I have a cavalier who is 7 and 1/2 years old. He has MVD. This is a rather long write-up, but I feel compelled that I should share more to get more proper and prudent advices.
I am seeking advices on when to start medicine to relieve his coughing from MVD.
A quick background:
My cav has been dry-coughing (hacking kind) seriously for about 5 months now. Coughing became more serious and apparent ever since he had his teeth cleaned (at the time of cleaning, we had no idea that anesthesia could speed things up on MVD). The frequency of coughing used to be about 10 times during the day whenever he gets up from his lying down positions - either on his stomach or on his sides. Lately, the frequency has increased to 15 to 20 times during the day. At night, coughing becomes more frequent because he changes his sleeping position more frequent.
He has been diagnosed with heart murmur at GRADE between 2 and 2.5 for almost two years by his vet. Otherwise, he has been very healthy. He eats well and demands lot of treats. He is still very healthy. He walks with me about 4 miles time to time on weekends. Otherwise he plays around in the backyard a couple of hours a day after dinner. He weighs about 25 pounds - relatively big, but not overweight. He is a big boy. He is all around a great cavalier. He is the center of our attention in our family.
Because of his difficult and laboring coughs, we decided to see a cardiologist two months ago. Ultrasound was performed. The cardiologist diagnosed him at GRADE III/IV systolic murmur with the following additional information:
- Moderate LV volume overload. This stage can still be subclinical and asymptomatic of heart disease but LA size could easily contribute to bronchi compression inducing a secondary cough.
To rule out any non-cardiac etiologies, the cardiologist recommended to have thoracic radiographs being done. There were no pathogens found attributing to any type of coughing. But the X-ray clearly showed his enlarged heart as a result of MVD.
The cardiologist said my cav might be at the border line of taking medicine to help him. The list of potential drugs to start with (by the cardiologist) were:
- Start enalapril 2.5 mg QD x 1 week, then increase to 5.0 mg QD
- Start furosemide 12.5 mg QD to determine if any cardiac role in genesis of current symptoms.
- If no change after 2-3 weeks then stop furosemide, but continue enalapril 5 mg QD until more advanced heart disease is present.
- Continue if beneficial, but decrease furosemide to 6.25mg QD. Keep in mind a few dogs may have an apparent non-cardiac response to diuretics, suggesting early CHF, but in reality itís could be a respiratory response to diuretics.
Below is what I am struggling with:
- He is relatively young - 7 and 1/2 years old. What are the trade-offs between taking medicine now to get the benefits (assuming that this would relieve his coughing) today but taking the risks of his critical body-part (liver, kidney, etc) failures in his later life.
Does taking medicine now make sense for my cav?
- Do some of the drugs listed above truly get rid of his nagging coughs? I am assuming diuretics will drain any fluid in his lung and possibly shrink his enlarged heart?
- I am looking for advice on when to start the medicine. It is so painful for us to watch he labors whenever he coughs.
- As per the cardiologist, do you have a direct relationship with him or her, meaning no "in-between" vets? Or do you go through your primary-care vet to get to the cardiologist? My recent experience has been rather confusing and perplexing. My expectation was I would directly work with the cardiologist to deal with this difficult and trying times, but I've learned quickly that the cardiologist was not responsive.
Any advice will be appreciated.