Pulmonary Disease or Disorder

Question: Hello Dr. Mike:

My 15 year old Westie, Whiskers, has been diagnosed with an enlarged heart. He also has a cough in the evening that is like he is trying to hack up a fur ball. He coughs about 4-5 times every evening and about 1-2 times during the day. My vet has given me amniophyllic tabs for his cough, but nothing for the enlarged heart. The only thing she told me to do was put him on a salt-free diet, keep his weight down to 24-25 lbs. and give him exercise. I have found a dog food that is very low in salt, less than 10 mg.

My question is is there anything else that can be done for the enlarged heart. She said there is no water around the heart. He is a very healthy dog except for these symptoms. He still has his cough, but she has advised me that the amniophyllic tabs are the best medicine for this cough. She did not say if it was related to the heart symptom.

Are there questions I should be asking my vet? Whiskers is a very active dog for his age. He likes his 1 mile walk every evening. With him being such a healthy dog, this is the first sign of a problem, I am not sure what kind of questions I should be asking, or what I should be looking for. Any advise you can give me will be greatly appreciated.

Thank you. Karen

Answer: Karen-

Westies are very prone to pulmonary fibrosis. This isn't a disease that veterinarians see very often, so it may be worthwhile to ask your vet if there was any evidence of this problem on the X-rays. If she isn't sure it might be a good idea to have the X-rays reviewed by a veterinary radiologist to make sure that pulmonary fibrosis isn't contributing to the problem. Aminophylline is a commonly recommended medication for pulmonary fibrosis so it would help if it was present.

While there isn't much proof, a lot of veterinarians believe that piroxicam (Feldene Rx), usually dosed at 0.3mg/kg every 24 to 48 hours, is helpful in reducing the pulmonary inflammation and making respiratory effort easier for affected dogs.

Right sided heart failure is a common complication of pulmonary fibrosis and so it may be present due to an underlying problem with pulmonary fibrosis. On the other hand, there may be no pulmonary fibrosis and your Westie may just have chronic heart failure like many older dogs do. If that is the case, there are several additional medications that may be helpful as time goes on. Enalapril (Enacard Rx), furosemide (Lasix, Rx) and digoxin are commonly used medications that all have a place at some point in treating heart disease.

When treating pulmonary fibrosis the most commonly used medications to control the coughing are corticosteroids. Traditionally this has meant using prednisone orally, but recently there is a lot of interest in using inhaled corticosteroids since there are fewer long term side effects with these medications. Again there isn't much strong scientific evidence for or against this therapy but it is similar to the use of inhalers for asthma in cats and there is a good reference to that in one of the recent "Kirk's Current Veterinary Therapy" books (XIII ?). Some vets also use azathioprine (Imuran Rx) as a substitute for corticosteroids, especially when chronic long term use seems necessary. Cough control is seems to be somewhat controversial but if the cough gets really severe using butorphanol or hydrocodone to control it seems reasonable, at least short term, to me.

I hope that your Westie is still doing OK and that this information is helpful in the future if things get a little worse.

Mike Richards, DVM 11/15/2001

Pulmonary congestion

Question: My French bulldog seemed to get sick suddenly last week. Lethargic, slow on his walk, then shivering. It has been very dry here, and I have felt like he had allergies related to dryness, etc. They did not seem severe enough to get concerned. Last week then I took him to his vet who did blood work, x-rays, endoscope. His lungs are very congested. His blood work is normal..no elevated white count. He seems very sore.. Seems to hurt to pick him up.

This little dog has never been sick in his 5 1/2 years. No elongated soft palate, his nose opening was widened early on. Very slight evidence of collapsed trachea..vet says not serious enoough to cause such congestion. I asked prognosis and he said "guarded".

He has been taking amoxicillin, 200 mg. 2x a day, albuterol sulfate 1/4 of 2 mg. tab 2x a day, and 1/4 of 10 mg torbutrol 2x a day. He .seemed to be doing better and was taken off the torbutrol today to start Theo-Dur 300 mg. 2x a day tomorrow. I have a strange feeling about Theo-Dur...can't explain. My pharmacist said it seemed kinda strong to him for a little dog like Cowboy.

(He weighs 32 lb.) Just a little while ago he had a reverse sneezing episode that scared us. He hunched up, moved around, became glassy eyed. I felt he was in pain. I gave him the torbutrol and after a while he relaxed and went to sleep. (Was very thirsty and wanted ice.)

The vet won't, or can't, say what is wrong, except that there is nothing anatomically wrong with him. What do you think? Are we doing the right thing? I know to expect respiratory problems with bulldogs...but not so suddenly and so severely, esp. in a seemingly healthy animal. Hope you can help. I feel his little life is hanging in the balance!

Thanks so much, Jean

(All the symptoms etc. are very new to him..none of this has happened before.)

Answer: Jean-

It is likely that your veterinarian has been considering the possibility of heart problems as a potential cause for the congestion in the lungs but you didn't list ECG or cardiac ultrasound examination among the tests, so it seems like a good idea to point out this possibility. I don't know of any specific heart problems in French bulldogs but individuals of any breed can develop heart related problems.

Allergic bronchitis can lead to pulmonary congestion when it is severe but that is often possible to detect with bronchoscopy and cytology (which was probably done during the endoscopy). Controlling this can sometimes only be accomplished by using corticosteroids but that is a problem if there is fear of an infectious cause.

Upper airway problems can lead to pulmonary congestion but it doesn't sound like that is a problem. Cancer is always a concern in non-responsive lung diseases but also is probably not highly likely.

We don't use Theodur (Rx) much, but only because I haven't felt like it did a lot for the patients we have tried it on. We have had a little nervousness in one patient while using this medication but no significant side effects other than this, that I can remember. So I tend to think it is reasonably safe but am not convinced it is all that effective. That's just my personal opinion, though. Lots of vets do use Theodur and think that it helps.

We see dogs that are afraid to be picked up when they pulmonary congestion from either lung disease or heart disease. I think that the pressure on their circulation from being picked up makes them uncomfortable or is frightening. Again, this is my personal theory, not something I know to be fact.

I would recommend asking for referral to a veterinary college or referral center for a second opinion. When dealing with a disease or disorder that isn't responding well to treatment and that seems as if it might be life threatening, getting a second opinion is important. Your vet has done a good job so it seems like it would be best to get a second opinion from a place with multiple specialists who can confer. This would be especially true if the condition is not heart related. Pulmonary congestion that isn't from a heart problem and isn't responding well to standard treatments is a difficult problem.

It is important to continue to seek a solution to this problem, whether you choose to work with your vet or to seek help through referral to a veterinary college or large referral center.

Mike Richards, DVM 1/6/2000

Degenerative lung disease (pulmonary fibrosis)

Question: Hi,

Do you have any information on the following condition and is there anything we can do to help our dog? After taking our Westie (7 year old spayed female) in to be examined for a dry hacking cough that wouldn't go away, she has been diagnosed with degenerative lung disease (pulmonary fibrosis). I have already been to the veterinarian, had bloodwork done, and was referred to a veterinary internist. At first the vet thought it was a problem with her heart since it was enlarged and there appeared to be fluid. But the internist said that was because the soft tissue of her lungs is hardening or turning fibrotic and those areas can't accept oxygen, so her heart is having to work harder to supply enough blood to the areas of her lungs that can accept oxygen. I can't seem to find any information on degenerative lung disease in dogs, what causes it, what exactly it is, what can be done, any new research or holistic treatments, etc. The Internist gave us a pill that acts like an inhaler but we were told she may only have another 2 to 3 years to live. The Internist had only seem a few cases of this (it's pretty rare) in his 20 years of practice. None of us smoke and since we have had her (since she was 2 years old), she hasn't been exposed to anything bad for her lungs. However, we found her running the streets when she was about 2 years old and she had a yellow sticky coating all over her that took several baths to get off. But that was several years ago and she only started experiencing symptoms within the last 3 months. Is there anything we can do to slow or stop the progression of this disease (interstitial lung disease)?

Thanks, V. L.

Answer: V.L.-

Matt Mellema DVM, who was at the University of California at Davis in 1998 (and probably is still there) is studying (or at least was planning on studying) this specific disease in West Highland white terriers. Your internist may be aware of this, but it might also be worth asking him or her if they are aware of this study. It would probably be possible for your vet to reach Dr. Mellema at UCD.

According to information posted on the Veterinary Information Network (www.vin.com), this condition may be heritable in Westies. There is a similar condition in humans known as idiopathic pulmonary fibrosis. The information posted presents a pretty bleak prognosis for most patients with this condition but suggests that 1 in 5 dogs may be responsive to therapy with corticosteroids (based on information from humans), making them worth trying as long as infection is not secondary problem at the current time. In addition, theophylline or terbutaline may be beneficial. Albuterol (given by nebulizer) has proponents and detractors but given lack of medications that seem to work well for this condition it seems worth trying. Oxygen would probably be helpful late in this disease, as it is used in humans with emphysema and other pulmonary disorders, but it is tough to use oxygen in dogs and allow them any quality of life.

Hope this helps some. I expect that there may be more information available on this condition as time goes on, so please feel free to check back and see if I can find anything.