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I have a 14 year old American Eskimo Mix with A LOT going…

I have a 14...

I have a 14 year old American Eskimo Mix with A LOT going on. He was diagnosed with Cushings in January, developed a suspected macroadenoma but on MRI there was no macroadenoma but localized brain atrophy was discovered. He was put on Selegiline. Then he developed seizures. We added Zonisamide and he has been doing well, considering. Today, at his chiropractic appt. the vet noticed a Grade 3 heart murmur (he had sometimes registered a Grade 1 intermittently throughout the course of his life. What should I be asking/looking into as it relates to the murmur--I certainly don't want him to now go into CHF or have it missed because it resembles some of the symptoms of the other struggles he is having. He has a neuro re-check on 4/4.

Veterinarian's Assistant: I'll do all I can to help. Seizures always look scary. Let's get you talking to the Veterinarian. What is the Grade's name?

The dog's name? Henry. I am also unfamiliar with this service. What is the fee and how does it work?

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

No. Just that it was Grade 1 which was only heard sometimes by some vets and today it was Grade 3.

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Answered in 17 minutes by:
3/27/2018
Sheena Christensen
Category: Dog Veterinary
Satisfied Customers: 56
Experience: Emergency Veterinarian at Willamette Veterinary Hospital
Verified

Hi there! I am Dr. Christensen. It sounds like you and Henry have been through a lot. It is good to be proactive when it comes to heart disease, and it sounds like you are doing just that. Give me just a moment to write up some of the things you should be asking about/looking for.

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Customer reply replied 3 months ago
Thank you. Also I just want you to know that I am assessing Quality of life daily and keeping a daily log of healthy versus illness related behaviors and he is scoring quite well. In fact today someone thought he was a puppy! He certainly is not and is very ill I understand but I want you to have a visual of a mobile, often happy, lizard hunting dog :)

I am glad to hear that you are both monitoringhis quality of life and that it has been really good. It sounds like you are a very proactive owner.

Things I recommend for patients with heart murmurs:

1. He should have some chest x-rays done. If he has had some in the past, that is even better, as the veterinarian can compare the size of his heart then to the size of his heart now. With heart disease, hearts will typically become larger. Even if he has not had xrays done prior, he should have them done now to assess the size and shape of his heart. This can be done at your regular veterinarian.

2. I would recommend he has an echo done. This is basically an ultrasound of his heart and will give the definitive diagnosis of what is causing the heart murmur and what the appropriate treatment is for the specific cause. Some general practice veterinarians have this capability, but you may get the most helpful testing and information from a veterinary cardiologist.

3. Watch for signs of heart disease. This includes coughing, being more tired than usual, and an increase resting respiration rate. You can monitor his respiration rate when he is resting (count number of breaths in 15 seconds and them multiply by 4) and then compare that week to week. If that number starts to increase, it may be due to heart disease.

The good new is that there are medications that can be started and given daily that will allow him to continue having a great quality of life for a long time. We used to wait until dogs were showing clinical signs of heart disease, but recent studies are showing that starting meds sooner is proving to be helpful.

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Customer reply replied 3 months ago
Thank you so much. That is very helpful. It’s tough because prior to the macroadenoma suspicion there were some who were suggesting euthanasia at that time. It is hard to put him through more testing post spinal tap, MRI, ultrasounds etc. but if there is a medication that can help? That might help us hang on a bit longer.

There are absolutely medications that can help and all of the tests can usually be done while they are awake or with mild sedation (depending on how well he tolerates holding still). I would absolutely continue to go forward if you have assessed that he is still a mostly happy and energetic guy. It sounds like you are very attentive and will know when his quality of life is suffering.

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Customer reply replied 3 months ago
Today wasn’t the best day so it’s tough. Quickly what would be a normal respiration rate? Ie x breaths per 60 seconds...

Resting respiration rates can vary, but I would say at his size 20-40 would be normal.

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The best way to monitor is to watch for trends. So monitor it tonight when he is resting. Do that again in a couple of days, and again a couple of days after that. Then you will have an average for him. Then as you monitor it going forward you can watch for it changing from his normal. So if his normal is 20 per minute but next month it is 40 per minute, you will want to get him in for evaluation.

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Please let me know if you have any further questions, I am always happy to help. Also, your positive review is greatly appreciated. You can do this by clicking on the stars at the top of your screen.

Wishing you and Henry all the best. I know these times can be very difficult as you navigate multiple illnesses. It sounds like you are doing the very best for him.

- Dr. Christensen

Sheena Christensen
Category: Dog Veterinary
Satisfied Customers: 56
Experience: Emergency Veterinarian at Willamette Veterinary Hospital
Verified
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That is the sweetest photo. Thanks for sharing it <3

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Hi,
I'm just following up on our conversation about your pet. How is everything going?
Sheena Christensen
Ask Your Own Dog Veterinary Question
Customer reply replied 2 months ago
Im so sorry I never saw this for some reason! I was signing in to check in with you again as consulting with you has been on my mind weekly.
Customer reply replied 2 months ago
It was difficult to get into the cardiologist until 4/25 and then she had an emergency pacemaker, so she cancelled. I was very disappointed after waiting so long yet I’ve been charting his respiration-at-rest daily since we spoke and it’s always under 40. Neurology re checks have gone well and no more seizures and no wetting the bed episodes for some time.So, the latest is that he can no longer go on his daily walk, even shortened. I had assumed this was cardiac or Cushings related but now I’m concerned he is in pain and it’s a pain issue. Then he rallied and started playing with his too big brother and got injured, rested for two days, and then immediately reinjured himself trying to chase a bird. Since then he has been very unhappy. His chiropractor is ordering an Assissi Loop for pain Mgmt.My concern, based on my own obsessive study, is that he has a cervical injury or IVDD or Wobblers. Based on the injury in action (shoulder collapsed, held front limb out in flexion, limping, etc. ) these are my novice conclusions.I feel like there are so many specialists and no one is treating the whole dog but me, the non vet! I’m desperate to know is his disposition pain? Neurological? Cardiac? Cushings?If he is in tremendous untreatable pain (he’s on too many meds to take anything else) from a cervical issue, I don’t want to put him through Cardiology treatment but ...I’m just confused.His quality of life has declined since Feb but he still scores as acceptable with my husband and I completing separate analysis in case I’m too biased.Who can help me diagnose some of my hypotheticals? What procedures would that involve? Is it still a question of pain Mgmt anyways since he is 14 and they have all said not a surgical candidate?
Customer reply replied 2 months ago
Some update huh? ;-)
Customer reply replied 2 months ago
PS Cardiologist rescheduled for 5/9 and on cancellation list for sooner if possible.
Customer reply replied 2 months ago
I’m so very sorry I didn’t see your follow up question from 3/29 until now (!!!) as I’ve been wanting to reconsult with you and thinking of checking back weekly.It was difficult to get into the cardiologist until 4/25 and then she had an emergency pacemaker, so she cancelled. We are rescheduled for 5/9 but I was very disappointed after waiting so long —-yet I’ve been charting his respiration-at-rest daily since we spoke and it’s always under 40. Neurology re checks have gone well and no more seizures and no wetting the bed episodes for some time.So, the latest is that he can no longer go on his daily walk, even shortened. I had assumed this was cardiac or Cushings related but now I’m concerned he is in pain and it’s a pain issue. He was doing great in the beginning of April and started playing with his too big brother and got injured, rested for two days, seemed better and then immediately reinjured himself trying to chase a bird. Since then he has been very unhappy. His chiropractor is ordering an Assissi Loop for pain Mgmt. She suggested it was strain or sprain.My concern, based on my own obsessive study, is that he has a cervical injury or IVDD or Wobblers. Based on the injury in action (shoulder collapsed, held front limb out in flexion, limping, head hanging low sometimes, etc. ) these are my novice conclusions.I feel like there are so many specialists and no one is treating the whole dog but me, the non vet! I’m desperate to know is his disposition pain? Neurological? Cardiac? Cushings?If he is in tremendous untreatable pain (he’s on too many meds to take anything else) from a cervical issue, I don’t want to put him through Cardiology treatment but ...I’m just confused. Mostly, I don’t want him suffering.His quality of life has declined since Feb but he still scores as acceptable QOL with my husband and I completing separate analyses in case I’m too biased.Who can help me diagnose some of my hypotheticals? What procedures would that involve? Is it still a question of pain Mgmt anyways since he is 14 and they have all said not a surgical candidate? Is a cervical slipped disc or IVDD just an X-ray or another MRI?
Customer reply replied 2 months ago
My new question seems to be getting rejected. Not sure if I’m using the app correctly. :-(
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Category: Dog Veterinary
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