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Dr. Kara
Dr. Kara, Board Certified Veterinarian
Category: Vet
Satisfied Customers: 15921
Experience:  Over 20 years of experience as a veterinarian.
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My 14 month miniature wired haired dachshund has never liked

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My 14 month miniature wired haired dachshund has never liked walking and sits down every 12 to 20 paces of mine. Everyone, my vet included has put it down to stubbornnes in dachshunds and she will grow out of it. I took her last week and another vet noticed her very laboured breathing. She had sedation and xrayed her and said she had a liver shunt. There was a large bulge on her heart. He said windpipe and lungs were good but she had a high level of bilirubin. A blood sample was sent off the lab and came back fine. The vet has now put her on heart tablets to make her heart work stronger to get all her blood going to the liver instead of leaking back to the heart. A breeder has just said it could be lungworm instead and another breeder has said she should have a liver biopsy. I am so frightened now. Her breathing is quite pronounced with effort and also resting. Will the heart tablets help this problem in a few days as the vet said it should. Please help me. Thank you. Rosalyn
Submitted: 2 years ago.
Category: Vet
Expert:  Dr. Kara replied 2 years ago.
Hello, my name is***** and I have over 20 years of experience as a veterinarian. I am sorry to hear that Charlie has a history of poor exercise tolerance, labored breathing and is now taking heart medications after diagnostic testing. If there is a bulge on her heart, and her bile acids test was normal then that would not fit with a liver shunt. It is more likely that Charlie has heart disease.
I am concerned that Charlie may have been born with a congenital heart defect. One of the most common ones we see is called a Patent Ductus Arteriosis (PDA). This is due to a vessel that shunts blood past the lungs when the pup is in the womb. Once the pup is born the vessel normally closes and normal circulation through the lungs results. If that doesn't happen the pup doesn't have normal blood flow through the lungs and thus poor oxygenation of the blood results. This would result in lethargy and poor exercise tolerance.
The murmur resulting from patent ductus arteriosis is fairly characteristic, but an ultrasound of her heart would be truly diagnostic.
Treatment is surgery to close off the abnormal vessel. PDA surgery is done at a specialty referral clinic or University teaching hospital by a cardiologist, not at a general practice, because specialized equipment and close supervision after surgery is needed.
Prognosis after PDA surgery depends what type of secondary damage the heart has sustained while it has been working extra hard and how development of the lungs is affected by poor circulation. The earlier in life this defect is corrected the better the pup does long term as a rule. If possible we like to diagnose and surgically correct this congenital condition early on in life, in the first few months of life if possible.
Sometimes if the defect is present too long and too much damage has been done then it is not possible to correct the defect and improve the pup's quality of life. In those cases drugs may be needed to improve the pup's quality of life.
The only way to know what we are dealing with is to have the pup examined by a cardiologist and have an echocardiogram (ultrasound of the heart) performed. There are other heart defects that are possible including aortic or pulmonary stenosis (narrow outflow tracts from the heart), heart valve defects, or a septal defect (hole between the two chambers on different sides of the heart) but all are best diagnosed by an ultrasound of the heart (echocardiogram) by a cardiologist which will also give you a very good idea of her prognosis and the damage done to her heart.
Here is a link to a very good write about PDA's, their diagnosis and treatment: http://www.animalmedcenter.com/faqs/category/patent-ductus-arteriosis-surgery
Here is a link to a list of veterinary cardiologists in the UK:
http://www.vetindex.co.uk/vetindex/cardio_ref.htm
Please let me know if you have any further questions.
Dr. Kara, Board Certified Veterinarian
Category: Vet
Satisfied Customers: 15921
Experience: Over 20 years of experience as a veterinarian.
Dr. Kara and 2 other Vet Specialists are ready to help you
Customer: replied 2 years ago.

Hello Dr Kara

Thank you so much. I am devastated to read your comments. I understood from the vet that the lungs on the xray were fine and that it was possibly the liver that was not right, but then the high bilidquin blood level was apparently all right and nothing to worry about. Please could you tell me also whether this should have been picked up throughout four visits to the vet last year when I mentioned each time that she would not walk and sat down and ran for a ball once and sat down. Hope you can answer and I appreciate your expert advice. Thank you Rosalyn

Expert:  Dr. Kara replied 2 years ago.
Rosalyn, of course you are upset because your puppy could be suddenly much sicker than you knew.
Sometimes the murmurs with these heart defects can be very subtle, and if the pup is growing well we may not think to look more closely. Most puppies don't have heart defects, so in a busy clinic with what seems to be a normal pup this could have been missed. Perhaps with a history of exercise intolerance though a closer look should have been taken.
But of course looking back and putting this all together it is easier for me to say what could be and what would fit with all that has now shown up. The important part now is for her to get a proper diagnosis and a plan to treat. It would have been ideal to find this earlier, no doubt, and because I haven't examined her perhaps this isn't as serious as I am thinking it may be. But if she were my girl I would want a cardiologist looking at her.
Please let me know what you decide to do, and the results should you decide to take her for a veterinary cardiologist to examine her.
Customer: replied 2 years ago.

Hello Dr. Kara

Thank you so much again for all that you say although I don't like to hear it. I will , of course, take her to a veterinary cardiologist and feel it is such a shame that one's local vet can't give this advice. Without your advice I would just rely on the heart tablets to do a good job and more time would be wasted. I will let you know what happens, if I may. Rosalyn

Expert:  Dr. Kara replied 2 years ago.
Rosalyn, I would love to hear what the cardiologist has to say, please do update me after your visit. Take care, and my best to your little one, Dr. Kara.
Customer: replied 2 years ago.

Hello Dr Kara

Thank you for your reply and concern. After the information I had from you I rang the vet who diagnosed the liver shunt and told him I was worried it could be PDA and asked if it an appointment should be made for Charlie to see a cardiologist and in the meantime continue with the tablets. He was very helpful and was very sure she had not got a murmur and told me not to worry and he was confident it was a liver shunt. Unfortunately I am going abroad tomorrow Monday and I was thinking of cancelling it, but he told me it was not so urgent provided she keeps on the tablets. So I am going for a week and leaving her with a very capable doggie minder and the vet will book a cardiologist if there is no improvement in her when I get back. I feel I have to have confidence that he is right. Difficult. If you have any comments, again, I would like to hear them please. Thank you. Rosalyn

Expert:  Dr. Kara replied 2 years ago.
Hello again, given that she has had this problem her entire life a few more weeks is unlikely to change things, so I think that you are fine to go abroad.
I am puzzled however that with a bulge on her heart on radiographs, and exercise intolerance that he believes that she doesn't have heart disease. It doesn't make sense to me to prescribe heart medication for liver disease either.
She may improve with the medications he prescribed simply because heart medications will help support a poorly functioning heart, so I don't see any contraindications for keeping her on them. I just can't follow his train of thought, and why they still believe that she has a shunt with normal bile acids. That just doesn't fit.
Enjoy your trip, just make sure the sitter is aware she should not be overtaxed and to keep her relatively quiet.

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