Visiting Vet: A Great Dane’s final journey

Pericardial effusion can lead to rapid deterioration.

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The phone rang. 10:30 pm. Alannah, a 6-year-old Great Dane, was acting oddly — restless, panting heavily, and occasionally making a “throat-clearing” noise. Late-night sick Great Danes alarm me. This breed has one of the highest incidences of my least favorite emergency — gastric dilatation and volvulus. GDV for short. Or as most dog owners simply say, “bloat.”

Here’s what happens. First, the stomach starts to fill with gas, and blows up like a balloon. We don’t know exactly why. What we do know is that it tends to occur in older, deep-chested, large- and giant-breed dogs, and it may be associated with eating too much too fast, especially dry food. In the early stages, while the stomach is still in a normal position, bloat can be treated with oral antigas medications like simethicone and, if necessary, by passing a stomach tube to release the gas. Left untreated, that inflated stomach may twist — picture Mother Nature making balloon animals. This incredibly painful situation compromises the stomach’s blood supply and blocks the outflow of gas and fluid. As the stomach distends even more, it puts pressure on major blood vessels in the abdomen, leading to circulatory shock.

Dogs with GDV don’t have much time. They need aggressive medical treatment and stabilization, followed rapidly by emergency surgery, or the stomach can die due to lack of blood supply. There is significant risk of life-threatening cardiac arrhythmias, before, during, and after surgery. Mortality rates are high, even with optimum care at referral hospitals staffed by specialists. Nowadays, if I see a GDV, I do my best to stabilize, then ship them to the mainland as fast as humanly possible.

But Alannah didn’t sound like classic bloat. Her owner said her abdomen wasn’t distended or tense, and as we talked further, I heaved a sigh of relief when I learned that Alannah had a prophylactic gastropexy when she was spayed. This is a surgery that tacks the stomach to the body wall, dramatically reducing the chances of GDV. So what was wrong with Alannah? She ate a treat when her mom offered one. We decided she seemed stable enough to wait until morning to see her regular veterinarian. I suggested antacids in case of tummy upset, and Benadryl to help her sleep, then went back to bed, grateful for owners like this one who save both dogs and doctors a lot of angst by having the preventive gastropexy surgery.

A few days later, I was on call again. Alannah’s owner contacted me a second time. She had seen her regular veterinarian after our first conversation. Nothing abnormal had been found, and Alannah had seemed better. But today she collapsed. A neighbor who also happened to be a veterinary technician had come over to help, and noticed that Alannah’s gums were extremely pale. “You better come right over,” I advised. When Alannah arrived, she was flat out in the back of the car. I checked her gums, and was surprised they looked fairly pink. “They really were almost white at home,” they said. So what diseases could cause symptoms like these that waxed and waned?

My first thought was hemangiosarcoma, a common tumor in middle-aged dogs that typically occurs in the spleen or heart base. These tumors cause periodic internal bleeding. If the tumor bleeds a little, then stops, the dog may just seem weak and tired, then bounce back. With large bleeds, dogs may become pale and collapse. In other words, symptoms can come and go depending on how much they are bleeding internally. This is a common history with hemangiosarcoma, and would explain why the regular veterinarian did not find anything wrong.

The simplest diagnostic tool for splenic hemangiosarcoma is abdominocentesis, which is tapping the belly with a needle and syringe to look for bleeding. I tapped Alannah’s tummy right in the car. No blood. Her gums were still pale pink, and she was looking more alert. Now what? If the problem was a heart base hemangiosarcoma, diagnosis would need x-rays … and my x-ray machine is in the basement. In my younger days, I wasn’t intimidated by getting a 110-pound sick Great Dane down a flight of stairs. Nowadays, well, let’s just say I’m feeling my age. “Let’s try to get her downstairs for pictures,” I said somewhat hesitantly. We lifted Alannah out of the car. She stood up for a moment or two then began to sway. Her gums went dead white, her breathing noticeably more labored. I grabbed my stethoscope. Her lungs sounded fine, but her heartbeat was so muffled I could barely hear it. “I think I know what’s wrong,” I said.

Pericardial effusion. A condition in which fluid (usually blood) fills the pericardium (the sac around the heart). It can be caused by cardiac tumors, or occur spontaneously in a syndrome known as idiopathic hemorrhagic pericardial effusion (IHPE). Initially signs can be vague, including weakness, lethargy, loss of appetite, fainting with exertion, and coughing. (Remember Alannah’s “throat-clearing.” Great Danes as a breed are predisposed to IHPE.) As the fluid increases, it progresses to cardiac tamponade, in which the pressure from the fluid prevents the heart from functioning properly. Signs include pain, restlessness, weakness, coughing, labored breathing, pale gums, muffled heart sounds, and sometimes sudden collapse and death. If cancer is the underlying cause of a pleural effusion, tumor removal and chemotherapy may be possible, but, more often, euthanasia is the only option. For IHPE, the blood must be drained from the pericardial sac, often repeatedly, and more than half the cases ultimately need surgery to make a permanent opening in the pericardial sac.

As we discussed options, Alannah’s condition deteriorated rapidly. Mother Nature was making the decision for us, whether or not my presumptive diagnosis was correct. Whether it was cancer-related or idiopathic hemorrhagic pericardial effusion, the prognosis was grim, even if she survived the trip to the specialists. The best thing we could do was give Alannah a good death rather than a difficult one. And so we did.

 

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