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anniemac
20th November 2012, 04:45 PM
Good news and bad news. I went with my friend to see cardiologist after vet said he had fluid in lungs on verge of CHF and prescribed vetmedin. Good thing because the good news is his heart is not bad. She saw tiny enlargement on one side but not concerned and said it would not be to the point where it would have caused fluid in lungs. She thinks that was due to something else. She had a print out of the heart and described everything. Kat asked about it being a grade 3 and she said it is more about the stage he is in and he is not close to being in CHF.

What did concern her was his breathing. Kat did test of how many breaths he takes sleeping and it's very low which is good. However, she felt he was not able to get enough oxygen. She said she did not think it had anything to do with palette so she had another specialist look and his nostrils are closed or something. He is being left with specialist because this is probably why he stops breathing.

Now for CM/SM. she noticed he was scratching quite a bit and had neurologist evaluate him. He did neck squeeze and he yelped. Kat had told me recently that he has been having trouble with fleas before this. I've been around Kennedy a lot and have never noticed scratching or any other symptoms of CM/SM. she said to put in back of her mind because his breathing issues is most important.
Kat has been around me dealing with Ella and of course that freaked her out. Honestly, does any cavalier pass the squeeze test. He's still at hospital but I would like to see what the neurologist says. I just don't see that with Kennedy but they can hide pain so well,

O feel like Kennedy is my own. So glad he went to specialist

RodRussell
20th November 2012, 05:33 PM
Sounds like a brachycephalic issue. Could be stenotic nares -- abnormally narrow or obstructed nostrils. What do the holes in his nose look like?

Pat
20th November 2012, 05:57 PM
She saw tiny enlargement on one side but not concerned and said it would not be to the point where it would have caused fluid in lungs. She thinks that was due to something else.

Honestly, does any cavalier pass the squeeze test.


Glad that she saw a cardiologist. I felt almost certain of the above outcome as your earlier narrative just didn't make sense.

And, yes, there are Cavaliers that pass the squeeze test.

Pat

Furrfoot
20th November 2012, 06:00 PM
I hope they figure out what he needs soon and he's feeling better very soon- sounds like the specialist was just what was needed:hug:.

(on a side note, thanks Rod Russell- you saved me a bunch of google time- now I'm pretty sure know why our new boxer grunts like a groundhog on occasion, and I can bring it up at the vet having done my research- she has nostrils that look halfway between the "before" and "after" pics of surgery for stenotic nares, and maybe has a little of a long palate issue based on what I've been reading, but since her gums are nice and pink after "boxer burns" and the grunting is not constant, nor is her snoring, I feel better after reading the articles- how often do you google a disease and actually feel better after reading up about it? lol).

anniemac
20th November 2012, 06:43 PM
Sounds like a brachycephalic issue. Could be stenotic nares -- abnormally narrow or obstructed nostrils. What do the holes in his nose look like?

He does have BAOS and had surgery but it never fixed anything. She (cardiologist) said holes looked enclosed/ slanted inward. He is staying there to have the specialist look more and talk about his options- surgery etc. She said it wouldn't have anything to do with palette but she was really concerned with him not getting enough air and so was the specialist.

As far as being uncomfortable at night and restlessness (which could be from if he has CM/SM) she feels it is his breathing problems and to get that looked into. Then keep in back of mind to see Dr. Bergman (neurologist) if he is still not helped because it could be pain. Etc.

Karlin
20th November 2012, 07:02 PM
A couple of my dogs would pass the squeeze test without any issue at all.

Sounds like a very good cardio and given that yelp I'd say she absolutely is right that he has CM/SM.

Scary that a dog can just stop breathing. :( These problems with flatter-faced dogs is alarming. For example with pugs, that flat face means they regularly have severe breathing problems -- and owners just think it is cute. :yikes YouTube has a lot of videos of people with 'funny' pugs seeming to fall asleep while sitting up. The reason they do that is lack of oxygen. The reason they sleep sitting up is that like many bulldogs, they cannot get enough oxygen sleeping in a normal position.

One reason I knew it was time for me neighbour's cavalier Susie (a rescue I placed with him) was when she started to need to sleep half-sitting up -- it was clear she wasn't getting enough oxygen any more with her MVD; heart enlargement and fluid. :(

I really do think people must start to rethink breeding dogs deliberately with faces that cannot supply enough oxygen to a significant number of the breed. :(

anniemac
20th November 2012, 07:05 PM
Glad that she saw a cardiologist. I felt almost certain of the above outcome as your earlier narrative just didn't make sense.

And, yes, there are Cavaliers that pass the squeeze test.

Pat

I'm glad she saw cardiologist also. The cardiologist said she was glad she came in before giving Vetmedin because he definitely doesn't need it. He wasn't coughing, exercise ok, and eating fine which were all good. She explained that there is loosening that can cause some backflow (I can't remember even though she explained it very well) but nowhere near where it would cause fluid in lungs.

I'm glad she had him see other specialists because if it isn't his heart causing his breathing issues, something is. It's not normal what he has been doing poor thing. I am glad his in good hands.

RodRussell
20th November 2012, 08:37 PM
I'm glad she saw cardiologist also. The cardiologist said she was glad she came in before giving Vetmedin because he definitely doesn't need it. He wasn't coughing, exercise ok, and eating fine which were all good. She explained that there is loosening that can cause some backflow (I can't remember even though she explained it very well) but nowhere near where it would cause fluid in lungs.

I'm glad she had him see other specialists because if it isn't his heart causing his breathing issues, something is. It's not normal what he has been doing poor thing. I am glad his in good hands.

It is particularly important to not let most general practice vets prescribe Vetmedin (pimobendan) without at least consulting with a cardiologist or internal medicine specialist. Vetmedin administered too early can make things a lot worse for the dog, than better.

anniemac
20th November 2012, 08:56 PM
It is particularly important to not let most general practice vets prescribe Vetmedin (pimobendan) without at least consulting with a cardiologist or internal medicine specialist. Vetmedin administered too early can make things a lot worse for the dog, than better.

I am so thankful to you for having that warning on your website. If it had not been for that, she would not have seen a cardiologist and the vet would be treating kennedy with Vetmedin and for his heart. Going to the cardiologist led to answers that his heart isn't as bad as thought (but she has all his diagnostics for future) to hopefully helping his real problem. Breathing and if he is having pain from what neurologist found in clinical exam. Good thing that she recognized that something else is causing these issues.

Karlin
21st November 2012, 12:55 AM
It is particularly important to not let most general practice vets prescribe Vetmedin (pimobendan) without at least consulting with a cardiologist or internal medicine specialist. Vetmedin administered too early can make things a lot worse for the dog, than better.

So very much agree! Also it introduces a large unnecessary expense.

Emkaybee
21st November 2012, 04:42 AM
Regarding the breathing issue, my vet told me recently that she sometimes sees dogs with seasonal allergies or dust allergies, and they can have breathing problem from that. Tess is going in for an ultrasound and consult with a cardio in a week, and they will be listening to her lungs. In the past year and a half, Ive gotten one Golden, then another, and I've had a hard time keeping the dust under control. They track it in from the back yard. So I'm hoping the breathing troubles Tess is having is in fact from dust and not the MVD. You might ask your friend to be sure Kennedy's vet has considered allergies as a source of the trouble.

Holly
27th November 2012, 12:57 AM
I think it's very important to keep in mind that just bc they "pass the neck squeeze test" doesn't mean that they are free of SM/CM. My sweet Scarlett, who I finally had to put down due to her SM pain, never ever yelped. She was stoic, yet she had one of the worst cases of SM that her neuro had ever seen. During her neurological exams, she never uttered a peep yet her MRI was terrible. Just something to note.

anniemac
28th November 2012, 01:39 PM
I think it's very important to keep in mind that just bc they "pass the neck squeeze test" doesn't mean that they are free of SM/CM. My sweet Scarlett, who I finally had to put down due to her SM pain, never ever yelped. She was stoic, yet she had one of the worst cases of SM that her neuro had ever seen. During her neurological exams, she never uttered a peep yet her MRI was terrible. Just something to note.

Oh holly, thanks for sharing that. I still think about your Scarlette. If only a "neck squeeze" breezer test? Would be that simple.

anniemac
28th November 2012, 01:48 PM
A couple of my dogs would pass the squeeze test without any issue at all.

Sounds like a very good cardio and given that yelp I'd say she absolutely is right that he has CM/SM.

Scary that a dog can just stop breathing. :( These problems with flatter-faced dogs is alarming. For example with pugs, that flat face means they regularly have severe breathing problems -- and owners just think it is cute. :yikes YouTube has a lot of videos of people with 'funny' pugs seeming to fall asleep while sitting up. The reason they do that is lack of oxygen. The reason they sleep sitting up is that like many bulldogs, they cannot get enough oxygen sleeping in a normal position.

(

I think a visit with Dr. Bergman (neurologist) would be good but the results came back from when they looked at breathing (palette, nostrils, etc.). He does have inflammation and something else but my friend was rushed into emergency surgery Monday and is in the hospital. She can't really handle Kennedy so I'm in charge of getting meds etc.

On the muzzle issue, Kennedy was diagnosed with BAOS and obviously has problems. I always thought Kennedy had such a big head but looking back on photos, you can see a difference in him and Ella side by side.


http://img.tapatalk.com/d/12/11/28/yqusyda3.jpg

Karlin
28th November 2012, 07:11 PM
I think it's very important to keep in mind that just bc they "pass the neck squeeze test" doesn't mean that they are free of SM/CM.

Yes very true! Some of mine with SM and other SM symptoms aren't sensitive around the neck.

Sorry your friend is having problems, Anne. :(

Holly
1st December 2012, 12:10 AM
Yes very true! Some of mine with SM and other SM symptoms aren't sensitive around the neck.



In fact, with Scarlett, oddly enough, her sensitive area was on her chest. Everyone always wanted to pet her there and I would have to ask them not to because it would send her into a tailspin. She couldn't wear a harness, either, but did fine with a wide, soft collar. The neurologist said it had to do with where the syrinx was, the width of it, and the nerves.

Sorry to hijack your thread, Anne, and I am also sorry that your friend's dog is having problems. I just thought it was important to note that not having neck sensitivity doesn't mean the dog isn't suffering.

anniemac
10th April 2013, 10:15 PM
Things have gotten extemely worse and my friend is extremely frustrated. She took Kennedy to see the surgeon about his BOAS on Monday and he said there was nothing he could do... In the meantime, Kennedy had an extreme episode the past week where he got to the point where he got off the bed, his back legs collapsed and he was on his side. There also was foam at his mouth. She called the vet today because she is extemely worried and I wondered if it was anything neurological. She said this:

"So nobody can figure out what is going on with him. Dr. Springer thinks that ďepisodeĒ the other night was not a seizure but more like the blood was not flowing correctly to his brain. He seems to lean towards the heart causing all this problems. Both him and Dr. Seyer agree that one of his heart valves is pumping blood the wrong way causing the heart to be enlarged, blood not fully flowing to his brain and the water around his heart. Both Dr. Springer and Dr. Sayer and the surgeon want to see a video of Kennedy ASAP to see what needs to be done. I donít like that nobody can seem to figure out what it could be."


She has explained his episodes as this:

"He has what I call "episodes" they usually start with him sleeping and his breathing being irregular. I mostly see it at night, he will be in deep sleep snoring and all of a sudden his snores will stop or change frequency. Once that happens it seems like he stops breathing and then jumps on all 4 and stands and pants as hard as possible for a few minutes. I always get up and pet him till it calms down, I can feel his heart beating out of his chest and him having a hard time catching his breath. His nose is always warm when it happens and itís worse when the room temperature raises, so I keep my bedroom super cold. He also has episodes similar to that during the day when he just starts breathing super heavy like he ran a marathon, but he would be sitting on the couch, not even walking around. Itís very hard to explain and I have not been able to get a good video showing this."

I really feel for her and she has been updating the cardiologist throughout and she still does not feel the breathing issue is his heart. So there is a disagreement with the vet and cardiologist. Please can anybody help? I know we can't give advice but I don't know where she can turn to next?

Karlin
10th April 2013, 10:39 PM
To me that does sound like heart and breathing problems related to his faulty heart valves (heavy breathing/fast breathing while at rest -- typical with later stage MVD).

Sadly quite often it IS difficult or impossible to know exactly what is causing a problem. Sounds like they are doing their best. I do not think she would want to risk anaesthesia for an MRI on a dog with a heart potentially that bad, given that these collapses are actually often due to poor blood oxygenation to the brain (see Rod's section on syncope/presyncope).

I think the specialists are right in suggesting she try to get a video of what happens.

I don't think keeping the room really cold makes much difference -- find that quite alarming actually -- surely must make him way too cold and contribute to his stress and discomfort. :-? I would think normal room temp is much better for him unless these specialists have said otherwise. Have never heard that keeping a dog in really cold temps inside would help a breathing much less a heart problem. Could well tax his heart instead. :(

anniemac
11th April 2013, 12:26 AM
Thanks karlin.

I agree with not having an MRI but anesthesia would have also been required if the surgeon suggested surgery (for scar tissue from surgery that vet did on his elongated palate). Strange because the cardiologist suggested that Kennedy sees the surgeon and so that was her next step which was a waste because he said he couldn't do anything.

I was with her at the cardiologist and her exam didn't make her or me think he was at this stage or that from what she saw would cause the breathing episodes. She actually didn't think he needed any medication yet.

Obviously things can progress and change since she saw the cardiologist. I told her to call the cardiologist and ask some questions (mainly that her vet is in disagreement about breathing) and that she is very concerned. I will have her ask the cardiologist about syncope. If it is heart related, then he has already done all the tests with her and she is a specialist. I personally feel a cardiologist would know more than a vet no matter how smart they are. if she has doubts about this one she may need a second opinion or have her look again?

She told me today that she is scared to go home because she fears he will be dead :(. I feel for her and I love Kennedy as my own.

Pat
11th April 2013, 05:27 PM
Anne - do you still have my phone number and email address? It will be easier if we can have a conversation about this rather than playing "20 questions" via email. I have a LOT of questions. I re-read the entire narrative, and it's difficult to follow. I often can't tell who (cardiologist, vet, owner) said what. Do you have written reports of what tests were done and results?

I don't think this is heart related - based on the quotes you've given from the cardiologist. There would have to be HUGE deterioration since the echo done five months ago which showed minimal cardiac changes. I would agree with the cardiologist on the problem - and it sounds like this is related to respiratory function with some abnormality. It almost sounds like sleep apnea, which could be the result of a physical abnormality.

The GP vet sounds clueless about heart disease, and I would only follow the advice and treatment recommendations from the cardiologist. (In fact, I'd look for a better vet.)

Is Kennedy overweight? Middle-aged - right?

If this were my dog, I'd go back to the cardiologist for a follow-up visit so that I could completely rule out heart disease as the cause of the problems, and I'd follow through with her recommendations about seeing further specialists. If heart disease is ruled out, I'd find a new GP vet because I would lose all confidence in his/her ability.

Pat

Pat
11th April 2013, 05:42 PM
Forgot to address the "cold room" aspect.

Karlin - you have to understand what it's like to live in the "deep South." I completely understand what Anne was saying. In the winter, most of us have our thermostats set on 68 or 70, and in the summer (it was in the 80's yesterday in Atlanta), most of us set our thermostats at 75 or higher. This is to keep the gas and electric bills at a reasonable amount. (Also, the a/c can only cool the house to a certain temp when it is in the 90's outside.)

I've had quite a few teen-aged dogs with advanced cardiac and respiratory diseases (including metastatic lung cancer). All of these dogs did much better when room temperature was around 68 (Farenheit - sorry, don't know celcius). They really struggle when temps are much higher than that. It is easier to breathe when the air is cooler and less humid. We talk about this alot in the yahoo canine CHF group.

In that situation, I kept my central air set at 76, but I put a window air conditioning unit in my bedroom so that I can keep that room at 68 to 70. These older dogs with compromised breathing always sought out that "cold" room. It meant that I had to sleep with two or three blankets in the summertime! I'm sure that this is what Anne was describing.

Pat

Karlin
11th April 2013, 06:53 PM
Hi Pat -- Oh, I spent my high school years in California's central valley where we had plenty of days in summer well over 100 degrees, and many summers traveling in states or countries with heat and high humidity -- so I know what heat and humidity can be like!:)

To me 68 degrees isn't really cold at all -- just a normal room temp depending on where you live (or normal range for air conditioning). As a matter of fact my house is normally a lot colder than that in Ireland. Right now it is 58 inside my house -- I just add a sweater. Heating is even more expensive in Europe.

From the post I thought it sounded as if the room was being kept really, really cold. I wouldn't consider anything in the range of 60 on up to be really cold! Just air conditioned! So I stand corrected if that is the temp range implied and would think that's a lot more comfortable for a poor-heart dog than high heat.

Also hadn't realised the dog had been seen so recently without heart issues of major concern, and the cardio was not thinking he needed meds. Agree that the line of this story and who said what, when, and what was done, is confusing. I hope Pat can give you some direct help.

anniemac
11th April 2013, 07:10 PM
Hey pat,

I do not have your phone number. I definately would love to talk to you or it might be easier to talk to her. She works in the cubicle behind me.

He had another bad night and she took him to the vet this morning. Another revenue things is he is having runny poop and this morning his poop was bright yellow.

I would appreciate any help you can give.

Thanks

Pat
11th April 2013, 10:41 PM
I think this is the key information:

I went with my friend to see cardiologist after vet said he had fluid in lungs on verge of CHF and prescribed vetmedin. Good thing because the good news is his heart is not bad. She saw tiny enlargement on one side but not concerned and said it would not be to the point where it would have caused fluid in lungs. She thinks that was due to something else. She had a print out of the heart and described everything. Kat asked about it being a grade 3 and she said it is more about the stage he is in and he is not close to being in CHF.

What did concern her was his breathing. Kat did test of how many breaths he takes sleeping and it's very low which is good. However, she felt he was not able to get enough oxygen. She said she did not think it had anything to do with palette so she had another specialist look and his nostrils are closed or something. He is being left with specialist because this is probably why he stops breathing.

He does have BAOS and had surgery but it never fixed anything. She (cardiologist) said holes looked enclosed/ slanted inward. He is staying there to have the specialist look more and talk about his options- surgery etc. She said it wouldn't have anything to do with palette but she was really concerned with him not getting enough air and so was the specialist.

As far as being uncomfortable at night and restlessness (which could be from if he has CM/SM) she feels it is his breathing problems and to get that looked into.

-------

OK -

We know that this is a good cardiologist, and I'm assuming that she did an echo, which would be definitive on the heart disease diagnosis. She has expressed concern that the physical abnormality (nasal stenosis) is causing serious issues.

I think the GP vet is totally in over his head, so I wouldn't waste money there. The cardiologist has totally contradicted what the GP vet has said. Big red flag there for when Kennedy is actually in heart failure.

Who was the "specialist" who examined the dog after the cardiology exam? Was this an IMS? What was diagnosis and treatment recommendation? I don't see that there was follow-up to this.

The surgeon who did the soft palate surgery says this isn't the issue, which agrees with cardiologist opinion that it's not soft palate issue.

The symptoms fit the diagnosis of upper airway disease.

I would schedule a visit with cardiologist to make certain there has been no rapid change in heart status and then follow up with specialist (IMS?) on treatment and diagnosis of nasal stenosis. If there is not a surgical fix, there are perhaps some drugs that could help such as bronchodialators. But I suspect that this is a surgical fix. I think this is quite serious.

I had asked if this dog is carrying some extra weight, and if so I would address that as it can make a big difference. I really suspect that this is all upper airway disease due to nasal stenosis/abnormality.

I can talk tomorrow if you'll send me your phone number. I need to take care of dogs and get ready to see "Zorro" tonight at the Alliance Theater.

Pat

Pat
11th April 2013, 10:52 PM
To me 68 degrees isn't really cold at all -- just a normal room temp depending on where you live (or normal range for air conditioning). As a matter of fact my house is normally a lot colder than that in Ireland. Right now it is 58 inside my house -- I just add a sweater. Heating is even more expensive in Europe.

It is 20 degrees warmer in my house right now, and I just turned on the a/c. Ceiling fans have been on all day. I could absolutely not function at all at a temperature of 58 degrees inside my house. I'd have to be in bed under several blankets with four dogs and a cat, and I'd still be shivering. Or I'd have to be running on the treadmill! We are not of hardy stock here in the Southeastern US!! I looked at average highs and lows in Ireland - there is not much fluctuation, is there? We have much greater temperature differences - even in the same week it can occasionally change as much as 40 degrees.

I'm sure that Anne's reference to a "cold room" is a room that is warmer than 58 degrees!

Pat

anniemac
11th April 2013, 11:14 PM
I think the GP vet is totally in over his head, so I wouldn't waste money there. The cardiologist has totally contradicted what the GP vet has said. Big red flag there for when Kennedy is actually in heart failure.

Who was the "specialist" who examined the dog after the cardiology exam? Was this an IMS? What was diagnosis and treatment recommendation? I don't see that there was follow-up to this.

The surgeon who did the soft palate surgery says this isn't the issue, which agrees with cardiologist opinion that it's not soft palate issue.

The symptoms fit the diagnosis of upper airway disease.

I would schedule a visit with cardiologist to make certain there has been no rapid change in heart status and then follow up with specialist (IMS?) on treatment and diagnosis of nasal stenosis. If there is not a surgical fix, there are perhaps some drugs that could help such as bronchodialators. But I suspect that this is a surgical fix. I think this is quite serious.

I had asked if this dog is carrying some extra weight, and if so I would address that as it can make a big difference. I really suspect that this is all upper airway disease due to nasal stenosis/abnormality.

Pat

Thanks Pat. To answer your question he does or has had a weight issue. She has been working on it and has gotten the weight down.

I think she is frustrated because she took the next step the cardiologist suggested and her husband took him to see a veterinary surgeon on Monday. I was not there and I have asked her to have carolina vet specialts fax her his file but she hasn't. All she said was the appointment was a waste of time and he said there is nothing he can do. I wish I had more information.

Actually her vet did the surgery for his elongated palatte. She had more information (or maybe I have more information) from her visit with the cardiologist. While he was in the back, she had the others look at him. I think the person that initially examined him is a different surgeon than the one she went to. The cardiologist mentioned that the specialist said there was scar tissue and something about the first surgery not completely doing what he feels needs to be done which is why surgery may need to be done. Since the appointment Monday really didn't address anything and the cardiologist doesn't feel it is the heart, she feels her vet is the only one that is addressing the problem.

This is very serious and she said and I agree that it is really scary to see him not able to breath and when she turns to the specialists, she is getting nowhere. I would really like to see the report from his visit.

Thank you so much for your time and help