AIBU to not give my dog this medication/procedure?

[bubbawubba]

I'm in pieces and don't know what to do. I have a beautiful 18 year old Jack Russell Terrier. She is extremely fit and healthy, goes walking and swimming twice a day, still fetches a ball/stick, eats well.

Anyway, last week I took her to the vet as she had a scaly patch under her front leg. The vet listened to her heart while we were there and told me she had a heart murmur and to bring her back next week. I took her back yesterday and he told me she had a significant murmur, was probably heart failure and wanted to book her in for an xray and ultrasound under sedation. He gave me medication to give her in the meantime.

This is the issue i have - She is not symptomatic AT ALL. She doesn't pant excessively, she eats well, runs and is super healthy. The tablets have some nasty side effects and she would be unable to tell me if they make her feel unwell. I am not happy with her going under sedation to have a chest xray or ultrasound either. The risks of something happening under sedation increase the older the dog is and I'm not prepared to put her through it. I'm happy to do all these things if she becomes symptomatic but not at the moment. Am i doing the right thing?

Thanks :) Tbh I feel slightly that he i just trying to squeeze money out of me. He asked if she was insured. I said she was up until 2012 when Lloyds TSB pulled the cover and no other company would insure such an old dog without being utterly extortionate. I really love her and want to do whats best obviously. I'll have a chat with him when i go back next week. Thanks again.

Our dog is getting on and we've already agreed that we don't want her subjected to unnecessary medical procedures.

At her age, it is the quality of her remaining years that count.

Gawd, when I first read this I thought it said 18 MONTH old Jack Russell At 18 YEARS I think you're absolutely doing the right thing. What a brilliant age, and how marvellous that she still enjoys playing :)

I'd have 2 issues.
First is that the evidence for whether early treatment of heart disease (before it becomes symptomatic) has any effect at all on progression is extremely sketchy.
Symptoms to look out for would be coughing, breathlessness, reduction in exercise tolerance, collapsing episodes.
Second is that the ultrasound can be performed without any sedation in all but the most fractious patient, and is difficult to interpret in a sedated animal (this is not true for Xray which would need sedation in most cases) so if you want to know if she is going into heart failure then the ultrasound would be a halfway house - there are a few simple measurements like comparing diameters of aorta to left atrium which give a good indication.
There are also blood tests available that can give some idea of the degree of heart disease present, again no sedation required (Cardiopet ProBNP test)
In your shoes I would want to know about the murmur and what to look out for so if she did become symptomatic I could be on to it quickly but I would not want treatment in the meantime, unless the ultrasound showed that she was borderline for heart failure already.
Development of heart failure often lags behind developing a murmur by some time....

I think this is a case of the vet not looking at your dog holistically . I think you are absolutely right. If she isn't sick and is a happy wee thing then carry on as you are doing. There isn't a cure anyway and without being too blunt I hope. Something has to get you in the end. All the best for your happy little bundle. It must be about quality of life. Xx

I think you are absolutely right. She seems happy at the moment and now you will be alert for symptoms and can deal with them as they arise. I doubt they would be planning on carrying out major heart surgery on your dog, so I would question the benefit of what the vet is proposing.

At 18yo I can understand your reluctance to put her through tests under sedation. As mentioned the signs of heart failure are slowing down at exercise, increased panting, coughing - especially when lying down and often weight loss. If there's none of those then I would just 'wait & see'.
Though one approach I have suggested to clients in the same situation is to trial a fortnights medication & see if you notice a difference - some people have found that what they thought were just typical old age changes have been reversed & have been very happy to continue the medication when they can see the difference it makes to their pet

My dog was diagnosed with a mitral valve murmur at 8 years old. At the time she was given a prognosis of a few months by the local vet. I took her straight to Leahurst where she was looked at by the specialist and had a full, active and happy life until she finally died at 15. She only had a week of symptoms right at the end of her life, the rest of the time she was perfectly fine but she was on a cocktail of drugs.

I was told early use of drug does help (there is some research on Vetmedin for example exactly on this), and I hope it made a difference to my dog.

Ultrasounds, x-rays and ecgs were done without anaesthetic and she was never stressed at Leahurst (she was a regular visitor, every 6 months so she spent her time between exams at the office charming everyone).

18 is a good old age for a dog. If I were you I would try to decide whether it is worth doing anything or whether it is best to let nature take its course. If you do decide to do exams or treatments go straight to a specialist centre - local vets are not equiped to deal with complex cases.

When my 13 year old lab was diagnosed with heart failure (also no symptoms) my vet suggested pegsters solution. Trial the meds for 2 weeks and see if there is an improvement, she certainly did say that she did not want to sedate him as he was to old and it really was not necessary, she cited that he was elderly and it was about quality of life and palliative care now. She is the only vet I will allow to treat my dogs!

I think you are right too.. Enjoy her as she is and if she feels alright then there is no reason to do x rays with sedation. My vet could do them without sedation, if the dog was calm.
Can you get another vet? Or another chat?
My dog had medication that did help and had no nasty side effects.

I agree with Bakingtins I never sedate my cardiac patients for ultrasound and I don't medicate early cases of mitral valve disease until I have ultrasound evidence of congestive heart failure.
The evidence of early use of vetmedin is related to dilated cardiomyopathy not mitral valve disease. Three of the top cardiologists in the UK specifically advise against treatment in unsymptomatic patients with mitral valve disease.
In general it is not possible to x-ray without sedation as the patient will not lie still doing so breaks a whole raft of health and safety legislation. It is only acceptable in a life threatening situation.
Where there is ultrasound evidence of congestive heart failure the correct combination of drugs can give a really good quality of life.

I can only tell you what I was told by Leahurst and that is that the latest evidence is that early medication with Vetmedin helps in mitral valve cases - the top cardiologist there came back with this info from a conference, but I don't have any other details.

My dog had absolutely no side-effects from the treatement so other than cost I saw no reason not to try everything possible in her case.

Looking at your post it may have been 7 years ago we used to think that Recent trials have said otherwise.

In my opinion there is no need for medication in a truly asymptomatic dog. The current, very strong, evidence shows there is no benefit in treatment of MVD before clinical signs of congestive heart failure develop (BooBoo, a lot has changed since your dog was diagnosed several years ago - this is a fast-moving area :) ). IMO medication is only indicated in these cases when there is room to improve the quality of life - it is true that there is frequently a large window of time during which they may seem very well, but what has been perceived as normal and expected slowing down of old age is actually directly attributable to the underlying cardiac disease. In these cases I will often offer a trial of medication without diagnostics. The potential benefit to the dog is huge, and while it is preferable to have a diagnosis, the drugs are in the main very safe when used judiciously.

I would also add that unpleasant side effects with modern treatments for this condition are absolutely minimal if anything. Treatment is about quality of life, not prolonging life. It will prolong life, but that is a by-product IYSWIM - the main reason for treating these cases is to allow the dog to continue to do dog stuff happily for longer.

I completely take it on board that new research emerges. I am not a vet and this is not an area I am familiar with, so I can only tell OP my personal experience.

Betty was on Vetmedin, Fortekor, Prilactone, Corvental and Furozenol (as well as Incurin for incontinence) from 2005 until she died in 2012. For the first 5 years she was seen at Leahurst every six months and then we moved to France so she was followed by a local specialist cardio centre (not as prominent as Leahurst but they were in contact with Leahurst).

There was a huge trial called the Quest trial that was multicentre and multi country published last year that gave us a lot of new information about mitral valve disease.

Oh I see, thanks!