Dear Dr. John,

We had our two dogs get their annual exams at our local clinic and were quickly concerned about the things we were told about our almost 14-year-old Cavalier King Charles Spaniel. She has always been pretty healthy other than a chronic dry eye condition.

She has been slowing down but does not seem ill. She has never had anything wrong with her heart, until now. The vet found what was called a grade 3-4 heart murmur. She also found her to have really bad teeth and a distended abdomen with possibly enlarged organs. Lastly, there were enlarged lymph nodes by her throat but also behind her knees. What could all of this mean? We were referred to internal medicine at a local specialty center for cardiology and more. We have an appointment in two weeks, and all is stable for now, but we are concerned. Can you give us an opinion on what to possibly expect?  C.B.

Dear C.B.,

All of this means that your dog is aging and succumbing to various conditions. I do not believe that they are related. Heart murmurs are common in the breed but typically many of these dogs have them at a much younger age and almost all have them by around age ten. Many can be managed and controlled with medication.

However, I am more concerned about the other changes that you cite. A distended abdomen with organomegaly or enlarged organs can suggest a mass in the liver, spleen, or other organs. Radiographs and/or ultrasound will need to be done and then a plan can be implemented from there. Complicating that fact is the enlarged lymph nodes. If they were limited to the retropharyngeal area near the angle of her jaw, I might attribute that to dental disease but located elsewhere could suggest a systemic problem, including a possible lymphoid condition, even cancer. A proper diagnosis will be necessary. Luckily, all is stable for now but swift intervention, as planned, will give you the answers to all of the physical examination findings. . Good luck.

Dr. John de Jong is President of the World Veterinary Association. He owns and operates the Boston Mobile Veterinary Clinic and can be reached at 781-899-9994.