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[personal profile] bunn
To the vet with lurcher in hand for vaccinations, (much to fear and trembling of said lurcher). We saw a vet we have not previously encountered, one John Parkin. I liked him, he seemed thorough and was prepared to answer questions in detail.

Az's heart murmur is quite noisy now, it seems, and he felt that Az having slowed down this year, being more of a trotter than a runner most of the time, is probably due to that rather than more general old age or decay. (Az is possibly 11-12ish: we aren't sure exactly, but he was an adult when he was found.)

I wasn't quite expecting that - I tend to think of Az as 'the healthy one' - so decided to go away and research putting him on the suggested Vetmedin* treatment in detail before making any decisions. The first step would be an ultrasound scan to work out exactly why his heart is making so much noise, and whether what is wrong with it is something that is likely to benefit from treatment. If it is a problem likely to be helped by Vetmedin, then it might extend his life and make him more active**.

One thing the vet did say was that although his heart is noisy, the amount of noise a heart makes isn't really an effective measure of how well it is working. The only thing that tells you that is symptoms. And the only symptoms he has so far are not being quite such a mad chasy loon.  He does not cough, vomit or have the runs.


*apparently there have been two recent major trials of heart medication in dogs in the last couple of years, testing the 2 major treatments on the market, one of which is Vetmedin (I think the other might be Frusemide?) Anyway, apparently both companies ran tests, but only Vetmedin published the results.

**it is, undeniably, easier to have a slightly less active Az than a very active one. But is it fair on him...? Hmmm.

Date: 2010-02-03 05:54 pm (UTC)
From: [identity profile] tovaglia.livejournal.com
I don't think you can even start thinking about drugs until you get the results of the echo (ultrasound) - see if you can get a copy of the written report.

Date: 2010-02-03 07:37 pm (UTC)
ext_189645: (Default)
From: [identity profile] bunn.livejournal.com
I'll make sure I get a copy of the report, thanks!

I think the plan was that medication would only be considered if the scan turned up a treatable problem - but that if there was one, Vetmedin would probably be the appropriate first thing to try.

(I always ask about possible treatment options when they recommend scans now, cos some vets will X-ray apparently just so they can nod and tut disapprovingly at the results even when there isn't actually anything they can do. Eg, Mollydog's front leg.)

Date: 2010-02-04 09:25 am (UTC)
ext_189645: (Default)
From: [identity profile] bunn.livejournal.com
... if there are Difficult Words on the report, may I ask you about it? That would be v. handy!

Date: 2010-02-04 01:09 pm (UTC)
From: [identity profile] tovaglia.livejournal.com
Yes, sure. Although the numbers may be just as important. (left ventricular ejection fraction) and whether they are within the reference range.

I'm a bit sceptical about the vetmedin to be honest.

Frusemide costs about 3p (ballpark figure, for humans), whereas Vetmedin is a patented combination drug (these tend to be v v expensive IME). Is the company giving the vet incentives to prescribe this?

Also it seems to be a combination of a vasodilator (and we have lots of other vasodilator drugs, in humans at least, which all seem about as good as each other) and a positive inotrope. My knowledge is a bit out of date, but IIRC positive inotropes have been pretty disastrous in the treatment of human heart failure - helpful in the short term (hours/days), like we used to give them on ITU when we couldn't get the BP up any other way, but not helpful when given for weeks or more. Some did more harm than good. Now I realise dogs are different from humans but.... not THAT different.

So see if you can get your vet to give you the references to relevant published research, preferably not by the manufacturers, and preferably a head to head comparison with the "next best thing" or "standard treatment". Same for any other drug he might suggest. Then read the research to see if you are convinced.

If there's no good evidence behind his recommendation, I'd be cautious about giving drugs to an otherwise well dog.

Date: 2010-02-08 12:46 am (UTC)
chainmailmaiden: (Mail)
From: [personal profile] chainmailmaiden
I have a slightly floppy mitral value. It makes a noise that leads doctors to offer me a seat, ask if I'm prone to collapsing and generally treat me as if I was about to die right there in front of them. Every time someone had to listen to my heart I ended up referred to a cardiologist and was being scanned every 3 years or so.

Finally I happened to see a different cardiologist who said I was actually perfect fine. He wrote a nice letter to go on my notes explaining to concerned GPs that I'm not on my last legs and to save me being referred again when I see a different doctor.

He said the noisy hearts are usually ok, it's the quiet ones you need to watch. I'm glad I was refered to him, because up till that point there had been talk of replacing the valve, despite the fact I had no symptoms other than the noise. Here's hoping Az is like me :-)

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