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Thread: Update: Cavalier that had heart murmur at age 1 year 3 months, now think SM...

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  1. #1
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    Unhappy Update: Cavalier that had heart murmur at age 1 year 3 months, now think SM...

    Thank you to everyone who replied to my previous thread regarding Ellie with her grade 1 heart murmur. I have read each and every one of your responses and they are all very much appreciated. In my original post, I noted that Ellie has "allergies", as I kept reading the board I noticed more and more that her symptoms seemed like SM. Please forgive me for not responding as the past month has been completely overwhelming in regards to first being diagnosed with early onset MVD and now presumed SM. I have an appointment with Dr. Marino's colleague (Dr. Loewn's - not sure if spelling is correct?) at LIVS next week. I am hoping she can be a part of his study, get the mri/work up, and then decide from there if surgery is best. If anyone has had any experience with Dr. Marino and/or his team and could share the experience on the board/private message me it would be greatly appreciated. Further, if anyone has had experience with surgery in general or knows of anyone else that is highly recommended in the NY/NJ area it would be very much appreciated. I have been thinking greatly in terms of whether or not I would want to proceed with surgery and do not have a great answer. Should I try medical management first and see how that goes? Should I get a second opinion from Clare regardless of what Dr. Marino and colleagues say? Mesh or no mesh? The cardiologist is recommending another echocardiogram in 6 months to see how much her heart has progressed, im not even sure how to include that in my decision making of surgery vs no surgery. I guess I am just rambling now and am completely overwhelmed/scared/upset/angry.

    my thought process of surgery vs medical management:
    surgery pros
    - may stop the progression
    - may halt the pain..i guess same thing as progression

    surgery cons
    - scar tissue
    - death during surgery
    - progressive pain anyway
    - surgery not working
    - complications from surgery
    - need for another surgery
    - anesthesia, even though cardiologist said she was ok for anesthesia
    - MVD may progress and this was for nothing...
    - may take away some of her quality of life in terms of recovery period

    medical management pros
    - no surgery
    - hopeful for meds to control symptoms
    - can live comfortably until she can't
    - can control pain


    medical management cons
    - lost the opportunity to get surgery during optimal time period
    - may not work
    - having to watch the inevitable degeneration and feeling like "what if I did surgery"


    I wish someone could just say the surgery worked and I would just do it...this just seems to be a high risk surgery for not necessarily a great outcome..i dont know..i am just angry/sad/devastated...if anyone has any suggestions/advice etc i would appreciate it..

    As a side note: As you can see from my previous post, I now have a 1 year 5 month old cavalier with early onset MVD and SM...anyone have any advice as to how to approach the breeder (already knows about the MVD, not about my concerns for SM yet)


    In case anyone is interested in Ellie's symptoms for future diagnosis here is her list:
    Scratches her face, neck, sides excessively on both sides
    Bites at paws on both sides
    Bites at back on both sides
    Yawns
    Sneezes (not sure if this is particular to SM)
    Licks (not sure if its "excessive")
    Has never yelped or had noticeable weakness in her extremities, though our regular vet examined her and noticed her reflexes in her left ear is diminished somewhat and slowness in left hind paw
    Last edited by lovemybubbles; 6th November 2013 at 09:40 AM.

  2. #2
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    Hopefully, several with CM/SM experience will jump in to answer your questions. LIVS is an excellent choice. Dr. Catherine A. Loughin is not a board certified neurologist. She is a board certified surgeon, as is Dr. Marino. Read about her here: http://www.livs.org/index.php?option...=80&Itemid=160

    Some cavalier owners have suggested that LIVS has been a little quick to recommend surgery. In view of that, I would ask Dr. Loughin what input your dog is going to receive from any of the neuros on LIVS' staff. They are Drs. Dewey and Bilderback. A well-done MRI should tell you a lot more about Ellie's condition, and may even show no SM. But, CM alone can cause pain, and after all, the surgery is designed to remedy the CM, not necessarily the SM.

    I would not tell the breeder about the SM until after the MRI.

    As for the MVD, the current recommendation of a leading cardio, Dr. Mark Oyama of PennVet school, is to not do periodic echos as a general rule. Instead, he recommends periodic auscultations and x-rays. He says that the echos normally are not needed unless and until the auscultations and x-rays show rapid changes in the sound of the murmur and enlargement of the heart.
    Rod Russell

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    Rod,


    Thank you for this information, it was very helpful, I was going to call LIVS today to find out how to spell Dr. Loughin's name and thought the link you provided was her!


    Would you or anyone else for that matter first recommend seeing a neurologist and then seeing the surgeon? Right now Ellie is not on any medication, I am going to call LIVS and make sure its ok to start something before they see her/prior to any imaging. My regular vet said she would start her on omeprazole right now if they were ok with it.


    I live in NYC, Dr. Chad West at AMC was recommended to me in terms of neurologist, anyone have any experience with him? I am not sure of the importance of seeing the neurologist prior to the surgeon or if the surgeon is adequate to initiate medications. My vet did a pretty thorough neuro exam.


    I am aware Dr. Marino's recommendation is usually surgery which is why i was hesitant to see him initially, but i have heard he is one of the best. I know regardless of his and Dr. Loughins recommendation that I need to make my own informed decision which I guess that is why I am here asking for advice and if there is any one else that perhaps I should seek a second opinion from. Perhaps Clare? Would a neurologists opinion also be helpful or another surgeons opinion?


    In regards to the echo, I had the same question. Dr. Petrie did the echocardiogram and it showed mild tricuspid regurgitation and trace mitral regurgitation, he said since it is congenital and not acquired and since she was diagnosed so early is the reasoning behind wanting it in 6 months. This doesn't necessarily make any sense to me but apparently there is some sort of distinction between follow up echos if it is congenital vs not? I did bring up just doing yearly chest xrays and my vet did say she will speak with him about this to find out why he recommended the echo in 6 months.


    Thank you again all.

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    Riley, my SM dog, had a craniotomy with a titanium mesh implant 5+ years ago and it was the best decision of my life, although I wasn't sure of it at the time. I did get a second opinion from another neurologist before surgery. I would definitely recommend seeing a neurologist before seeing a surgeon. Many dogs are managed lifelong on meds. Riley however did not respond at all pre-operatively to any meds. Post-operatively, Riley has been one of the lucky ones. Her life since surgery - after a rocky 6 months while we adjusted her post-op meds - has been amazing. She is my wonder dog. She's definitely handicapped because she had the surgery late (she was almost 6 years old) but she loves life and nothing holds her back. Whatever challenges she has, she picks herself right back up (literally - she falls often) and goes right on as if nothing happened. Without the surgery, I doubt she would be alive. Oz, my dog with the congenital murmur (grade 1) has had dental cleaning with anesthesia without incident. His cardiologist assured me he would be fine for any surgery. So, if Ellie's cardiologist clears her for surgery (if you decide to go that route) then I wouldn't worry. Hope this helps.
    Bev
    Oliver (blenheim, born 3/2001), Riley (black & tan, born 8/2002,), Madison (ruby, born 9/2003), and Oz (tri-color, born 7/2007)

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    I just bumped a past thread (titled "opinions on getting a second mri") up that has some comments about Dr. West. Irene (mom of Jack) uses Dr. West, so you can use the search function and read about their experiences.

    Pat (in Atlanta)
    Pat B
    Atlanta, GA

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    FYI- ellie is clear from a cardiology perspective to have anesthesia

    Love my cavaliers- a truly great surgical outcome, i can only hope if we opt for surgery that we would be as lucky, i have read a lot about Riley and she seems to really be a trooper and am so glad she is doing well

    Pat- thank you very much for bumping the thread with Irene's experience, I wonder how Jack is doing. From her most recent post he seems to be managing fairly well medically.

    The more I am reading the more it seems like I should at least TRY medical management, meaning i should at least TRY the medicines and see what happens. It seems if that fails, or if the symptoms progress fairly rapidly people have opted for surgical management. Please correct me with your experiences if I'm wrong. I think I need the mri to help steer me which I can hopefully get the same day of my consultation if I am allowed into the study.

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    Quote Originally Posted by lovemybubbles View Post
    ... In regards to the echo, I had the same question. Dr. Petrie did the echocardiogram and it showed mild tricuspid regurgitation and trace mitral regurgitation, he said since it is congenital and not acquired and since she was diagnosed so early is the reasoning behind wanting it in 6 months. This doesn't necessarily make any sense to me but apparently there is some sort of distinction between follow up echos if it is congenital vs not? I did bring up just doing yearly chest xrays and my vet did say she will speak with him about this to find out why he recommended the echo in 6 months.
    If the tricuspid regurgitation is more pronounced than the mitral valve, and since Dr. Petrie called it "congenital and not acquired", I would follow his recommendation about when to re-examine with an echo.
    Rod Russell

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    Karlin- thank you for you for your thoughful response. basically what you are saying is where I am coming out - why do surgery when we have this heart issue and why not at least try medical management. I really do not want Ellie to have this long drawn out recovery with complications just to find out her heart has progressed and I took away her quality of life for the time she did have. How many dogs do you know that have gone through the surgery with Dr. Marino? This is what I am most interested in finding out when I meet with LIVS, how they keep track of how the dogs do in the long term and what outcomes they have.

    Kate- thank you for the words of encouragement! yes, that was my thought, however, i don't know if its perhaps the fact that the echo shows both tricuspid and mitral regurgitation? im still waiting for a response from my vet for an answer to this

    Momobvious- thank you, yes i have read through numerous blogs specifically these three: http://rileybeatssm.blogspot.com/, http://abbeygeorgelinda.blogspot.com/, http://fightforella.blogspot.com/

    Rod- what makes you believe to go by his recommendation? I am still struggling to figure out why the follow up in 6 months via echo vs's yearly xrays? I will let you all know when I hear back from him as to his reasoning. That being said, does anyone have a good cardiologist in NYC? I never actually met Dr. Petrie - he comes to my vet once a week to do echo's, reading of chest xrays, and auscultation. My vet acts as a liasion between myself and Dr. Petrie and think it may be best to have a cardiologist I can speak with myself.

    Thank you all - it has been very difficult to get opinions from friends and family as they sometimes don't understand the disease processes and even if they do, it is hard for them to be objective as I am telling them the information I know from researching, not from there own research, so thank you for everyone who has posted not only on my threads but on previous threads as well.

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    Quote Originally Posted by lovemybubbles View Post
    ... Rod- what makes you believe to go by his recommendation? I am still struggling to figure out why the follow up in 6 months via echo vs's yearly xrays? I will let you all know when I hear back from him as to his reasoning. That being said, does anyone have a good cardiologist in NYC? I never actually met Dr. Petrie - he comes to my vet once a week to do echo's, reading of chest xrays, and auscultation. My vet acts as a liasion between myself and Dr. Petrie and think it may be best to have a cardiologist I can speak with myself. ...
    I suggest following Dr. Petrie's recommendation for these reasons:

    -- He is a very well qualified, experienced cardiologist.

    -- He noticed the tricuspid valve regurg and that it was more pronounced than the mitral valve regurg.

    -- He diagnosed it as "congenital" instead of "acquired". The typical MVD in cavaliers is acquired. Congenital means that it was there either at birth or very soon thereafter. Acquired means that it was not present at birth and began and progressed afterwards.

    -- For whatever reason, he believes that the tricuspid regurg is the bigger issue and is congenital. So, this is not a typical MVD problem.

    -- Dr. Oyama said that, while an echo is not necessary for about 85% of MVD cases in small dogs, there may be other reasons for doing periodic echos.

    -- If it was my dog, I would follow Dr. Petrie's advice, but I would ask him about the congenital diagnosis and the tricuspid diagnosis and whether they mean my cavalier has something different than garden-variety MVD.

    Here is a list of the board certified cardiologists in NY: http://www.cavalierhealth.org/Cardio...s.htm#New_York
    Rod Russell

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    Karlin- thank you for you for your thoughful response. basically what you are saying is where I am coming out - why do surgery when we have this heart issue and why not at least try medical management. I really do not want Ellie to have this long drawn out recovery with complications just to find out her heart has progressed and I took away her quality of life for the time she did have. How many dogs do you know that have gone through the surgery with Dr. Marino? This is what I am most interested in finding out when I meet with LIVS, how they keep track of how the dogs do in the long term and what outcomes they have.

    Kate- thank you for the words of encouragement! yes, that was my thought, however, i don't know if its perhaps the fact that the echo shows both tricuspid and mitral regurgitation? im still waiting for a response from my vet for an answer to this

    Momobvious- thank you, yes i have read through numerous blogs specifically these three: http://rileybeatssm.blogspot.com/, http://abbeygeorgelinda.blogspot.com/, http://fightforella.blogspot.com/

    Rod- what makes you believe to go by his recommendation? I am still struggling to figure out why the follow up in 6 months via echo vs's yearly xrays? I will let you all know when I hear back from him as to his reasoning. That being said, does anyone have a good cardiologist in NYC? I never actually met Dr. Petrie - he comes to my vet once a week to do echo's, reading of chest xrays, and auscultation. My vet acts as a liasion between myself and Dr. Petrie and think it may be best to have a cardiologist I can speak with myself.

    Thank you all - it has been very difficult to get opinions from friends and family as they sometimes don't understand the disease processes and even if they do, it is hard for them to be objective as I am telling them the information I know from researching, not from there own research, so thank you for everyone who has posted not only on my threads but on previous threads as well.

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