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Oldish dog - decision on whether to do more tests

1036 Views 2 Replies 3 Participants Last post by  Laco
Hi everyone,

I have a 13 year old Staffie. Our vet has been aware of her having a heart murmur ever since we adopted her 3 years ago. A couple of weeks ago she started to develop a cough, initial it would just be when she started to play (after an initial couple of coughs she'd then be fine for the rest of the play session).

We told the vet this, and they said that given her heart murmur they'd like to do an x-ray. The x-ray revealed what looked like an enlarged heart, which the vet said was 'quite a cause for concern'. This seemed to fit in with the coughing, as I understand that an enlarged heart can cause fluid to collect in the lungs. They put her on vetmedin for her heart and vivitonin to help with her breathing. Initially her cough continued to get slightly worse, but after 4 or 5 days on the meds it has stabilised.

The vets also sent the x-rays to a specialist who spotted something in/on/next to her lungs and said this was now the main concern. They've suggested a CT scan and endoscopy to check her lungs.

Naturally the thought of losing my dog is very distressing, but I'm trying my hardest to do what is best for her. I think I should get the CT and endoscopy done (they would both be done in the same session), but I'd like other people's opinions.

It's possible that the lung problem is relatively easily treatable. Or it could be something serious such as cancer, in which case I'd then have the difficult decision of whether or not to put a fairly old dog through surgery, chemo etc. If the lung problem turned out to be untreatable, the vets would have at least identified the problem and would be able to medicate appropriately to minimize her suffering during her last days/weeks/months.

Two possible reasons not to get the CT and endoscopy done: it's putting her through more discomfort (although I would say this isn't a compelling reason - she'll be zonked out most of the time and won't know what day it is), and there's the risk of her not coming round from the anesthetic (given she's an older dog with a heart condition).

To add to all this, I understand that an enlarged heart really only has one outcome. With medication it can be controlled to some extent, but the life expectancy for a dog with an enlarged heart is at most a couple of extra years.

When I next speak to the vet I'm going to ask if he can give any indication of how much longer her heart will last ... although I suspect this is a very difficult question to answer. If the vet thought we were talking months then perhaps it's wrong to put her through the tests on her lungs?

Aside from these problems, she is generally in good health, and despite her age is still quite active. She trots along quite happily on her walks, looks bright, and still loves to play - people always say that she's like a puppy the way she plays, and don't believe us when we tell them she's 13.

Anyway, I'd love other people's opinions please.
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I usually ask/consider whether a diagnostic will change the way a given illness will be treated- if treatment would be the same whether it's a mystery illness OR disease x, then it really doesn't matter much. If there's something they would do differently to treat disease x, then better to test so you can tailor treatment better. Example, when one of my dogs had a mast cell tumor removed, I had already decided not to pursue further treatment (chemo, radiation, etc), so didn't take her for staging. I did take her to see a specialist when she had multiple enlarged lymph nodes which had needle aspirates repeatedly negative for lymphoma- the lab had suggested several differentials (sterile abscesses, fungal) that might be treatable, and I wanted to rule them out and/or treat if she had something which was easily treatable. The specialist was able to get a better LN sample via ultrasound guidance, and she did have lymphoma, which I decided not to treat due to her other health problems.

There's also the not knowing factor, which can be both good and bad. A lot of people who I interact with decline a biopsy of a growth because they'd rather not know, and wouldn't treat if it IS cancer. Others want to know so they can pursue further diagnostics and treatment if there is a malignancy. Still others just have to know, and/or are undecided as to where they'll go if there's a "bad" diagnosis. I don't think any of those choices is "wrong".

I think, "how will it change the treatment plan?", is an important question to ask regarding a given test, particularly with older or otherwise infirm/sickly dogs. If it won't change the treatment, or the treatment for a given thing you are testing for isn't something you would choose to do, I don't think it's necessarily the worst thing to decline additional testing and just treat symptomatically. Maybe ask what the differentials would be for the area of concern on her lung, and what treatment options would be feasible for a dog of her age and health status- if there is minimal benefit to be gained from the tests, I would be reluctant, but if there's a possible "easy fix" that would make the dog feel better for a longer period of time, that would sway me more toward considering them. Will it drive you crazy not to know?
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busannie gives you good advice. About all I can add, is it always boils down to quality of life, and that winds up being a decision only you and your Vet can make.
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