Blue
Sunday, August 3, 2025 at 11:14 PM
Subjective
Chief Complaint
Blue, a 7-year-old spayed female mixed-breed dog, presented for evaluation of chronic panting and progressive weight gain over the past few months.
History
- Owner reports that panting began approximately three months ago and has remained persistent, though not worsening.
- Panting occurs at rest and is not associated with exertion or ambient temperature.
- Weight gain noted beginning around the same time as panting onset; appetite has remained normal.
- No known exposure to toxins or changes in environment, diet, or medications.
- No history of coughing, exercise intolerance, fainting, or seizure-like episodes reported.
Objective
Physical Exam
- General Appearance: Bright, alert, and responsive; BCS 7/9
- Respiratory: Panting not observed in clinic; no increased respiratory effort or abnormal lung sounds auscultated.
- Abdominal Palpation: Soft and non-painful; no organomegaly, fluid wave, or masses detected.
- Mucous Membranes: Pink, moist; CRT < 2 sec
- Musculoskeletal: No orthopedic pain noted; gait normal
- Neurologic: Normal mentation and proprioception
Cardiology
- Temperament: Calm and cooperative during exam
- Hydration Status: Within normal limits
- Jugular Veins: Not distended; no pulsations noted
- Oral Cavity: Moist, clean; no lesions or dental disease
- Cardiac Auscultation: Arrhythmic rhythm noted; no murmurs detected
- Heart Rate: WNL
- Auscultation Quality: Good; no muffled or distant sounds
- Auscultation Rhythm: Irregularly irregular rhythm consistent with arrhythmia
- Heart Murmur Intensity/Timing: None appreciated
- Femoral Pulses: Strong, synchronous, and symmetrical
Assessment
- Arrhythmia noted during physical exam, not currently associated with clinical signs such as collapse, ataxia, or lethargy.
- No evidence of congestive heart failure based on auscultation and clinical findings.
- The arrhythmia is considered
low risk for sudden cardiac death at this time.
- Chronic panting is suspected to be non-cardiac in origin, potentially due to discomfort (e.g., early osteoarthritis, skin discomfort) or anxiety.
- Weight gain may be contributing to panting and decreased stamina but does not appear to be endocrinologic based on physical exam (no pot-bellied appearance, alopecia, or dermal changes suggestive of Cushing's).
- Skin abnormality noted and scheduled for removal and biopsy; unknown at this time if it contributes to systemic signs.
Plan
- Schedule surgical procedure for skin mass removal under general anesthesia with specific anesthetic precautions due to arrhythmia.
- Monitor arrhythmia perioperatively and consider post-operative ECG or Holter monitoring to further characterize frequency and severity.
- Consider initiating sotalol after surgical recovery to reduce arrhythmic episodes, depending on arrhythmia persistence or progression.
- Encourage home monitoring of respiratory rate and effort; recommend tracking sleeping respiratory rate (SRR) over the next two weeks.
- Weight management plan to be discussed at follow-up; consider diet adjustment and low-impact activity to help with panting and long-term cardiovascular health.
Client Discharge Note
Thank you for bringing Blue in today. We appreciate the opportunity to evaluate her and partner with you in her care.
Summary
Blue has been experiencing increased panting and gradual weight gain over the last few months. After a full physical examination, we identified a cardiac arrhythmia. The good news is that Blue is not currently showing signs of heart failure, and her heart size and function appear stable based on our clinical assessment. The panting is
not likely to be cardiac-related, and we suspect it may be due to another underlying issue such as discomfort, mild pain, or excess weight.
Key Topics We Discussed
Arrhythmia Management
- Blue has an irregular heartbeat, which appears to be
low risk at this time.
- She is not fainting or stumbling, and her pulses and heart function are stable.
- If the arrhythmia worsens or becomes more frequent, we may consider starting
sotalol, a medication to help regulate heart rhythm.
- Sotalol does not reduce the risk of sudden death, but may improve comfort and reduce the occurrence of irregular beats.
Monitoring Breathing
- Begin tracking her sleeping respiratory rate (SRR) daily to help monitor her comfort and detect any subtle signs of heart disease.
- If you observe any increases in respiratory effort, labored breathing, or resting panting, please let us know immediately.
Surgical Planning
- We plan to proceed with removal and biopsy of the skin lesion under general anesthesia.
- Her arrhythmia will be considered during the anesthetic protocol to ensure safety.
- Following the procedure, we’ll determine if additional cardiac work-up (e.g., ECG, echocardiogram, Holter monitor) is needed.
Weight and Activity
- Blue is moderately overweight, which may be contributing to panting and general discomfort.
- We recommend avoiding intense or prolonged activity, but encourage gentle walks as tolerated.
- A weight loss and nutritional plan will be discussed after surgical recovery.
Follow-Up
- We will call you 48 hours after the procedure to check on her recovery.
- Please contact us sooner if you notice fainting, excessive panting, lethargy, or changes in appetite, urination, or energy.
Thank you again for trusting us with Blue’s care. We’re here for any questions or concerns you may have.
— Dr. Judith Miller