My Tommy - Heart Murmour

I am new so sorry if I have not posted in the correct place. My Tommy is 7.5 years old, was told about 18 months ago he has heart murmour. Shortly after he has had three horrible attacks and vets cant say what it is. He gets weak in back end, wont jump on sofa or bed because of pain, he welps in pain when walking or trying to get comfortable. He has had 3 attacks in 18 months and each on gets worse then the one before. Had xrays for tumour on spine but nothing found. Can anyone help - any ideas? Its been about 4 months since last attack which lasted about 2 weeks - it was horrible to watch but he pulled through

Have you heard of syringomyelia? You and your vet should defiitely learn about this neurological issue that has a high incidence in the breed and can in particular affect limbs and spine and cause pain sessions. I maintain this website on the condition, with information and downloadable documents you can print out for your vets:

www.smcavalier.com

If you and your vet are not finding any other likely cause from xrays etc, you will definitely want to investigate this possibility which will require meeting with a neurologist. There are listing of neurologists and some low cost MRI schemes on the site; I highly recommend looking for a neurologist familiar with the condition in cavaliers. If this is what he has you can give medication that will help the pain sessions. Check the symptoms list to see if anything else looks familiar, such as excessive scratching or air scratching. These are common signs as well but not always present.

Also there are some good resources for handling MVD here:

http://board.cavaliertalk.com/showthread.php?t=9214

Oh dear - this sounds like my Tommy, although he does not scratch terribly. But the pain he is in is awful, he actually welps and cries so loudly, he cant walk properly, its like his back end gives way. It is awful to witness and almost had him put down last time as i could not bear to see him suffer but within a week he improved and has been ok since but does still scratch one side of his head, his ear actually, often. How will this progress? Will each attack get worse? That seems to be the pattern. He is 7.5 years old

They have never even told me the grade of his heart mur, I will ask because he is due injections this month, now I know more I will be able to ask more. I really do fear he is coming to the end - its horrible

It's a good idea to have a cardiologist grade the murmur. If they xray his heart they will also have an idea of how far along he is. With a good mix of medications many cavaliers live years, even a decade or more, with a murmur that never or hardly worsens. You want to make sure he is in good shape and lean, carrying no extra weight, for starters though -- extra weight puts a huge extra strain on that heart valve so keep him in the best physical shape you can. The link I posted on MVD gives the real best practice approach. The way this progresses is highly variable.

If you think the pain sessions sound like they possibly could be SM, talk with your vet. You could try Dr Rusbridge's treatment protocol and see if that helps. There are a variety of medications that would help especially either steroids and/or gabapentin (neurontin) of he is having those actual sessions.

Scratching to one side is very typical of SM -- dogs scratch to the side of their syrinx as that is where it is pressing on nerve endings. I would consider trying a CSF inhibitor like frusemide (Lasix) to see if he responds. But this is also often prescribed for hearts so if you start him on this for the MVD it will possibly have some benefit for the syrinxes, if he has any. Scratching with CM/SM is a sign of some level of discomfort and pain -- you can see some videos of SM dog behaviour on my site and all three dogs in those videos scratch. Gabapentin has stopped most of the severe scratching one of my SM dogs does. So that's something to consider. Be sure to have your vet check the SM information and then consider what to do.

I don't know if I'd put a 7.5 year old dog with some heart issues thru an MRI for diagnosis though (it is expensive and requires a general anesthetic) -- but I'd definitely consder a clinical exam with a neurologist and trying some of the treatments to see if they help. If they help, most likely you are looking at SM as these specific medications wouldn't generally help with other types of scratching or pain.

Progression is highly variable but it does tend to progress. If he is doing well otherwise I'd do as noted above -- see a neurologist, ask if you can try him on gabapentin; he'll probaby be put on Lasix for his MVD anyway and that may also help the SM if tht is what he has.

PS Your vet could contact any of the low cost MRI centres for advice on trial treatments; I am sure they will advise. Not sure what part of the country you are in but there are several centres around the UK, listed on the website in the MRIs section. All of these will do low cost diagnostic basic MRIs for cavaliers.

Karlin - Thanks SOOO much for all that information, i live in Suffolk. When Tommy had his last attack but him to sleep was discussed with vet and now feel horrified it was discussed when they were not even sure what was wrong with him and did not suggest any of the above. They simply said it must be a nerve problem and unless I wanted to take him for extensive tests which would only result in treating with tablets they gave him, basically they said i would be throwing money away because a big centre would only treat him exactly as my local vet is treating him. He is overwieght but nor grossly so but has over the past year lost some, I think that is down to declining health although I have made a big effort to control his food intake. My Tilly is a tiny little girl and they eat the same!

No, care has advanced a lot more than that. Is he on anything for his murmur at this time? Is he coughing or anything like that?

The low cost MRI clinics are at this link:

http://sm.cavaliertalk.com/diagnosing/mris/mris/lowcostmris.html

My UK geography isn't great so you'd know what you'd be closer to. But at the same time, you might just try some of the meds. Different dogs respond to different things so it is usually a matter of working along through Clare Rusbridge's treatment scheme. Most of us with scratching dogs try one of the medications targeting CSF flow and then add gabapentin if the former don't work on their own.

A lot of vets especially country vets stick to very old approaches to some of these conditions or don't know about things like SM. However to be fair most vets don't realise how high the incidence is for an otherwise rare condition like SM, in CKCS. Most of us with SM dogs are the ones who teach our vets about the condition. It is often misdiagnosed as allergies, ear problems, spine problems... there are a lot of things that can be done for both SM and MVD with the right treatment mix. If he has SM he'd likely be a lot more comfortable day to day with something like gabapentin so it's worth exploring this a bit more if no other causes for the pain etc come up.

Just went to get his meds but now realise I left them with the dog sitter, we were away so that spent a few days with her. They were not given for his heart but to treat pain. I cant off hand remember the name of the 2 meds he was given but will get that info from vet. One was a muscle relaxant and the other pain relief as they thought him going lame and yelping was a nerve thing. i looked at the videos and he scratches like the first one. Not as severe as the other

Had a look at the list and Cambridge would be the closet centre for me. Its about 75 minute drive. Would vet have to refer me?

The first one is my dog Leo -- if I were you I'd ring whatever neurologist is closest and see if you can set up an appointment, if your vet is reluctant to. A clinical exam will on its own likely reveal a likelihood of this being SM ithout an MRI. It sounds like your vet tried all the obvious other possibilities including xrays.

Not all vets feel cavaliers should be treated for MVD before they start showing more serious signs like coughing but I was recently told of a vets seminar were they are recommending starting treatment now before the coughing and obvious outward signs.

You might try a different vets to get a different opinion -- lots of us use more than one practice because some tend to be better at one thing than another. I use three practices myself.

you have been so helpful i wish I had found this site long ago! He does not cough but when he gets these attacks is breathing is very rapid, i even filmed one of his yelping sessions and vet was still puzzled so I am first going to take him to different vet and i would really like to know the grade of his heart problems. In between these spells he seems well apart from the scratching and he hesitates to jump on the sofa, it takes him a few attempts to get up!

It would probably help to get a small stool or pet step that he can use to get onto higher places like the sofa, if that is where he regularly goes. He may well be gettingstiff from older age and whatever the case trying to get up is probably painful for him.

Only a cardiologist can give you an accurate heart murmur grade most of thetime -- vets don't tend to be very good at this, especially early murmurs. Tha cavalier club often has low cost clinics at events that anyone can go to -- might be worth checking with your regional CKCS club.