Any advice on MVD treatment for our cavvie Panda

Hi there


My husband and I originally registered on this forum a couple of years back as we have gained a lot of helpful advice
re our dog Tails, who is now 3.


Since then we have adopted a second cavvie, a five-year old (we think) rescue named Panda who is the sweetest little boy in the world but has
been having some problems with his heart.


About 3 months ago he started coughing (about once a day) so we took him to the vet who did an examination and told us
there was nothing wrong. We knew from the initial examination that Panda had a grade 2 heart murmur but the vet was convinced
that this was unrelated. He suggested that a few of the cavaliers that he looked after had such abnormalities so we shouldn't
worry about it.


A few weeks went by and we both became more uncomfortable withe the coughing so we brought Panda back in (this time to
see a different vet) who examined him and decided it felt like a problem in his trachea probably caused by an enlarged heart
so she gave him some anti-inflamatories and antibiotics (in case it was an infection), which seemed to have no effect. So we went back and AGAIN the vet told us it was
nothing to worry about and we should just monitor it.


Then finally about 2 weeks ago the cough got dramatically worse - going almost immediately from about once or twice a day to
20-30 times a day. So we rushed back to the vet who this time heard the cough and gave Panda a diuretic shot and a
dose of Frusemide which instantly eased the problem and took Panda back down to about 1 cough a day (and made him
visibly MUCH happier).


So on our next visit to the vet (about 4 days later) the vet concluded that it had to be that Panda's heart murmer
had progressed to heart faliure and it was time to start medication...


So he prescribed us Frusemide (20mg x3 per day), Benefortin (5mg x1 per day) and Vetmedin, (5mg x1 per day). This has ALMOST completely cleared the cough but not 100%
- since starting the medication he has been coughing about once per day (at night), until last night when for the first time he didn't cough at all. We're hoping
that means that the medication has taken effect properly and that he won't cough again.


Now I was wondering if this sounds right to everyone, or whether there is anything else we should ask the vet about. The vet says he has dealt with many
cavs with MVD and some have gone on for years on these meds but I was wondering if there is anything else that
Panda should be taking. We just want to make sure we aren't missing anything!

Hi! If you can, I'd recommend seeing a vet cardiologist. I agree with your concern, it's hard to see how a grade 2 murmur would suddenly have all these associated symptoms which suggests the grade was wrong, or that other signs were missed, or perhaps that something else is going on. For example, lungworm can cause coughing... but that aside, such a fast change would to me, be a sign that you'd want to get better information on what is actually going on and whether all the medications are the route to take. Normally vetmedin for example, isn't introduced until congestive heart failure (if resting/sleeping breathing rate is over 40 breaths per minute) -- there is evidence giving it early can cause more problems including heart failure earlier. A cough on its own is not a sign of CHF. So I'd at least want to make sure he should even be on that.

A cardiologist will be able to give far more accurate help and a precise diagnosis.

I agree with Karlin about consulting with a cardiologist. We've had cavaliers since 1969, most with MVD at some stage of their lives, and we've learned to never allow a general practice vet to make the diagnosis and/or medication decisions regarding our dogs affected with MVD.

As for coughing, it is not unique to heart problems. It could be something else or something coincidental with a cardiac cough.

There is a list of supplements you might consider giving to your cavaliers, either with or even before MVD, here: http://cavalierhealth.org/diets.htm#Heart-Healthy_Supplements

Also, here is some advice about detecting heart failure in a cavalier with MVD: http://cavalierhealth.org/blog.htm#June_18,_2014

Karlin wrote: 'until congestive heart failure (if resting/sleeping breathing rate is over 40 breaths per minute)'

Just to muddy the waters, Aled's breathing has never been that rapid, if anything it has slowed since he went into CHF. His Doppler examination showed both valves flapping and useless, but his breathing is somewhere around 16-20 breaths a minute; just once or twice it has gone up to 30 but slows down again as soon as he has his vetmedin. He seems to take slower, deeper breaths from his abdomen to give his heart a stronger push, rather than rapid breaths from his lungs. On the other hand, when he went into heart failure his heart rate rocketed from the normal 120 to 220 beats a minute. Six months later he is still with us, though getting tired.

Kate, Oliver and Aled

Just to add my experience. Leo was diagnosed with CHF in November 2013....He was started on Cardalis, Frusemide and Vetmedin....he responded really well.
His Frusemide has been decreased (10mg twice a day) but his Vetmedin is the same at 1.25mg twice a day....

Like Kate's Aled his breathing is about 20-25 resps a minute at rest.
I also give him fish oil supplement....I don't know if it helps but its been 14 months now and he's doing great.
He had a check with the cardio vet last week and she was delighted with him. No change in meds and he's lost weight which is really great!
He's due another echo cardiogram in April....fingers crossed....

I guess each dog is individual and you never know how they'll respond to the meds, we take one day at a time and enjoy what ever we've got left....I pray its many years yet

Good luck

No one has mentioned -

Is that a typo on the Vetmedin dosage? Vetmedin is always given every 12 hours (twice a day) and not once a day. And 5 mg.? How much does this Cavalier weigh? I'd be even more concerned if the vet is giving the wrong dosage.

Pat

Thanks for the great responses everyone; I really appreciate your concern and support.

We are going back to the vet on Monday for a checkup and will ask to be referred to a cardiologist. (Our did say that we could be referred if we would like Panda to have a scan, so we'll take him up on that.)

Panda's breath rate varies a lot but has never yet counted above 40. However, as I mentioned before, the Frusemide has had such a dramatic effect on the cough that we don't want to get our hopes up that it isn't CHF. (In fact, does anyone know if it is possible that Frusemide could cure a cough not caused by CHF?) The vet asked us to drop the Frusemide to 2 a day instead of 3, but straight away the cough started coming back so we called him up and we're going back up to 3 for now.

Pat- sorry, my head wasn't straight when writing the last post. Panda takes 5mg split into two (2.5 in the
morning then 2.5 12 hours later). He's 12kg. He's not especially chunky but does have a large frame
and an enormous barrel chest. (We suspect that he is part beagle; he has a number of very beagle-like
physical attributes).

Thanks again so much for the advice. This is such a difficult time for us and it's good to have some
people to talk to.

I've had a few cavaliers through rescue that are barrel-chested! But again there's always the possibility of a cross somewhere in the mix. Let us know what the cardiologist says -- I think you will feel more confident and informed once you've been to a cardio. I always feel much more on top of things after a visit.

Thanks Karlin! We'll definitely give an update when we've been to the cardio.

Hiya
Its a hard place to be...trust me I know...but like Karlin says once you've spoken to a cardiologist you'll feel much better as you'll know whats going on....I know I did

I really hope Panda settles once the meds kick in and you find the right combination and dosage.

I don't think Frusemide cures a cough that isn't related to a build up of excess fluid in the lungs....the diuretic effect is to get rid of the fluid hence taking the strain off the lungs and other organs.

Hi Mel,

Thanks very much for the support!

Panda seems to be doing well on his meds at the moment - the cough has gone again now that he's back on 3 Frusemides a day, which is a relief at least. You confirmed what we thought, i.e. the fact that Frusemide cures the cough means that it must be due to a heart condition.

If you are giving such a high dose of frusemide, you will need to take bloods every 3-6 months to monitor the kidneys and liver. Frusemide draws out fluid from all over the body, not just the lungs, and can leave kidneys without enough fluid passing through to keep working properly.

Kate, Oliver and Aled

Thanks very much for letting me know; that's really important information. I'm hoping we'll be able to lower the Frusemide dose once the heart medicine starts working, but we will definitely have to monitor this in any case.

Question about referral to a cardiologist

Hi everyone,

Again, thank you all so much for your support and helpful advice; it really means a lot to me and my husband James. This might seem like a stupid question, but I was wondering if I could ask what the best way to go about getting an appointment with a cardiologist is. I mentioned in a previous post that our vet offered to send Panda for a scan. We had understood that to mean that he would have a consultation/assessment with a cardiologist, who would do the scan as well - but then we started to wonder whether it just means that the scan would be done and sent back to our vet to interpret. Does anyone know how this works? I.e. does a vet's referral for a scan usually include a consultation, or would it be better to make an appointment with a cardiologist separately (we live in London, so I imagine that we should be able to get an appointment independently), without going through the vet? I hope this makes sense; we've never had to be referred to a specialist before, so we're not sure how to go about it.

Many thanks!

Hiya,
I would ask your vet to refer you to a cardiologist. Explain you want the scan and then for Panda and you to see the cardiologist for a consultation.
Several years ago I asked for Leo to be referred to a neurologist and for an MRI. We were referred to Cambridge royal vet college, Leo had the scan and we saw the specialist too. It was all part of the referral.

Im sure your vet will understand you want to see a specialist.
I guess you could also self refer....once you've found out where your nearest cardiology specialist is.

Good luck

Hi Mel,

Thanks very much; that's really helpful. We'd like to go through our vet if possible, since he has been good to us and Panda and it would be nice for him to be in the loop.

Lily

I have two cavaliers- one sweet Tri girl 7 1/2 years old with mild to moderate chiari and heart clear, and I have a precious Bleinheim boy who is 8 1/2 years old who was heart clear until he was 7. He developed a 2/3 murmur which became a grade 4 in less than a year, which was noted in March 2014- at that time because his murmur and echo findings both worsened, he was diagnosed with severe chronic MVP and placed on Benazapril 2.5 mg one in am and half in pm. On Valentine's Day this year (11 mos later), I came home to find him breathing very fast and threw up foam. I rushed him to the ER where the vet initially did not agree he was in much distress but his gums were very pale. He placed him in the oxygen tank and looked absolutely fine in minutes. His chest X ray showed patchy infiltrates and slight increased markings and slightly enlarged heart. He gave him Lasix 12.5 mg IM and he improved further. I made the decision to bring him home as his oxygen saturation was 95% before the oxygen tank and Lasix. I'm a physician asst. and live close to the ER, so I preferred to monitor him at home as he was stable. I did not sleep but at least I had my baby and he was ok.

I took him to see the cardiologist the next day, and his echo was not significantly worse than it was 5 months ago, except for slight regurge of the tricuspid valve and dilatation of the atrium. I asked him to draw cardiac markers which were not terribly elevated (in fact troponin minimally elevated and ANP 436; BNP was elevated c/w with heart disease) and he feels he may have had mild CHF. I wanted to mention I had to induce vomiting 2 nights before this happended, so perhaps some aspiration complicated the picture and the vomiting stressed the heart (increased intrathoracic pressure). Anyways, he added Vetmedin to his regimen (I noticed just this weekend his breathing is slow around 20 from 26-28). The cardiologist also picked up a "respiratory sinus arrhythmia" which is supposed to be healthy and does not occur with CHF from what I've read. His heart beat always feels strong, and I asked cardio whether he was totally safe in taking Vetmedin and he said it was very safe. I have read great things about Vetmedin but it also is not good to give and may worsen symptoms or even cause early death if the heart does not have decompensated contractility. If anyone has any experience, please share!

I hope and pray he lives well and long enough to be around when the valve surgery is effective and available. I know valve replacement surgery is very successful with the Japanese cardiac team, however, besides being very costly if you don't have insurance, it is very invasive and risky. The dog has to have bypass surgery and the tricky part is removing the machine once the heart is ready to let pump on its own after the procedure. Just so scarey, but I will do whatever I have to do to keep the love of my life! What worries me is that procedures are not done unless the dog is failing meds and by that time can have other co-morbities (kidney insufficiency from long term meds for example) that would complicate the procedure's success or not make the dog a candidate.

For sure Serotonin is a huge player in the MVP problem and when they find some kind of serotonin blocker maybe it will make a difference. However this could change their happy, loving dispositions that's practically inherent in the breed. Antidepressants work on keeping serotonin available in the blood. Low serotonin levels are consistent with depression. I am also an acupuncturist-- In Chinese Medicine, too much happiness injures the heart energy. So that is the definite connection, and I hope further studies will soon prove much needed value and hope in approaching this devasting disease.

Hi everyone,

With everything happening we kept forgetting to reply to this post and thank everyone again. We went to a cardiologist in the end who said there was a problem with one of the valves (it was nobbly and only half closing) and Panda's heart was quite enlarged. We've dropped Panda's frusemide down a bit so he has 2 a day most days and occasionally give him a a third if his cough starts to get worse and this seems to be keeping him under control and he is doing well.

Thanks again to everyone who helped.

That's great news....so pleased to hear things have settled and Panda is doing well.
Leo has a heart scan booked in 2 weeks....we haven't had to increase his meds in a year and I am so thankful for that.

Sad thing is I know it wont last for ever but have everything crossed the scan result wont show any deterioration....

I'm so glad to hear that Panda and Leo are doing well on their meds and are fairly stable. Sadly (as Mel knows already) Aled's heart gave up completely, and he also started some sort of pneumonia, and the only thing to do was put him to sleep on 5 February. He was only 7 and had been in CHF for 7 months. Both his valves were useless, so there was never much hope of keeping him going for very long. I hope you will have your boys for much longer.

Kate