Question:

My niece’s Shih Tzu had two puppies. One was born with a flat chest and sometimes gasped for air. I took her to the vet at the emergency clinic to find out what was wrong with her. The vet did x-rays and told me she has Pectus Escavatum and said it was genetic. She also told me there was no cure and she may not last long and if she did, she would die at an early age and would never run a marathon. This little girl has stolen my heart.

I read on the internet surgery is an option. Can you tell me if it is worth my time and money for surgery and what are the risks? Will the surgery correct the problem? What can I do? She is 6 weeks old.

Tanya Shepherd
Gautier, MS

ANSWER:

Hi Tanya,

What an awful congenital defect! I have never seen this a true case of Pectus Escavatum in a dog but I am familiar with the problem and the debilitating effect it can have on a dog (or human for that matter!).

Pectus Escavatum is where the term ‘hollow chested’ came from and the chest has a sucked or hollow appearance. The sternum and several ribs growing abnormally and possibly displacing or rotating the heart cause the hollow appearance of the chest. There is a decrease in lung capacity and sometimes complaints of chest and back pain. The cause is somewhat unknown although increased pressure in utero is thought to be one possible cause as well as an increase in pressure or traction on the sternum because of abnormalities of the diaphragm.

There is some question in regards to how effective surgery is at alleviating the problem, at least in human medicine. It seems there is some debate on whether it actually improves the lung or cardiac function – that is open for discussion it seems.

Surgery in animals is believed to more effective then it is in humans although no one can really accurately judge pain levels in animals post surgery.

The good news is there are more surgical options for animals and the prognosis is good that it will correct the deformity. Vet Surgery Central Inc has some great information on the actual procedure.

These are the questions I would answer if she were my dog – some would be for your vet to answer, and some only you can answer.

1. Are there any other medical conditions relating to the heart and lungs that could impact her health? Heart murmurs are common with PE so make sure she does not have one and if she does, how will this effect her prognosis. Ask to see an Internal Medicine Specialist and have him do a cardiac ultrasound and EKG to check for other abnormalities before putting your pup through the discomfort of the procedure




2. Ask your vet for a referral to a veterinary Surgical Specialist. No one understands what goes into the procedure as well as a surgeon and although this is not a complicated procedure, it is not common and there are risks involved because of the potentially restricted cardiac and respiratory system




3. This is an ongoing procedure for at least six weeks that actually casts the dog’s chest. The cast must be replaced every two weeks, more if she is growing quickly. There is risk of infection as well as anesthetic death, pneumothorax, and bleeding into the chest if the heart or thoracic artery is punctured during the procedure. What is your ability to handle these issues? Ongoing care with multiple visits to the vet? Can you emotionally handle the procedure and risks? What is your ability to finance the surgery and this level of ongoing care?




4. This is a touchy subject and I am probably going to get deep-fried for saying it but sometimes in veterinary medicine, I wonder whether it is fair for us to do what we do to our pets just because we can. I have personal experience with this so do not think I am saying it lightly but I think sometimes in our attempt to keep our companions with us, we sometimes forget to ask whether it is the best thing for them. I know I have had second thoughts after going to the ends of the earth to save my pup and when her disease returned like we all knew it would, I let her go because I couldn’t put her through the necessary treatments a second time. I have spoken to others who felt the same way so I am not alone on this. This is not to say that you do not go through the testing and research stage of talking with a surgeon and internal medicine specialist but when you have all the information in front of you, make sure you are go through with the procedure for the right reason. If they say everything is wonderful and the prognosis excellent, then go for it. If they have any reservations about quality of life or anything after the procedure is complete, sit with your thoughts for a while and decide what is best for your pup.

Good luck and let us know how it goes. I feel for you – this is a tough decision.

Ann

PS Make sure your niece does not breed the dam and stud again! As a congenital deformity, it is best if both dogs are ‘fixed’ and the bloodline stopped.