I sent the dog to a vet who did the X-rays and the
ultrasound of the heart as well as pericardiocentesis as
I don't have the equipment in my very small practice of
50 sq m.
"The X-ray of the lateral view does not show a
mediastinal mass," he agreed that the ventral/dorsal
view had shown such a mass. Therefore, he did not
support my tentative diagnosis of mediastinal mass. More
investigations will be needed.
The dog's skin swelling returned to normal after a few
days of lasix. But the dog is fully cured.
An anterior
mediastinal mass could be due to a tumour like thymoma
or thyroid enlargement extending backwards and other
causes. The pericardial effusion fluid showed
mitotic cells. The ultrasound showed a heart mass
tumour. Reviews are necessary.
Pericardial effusion is seen on
echocardiography (right and above)
--->
The dog had no
more "double chin" 3 days after pericardiocentesis
and on furosemide injection and oral medication
which lasted 8 days. 13 days after
pericardiocentesis, the dog was reviewed. He had
put on weight and is no longer short of breath as
before. More alert and barks at outside dogs on
walk at night. The furosemide medication is
continued. "Spend more time with him," I advised
the owner. This is a beloved companion and a most
gentle big dog.
September 6, 2011
report
"Let him enjoy his life," I
said to the lady owner as I phoned her about the
2nd blood test done on Sep 6, 2011 and compared it
to that done in Aug 25, 2011 when the dog had
anaemia. Blood transfusion cost $1,200 when she
asked me. I had not advised her as I did not think
that this dog whose gums were pinkish would need
one and in any case, it would be costly. So, I
advised good food like liver, egg yolk, iron,
folic acid and multivitamin tablet
supplementation.
Compare the blood results
Aug 25, 2011. Can't breathe. I couldn't hear sounds. Double Chin. Both paws swollen and other
parts of body. I gave 60 mg Lasix Iv and sent to
Vet 2 for ultrasound, X-ray and 3rd opinion as to
the cause of this "double chin" which I suspected
was due to a large mediastinal mass. Cardiac
Tamponade. Pericardiocentesis done and goes home.
Vet 2 said possible heart tumour at base of heart
and mitotic figures seen in pericardial fluid
indicated neoplasia.
Aug 25, 2011
Haemoglobin 8.1 (12-18)
Red cell count 3.5 (5.5-8.5)
Sep 6, 2011. Left paw swollen slightly. Heart
sounds can be heard at 30% of the normal breed
size which was used as benchmark and teaching for
my assistant and the lady owner. The belly looked
a bit swollen when lying sideways. Lasix tablets
had been given for 8 days from Aug 25, 2011 to Sep
2, 2011. Then no furosemide. I had advised to
continue for the life span of the dog and so had
phoned the owner to come for review.
Sep 6, 2011
Haemoglobin 10.3 (12-18)
Red cell count 4.3 (5.5-8.5). > 20% increase in
red cell count due to good nutrition and
supplements.
I could feel the spleen much enlarged like a
child's shoe. That was not possible earlier.
X-ray did show splenomegaly. Bad news.
WHITE CELL COUNT normal range. However see the
composition:
Sep 6, 2011
WBC 8.5 (6-17) - normal
Neutrophils 57%
Lymphocytes 21% Monocytes 8.7%
Eosinophils 11.5% Basophils 1.5%
Platelets 316 (200-500)
PCV 0.27 (0.37-0.55)
Why the increase in monocytes and eosinophils? Is
it associated with splenomegaly and endo-parasites?
Heartworm blood test on 6 Sep was negative.
The Labrador now barks at passers-by outside and
is more active. No long walks. Urine colour now
much lighter and normal said the owner. Not so
thin as there is flesh above spinal process. But
weight was 35kg compared to 38 kg on Aug 25, 2011.
"The water inside the skin and heart must have
weighed 3 kg," the owner remarked. It was
possible.
HISTORY
Jun 21, 2011. Diarrhoea and fever. 2 days.
Recovered with tolfedine medication.
Aug 11, 2011. Very weak. owner gave tolfedine
medication 60mg tablet 2x/day for 2 days.
Recovered
Aug 16, 2011. Appetite normal but lethargic.
Aug 22, 2011. Neck swelling prominent. double
chin. Went to Vet 1 who diagnosed "fat" or suspect
cancer. X-ray abdomen and blood test normal.
Aug 25. 2011. Consulted me. Cardiac tamponade
based on ultrasound and X-ray. Pericardiocentesis
done by Vet 2. Medication for 8 days and advised
review after that.
Sep 6, 2011. Reviewed. Left fore paw swollen and
other signs as above.
Overall, the owner said by August 29, 2011, no
more double chin or preputial and other swellings.
However, I advised that the dog needs regular
monitoring and treatment. From her description of
"very red left eye" as spotted by Vet 1's nurse
before the owner consulted me and the swollen left
fore paw on day 13 after pericardiocentesis and
treatment, I suspect that the originating cause
comes from the left side of the dog's chest. But
what is it?
A heart base tumour as possibly detected in the
ultrasound? Mitotic figures were reported in the
pericardial fluid by Vet 2. The probability of the
dog having a tumour is high. Some mass on the left
side obstructing venous flow. There would be left
jugular vein distension if the case is presented
in a person but this dog has folds of skin and the
jugular vein would not be prominent. There is also
the worrying sign of a very big spleen that may
need to be removed later. A lymphoma is developing
in this dog?
In any case, the couple takes excellent care of
this dog and got him treated early.
TOA
PAYOH VETS
