"Your Pom has less than 1 week to live," I examined the
one-year rapid panting and gasping for breath open-mouthed
Pomeranian with a pad wrapped around her backside. "If you
can't help her to breathe normally."
2 days ago, the Pom coughed blood, splattering red clots onto
the apartment's floor. Vet 1 had warded her and advised
euthanasia a few times while the dog was treated past
midnight, according to the owner. "Your dog would need to be
hooked up permanently to an Oxygen mask," Vet 1 had said.
"Yet, I did not see the dog with the oxygen mask all the time
during treatment," the boyfriend commented to me. I did not
say anything as it was one side of the story.
In the morning, Vet 1 discharged the dog while another Vet 2
from the same practice gave a second opinion and medication.
Vet 2 said: "This dog will live from 1 month to 1 year."
48 hours later, I was consulted, being referred to by the
owner's 2 friends. It was kind of Vet 1 to give the two X-rays
of the heart to the owner so that there was no waste of time
for second opinions. Even the Singapore General Hospital where
I had a chest X-ray recently does not do release X-rays to the
patient.
"The vets said that this tablet will reduce the size of the
enlarged heart." I shook my head. "Or stop it becoming more
enlarged." I did not comment as there might be some
mis-communication. I need to check this medicine out.
The dog's heart was beating too fast. I passed the microscope
to the Temasek Polytechnic Vet Technician intern so that he
could hear abnormal heart sounds. "Can you hear the
'whooshing' heart sounds in the stethoscope?" I asked him.
"Normal heart sounds are distinct." He nodded his head. I
offered the stethoscope to the young lady. She declined. This
was too stressful. The dog was about to die from heart failure
soon. His tongue was purplish.
However, I immediately gave an injection of 20 mg Furosemide
from the one ampoule of Lasix IM in the left muscle of the
thigh. There was hope. Then the dog was crated while I showed
the lady pictures of the normal heart in X-rays from Vet
Medicine text book.
"Is it dangerous to the heart if the dog has more than 1
X-ray?"
"No," I said. "Your dog had only 2 X-rays at Vet 1 and never
had X-rays before."
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Vet 1's X-rays |
Toa Payoh Vets'
repeat X-rays, as requested by the owner |
"Please take another
X-ray," the lady said. I was surprised by this request.
"The X-rays from Vet 1 are excellent," I advised that there
was no need for more X-rays. However the lady insisted. It was
10 minutes after my Lasix injection.
The young Pom was barking loudly and her breathing was normal.
She passed out a lot of urine. Lasix had reduced the amount of
water in the lungs by getting the kidneys to increase urine
floe. The onset of diuresis is within 1 hour. So the dog felt
normal now.
As the duration of action is 6-8 hours, I got the Pom
X-rayed 4 hours later by Vet 4. It was also good to discuss
this case with him. Vet 4 proposed cardiac ultrasound to check
whether there was pericardial effusion which could be treated
via ultrasound imaging. Also, ultrasound could reveal any
disorder of the tricuspid valve.
"Would the Lasix resolve any pericardial effusion?" I sought
his opinion. He nodded his head. He had one case of success in
draining the pericardial fluid from a dog who is still alive.
"The owner is concerned about the cost, saying she had spent
$800 at Vet 1 and 2." Now, X-rays and a cardiac ultrasound
could add up to $400. Vet 4 reduced his fees while I forgo my
consultation fee so that this Pom could get the ultrasound
done. His fees were a low $171.00. I appreciated his kind
gesture and agreeing to X-ray despite the fact that Vet 1's
X-rays were good. I charged $96 for the medications. The owner
had spent nearly $1,000 which is a large sum for a young lady.
The dog went home on a strict advice to stay at home and
3-hourly medication for the first week and communication with
me. No more fun and exercise at East Coast Recreation Park.
"How log will this dog
live?" I asked Vet 4. "Vet 2 had said up to one year."
"Vet 2 is a bit too optimistic. This dog is unlikely to live
past his 2nd year birthday."
The lady owner was extremely sad that there was no cure or
drug to reduce the size of the right side of the heart. Her
dog was a living time-bomb.
This was a young dog. A
present from her boyfriend. With no more outdoor
activity, strict compliance to taking drugs, a
proper diet and giving medication when the dog started panting
past midnight, the Pom is still alive at this time of my
record today, Sunday Sep 27, 2009. It is only 7 days since the
Pom coughed out blood, but there was no more horrible panting
episodes now.
UPDATE ON SEP 29,
2009
The heart medication was running out. The young lady owner was
quite happy compared to 7 days ago. The Pomeranian looked
normal and had gained weight.
Strict
compliance to giving of drugs was the reason for
success. The battle is won but the war of the congestive heart
failure is not over.
In the past 7 days, this was done. Every 3 hourly, 3 mg of
Furosemide (10 mg/ml given at 0.3 ml) was given without fail.
Every 12 hours, 1/4 tablet of Fortekor 5 mg tablet. Dog was
not allowed outside the apartment. "Dog was breathless when
let outside to the corridor," the young lady now stopped her
dog from venturing outdoors.
"At 4 pm, the dog panted. Why? Was the drug ineffective?"
We came to the conclusion that it was the boyfriend coming
back from work at that time and the dog was excited to see
him.
 Antibiotic
syrup (once a day), multi-vitamin syrup (once a day),
multivitamin paste (1 teaspoon twice a day) was also given.
Vegetables and home-cooked food.
Dog food pellets available at all times. Dog was said to pass
thick urine. Overall, the dog was leading a normal life for
the past 7 days. Furosemide at 5 mg every 6 hours has been
proposed while Fortekor 5 mg will be
given as before. Low salt diet. Potassium supplementation.
The young lady and her family had saved the dog and nursed her
back to good health. Heart drugs will not work
effectively later and the young lady was informed accordingly
to prepare for the worst.
UPDATE IN AUG 5, 2015
This Pom lived for around 1.5 years after diagnosis.
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TOA
PAYOH VETS