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View Full Version : Advice needed-does Vetmedin cause lethargy



motte platts
5th July 2008, 12:45 PM
I adopted a 5 yr old in February and this week after a lot of coughing last weekend, the vet diagnosed CHF and prescribed Vetmedin and a diuretic. Since taking the medication she has become increasingly lethargic to the extent that I have to lift her out of her bed to go in the garden to pee etc. (She will still come at dinner time but goes straight back to her bed afterwards). Last evening as she came to her dinner bowl she had difficulty standing and eventually seemed to loose the use of her legs and lay down but stayed conscious. I rang the vet who thought it was low BP and said to stop the meds last night. She was okay after about 20 mins, ate her dinner and went back to bed. This a.m. the vet said to stop the diuretics (she is hardly coughing) and to give only 1 vetmedin 2.5 mg per day. She is still very lethargic and I don't know if this is her heart weakening or the effects of the medication.This is all made worse as I adopted her from an English lady in France and I cannot take her back to UK to see my UK vet until August when her passport will be valid. Any ideas much appreciated. Jan Platts

Cathy Moon
5th July 2008, 02:16 PM
I'm sorry this is happening to you. Would it be possible to take her to see a cardiologist as soon as possible, rather than a regular vet?

Has the vet performed an ultrasound on her to diagnose the exact problem? I wonder if in your dog's case maybe Vetmedin isn't the correct drug for her. A cardiologist will factor in everything about her to determine which drugs are most appropriate.

Another idea - maybe her potassium is low from the diuretic. Could you feed her a small amount of banana twice per day to see if that helps?

My cavalier boy Geordie, who will turn 5 this month, has had an ultrasound and xrays, and he is taking Enalapril rather than Vetmedin. He just started coughing in June, and has been taking Enalapril since June 18. He improved within 2 days of staring the drug. And he took a diuretic for 10 days, and we gave him banana with his Lasix tablets.

sallymum
5th July 2008, 07:22 PM
I have had 2 cavs on Vetmedin Sam who died last yr and Bonnie who is on it at the moment, I havent came across this problem, the opposite in fact i find they are more energetic on it.

Ruth
5th July 2008, 07:33 PM
Have to agree, my dogs on vetmedin have a marked improvement in their energy levels.

motte platts
6th July 2008, 11:53 AM
Thanks very much for the comments. Holly has started coughing again this a.m. so I am going to give her a 1/2 dose of the diuretic (as suggested by the vet yesterday) but I'm going to give a little bit of banana as well to see if that helps. Re the suggestion of a cardiologist - I don't know if that's an option in France - she has had no tests at all - the vet listened to her chest and made her cough by holding an area under chest and then prescribed the treatment. I am going to ring my vet in the UK next week to make an appointment for 18th August (the date her passport is valid) - and hope I can keep her comfortable until then. Any more advice gratefully received.

Karlin
6th July 2008, 12:54 PM
I would definitely ring your vet for advice and/or try another vet in France. A UK vet -- who will likely be far more familiar with the breed and its heart issues -- may well be able to suggest some things to try until you get back.

There is also a cavalier rescue in France (http://asenack.com/)(which is a member of the board here but she doesn't come online very often). I would contact her for advice.

There are a whole range of drugs for heart problems and it sounds like either she has additional complications or tha dosage or drug is wrong. I doubt frusemide would be causing lethargy etc and it would probably take months on the drug for it to affect potassium levels, so I don't think that is too likely to be the problem (it only rarely causes this problem, and generally only is tested for every year or so). It is more likely to be the vetmedin I'd think or some complication.

Frusemide should have quickly helped her cough (sounds like it did). If she is at the point of coughing that is when they have entered congestive heart failure and they do decline at different rates. Often they can go for a good few years once on a correct mix of medications so this isn't necessarily a serious worry but not all dogs do well on medication. Not all dogs respond to Vetmedin either.

There's a detailed post on hearts and MVD in the Library section under the Health section that should be of help. You could print that for reference. Usually a vet will want to do an xray to get a reading of the heart size at this point.

Just fyi I did have one rescue come in whose heartbeat was extremely slow because he'd been given the wrong dose of a human heart med. Once he was on to a correct medication he rapidly improved and though the first vet who saw him believed he had at best a few weeks or months to live he's been going well for over a year now with no serious problems since.

Good luck, I hope you can find something to imrpove her condition.

Cathy Moon
6th July 2008, 03:05 PM
I have two more suggestions. First, here is a link to veterinary cardiologists in Europe and there are some in France:
http://esvcardio.org/site/view/114272_2007MembershipDirectory.pml;jsessionid=f90w cp0fd93w

Second, perhaps her vet in France would consider putting her on an ACE inhibitor rather than Vetmedin for now. I re-read this article about MVD in cavaliers, and it seems that she may need the ACE inhibitor (scroll down to read the cautionary warning about prescribing Vetmedin/Pimobendan:
http://www.cavalierhealth.org/mitral_valve_disease.htm#---

I'm hoping you can get some help with this very soon. :flwr:

sallymum
6th July 2008, 05:18 PM
Even though Bonnie is doing fine on Vetemedin at the moment, when i look back, and i may of already remarked about this on a previous thread i really think it made Sam worst. He only lasted 10 days on it before i had to have him PTS. When he was put on it Sam just went down hill very fast. I have heard since, a small % of dogs dont get on with this drug and i think Sam may have been one of these dogs. I know he was well advanced with his heart prob but still he really went down hill very quick, maybe to quick.
I dont want to put anyone of Vetmedin as for most dogs it is a great drug and even for Bonnie she is doing fine.

Karlin
7th July 2008, 10:41 AM
This is an interesting detailed article by a vet that includes some side effects of the different medications:

http://www.2ndchance.info/conghtfaildog.htm

This is a more general introduction by the same vet:

http://www.2ndchance.info/dogdilcardiomyopathy.htm

motte platts
7th July 2008, 11:27 AM
Thank you all so much for the information which I have read with interest and am now trying to digest! Holly seems brighter today and even came out for a little walk with a very waggy tail! I am going to keep giving 1/2 dose diuretic and 2.5mg Vetmedin daily for the next few days and see how she goes. I'll keep you posted.
Jan:xfngr:

motte platts
8th August 2008, 05:08 PM
I am bemused! We are going back to UK on 18th August when Holly's passport is valid. On the basis that it might be cheaper in France, I persuaded the french vet to x-ray Holly with a view to taking the picture back to the UK to show to my vet there. After a few problems with getting an x-ray developed, he examined it and said her heart is the normal size for a dog her size, there is no evidence of fluid on the lungs but she appears to have an inflamed larynx (now have cough syrup) and to stop the diuretic. When I queried with him how bad her heart condition is on the grading scale that I believe is used, he said grade 1 (i.e. not bad). He also said she is to continue the Vetmedin. I am not sure whether to laugh or cry (or even whether to believe him!) I can't wait to get back to UK now to get to my vet (appt. made for 19th) so he can do a proper examination (he has all the proper equipment for heart cases). Hopefully all this worry will have turned out to have been for nothing and it was just a misdiagnosis of her cough - does anyone else have experience of this?
:confused:

Cathy Moon
9th August 2008, 12:09 AM
I'm surprised she needs any heart medicine at all if she's only a grade 1. Geordie was put on an ACE inhibitor when he reached grade 4, and the cardiologist will not change Geordie to Vetmedin until he sees signs of congestive heart failure, which it has been confirmed Geordie doesn't have yet. Geordie didn't need any heart medicine until he reached grade 4!

You really need to see a cardiologist. Could you get a second opinion from a regular vet if you cannot see a cardiologist? I just feel very strongly that your current vet is making a mistake. Sorry if I offended him/her, but someone needs to look out for your little dog. :flwr:

motte platts
9th August 2008, 08:36 AM
Yes Cathy, my vet in UK will give a second opinion on 19th August (I hope she will be ok taking the Vetmedin until then) & he will refer me to a cardiologist if necessary. I don't feel I can stop the Vetmedin in case the French vet was right at first and the x-ray maybe wasn't clear enough. She seems very bright in herself (and always has been except for the 1st few days after she was started on diuretics and Vetmedin which was when I started this thread). Luckily she seems like a pretty tough little dog - very sweet and gentle - with a love of everything and everyone.

RodRussell
17th August 2008, 04:47 AM
I finally figured out -- thanks to Karlin's patience -- how to activate my membership on this list, which (I am embarrassed to admit) I think I have had for a couple of years. So, I am reading some posts that may be a little archival for some of you. This one, however, seems still to be somewhat current, since the dog is going to see the UK vet this coming Tuesday.

I am a strong advocate of having MVD patients examined and treated by cardiologists. It is frustrating to read that there are very few veterinary cardiologists in France, and that you have to go to the UK for a decent examination. I know of some French cardiologists who are ECVIM-CA board certified: Drs. Valerie Chetboul, Gerard Le Bobinnec, and Jacques Sottiaux. An alternative could be a internal medicine specialists; ECVIM-CA board certified internal specialists in France include Drs. Jean-Luc Cadoré, J. P. Cotard, Patrick Lecoindre, Karine Savary-Bataille, and Eric Schrauwen. That certainly is not a lot, and I know that some of them do not see patients.

If the grade one auscultation is accurate and the x-ray analysis is accurate, then Bonnie barely has MVD, and I would be very concerned about giving her Vetmedin at her early stage of the disease. Vetmedin has its downsides, and it seems that most of them are the result of prescribing it too early -- which means before congestive heart failure. If the auscultation of grade one and the x-ray are correct, she is not anywhere close to congestive heart failure, and it is possible that she may not be there for several years. At her stage (and I am writing only as a layman), I would not give my grade one Cavalier -- with no outward MVD symptoms -- ANY medications like Vetmedin, ACE-inhibitors, or diuretics.

Two of the problems I have observed about general practice vets prescribing these medications are (1) the do it too early, and (2) they prescribe too great dosages. Many of them seem to have only a superficial knowledge of MVD and when medications should be given, and they are much too susceptible to the sales hypes of pill salesmen. In the United States, since Vetmedin was approved for dogs last year, the Boehringer Ingelheim sales forces have been pushing Vetmedin on general practice vets with a vengeance. Our family's own general practice vet, who we know well and socialize with, has been convinced by pill salemen that Vetmedin is a wonder drug for any dog in any stage of MVD. I have been able to show her research articles which directly contradict the sales hype that Boehringer Ingelheim's representatives have spread. Just imagine how many other general practice vets there are, in the USA alone, who have this misapprehension and are prescribing Vetmedin too early and too often and may well be killing their patients by over-working their heart muscles.

So, I hope that the UK vet's exam reaches the same conclusions of grade one murmur and no enlargement and no fluid in Bonnie's lungs. If that is the case, whatever problems she may be having would not seem to be due to MVD and should be treated for what actually is causing them.

motte platts
17th August 2008, 04:38 PM
Thanks for your observations - less than:dogwlk: 2 days to go now - her name is Holly by the way!