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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 30376
Experience:  University of California at Davis graduate veterinarian with 45 years of experience
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I have a Great Dane with cardiomyopathy and

Customer Question

I have a Great Dane with cardiomyopathy and kidney disease. Yesterday his right leg bothered him and by afternoon his whole elbow was swollen like a baseball. We took him to the vet and by the time they got him and we left -- about 4 hours -- it had moved all down his leg. She said it was edema. Gave him pain pills and antibiotics. We had to force the meds down hi. This morning -- as he wouldn't take them. Now his leg is about 2-3 times larger all the way down his leg -- and he has a bubble now in his chest / arm pit area that is starting to swell -- the size of a large egg. How do I know if this is just edema or related to his heart condition. He is within months of passing from his heart -- is this a sign?? His cardiologist is not in on the weekends and his regular does not seem alarmed -- but I am. Please advise...
Submitted: 2 years ago.
Category: Dog
Expert:  Dr. Michael Salkin replied 2 years ago.
I'm sorry to hear of this with Ralfie. There are three main considerations in such a presentation. The first is that right-sided heart failure is causing a dependent edema. This is treated with diuretics and heart drugs rather than antibiotics. The second is hypoalbuminemia - low serum albumin level caused by loss of albumin through his diseased kidneys. Albumin is a small protein needed to keep fluid within vessels and out of interstitial spaces such as you're currently seeing. This is difficult to manage but diuretics and an ACE inhibitor such as enalapril are often prescribed. The third and least likely considering his history of heart and kidney disease is that the fluid represents lymphedema - an accumulation of protein-rich fluid due to poorly functioning lymphatic vessels often due to the accumulation of malignant cells from a distant site or locally in cases of cancer of the lymphatics - lymphangiosarcoma. His regular vet should take another look at Ralfie and treat according to the guidelines I posted above. Please respond with further questions or concerns if you wish.
Expert:  Dr. Michael Salkin replied 2 years ago.
Hi Fran,

I'm just following up on our conversation about Ralfie. How is everything going?

Dr. Michael Salkin