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chopsuey 47
24th January 2009, 04:33 PM
Hi

I posted last week about Luka's ( aged 2.5) heart murmer which was picked up at the vets. I saw a cardiologist on Wednesday and she confirmed the worst. He has a leakage accross the mitral valve. I was expecting this having gained so much information from this site and others experiences. But its still very upsetting.

I watch his every move and I am sure I am transmitting some worry vibe to him He looks so glum and wont let me out of his sight. So I must get a grip.

I have read lots of postings about other peoples experiences and have gained some comfort. Every case is different I know but I feel that I need to look to the more optimistic stories that will give me hope that it is not an immediate death sentence.

The cadiologist said that he was a 4 on some condition scale (not sure what this was, does anyone else know?) and that is close to perfect in that he was slighty underweight. She also confirmed that regular off lead excercise was vital. She wasnt overly encouraging when it came to supplements such as co q10 but did advise fish oil. Said the former wouldnt hurt though.

Thanks again for all your responses to previous posts. I really enjoy looking on the sight.

Sue

brotymo
24th January 2009, 06:35 PM
so sorry, I hope that Luka will be okay. I remember reading someones posting about a fairly young dog, like 5 or something that had been diagnosed with a grade 4 murmur and lived a very normal long life...like was 13 or something. Can't remember the details. I am sure the scary sad stories get posted more often than the good ones. When things are fine, people tend to just go about their way without saying much, but it is when things are bad or scary that they post and want advice or reasurrance. I think this is why you read so much bad and very little encouraging. Hopefully others with encouraging words will post.

ilsamom
24th January 2009, 07:50 PM
I agree, I had a maltese with advanced MVD. It's distressing and difficult, I know, but my Princess lived 12 years, did very well on medication and had an excellent quality of life.

It is far from a death sentence, with proper treatment Luca will be just fine, and will be as happy and active as ever.

Take care
Jen and Ilsa

GinnyJ
26th January 2009, 02:04 AM
My Sophie (5 years) has a grade 3 heart murmur. She is on 10mg Lasix once a day and 5mg Enalapril twice a day. We've noticed in the last few months that she has really slowed down. But then sometimes she will run and play like a pup.
Sadie (5 years) has mitral valve prolapse. No medications.

I know the shock you feel. The need for information. Every few weeks I'm looking for clinical trials to enroll them in. I am sorry that Luka is going through this. Thank goodness that you know and are able to give the best care. I wonder how many dogs have heart problems and the owners dont know.
God bless ...

jasperpaw
26th January 2009, 07:54 AM
Hi, just found the thread about Luka, must be a real worry, but try to stay positive, like was mentioned in a previous post not all the more positive stores will get posted as I guess we all take for granted health when it is going smoothly, but it is good to have a site like this to get information and support from, everyone seems to genuiely care.

Pat
27th January 2009, 12:48 AM
Some quickie comments --

Likely your boy is a 4 on the BCS - body condition scale - which is from 1-10 with 5 being ideal. You said he was a bit underweight and a 4, so this must be the BCS the cardio is referencing. Better a 4 than a 6, IMO!!

Omega 3 (NOT 6 or 9) fish oil capsules - absolutely a good supplement with many benefits to brain, heart, kidney function, coat and skin. Look for 1000 mg with the highest EPA and DHA possible (I use Puritan's Pride super omega 3 fish oil capsules). I'll go more into this whenever the heck I have time to finish my posts on food and supplements in the thread from last week.

For Ginny's Sophie who is on lasix and enalapril - if she is on lasix, she is in congestive heart failure versus simply having a grade III murmur. Remember that a murmur just describes the amount of "noise" that is heard from the regurgitant flow (blood flowing in the wrong direction) but the murmur grade does not tell us whether or not a dog is in heart failure, etc. Generally a diuretic isn't started until there is pulmonary edema, which is officially heart failure. For Sadie, her valve is prolapsed (the valve leaflets are misshapen and bow inward, but they still close and there is no leaking yet).

Regarding personal stories, death sentence, etc. -- I can tell you horror stories of rapid progression (but I won't in this post) but, with only one exception, I've had Cavaliers live for many, many years with well-compensated acquired valvular disease and (other than that one exception) they died from other causes well into their teens. (10 Cavaliers over a 20 year period.) The one (and this is a miraculous exception, but I will tell it) boy I had that was diagnosed at a heart clinic with an MVD murmur at 18 months died at 15 years old without ever having gone into CHF. Now, this is not typical, but I am using it as an example that you should not live as if your dog is going to die quickly.

I think there are many factors involved in longevity in the presence of MVD - including:

Just plain luck - or the "roll of the genetic dice"
Weight, diet, supplements (and not that TRASH Hill's prescription HD diet! more later)
Quality of medical care - i.e., cardiologist with echocardiogram, etc. to do diagnosis and treatment planning versus GP vet
Limited vaccinations (I basically don't vaccinate middle aged and senior dogs with chronic illness)

This is a LONG topic that I'd love to discuss when I have an hour or so to write some long posts. I will say that there is no magic bullet - I think the above factors play a role in helping a dog with acquired valvular disease cope with the illness to live the best possible life in terms of quantity and quality. When I have time to do the long post, I'll use as an example a litter of 7 in which one died at 8 of CHF while two others lived to be 16.

More later!

Pat Beman
Atlanta, GA

P.S. I absolutely support the 1998 MVD breeding protocol and I believe that if breeders adhered to this we would fairly quickly move the lifespan of the Cavalier to 14 years or so where it should be in a breed weighing less than 20 lbs. AND greatly reduce early onset acquired valvular disease.

chopsuey 47
27th January 2009, 07:38 PM
Hi Pat

Many thanks for your post. I appreciate your info and am mindful of your time constraints, but if you have time could you explain this to me.

The Cardio said exactly what you have pointed out that the grade of the murmur only indicates the sound the that can be heard and is not totally representative of the level of deterioration.

The cardiologist said that Luka valve was prolased, but she coloured the scan and was able to show me some regugitation of blood from the mitral and tricuspid valve. Does this indicated that he is worse than a grade 2 murmur might suggest. She did heart measurements and felt that due to the subtle nature of the regurgitation he was not ready for medication and that I should come back in a year.

He is asymptomatic and still lively on walks but he is a little more subdued than normal. I put that down to my giving off vibes to cause him to stress.

On a general note, to all. I advised my breeder at the recommedation of the cardio. She seemed genuinely shocked but said she had had no other person in the whole of her 30 yrs of breeding 10 litters a year, ever say they had an early onset MVD dog from her breeding program. Her comment was its one of things, which I took to mean a genetic fluke. I urged her to note it, and said I would keep her informed. She said if more problems came to light in other dogs she would remove the pair of dogs that parented Luka from here program, But I got the impression that she didnt think it highlighted a problem within her dogs. Is she misguided or can the problem be caused by a genetic throwback.

I hope the above is not a problem post. I have not named her but nor will I ever recommend her.

Sue

Love my Cavaliers
27th January 2009, 08:12 PM
I don't know if MVD can just be a fluke or a freak occurrence. When I told Oz's breeder, she was so responsive and heartbroken. Like your breeder, she said she has heard of only one other of her dogs that had early onset MVD. But, unlike your breeder, she said she would never breed either his mother or father again. I hope that's true. She truly seemed shocked and saddened to hear he was diagnosed at such an early age. She still has his sister and had her checked out right away by a cardiologist. There were only two in that litter and it was his mom's first breeding.

*Pauline*
27th January 2009, 08:32 PM
On a general note, to all. I advised my breeder at the recommedation of the cardio. She seemed genuinely shocked but said she had had no other person in the whole of her 30 yrs of breeding 10 litters a year, ever say they had a MVD dog from her breeding program. Her comment was its one of those freak/throw backs. I urged her to note it, and said I would keep her informed. She said if more problems came to light in other dogs she would remove the pair of dogs that parented Luka from here program, But I got the impression that she didnt think it highlighted a problem within her dogs. Is she misguided or can the problem be caused by a genetic throwback to history.

Hi Sue, this sounds very familiar. I got the same response from my breeder, almost word for word apart from the throwback thing. When I heard of another suspected case of SM, a brother of Dylan's with the same sire (different breeder), I VERY tactfully suggested to my breeder that she scan her dogs. I got a very nasty email back from her. You'd be shocked if you read it.:(

chopsuey 47
27th January 2009, 08:46 PM
Hi Bev

She sounds like she really cared. Perhaps having a litter pup made her think it could be her.

My breeder was nervous as hell until I explained I didnt want anything more than info. But when all you get is a flat denial that any of her dogs have early onset MVD she couldnttell me anything that was worth much to me.

Do you know what the outcome of Oz's sisters check.

Re the throw back thing, I think I have read in one of Karlin's 'sticky' posts that this is a common breeder excuse.

By the way, you describe Oz as alittle pistol. Is this when hes out for walks or all the time. How much do you think he rests on average during the day.

Sue

Pat
28th January 2009, 01:39 AM
You’ve got a GREAT cardio that you are working with if you are able to watch echocardiograms done on your dogs. I’ve been able to do that for 20 years now, and I have learned so very much about understanding diagnostic tests and treatment options of acquired valvular disease from working with a cardiologist who loves to teach and allows clients to be present during the entire evaluation as well as from reading.

Your cardio is exactly right – and that is why I don’t pay a whole lot of attention to murmur grades except to use them as a signal as to when to get further diagnostic testing. My GP vet has graded my dogs’ murmurs the same as the cardiologist over all of these years, so I don’t bother to get an auscultation from my cardio (who is a two hour drive away) for a soft murmur when my GP vet hears one. (I will, though, shoot a baseline chest x-ray at some point after my GP vet first hears a murmur. I keep my x-rays at home so that I can take them to cardio appts. and it’s also nice to have them at home in the event I have a middle of the night ER visit for some crisis.) I do pay attention, though, if there is a significant increase in the grading of a murmur over a six month or one year period (i.e., a grade II murmur jumps to a IV quickly).

So knowing the grade of a murmur isn’t all that informative as it doesn’t give you a good picture of how the heart is actually functioning – but a color Doppler ultrasound (echocardiogram) when done by a specialist with training and experience (versus a GP vet simply with enough money to purchase an ultrasound machine) is very informative. That test will show the functioning of the valves, and you can see changes in the valve leaflets, whether or not there are ruptured chordae tendinae, whether there is valve prolapse; you can see the regurgitant flow and measure the velocity of the regurg, and you can get exact measurements of the cardiac chambers and compare them to normal measurements. Other complications such as whether or not pulmonary hypertension is present can also be measured by an echo. Another important measurement obtained from an echo is contractility or shortening fraction, which is given in a percentage (like 20% or 50%). This is a measurement of the pumping strength/ability of the heart. In acquired valvular disease, this usually remains normal until end stage heart failure whereas in DCM (dilated cardiomyopathy – the heart disease commonly found in large breeds) contractility is usually compromised early in the course of the disease.

Luka has leakage of his mitral and his tricuspid valves (very common to have leaking in more than one valve) and you will usually find on the report a description (trivial, mild, moderate, severe) and sometimes a figure measuring the velocity of the leak/regurg. Since she said subtle leakage and it appears that his heart chambers were not enlarged, she correctly prescribed watchful waiting/monitoring and no meds at this time. Generally, in the US anyway, cardios will prescribe an ACE inhibitor such as enalapril when there is moderate or greater chamber enlargement and moderate or worse regurg. even if the dog is not yet in active CHF. Once heart failure ensues, diuretics and other meds are added as needed to control overt symptoms. But all cardios don’t agree on exact time to start meds before CHF. (I tend to start an ACE inhibitor rather early in the game particularly if my dog is over 6 or 7.) Blood chemistry should be done before starting an ACEI and then again after 7-10 days and then periodically to watch for changes in kidney functioning, monitor electrolytes, etc.

It sounds as if Luka is in the early stage of the disease, and he could stay compensated for a long time. Have you taken a baseline chest x-ray? I would actually do that and then get another two-view chest x-ray in six months to look for changes. This isn’t too expensive, (not like an echo) and it will give you an idea if you are dealing with rapidly progressing or slowly progressing valve disease. As you go through the next year or two, you’ll have more of a prognosis/idea of how things will go for Luka. As for being more subdued, I can’t see any reason that this would be related to his heart disease.

Regarding the breeder’s comments – there is NO Cavalier breeder in the history of the world that has bred 300 litters (10 yr x 30 yrs) and has had only one Cavalier develop a murmur due to endocardiosis. (Are you saying she said “not at any age” or “not at Luka’s age”?) That person is either in denial, lying or is incredibly ignorant. There is no shame in producing a Cavalier with a murmur – 50% have them at age 5 and nearly 100% by age 10. It’s a fact of life. The way to approach the problem (IMO) is to simply breed to the protocol – only breed Cavaliers that reach age 2.5 with no murmur and have parents over 5 with no murmur. I have dear friends who are breeders; I know about proving a male early, etc, etc. But the way to minimize early onset endocardiosis and lengthen the lifespan of the Cavalier to one more normal for a breed of that size is to breed to the protocol. But even if you breed to the protocol, you’ll produce some Cavaliers that develop murmurs early and more that develop murmurs later – you’ll just start pushing the age of onset for the majority later and later.

I don’t know what the “throw back thing” means – endocardiosis is in the genes (we don’t know which ones obviously) of all Cavaliers. No “throw back” to anything – it’s there in all. It manifests itself in various ways depending on the combination of genes inherited in the particular Cavalier. Even within the same litter there will be differences. (i.e., the litter of 7 I described earlier where one died of CHF at age 8 and two others lived to 16+ and died of other causes.)

Sue, are you in the U.S.?

Pat

chopsuey 47
28th January 2009, 09:23 AM
Thanks again Pat

Its hard to get the gist of all the facts and what they mean. I am afraid I am the type of person who rests easier with all the facts to hand.

I am in the UK by the way. I agree I was very happy with my cardio she was very good. She sent me a full list of measurments( a copy has gone to my vet. It doesnt mean much to me. The only thing she didnt do was an Xray. I will look into that.

Thanks
Sue

GinnyJ
29th January 2009, 07:29 PM
Like I have stated in the past I regularly check for clinical trials that would maybe benefit Sophie or Sadie. Yesterday I got a email from Dr. Sonya Gordon(Vetmedin study) and she wants to see Sophie and Sadie next Friday (Feb. 6) to see if they are candidates for 2 clinical trials.
*below is`taken from the email:

1) . Purpose of the project: To determine if serial NT-proBNP and NT-proANP alone or in combination with other physical examination or thoracic radiographic parameters can predict the first onset of congestive heart failure (CHF) in asymptomatic dogs with significant left atrial enlargement due to chronic mitral valve disease (CVD).

Each scheduled re-evaluation will include a history, physical examination, thoracic radiographs, and echocardiogram





2) . Purpose of the project
The purpose of this project is to determine if oral administration of a new drug (BAY 41-9202) can delay the onset of heart failure in dogs with asymptomatic chronic mitral valve disease (MVD). The initial visit and each re-evaluation will include a combination a range of tests at specific appointments (please see the table below). Procedures include history questionnaire, physical examination, chest radiographs, an echocardiogram, electrocardiogram (ECG), blood pressure evaluation and blood work.





I am in the process of getting copies of radiographs from our regular vet and filling out all the paper work.

chopsuey 47
29th January 2009, 08:32 PM
Hi margi

You must be a tenacious lady. One of the things I feel helpless about is this sit and wait process involved with this disease. To be proactive must make you feel you are doing all you can to help your girls. I truly hope you get on the program if you feel it is going to help not only your dogs but others in the future.

How did you go about finding trials was it all on the internet.

Once again good luck and good on you.


God Bless YOU
Sue

Karlin
29th January 2009, 11:12 PM
A grade 2 murmur is quite low. Really as Pat says you just move onwards and care for your dog(s) to keep them as healthy as possible and don't worry about things that are not yet present. I doubt a grade two murmur in a young dog is causing him to be more subdued as he's not having any direct problems as a result, as the cardio has confirmed to you. He has probably quickly noticed that if he acts more subdued he is getting more looks and attention though and that he will see as a reward. They can be very bright at picking such things up! :)


My breeder was nervous as hell until I explained I didnt want anything more than info. But when all you get is a flat denial that any of her dogs have early onset MVD she couldnttell me anything that was worth much to me.


Well, I would say-- if she is breeding 10 litters a year, that is a HUGE amount of breeding and generally would raise a few questions... that means she is placing perhaps 50 puppies a year :eek:; how can any breeder possibly track what happens to all those offspring? As many here will confirm, they have never spoken to the breeder about any health issue -- it can be very intimidating as Pauline notes. All this being one reason I really urge people to notify their breeder at least by (registered) letter if there's a health issue -- good breeders will value the information as it will help shape their breeding programme; for indifferent breeders it will at least rattle their cage a bit and hopefully make them think a bit more about trying to do more for the dogs rather than their pockets.

If breeders do not cardio their dogs, by the way, they are unlikely to pick up problems, and if they don't ask their puppy buyers to come back to them with any info, they provably are not likely to get any. It clearly suits some folks to not hear. Keep in mind too that most vets miss early onset murmurs. So another reason breeders may hear nothing back even if they are producing early onset cases, is that the murmurs are not heard til well progressed in middle aged or older dogs.

GinnyJ
30th January 2009, 03:45 PM
Sue,
I'm not sure if my girls will get into the trials or if it will help them. Just knowing that xrays, echos, and blood work is being done on regular visits by one of the best cardiologist in the US is what I am excited about.
I found these trial by doing google searches. "MVD + clinical trials" , "Clinical trials + cardio + veterinary" , " Sonya Gordon + Clinical trial'
We just happen to live 7 minutes from Texas A&M Veterinary Hospital and Dr. Gordon is the one that did our echos.


Pat,
You actually took my breath away when you said that Sophie was in CHF. I had never thought of it but of course it makes perfect sense. I have a strong
medical knowledge base and so of course my brain already knew it to be true but my heart wouldn't let me acknowledge it.
I am really looking forward to your information on diet and supplementation!