View Full Version : Looking for advice for Cavalier with SM and newly diagnosed Mitral Valve issue

12th August 2008, 05:56 PM
Hi All,

Long message ahead, but I'm looking for some help with my Cavalier. He's my companion and best friend and I want to make his life as comfortable as possible and give him the best care I can in the face of some not-so-good health news. He's too young and I'm not ready to give up on him!

I have a five-year old Cavalier (Bogie) who was diagnosed with SM about 18 months ago and who was just recently found to have some irregularities with his Mitral valve. So far the heart issue is just that when the vet listens very carefully he can hear some irregularity in the sound of the blood going through the mitral valve. We haven't done a heart ultrasound yet. Up to now he's been heart clear through many vet visits and from his previous owner. I haven't had Bogie from a puppy but got him at 1.5 years old from a breeder who was looking to rehome an adult Cavalier. (He was a show dog who wasn't winning)

After having him for about a year I guessed at the SM diagnosis from symptoms and had it assessed first by his normal vet and then by a veterinary neurologist who did an MRI. Once I had learned more about SM trying to figure out what was wrong with him I guessed that he had it from the beginning but I didn't know the early signs as well and couldn't see it when I got him from the breeder. The breeder I got him from wasn't his original breeder but had purchased him as a show prospect and stud dog. I've never bred him as he was meant as a companion only and so I had him neutered some time ago.

He's got a significant problem but he's pretty ok functionally. He does "air scratch" but no yelping, etc. The neurologist said he would make a good surgical candidate at the time but also stressed the risk of the issue not being resolved because of scar tissue and that the surgery was high risk for complications or death since the neck area is so small. The vet neuro was suggesting the surgery which would remove part of the back of his skull to release the pressure. She's done this before on other Cavaliers with success. At the time I decided to wait and see if the problem could be managed with medication.

My current vet had been prescribing prednisone at 5mg daily at first and then we moved Bogie to a slower schedule to minimize stress on his body, to a two days on one day off schedule. I've also tried to slow it further when possible. Now he's exhibiting some signs that the prednisone needs to be stopped which according to my vet are concerns about weakening of the adrenal gland like chronic dry eye, stuffy nose/sinus problems- signs that he's not naturally able to fight off every day irritantants the way he should be at his age.

Also he's gained some weight fromt he prednisone and is always hungry which is hard for both of us! Before the Pred he was a natural eater, clearly eating when he was hungry eventhough he's fed at regular times, morning and evening only. (Not free fed) He was interested in people food but ok if he was denied and good about eating his normal dog food. Now he seems constantly starving and cleans his bowl in seconds and then looks at me as if to say, "is that it?" He was on the small side for a male when I got him, and maintained weight of around 16-17 pounds. Now he's at 20 pounds and I've had to switch to low calorie food with veggies as treats in an attempt to lower his weight. So that's not good for his heart or health either and I'm hoping weight loss may help the heart problem.

Also he was on Prilosec/Omaprazole for awhile. The vet and I would like to put him back on it at his former dose of 10mg per day. I have trouble getting my local pharmacies to carry that dosage so I haven't been able to get it for awhile and was wondering about buying OTC Omaprazole at the human dose of 20mg and splitting the pills. Has anyone done that and has anyone had any problems with it? I had one vet suggest that it wouldn't be good for dogs since there's a coating on the human dose and splitting the pill would cause a different absorption and be less effective.

In addition we're looking for another medication to help with the SM other than prednisone. Also my vet has suggested that I go back to the vet neurologist for another assessment to see if we should go ahead with surgery now since in a few years if his heart degrades further he may not be able to make it through the stress to his body of the surgery and recovery. Finally, he wants to do the heart ultrasound and decide with the neurologist if surgery is worth it at all if the heart is going to degrade in a few years anyway to the point where he may need to be put down. I can't bear the thought and want to do anything I can to keep him healthy and happy for as long as possible. He's got great spirit and I want to find a way to make him more comfortable. If possible I'd like to find a way to get him a few more comfortable years where he's the dog he was when I got him, able and happy to play and run around the back yard searching for lizards and chasing butterflies. Now he's a little slower and naps more often, particularly since we've stopped the prednisone.

Any thoughts, shared experience or advice would be greatly appreciated.

Monica and Bogie

Cathy Moon
13th August 2008, 12:21 AM
Hi Monica, so sorry that you and Bogie are going through this.

First, I would schedule an appointment with a cardiologist for Bogie, and find out what his grade is, as well as if he could benefit from being on medication for his heart. Only the cardiologist can grade Bogie's murmur. And how Bogie's heart is doing is going to influence his SM treatment. (Just as an example, my 5 yr old Geordie is a grade 4 of 6 murmur, so SM surgery is out of the question.)

As far as Bogie's SM goes, I'm wondering why he isn't taking Gabapentin instead of Prednisone. Gabapentin is much easier on our little dogs! I would talk to the neurologist about it. One important thing to remember is that Prednisone cannot be stopped suddenly (in humans or dogs), so he will need to be slowly phased off the Prednisone under the neurologist's instructions. Geordie takes a 100mg Gabapentin every 8 hours, and it works fine for him. We actually get it as a generic costing $4.00 for a 30 day supply at our local supermarket human pharmacy (with a prescription from the vet).

Bogie needs to be on a drug to reduce his cerebrospinal fluid (CSF), such as Omeprazole (a proton pump inhibitor) or Lasix (a diuretic). I found that Omeprazole is easier for Geordie and I. Reducing the CSF pressure could actually slow down the progression of the disease, so it's very important.

I buy Omeprazole on sale at the human pharmacy, and cut it into 4 equal pieces with a pill cutter. Geordie gets 1/4 tablet every 12 hours, and I am very careful to space his dose 2 hours before and 2 hours after any other drug he takes, so he won't have complications. He is doing fine on it. I tried 1/2 tablet every 24 hours, but that was not as effective, and he'd start scratching hours before his next dose was due.

Talk to Bogie's neurologist and vet about his medicine, and hopefully they'll find a combination that is just right for him.:flwr:

Cathy Moon
13th August 2008, 01:31 AM
I neglected to mention that either Metacam or Rymadil are excellent if Bogie needs additional relief at times. These should both be given with food to make it easier on his digestive system.

Tramadol is also good as additional pain relief if the Metacam or Rymadil is too hard on Bogie's tummy.

Cathy T
13th August 2008, 03:48 AM
Gosh Monica...I'm so sorry to hear Bogie has so many issues going on. Sounds like you are really vested in doing the best for him. Hoping you are able to get his medications sorted out. And really glad you found this board. Karlin has put together some really great information.

15th August 2008, 08:01 PM
Thanks to those who have posted on this thread- these responses are going straight to my vet for inclusion in our treatment plan!

I've put Bogie back on Omaprazaole but the's showing signs of more and more discomfort without the Prednisone- lots of sleeping, severly decreased appetite. :( Hopefully, my vet will help me try some of the other ideas mentioned here.

Thanks very much for the information and kind words!
Monica and Bogie

Cathy Moon
16th August 2008, 12:12 AM
It really sounds like he needs to be taking Gabapentin for the pain. Let us know how his vet appointment goes. :flwr:

16th August 2008, 11:47 AM
I would echo Cathy Moon's recommendations on medications -- usually prednisalone is only used when nothing else is left that works as it does have the unwanted side affects you are seeing.

I'd think gabapentin and splitting OTC prilosec (or also cimetidine or frusemide has a similar function; it is worth discussing these alternatives with a neurologist). You can buy a pill cutter cheaply in any pharmacy which makes cutting pills really easy. I have always just split human OTC dosages. IT is odd that you haven't been advised to use gabapentin as it really helps most dogs for pain and scratching.

The surgery is actually not considered too high risk. What Dr Clare Rusbridge, who is one of the pioneers in this area, stresses is that although it is in a sensitive and risky area that actually the morbidity rate is very low. The success rate with surgery is 80% get relief and 45% still have good relief two years later according to Dr Rusbridge, but by this she does not mean that 55% decline steeply, just that many will have some recurrence of pain, probably due to scar tissue formation, and this is generally managed with medications. For many dogs this is a minor issue.

Have you seen Dr Rusbridges' info on the condition and pain treatment diagram on my site, www.smcavalier.com? You can download both as documents.

I'd also definitely see a cardiologist s you need to now start tracking heart function an need to get a grade for the murmur -- vets are not too good at doing this as it is a specialist area. A low grade murmur should not have much implication for surgery.

Also you should definitely inform the original breeder of this diagnosis for both heart and SM. Good breeders need to know if dogs are affected as it can have major implications for their breeding programme as none will want to be producing puppies with SM and this would also be considered early onset (eg unusually early affliction with) MVD. There is a breeding protocol good breeders follow to minimise the risk of early onset MVD.