Stage 5 heart murmur and fluid on the lungs

Wow it's been a number of years since I last posted here but I knew this was where I needed to come because I've got such great advice in the past and guys I really need ur help.

My little cav, Lady is now 11 yrs old and she has Mvd. she's taking Fortekor and aldactone. Today she seemed to be panting a lot and I didn't like the sound of it so I took her to my vet. She told me that the Mvd had progressed to a grade 5 and she has fluid on her lungs. She doubled her dosage of meds and told me to bring her back in two weeks. She also said she needs some of her teeth removed but the priority at the moment is getting her Mvd under control.

My question is do I need to bring her to a cardiologist and if so can u please recommend one? I live in Cork, Ireland and after googling I discovered one but I would really appreciate a recommendation. It was so hard to look at my little girl panting and wheezing and I'm so worried about her. Do you think she needs more immediate attention or will the higher dosage of meds do the trick? I feel so helpless and I need to help her in any way I can

Hi Edel,
So sorry to hear about Lady. I do not know of any cardiologist here in Cork - someone else may have better information. However Emma Tobin comes to Gilabbey Veterinary Hospital in Togher. She is a veterinary radiologist and will do ultrasound of the heart Think she is there once a week. Maybe if you ring them they will give you more information. I know this is not exactly what you are looking for but it is a starting point. Good luck with Lady. Thinking of you.

Hi Edel

KCB's suggestion sounds a good starting point. An ultrasound will give you a more accurate picture of what is happening in Lady's heart and whether she is about to go into heart failure. Do you know how to check her breathing rate? A rate of 25 breaths or more a minute indicates that the heart isn't coping. However, on a more positive note, there are a number of drugs that can help to support the heart and enable even a dog in heart failure to have some quality of life.

Karlin may know of a cardiologist near you. The higher dosage of Lady's meds should clear the fluid from her lungs and will support the heart as it battles to keep everything working. MVD is a very individual disease - some dogs in heart failure can live a good life for several years, others get worse very quickly. And not all dogs with a grade 5 murmur actually go into heart failure. One thing that I have found makes life easier for both humans and dogs is a buggy or pet stroller - it would enable Lady to walk as far as she can manage and then continue to watch the world go by (and in my experience get a lot of fuss from passers by!) from her chariot. There might be someone local who could lend you one, or they cost about £30 on Amazon.

I do hope you will be able to get Lady more comfortable - do let us know how she gets on.

:hug:

Kate and Ruby

Hi Edel -- There's just one cardio in Ireland; that is Tom Mullaney at Nutgrove Vet in Rathfarnham, Dublin. All mine have been to him at various times; it might be a good idea to see him if you want the best possible recommendations on meds.

I would certainly suggest getting a second opinion, at least. Aldactone (spironolactone) is a fairly weak diuretic and usually instead of doubling up on that, a vet would add in frusemide. I just had exactly this discussion with my vet in the past week and that, at least, is what my vet suggested with me. The other thing I would wonder about is removing teeth on a dog with a grade 5 murmur. I wouldn't consider doing that without getting the opinion of Tom Mullaney.

I'd want someone really good at assessing MVD to determine where Lady is at the moment, and whether she is in CHF and needs pimobendan at this point. Panting and a high grade murmur sounds like poor heart efficiency, the time when pimobendan is generally considered. I'd be very surprised of a cardiologist would suggest doing anything involving a general anaesthetic on an 11 year old with an advanced murmur but there could be a special argument for doing so. Tom said not to bother doing teeth with any of mine once the murmur is significant and the heart isn't working at a good level.

Gilabbey is quite a good vets too.

Thank you for all the helpful replies guys, really appreciate it.

Lady had an ultrasound today by a specialist my vet told me was a cardiologist, can't remember her name. She said that Lady was in fact in CHF and I'm so saddened by the news. However I'm being proactive about it and hopeful. Her medication has been adjusted and is, per day, as follows:
Benazeril (fortekor) 5mg
Aldactone 50mg
Frusemide 80mg
Cardisure 5mg
She told me that the left chamber of her heart is twice the size that it should be and she also has a leaky valve. She said she would rate the CHF at around 7/10 with regard to severity, bad but not terrible.

With regard to her teeth, she said that this wasn't a good idea at this stage so that's out.

Her resting breaths per minute at this point appear to be about 44 per minute, extremely fast but again hopefully the meds will help to alleviate this. I asked the specialist how long did she think Lady has left (I had to ask) and she said she believed between 6 months to a year but obviously could go either way.

We are devastated at the thought of losing her. I feel like I'm on the edge of tears all of the time, can't imagine my life without her.

Can anyone tell me what is expect at this stage? I know every dogs experience is different but I feel like knowledge is power and I'd like to know Wat to expect.

Thanks again

Aled went into CHF in July 2014 shortly after his 7th birthday. His breathing got very rapid in the evening and I took him to the emergency vets who kept him in intensive care overnight, giving him vetmedin by injection. In the morning I collected him from them and took him to our usual vets, who kept him in for the rest of the day doing tests and getting him reasonably stabilised. Ten days later I took him to a cardiologist for a full examination; both his valves were useless, you could see them on the computer screen simply flapping. So he was a very fragile dog. The meds definitely helped, and I organised steps for getting onto the settee and we already had a buggy so Aled was able to go everywhere with me and my other Cavalier Oliver. For 2 or 3 months he lived a fairly normal life, except for restricted walks and no stairs or excitements. If he felt well enough to get out and walk in the park for a little while he could. Twice he got a build-up of fluid in his abdomen, but another diuretic on top of his frusemide dealt with that quite quickly. He had bad teeth - but like Lady, no question of doing anything about it; but at one stage, a tooth got very loose and he found it difficult to eat - something to watch out for; I changed him to a very small puppy kibble that he could swallow whole, and after that he never lost his appetite! His breathing never got bad again, it stayed at around 20 or less. Aled also had mild CM/SM and myoclonus, so he was taking 16-18 pills a day and went on strike! So I started grinding each lot of pills in a pestle and mortar, adding a bit of honey and some water, putting the mixture in a plastic syringe (left over from some metacam) and squirting it into the side of his mouth. This saved a lot of hassle.

Generally speaking, Aled just gradually got weaker, spent more time dozing, and seemed a bit disoriented. He liked to lie on his side with his legs stretched out, as he could breathe best that way, so I bought him a padded fluffy mat that gave him plenty of room to lie flat out. He slowly declined until early February 2015, when Oliver woke me wanting help with changing position (he had paralysed hind legs) and I found Aled standing in the middle of the bedroom desperately trying to breathe - it was obvious his heart had finally given up. I gave him his heart meds and sat cuddling him until our vets opened (during which time, I may say, he consumed half a tin of Butchers Tripe!) and then took him over to be put to sleep. Aled liked meeting other dogs, though I had restricted this as much as I could, and a friend had brought her Cavalier in for a few minutes the afternoon before and there was a lovely few moments when the old Aled appeared, playing with Mia. But I think that was too much for his heart; it's a difficult balance between letting them do what gives them pleasure and quality of life, even if it hastens their death, and protecting them from activities that will put strain on their hearts so that they stay alive longer. On the whole, I was glad the real Aled had appeared for those last few moments - it was a great goodbye. He had lived for 7 months since going into heart failure. He was registered with the Cavalier Collection Scheme, so our vet did a post mortem and took tissue samples for heart and pancreatitis research. He was then individually cremated and the ashes returned to me, and in June I scattered Aled and Oliver's ashes together on our favourite beach in Norfolk (Oliver had been put to sleep 5 days after Aled).

But Lady's path may be completely different to Aled's - MVD is a very individual disease. It is also a disease that is very hard on the owner doing the nursing. You will find yourself doing a lot of your grieving beforehand, as you carry Lady out into the garden, get yet more pills down her, and watch her declining. You may feel tied to the house, because it is difficult to ask someone to look in for an hour or two if they may find a dog who has taken a turn for the worse and needs to be rushed to the vet. You get into nursing mode and then suddenly find you no longer have a dog to nurse and it takes time to adjust. So do look after yourself as well as Lady and make allowances for being stressed.

If this can help you and Lady, I'm glad. It may, of course be of no help at all!

I still so miss my little Aled.

:hug:

Kate and Ruby

PS If it would help to phone or email me, I'll message you my contact details. Don't mind you having a cry down the phone if that's what will help - I've done that myself!

Kate thank you so much for your advice, insight and support, it made for tough reading but it's important for me to know and I appreciate you taking the time to tell me. I'm so sorry you lost both Aled and Oliver so close together, it must have been very traumatic for you.

The meds have started to work and the panting has subsided a lot which I'm very happy about because my main concern is that she is comfortable. At the moment I am back in optimistic mode, perhaps you could call it denial, but I'm thinking she might defy the odds and stay with me for longer than a year.

I'm bringing her back to the vet on Friday to see if her meds need to be adjusted so I'll keep you all updated.

I want to express my appreciation and gratitude again to anyone who is sending me and my little girl kind and positive energy, it means so much when it's from those who truly know what it feels like. Thank you again xx

Hi Edel, Hope Lady is doing okay. Will be thinking of you tomorrow for good news from your vet. I heard today that Mike Martin holds a clinic at Gilabbey vets. Karlin may know more about him. I don't know how often he visits but it is another option in Cork for you. Positive thoughts and prayers for you and Lady ����

If Mike Martin is the cardiologist from The Willows referral hospital in Solihull, he is excellent. Of course there may be two cardiologists called Mike Martin!
Hope your vet does a good job today.

Kate and Ruby

Hello Edel.
I'm so sorry to read about the pain you're going through, sadly like so many here Ive been through it. I lost my boy last October and I remember the fear, denial and hurt that this terrible disease caused us all.

I have every thing crossed for you and Lady. Sending hugs and prayers your way.

Mel :hug:

Thank you all for such kind and positive thoughts. Lady has been back at the vet yesterday and it would appear that the fluid has been cleared from her longs, the diuretics must have done the trick. Her resting breath rate has not come down from 44 per minute but I'm hoping we can get that under control also. Right now she is in good spirits and the excessive panting only seems to happen at night.

I'm going to continue wit the regimen of meds that she was prescribed and hope for the best. I feel like I'm dealing with the situation better now, the initial shock has subsided but I know of course that if she takes a then for the worst the fear will return and then some.

The vet that I saw today was not the one I usually go to as he was away but I appreciated the new perspective (4th vet she has been in 3 weeks). He said that although her heart was in a bad way, once her quality of life was good, there was no reason why she should not be wit me for another year or two, he said he has seen it wit cavaliers in the past. I was delighted and I must say I am really holding onto that thought.

So as of today everything is good and she is responding to meds. Thank u all for your kind wishes and positive energy. I will update wit any changes.

So glad Lady is a bit better and lungs clear. Long may it last!cl*p

Kate and Ruby