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Heart disease or cancer?

Species: Dog
Breed: Chihuauhua
Age: More than 15 ye
Lazarus is still fighting. I appreciated that you understood my humor on the last post :-)

His cardiologist is a bit concerned that Lazarus has not responded as well as he should have under the current treatment plan. The cardiologist suspects that the pleural effusions are being caused not just by his bad heart but by other inflammatory or neoplastic processes.

I am trying to get to the bottom of this while keeping my puppy's best interest in my mind and heart. If such a case were to be presented to you, what tests/diagnostics would you recommend to ensure that Lazarus basic organs and systems are OK?

I was thinking of the following:

An abdominal ultrasound
full body 3-view x-rays
stool sample analysis
complete cbc
biochemistry blood profile
liver blood profile
kidney blood profile

Also, Lazarus has lost weight and muscle mass. His cardiologist has explained to me that that is a byproduct of his heart condition despite having a good appetite. Do you know of any highly caloric food supplement I could give Lazarus to supplement his feeding.

Like always, any insight would be greatly appreciated and thank you for your good sense of humor!

Online vet, Dr. Marie

Dr. Marie replied:

I'm glad to hear that Lazarus is still fighting! That's good news. But the fat that we can't keep on top of the fluid being produced is not a good sign.

For reference, here is your previous question.

Thank you for sending me the report from your veterinarian. I think that one of the most important lab tests right now is the analysis on the fluid that was removed from Lazarus' chest. One of the main concerns over his condition is that the fluid in the chest might be the result of inflammation or neoplasia (which means cancer). If one of these things is the cause of the fluid, then the fluid analysis really should give us some clues. If they see signs of inflammation or infection (which can cause inflammation) then appropriate medications can be given. However, if there are cancerous cells present then this is not a good sign.

Regarding what tests to do next, really this decision needs to be made by your veterinarian. I think that a full set of bloodwork is always a good idea. As they are concerned about ascites (fluid being produced by the liver), xrays and and abdominal ultrasound are probably a good idea as well to see if they can find something like a liver tumor. However, another more likely cause for the liver to be producing fluid would be because of the heart disease. A diseased heart will have trouble receiving the blood that flows back to it from the abdomen. This can cause a bit of a pressure backflow which can cause the liver to swell. The "fix" for this is to fix the heart problems. But, it sounds like everything that can be done for the heart is already being done.

The weight loss that you are describing is likely caused by something called "cachexia". Cachexia can be caused by heart disease or sometimes by cancer. This can cause animals to lose muscle mass even though they are eating well. Or, if they are not eating well, can cause way more weight loss than should be happening. The problem though is that you have to be careful what you feed an animal with heart disease. You obviously don't want to just pile on high fat and sodium foods to encourage him to eat as this would not be healthy for the heart.

The ideal nutrition for a patient with heart cachexia is one that has high protein, high fat with a good proportion of long-chain omega-3 fatty acids, moderate to low carbohydrate, and moderate to low in sodium. There are some prescription foods available that are meant for dogs with heart problems such as Hill's h/d. Sometimes if a patient won't eat h/d However, I have found that some dogs don't like the taste of this food...not all though. There are some home made diets that can be made, but it is often difficult to get the right balance of nutrients in a home made diet. This type of diet advice really should be given by your own vet though. You can ask them about trying a prescription heart diet or possibly giving you a recipe for a home diet.

Hope Lazarus continues to hang in there!

Dr. Marie

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.