"Listen to that, Doc," said Mr. Hart. "B.D. has been doing that all week. It was not so bad earlier, but I can barely get any sleep for his coughing most of the night." As if to prove Mr. Hart's point, B.D. conveniently obliged with a coughing spell as he walked into the exam room. After a few seconds, the 9-year-old beagle regained his composure enough to wag his tail at me. "Hi, B.D.," I said. His tail wagged faster. "You said this just started this week?" I asked Mr. Hart. "Yes," he replied. "He has coughed off and on before, but it has been pretty much every day this week." "You mentioned that he has been keeping you up at night. Is he coughing more at any particular time, like nighttime when he is resting, or after exercise?" "It seems to be mostly at night. See the rings around my eyes from lack of sleep?" I smiled. Mr. Hart was obviously exaggerating. "Is B.D. on heartworm preventatives?" I asked. "Yes, he is on that monthly heartworm preventative." "Has there been any lapse in you giving it to him?" I asked. "No," said Mr. Hart. "My wife makes sure that he gets it the first of every month. She puts those stickers on the calendar and crosses them off when she gives it." "Have you seen any changes in his behavior, other than the coughing?" I asked. "Is he as active as usual?" "He has not been running around as much as he used to do," Mr. Hart replied. "He liked to chase the squirrels in the backyard, but I have not seen him do that lately. He has not even been going full force at the mailman like he usually does. He just barks where he is lying instead of rushing to the door." "How has his appetite been?" I asked. "Has he had any vomiting or diarrhea?" "I guess he has been eating okay, maybe not as fast as usual. I have not seen any vomiting or diarrhea." "Has there been any sneezing or any discharge from the eyes or nose?" I asked. "No," said Mr. Hart. "Everything else has been okay." "Well, let's take a look," I said. We put B.D. on the exam table. I listened to his chest with a stethoscope. "B.D. has a heart murmur," I said. I looked back at his previous exams. The heart murmur was new. "His lungs sound a little raspy, like he may have some fluid in his lungs. After I finish examining him, we need to get some x-rays of his chest." The x-rays showed some enlargement of the heart. There was fluid in his lungs. I showed Mr. Hart the x-rays. "The heart is a little enlarged," I said. "The heart gets bigger in an effort to keep the circulation going. That works for a while, but now it has gotten to the point where the heart is getting a little backed up. That is why fluid is building up in the lungs. The reason you are hearing more coughing at night is because when B.D. lies down, it makes it harder for the heart to keep the circulation going. When fluid builds up like this, it causes coughing. B.D. is trying to cough up the fluid. "We are going to need to start B.D. on a diuretic to get some of that fluid out of his lungs. We will also start him on antibiotics because fluid in the lungs predisposes them to infection. Sometimes we need to add other medications that ease the load on the heart. "We will get some bloodwork to see how the organs are fairing. Since the liver is one of the major abdominal organs that feeds blood to the heart, when there is a backup, the liver can become engorged and experience some dysfunction. Other organs can also be affected. "You should consider taking B.D. to a cardiologist. A cardiologist could do an echocardiogram and get a baseline on how well the heart is functioning at this point. Other medications might be needed to help the heart work better." We got the bloodwork and started B.D. on the diuretic and antibiotics. The results did show that the liver was being affected, and we made some dietary changes to help that. Within a few days of starting the medication, there was much less coughing, and B.D. had regained some of his old energy. The mailman was having to be on his guard again. The owner opted to see the cardiologist, and a medication that dilates the blood vessels was advised. This decreased the force necessary for the heart to effectively pump the circulation throughout the body. B.D. responded well to the medications, and Mr. Hart got to get some sleep. -Reggie R. Cox, D.V.M., is a graduate of the University of Missouri, Columbia and co-owns and practices at Prime Care Animal Hospital, a small-animal practice located at 750 Route 3 South, Suite 12, Gambrills, MD 21054. She can be contacted at 410-923-7387 or faxed at 410-923-3630.

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