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Daisy - More Bads News From Chestergates Last Night

Hi

Back home but they are keeping Daisy there to check her blood pressure, and echocardiogram and an electrocardiogram and with no need for sedtion
but to shave her chest a bit to enable items to be stuck on, and I go back and collect her at 4.00 pm .

Mr Swifts initial diagnosis is a Grade 2 murmur and it is MVD ,so we wait till 4 pm for details.


What a blxxxxx week but Luke.s just back from school and he's happy enough with his A's and B's in his exams so these results
give him what he needs to progress onto his A Levels in Maths,Eng Lang,History and Geography with his aim in life so far of
career teaching History.


PS What a lovely man Mr Swift is ,very impressed.
 
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Glad things are going ok for Luke and he got the grades he needs.

Yes Mr Swift is a very nice man. I meet him once when he checked Ebony at a Cavaliers Club day.

Fingers crossed for you. Looks like we are both waiting.
 
Sorry to hear this Brian - I think Daisy is 5 now, and 50% of Cavaliers will have a murmur at that age. Don't forget though that the grade of murmur is not hte most significant issue - symptoms are far more important - such as panting, reluctance to exercise, coughing accumulation of fluid.

This the best explanation I've seen of how the canine heart works
http://www.heartydog.co.uk/healthy/en/index.shtml

[the diagram is small but if you press the CTRL and plus keys together on the keyboard, that enlarges it - CTRL and minus to reduce again] - it will help you to understand when you go back for the results.


You are doing the right thing seeing a cardiologist - and you have probably the best man in the UK there in Simon Swift!! He can take baseline measruements today so will have those for the future to compare for changes.

Yes a murmur may be more apparent when a dog is stressed and sometimes if they are ill - it "disappears" again when they recover, but actually there are still issues there, it's just that a murmur is not apparent.

Cardiologists can hear murmurs at least 6 months before a vet would recognise it - due to their experience and training.

Things you can give Daisy in these situations is Vitamin E and Co-Enzye Q10 which are both naturaal blood thinners available at any health shop or chemist.

Mine go on to Vit E 200iu daily from the age of 5 - there are no studies proving its efficiacy but it is believed to help the circulation. It has to be natural source Vit E though - NOT the ones you can buy in the supermarket. There is no point in giving Co-Enzyme Q10 for the heart until there is muscle involvement ie the heart is enlarged, however it is believed to help with dental healthy and reducing bacteria which *may* also affect the heart - this is sometimes disputed.

The MOST important thing you can do is reduce Daisy's weight - bred standard weights don't really mean anything, she needs to be the right weight for her.

This is from Laura Lang [Roycroft Cavaliers] website:

Due to MVD, being overweight is nearly a death sentence for a Cavalier. I guarantee you the best way to prolong your Cavalier's life is to keep its weight to a MINIMUM! Not overweight even a little bit. THIN! If your Cavalier is even a little bit overweight, it will hasten the onset of MVD and death. Do not allow this to happen.

Strong words but the message is SO important.

Do read through this page in particular
http://www.roycroftinformationcenter.com/Roycroft Cavaliers/Roycroft Cavalier Care Feeding new.html
 
Hi

Tks Nicki ,as I wrote yesterday at the vets on Monday she weighed in at 8.15 k ut I want her at max 7.25 then a review.I hardly feed her she has been having 18 gramme only of raw rabbit meat n fat with veg and fruit twice daily ,shes looks at her dish then at me "Is THAT it " I can hear.From what I know there are no smptoms yet such as you say panting ,reluctance to walk/run or coughing but I get his full repost at 4 .She was very relaxed with him and enjoying the attention and even on her back so he could rub her tummy and then went off and sat between his legs while we were talking .She is already on VIT e together with Omega3 (600 mg EPA/DHA ) and a 50mg softgel of Ubiquinol.

Tks

brian
 
This is from Laura Lang [Roycroft Cavaliers] website:

Due to MVD, being overweight is nearly a death sentence for a Cavalier. I guarantee you the best way to prolong your Cavalier's life is to keep its weight to a MINIMUM! Not overweight even a little bit. THIN! If your Cavalier is even a little bit overweight, it will hasten the onset of MVD and death. Do not allow this to happen.

Strong words but the message is SO important.

Do read through this page in particular
http://www.roycroftinformationcenter.com/Roycroft Cavaliers/Roycroft Cavalier Care Feeding new.html

Very good words of advice, if not just for MVD but for overall health.
 
You now are putting action plan in place...

And you already have started on the diet. I am having to cut back food for Gracie as her inactivity after surgery has had more impact on her metabolizing food than expected. So she is now giving me that look... "is that ALL?? REALLY???"

Gracie is doing so well after surgery so far. It is amazing. She has bounced back so much in the past few days. I hope this gives you some hope. I can just see in her eyes how much BETTER she feels.
 
Hi Annie


I asked Simon what Daisy's weight was on their scales and he said 8.00 Kilo ,then I asked his comments about her was she over weight,
he looked her over from top to bottom from above and fom the side and said "she looks Ideal " though I still want her down a bit maybe
7.25 to 7.50 .We have a conundrum over medication he commented that she needs no medication but he is not happy she is on frusimide
as that stimulates certain hormones to over produce some items which may affect the heart so he is considering if he should prescribe an
Ace Inhibitor to counter act the frusimide but he doesnt know if that is the right thing to do .So he is going to approach many other cardiologists
both in the UK and the US to ask them and then arrive at a majority decision and then tell me which way we will go .Sounds good to me.He wants
her on a low sodium diet so is happy with my raw list I showed and wants Omega 3 supplementaion with a minimal level of 420 epa and 280 dha.
dMy Puritans Pride Omega 3 I give has a level of 600 epa and 600 dha so we should be ok there .Poss chg in 3-4 years but they vary so much and
to see me in 12 months .Lovely man ,great respect from me and the report is slightly better than I expected .

I will contact Dasiys breeder but only when I have all the reports which I will send copies of ,I do not know if her breeder scans if not I will suggest
she does all politely of course.I am greatly relieved now that Daisy "is overweight hints" have been quashed and I can confim Jackie Thompsons little girl Lily is not over weight either and nor are pops or rosie and neither am I or Dawn or Luke .the end .If anybody would like a copy of her cardiologist report pls ask /pm.
 
Barney is on Frusimide and as it's long term he is now on Fortekor to counteract the effect on his heart... I also have him on a strict diet...Recent studies show that dogs at the lighter end of normal live long in general...

I am currently filling out a tally chart for behaviours noted for him as I feel his symptoms are more apparent now (SM and he also has CM)My vet has asked me to do this. I am not keen to pump him full of drugs but I do believe in the philosophy of having an animal happy and comfortable today is good...They don't seem to give a fig about tomorrow...

I am hoping his SM won't progress too much :/ I am luck as at nine his murmour is a grade one and has been at that for ages...
 
Hi Annie


I asked Simon what Daisy's weight was on their scales and he said 8.00 Kilo ,then I asked his comments about her was she over weight,
he looked her over from top to bottom from above and fom the side and said "she looks Ideal " though I still want her down a bit maybe
7.25 to 7.50 .We have a conundrum over medication he commented that she needs no medication but he is not happy she is on frusimide
as that stimulates certain hormones to over produce some items which may affect the heart so he is considering if he should prescribe an
Ace Inhibitor to counter act the frusimide but he doesnt know if that is the right thing to do .So he is going to approach many other cardiologists
both in the UK and the US to ask them and then arrive at a majority decision and then tell me which way we will go .Sounds good to me.He wants
her on a low sodium diet so is happy with my raw list I showed and wants Omega 3 supplementaion with a minimal level of 420 epa and 280 dha.
dMy Puritans Pride Omega 3 I give has a level of 600 epa and 600 dha so we should be ok there .Poss chg in 3-4 years but they vary so much and
to see me in 12 months .Lovely man ,great respect from me and the report is slightly better than I expected .

I will contact Dasiys breeder but only when I have all the reports which I will send copies of ,I do not know if her breeder scans if not I will suggest
she does all politely of course.I am greatly relieved now that Daisy "is overweight hints" have been quashed and I can confim Jackie Thompsons little girl Lily is not over weight either and nor are pops or rosie and neither am I or Dawn or Luke .the end .If anybody would like a copy of her cardiologist report pls ask /pm.

Brian,

I can't do math but I was not saying daisy is overweight! Ella was morbidly overweight but I think it is hard to say a certain weight without looking at the cavalier. Elton is not quite 11 lb which is under standard but according to vet and others he is ideal to his structure. Put it this way, ella was 2X the size of elton.

You went the best cardiologist and I'm interested in what he said about the medication and heart increase.

Overall, how are you hanging in? Poor you and dangerous daisy.. you are lucky to have such great people close by and daisy is lucky to have you!

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We have a conundrum over medication he commented that she needs no medication but he is not happy she is on frusimide as that stimulates certain hormones to over produce some items which may affect the heart so he is considering if he should prescribe an Ace Inhibitor to counteract the frusimide but he doesnt know if that is the right thing to do .So he is going to approach many other cardiologists both in the UK and the US to ask them and then arrive at a majority decision and then tell me which way we will go.

Well, thank you Simon Swift!!! I have long been concerned about dogs receiving furosemide (US spelling) long-term for SM. I have made a few mild comments here that I would never give this drug long term for SM because of the side effects. The drug activates the RAAS (renin-angiotensin-aldosterone system) - a very complex compensatory neuro-hormonal system that I'm not going to try to explain here. The RAAS is compensatory and helps with an acute problem but it becomes maladaptive over the long term so this is something that you don't want to activate. This is why furosemide alone is never given for dogs in heart failure but an ACE-I is always added. (Any vet that gives furosemide only to a dog in heart failure is sadly out of date.)

I personally would not want my dog on furosemide for SM, and I'd certainly not want to prematurely add an ACE-I simply to compensate for the furosemide for a dog that is in the early stages of MVD. Since cimetidine and omeprazole are also drugs given to reduce CSF, I would opt for one of those drugs and not use the furosemide. I also know what furosemide does to kidney function, so I would not use that drug long term unless it was necessary to control symptoms of CHF.

All of this is of course my own opinion, but I feel somewhat vindicated that Simon Swift has voiced the concerns that I've had for a long time about this drug in the SM treatment protocol. I've also not been happy with the monitoring recommendation for dogs on this drug - I'd monitor much more aggressively.

Brian - would you consider talking with the neurologist about using one of the other drugs that is reported to reduce CSF and just skip the furosemide and the ACE-I? Then you would start those drugs when necessary for CHF from MVD, but that may well be years down the road.

Pat
 
brian,

It seems like you have done a really good job going over the different drugs etc and got a lot of information. What pat wrote, it seems like this might be something good to know for others too. Since simon swift is such a well known cardiologist (is he the breed clubs cardiologist?) anyway since SM and MVD are both concerns it seems like something that might be beneficial to address which it looks like he might do. Oh daisy and brian, you have had a tough week but you are in good hands

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Hello Ladies

And Good Morning to all ,How are You my good friend Sabby and Harley.

Pat I dearly hoped you would respond and your comments are what Ihoped for and I will be phoning Geoff Skerritt this morning to advise
what Simon Swift said and to ask for a change from frusemide to the negate the need for an Ace Inhibitor at this stage of Daisy's journey.
Your comments on frusemide activating her renin-angiotensin-aldpsterone system (RAAS) and that these are harmful hormones in the setting of
heart disease and that ACE Inhibitors such as Fortekor will help blunt this effect,are Simos words

Pat I will pm you and wish to ask you a confidential question which I think you will be interested in so pls look out for my PM .


I would also like to hear Rods comments if hes about .

PS Hello Annie ,yes Simon is the clubs cardio and deals with all the breeders.
 
For some reason I thought he was who rod always mentions that spoke to the ckcsc usa meeting in 98 about MVD and set forth the mvd protocol. I must have been wrong but I have heard many talk about him in good ways

I am sure he will be able to make sure she gets managed.

You got a double whammie and I'm so sorry

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3 am. I'm up. I'm always worry about these babies. I went through some old emails and read my blog going back in time. I have an 11 lb baby in my lap telling me its time to sleep.

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I looked at my calendar for some reason and it was on daisys photo. Maybe someone was telling me something ...

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Your comments on frusemide activating her renin-angiotensin-aldpsterone system (RAAS) and that these are harmful hormones in the setting of heart disease and that ACE Inhibitors such as Fortekor will help blunt this effect,are Simos words.

The problem is that I believe that furosemide causes these unwanted side effects for ALL dogs, not just for dogs with heart disease. This is not a benign drug (probably no drug is entirely benign). There are always negative consequences that one must balance against the positive effects when giving any drug, especially long term.

Furosemide is an essential drug in the treatment of heart failure - in that situation the positive effects outweigh the potential harmful effects. It is also never used as monotherapy for heart failure but it is part of a multi drug treatment program.

For these reasons, if I had a dog with SM, I'd select one of the other drugs used for CSF reduction. I have not studied these other drugs in depth so I'd probably want to read up on them but I feel pretty certain I'd not want to use furosemide.

Pat
 
I am not sure where we all are on this topic, but I want to jump in based upon what I think is going on, because I am in a rush and need to get out of here before being able to read all of the foregoing posts. I have read the two reports, one from Geoff Skerritt and the other from Simon Swift. This is what I think concerns Simon Swift:

From http://cavalierhealth.org/mitral_valve_disease.htm#--_moderate:

In a 2009 study report which did not include CKCSs, veterinary cardiologists observed a three-fold increase in RAAS activity using furosemide. Their conclusion was that "furosemide is not recommended for chronic use in the absence of concurrent therapy to blunt RAAS activity, such as ACE-I, aldosterone receptor blockers, or angiotensin II type I receptor blockers.

Here is a summary of that 2009 report (from http://cavalierhealth.org/mitral_va...Angiotensin-Aldosterone_System_(RAAS)_in_Dogs ):

The Effect of Furosemide and Pimobendan on the Renin-Angiotensin-Aldosterone System (RAAS) in Dogs. AC Lantis, CE Atkins, TC DeFrancesco, BW Keene. J Vet Intern Med 2009;23; (ACVIM 26th Ann. Vet. Med. Forum Abstract Program: Abstract #2). Quote: "We have shown that pimobendan, at the labeled dosage, does not accentuate furosemide- induced RAAS activation. We observed a three-fold increase in RAAS activity with furosemide alone and in combination with pimobendan. Therefore, furosemide, with or without pimobendan, is not recommended for chronic use in the absence of concurrent therapy to blunt RAAS activity, such as ACEI, aldosterone receptor blockers, or angiotensin II type I receptor blockers."

I'll let you all chew on this for a while and get back to you tomorrow.
 
Hi

At long last I have sent Daisy and Rosie's MRI scan reports to the A.H.T. and have also advised Daisy's breeder
via recorded post with a polite letter of advice ,thanks to Sins guidance, together with copy reports .

Also as advised on another thread I spoke to Daisy's cadiologist on Monday and we still await gudance re the
frusemide and fotekor issue .
 
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