Judge John Hodgman Episode 183: Vehicular Hound Inside

| 10 comments

Alexa brings the case against her mom, Leslie. Leslie loves her dog Boo and takes her everywhere. Alexa says her mom allows Boo to do whatever she wants, like riding in the front seat of the car and often in her mom's lap. She believes this behavior is unsafe, both for her mom and the dog. Leslie claims she has Boo's well being in mind, and that her behavior is perfectly fine. Who's right? Who's wrong?

Thanks to Kathleen Keating for suggesting this week's case name! To suggest a title for a future episode, like Judge John Hodgman on Facebook. We regularly put a call for submissions.

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EVIDENCE

Submitted by Alexa

Exhibit A: Photo of Boo

Exhibit B: Dog car seat, similar to the one Alexa gave her mom

Comments

How is Boo now?

This is one of my fav episodes and every time I re-listen I wonder, "How is Boo doing now? Does she like her special dog seat in the back? Is she still getting chicken nuggets in the drive through?"

I have a dog that I spoil so I just want to know.
(and no, she does not ride on my lap when I'm driving. If I'm riding in the backseat, well, yeah, she's on me then. :))

L.

How is Boo now?

This is one of my fav episodes and every time I re-listen I wonder, "How is Boo doing now? Does she like her special dog seat in the back? Is she still getting chicken nuggets in the drive through?"

I have a dog that I spoil so I just want to know.
(and no, she does not ride on my lap when I'm driving. If I'm riding in the backseat, well, yeah, she's on me then. :))

L.

Turner & Hooch

I feel it's a massive oversight that The Right Honourable Judge John Hodgman, when discussing the hypothetical car-non-restraint-related death of Hooch IV, neglected to mention that this echos a technique used by Turner to kill a villainous henchman in the original film, in which he buckled his seat belt (whereas the henchman had not) and intentionally drove into a wall. Without acknowledging this, you miss the extra layer of pathos due to Turner's guilt over failing to take into account his prior experience.

Data

loved the show. I was hoping I would hear some statistics on irreversible consequences involving dogs. I guess I will have to Google it.

John Oliver Tonight

Judge! Jessie!
You have probably already been inundated with comments about this. Last week on the John Oliver show they showed a clip of a few good men made to be acted out by dogs. This plays directly into your intro in this weeks episode. See the clip below. https://www.youtube.com/watch?v=NiHh8NPN8fY

Wheezy the dog

Wheezing like that is very common in Lhasa Apsos. It's the common genetic defect associated with the breed. My family had 3 Lhasas when I was growing up & each dog had it.

Is the lady sure her vet is qualified? It's a bit strange that he would a) not know about this basic ailment, & b) start freaking out about it...

In defense of the vet

It was actually the vet tech who was alarmed and put Boo on oxygen; the vet has just been compassionate. Wheezing is common, but hers is severe and it has strained her heart. Her heartbeat has been irregular and slow, so that started the heart investigation. She is on albuterol to help her wheeze less and enalapril to open up her blood vessels and enhance blood flow through her heart (won't back up into her lungs). Her hear is no longer as enlarged since she started on the medicine. The next medicine she might have to take is (you won't believe it) is Viagra! It relaxes the blood vessels in the lungs and lessens pulmonary hypertension. This is all on the advice of the cardiac vet specialist. (This comment is from Leslie, Boo's mom.)

More about your Case:

I have been trying to read the entire case but I can only find bits of it. Im guessing boo is your dog and I understand that the dog has what was thought to be just an irregular heart beat and wheezing ( which as I have read is common in the specific breed). I also read that you are a cardiac vet specialist. So my question is, how did you, do you know when this combination is more then just a common arrhythmia and wheeze? In humans it's pretty clear ( for the most part) that wheezing is a sign of a lung issue, with an arrhythmia of course both heart and lungs would be monitored and there is that chance of a more severe issue). But I'm confused when it comes to a dog prone to both. I have a lasa that I can clearly hear an arythmia/ irregular heart beat; I found this after listening to a short wheezing episode that I believe came from the mouth not the nose. His breathing sounds good, I don't hear any signs of fluid in the lungs. He breathes rather heavy through his nose ( common in this bread I think from what I read but it's a lot of work for him to breath compared to my other lasa). He has always been lazy, yet plays like a puppy ( he is a little over 2 years old). However, he has recently not been able to jump like he use to. He struggles to jump on my bed ( he is not over weight and has no ortho or muscle issues). He also has slowed down on his stamina when playing, but he's growing out of the puppy play age so that maybe expected. The vet I spoke with doesn't seem to think that there's any reason for any testing, I made him draw blood to atleast get WBC, En. Levels etc. But my dogs ( Motley "Motty") symptoms seem to be gradually getting worse ( very gradual, slowly). So I being an over protective mom or do I have evidence to be concerned and push for further testing ( with a different vet). ?

Wheezing dog; irregular heartbeat

Hello Someone,

I'm sorry it took me so long to answer this. I just now saw it. Let me tell you about Boo to give you a clearer idea of why I was concerned.

I go to a very good regular vet, or so he seems to me. I ask him many questions and his answers make perfect sense. I am a clinical nurse specialist in pediatric and cardiovascular critical care and a nurse anesthetist, so I do know a wheeze when I hear one. All along, my vet and I have compared dogs and children; they have an amazing number of physiologic similarities.

Boo is old, about 13 1/2 years old. She had no problems until she was about 11, when the vet first noticed that her heart rate slowed substantially and frequently, but she appeared otherwise well. Aging people do this too, so we both attributed it to an aging process in a dog. She had no real symptoms, so there was no reason to treat her. She certainly didn't need a pacemaker (although you might give an adult human a pacemaker for the kind of problem she was having).

At 12 1/2 she started wheezing. It was pretty obvious: she would stop what she was doing, plant herself, and use all her abdominal muscles to exhale. Her exhalation was a long, loud, low-pitched, harsh whistling sound. Then she would cough up phlegm and swallow it (as children do). I gave no thought to her arrhythmia, but was concerned about her lungs. So, I took her in to be seen.

The vet examined her, listened to her lungs and heart, and heard what sounded like a leaky heart valve. He got an X ray which showed overinflated lungs (like asthma or COPD) and an enlarged heart. He called a cardiac vet, who recommended an ultrasound of her hear (echocardiogram), so we got that. I take care of cardiac babies with this same picture, and untreated, this can be a miserable experience of suffocation and exhaustion. I didn't want her to suffer unnecessarily if there was a treatment.

The echocardiogram showed that her left heart (atrium and ventricle) were dilated and not pumping blood well. The dilation was stretching a valve and causing it to leak. Apparently the blood was backing up into her lungs and had raised the pressure in her lungs (pulmonary hypertension). This caused the right side of the heart to fail as well. All this heart enlargement may have caused the arrhythmia.

They treated her in a step wise fashion: First, they put her on enalapril. It is used to reduce blood pressure in hypertensive people and animals. It works by opening up and relaxing the blood vessels so the heart does not generate so much pressure. It is also used to treat a failing heart, because opening up the blood vessels makes it easier for a weak heart to pump blood out to the body and NOT back up into the lungs. The side effect, though, is inadequate blood flow to the kidneys and kidney damage or failure, especially in an older dog (or human).

After a month we checked her kidney function (blood work) and it was fine. Her echocardiogram was a tiny bit better but her wheeze was still just as bad, so the next step was to add albuterol to treat her wheezing. It dilates the bronchi and also increases heart rate a bit. In Boo's case, it was a great combination. After another month her wheeze was better (though not gone) and her heart function had improved a little more still. Most important, the progression of high blood pressure in her lungs had been reversed somewhat. That's what would kill her: pulmonary hypertension. Her kidney function was still good. My vet checked with the cardiac vet, who recommended against any more aggressive treatment for now. Believe it or not, they would have used sildenafil aka Viagra to treat pulmonary hypertension. It works well for this in animals and in human children. No comment on adults.

We agree that we just want Boo to be comfortable-no extraordinary measures.

I think the take home messages are (and feel free to let your vet read this):
This breed and a lot of flat nose dogs make a lot of horrible snorting noises because of their facial anatomy.
It is easy to confuse noisy nose breathing with noisy chest breathing, but that's what vets are trained to do.
Common things are common; rare things like COPD are not the most likely problem.
Even so, especially if Motty has symptoms the vet has not seen, you may be right. Try recording the sound on your phone.
Ask questions until you understand what is going on. If your vet is dismissive of your concern, this is not a good relationship for you, your dog, or the vet. You are Motty's mom and you have a right to know (look up the Patient's Bill of Rights (for humans). I think it applies here just as it applies to parents of human children, who cannot speak for themselves).
Not all tests give all answers and you want to be selective about the tests conducted. An honest and careful vet will avoid unnecessary tests. This is both for Motty and for your bank account. In Boo's case, it was an abnormal chest X ray that revealed more and the blood tests were later and of a different sort to test her kidneys specifically (BUN, creatinine, potassium primarily)
It is perfectly fine to seek a second opinion if you are truly worried. You should be able to enjoy your dog and if a second opinion will set your mind and heart at ease, go for it. I would just try to go to a vet your friends rave about.
If that vet agrees with your vet, then you can rest assured that you have done everything a good mom would do for her dog. Just like siblings, they are all so different. They both may run track, but one's a sprinter and the other a marathoner. This breed in particular likes to lie around a lot, interspersed with short bursts of energy. If she has always been lazy, she will probably be even more so.
Finally, I think it is wonderful that you love your dog so much and just want the best for her. So don't beat yourself up.

Leslie

PS I hope that helped.

Loved this episode! I was

Loved this episode! I was laughing all the way from start to finish. Lovely litigants.