PDA

View Full Version : Not good news for Pippin at annual check up:(



pippa
22nd April 2011, 12:33 AM
Hello all...

Don't get a chance to post on here much lately.


I had Pippin up for his annual bloods and new vet (who has specialized in heart problems) found a murmur..., itís not the usual kind of murmur that cavs get (trust Pippin) itís a problem with the valve not opening fully rather than not closing and closing too quickly, so doesnít cause fluid to build up on the lungs but blood to gather around the heart,we could clearly see what was happening on the scan, anyway she has scanned and done an ECG, which she took a close look at later and called us about after giving us loads of info at the scan,- she is excellent,- and he is not showing any signs of heart failure, but is showing signs of some damage caused by the heart trying to compensate, and slow heart rate. She said this type does not show the normal coughing or abdominal swelling that the usual murmur does, so can get bad without noticing any problems other than a little weakness and loss of energy, which he does have recently.

She has started him on vetmedin 2.5 twice daily for two weeks and if it gives him more energy she will keep him on 1.25 twice daily but if heís much the same will leave him off meds for the moment, she has reduced his phenobarbital to half a 15mg tablet twice daily, (sheís not sure now whether it may have been his heart all along it was a different vet who thought it was fits although they werenít the classic fits) she is not withdrawing them altogether at the moment just in case.

Other than this she said she will scan him annually and told us not too worry too much about walks and playing as it is important at the moment that he is happy and allowed to live as normal as possible. We only walk him for 10-15 mins twice daily anyway and he doesn't play as much as he used to...

Pippin was 7 last feb, we have had him since he was 9 weeks.

Gus (who is 9 and a half) has his check up next week, and DJ (7 in June) next month, so I am a little nervous about that, but fingers crossed.

Just wondering if anyone has experience of this type of murmur?

Pat
25th April 2011, 10:27 PM
I saw that you posted again in the health section.

Do you have a written report with a diagnosis? It's not at all clear to me what your vet is describing. If you can find out the name of the particular heart disease/condition, I could tell you much more.

Remember that a murmur is only a noise, it is not a heart disease or condition - so saying that a dog has a murmur or even that a dog is in heart failure tells you nothing of the underlying disease. Cavaliers typically have degenerative valve disease - there are several names for this disease including MVD, endocardiosis, acquired valvular disease, chronic valvular disease. In this disease, the valves become leaky, mishapen, warped, prolapsed - or similar and the valve becomes incompetent and doesn't work properly. This can result in several problems - not just fluid backing up into the lungs (pulmonary edema) but ascites (fluid building up in abdomen and extremities), pulmonary hypertension when the tricuspid valve fails (high blood pressure in the lungs only), etc. Blood gathering around the heart (in the pericardium or sac that surrounds the heart) is called pericardial effusion.

Find out an exact diagnosis and I can give more information. I can't tell if you are describing mitral valve dysplasia (present at birth) or stenosis or a rhythm/electrical disturbance or what. There should be an official name for the exact disease.

Pat

Karlin
25th April 2011, 11:59 PM
Sorry to hear this.

Don't now at all what is being described -- but putting a dog on Vetmedin early (before advanced CHF) remains controversial, I would want to understand exactly the reason for this.

For anything heart related, especially if it is unusual like this, I still would go to the cardiologist (Tom Mullally at Nutgrove vet, or Bray Vet also has one who visits once a week or every two weeks or so)) if this were one of my dogs. Vets with some heart training still lack the expertise of cardiologists.

Pat
26th April 2011, 01:41 AM
The description of "damage from the heart trying to compensate" almost sounds like myocardial disease. Myocardial disease is most often DCM - dilated cardiomyopathy - which is the disease found in large breed dogs. In this disease the heart muscle becomes flaccid and enlarged and doesn't pump blood efficiently. A dog can have myocardial disease AND degenerative valvular disease at the same time. I definitely agree with Karlin that using a cardiologist for diagnosis and treatment planning really will give the best results as far as quality and quantity of life. Vetmedin is actually used earlier in myocardial disease (because contractility or the pumping strength of the heart is a problem early on) than in valvular disease and can be a very useful drug. It may be problematic, though, in the presence of bradycardia (slow heart rate) that you describe as the drug can slow the heart rate even more.

Here's one link that describes heart disease in very everyday language:

http://dogtime.com/heart-disease.html

This link also talks about why dogs don't have heart attacks (myocardial infarcts) as humans do. MI, or heart attack, is when the blood supply to the heart is suddenly cut off. This is generally due to coronary artery disease, or athlerosclerosis. It appears that this link was written before the advent of Vetmedin.

Pat

pippa
26th April 2011, 08:35 AM
"It's problem with the valve not opening fully rather than not closing and closing too quickly, so doesnít cause fluid to build up on the lungs but blood to gather around the heart,"


I should have said it's the Mitral valve that's the problem, the left one, which means that when the blood is trying to leave the heart the valve is closing too quickly, therefore not allowing all the blood out, also he has a slow heart beat which doesn't help resulting in low blood pressure.On the scan there was a lot of disturbance either side of the valve and blood mixing.

The vetmedin is to see if there in any improvement in heart rate resulting in increased energy levels. After a week we are seeing some improvement, we are due to see the vet again on Thursday next.

I was a bit shocked at the time of posting so sorry for not explaining fully.

We will be discussing on Thursday where to go from here.

pippa
4th May 2011, 11:07 AM
Talked with the vet on Thursday, she has reduced the vetmedin to 1.25 and will keep him on this and see how he goes, he had to have his phenobarbitol increased back up to 15mg twice a day last Wednesday as he was showing signs that he may have being going to fit.

Also poor little man ended up in emergency vets on Monday (bank holiday) as he had been having trouble with his hindleg, pain and reluctance to use it on Sunday, I had checked him over and couldn't find anything obvious, but wasn't happy to leave him in pain, vet didn't find anything either after a very long and thorough check,(he looked for hip and patella problems also) so presumes it may be muscular and has him on metacam for 8 days and no walks for two weeks. I have to bring him back for x-rays if it doesn't improve. The thing is Pippiin has always had weakness in his hindlegs and had a whole serious of x-rays last year which showed nothing and then the weakness improved when he was put on PB for epilepsy..my vet is very clued in on SM and has said if we are worried could have MRI done...at the moment I am hoping this is just a pulled muscle, he is showing some signs of improvement after only two days on metacam. If I am not happy with him by Friday I will bring him to see my usual vet.


Gus (who will be 10 on Oct) got a clean bill of health on Thursday, no heart problems or any other problems other than he is deaf in one ear and almost in the other. Poor Pippin gets everything and he is such a little character, and only a little cavalier, he is so sweet and gentle and never complains. I only know he has pain in his leg because he is so quiet and reluctant to use it. Although if he brushes it against anything/one he yelps and then holds it up for a couple of seconds, but is ok after I comfort him and massage if for him.
Hopefully he will be better today/tomorrow, if not it's back to the vets on fri, even though he is not finished on metacam until monday.

Does anyone have an opinion on whether this could be muscular or something else?

Nicki
4th May 2011, 06:59 PM
Oh goodness such a lot going on :( poor wee fellow.

I'm still not quite understanding the heart issue, did your vet give you the name of it?


Sorry he is also now limping - hoping it is just muscular, Metacam would also help pain from SM so it's no guarantee that it is not that. See how he goes, is he showing any other signs?


Good news on Gus though :-D

mommytoClaire
4th May 2011, 10:55 PM
I'm so sorry to hear that he is continuing to have problems with his leg/hind end.

I can't imagine what is going on if the Vet hasn't figured it out. Could it just be arthritis? Do you have acupuncture there? My Vet facility has 3 Vets, and one is an acupuncturist, which I have been told works well with pain issues.

How big is Pippin?

pippa
4th May 2011, 11:50 PM
As far as I can gather he has MVD, just a different type, and low blood pressure intermittently. It was a lot to take in but I'll be talking to the vet again tomorrow as he was only given a week's supply of the lower dose of Vetmedin and we will review again tomorrow.

The leg has me baffled; he is much brighter today, so not in constant pain, and he can walk on the leg when he needs to go out to toilet or drink/eat etc. We are careful to lift him when he needs to be lifted up steps, etc. and he is not having any walks, but although much brighter today he still is getting intermittent pain, where he suddenly yelps and holds the leg up, but a few seconds later is fine?

Hopefully my own vet can shed some light on things tomorrow.

He had a metacam injection on monday and a tablet yesterday, and today, he has 6 more tablets for 6 more days. I am just worried that he is still having these episodes of pain that don't seem to be brought on by anything in particular eg. tonight he was walking away and moved too quickly which caused him to yelp and lift the hind leg, but 10 seconds later he was fine...

Has anyone else had to deal with anything like this? Is it likely to be muscular or ligament like the emergency vet said or something else? I am of course as I said going to say all this to my vet in the morning. just wondering if anyone can shed light on these symptoms to put mind at rest as I am thinking all sorts...

'mummytoClaire' he is a smallish cavalier and weighs 7.5 kg and is lean. Thanks for your suggestion...
I may consider accupunture but really want to try find out what's going on first.

sins
5th May 2011, 09:38 AM
I presume you're beginning to think the leg issue may be neurological in origin,like SM.
It may also be a simple sprain,muscle injury or a disc problem.
Hopefully giving the metacam will reduce inflammation and allow a chance to heal.
I think watch and wait for a few weeks and if it recurs,then perhaps consider a scan.
Many people assume that cavaliers with SM will scratch.
It's not necessarily so.Daisy was not a big scratcher,but it was intermittent lameness and unsoundness that gave away the fact that she had become truly symptomatic around 3.5 years of age.
I know it's frustrating and worrying,but it makes sense to see if it improves before deciding on a scan.Considering the cardiac concerns,maybe a scan should be a last resort?
Sins

Kate H
5th May 2011, 11:12 AM
My second Cavalier, Meg, never had slipping patellas, but once, jumping awkwardly, she momentarily dislocated her knee cap - it twisted out and went back straight away. The bone pushing into the surrounding muscle caused some inflammation and she needed a couple of weeks of rest and some painkillers to calm it down, but that was all it was and it never happened again. I had her before the days of readily-available MRI scans, but in retrospect she never showed any signs of SM and was very healthy until her heart murmur accelerated and she died of congestive heart failure just before her 8th birthday. Damaged muscles take time to heal - there are no short cuts, rest is essential - and spine and disk problems are also quite common in Cavaliers (my Oliver has spondylosis in three of his vertebrae), so give it time before you fear the worst.

Inevitably, we all get jumpy at anything that could be a sign of SM, but part of the problem is that what may be symptoms of SM can also be symptoms of other things, and even vets get confused!

Kate, Oliver and Aled

Wagtails
5th May 2011, 03:01 PM
Yes I'm another one with an old girl (Megan, my ruby) who has a weak back leg from an unknown cause. We know that she has mild SM, hydrocephalus, and also a degenerated disc in her spine. She had an MRI in 2007, but I wouldn't want to subject her to another one, so we live with the lameness and various other minor symptoms.

I'm sure your vet will advise you best - we do seem to have to learn to live with various peculiarities. There's a tendency to blame everything on a diagnosed problem, but they still get other ailments from time to time.

Good luck little Pippin - we're all following your progress and holding you and your mum in our hearts http://i673.photobucket.com/albums/vv97/Cavviewagtails/Animations/Heartblowingpoog.gif

pippa
5th May 2011, 06:52 PM
Well Pippin is much more himself today:)

I spoke to the vet again this morning and she has said it will take time and rest (which he is getting) to heal fully and if after that time (2 weeks) I can worry then, it did reassure me as all of your replies did, Thankyou:)

Pippin of course still has his epilepsy and the vet confirmed MVD, with some slight damage to the heart because of this and thinks the onset is only months ago, as he got the all clear at his annual health check last July.

We do know what road we are heading down but hopefully it will be a long one for Pippin and an easy one...

In the meantime the vet has said allow him to get over this leg issue and then let him live his life as normal and not to curtail his walks/playing etc. until we really need to which hopefully is a long way away...

Thanks again for all the reassuring posts x

pippa
19th August 2011, 07:49 PM
Pippin had his annual check up today. My vet said his heart is very stable at the moment, she said he still has the murmur of course and she would grade it 1-2.

When talking about how he is doing I told her that he gets quite tired some days and seems to lack energy and be a bit breathless on walks, and on hot or humid days can be breathless without any walking.

She has prescribed Fortekor (1/2 a 5mg tablet) for 7 days but said unless i notice a huge improvement she would not keep him on them, as he will need them at a later stage and said it would be pointless and expensive having him on them now if they don't make a difference.

Has anyone any experience of these meds used together and how much difference should I see as regards panting and energy levels?

RodRussell
19th August 2011, 09:15 PM
... how much difference should I see as regards panting and energy levels?

If the MVD is only grade 1 or 2, then I doubt the panting and lack of energy are due to MVD.

Fortekor is an ACE-inhibitor, and the official consensus statement of board certified cardiologists in the US -- the ACVIM Consensus Statement -- does not recommend giving any cavalier any drugs, ACE-inhibitor or otherwise, if all the dog has is a mild murmur, like a grade 1 or 2, unless the dog's heart is clearly enlarged.

I am wondering if your vet knows what she is doing. I suggest that you print out the ACVIM Consensus Statement and give her a copy of it and let her decide if she still thinks prescribing Fortekor is appropriate. The link is here: http://cavalierhealth.org/images/acvim_guidelines_ccvhd_2009.pdf

If the panting and energy level is not due to a bad heart, it could be a airway passage problem due to the heat of the summer. Is it hot in Ireland now? It sure is here in Florida, close to 100 degrees Farenheit every day.

There are any of a few other reasons why Pippin may pant and be lethargic. One is called BAOS. Read about it here http://cavalierhealth.org/brachycephalic.htm

pippa
19th August 2011, 09:57 PM
Thanks Rod, Pippin does breath very noisily at the best of times and snorts now and again also snores loudly when asleep. I will talk to my vet again....

Kate H
19th August 2011, 10:34 PM
The main UK researchers into MVD agree that Ace-inhibitors are useless until the final stages of congestive heart failure (which would be a Grade 6 level), but that Omega 3 oil can slow down the development of a mild murmur - so might be worth giving to Pippin at this stage?

Kate, Oliver and Aled

Pat
20th August 2011, 12:34 AM
If the MVD is only grade 1 or 2, then I doubt the panting and lack of energy are due to MVD.

Fortekor is an ACE-inhibitor, and the official consensus statement of board certified cardiologists in the US -- the ACVIM Consensus Statement -- does not recommend giving any cavalier any drugs, ACE-inhibitor or otherwise, if all the dog has is a mild murmur, like a grade 1 or 2, unless the dog's heart is clearly enlarged.

I am wondering if your vet knows what she is doing. I suggest that you print out the ACVIM Consensus Statement and give her a copy of it and let her decide if she still thinks prescribing Fortekor is appropriate. The link is here: http://cavalierhealth.org/images/acvim_guidelines_ccvhd_2009.pdf

Note that it seems that Pippin has been taking Vetmedin for the past four months. An echocardiogram was done so medication decisions would not be based on the grade of the murmur but on measurements and observations from the echo. I really don't have a good picture of Pippin's situation as the information doesn't make sense to me so I can't really say anything useful.

Pat

pippa
20th August 2011, 01:35 PM
"It's problem with the valve not opening fully rather than not closing and closing too quickly, so doesn’t cause fluid to build up on the lungs but blood to gather around the heart,"


I should have said it's the Mitral valve that's the problem, the left one, which means that when the blood is trying to leave the heart the valve is closing too quickly, therefore not allowing all the blood out, also he has a slow heart beat which doesn't help resulting in low blood pressure.On the scan there was a lot of disturbance either side of the valve and blood mixing.

The vetmedin is to see if there in any improvement in heart rate resulting in increased energy levels. After a week we are seeing some improvement, we are due to see the vet again on Thursday next.

I was a bit shocked at the time of posting so sorry for not explaining fully.



As far as I can gather he has MVD, just a different type, and low blood pressure intermittently.


Pat- It's hard to try explain when on a forum, but I have explained as best I can, from my understanding of his condition, as well as ECG in April he also had a doppler scan and was as you so rightly say medicated on the results of this rather than on the grade of the murmur. We did see a big improvement in him on the first couple of months on Vetmedin but when the weather got hot and humid he seems to slow down a lot and suffer breathlessness. I called the vet again this morning and she was not there today but spoke to the head vet and he said he would still go with the Fortekor for 7days and if no improvement stop it and review again in a few months. Yesterday my vet said his heart sounds very stable and she is happy the he does not need repeat ECG or scan at the moment but said (unless there is any worsening of his symptoms) she will scan again next April, a year since his last one.

She also said the even though a dog may show no worsening of symptoms it does not mean that the condition is not getting worse so it is wise to scan annually. She really is quite good and anyone with cavaliers seem to go to her she had Three waiting to see her yesterday and treats Pippin as if he were hers and dotes on him:)

pippa
29th August 2011, 07:04 PM
Well after 7 days with no real improvement we have now stopped the fortekor and with the weather gone suddenly cooler he is not as breathless so I presume it was the heat.