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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 33263
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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Hi Dr Deb I have a shit Tzu who will be 12 on 1st January. We

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Hi Dr Deb
I have a shit Tzu who will be 12 on 1st January.
We have know for a few years that Giddy has a heart murmer. Several weeks ago we took him to the vets as he had started to cough not a lot just occasionally like he had something stuck.
She said on a scale of 1 to 10 Giddy's heart murmer was a 6. She prescribed Vetmedin 1.25mg twice daily. He went for a check up on Monday and get a repeat prescription and she said things were just the same no worse. But she prescribed a course of antibiotics Oxycare 250 mg twice a day also Frusemide 10 mg even though she said his lungs were clear of fluids. Giddy has been really lethargic today and I'm worried it this new medication. Giddy can wee for England so I don't know why she prescribed those?
I'm sorry this is such a long question but I wanted to tell you everything to give you the whole picture.
Also Giddy takes Salazopyrin 500mg just 1/4 tablet once a day for Collitis.
Thank you Mrs P Maddocks
Aloha! You're speaking to Dr. Michael Salkin
The usual triumverate of drugs for dogs such as Giddy are pimobendan, furosemide, and an ACE inhibitor such as enalapril (which acts to lower blood pressure). We have considerable leeway, however, with the furosemide; the lowest effective dose is the correct dose. If coughing has abated with its use, it should be continued and you can find that lowest effective dose by trial and error. Please note that although X-rays may not reveal fluid in the lungfields, there still may be excess fluid present there which would be removed by a diuretic such as furosemide. That would be evidenced by Giddy peeing like a racehorse or as you said, "wee for England"!

Antibiotics aren't indicated unless bacterial infection can be documented by the presence of penumonia on X-rays, culture of a tracheal/bronchial wash, fever, and/or an increased white blood cell count. Oxycare is oxytetracycline which can cause gastrointestinal distress and malaise and considering Giddy's lethargy, should be the first drug to discontinue. Be sure to let Giddy's vet know what you've done, however. Giddy's sulfa drug shouldn't be incriminated in his malaise.

Please respond with further questions or concerns if you wish.
Customer: replied 3 years ago.
Thank you so much for your reply.
I think I will discontinue the antibiotics as I'm sure this is causing Giddy to be so lethargic today. Do you recommend him staying on the furosemide?
I'm thinking maybe go ahead with the ultrasound as the vet mentioned but said it wasn't essential it was up to us. What are your thoughts on this?
You're quite welcome. Once Giddy normalizes after withdrawing the Oxycare, as long as his coughing has abated you can see if a lowered dose of furosemide still works to control his coughing. If so, you can give that lowered dose less frequently and if that still works to control his coughing, you can stop dosing the furosemide altogether and see how he does. This is what I meant by trial and error. Please note that any time Giddy's cough exacerbates, you should reach for the furosemide first. It won't be harmful and can be life-saving.

An ultrasound is nice but not essential when myxomatous valve disease ("leaky heart valves") is expected in an elderly Shih Tzu. In the great majority of these cases, auscultation (listening to) of my patient's chest and three-view X-rays give me enough information. Please continue our conversation if you wish.
Dr. Michael Salkin and 2 other Dog Specialists are ready to help you
Thank you for your kind accept. I appreciate it.

I'm going to check back with you in a few weeks for an update. Feel free to return to our conversation - even after rating - prior to my contacting you if you wish.

Please disregard the info request.