ASK THE VET

Heart condition complicates dog’s health issues

6/16/2013

I have read your article “bump on dog's gums could be very serious” and would like to ask your advice. My dog (Cairn terrier, 13 years old) had an epulis two years ago, and the vet surgically removed it. It has grown back, and even though it doesn't seem to affect my dog, I believe it needs to be removed.

However, my dog is old and has multiple problems such as enlarged heart, bad lungs, and arthritis. He is on Furosemide and Enalapril, but his breathing is labored even if he walks a little.

My question: Considering my dog’s heart problem and his age and fearing that he would not tolerate anesthesia, do you think I could let that tumor be and wait to make sure it doesn’t grow too big?

I am going to attempt to answer your question in three parts because it is a complicated condition.

The first part is the growth on the gums. You mentioned it was diagnosed as an epulis, of which there are a few forms that vary in severity. There is a fibromatous type which is a benign variant that contains relatively little bone tissue. These are problematic if they lead to infection or cover teeth that become abscessed. An ossifying epulis is harder but still generally only a problem in the impact on the underlying bone or tooth structure. An acanthomatous amelioblastoma is a more aggressive tumor that arises from the enamel and can be destructive and invasive.

These growths also need to be differentiated from more aggressive oral cancers such as squamous cell carcinoma or melanoma, so a biopsy would be needed to know for sure.

However, some types of epulis have a characteristic look and feel, so your veterinarian may have been able to establish a diagnosis without a biopsy.

His heart condition is the more serious part to address. If he is not managing well, his medications may need to be adjusted and potentially a third medication called Pimobendan might be added.

The two medications he is taking lessen the workload for the heart but help improve the function. Pimobendan is class of drug called a positive inotrope which increases the strength of the heart’s contractions. It is not appropriate for certain types of heart disease, but if he has congestive heart failure it may help improve his quality of life.

If his heart condition can be adequately managed and he is doing well, anesthesia can be appropriate and safe if certain precautions are taken. Depending on the type of growth, aggressive surgical removal may be needed.

You and your veterinarian can determine what is the best course of action. Generally tumors in the mouth are much easier to remove when they are smaller.

However, I think you should visit your veterinarian to determine what more can be done for his heart condition.

Questions for Dr. Gary Thompson can be emailed to askthevet@theblade.com or mailed to The Blade, Attn. Ask the Vet, 541 N. Superior St., Toledo, OH 43660. Dr. Thompson regrets that he cannot answer individual letters.