View Full Version : MVD Drug Types and Amounts??
9th March 2009, 07:46 PM
I am wondering if anyone could tell me what types of drugs their Cavaliers are on for MVD and the dosages? Also what kinds of side effects you have seen?
Right now I am deciding if I should enlist Colleen in a new Beta Blocker study that they are doing in my area. We are running the tests soon to see if she qualifies. I am not sure if I should participate or just go with the normal protocol. So I am trying to collect as much info as I can to make my decision. Thanks
9th March 2009, 11:38 PM
Geordie is taking Enalapril - he gets one 5mg tablet in the morning and 1/2 tablet (2.5 mg) in the evening. He weighs 18 lbs, and the dosage is based on his weight. He has no side effects that we are aware of. Geordie's most recent cardiologist visit was in Feb. 2009, and his murmur is grade 4 of 6, x-rays show moderate heart enlargement, no evidence of congestive heart failure.
10th March 2009, 01:40 AM
I hope that Pat B weighs in for you here. She is extremely knowledeable and helpful when it comes to MVD, among other things!
10th March 2009, 08:29 PM
No sense in reinventing the wheel! Dr. Gordon's (veterinary cardiologist at Texas A&M) paper is probably the best reference I've seen regarding drugs for heart disease. This should be more accurate than anecdotal info from pet owners. Look under CVD (chronic valvular disease) and you can find wonderful flow charts about drugs used under various scenarios (such as complicated versus uncomplicated heart failure, etc.) Then look at the very last page, and she has a very useful chart of drugs, indication, dosage amounts and side effects.
Is this a trial for a new drug or a trial for a current drug (such as atenolol) to be used for canine patients? Where is the trial taking place? Who is doing the trial?
Everyone should print and save a copy of this in case it disappears from the internet.
10th March 2009, 08:38 PM
Oh - sorry - Ohio! Is this a study that OSU is doing? Under Bonagura?
Is Colleen currently in CHF? Taking meds? How advanced is her MVD?
I'm sorry to admit that I'm kinda selfish and I'd be reluctant to participate in a trial because I wouldn't know if my dog was getting the placebo. It would depend on the circumstances for my particular dog. And I really hate to say that because someone's dog has to be in the trials or there would be no drug trials!
10th March 2009, 09:09 PM
A couple of terms for clarification in Dr. Gordon's paper:
PO - this is a medical abbrev that means "by mouth" -- i.e., a medication that is taken orally versus IV or IM, etc.
ACEI - this is abbrev for Angiotensin Converting Enzyme Inhibitor - a class of drugs which includes enalapril, benazepril, captopril, lisinopril, monopril, etc. These are generally the first line drugs given for degenerative valvular disease.
10th March 2009, 09:11 PM
Jasper went on heart tablets about 6 weeks ago, he has a grade 4 murmur, he takes 1 5mg Fortekor tablet once a day and Frusimide tablet - it was 1 a day , then down to 1/2 , now down to a 1/4 and he will come off them, he does`nt appear to have any side affects and when he visited the vets just over a week ago she was pleased with him.
10th March 2009, 09:16 PM
It is through MedVet here in Columbus. And yes I wouldn't know if Colleen was given the placebo, unfortunately. The study is through Bayer. they have already done the dosage study, so this is to see how dogs react to the medication, does it actually help them out. I don't know much about this at all, which is why I am so very nervous. I need to ask them what the drug is. I do know that they monitor the dog very closely and if something happens they immediately take them off of the study. and will treat them accordingly. There aren't any side effects I am told. I am torn and I have no idea what to do. I have only had her for 2 1/2 years, I just don't want to do anything to compromise her health. I really want to help her. I hate to say it, but she is really the best dog I have every had. She isn't showing any signs at all yet. She is happy and healthy otherwise, just with a murmur. I am very nervous and I have no idea what to do. Now, she may not qualify at all. They are looking for very specific profiles, and it is on all breeds, not just Cavaliers. She may not qualify. I hope that answers some of your questions. I do know that my vet has Dr. Bonagura read all of the x-rays and ekgs.
10th March 2009, 10:21 PM
Honestly, I'm way too much of a control freak to have one of mine participate in a drug trial. You have to follow a strict protocol for the time period of the trial regarding adding other meds, etc., and as we mentioned, your dog could be on the placebo. And, how the heck can they say "there are no side effects" if the trial hasn't taken place?! They can only say "we THINK there are no side effects" or "thus far we haven't seen side effects." (Not to mention new veterinary drugs that have been released with limited trials only to find out that there are side effects that aren't discovered until the drug is in wider usage - think rimadyl.) On the PLUS side - Colleen would get a lot of free diagnostic testing, including echocardiograms - and I presume they would share results with you. Also, you would be helping other dogs by participating.
A similar trial was the VETPROOF trial using enalapril. You can read the abstract here to get an idea of drug trials.
I guess I would reconsider if my dog was dying and it was the only way to get a shot at a promising new treatment. In a sense, though, I have participated in drug "experiments" but that was working closely with my veterinary cardiologist over a 15 year period. For example, one of my boys used sildenafil (viagra) for pulmonary hypertension way before Dr. Meg Sleeper did the drug trial on that at U Penn, and my dogs used pimobendan long before it was FDA approved here in the US.
Anyway, my best advice is to select a cardiologist - either Dr. Lehmkuhl at Medvet or Dr. Bonagura at OSU (depending on your preference for a teaching hospital versus a private practice) and work with him/her DIRECTLY (not having your GP vet consult with the cardiologist but having the cardiologist perform the tests directly and work with you directly rather than working through an intermediary). I presume you mean an echocardiogram versus an EKG/ECG (electrocardiogram). ECG's are pretty worthless tests for diagnosing chronic valvular disease - an echocardiogram (ultrasound of the heart using color doppler flow) is the correct diagnostic test. ECG diagnoses any heart rhythm disturbance, but an ultrasound will show the exact functioning and condition of the valves, presence and amount of regurgitation (blood flowing the wrong way because of malfunctioning valves), exact measurements of the cardiac chambers, and other valuable diagnostic info. My cardiologist and I generally make medication decisions based on the history, speed of progression, and the results of the echocardiogram.
10th March 2009, 11:12 PM
I can't tell you a thing about MVD protocols but I would be very non trusting of any individual that would say "there are no side effects". Every drug has side effects and ,depending on the individual sensitivity of the dog, may or may not cause problems.
11th March 2009, 02:51 PM
Thank you to all who have replied so far to my message. Pat you are an incredible wealth of knowledge, WOW! I am new to this. These are my first two Cavaliers and I have really been lucky so far with Polka, at 13 1/2 she is just showing signs of her age. But she still loves her walks. I have never had to deal with something like this before. The advice of dealing directly with the cardiologist was really great. I am going to work on that today. I do agree with everything. I do need to figure out the severity of colleens problem and treat it if that is what is recommended. I am not going to participate in the study. I just can't do that to her. Thank you all. I will keep you posted.
11th March 2009, 03:18 PM
Above is another of my favorite links for folks learning about heart disease in canines. This is an older link, but the points made that I think are important are:
1. Treat each case individually rather than using a "one size fits all" treatment plan. Cardiologists and internists tend to do that whereas GP vets tend to use a set approach for all patients. For obvious reasons, using a specialist generally gives you a much better outcome.
2. For dogs in CHF (congestive heart failure), there is no effective monotherapy. (In other words, there is no one drug that will take care of all the problems of CHF.)
11th March 2009, 03:41 PM
My favorite webpage for MVD treatment is http://cavalierhealth.org/mitral_valve_disease.htm#Treatment_
12th March 2009, 03:42 AM
We are looking at putting our Sophie in the same trial at Texas A&M Vet Hospital with Dr. Sonya Gordon. We havent decided what to do but I trust Sonya. She is truly one of the nicest and caring people I have ever met. My Sophie LOVES her...she gets so excited when she hears Dr. Gordon's voice from across the room.
12th March 2009, 03:12 PM
It's me again. I spoke at length with my vet yesterday. I still need to do more research and the best way to do that is to take Colleen in. So we have an appointment in two weeks for her ultrasound. Unfortunately the measurements of her xrays qualify her as a possible candidate. All of her blood work is perfect. So she is a happy healthy dog with a heart murmur and bad teeth. The medication is a beta blocker, the side effects are vomiting, lethargy, loss of appetite. As we all know any drug can cause a bad reaction. So I am going to look more into this also. I am still confused if the drug they are using has already been tested, and in this study they have added another drug to this one. That is one of the questions I need to find out. They do watch her very closely, every 3 months she will be rechecked. So I misspoke earlier. I am truly not sure if I am going to do the study. but I am going to see exactly what is going on. If any of you have questions please let me know. I will keep a list and ask them at the appointment. This will help me out. Thanks.
12th March 2009, 09:07 PM
You said bad teeth - do you plan to have a dental done for her? I'm a fanatic about making sure there is no periodontal disease especially in light of an older dog and heart disease. Periodontal disease has an overall detrimental effect on all systems, esp. in older dogs.
(I just did a dental on one of mine who is 13 yrs. 9 mos, and I've always done dentals on "at risk" dogs and senior and geriatric dogs. There is almost no risk as long as certain protocol is followed and you have a good vet who is comfortable with it.) I would absolutely do this before she starts any kind of drug trial. I like to stay on top of this so that it's under control before a major crash when you might not want to risk anesthesia.
Other question - who is doing the echocardiogram? My strong opinion is that it is relatively worthless if a GP vet does it. They just don't have the training and the experience to properly "wand" (I don't know the real term for this - but I mean manipulate the wand device to obtain the proper view) and interpret what they see. Exact calculations and measurements are done, and it takes training and experience. (I don't care to pay someone to practice and learn on my dog.) Cardiologists and internists do this multiple times every day. GP vets' ultrasound equipment is also usually not as good as that used by an internist or cardiologist. JMHO. (If you were having an echocardiogram, your family practitioner would not be doing it - a specialist would be doing it.)
My guess is that this will be a trial like the VETPROOF trial - which was to see if early use of enalapril would shorten the time to CHF - only this time they are using this b-blocker. See if you can find out the name of the drug - we would then be able to find out if it is currently in use. Most drugs are used "off label" in veterinary medicine long before any drug trial is done. Examples are enalapril and sildenafil - as I recounted before used long before any trials.
Also - if you participate in the trial - who is your contact person - GP vet or cardio? I would be inclined to do this if it was working directly with Sonya Gordon as the other person who posted - Dr. Gordon is like one of the top five cardios in the US. But I just wouldn't do it if I was dealing with a GP vet who was "passing everything along" to another cardio. To me, not enough benefit to justify the risk. I use my GP vet for "everyday" things like chest x-rays and blood chemistry, but I only deal with cardio for ultrasounds, looking at x-rays for diagnostic evaluation and treatment planning, etc.
Oh - you mentioned her chest x-ray measurements - I'm guessing she has probable cardiac enlargement but she is not yet in CHF? Can you elaborate?
13th March 2009, 06:53 PM
Thanks for all of the questions. When I talked about "bad teeth" i didn't give you Colleen's history. 2 1/2 years ago when she was given to us by our breeder, she had been spayed and all but 3 of her teeth had been removed. So i just found out 2 days ago that of the 3 left, one is loose. So we are going to do the ultrasound and see if it is safe to pull it out.
I adore my GP, she is wonderful!! But I do agree with you that the echo should be done by a specialist. My vet doesn't even do them. So we are having it done in the Cardio dept at MedVet by Dr. Bancroft, with Dr. Lehmkuhl also advising. My GP has asked that Dr. Lehmkuhl look at everything going on with Colleen even though the study is through Bancroft.
I will ask her about the VetProof trial and see if this one is similar. I am going to call/email on Monday and find out what drug it is. That is a great question.
None of this will be handled by my GP, it is all through Cardio at MedVet. My GP will be getting copies of everything.
As far as I know Collen is not in CHF, but I am not sure how i know this definitely if we haven't had the echocardiogram yet. Right now she isn't showing any signs of a cough or distress or slowing down. She is crazy and happy as always. We go on 5+ walks a day. She has an enlarged heart and a stage 4 murmur. I guess I will know more about it on the 23rd when I take her in for the echo.
Let me know if I have answered all of your questions. Thanks for all of the help.
Here is the link for the medvet trial if you would like to see it.
13th March 2009, 09:28 PM
Thanks - that link explained it all except that it didn't name the drug. I tried to search for a list of beta-blockers made by Bayer, but didn't find anything but a calcium channel blocker called Adalat mfg by Bayer. I did find an interesting link about the motivation of drug companies:
"Big Pharma Chases Dogs & Cats"
Anyway, the drug trial is the same as the trials done on enalapril - they are looking for dogs with endocardiosis who have changes in the heart (enlargement) but who are not yet in CHF to see if there is a drug that will prolong the time to full blown CHF. Dogs must not be on any other meds. Of course there would be a huge market for a drug that would perform well in a trial.
Considerations (remember I am majorly over-analytical!) -
Cons - I'd strongly consider doing this with Dr. Gordon or Dr. Lehmkuhl doing the hands-on evaluations. But.....below is what I found about Dr. Bancroft:
Dr. Ann Bancroft received her Veterinary Medicine degree from The Ohio State University in 2006. Prior to graduating, she worked at MedVet as a technician (since 1998) and is now currently employed at MedVet as a veterinarian. Dr. Bancroft is also a member of the AVMA and International Veterinary Academy of Pain Management (IVAPM).
So - she's a young vet, not an internist or a cardiologist. Even though Dr. L is supervising, I wouldn't be too happy with this, but then again I'm pretty "hard core" about who I want doing diagnostics on my dogs.
Pros - you'd get a lot of free diagnostic work. If finances are tight, this is a strong incentive. But, to me, that's really the only incentive (other than the altruistic factor). And, as above, free diagnostics done by Dr. Gordon are not equivalent to free diagnostics done by Dr. Bancroft. I think there is, in reality, little chance that this drug trial would actually benefit Colleen directly. 50/50 that she would even get the active drug, and I'd be truly surprised if this drug is the "magic bullet" that Bayer would like for it to be!
Questions to ask - see if they will even tell you the name of the drug. If you knew that, you could do a little research on your own. You could at least look at the human literature even though that's not a perfect correlation.
Will they do blood chemistry every three months? This would be to watch for kidney or liver damage - frequent side effects in canines of many drugs. Will they give your vet copies of all reports every three months? (And I presume your vet would give you copies.) Will they do an echo every three months? They kind of waffle on what exactly they will do every three months - give a list of tests that MIGHT be done but don't guarantee all tests will be done to all dogs every three months. What is the length of the trial - dogs are pulled out when CHF ensues or ? what is the maximum time they'd be in the trial?
If your dog goes into CHF during the trial, I presume that she would be removed from the trial (since that is the endpoint of the trial for each dog) so that you could treat appropriately with other medication.
Make sure if you pull her out of the trial for any reason, there aren't any repercussions (like breaking a cell phone contract!) where you have to pay anything.
That's all I can think of for now. Oh - looking into my crystal ball, I predict:
No problem for Colleen to have a dental including extraction - don't forget pre and post dental antibiotics.
The drug trial will end with no significantly statistical proof of longer duration before onset of CHF due to the drug!! (There are so many variables that cannot be controlled in a drug trial - specifically the great variability from animal to animal in the progression of endocardiosis (genetic makeup, environment, weight, nutrition, nutraceuticals, vaccinations, and on and on and on). This is also why I put little faith into the results of the two enalapril studies. I have discussed this ad nauseum with my cardio, and this is why we've put some of my dogs on early enalapril (before CHF) and some we have not. Each case is treated as an individual.
Pat (sorry to have rambled on and on and on!)
14th March 2009, 05:30 PM
I have a lot of reading to do and a big email to compose to MedVet with all of my questions! Thank you very much for your diligence on responding to me. Maybe you can help me with this. If I don't do the study, how often will I need to get Colleens blood work done and echocardiograms performed? I know it varies, but I am wondering what most people do. I am trying to figure out what I am in for before I say yes or no to the study. And also look at how comfortable I am with everything going on. Not only is the study a commitment physically and mentally on Colleen. It is on me too and I need to think about it. It is difficult going in the emergency waiting room. that's all for now.
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