If heart disease is diagnosed, the owner has to give the medicine diligently if she wants her beloved old dog to live long. Otherwise, the coughing recurs and the dog dies from heart failure.
Effective dosage is the key to success. This is done by observation of no coughing with minimal dosage and regular timing of medication. You cannot just forget one day or two.
An example of effective dosage is this 15-year-old dog. Every 2 weeks, the lady would come for the medication which is:
Body weight 19 kg. Vetmedin 5mg x 14 (1/2 twice a day) Fortekor 20mg x7 (1/2 once a day) Fursemide 40mg x28 (1 twice a day).
The dog is active and she is so happy.
-------------------
Treatment 1. Vetmedin. Congestive heart failure originating from valvular insufficiency or dilated cardiomyopathy in dogs. 2. Fortekor. Heart failure due to mitral regurgitation (endocardiosis) and dilated cardiomyopathy and chronic kidney disease in dog.
Frusemide 1-4mg/kg orally to clear fluid from the lungs as a diuretic
Calculated dosage
1. Vetmedin 0.2 to 0.6 mg/kg/day (half dose in morning and the other half 12 hours later). In this 19 kg dog, the dosage should be 3.8 mg to 11.4 mg/ divided in 50% 2 x /day
2. Fortekor 0.25 - 0.5 mg/kg once daily with or without food. In this 19 kg dog, the dosage should be 4.75mg - 9.5mg once a day.
3. Frusemide 1-4mg/kg orally to clear fluid from the body as a diuretic In this 19 kg dog, the dosage should be 19 mg - 76 mg once a day.
Effective dosage in this 19kg dog after 2 months of trial and error:
Body weight 19 kg. Vetmedin 5mg x 14 (1/2 twice a day) ie. 5 mg divided into 50% of 2 doses 2x/day Fortekor 20mg x7 (1/2 once a day) ie. 10 mg/once/day Fursemide 40mg x28 (1 twice a day). 40 mg 2x/day
CASE 2 There is another old coughing Chihuahua with congestive heart failure and abandoned by his owner who went to Thailand and now adopted by a young couple, doing well with the above-mentioned drugs for several months. Able to eat and no coughing. Once the drugs are not given, coughing recurs. Some cases may need injections to stabilise. Coughing affects the caring owner as the nocturnal cough can be quite stressful for the dog and owner.
My
dog's sclera has bloodshots and turns red specially at night. In the
morning its not that red. I dont know whats causing it. :(
REPLY FROM DR SING DEC 8, 2014
Pl send two images of the red sclera and eye involved..
3 IMAGES SENT
Sorry I couldn't get a clear photo. Attached are photos of his right
eye. It started on his red eye May (2014) this year. He's been on
different eye drops since then but nothing really helped. Now his left
eye are showing signs of bloodshots too. At first i thought it was
glaucoma but it's not. Vets here are also clueless as to whats causing
it.
EMAIL FROM DR SING DEC 9, 2014
Any image of lower half of sclera?
Im having a hard time taking pics of the lower part of his
sclera but right now its not red but it has blood shots as well. Thin
ones.
Are you a Vet? Where are u from? I just came across an
article online so i decided to email you. Im hope im not so much of a
bother. Its just that im worried about my dog I dont want him to go
blind. Ive already brought him to an animal hospital here in my country
but they also dont know whats causing it.
Which article you saw online? Which animal hospital and which country you are in?
Good morning doctor!
I think its your rticle about red sclera. I've been
searching the internet of anything that could help me figure out whats
causing the redness and bloodshots in my dog's right eye when i came
across your article.
I brought my dog to vip hospital (vets in practice) already
and recently in Animal House hospital here in the Philippines. But they
can't figure out whats causing it. Accdg to them his eyes seem normal
other than the redness and bloodshots of the sclera.
He's been on diff eye drops, ointments, steroids.. His eye
improved but the sclera is still the same. His blood test results are all
okay. His blood pressure is high so but even after giving him meds for
hypertension his eye didnt improve.
If you have any idea as to whats causing i hope you can help me.. Thank youuu so much. :)
This dog owner in her 50s with 2
children is one of those natural story tellers. She not
only could tell stories very well but the way she acted and told it
was a master performance.
"I was alone in the house when the 2nd attack occurred," she
said when I asked about her two domestic workers. "I
rolled up a carpet, pick up XXX (the dog being attacked). Yet
TTT held onto the left ear and chin of her sibling till gravity pulled TTT
down to earth. "Did TTT bite you?" I asked.
"No, she growled at me." the woman said. "That is why I boarded TTT
at your Surgery after the attack." TTT sounded like a ferocious Jack
Russell and I took precautions of muzzling TTT for examination after
the attack. Today was some 2 weeks later. The lady had now diagnosed
shingles infection linked to the dog attack, according to her
diagnosis. This is what she said to me.
"Two days after the attack, I saw a circle of 'insect
bites' on my right lower elbow area." She displayed her
wounds on the inner side of her elbow joint. They were now maroon
red with a black centre in the bigger wound.
"Are you sure that the circular line of wounds were not caused by
TTT biting you?"
This would be my first diagnosis although I am not a medical doctor.
"Well, TTT's teeth was sunk into XXX's left ear. I held XXX up till
TTT had to let go as gravity pulled her downwards. So, she
could not have bitten me."
The lady waved her hand up and down to show that she had held XXX
high up, until TTT gave up to the forces of gravity and dropped to
the ground.
"The next day, I felt tired," the lady continued. "Tingling
sensations rippled from under the skin of my right elbow to my back shoulder", she pointed to
her back. "More rashes appeared in the area. Watery blisters formed.
The tingling sensation was unbearable. I
quickly went to consult Dr Thiru, the
famous skin
specialist. Do you know him?"
"I don't know him nor have I met him," I said. "Is he the distinguished
looking man with
silvery grey hair and white sideburns?" I had attended a talk
given by Attorney General Walter Woon's lecture "Criminal Aspects Of
Medical Practice" to a full house of at least 1,000 doctors and
lawyers in the
Supreme Court Auditorium on Nov 30, 2009. The moderator was a doctor
who is a skin specialist. "Yes," she confirmed my
description of the good doctor.
"The doctor asked
whether I had been to the vet?" the woman commented. "Probably my doctor was thinking that
my right elbow I had been infected at your
Veterinary Surgery."
I don't think the good doctor would have thought that she was
infected by putting her elbow on the veterinary examination table
and got infected by Shingles. I don't know why he asked whether she
had visited the vet earlier.
"So, did he prescribe you the
antiviral drug?" I was more interested on the cure.
"He said to wait 3 days," the woman replied. "Then more rashes
appeared. They become watery and burst. I felt tingling, as if some
snakes were travelling up my hand to behind my back and forth. I
quickly went to see him. He was not available but his colleague gave
me the medication. Now I feel so much better and have the time to
quickly get my 2 dogs vaccinated."
"My sister had
shingles." I said. "The viruses travelled along her nerves in her leg
and the serpentine lesion manifested as snake-like in appearance."
This woman did not have the serpentine tracks as she had sought
prompt medical treatment. "If the virus completes the travel from
one end of the nerve, go round the body, the person will die," the
lady told me about a common Chinese belief. "That
is why the Chinese temple medium used incense to burn the shingles
skin. To kill off the head
of the snake."
"Some Singapore people don't know what is the cause of
this serpentine skin problem," I said. "So, they seek the help of
Chinese mediums."
The lady enlightened me: "Actually, shingles is the re-activation of the
chicken pox virus due to stress. The virus lurks in the body for a
lifetime. It is extremely painful, itchy and causes tingling
sensations."
This lady is surely knowledgeable about shingles. I just could not
believe that separating two dogs in a fight would lead to a shingle
infection as this lady was definitely in good health. I
believe that there is a remote possibility that TTT had bitten her
right elbow when the dog loosened her grip on XXX and was falling
down to earth. I mean, how would the lady know since she was highly
agitated and in that instant, TTT's bite would have resulted in what
she first told me as "circular rashes" in a small area in the inner
aspect of the skin of her right elbow. I remembered asking her to
repeat what she said. She said "circular rashes".
She
meant that she had rashes clustered in a circle. Or semi-circle. The
pain and tingling sensations could be due to the spread of
micro-organisms along the nerve and tissues originating from the
bite wounds. This condition is documented in the skin to owners
owners who had been scratched by the cat.
These bite rashes from the upper
and lower incisor teeth of the attacking dog would become infected.
That could be the reason that the first doctor did not think this
was a shingles infection. As for the appearances of more rashes in
the surrounding area, it could be due to the scratching of the
infected skin. This is my hypothesis which
I am sure the lady would not agree. I have not seen shingle
infections in human beings. Maybe they manifest as rashes clustered
in the circle too.
Medicine is full of diagnostic mysteries. I asked to see the inner or medial aspect of the elbow again.
I could see that the rashes covering an area of 10 X 10 cm of skin
in the elbow. The biggest rash was 8 mm in
diameter. It had a black centre. Other rashes were healing.
This is an incredible but true
story of an apparent shingles infection linked to dog assault. Did the attacking dog get any shingles
as well? She had really
blood shot eyes. Red sclera in both eyes after her ferocious lunge
for the jugular of the sibling who garnered more attention at home.
The redness in both sleras persisted for several days. So, would
this be caused by a virus activated by the high stress of trying to
get rid of the rival in love? A latent herpes
zoster-equivalent virus in the dog, a canine type of chicken pox
virus that gets reawakened in times of high stress? This dog was
lunging for the jugular of the sibling with only one intention. To
kill a rival in who is favoured
more by family members. But her attempt was thwarted and
now she was "in the doghouse". Or to be precise, waiting to be
rehomed (Re-homing picture must be
attractive).
P.S.
1. Herpes zoster (Shingles). Anybody who has had chicken pox
is at risk for developing shingles many years later. The chicken pox
virus lies dormant in the person's body. Stress or a decreased
immune system reawakens the virus, resulting in shingles infection.
It appears as a rash. Rashes cluster around the eyes, face or body.
The Shingles infection is also called herpes zoster. It is an
extremely painful and itchy condition. Early aggressive treatment
with antiviral drugs can lessen the length and severity of shingles
attack.
2. Red scleras in the dog. I had encountered a few cases.
Some are due to traumatic injuries. Some are a result of intense
rubbing of the eye arising from some chemical spills. I note that
there is a dog owner posting a picture of his dog with red sclera in
a local website called Stomp.
I had 2 memorable cases of red scleras in Jack Russells.
2.1 This Jack Russell had a chew rope stuck inside its colon for
some time.
2.2 This Jack Russell had intense abdominal pain and was vomiting.
Exploratory laporatomy revealed petechial haemorrhages in the
pancreas.
This present case would make it 3 memorable cases of Jack Russells
with blood-shot eyes. E-mail to
judy@toapayohvets.com if
you have seen more cases.
Most dog owners in Singapore live hectic lives. There are just too many distractions and too much work or enjoyment. After an intense period of love and care for their new puppies, the senior dogs are just left alone as there is no time for them after their puppy hood. It is usually too late for many old dogs when they are sent to the veterinarian for some chronic disease problems. Veterinary costs become high as the dog is in poor health and need more intensive care.
Senior dogs are: Small and Medium-sized breeds: Over 7 years Large and Giant-sized breeds: Over 5 years.
For those who may want their senior dogs to live longer, here are the following health screening recommendations by Toa Payoh Vets: 1. Veterinary examination every 6-12 months including examination for tumours and growths, ear infections, eye diseases and skin diseases. Skin diseases are the top 3 cases in Toa Payoh Vets. An educational video is at: Video: Microscopic exam of ringworm
2. Blood tests to check for blood disorders, diabetes, liver and kidney diseases. Special veterinary diets can be given to prevent further health deterioration when such health screening show disorders of the liver and kidneys, prolonging the dog's life.
3. Urine tests to check on bladder and kidney infections and presence of urinary stones. Urine tests for bladder stones 3-months or periodically after operation as advised by your vet, but many Singaporean owners don't bother and bladder stones recur 3 times.
Some owners euthanase their dogs when stones recur but others incur high veterinary costs to get them operated. Monitoring of the urine and X-rays as advised by your vet after bladder stone removal would have prevented much medical costs.
4. X-rays for arthritic hip joints (can't stand up easily), spinal column, heart and lungs. X-rays for bladder stones 3-months or periodically after operation as advised by your vet.
5. Ultra-scans of the abdomen for abnormal growths of the internal organs.
6. An MRI scan of the brain for brain tumours.
7. Dental check up and scaling every year. Prevention of oral tumours and oro-nasal fistulas (carnaissal tooth abscesses) in the old dog can be done if the owner checks his or her dog's teeth at the vet yearly.
9. A report and discussion about the delay in senility, obesity, behavioural problems, skin problems and any questions related to each individual dog. 10. Excision of small skin, mammary, circum-anal and other tumours. Tumours detected early can be excised saving the dog's life and reducing veterinary costs. Delaying treatment results in tumours growing and multiplying as in the circum-anal tumour. Many Singapore dog owners delay removal of their senior dog's tumours till they grown big, become smelly and bleeding, messing up the apartment. In such cases, the anaesthetic risks are very high and the dog may die on the operating table.
An example of the investigation tests and surgeries done for one older dog with heart disease and another with gum tumour is shown below
Case 1: Heart disease confirmed in an old companion
Case 2: Get tumours excised by your vet when they are smaller
Old dogs are very high anaesthetic risks as they are seldom in the best of health unlike younger ones. Everyone is happy when the old dog does not die on the operating table after surgery. But every vet will have cases of old dogs dying on the operating table as it is impossible to get good clinical outcomes when the vets undertake high-risk anaesthetics. This is one main reason why some vets discourage or reject old dog surgeries. "The old dog will pass away before the circum-anal tumours grow much bigger," one vet said to the owner. But the dog lived longer, splattering the apartment with blood from the bleeding tumour and requiring frequent cleaning up.
5646 - 5648. Mammary adenoma. A kind Buddhist teacher. No further news from the teacher as at April 4, 2013
When a dog dies on the operating table, it is just too emotional for everyone including the operating veterinary surgeon. Such deaths may be bad-mouthed by the owner or the family members to friends and recorded on the internet forum. The bad news adversely affect a vet's reputation that takes so much time and effort to build. So it is understandable if a vet does not want to operate on high-risk cases. I do avoid such cases if possible as deaths on the operating table means a beloved family member that has been growing up with the family children who have become adults is lost forever. The average life-span of a big breed dog is 12 years. Oldest small breeds in Singapore can live up to 20 years. However, many die before they are 10 years of age due to bad health and other preventable causes such as bacterial infection of the heart valves due to severe gum diseases (preventable by regular 2-yearly dental scaling and checks), pyometra (preventable by early detection or spaying), kidney diseases, diabetes and tumours like breast, testicular (undescended testicle), gum and circum-anal tumours (much less occurrence in a male dog that has been neutered).
Many diseases such as circum-anal and undescended testicular tumours rarely occur in male dogs that have been neutered. If you don't wish to neuter your dog, please check his backside monthly as small circum-anal tumours are easily removed and cost you less too. Tumours like breast tumours are best removed when they are small.
BE KIND TO OLDER DOGS & CATS --- GET TUMOURS REMOVED EARLY --- WHEN THEY ARE SMALLER. More case studies, goto: Cats or Dogs To make an appointment: e-mail judy@toapayohvets.com tel: +65 9668-6469, 6254-3326