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Back to the Cardiologist

Viagra (a/k/a sildenifil) is prescribed to lower pulmonary hypertension by some cardiologists for dogs with congestive heart failure, often in combination with pimobendan.

Sildenafil (see Plumb's Veterinary Drug Handbook page 1100 and Manual of Canine and Feline Cardiology page 309) is used exclusively for pulmonary hypertension. It does nothing for congestive heart failure, and it does nothing for pulmonary edema or ascites (fluid in lungs or in abdomen as a result of CHF). I've used it for two dogs - one had CHF but also had moderate PAH, for which the drug was prescribed. The other dog had no heart failure (but had very mild heart disease) but had severe acute PAH most likely as the result of a pulmonary embolism. The drug is also used in humans for PAH but most humans with significant PAH end up getting a lung transplant. I know a couple of dogs who use it due to permanent lung damage from heartworm disease.

From Manual of Canine and Feline Cardiology:

"Sildenafil has been shown to improve both exercise tolerance and quality of life.......may have a positive effect in dogs with acquired pulmonary hypertension secondary to chronic valve disease, congenital heart disease, chronic pulmonary disease and heartworm disease......can be used in combination with pimobendan for additional inodilator effect. Dosage is .5 to 1.0 mg/kg two or three times a day."

Pat
 
I have written my post about 4 times now and each time I have deleted it. I wanted to share my experience with you as someone who just lost her dog(a peke) who had the heart issues. I wanted to go into detail but I don't think this forum needs that. I have shed tears just remembering back 2 months ago. But I will only write this, you are not alone. This forum is a great support system for those with health issues, I wish I knew of a forum to go to when I needed it the most. Wagtails is right, your CAV will tell you when its time. I needed him to tell me and I asked him to tell me. He finally showed me in no uncertain terms that it was time. Trust in your vet they will be there for you every step of the way.
I just want to give you a hug :hug:
Becky
P.s. sorry if this does not make sense. Trying to think while crying. sorry

I'm sorry about your Peke. I had a wonderful black Peke named Raisin who lived to be 16 1/2. He is my only dog that ever died on his own - he had a fatal arrhythmia one night during his sleep and just didn't wake up. He was curled up very peacefully, and I think it was a good way to go. He had severe heart disease for a long time but symptoms were well controlled until the very end. I'd like to have another Peke one day; he was very special.

Pat
 
UPDATE: More Medication, Viagra
Last week, when Sydney had abdomenal fluid drained, his cardiologist added another diuretic AND increased the doses of some of his other heart meds. Yesterday, one week later, we were back for a recheck. His abdomen is starting to fill with fluid again and the pressure in his lungs in increasing. Rather than increase the doses again which can damage his kidneys, we added Viagra to the mix. I hope this helps him. The good news is that they did a kidney panel and his kidneys are functioning great!

Joyce,

I've used sildenafil (viagra) for two different dogs some years back before most vets and many cardiologists knew about its use for PAH. This drug can be very effective for PAH (pulmonary arterial hypertension) and can greatly reduce symptoms such as dyspnea (difficulty breathing) and tachypnea (rapid breathing) caused by the PAH. But the drug does nothing for heart failure so it can't help pulmonary edema (fluid in lungs) or ascites (fluid in abdomen). I purchased 100 mg tablets at Walmart and split them into 12 pieces. But the price then was only about $10 per tablet and I understand it is much higher now. I understand that Pfizer loses the patent next year so generic should be available soon.

My boy who was most like Sydney also took enalapril, furosemide, sildenafil, digoxin and pimobendan. (He did not have the arrhythmia as Sydney has.) He actually did go into kidney failure when he was 15, so I understand that worry. We adjusted his meds and discontinued the digoxin and changed his diet to low phosphorus, added a phosphorus binder, and I gave twice daily subq fluids. His symptoms were well controlled for another year and a half, and he was put to sleep at 16 1/2 for reasons other than heart or kidney failure (quality of life - he ended up blind/deaf with extreme senile dementia agitation).

I can't say that I agree that ascites is "better" than pulmonary edema.......they both are serious. The procedure to drain fluid is called abdominocentesis if you want to google and read about it. I've known many dogs who have had this process done repeatedly.

http://www.vmth.ucdavis.edu/cardio/cases/videoatlas/Abdominocentesis/abdominocentesis.htm

Question - you said earlier that Sydney took furosemide ONCE a day - that's unusual as it is generally given twice a day and can be given up to four times per day. Has that changed now that the ascites is not well controlled? If not, I'd certainly discuss it with the cardiologist. And you've now added spironolactone? Hydrochlorothiazide can sometimes also be given - this is called triple diuretic therapy for cases that become refractory. These are three different acting diuretics.

Has the cardiologist asked you to monitor resting respiration rate? That is something that pet owners can do. There is a canine CHF yahoo group where there are discussions about these things in great detail.

Do you have urinalysis run as well as blood chemistry to check kidney function? Kidney failure will show up in urinalysis long before it shows up in blood chemistry. By the time that BUN and creatinine are elevated, kidneys are only working about 25%. But a low urine specific gravity gives you an advance warning and you can make some dietary changes, etc. I have actually purchased a digital refractometer so that I can measure USG at home.

Pat
 
Thanks Pat, I was hoping you would see my post and reply. I've learned much from your posts. Now as to your comments:

This drug can be very effective for PAH (pulmonary arterial hypertension) and can greatly reduce symptoms such as dyspnea (difficulty breathing) and tachypnea (rapid breathing) caused by the PAH. But the drug does nothing for heart failure so it can't help pulmonary edema (fluid in lungs) or ascites (fluid in abdomen). I purchased 100 mg tablets at Walmart and split them into 12 pieces. But the price then was only about $10 per tablet and I understand it is much higher now. I understand that Pfizer loses the patent next year so generic should be available soon.

I did know all this. In order to get Sydney on the Viagra immediately, I had a local pharmacy fill a RX for 2 100mg tabs (which I split in 3 each for a 6 day supply) for a cost of $44!!!!! The cardiologist hooked me up with a compond pharmacy and I can get a 30 day supply for $60 plus shipping. Big difference.

I can't say that I agree that ascites is "better" than pulmonary edema.......they both are serious. The procedure to drain fluid is called abdominocentesis if you want to google and read about it. I've known many dogs who have had this process done repeatedly.

As it was explained to me, it is still serious, however, as far as controlling it, it was easier on his body to drain the fluid rather than give more drugs at this time. In all likelihood, since he is starting to retain fluid in his abdomen already, he will need the proceedure again. But, just one day with the viaga, I can see that he is already urinating more and his belly doesn't seem as bloated.

Question - you said earlier that Sydney took furosemide ONCE a day - that's unusual as it is generally given twice a day and can be given up to four times per day. Has that changed now that the ascites is not well controlled? If not, I'd certainly discuss it with the cardiologist. And you've now added spironolactone? Hydrochlorothiazide can sometimes also be given - this is called triple diuretic therapy for cases that become refractory. These are three different acting diuretics.

Orignially, it was once a day. The cardiologist is conservative and wanted to keep some "wiggle room" for increasing the meds. He is now on furosemide twice a day and spironoactone twice a day and his dose of vetmedin has also doubled. I haven't heard of hydrochlorothiazide, I will ask about that. Thanks for the suggestion.

Has the cardiologist asked you to monitor resting respiration rate? That is something that pet owners can do. There is a canine CHF yahoo group where there are discussions about these things in great detail.

Do you have urinalysis run as well as blood chemistry to check kidney function? Kidney failure will show up in urinalysis long before it shows up in blood chemistry. By the time that BUN and creatinine are elevated, kidneys are only working about 25%. But a low urine specific gravity gives you an advance warning and you can make some dietary changes, etc. I have actually purchased a digital refractometer so that I can measure USG at home.


I have been monitoring the resting respiration rate. It seems to be at an average of 32 breaths a minute. As far as a urinalysis, we haven't had that done. Another thing I will ask about. I will also look into a digital refractometer. Another good suggestion.

I appreciate your imput. Please, if you have any more suggestions, please let me know.
 
Joyce,

All I want to say is I've been crying for you and my post deleted so I just got back to tell you I feel for you. I will be praying for you and sydney. Ok. Here comes the tears. I can't offer advice about medication and mvd. I can pray for you and want you to know you have touched me. I will say that having recently lost my first cavalier (the love of my life), I will tell you they have a way of letting you know. All you can do is what you are doing and try as hard as it is, to savor each moment. People would tell me they can sense your pain, so no matter how hard it is I hope you find strength.

Thinking of you

Sent from my Droid using Tapatalk
 
Thanks Annie. I followed Ella's journey and shed many tears for both of you. Sydney is so special for me in so many ways. He was here for me when I was sick and would just lay near by watching over me. If I tried to get up he would walk next to me. I need to do that for him now. He deserves nothing less.
 
I am just reading this right now and I want you to know I am thinking about you and Sydney. I went through the same thing with my last dog Sam so I know what you are going through. It's tough to deal with as you don't want to lose them but you don't want them to suffer either. My thoughts are with you.
 
Hydrochlorothiazide can sometimes also be given - this is called triple diuretic therapy for cases that become refractory. These are three different acting diuretics.

This is the new diuretic that Nicki recommended I ask my vet about for Victoria's ascites and I've just picked up the prescription this morning. In the UK it's called Co-amilozide (which contains two active ingredients, amiloride hydrochloride and hydrochlorothiazide). The vet's wholesaler had never heard of it (!) but forunately a local pharmacist had some in stock so we start the new regime tomorrow

So we are now on the "triple diuretic therapy" you outlined, Pat. Thank you, as always, for your helpful and informative posts - where would we be without you?

I'll let you know how Victoria gets on.
 
Thank you. They are really great dogs, I would have bought another but the memories would be too much. I'm so glad Raisin was able to go in peace. I had wished ours would have done the same but he was very comfortable with us there with him. With him his heart was enlarged so much that it started cutting off his trachea so it was the only choice we could make. It will take time to get over this loss and with a new puppy coming into our home it won't be so quiet. We will be happy to have a young pup in here.
I wish you nothing but the best and I hope you are able to get another peke someday.
Becky


I'm sorry about your Peke. I had a wonderful black Peke named Raisin who lived to be 16 1/2. He is my only dog that ever died on his own - he had a fatal arrhythmia one night during his sleep and just didn't wake up. He was curled up very peacefully, and I think it was a good way to go. He had severe heart disease for a long time but symptoms were well controlled until the very end. I'd like to have another Peke one day; he was very special.

Pat
 
As always Pat thanks for the detail -- am going to get Lucy into the cardio and ask about some of these possibilities for meds down the line; she is managing really well at the moment with the addition of spiro. but useful to know frusemide could go up and spiro. could be twice daily; as well as triple diuretics.

One thing I am learning with Lucy -- you just cannot make predictions with cavaliers and MVD as to how they will do and the RIGHT combination of meds can add weeks/months/years to a dog's life even when you think they are on their last few days!! It is so worth working with a cardiologist. It is also worth our (owners) doing our best not to panic or get really upset as the journey with MVd can be quite long with much quality of life left for a diagnosed dog. I really try not to worry and just go day by day. Almost five months ago I was very upset and sure Lucy was on her final days while I was away. :( And she is sleeping beside me on a footstool right now. :)
 
I can't figure out how to add photo, but I added a prayer photo that is under my photo library on my profile. It will not let me add it!
 
I always think having a dog with severe SM is terrible, but then I read all these stories from Marie-Anne, Sharon, Joyce, Karlin, Deb, Shirley who have dogs who are suffering with various or end-stage MVD and my heart breaks for you all. It just sounds horrible to witness your dog not being able to breathe. Three of my dogs are already oldies and are murmur free (yeah!!!!). Oz was born with a congenital murmur which has not changed since he's been born (he'll be four in one month) and his cardiologist (Dr. Michael Leuthy) doesn't think it makes him any more prone to MVD than any other cavalier. So, my heart aches for all of you. I hope I never have to experience what any of you are going through. SM is bad enough thank you.

Becky, I am so sorry for the recent loss of your peke. I hope he is running around like crazy at the bridge meeting all of our wonderful cavaliers that are there waiting to be his best buddies.

Hugs for all of you and your dogs.
 
Thank you very much. Many thoughts and hugs to everyone else:hug:

Becky



I always think having a dog with severe SM is terrible, but then I read all these stories from Marie-Anne, Sharon, Joyce, Karlin, Deb, Shirley who have dogs who are suffering with various or end-stage MVD and my heart breaks for you all. It just sounds horrible to witness your dog not being able to breathe. Three of my dogs are already oldies and are murmur free (yeah!!!!). Oz was born with a congenital murmur which has not changed since he's been born (he'll be four in one month) and his cardiologist (Dr. Michael Leuthy) doesn't think it makes him any more prone to MVD than any other cavalier. So, my heart aches for all of you. I hope I never have to experience what any of you are going through. SM is bad enough thank you.

Becky, I am so sorry for the recent loss of your peke. I hope he is running around like crazy at the bridge meeting all of our wonderful cavaliers that are there waiting to be his best buddies.

Hugs for all of you and your dogs.
 
I always think having a dog with severe SM is terrible, but then I read all these stories from Marie-Anne, Sharon, Joyce, Karlin, Deb, Shirley who have dogs who are suffering with various or end-stage MVD and my heart breaks for you all. It just sounds horrible to witness your dog not being able to breathe. Three of my dogs are already oldies and are murmur free (yeah!!!!). Oz was born with a congenital murmur which has not changed since he's been born (he'll be four in one month) and his cardiologist (Dr. Michael Leuthy) doesn't think it makes him any more prone to MVD than any other cavalier. So, my heart aches for all of you. I hope I never have to experience what any of you are going through. SM is bad enough thank you.

SM is terrible. I don't know much about it except what I've read on this forum. By the same token, I know a lot of people know alot about heart diseases. I don't always come here for answers and when I get people addressing my concerns, both the emotional and medical, I always feel better. Glad Oz is OK and hope he stays that way.
 
As always Pat thanks for the detail -- am going to get Lucy into the cardio and ask about some of these possibilities for meds down the line; she is managing really well at the moment with the addition of spiro. but useful to know frusemide could go up and spiro. could be twice daily; as well as triple diuretics.

One thing I am learning with Lucy -- you just cannot make predictions with cavaliers and MVD as to how they will do and the RIGHT combination of meds can add weeks/months/years to a dog's life even when you think they are on their last few days!! It is so worth working with a cardiologist. It is also worth our (owners) doing our best not to panic or get really upset as the journey with MVd can be quite long with much quality of life left for a diagnosed dog. I really try not to worry and just go day by day. Almost five months ago I was very upset and sure Lucy was on her final days while I was away. :( And she is sleeping beside me on a footstool right now. :)

I remember when you were really upset about Lucy and was thinking it was close to her time. That is really good advice because sometimes they surprise us. I thought Ella was going to have months and she could have had years. I too only know about SM but reading this and seeing all the medications and heartache, I feel for all of you. I do understand about taking things day by day and since you said Sydney still wags her tail, then thats something to treasure. All we can do when our loved ones are sick is what you are doing. Asking questions, talking and visiting her cardiologist and making things the best they can. It's hard not to worry about tomorrow, when you have today but I am thinking of you
 
Marie-Anne, I really hope that the Co-Amilozide will give Victoria a good while longer - It's not used as much now as most vets think that modern drugs are better, but my [older] cardiologist thinks it is brilliant for belly fluid - it really helped Fufu, cleared all her fluid. I think it must be so uncomfortable for them :( I was taught to tell if it was fluid by turning them on to their backs and tapping the belly slightly, you can see it sloshing around. It helps to compare it to a normal dog to start with.

I'm sorry that so many of you are struggling with MVD dogs right now - like SM it is an emotional rollercoaster but I think that with MVD they do not have the pain which is a blessing. They seem to gradually adjust to a lower activity level, and it's only when their breathing is badly affected that they get distressed with it. They do surprise you though as Karlin has found, which is lovely to hear.

This is upsetting to read but I think it is important and you need to have things clear in your mind.

I think dogs do let you know when they've had enough - there are lots of posts about this, my thoughts are:



I think it is important to be around for the dog, not least for them to be able to go out for a pee when necessary also you have some special time together.


I would write down the things that you think are important to your dog to give them a good quality of life

These would be on my list:

managing a short walk - even if it's only 5 minutes for the stimulation


Being able to eat and wanting to eat [2 different things]

Able to move about happily

Managing to access water bowls - make sure you have one near their resting areas so they don't have to walk too far if not feeing too good

Managing a cuddle or whatever affection They want

Being able to breathe when lying down

Not in any distress


You are going to get times where things aren't totally under control and you need to speak to your vet then to see whether it is a temporary crisis or a permanent state.


Most importantly obviously - is your beloved companion still enjoying life?



Mine have always let me know in some way or other that things are coming to an end - and once you've made that decision, there is an air of peace about them even if they are in pain. I think there is also a calmness within you that the decision is made, even though it's not the one you would like.


Yes in some ways we'd like them to go naturally - but actually going naturally can be extremely unpleasant for them, and a huge shock to us to find them suddenly gone.


So I've always felt it is better to let them go too soon, they don't suffer at all that way. Too many are left too long and that is just cruel and you feel guilty forever.

I always have the vet out to the house [put other dogs away] - have something very special for a treat - such as prawns or sausages - and have them lie across my lap on a towel and feed them the treat whilst the vet lets them go. This way it has always been peaceful. You can have time to say goodbye - and I always let the others say goodbye too so they don't look for them [will still grieve but not search which can be distressing].



Sadly some people seem to leave them too long - please if your dog cannot breathe if he or she is lying down, so is sitting up all the time, then get them straight to the vet to see if it is something that can be helped or if maybe it is time. :( I know it is very hard but so many times I've read posts of people leaving dogs like that for hours and I can only imagine how distressing it is for the poor dog.



Please know that you are all in my thoughts:flwr::flwr:, I hate that we have to face these battles with our beautiful dogs - we go in to the relationship knowing that they will not live forever - but you do feel cheated when you get less time with them than you hoped. All we can do is make the time together as special and precious as possible.
 
Pat thank you so much for your posts, I always learn so much from you and I know so many people benefit from your knowledge and experience (y)
 
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