Naples Daily News' "Dr. Fox Animal Doctor" column today seemed to send mixed a mixed message.
In the first letter, "LAJ" explained that her 9 year old 20 pound beagle mix was seen by a vet who noted a heart murmer and suggested taking the dog to a cardiologist. The owner continued that her dog was quite active and was asking Dr. Fox's opinion. His reply was that unless the dog "had poor execrcise tolerance, coughs frequently and/or has a swollen abdomen" he would avoid "costly diagnostic tests."
His next letter, from "PL" concerns a senior cat who was howling in pain and could not move his hind limbs. The owners took the cat to the local emergency clinic where it was euthanized. The Dr. repsonded that this "painful and terrifying malady" was due to a blood clot in the hindquarters called thrombosis, which can be treated if small, but that euthanasia was appropriate.
Here is the mixed message and my disagreement with the advice given - and the advice left out:
In letter number one, it should be noted that by the time a dog exhibits poor exercise tolerance and is coughing - or certainly has a swollen abdomen, the dog would be in congestive heart failure. At this time , compromises to the heart muscle that are not reversible may have already occurred. In a one yr old dog with a mild murmer, (which just means that one of the heart valves is leaking) and no clinical signs, it might be appropriate to treat conservatively, but a 9 year old dog is a different story. Evaluations of heart size, ability to contract properly, and severity of the leak may lead to appropriate, convenient treatments to prevent or prolong the time before congestive heart failure occurs. These "costly diagnostic tests" don't seem quite so costly when compared to an emergency hospital visit and intensive care treatment as well as the stress from seeing your beloved pet suffering and struggling to breathe that often goes along with congestive heart failure.
In letter 2, Dr. Fox is correct in noting that a saddle thrombus is a painful condition in cats that often does not respond well to treatment. What he neglected to mention was that this condition is most often a complication of - HEART DISEASE. In cats with a condition called hypertrophic cardiomyopathy, the muscles of the heart wall thicken causing the heart chambers to become smaller compromising the heart's ability to pump blood. Since the blood is not pumped as it should,along with other complicating factors, the static blood sitting in left atrium can begin to clot. Portions of the clot can break loose and lodge where the large vessels supplying blood to the legs split and stop blood flow, causing pain and even tissue death. Sometimes, this can be the first indication that the cat has any sort of heart disease. In cats that have HCM and have the potential for forming these clots, medication to thin the blood and address the cardiac compromise can be provided to reduce the chance your cat will have to experience this "terrible malady." Cats that are prone to developing HCM like Maine Coon cats can now be screened with a blood test to help evaluate disease status. Take home message - don't wait for until it becomes an emergency - and know the rest of the story.
Dr. Reiff
