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very bad heart issue and teeth removal :(

duseskiz

Active member
hi everbody,

I really need your advice for my friend's 7 years olad rescue cavalier, Suslu. She is rescued from a shelter and has bad health issues. She probably has sm, my friends could not have her mri scan because of her health problem. she firstly wanted to know how bad her heart and a cardiologist examined Suslu saying she had C2 level (in Turkey might be different scaling) MVD. She also wanted to have suslu's teeth cleaned and some of them removed (her teeth are at really really bad condition) as teeth effect the hearth and went another vet for it after 2 months. the second vet did all examination, cheching etc. yesterday for teeth and said Suslu's heart rate was like the most 168 and the least 143 :( He said he could not operate her with this heart rate, if he would Suslu probably wont wake up :(

My friend is now in dilemma. Suslu's teeth has to be done, otherwise they will keep effect her heart badly day after day. On the other hand, her heart is not strong enough to have anestesia. We are trying to find a way to follow, we thought about removal operation without anestesia but we dont want to put her in pain as lots of teeth might be removing :S

I asked my friend to have Suslu's teeht photo to Show you how bad her teeth are. I hope she could manage to take. So, any idea is appreciated for us cos we are sooo desperate :( Thank you...

Ebru
Istanbul,Turkey
 
Ebru, the ACVIM Consensus Statement on MVD has a Stage C. See the article here: http://cavalierhealth.org/images/acvim_guidelines_ccvhd_2009.pdf Stage C is the "congestive heart failure" stage, and C2 probably means that the dog is being treated at home rather than in a vet clinic.

In the USA, there are some people trained in non-anesthetic cleaning. It is not at all as effective, and some vets have criticized its lack of thoroughness. But in this circumstance, it may be the solution. Here is a link to a site about it: http://petdentalservices.com/
 
Thank you Rod, i will look at the links. At this point we are all open to new ideas...Thank you again...
 
I would suggest finding a school of veterinary medicine if there is one is Istanbul. Her heart may be too fragile for surgery, but my understanding is that veterinary anesthesia has progressed to the point where it such surgeries can be done relatively safely. In any case, a vet school would give you access to specialists in heart disease and in anesthesia. Good luck and best wishes to the little dog.
 
I also would note that Pat has pointed out in some previous threads, that the link between dental health and heart issues has been disproven. I have two with so-so heart health and bad teeth but my vet does not recommend aneasthetic even though neither is medicated for the heart issue. He's suggested using an enzyme gel for the teeth.
 
Yes, there is a a school of veterinary medicine in Istanbul but i am afraid it is not as well equipped as needed. ohhh God, it is really hard for me to discribe but we prefer to take our babies to special clinics other then the veterinary school in Turkey. However, my friend took Suslu to a lecturer of the school. My friend said to me yesterday that Suslu has began to take Vetmedin, later on the cardiologist check on her hearth again if it is ok for the surgery :(( Thank you Emkaybee...
 
I also would note that Pat has pointed out in some previous threads, that the link between dental health and heart issues has been disproven. I have two with so-so heart health and bad teeth but my vet does not recommend aneasthetic even though neither is medicated for the heart issue. He's suggested using an enzyme gel for the teeth.

i will look out enzyme gel, is it like Petzlife or something?
 
My Pippin had his teeth cleaned without anaesthesia, but as others have said it is not as effective but like Karlin's vet and your friends vet mine will not put Pippin under any form of anaesthesia no matter how light. I use an enzyme toothpaste, I have tried different one's but haven't found one I am completely happy with yet.

Pippins teeth are not rotten but have a lot of plaque build up, which seems to keep coming back no matter how much I clean or brush.

Karlin what enzyme gel do you use?
 
OK, here's an easy to understand summary from the well respected Mayo Clinic in the US -- when studies were reviewed in 2012, no definite connection was found between heart disease and gum disease.

http://www.mayoclinic.com/health/heart-disease-prevention/AN02102

And an article in the press:

http://www.telegraph.co.uk/health/h...um-disease-causes-heart-attacks-debunked.html

On the enzyme gel -- my vet supplied it and said it works better than brushing, he thought. He gave me Dentisept to try.
 
OK, here's an easy to understand summary from the well respected Mayo Clinic in the US -- when studies were reviewed in 2012, no definite connection was found between heart disease and gum disease.

http://www.mayoclinic.com/health/heart-disease-prevention/AN02102

And an article in the press:

http://www.telegraph.co.uk/health/h...um-disease-causes-heart-attacks-debunked.html

On the enzyme gel -- my vet supplied it and said it works better than brushing, he thought. He gave me Dentisept to try.

ok, i am reading them now, thank you Karlin...:)
 
i give non-cooked bone to my own cavalier for her teeth and it is really working for plaque. in the morning food time i add some plaque-off, i have oral gel but it is impracticable to me, you know you have put all the food and water away 30 min. before and after giving the gel. i do brush Duses' teeht but i suppose i need to do more often. I think i had read somewhere saying that coq10 is to help preventing gum diseases.

I really feel bad about Suslu as she is sooo innocent, silent and cute and i do want to see her more active and healthy :)
 
Ebru, I just sent you a private message about someone in Istanbul looking for a cavalier.
 
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I am not sure if there is a cardiologist here but what would you think? Suslu's vet had asked her consition to his foreign colleagues and they said;

"After reviewing the echo study I am not convinced your patient is in CHF. The presence or absence of CHF cannot be determined by echo. Physical exam, thoracic radiography and the SRR with a proven Lasix response if the SRR is elevated are much more accurate. The echo can readily assess the presence or absence and degree of cardiac pathology and verify the reason for murmur generation and provide info that is consistent or inconsistent with CHF but cannot tell you that CHF is definitely present.
The echo confirms the murmur in this patient is due to MR most likely associated with MMVD in the CKCS. However, the LA and LV size is not consistent with CHF.
I would have the owner log the SRR for 3-4 days and if <30/min stop the pimobendan and enalapril and begin to taper the Lasix dose lower and lower monitoring the SRR at each step.
Client education is important here as it is likely that this dog will go into CHF at some point in the future due to a worsening of the MMVD. Careful monitoring of the SRR will allow you to restart meds when the SRR begins to approach 30/min. No study to date has shown that early intervention with the drugs you are using is beneficial in either prolonging life or prolonging time to onset of CHF."

And

"The LV is reported as "normal", but the LA is listed as "dilated". There's only 1 view of the LA, so I can't really assess how large it really is.

So, we know the dog has MMVD - no surprise there. We think it might be relatively mild, but we're not 100% sure.

The fact that the previous vet had prescribed the drugs to be given "every 3rd day" argues against CHF - the pharmacology of these drugs is such that this type of dosing would do almost nothing to CHF.

How was the original diagnosis of CHF made?"

i have her heart's images but i cannot download here :(((

Suslu was taking;

morning and evening 1/2 Kapril (later on changed to enapril as kapril was getting her worse, same döşe)
1/4 Lasix once in 3 days
morning and evening 1/4 vetmedin

and now she is taking only everday in the morning 1/4 lasix. Her blood work is normal and PT'si 10 sec, APTT'si 11 sec.

Thank you...
 
Well, sounds look very good advice from the foreign colleague! :) Lots and lots of vets make assumptions that a dog is in CHF when they are not, and start meds too soon. I have just taken my two fosters off some of their meds Ion advice of two vets) as there's no evidence they need all the stuff they were on. I think their vet just kept increasing medications as their murmur grade increased, but grade does not necessarily correlate to start of CHF.
 
Well, sounds look very good advice from the foreign colleague! :) Lots and lots of vets make assumptions that a dog is in CHF when they are not, and start meds too soon. I have just taken my two fosters off some of their meds Ion advice of two vets) as there's no evidence they need all the stuff they were on. I think their vet just kept increasing medications as their murmur grade increased, but grade does not necessarily correlate to start of CHF.

after seeing many vets for her heart, my friend is very very confused who to believe, believe or not her vets supposed to be best ones :((
 
Vets can be very very good in some ways, but still stick to old ways of treatment. It can be hard to change a treatment mindset! Think how manyvets still insist dogs be vaccinated yearly when their own international vet bodies have recommended every three years now for ages.

The bottom line is really that there's no longer considered to be a connection between gum disease and heart disease so I would definitely not out an older dog with a poor heart under aneasthesia just to care for teeth.

It would be hard for the vets to determine CHF with the information they have, as the other vet noted. So it sounds as if they are just putting the dog on lots of heart meds the dog probably does not yet need. There is evidence these meds given too early can cause damage to the heart. A very good guide as noted in the other vet's report is tracking resting breathing rate. I took my foster girl off vetmedin because she has no breathing issues at this time. Another was put on frusemide yet was retaining to liquid on lungs or anywhere else. A lot of good vet practices just stick dogs on these things.
 
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