian currently undergoing some tests for a hardened abdomen. I am sorry to hear about the problem you are experiencing. Did the veterinarian happen to feel an enlarged organ on palpation and that is why they feel that way?

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Customer reply replied 6 months ago
The vet believes it could be an enlarged organ, however they were unable to provide me with an accurate result yet without carrying out he X-ray scan. They informed me that once they’ve done that, they can establish the cause of the hardened abdomen. They also mentioned his heart beating at an abnormal speed

Than you for that information. A hardened abdomen could also indicate pain. Shaking and a faster than normal heart rate are also commonly observed with pain or anxiety. Those features in itself do not create a suspicion of an enlarged organ or heart problem. Having said that, it would likely be a good idea to get some imaging tests performed to see if there are any problems they might be able to detect. Just be prepared that the organ sizes may look normal. Blood testing may be necessary to look for organ inflammation that would not show up an a x-ray. For instance, liver or pancreas inflammation can cause a painful abdomen and there are blood tests for that.

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Does that help to answer your question?

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Customer reply replied 6 months ago
I will ask them to perform the aforementioned blood tests, however I would like to know, based on your experience, is such a case common and is it dangerous to the dogs health? I am very worried right now and not ready to lose this dog, he has been a part of the family for over 9 Years now.

Enlargement of organs are somewhat common, but that finding would not be very specific. For instance, older dogs can get a benign condition of their liver called nodular hyperplasia, which makes the liver larger than normal. It is not painful and it is not dangerous. However, a tumor would be relevant information and that could cause pain and be dangerous if left untreated. They will want to identify any enlarged organ, but then look at that with an ultrasound and possibly take a biopsy to determine if the enlargement is from a tumor - blood work can also differentiate enlargement from inflammation or a tumor. Therefore, hopefully they will use a few different tests to make a diagnosis.

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Please let me know if you have any other questions. I am here to help. If you have no other questions, I would appreciate very much a 5 star review. You can do this at the top of the screen (rating me now does not close your question). We can continue here until you are satisfied. Thank you!

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Customer reply replied 6 months ago
Thanks for your help! I have asked the vets to perform all these tests. However they just informed me that after an X-ray was performed, they discovered an enlargement in his heart due to fats. Apparently this is due to his diet, they informed us that we need to switch his food from wet to dry. Also they discovered some gases in his abdomen, they will perform a manual extraction of his faeces in order to reduce his abdominal swelling.

This is an unusual explanation. It is not a known condition in dogs for fats to cause an enlargement of the heart. Furthermore, fat deposits are not correlated with the diet, so changing the food would not likely help you. I am confused about that diagnosis. Gas in the intestines could be a sign of intestinal inflammation, which is likely the source of the pain. Extraction of the feces will unlikely help that unless there is constipation. It will not reduce abdominal swelling. Did they mention the option of giving a pain medication or anti-nausea instead?

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Customer reply replied 6 months ago
I am quite confused with their assessment too, I am worried they are unable to determine the actual cause of his pain.he has no problems with constipation. I believe his problem is in his abdomenal area. If this is an inflammation in the intestine, what could we possibly do to help him recover? I believe the vet clinic over here are not very professional in this field and this is making me stress even more. They did not mention the need for any medications yet but are still performing some tests I believe as they informed me he will be ready for pickup in a couple of hours.

Gas in the intestine is normal to some extent, but if the intestines appear distended because of this gas then that could indicate intestinal pain. I am not sure if you would trust them to make this assessment, but if it is there then treatment for this would be best with medication for nausea. Cerenia is one such example of a medication.

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Please let me know how it goes. Please consider a rating when you have time. I will continue to be here to answer all your questions.

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Customer reply replied 6 months ago
Thank you doctor! I will definitely update you once all tests have been performed and I have my dog back.

Please do. I would love to hear how it is going. Thank you.

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Customer reply replied 6 months ago
Hello once again! I have received the X-ray scans that were made on my dog. The vet said there is nothing threatening but I am not convinced. I am attaching copies of the X-rays to this message for your review. I am worried that the dog has Gastric Dalatation and Volvulus. Could you please help me review the X-ray scans

Just got them. Please stand by. I will look over them and then send a reply. I would appreciate a response from you to make sure you got my message. Thanks for sending the x-ray images.

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Customer reply replied 6 months ago
Thanks for your swift response. I have received your reply and I’ll be awaiting your response!

I looked through the x-rays and made a few determinations. The heart size is normal, although it is on the higher end of the spectrum. We use what is called a vertebral heart score. Normal is 8.7-10.7, and Muffin scored a 10.0. That does not necessarily mean anything significant as many dogs can have a higher value. As long as she does not have a heart murmur, which would be determined by listening to the heart, there is no reason to suspect there is any problem with the heart. Definitely there is no fatty deposits around the heart. There is a redundant tracheal membrane, which is likely insignificant. This is a muscle on the top of the trachea, and Muffin's is sagging into the airway. It can happen with certain dogs, but it does not require treatment if there is no cough. Those are the only significant findings that I see. There is gas in the colon, but that is normal. No substantial or abnormal gas is observed in the small intestine. The abdominal x-ray is underexposed, which means the image quality is not the best, ***** ***** makes it a little difficult to observe details because the image is very bright. There is also a missing image of the abdomen where Muffin should be on her back - they took lateral images of her on the side of both the chest and the abdomen, but the image of her on her back was only taken of the chest. Usually one will always compare a lateral image with one on the back. However, I do not see any abnormalities on the lateral image of the abdomen, so I do not know how much benefit it would be to get the other view.

There is definitely no gastric dilatation volvulus. The stomach is in normal position and size. Here is one possible abnormality, although it is not overtly obvious. One of the lateral images shows that she is hunched on her mid spine (thoracolumbar region). This is called kyphosis and dogs often display this position when they have back pain. Again, this is a hunched spine that tries to offset the back pain by standing in a bent over position. Sometimes it is only observable on the x-ray. Spine palpation of that region should reveal tightness or a pain response, but this is a delicate area and a veterinarian that has good palpation skills should do it. I will send a link to show the area I am talking about.

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I am having trouble attaching the picture. I think it is a file size issue. Please bear with me. I am trying to fix it.

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Please click on this link to see the area on the x-ray I am referring to: http://www.animaldoctoradvice.com/x-ray-image.html

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Customer reply replied 6 months ago
Thanks alot for all you have said and done in assisting me with this case. In terms of the muscle on top of the trachae, there has never been any coughing involved, so i believe it does not require any treatment as you have mentioned. My main concern was her suffering from GDV but you have given me rest of mind regarding this. I have also seen the location of the hunched spine, but unfortunately since the vet around me isnt very professional, i would not want to risk having them perform any treatments on that area if its not necessary. A few blood test results will be out tomorrow as well. Do you think i need to perform an ultrasound scan for her? Or are the X-ray results enough? Are there any recommendations or suggestions you would like to make after seeing these X-ray scans?
After seeing these x-rays, my recommendation would be to treat for generalized pain and nausea. The x-rays do not make me think there is nausea currently, but it would be safe to treat with an over-the-counter antacid. We have Pepcid or Zantac here, but I see you are typing from Nigeria, so I am not sure what is available there. I more suspect this to be spine pain and a prescription opioid type of medication would be best. There are really no good alternatives that are safe to give over-the-counter unfortunately. Tramadol would be a decent option or buprenorphine or fentanyl would be better. My approach would be to wait on the ultrasound to see how well she does on treatment. If she is not getting better, then an ultrasound can be performed. The x-rays were normal enough that being conservative with further testing is appropriate.
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Just checking in. How is Muffin doing? Do you have any other questions?

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Customer reply replied 6 months ago
Hello Mr Scott! Apologies for not getting in touch or updating you on muffin situation, i had a very long day yesterday. I sent him in for an ultrasound today, the vet here says he has arrhythmia and also has some problems with the blood vessels that supply blood to the heart, due to what he referred to as fats around the vessels. Thus the reason his heart is enlarged. To be honest i dont know how much i can trust the vets diagnosis over here. But i do remember you mentioning his heart being at the optimal size in the X-ray scans. Also from the ultrasound results, apparently he has an enlarged spleen as well. Unfortunately i could not get copies of the ultrasound results due to the machine being a bit outdated. The doctor suggested i give him a medication called Cellgevity and multivitamins. I honestly do believe there is something else wrong with my dog and the vet is unable to identify it. He was playing around and seemed fine last night, but right now he is looking weak and not active. He had problems releasing his feaces for about 36 hours, but i added a tea spoon of olive oil to his meal today and he managed to relieve himself but not like he usually does. His weakness is very worrisome to me and i am uncertain of what to do next.

I am sorry to hear about the problems you are experiencing with Muffin. Your veterinarian is describing a condition common to humans called atherosclerosis where cholesterol gets deposited in the blood vessels and impedes the blood flow to the heart. Dogs do not get this condition. Also, the spleen naturally engorges with blood and contracts, so it is normal for it to appear larger (or smaller) at times. There is really not a "normal" size for a spleen, but if there is a mass on the spleen then that is different and should be evaluated. If the veterinarian is making an assessment based on the size of the spleen then that would not be helpful for Muffin. A heart arrhythmia would be a potential problem, although some arrhythmias are normal and do not require treatment, but the question now is do you trust this veterinarian to make the diagnosis?

It sounds like your veterinarian believes the primary problems are fatty deposits that are impeding the blood flow to the heart and the treatment for this is to give multivitamins and antioxidants (i.e. Cellgevity). This is probably an incorrect diagnosis and not an effective treatment approach. I am not sure if they thought the heart arrhythmia or enlarged spleen was a problem, but the vitamins would not treat this either. Is it possible for you to find a different veterinarian?

Muffin should have a normal temperature, pink and moist gums, and normal hydration. These are things you can assess at home. Hydration is best assessed by feeling the gums and ensuring they are wet and slippery feeling. This only works if Muffin is not panting. There is a second method where you tent the skin behind the shoulders until you feel resistance and then let go and count how long it takes for the skin to return to a normal position. The normal time is less than 2 seconds. You can send a copy of the blood test results to me to review and I can offer my opinion on them. I would also recommend for you to ask testing for pancreas inflammation - this is called a cPLI. Have you asked them for a pain medication or anti-nausea medication?

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Customer reply replied 6 months ago
Hello Dr. Perry.
Apologies for the late response. I had my hands full with muffin situation yesterday. Regarding your post, the vet i am dealing with is the best in Nigeria, but i can tell you i am not very convinced with his diagnosis. The Vets opinion is muffin has a problem with his left ventricle, as blood flow is not sufficient, therefore his reason for believing the heart is over working itself in order to maintain body function, thus the enlarged heart condition.
His temperature is fine, it was slightly above average yesterday, at 39.2 celsius. He has been drinking a lot of water which to be honest worries me a bit as he has been consuming more than double the usual quantity he normally does.
There was also an issue yesterday, as i came back home, i took muffin for a quick walk, he urinated and emptied his stool, stool was a bit diarrhoea in nature, urine was normal color. once i took him back in after his walk, he began panting heavily and shivering a-lot. He then laid down and refused to get up. I took him to the vet, and while checking him up, they tried reading his heart rate using a digital stethoscope, but due to his heavy panting they could not establish the heart beat rate, the vet then gave him some liquid mixture of medications that slowed down his heart rate and stabilized his condition, then a heart beat rate was acquired an hour later, it was 100 beats per minute. The vet then told me to monitor him and give him another dose if he pants again, i gave him half a doze 12 hours later to stay on the safe side and he has been fine ever since he left the vets yesterday.The vet also mentioned that muffin will need to take this medication for a long time to maintain a stable heart beat. I will find out today what this medication is called.
I will also ask for the vet to test for pancreas inflammation. Also, no medications for pain have been recommended, the vet says all his organs are ok. i am considering having them perform another X-ray scans or ultrasounds. which do you think is more important?
Also, What do you think of all this?

It sounds like the veterinarian is modifying the reason for the enlarged heart. The condition you just described is more common in dogs and sounds reasonable. However, a few things need to be present in order for the heart to be considered main problem. First, the veterinarian should be hearing a murmur, which is a sound that indicates the blood flow is moving backwards. It is caused by a "leaky valve," or more clinically termed, mitral valve regurgitation. The other thing that needs to be present to conclude the heart is not maintaining body function is pulmonary edema (i.e. fluid in the lungs). This can sometimes be heard with a stethoscope, but more often it needs to be observed by x-rays. These are signs of heart disease and it can make the heart size bigger. Muffin's heart size on the x-ray was on the upper end of the normal range, but there were no signs of pulmonary edema. Therefore, I do not see a reason to conclude the heart is not maintaining body function. Also, you may see that there is no association with fats causing an increased heart size. The size of the heart is caused by a leaky valve, which is degenerative over time and is caused by age-related changes, but this does not require treatment unless there is pulmonary edema. It does not cause a hardened abdomen, which was Muffin's initial presentation. It does not cause diarrhea or excessive drinking either.

Has blood work been performed yet? Can you give me the name of the medication they used to slow down the heart?

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Customer reply replied 6 months ago
Hello Dr. Perry.
I took muffin in yesterday for another round of checkups. The vet checked his lungs for any signs of pulmonary edema and thankfully there was none, so lungs are healthy. He prescribed 2mg of Atenolol to give muffin daily for the next week, and since he's been on it for the past couple of days, he's been active and looking better. However, i did schedule an appointment for tomorrow in order to perform a new set of X-rays as well as the cPLI and a stool test too. His blood tests result were good, there was a slight increase in cholesterol levels only. Ive noticed that muffin has been drinking a lot more water, more than double what he usually has. Aside from all this, he has been eating his two meals everyday, pee and stool are normal. I also have been giving him multivitamins and Cellgevity which the vet recommended.

That sounds good. Let me know if you have any other questions. Would you please mind taking a moment to give a rating of the service you feel I have provided so far? Your rating does not close out the question and we will still be able to talk. I appreciate that very much.

Scott Perry
Scott Perry, Dog Veterinarian
Category: Dog Veterinary
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Hi,
I'm just following up on our conversation about your pet. How is everything going?
***** *****
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Customer reply replied 5 months ago
Hello Doctor Perry,Apologies for the late response, for some reason your email ended up in my junk mail, i just came across it while clearing out my junk. My dog is doing well, his behavior is back to normal, he is very active, and eats well. However he has been on Atenolol for the past three weeks and i am wondering for how long i am to give him this medication. What do you suggest? my vet asked me to bring him in for another round of x-rays and ultrasounds once a month has passed since he started taking his medications.
Thanks!

I think your veterinarian will tell you when to stop giving the atenolol. It is used to slow down the heart rate, so if the heart rate is normal then the medication can be slowly weaned at the recheck.

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