Sydney's cardiologist appt. wasn't good.

Just came back from the cardiologist. The chest x-ray and echocardiogram show that his heart has worsened significntly in the past 5 months and he's in early stages of CHF and has pulmonary hypertension, which is elevated pressure in his lungs. I knew this was coming but I still can't believe it. I can't stop crying.

We have prescriptions for furosemide, enalapril and vetmedin. Poor baby, he was so stressed at the drs. that his heart rate was up to 190 beats. Any and all advice is appreciated. Finding this board has been a great help to me so when the doctor was talking about the diagnosis and all the meds, it sounded familiar. I just want to make sure I know the best way to help Sydney and give him the best possible care in the world.

I am so sorry I can't give you any helpful advice but wanted to tell you I'm sorry

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What is his age and history? At what age was a murmur first diagnosed and what was the progression? Have you been monitoring with radiographs and echos? Can you give a short summary of dates of tests and results?

So he is just now starting meds, and he is starting all three at the same time? Did you do baseline blood chemistry and urinalysis before he starts the meds so that you have something to compare blood chem after 7-10 days to monitor side effects? That's a reason that I really like to start one med at a time if possible in order to monitor both positive changes and side effects. Does he have overt symptoms yet? Do you have a written summary report from today's visit?

One thing you can do is get a copy of the ACVIM Consensus on Diagnosis and Treatment of CVD - look on Rod's Cavalier Health website, and print that out and read it and study it. It explains staging and treatment options. That will help when you discuss things with the cardiologist. What are your follow up instructions other than doing follow up blood chem in 7-10 days?

How significant is the PAH and how bad is the tricuspid valve leak? Once he gets stabilized on the new meds I would discuss at what point you should add sildenafil (Viagra) to treat the PAH. It is an amazing drug with almost no side effects (except to your wallet, but I can help with ways to make it cheaper).

It is great that you are working with a cardiologist - that can make an incredible difference in longevity and quality of life. What are your instructions from the cardiologist about follow up visit?

I'll try to search for your past messages to see what history I can find.

Remember that Sydney is not afraid and he is not sad; he is living in the present and is happy and loves you very much! Try (and I know it isn't easy) to also live in the present with him and don't let your sadness rob you of the joyful times still here and yet to come. And the more that you learn, the more confident you will feel as you work with your vet team to give him the best possible care.

Best wishes,

Pat

'Remember that Sydney is not afraid and he is not sad; he is living in the present and is happy and loves you very much! Try (and I know it isn't easy) to also live in the present with him and don't let your sadness rob you of the joyful times still here and yet to come. And the more that you learn, the more confident you will feel as you work with your vet team to give him the best possible care.'

Great comment Pat, and so true. We get so caught up in our own emotions, but it is so hard when we love them so very deeply.

Though I have no advise, like Anne, I just wanted to say I am sorry, I'm thinking about you and praying for you both!

Thanks every one for your good wishes. Pat, you have given me a lot to think about . Thank you. In answer to your questions

What is his age and history? At what age was a murmur first diagnosed and what was the progression? Have you been monitoring with radiographs and echos? Can you give a short summary of dates of tests and results?

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Sydney will be 11 next month. His murmur was first diagnosed as a grade 1-2 when he was about 5. Up until 2 yrs ago it stayed that way then jumped to 4. He first saw a cardiologist in Jan 2010. Xray and ultra sound confirmed a faulty valve plus a mass in the middle of his chest. Not sure what that is as surgery would be involved and the location, along side his heart and lung, plus anesathea would make biopsy very risky. Best medical guess, based on his health, is the mass is benign. This past weekend, after walking around the yard, he just stopped and fell over…did not lose consciences….and only lasted a few seconds, then he was fine.

So he is just now starting meds, and he is starting all three at the same time? Did you do baseline blood chemistry and urinalysis before he starts the meds so that you have something to compare blood chem after 7-10 days to monitor side effects? That's a reason that I really like to start one med at a time if possible in order to monitor both positive changes and side effects. Does he have overt symptoms yet? Do you have a written summary report from today's visit?

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4 weeks ago he had his check up with his vet and they did a complete blood work up along with urinalysis and stool. All came back normal so in light of that the cardiologist will wait until next week when we go for a return visit. I do have the written summary from today and a more detailed copy of it has already been faxed to the vet

One thing you can do is get a copy of the ACVIM Consensus on Diagnosis and Treatment of CVD - look on Rod's Cavalier Health website, and print that out and read it and study it. It explains staging and treatment options. That will help when you discuss things with the cardiologist. What are your follow up instructions other than doing follow up blood chem in 7-10 days?

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We haven’t discussed yet other instructions other than the follow up next week. What questions do you recommend I ask?

How significant is the PAH and how bad is the tricuspid valve leak? Once he gets stabilized on the new meds I would discuss at what point you should add sildenafil (Viagra) to treat the PAH. It is an amazing drug with almost no side effects (except to your wallet, but I can help with ways to make it cheaper).

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Not sure what PAH is. I will look it up and look at Rod’s website. If the tricuspid valve is the one in the center of the chest, that is where they are having a hard time seeing because the mass is in the way. Since his symptoms (at least the coughing and falling) seems to have come on within the last month, they feel we caught it in early stages of CHF.


It is great that you are working with a cardiologist - that can make an incredible difference in longevity and quality of life.

What are your instructions from the cardiologist about follow up visit?

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Follow up next Thurs.

Again, thank you so much for caring and helping me sort out all of this.

Hi, I am not yet dealing with this issue but wanted to say I am sorry to hear about Sydney's condition and am thinking of you both
:lotsaluv:

So sorry to hear about Sydney. I really feel for you it's awful to go through and so emotional. I wish I had been on this forum when I was going through the same thing with my last dog. Which was 2 years ago this April. It's so good to have people here like Pat to help you deal with something like this. Just keep loving him. Thinking of you both.

I recommend you read Darcy's Daily Blog -- http://darcysdaily.blogspot.com/ -- about a cavalier waging a battle with congestive heart failure. She was only 6, but the blog includes discussions about meds and cardio visits and reduced physical activity.

Many of us have been in your situation, and it's tough. But as Pat said, Sydney doesn't know he's ill, just that odd things happen to him occasionally. But one of the loveliest characteristics of Cavaliers is their ability to enjoy life - even when that life is made limited and difficult by illness. They will still enjoy their food, enjoy pottering round the garden, enjoy cuddles, enjoy their humans, until the day comes when they tell you very clearly that it's their time to go. So enjoy each day with Sydney, as well as continuing to do all you can to care for him.:hug:

Kate, Oliver and Aled

Update from yesterday. After a stressful evening, for Sydney and me, Sydney finally setteled down and had a good night sleep. This morning he's actually has more spunk than he's had in the last week. :l*v:

He's fought lots of health battles in his life. Relatively minor in comparision to his heart. He has hypothyroidism since he was about 3 yrs., arthritis, ear infections (which I think have now made him deaf), skin infections brought on by his poor auto-immune system, and of course, rotten teeth.

I want to thank everyone again for all their good thoughts and information. I haven't yet read all the info that was suggested. My mind is too muddled for that right now. I know this is going to be hard and painful for me, but I will pull myself together and I will take care of Sydney to the best of my ability. He will want for nothing, which is pretty much what his life has been anyway.

Please keep the information and suggestions coming. I appreciate it all. I have never been through this before as Sydney is my first pet. Knowing what to expect is helpful and even though I have read up on MVD/CHF in the past, there is so much I don't know.

I so agree with what many have said previously. I am just going through this experience myself and one thing I have learned is to stay in touch with your vet or cardiologist to adjust medications anytime you see changes, or to get perhaps a small boost like a frusimide injection to help Sydney over a bad phase. also, they can go through a setback, and then the heart remodels to deal with the new situation over hours or a day or two, so you can find that a dog you thought was really perhaps on its last day is back in very good form after a short period. That's why I think it is important to keep an eye on any changes to give your dog the help he might need if he is uncomfortable or in distress–but at the same time, not to jump to the conclusion that the moment has come when you will need to say goodbye because often they will come around. It is all a delicate balancing act and there comes a point, generally after a few of these up-and-down phases, when you realize the time has come because the dog is struggling and quality of life is just not there. Unfortunately with this condition, it can be hard to know whether the moment has come or whether it is just one of the small setbacks–in my own mind, I will make that final decision when my dog Lucy is struggling and not showing any sign of recovering and where the vet says nothing can be done.

Meanwhile, they just get on with it and I just keep life as normal as possible, albeit with hugely reduced physical exercise (and lots of favorite treats!)

Thanks Karlin for your support and wisdom. I know you recently went through a loss with Quincy and now, so soon after, you need to face a touch decision again. I sorry.

I have a wonderful vet for Sydney who called me today. The cardiologist had faxed her the detailed report and she wanted to let me know that she was there when I or Sydney needed her.

I too have had experiences like yours and so many others on this forum. At the moment it is my 10-year old tri Victoria who is struggling occasionally. As others have said, reduced exercise, wholesome food and lots of TLC combined with the vet's advice on adjusting medication have already helped her enormously.

Every day is different, and I know that we are only "buying time", but the time in question can be very valuable and an even closer bond can develop between a beloved dog and a careful and caring owner as they approach their twilight days.

We'll all be holding you and Sydney in our hearts - you are not alone

Thanks Ann-Marie. I'm looking forward to small victories and goals. Next one up is his birthday next month. A special dinner and I already have his birthday hat! :fool:

When I first came to this message board, I was looking for information from "regular people" who have gone through this, not just the medical community. What I found was not only information, but the support complete strangers give one another. It's nice to have a place to go.

I will keep Victoria in my thoughts and pray her struggles are minor.

Anything I should ask the cardiologist?

Sydney is going back to the cardiologist for his one week checkup. In my opinion, he does seem a little better after being on the meds all week. Pleased keep your fingers crossed that this is really true. :xfngr:

Any advice or any particular questions I should ask? Thanks so much for all the help and support.

Sydneys Mom said:

Sydney is going back to the cardiologist for his one week checkup. Any advice or any particular questions I should ask? Thanks so much for all the help and support.

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Glad to hear that he seems to be doing better.

These are the questions that I would ask:

1. How would you rate his PAH (pulmonary arterial hypertension) - mild, moderate or severe? At what point do you recommend starting sildenafil or a similar drug for the PAH? (This way, the cardiologist will know that you are aware that there is specific treatment for PAH.) You may already know the "rating" from the written report that you received.

2. Has the mass in his chest changed or grown from the Jan 2010 echo to the echo done last week? Is this a heart-based tumor or is it attached to other organs? How do you think this tumor (even if it is benign) might affect his failing heart to make treatment or prognosis different from more "typical" CVD heart failure.

3. Does Sydney have an arrhythmia (irregular heart rhythm)? I'd ask this because of the fainting (syncope) episode.

The answers to these questions might already be on your written report, but this is the info that I'd want to understand well.

Pat

P.S. I forgot to ask before - I presume he is taking Soloxine for his hypothyroidism? How do you monitor that and when was his last full thyroid panel? I might want to ask if a new thyroid panel (not just T4 but the panel that gives about six different values) should be done. Oversupplementation with thyroid meds can very negatively affect heart failure so you'll want to keep a watch on that.

Thank you Pat.

1. How would you rate his PAH (pulmonary arterial hypertension) - mild, moderate or severe? At what point do you recommend starting sildenafil or a similar drug for the PAH? (This way, the cardiologist will know that you are aware that there is specific treatment for PAH.) You may already know the "rating" from the written report that you received.

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This question is on my list, though in not so much detail, go I'm glad you gave me more info to look for.

2. Has the mass in his chest changed or grown from the Jan 2010 echo to the echo done last week? Is this a heart-based tumor or is it attached to other organs? How do you think this tumor (even if it is benign) might affect his failing heart to make treatment or prognosis different from more "typical" CVD heart failure.

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The mass has stayed the same size. Because of the location, mid chest between his heart and right lung, they had a hard time seeing the amount of fluid in his lung. This is a complication that they are monitoring closely.

3. Does Sydney have an arrhythmia (irregular heart rhythm)? I'd ask this because of the fainting (syncope) episode.

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Not sure about the arrhythmia, I will ask. Sydney didn't faint or lose conciousness. He just seemed to collapse and looked stunned for a sec.

I presume he is taking Soloxine for his hypothyroidism? How do you monitor that and when was his last full thyroid panel? I might want to ask if a new thyroid panel (not just T4 but the panel that gives about six different values) should be done. Oversupplementation with thyroid meds can very negatively affect heart failure so you'll want to keep a watch on that.

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Yes, he is taking soloxine for hypothyroidism. His vet has been checking yearly, his last one about 5 wks ago. The cardiologist has copy of that and other blood tests he has for his senior panel. I believe it is just the T4 since there was, until now, never any other reason to go further. I will ask about more extensive blood testing today.

Thank you for taking the time to help me. I will update when we get back.

Sydneys Mom said:

Yes, he is taking soloxine for hypothyroidism. His vet has been checking yearly, his last one about 5 wks ago. The cardiologist has copy of that and other blood tests he has for his senior panel. I believe it is just the T4 since there was, until now, never any other reason to go further. I will ask about more extensive blood testing today.

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Something that my GP vet told me years ago made a strong impression - basically, you can accidentally cause a dog to have hyperthyroidism if you are supplementing for hypothyroidism. The effects of hyperthyroidism are more serious than the effects of hypothyroidism - you can literally "burn up" organs. It's especially dangerous in the presence of heart disease.

If I run blood chemistry and see a low T4 on a general panel, I won't start soloxine without running a 6 value thyroid panel to confirm the presence of hypothyroidism. The panel is not expensive to run. I send mine to MSU in Michigan but if I were in California, I'd send blood for a panel to Jean Dodds' Hemopet.

There have been several instances of my dogs or foster dogs (especially seniors) having a low T4 (with no symptoms) but then their thyroid panels came back with all values in the normal range so my vet team has not started soloxine (or has stopped the drug when new dogs or fosters were already taking it) after getting the results of the panel.

So.......I would ask the cardiologist if he recommends running a full panel to make sure that Sydney is taking the right dosage assuming that you've not run a panel ever or in the recent past. I'm just very watchful about oversupplementing and causing hyperthyroidism.

http://www.advancedveterinarycarecenter.com/veterinary-specialty.asp?spec=ms&specID=45

Pat

Update

:updte: Were at the cardiologist yesterday. She is pleased that he is handling the meds without any undo side effects. They did a kidney panel and packed cell volume and both came out great.

Pat, you mentioned to me to ask about his PAH level and it is classified as severe. I also asked about adding sildenafil. She does use it often in PAH andCHF however, at this time, since Sydney is responding well to his current meds, she would rather hold off and wait until these drugs are no longer effective.

I was so pleased all week that Sydney was doing OK. Then today, he and an accident while he was taking his nap, he woke up in a pool of urine . I know this can happend because of the furosemide, but I just felt so bad for him. I cleaned him and the floor up and just felt deflated afterwards.

Sydney had another "accident" today . This time he went to get up and just didn't make it to the door. Any advise on helping him? He just looks so confused when it happens. I just give him a big hug before I clean up.