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View Full Version : I could REALLY do with advice right now :(



kaytee576
9th July 2009, 10:57 PM
Hey guys. Hope you can help.
I have been at the same vet practice for years now and have always taken my cav Kaytee who is age 9. She has many health problems, Syringomyelia, dry eye, IBD and a heart murmur.
We moved house just over a month ago and today I visited a new vet that is local. Before they could dispense kaytee's tablets they wanted to see her, I chose to go to this vet as when I looked around most had vets that cover all illnesses and this place had someone who had trained and worked with a lot of heart patients.

Well I saw the new vet today and he said he can hear kaytee's murmur. she is on Vetmedin and frusemide for her heart and the vet asked why she wasnt on Fortekor, he explained that the vetmedin helps to pump the heart and work better pumping but fortekor helps in another respect something to do with hormones too and that she would be better off with these as well as the vetmedin.
You see the thing is my vet I saw for years said her heart was stable, all he ever did was listen to it but he said he wanted to leave well alone and not change any of the medication.

The new vet wants to do a "heart work up" or something, she is booked in for tomorrow to have a heart scan, Xray, Blood tests and blood pressure tests. They are not going to use anesthetic but they are going to do these tests so that he can have a better idea of whats going on with her heart.

Kaytee had one xray in her old vets a few years ago, they have only listened since and never did a scan as they didnt have the equipment.

I was wondering do you think I am doing the right thing? Im pleased someone is looking into kaytee's condition further yet Im worried, my last vet said leave well alone and the new one wants to see what else can be done for Kaytee.

I would really appreciate your thoughts and opinions. Maybe im worrying as its a new vet I cant help It I find it so hard to trust them after one a long time ago over dosed my first cav causing her kidneys to fail :(
PLEASE reply if you have the time thanks so much xxx

Karlin
9th July 2009, 11:13 PM
I know several of us have suggested a few times over the past couple of years that it would be wise to get Kaytee to a cardiologist for a proper heart workup and I am glad this has been encouraged by your new vet. :thmbsup:

I think we had expressed some concern about a few of the approaches of your old vet to Kaytee's issues and thus seeing a cardiologist/getting a proper heart workup would have seemed a good thing to do. Vets are not particularly good on heart issues and many will not do much more than presrcibe the old medications. Fortekor has been used for several years now and there is information on it in the info on caring for cavaliers with heart problems in the health section of the library. It is good that your new vet is more aware of all these issues and wants to take a more active approach.

I would recommend following your new vet's advice if you wish Kaytee to have thorough heart care and the longest and most comfortable life possible. :thmbsup:

kaytee576
9th July 2009, 11:18 PM
Oh my gosh you remembered me :) :) Thank you so much. I will let you know how she gets on and go ahead with the work up tomorrow, Im just so scared and didnt know whether to leave well alone. Your opinions mean a lot thank you xxx

Karlin
9th July 2009, 11:20 PM
Actually I just did a search and according to this 2007 post, you did have her on fortekor? Maybe you'd forgotten?

http://board.cavaliertalk.com/archive/index.php/t-20239.html

kaytee576
9th July 2009, 11:22 PM
Actually I just did a search and according to this 2007 post, you did have her on fortekor? Maybe you'd forgotten?

http://board.cavaliertalk.com/archive/index.php/t-20239.html

Yeah sorry, she was on them and then they took her off them and put her on Vetmedin on its own, The new vet is talking about giving her vetmedin and fortekor at the same time.

Karlin
9th July 2009, 11:41 PM
They may have felt it was too early for Fortekor back then, and taken her off.

In general it is always a good idea to get a full heart workup, heart xray etc so you have baseline measurements and can watch for changes and manage heart care accordingly. Cardiologists are far better than vets at heart care once a dog has a degree of heart problems. Targeted well-informed care generally is far better for the dog as what happens with MVD and heart failure can vary greatly and meds need gradual (or sometimes, swift) adjustment.

There's an excellent post on heart care for cavaliers here, mostly written by board member Pat:

http://board.cavaliertalk.com/showthread.php?t=9214

Pat
10th July 2009, 07:24 PM
And here I am......(by the way, I very badly need to update that general post as it is rather outdated - written before Vetmedin (pimobendan) was in existence and before enalapril was available at discount drug stores for $4 per month's supply!)

In short, your new vet is much, much better and is proceeding properly! He/she may not be able to interpret an echocardiogram (heart scan or heart ultrasound) as well as a cardiologist, but this approach is much better than that of the old vet. If you want a long answer about why I say this, complete with links to vet references, I can give that but it will take a bit of time to write.

In general, the more widespread and effective treatment for acquired valvular disease is to begin an ACE inhibitor (Enalapril in the US; Fortekor in the UK) when there is moderate to significant heart enlargement (which can only be found by x-rays and/or echo) even before there are signs of heart failure; then add a diuretic when fluid in the lungs (pulmonary edema) or abdomen (ascites) starts and then add Vetmedin (and/or other drugs as there are many) as the heart failure progresses and the heart needs more assistance to pump properly. (So, Karlin, Fortekor is a "first line drug" rather than saved for progressive disease.) Now, there is some new thinking about starting Vetmedin earlier in the course of CHF (congestive heart failure) and various cardiologists differ in their opinion of when to start - US cardiologists tend to wait longer, but perversely US GP vets are using it early because of aggressive marketing by the manufacturer, which can lead to problems. But the best results for symptom control are due to the synergy of drugs working together. (And I personally would never give Vetmedin without an echo/scan done first because the drug can be harmful if there is normal heart contractility, and you can't measure that without an echo.) The blood chemistry profiles are to monitor kidney and liver functioning as drugs can adversely affect those organ systems, watch electrolytes to make sure they are in balance, etc., and they are a key part of ongoing treatment.

I have had ten plus dogs with heart disease live well into their teens, well compensated (showing very few symptoms) on heart meds, and all but two dying of other illnesses. I attribute much of that to having an excellent cardiologist and being very proactive in diagnostics to determine the best treatment planning. The most dramatic example was Capers (Kilspindie Capercailzie) - diagnosed with a murmur at 4, went into heart failure at 11, pronounced to be in end stage heart failure at 13, went into kidney failure at 15. He was put to sleep at 16 1/2, not because of heart or kidney failure symptoms, but because of quality of life issues as he had become blind, deaf and senile. He was on five heart meds when he moved into end-stage failure, but backed down to four meds and lower doses and daily subq fluid when he went into kidney failure - which shows the value of those blood chemistry profiles.

I could go on and on and on as I'm passionate about this topic........but I won't because readers are starting to snore!

In short, I really like your new vet!

Pat (and this was my "short" answer!)

Karlin
10th July 2009, 07:51 PM
Thanks for that detailed information, Pat. I'd love to have you do whatever you would like with the existing post in the Library, anytime -- just copy it to any word processing program, edit as you like, and send me the post and I'll put it up. Or simply make a fresh post into the health forum and I'll copy it over to the Library.

Thanks for the correction too. I was confusing Vetmedin and Fortekor. :sl*p: I get confused by the different brand names between the US and Europe too. :lpy: I don't yet have a dog on heart meds so these are not fixed in my mind!

kaytee576
10th July 2009, 11:02 PM
Thank you all so much for your replies. I wanted to post to let you know how kate got on today :)
Well she was dropped off at 9am. Zak our new vet did an xray, ECG (something about checking if the heart was irregular) a scan, blood tests and blood pressure test.

The results showed that all of kaytee's other organs seem to be working well which was a relief as I worry about the effect her pills could have on her.
Her heart chambers didnt seem enlarged but Zak did see that there is a definite murmur and was able to see the blood flowing backwards from a valve (I think) also the valves seemed thickened he said this often happens with older dogs. The heart beat wasnt irregular.

He found that kaytee has high blood pressure which he was most concerned about. He has given her a drug for this called PRILACTONE 10MG 2 TABLETS ONCE A DAY. He hopes this will lower the blood pressure and help the function of the heart.
He also put her on Fortekor 5mg once a day.

He then went on to tell me that he couldn't see any fluid in the lungs. It was really weird, yesterday he said he heard a noise which made him think it was the heart (fluid) but on further investigation he realized the noise he heard was coming from her stomach. As he listened near the stomach it was there he heard the noise louder which I think is strange? Could this be to do with her IBD I wonder and forgot to ask! He did say he could notice slight crackles but the heart was a lot better then he thought.

All he could see was a slight bit of fluid below the heart he said hardly any..I wonder though if me giving her her frusemide in the morning made a difference to this?
Well to cut a story short he said that he is wondering if her cough is actually related to her throat, her elongated soft pallet and irritation there. This is something I always put the cough down to, I think I even posted before to say I thought her cough was throat related, but my other vet said it wasnt. It was weird to hear Zak say he agrees with me.

BUT he is not definite. We have synulox for 2 weeks to make sure there is no infection in the throat. We are going to spend a few months as he put it "Tweaking" Kaytee to get things right. He wants to try lowering the frusemide at some point to do a little test to discover where we truly think the cough is coming from. Sadly he cant look at her throat with a camera as he dosent think she is well enough to be put out during the investigation.

Anyways we have a lot to go on. Im kinda anxious I know nothing about these new pills and I always find it hard to trust anyone when it comes to my little girl...but im gonna ride with it and pray things turn out well!

THANKS FOR READING xxx

Kaytee's Medication.
Vetmedin 1.25mg 1 twice a day.
Fortekor 5mg once a day.
Frusemide 20mg twice a day
Prilactone 10mg 2 tablets once a day. (new for blood pressure and he said works as a slight diuretic too)
Prednisolone (for ibd) 5mg one every other day.

MishathePooh
10th July 2009, 11:13 PM
Thanks for the info Pat! I have a turning-13-August-1 wonderful boy who has a heart murmur. He is currently unmedicated and full of energy. I was so worried that MVD was an instant death sentence, but am now thoroughly relieved that this is not necessarily the case. My boy Misha has seen a cardiologist, and wihle I was really worried about the stress at first, Misha was far more relaxed than I was! I will hope for many more years:)