REVIEW OF AN UNUSUAL CASE

"I paid over $700 and the vet does not know what's wrong with my dog!" the owner had to paid for the emergency treatment for continuous panting which started on Friday at around 6 pm. She brought him to the emergency practice at 10.15 pm and the next morning, the dog was still furiously panting.

"It is not easy to diagnose what's wrong in some cases of uncontrollable continuous panting," I told the owner. I auscultated the lungs and heart on this fine sunny Saturday morning of Oct 26, 2012 at 10 am. The lung sounds were harsh and loud - the rhonchi and the rales of bovine pneumonia as that was what was taught in my Glasgow vet school in my final year in 1974.

Basically these were descriptions of the crackling noises in the lungs obscuring the heart sounds. Dr Jason Teo closed the muzzle while I placed the stethoscope inch by inch on the cardiac area of the left chest. I heard a "machinery murmur" in the midst of rapidly beating heart. It was just impossible to hear anything.

The dog had been panting non-controllably since 12 hours ago.

HISTORY
Thursday, Oct 25, 2012 - Nothing wrong. As usual playing on his own. Excellent appetite as usual.
Friday, Oct 26, 2012 - Did not poop since Oct 24. Brought him downstairs to walk and poop in the morning at 10am.  Walked for only 10 minutes in the car park, not hot. Dog wanted to go home. Ate t home.
Then at 6 pm, dog started to pant heavily and continuously and at 10.15 pm, owner brought him to the emergency centre.
 

TOA PAYOH BLOOD TEST ON OCT 27, 2012  AROUND 11 AM on admission to Toa Payoh Vets. The dog had been treated by Vet 1 on Friday evening and overnight and had done a great job. But the owner was not impressed as the dog was still panting continuously. 
13 kg  39.3 C. The significant findings are shown below:
 

The problem for me on this Saturday morning and afternoon was that the dog kept panting after the sedation of dom + ket given at 50% IV wore off. Continuous panting started after 2 hours. Gave IV diazepam, lasix and usual IV drips. At times, the tongue turned cyanotic. The panting was still continuous throughout the night but at 50% lesser pace. Nothing seemed to control it.

SUNDAY
Panting still persisted esp. after the owner visited with her 85-year-old mum who was most worried. The dog tried to stand up despite sedation. The owner changed the water bowl and wiped the dog. I told her not to stay more than one minute as the dog got excited and panted again. But she would not listen. The dog had "recovered" but that was due to medication. Soon the dog started to pant continuously again. "The dog is very sick and should not be visited," I said to her. One of my other clients said to me: "You are harsh to her." I told him that I had spent my Saturday afternoon ensuring that this dog's health was deteriorating and it should not be excited by getting up to greet the owner. I understand that the owner was anxious and worried to see her dog but visits ought to be very short in the interest of the canine patient.   

"Do you visit a person in intensive care and change the bandages?" I asked her. "Let the dog rest and recover. If you insist on visiting the sick dog, please consider another clinic." It was a busy Saturday afternoon for me, trying to stabilise this dog as his panting would return once the sedation wore off. This was an unusual case but not uncommon.

If this dog kept panting for many hours and days, his heart would fail and he would die. The owner must understand the situation and not insist on patting the sick dog for the first day at least.  

MONDAY
Got owner's permission to do X-rays of chest and abdomen again, ultrasound of abdomen (no gall bladder obstruction or pancreatitis, liver enlarged, urinary stones x2) and ultrasound of the heart (one coronary artery blocked 30%, dilated cardiac myopathy right heart). Panted again when brought to X-ray but much less.

TUESDAY
On heart medication. Dog no longer panted and the owner came to bring him home. Panted when brought out of the cage.

ADVICES
Some bacterial attack in the blood causing such sudden onset continuous panting. This would be my tentative diagnosis. Ultrasound did show 30% blockage in one coronary artery and Vet 3 diagnosed dilated cardiac myopathy of the right heart. Acute bacterial pericarditis?

The dog is obese and so high cholesterol and triglycerides were found. The dog should stay at home. Not going out for one month. No greeting neighbour's dog. Heart medication and H/D diet. This is an unusual case as continuous panting had persisted for over 48 hours despite medication. I agreed with a poor prognosis from Vet 1 but veterinary medicine is full of surprises. The dog survives after intensive treatment.

My associate vet said to me: "Better not to handle this case." I understood his concern he did not want any litigation and complaints if the critically ill dog with no hope should die at Toa Payoh Vets. Dogs do die and many owners don't forgive the vet. So I understand his advice. Yet, for this owner, it is hard for her if she had to go to the 3rd vet as time was of the essence in treating a continuous panting dog.  
 

Wed Oct 31, 2012 at 7 pm, I phoned the owner as to the status of the panting of her 3-year-old Tibetan Spaniel weighing 13 kg and on heart medication.

She said: "He pants a little. But yesterday night, he slept well. Today he does not want to eat much. Usually he is very greedy. I tried feeding him the H/D diet but he would have none of it."

"It is expected as the H/D diet cannot be appetitising to him, " I said. "Just give 5% and mix with his usual chicken meat less fat."

"I gave him the dog treats which I had bought a lot," the owner did not heed my advice not to feed the red and green coloured rectangular pieces of dog treats as they might be the cause of bacterial infection in her dog. The total white cell count during the emergency and my treatment were very high, indicating a bacterial infection. A serious type of bacterial infection that cause continuous panting and heart attack on Friday evening and only on Tuesday morning was the dog back to normal breathing. But it is hard for the owner as the dog did not eat at all.

If the dog does not eat much, the owner is worried. The dog is recovering from a major infection and so may not have appetite. But it is best not to feed the processed dog treats as the quality is unknown. Many dog owners are not that well educated on this aspect.

In conclusion, the dog had short episodes of panting during walks and had recovered but this time, he just had uncontrolled continuous panting. A bacterial infection of the blood was present. As to the source of the bacteria, it could be from the dog treats or the soil during exercise.

UPDATE ON NOV 11, 2012
18 days after the first consultation. The dog no longer pants and starts to eat his usual favourite food. The dog is given heart medication.