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Moviedust
22nd December 2014, 05:24 PM
Bella is 7, almost 8 years old, and she was a puppy mill foster fail for me 6 years ago. She recently started coughing, and I suspected MVD. Last week, the vet confirmed heart disease, with a 2 - 3 stage murmur with a heart size measurement of 12.1. A year ago in Oct, she struggled with anesthesia for a routine dental cleaning. We had an xray at that time to check her heart, and it was normal at 9.

My doctor, after conferring with a cardiologist at the local vet school, recommended a triple cocktail of Vetmedin, Enalapril, and Lasix(furosemide). She takes 1.25mg Vetmedin and 2.5mg Enalapril twice a day, and she takes 12.5mg Lasix just once a day. She takes them all easily, and she's been on them for about a week at this point. It's an expensive cocktail ($80/mo), but when all is said and done I didn't want to think I could have done more. I have no idea how long she has with us; aside from the cough she seems her normal self, which basically means she wants to sleep and cuddle all day, and she gets excited for food and any treats. She keeps a close eye on my daughter, though at this point she generally tries to keep a safe distance when the kid is flitting about (clearly, you have to give a 2 yr old kid her space).

I know Bella isn't going to get better and that we're really just trying to prolong the inevitable. While she's my first dog to suffer from heart disease, I do have three other cavaliers that are older than Bella (8.5 - almost 10 yrs). So I'm trying to learn what I can to prepare myself and to give my girls the best that I can in their golden years.

Pat
23rd December 2014, 08:00 PM
Hi Cindy,

I remember you and your girls. You are paying way too much for Bella's meds. I would pay $21 per month for those same meds. Ask your vet to give you prescriptions for the drugs. The vet must do so by law in most US states.

I have a 12 year old Cavalier with a grade III murmur. His vertebral heart scale on radiographs is normal, he has no symptoms, and he is on no meds. My 14 year old shih tzu (murmur of grade III to IV), though, was hospitalized a year ago because of a ruptured mitral valve chord which caused an acute episode of CHF. (I knew she was in trouble because of her rapid resting respirations - which were up to around 50 per minute. Radiographs and echocardiogram confirmed her diagnosis.) She then went into kidney failure. She is completely stabilized now with no symptoms and is taking only Vetmedin (we stopped the lasix and benazepril because of the kidney failure, but she'll need more heart meds when/if she experiences another episode of pulmonary edema). They are both under the care of a cardiologist. The Vetmedin has been nearly miraculous for Roxie, with her heart size decreasing on follow-up echocardiograms given by her cardiologist.

I purchase Vetmedin from Allivet pharmacy. I split the 5 mg tablets into four pieces of 1.25 mg. each for my girl, and the cardiologist has approved this (recommends it to save money on drugs). Allivet charges 1/2 the price that my GP vet charges for Vetmedin, and she gives me a prescription at no charge. If you purchase two bottles of 50 5 mg. Vetmedin at Allivet, shipping is free, and the monthly cost of Vetmedin at 1.25 mg. twice a day is $15.90.

Enalapril and lasix are available at Walmart, Target, Sam's Club, and may other pharmacies at $10 for 90 tablets (a three month supply). These are generic. You can get enalapril 5 mg. and split the tablets for Bella's morning and evening dose. You can get 20 mg. of lasix (the 12.5 size is only a vet product) and split those. The cardiologist will have no problem prescribing 10 mg. rather than 12.5, esp. since Bella likely doesn't have pulmonary edema but is coughing because of her enlarged heart compressing her airway.

So the total for these drugs (when purchased as above) will be $15.90 for Vetmedin, $1.65 for Lasix, and $3.33 for enalapril - for a total of $20.88 per month - about one-fourth of what you are paying! You need to save your money for vet appointments, radiographs, etc. I hate it when people pay too much for things!

http://www.allivet.com/

The Vetmedin comes in original sealed packaging from Boehringer-Ingleheim, and generally has an expiration date of at least a year out. I have 100% confidence in this pharmacy. They require a prescription. I split the drug as I use it - don't split an entire bottle. I use a knife to split one chewable tablet in half along the score line, and then I split the half into two more pieces in a pill splitter. I use the same half (split into two pieces) for each day's two doses.

Has your vet explained about monitoring Bella's resting respirations? I keep a diary for both dogs and monitor resting respirations and record them. You can also keep track of appetite, coughing, etc.

Best wishes,

Pat

Moviedust
23rd December 2014, 08:37 PM
Hi, Pat!! Thank you so much for the information!! My vet mentioned that two of the meds were available at pharmacies, but that the third wasn't. At the time, I was a bit overwhelmed and wanted to get the meds then and there (it was finals week, holidays approaching, etc.), figuring I'd have time to do more research later. This information from you is a total gift. Thank you! I have been anxious knowing that, if any of the others were diagnosed, we'd struggle to afford the meds. $20 a month is much more affordable, and I will definitely go that route for next month's meds.

Part of our challenge of late has been a lack of a steady vet. The vet we used for 8+ years retired and sold his practice. We stayed with the old practice for another year or so; the prices were jacked up and the new owner had a surgical solution for any and everything, but one of the junior vets was really great, understanding, and willing to work with me. However, she ended up breaking her contract to get out of that practice and moved to one 20 miles away. After going from a practice where everyone knew us when we walked in the door and understood our need for economy (esp with four aging dogs and newborn) to a practice that couldn't maintain steady staff, charged an arm and a leg for any and everything, repeatedly failed to get us appointments, and then had two bad experiences with crises situations, we were out of there. We struggled to find a local practice that would take us (everyone was leaving the other practice, so all the other vets were swamped), and the one that did was full of inexperienced vets and what seemed to be a $300 minimum charge. When Bella started coughing, I knew I needed a vet I could work with long-term; I figured if I was going to pay crazy prices, then at least I wanted to trust and be comfortable with my vet. So I took her 20 miles to the vet we liked. We do have a local vet school with cardiologists, but it's crazy expensive just for a checkup and every appointment is unbelievably long/tedious because you have to go through students first. So, for now, we're sticking with our vet (who is connected to teaching staff at the vet school) who is 20 miles away. I'm sure she'll give me the scripts since she already mentioned it at the last appointment. The info you've shared has saved me a tremendous amount of stress/time doing all the research as well as $60 dollars a month!! Thank you!!

Pat
23rd December 2014, 10:48 PM
I'm glad that I can help! One problem is that, to get those prices, you buy a good quantity, so you spend about $125 up front but then you are set for many, many months. You can buy one bottle at a time of Vetmedin at Allivet, but then you pay shipping; I buy two bottles at a time so I don't have to pay shipping. You can also buy enalapril and lasix for $4.00 for a 30 day supply as well as for $10 for a 90 day supply. Do get the larger dose tablets for both so you can split them as that really saves money. A good pill splitter cost just a few dollars.

I'm sorry to hear of your vet situation. I have a 25 year relationship with both my GP vet and my cardiologist, and I get wonderful service at very fair prices. My cardiologist went from a university setting to private practice, so I don't have to deal with the students, etc. I do have a long drive, though - 90 minutes each way. There are private practice cardiologists much closer to me, but I don't get the personalized service that I get with Dr. Jacobs, and the prices are much higher at the specialty hospitals in Atlanta. Dr. Jacobs is great about answering questions on the phone or via email, so I don't have to make that long trip very often. My nearby GP vet handles routine things - radiographs, checkups, blood chemistry, etc.

Speaking of blood chemistry, did your vet explain about checking kidney and electrolyte values before you started enalapril and lasix and then rechecking about ten days after starting? It doesn't happen often, but the drugs can affect kidney function and that is something you don't want to happen without your knowledge. My shih tzu went into kidney failure within days of starting the drugs, and we stopped them even though we were not certain that her kidney failure was a direct result of the drugs (it could have been a result of the sudden lack of perfusion to kidneys when she went into acute CHF). With a second hospitalization and IV fluids and reduced phosphorus diet for support, her kidney values went back to normal and have stayed normal for the past year.

Pat

Moviedust
5th January 2015, 03:52 AM
Pat, I have made my first order for Vetmedin online and the vet has called in the other 'scripts to a local pharmacy. Everything seems to be going smoothly so far with getting the 'scripts and meds. Bella is still coughing, so we're upping her Lasix/furosemide to twice a day. I also got Bella a raised water/food dish. I just wanted to thank you again for all of your help and advice!!