Not good news for Pippin at annual check up:(

[Kate H]

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]

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

[pippa]

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]

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]

... 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/acv...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]

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]

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]

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/acv...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]

"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]

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.