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

  1. #11
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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.

  2. #12
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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.

  3. #13
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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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  5. #14
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    Quote Originally Posted by RodRussell View Post

    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.

    Not "very soon thereafter" - Congenital means "present at or before birth." This includes damage that occurs during the birth process or an abnormality during development of the fetus.

    Endocardiosis (MVD, chronic valvular disease, myxomatous degenerative valve disease) BY DEFINITION is an acquired disease and not a congenital disease. Itís caused by a degenerative process thought to be genetic (hereditary). It can definitely be acquired at a pretty young age (defined as "early-onset") but it is not present at birth (although the Cavalier's genetic propensity to develop MVD is, of course, present at birth). A congenital disease is a condition or defect that is present at birth, such as tricuspid valve dysplasia. TVD, PDA, aortic stenosis, and others are cardiac birth defects. MVD is not a birth defect, but (repeating myself, I know) it is an acquired disease with a genetic component. Confusion about this is common.

    My guess is that this is early-onset chronic valvular disease (typical in Cavaliers) rather than tricuspid valve dysplasia (often found in retrievers) but I would specifically ask that question. I suspect a miscommunication, because the alternative would be a very, very rare situation.

    I would also want to work with my cardiologist directly rather than having the GP vet in the middle. This may be the source of the miscommunication. Also, a cardiologist with his own practice location generally has better ultrasound equipment than one who travels to GP vet offices and either uses their equipment or portable equipment.

    By the way, Monica, I had a Cavalier (Darby, born in 1993) who was diagnosed with a murmur at 18 months. He lived to be 15 and died before ever going into heart failure of causes unrelated to heart disease. This is, of course, on the extreme end of the expected progression, but it shows that there is quite a wide range in the disease progression. (Coincidentally, he also had early tricuspid valve insufficiency.) I would be unhappy but not in despair about Ellie's heart situation. Monitoring her progression over the next 6 mos, 12 mos, 18 mos, 24 mos will give you a better idea of whether she has slow, moderate or rapid progression. If you haven't done baseline chest radiographs already, I would do that so that you have a record to compare with follow-up rads. Unless I had money to burn, I wouldn't do echos every six months unless a cardiologist gave me a good explanation of why this would be necessary. It's too vague at this point since you haven't even spoken with the cardiologist. If there is RAPID progression of murmur grade or increased heart size on chest rads or symptoms appear, then there is a reason to be more aggressive with diagnostics and do echos more frequently. I would probably get an auscultation every three months and more x-rays every six months until you feel comfortable that she doesn't have rapid progression. Then you can lengthen the time between check-ups.


    Pat
    Pat B
    Atlanta, GA

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  7. #15
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    Quote Originally Posted by Pat View Post
    Not "very soon thereafter" - Congenital means "present at or before birth." This includes damage that occurs during the birth process or an abnormality during development of the fetus. ...
    I was relying upon this cardiology definition: "Congenital if it is diagnosed in utero, at birth or within the neonatal period (0-27 days after birth)".

    Here is another set of definitions of human congenital cardiac problems:

    Question 1: Is there a definition of major congenital heart
    disease (MCHD) and if so, what is the birth prevalence of
    isolated MCHD?
    LA: There is no universally accepted definition of MCHD.
    It has been variously defined as:
    1 CHD resulting in presentation to a cardiologist during
    infancy;
    2 CHD requiring intervention during the first 6 months;
    3 CHD requiring intervention during the 1st year of life;
    4 an abnormality of connection
    Last edited by RodRussell; 7th November 2013 at 05:41 PM.
    Rod Russell

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    Pat and Rod- thank you SO much for clarifying the distinction between congenital and acquired. I was having immense trouble wrapping my mind around it and I think that is why I was having trouble understanding Ellies diagnosis (and perhaps my vet did too?). Based on what I'm reading it seems that Ellie does not have MVD. I did not realize MVD is typically acquired and NOT congenital. I have no idea what this now means in terms of prognosis and I do realize she could still develop MVD. I do know that early onset mvd supposedly progresses faster but I wonder what the typical progression is like with congenital illness and that is what my question is to Dr. Petrie. I have not really come across any readings in terms of congenital disease in cavaliers but if he is asking for an echo in 6 months my assumption is that it probably could also progress fairly rapidly..or not..

    Im assuming since this was congenital that the murmur has been there since birth and there was just no prior detection of it. I am also assuming that this is not a hereditary condition, that it is genetic. In other words I don't know if there was any way of detecting this in the parents prior to Ellie's birth unless genetic testing was done. Please correct me if I'm wrong.

    I also don't really care per se about the nitty gritty details about the heart condition/definitions (it is really more interesting and good to generally understand than anything else), I care more of how it will progress and ultimately affect her as I continue to weigh the pros and cons of surgery.

  9. #17
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    Hello All,

    I know how frustrated I was when I never got to see a follow up on a cavalier and how they were doing. The past couple months have been very busy but I wanted to circle back to give an update that I did meet with Dr. Loughin/Dr. Marino and Dr. West. If anyone is struggling through the same decision, please do not hesitate to ask via PM and I will be happy to respond.

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