There Is New Hope for Dogs With MVD

If you've read Darcy's Daily you'd be forgiven for thinking there is no long-term hope for dogs with MVD. And that used to be the case. However there are now much better treatment options, with much more experience with pimobenden (Vetmedin®) and recommendations from the EPIC study, as well as an actual proven mitral valve repair procedure. One of Darcy's successor family members, Harper, underwent MV repair surgery in May 2017 and just celebrated her third anniversary. She's medication free with a normal-size heart and very little regurgitation. The down side? The surgery is expensive, and it's not yet available in the U.S. It is available in Japan at the JASMINE Clinic in Yokohama where Dr. Uechi, the creator of the procedure, has been perfecting the surgery since 2006. For a few years (around 2016 to 2018) Dr. Uechi and his staff traveled to France every two months to work with Drs. Bozon at a veterinary clinic in Versailles to offer the surgery at a location that didn't require a minimum seven-month quarantine. Since 2018 Dr Uechi has only offered the surgery in Japan, but plans are under way for him to travel to the University of Florida and work with Dr. Simon Swift and his team to provide the surgery within the U.S. For more info on MVD treatment and MV repair, as well to join a knowledgeable and caring community of people whose dogs have MVD, visit http://www.mightyheartsproject.org.

A far too late update: Darcy's sister Bella passed on last year at the ripe old age of 15, 12 of which she had murmurs, but only had to be on medications the last three. So hang in there, people! It is possible for Cavaliers to have long lives even on medications. Unfortunately, we also lost Twyla this past week at the age of 12 but again she was diagnosed at age five, so she set another fine example of how early diagnosis and treatment can lead to longer life.

Please view this blog from the bottom up.

Also, all Darcy Fund posts can now be found at the Darcy Fund blog. We hope to keep Darcy's Daily free for MVD news and tips, and of course to honor Darcy and her struggle.

Kim had an interesting experience recently. She took our other Cavaliers, Bella and Twyla, to the monthly Cavalier Park Day on Saturday. As she approached the group with the girls on leash, a woman commented that it must be difficult to handle three Cavaliers by herself. Kim replied, "No, I only have two of them," and the woman said "Oh, I was sure I saw you with three." Kim didn't think anything of it at the time, but later it occurred to her to wonder if a little tricolor ghost had been tagging along. Maybe Twyla doesn't just bark at "nothing" sometimes.

As an assist to recognizing MVD emergency signs, I will give examples of Darcy's behavior for the symptoms listed in Lessons Learned Part 1:

1) discomfort exhibited by restlessness or the inability to get comfortable;
Darcy would move from spot to spot never staying more than several minutes in any one spot. Sometimes she would lie on her side, then sit up and then lay on her stomach all in the same spot and all within a short time. She would try to lie in our laps but would get down within a few minutes.

2) shallow and more rapid breathing (panting). Anything above 30-35 breaths per minutes is too rapid;
No explanation needed. Count the breaths. Too many, take your cavalier in.

3) visible heartbeat due to an enlarged heart;
Darcy's heart was so enlarged her body would "bounce" in time with her heartbeats when she was lying on the floor. Also, we could feel a very strong heartbeat when she would lie in our laps. Your cavalier might not visibly exhibit such an enlarged heart but if you can feel it just by lightly placing your hand on your dogs chest it's pretty strong.

4) a look of worry or panic (this is due to an inability to get enough oxygen either through restricted breathing or cardiac output);
Sometimes the look is interpreted to be "spacy" rather than worried or panicky but it is definitely not a usual alert look for a cavalier. The eyes may seem to not focus on anything in particular.

5) labored, raspy, or "wet" breathing sounds.
Darcy's breathing would sound wet, almost as if she had a chest cold, but there wouldn't be any sneezing. There was also the classic "hacking (or gagging) cough" which had been ongoing for a while.

Lessons Learned: Part 1

When to seek emergency treatment for MVD (or CVD).

All three of Darcy's visits to the emergency hospital were immediately preceded by episodes of visible cardiac and respiratory distress. Based on Darcy’s experience and our subsequent discussions with many cardiologists, these signs include but are not limited to

1) discomfort exhibited by restlessness or the inability to get comfortable;
2) shallow and more rapid breathing (panting). Anything above 30-35 breaths per minutes is too rapid;
3) visible heartbeat due to an enlarged heart;
4) a look of worry or panic (this is due to an inability to get enough oxygen either through restricted breathing or cardiac output);
5) labored, raspy, or "wet" breathing sounds.

It is imperative that an owner get their cavalier to an emergency clinic (or some facility with oxygen cages or tents) not just their vet as soon as possible when even just several of these symptoms appear; delaying oxygen treatment can lead to a cascade failure of major body systems. Our family vet even advised us to NOT bring Darcy to his office since they did not have oxygen facilities. As the body suffers from decreased oxygen delivery to vital organs, blood is diverted from peripheral limbs and organs resulting in oxygen deprivation damage to muscle, eyes, limbs, and kidneys which may be already compromised by drugs. Additionally the heart beats faster to try to deliver more blood (which it can't push due to its damaged valves) which requires more oxygen, which results in more rapid breathing, more panic, etc.

Luckily for Darcy, Kim was familiar with the many signs due to her writing research. I know now what these signs mean but if we had waited based on my ignorance, Darcy would never have made it past her first emergency.

In Memoriam.
Darcy Thornton
born November 11, 1999
died June 27, 2006.

Blessed Darcy rest in peace. Catch your breath. Love Dad.

We couldn't have asked for a better first puppy. Darcy, you made raising a puppy seem like the easiest thing in the world. Your nickname was The Perfect Puppy. You could just see the light go on in your head every time you learned something new--which was constantly. Living with you and seeing you spread all that sweetness and love to everyone you met has been one of the great pleasures of our life. Love Mom.

The last update from ACC is not good. They don't believe Darcy will get any better no matter what they do now. Please keep thinking and praying for her.

Update for Darcy (who's not feeling much like blogging right now): ACC is giving her pedialyte instead of water. I guess her electrolyte levels were so low that it was determined they were the greater risk than the edema in the lungs. She is eating some when hand fed, but she continues to have periodic episodes of panting and gagging. We should know more about her prognosis shortly. Thanks so much to everyone who's left comments and emailed. Your love and concern for Darcy mean so much to us. Hopefully, she'll pull through this episode and we can all claim to have helped.

Darcy wouldn't ask this for herself so I'm going to ask for her: Pray for her please. She's back in the hospital, under oxygen, and her prognosis is not good. Her electrolytes are way out of balance due to the large amounts of furosemide she's needed and treatment for the imbalance fights the furosemide. She's a trooper and still fighting, but we don't know how much longer she'll hold out. Hopefully, the doctors at Advanced Critical Care in Tustin can work a miracle, so please help them with your thoughts and prayers. Dad.

What vicious circle! I need to be handled and carried to go potty, but it distrupts my breathing, and I love to be handled but I hate coughing and not being able catch my breath. I get stressed and then MomDad don't want to disturb me, and then it's time to pee again. Sigh.

Mom writes in an email: today at Noon, Darcy took her shot like a champ, ate some mango and some Charley Bear treats, and went outside to pee. So it sounds like Darcy's hanging in there!

I do NOT like those lasix shots! They make me agitated, and then I get out of breath, and I wander and can't get comfortable, barka, barka, barka (yada, yada in human). I did OK with the midnight shot, but I'm not handling the 6AM today shot too well. It was an 0.8 ml shot. Mom has a call into Dr. Schroeder to see if I need to go back into the oxygen cage.

Thank Dog I'm back home now! I'm still having some breathing trouble and don't have any energy left, but Dr. Barrett and Dr. Schroeder figured that since I wasn't doing any better in the oxygen cage I might as well go home. My appetite is still good so they feel pretty good about my status. I am now on injectable lasix rather than pills, my hydralozine was doubled and so was my pimobendan (sorry, I repeat myself with that one; it's the drugs ;-)). Luckily MomDad have LOTS of experience giving shots; they used to serve a cat named Peter that had diabetes and they had to give him his insulin twice a day for 10 years! Demanding Cat! But at least I can count on MomDad doing the same for me if I should need it.

I'm still in the hospital. Dr. B didn't feel I was able to go home Saturday, but maybe today. MomDad came to see me which I really liked, but I still didn't have a lot of energy. I sat up for them and licked their noses, though. MomDad said they would come visit me today. I hope I'm more energetic for them.

I'm resting comfortably tonight at California Animal hospital. I REALLY appreciate all the prayers and concern, and I give big licks to everyone. I hope to come home tomorrow so I can lick everyone in person.

I have to stay overnight with Dr. Barrett. My lungs are filling with fluid more rapidly than before and I'm in the oxygen tent. Dr. B is going to send me home with Lasix injections cause the pills and compounds weren't working very well.

Oh, boy. I'm not doing too well. I was rather lethargic last night, with some shallow breathing, and Mom has taken me to Dr. Barrett. I was good about peeing and lasted through the night, but Mom is definitely worried. I know everyone is interested, so I'll keep you posted.

Well, I'm certainly peeing a lot. MomDad and Dr. Barrett upped BOTH my diuretics so I'm drinking a lot more and it's got to go somewhere! Of course, MomDad have to take me out a lot more frequently, like at 3AM. I don't like being asleep and then trying to wake them when I'm so full I going to burst.

The up side is that I'm definitely NOT sounding wet anymore, and my breathing is easier.

Bella now has to be carried up and down the stairs. She has a bruised spinal disk and some sort of arthritis in her spine. Mom took her to Advanced Critical Care in Tustin the other morning at 3:30. I hope Twyla doesn't need to be carried down stairs; three of us dogs and only two of MomDad. Good biceps work for them though, hee!

We now think that my furosemide wasn't adjusted high enough several weeks ago. I got better for a few days after the first extra set of doses, and then I started to get "wet" again back on my regular dose. They started giving me 10mg extra every six hrs yesterday. I'm better today, but my breathing is still a little shallow, although my rate is back down around 32-35; it was up over 40 last night. And of course the heat doesn't help either. We have a call into Dr. Barrett to discuss my meds. I felt good enough this morning to lick Dad's nose several times when we went outside. He looked like he needed some cheering up.

I had a worse than normal day on Sunday. I was coughing and breathing very "wet". Luckily Dr. Barrett had told MomDad that they could give me one or two emergency doses of furosemide if I should need it. We had some liquid furosemide around and Dad gave 20mg of that to me first, the thought being that the liquid would work faster, and then later on in the day I got another 20mg tablet 1/2 with each of my next two regular doses. Seems to have worked; I was breathing better by late that evening and seemed all better by Monday. I may have eaten something with sodium that MomDad didn't know about; I'm good about eating found food as fast as I can.

Nothing new to say, just checking in. Boy, are we glad June gloom is back in SoCal. It was so hot for a while, I couldn't get comfortable. I'd move from cool spot to cool spot on the floor. The heat didn't help during park day, either, even though MomDad did their best to keep me in the shade.

Oh My Dog, there were a lot of tricolor cavs at the park, it seemed at least half of them were puppies! I hate to say it but they were pretty cute. I'm still the champion licker, though.

MomDad took me to Park day Saturday. Our friend Tamela organizes a Saturday get together in Mission Viejo for anyone with cavaliers. Sometimes there are talks by local veterinarians, but this time Tamela gave a grooming demonstration. MomDad loaded up my wagon and we had a good time. We met a woman who had lost her cavalier companion in Feb due to MVD. It was sad to hear her story.

I enjoyed park day, but I was stressed the rest of the day: shallow breathing, never comfortable, all the signs of respiratory distress, so that will probably be my last park day. I'm fine now, but it just took too much out of me to allow MomDad to take me again. I loved walking around and checking out every bag for treats, though. I'll miss that.

I'm so glad we adjusted my meds. I feel more alert, I have more energy, and I even try to play with Bella and Twyla when they return from their walks, so I'm better than I was. I've even stopped coughing, again. Dr. Barrett had said all along that we had lot's of room to adjust my furosemide and my other drugs. The only problem was that my B.U.N. numbers had crept up to the high normal area, so we need to keep a watch on that.

I had a good checkup with Dr. Barrett Saturday. I'm doing well, but I had a little fluid in my lungs so we increased my furosemide to 20mg q.i.d., and we increased my hydralazine from 1/4 to 1/2 tab b.i.d. Dad thinks he saw a little more energy and interest this morning at breakfast, and last night MomDad both commented on how my breathing seems a little smoother. My blood work came back very good also, everything normal except my Na was slightly low, but since I don't get any salt that's OK. A good report.

Dad's doesn't like it when my medications change. My enalapril compound began using a different manufacture and my furosemide tablets changed also. I guess we just have to trust that everything works the same way between companies. It's kind of scary (to Dad, not to me) when he realizes how much my life depends on blind trust; trust that the companies are making the pills the same way as each other, trust that they haven't been substituted with fake ones, that the pharmacists are paying attention when they're compounding my meds. Dad always says I'm here to teach him things; I'm sure that includes trust.

I had some blood work done today to prepare for my vet exam on Saturday. I got to see all my friends at Canyon Animal Hospital in Laguna Beach. I've been going there since I arrived in the States (I'm from Ireland and MomDad says that's why I'm so friendly!) and I love it there. I'll report my blood work results as well as my exam on Saturday. Keep your paws crossed!

Mom found several very good articles on CHD and treatment regimens. I'll put them in the links section to the right.

I seem better now. Thanks for all the support and concern. We don't know what precipitated (there's your big word, Jen!) my issues, but I haven't thrown up since then. Whew! Maybe I just can't stomach the news anymore (see previous post). HaHa! I felt good enough that MomDad took me around our neighborhood in my wagon. It was good to mark some old territory.

Yesterday wasn't a particularly good day for me. I wheezed and coughed a lot, had an accident in the house, vomited twice (once with my latest furosemide pill in it) and just generally had MomDad worried all day. The vomiting may have been due to some newspaper I chewed up or maybe something else as yet unidentified, but we just don't know. So far today I seem better, but I'm sure everything I do will be watched, analyzed and debated. Is there no privacy anymore?

We went to our friends' house (Farley, Chloe, Sophie, and of course "Eliot" an English Toy Spaniel) last night for dinner. MomDad were invited, too. They have a great backyard. Their mom and dad, Tamela and Mike, were there also, so we couldn't get too wild but we tried. Twyla has a thing for Farley. She always tries to get his attention. Shameless. Anyway, I don't get to go too many places these days but that's one place I'm allowed to pretty much wander freely and MomDad don't worry about me. I pretty sure they enjoy it as much as I do.

Stable. Stable. Stable. That's our mantra. Keep things even, no changes just for the sake of change, and routine, routine, routine. Mom is always telling Dad that dogs love routine, so Dad has taken it to heart. I don't seem to have gotten any worse over the past months , so I'm not going to argue. I just stare at Dad and make him think I'm bored. Hee! Stable. Stable. Stable. Ommmm! (I do down dog very well).

It's interesting that my last post was about sleep. I remember our family vet telling Mom that if I could talk I'd probably describe MVD as being tired all the time.

I've been trying to sleep all day, but it hasn't been very restful until this afternoon. I watched Mom & Dad clean the house while I was trying to sleep. They kept moving me, starting noisy machines, and kicking up a lot of dust. Oh well, at least now I have Mom asleep on the soft where I can trap her for a while.

Due to reader comments (you know who you are), I say the following: "I looooooooove ALL my neighbors!" There! Have you ever known me to slight you in the licking department?

I sleep through the night most nights, but sometimes I get restless and need to go out to pee. Luckily Mom's a relatively light sleeper and hears me, then she gets up and takes me out. This morning it was 2:30 and I had been out around 11PM. I wish I knew why I can make it some nights and not others. I like to sleep through, too, just like Mom or Dad. (PS. Dad takes me out every morning around 5:30 or so to let Mom sleep so please no comments about why doesn't Dad take me out when I get restless.)

I love to see NeighborJen! I wiggle my whole body when I see her and lick her hands (and face when I can!). And she's so nice about it, especially since she's allergic to me! She loves dogs, even my sisters (I know; she's not very discriminating), and has always wanted one but just can't live with them. She has to was her hands and face after petting me and sometimes even has to shower. Wow! But I loooooooovvvve her. Dad says I need a daily dose of Jen; she keeps me happy!

Dad was so frustrated yesterday. He had to throw out both Bella's and my meals after he had put most of the meds in them and start over. Everything was in the right bowls until the last dose of liquid med and then "Squirt!" One moment's inattention and he put my med in Bella's bowl. No way to separate any of the stuff already in the bowls.

Bella is getting antibiotics before her teeth get cleaned; she already has a heart murmur and we don't want any of the germs in her gums to work their way to her heart to make her murmur worse. The last thing this family needs is another heart case.

I've discovered I like grapefruit. Mom and Dad always thought it would be too tart for me but once I tasted it I liked it! The more fruit the better, I say.

A word about vaccinations: there is a school of thought out there that says Cavaliers with advanced MVD/CHD shouldn't get vaccine boosters. There is a chance of a reaction to the shot that could prove fatal or at least send me to the emergency room. I don't like the shots of course, but the county says I need a booster to renew my license. At least the county will accept a letter from Dr. Barrett exempting me.

Great news! Dr. Barrett saw me on Saturday and said my blood work and my kidney values are all excellent, and that after examining me and watching me for about 15 minutes while she talked with Mom and Dad, she's amazed at how well I'm doing considering how advanced my MVD is.

She also thinks Dad's idea about food coloring in the liquid meds to differentiate them is a great idea. Dad asked about treats with no sodium and she recommended unsalted matzo crackers. I love them so they're a great idea! Everything's great!

Dad saw on B and B Pharmacy's website that not only can they compound meds into liquids, they can make them into chewable treats or other edible forms, as well as a type of transdermal gel that can be applied behind the ear and absorbed through the skin. Per their web site:

Transdermal gels offer many advantages:
• Due to the excellent absorption of the drug, smaller amounts of drug can be given, which can greatly reduce the side effects your pet may experience.
• If your pet is on several medications, many drug interactions can be avoided when one or more of the medications are given through a gel.
• Numerous medications can easily be administered to pets who are nauseated or who may not be allowed to take anything by mouth.

It sounds very interesting but I'm not sure I want any gel getting on my nice long ears!

Dad had a problem tonight; he was adding my liquid meds and forgot which ones had already been added. He was able to figure it out, but it worried him that I might get too much or not enough of a med if he couldn't figure it out. One of the meds is bluish and the other two are white and he wondered if each med could be made a different color to help distinguish between them. He's going to ask the pharmacist the next time we need refills.

I think mom and dad will take me in to Dr. Barrett next week. My coughing picked up just ever so slightly. Of course they notice each and every little noise I make and flip out. Parents! Good Grief!

If anyone's interested here's my dietary regimen.

Breakfast (Dad makes)
2 and 1/2 medallions Prairie (Nature's Variety) Organic Raw Chicken or Chicken and Turkey
Scant 1/8 (or less) cup of Praire chicken kibble, just for a little crunch
200mg CoQ10
Fish oil
Plus all my AM meds

Snacks
Tangerines, bananas, apples, carrots, Newman's Own Organic Vegetable Treats, any other fruit Dad happens to be eating, and of course all the indian hawthorne berries I can sneak.
Plus my afternoon meds

Dinner (Mom makes)
2 and 1/2 medallions Prairie Organic Raw Chicken or Chicken and Turkey
Scant 1/8 (or less) cup of Praire chicken kibble , just for a little crunch
raw or slightly steamed vegetables (green beans or broccoli or spinach or whatever we have)
1 heaping tsp. yogurt
Plus my evening meds

Mom spent the past few weeks attending several pet and vet conferences. American Animal Hospital Association (AAHA) in Long Beach, CA, Humane Society of the United States in Anaheim, CA, and the Global Pet Expo in San Diego, CA. She says she learned a lot about new treatments for MVD, but that I'm already on all the meds recommended at the moment. Bummer! Dad was hoping for a magic pill. Mom attends these as a member of the press thanks to her msnbc.com column Creature Comforts (the url changes every month, but it's under msnbc.com/health/pethealth/ . She also gets to bring home new treats from the Global Pet Expo which I think is great! Of course, I'm just as happy getting carrots or tangerine slices.

A woman on the MVDincavaliers Yahoo! group had a problem getting her last order from GlobalDrug.tv. I hope Dad doesn't. He says he has enough to last until he knows whether or not he need to order from B&B Pharmacy. Luckily we can drive there to pick them up if we need, but it must be maddening to order and not know if you'll receive the medication.

Dad and Mom have to read all food labels very closely now. When Dr. Barrett took me off all sodium, they examined all my supplements for sodium. Almost none of the supplements listed the amount of sodium. They then looked for ingredients with sodium. None of the food items, e.g., the raw food and/or kibble listed any ingredients with sodium. One of the supplements didn't list any sodium, BUT IT HAD KELP which can be quite high in salt, so of course I can't have that any more. Be careful of anything with sea food, kelp, anything from the ocean.

The moral is to pay attention to ALL ingredients, not just look for ingredients starting with or containing sodium in their name.

No changes with my medications or condition and that's as good as it can be. Dad says we'll take this any day.

Mom and Dad went to San Francisco for a few days and we stayed home with a new pet sitter, Dakota. She's our kind of pet sitter; sits on the sofa watching TV with us all day and gives us LOTS of treats. She even got Twyla to like her right away, and that's unusual.

Of course, it rained every day. Carried down the stairs and back up the stairs, down and up, down and up. Cabin fever and wet paws. No running or sunning. Neighbors staying indoors because of the rain. BORING! Thank goodness there's always Bella to annoy/hump!

I had a VERY good report from Dr. Barrett. She was extremely pleased with my lung xrays, the way my lungs sounded, and my entire demeaner. She had a second doctor review the results, and when he heard my appetite was quite good, he remarked, "Excellent!" So no changes to my meds for now. I need a blood panel done in about three or four weeks, but I'm happy, happy, happy (and driving Mom and Dad crazy with my new found energy!).

I haven't been posting every day. Maybe I should change the name to Darcy's Whenever. Ha!

I have a cardiologist appointment tomorrow with Dr. Barrett. I think she'll be pleased with my status: stable, no wet sounds, and almost no coughing for days at a time. Let's keep our paws crossed.

Dad was gone for a few days to Orlando for business. Wow! I do my business in the yard, and he has to go all the way to Florida! Glad I'm not Dad!

Mom and Dad entered my med schedule (listed below) into something called a PDA. It sounds an alarm whenever my meds are due, and I know from the sound that if I go into the kitchen I'll get a treat. Dad thinks it's great because now he doesn't have to call me; I'm already right there when the treat's ready.

This newspaper in Scotland claims that owning a dog costs as much as buying a new Mercedes. Yes, but will the Mercedes lick your face and hands and wiggle its butt to show you how happy you make it? I will, so I think I'm the better deal.
PS: I'm doing really well on my current med schedule. I'll get a recheck with the vet next week.

Bella has to be carried down the stairs now, too. She has an inflammed spinal disc and isn't supposed to exert herself at all. Guess she'll be using MY wagon now, too.

Guess I forgot to tell you that I'm now also taking digoxin. Dr. Barrett wanted to slow my heartrate just a little bit so I take 1/2 of a 0.125mg pill once a day. So here's my updated med schedule:
6:30 AM enalapril, furosemide, hydralazine, aspirin, spironalactone, pimobendan
2:30 PM furosemide
6:30 PM enalapril, hydralazine, aspirin, spironalactone, pimobendan, digoxyn
10:30 PM furosemide

Mom used a new photo of me in her monthly MSNBC column, Creature Comforts. She mentioned my ER visits to illustrate how to know to go to the ER. Dad took the photo last Saturday. I don't usually pose well; I look very serious and always try to approach the camera while the picture's being taken.

My pimobendan arrived on Saturday from Globaldrug.tv. It only took 11 days to arrive and it came in the original package. Dad says we can highly recommend this online pharmacy.

Saw our neighbor Bud yesterday. He was working in his garage. I like him cause he always asks how I'm doing, and he commiserates with me about how many meds we both have to take.

I just really love Indian Hawthorne berries. They grow all over SoCal and the berries ripen in late fall. Both Bella and Twyla likes the berries, also. Dad has hard time keeping me from eating too many, although we haven't found out just how many that would be. We've never seen any bad effects and we've eaten lots.

We had a time getting several of my prescriptions refilled. CalMed Pharmacy in Mission Viejo called in the refills almost four days before the Doctors at Advanced Critical Care in Tustin returned their calls. Dad had to call ACC and read them the Riot Act. No way were Mom or Dad going to let me run out of any med! ACC is great and they saved my life when I first got really sick, but they seem to be a little disorganized away from the ER.

Guess I was lazy for a few days and didn't post anything. Oh well.

I had my lungs xrayed Saturday and they're borderline for fluid. Dr. Barrett took me off the electrolyte solution. She said I can't have any sodium, it's fighting the furosemide which wants to remove fluid. The sodium wants me to retain it. We'll see how I react.

Dad found a very good page from Balgownie Vet Hospital that explains how pimobendan (vetmedin®) works.

My cough came back a little today after having tapered off the last two. Dr. Barrett wants to take some more xrays Saturday to see if there's any fluid left in my lungs. If so, I may have to take more furosemide or spironolactone. At least the furosemide will be in pill form; Dad got a new prescription for it today. The liquid has alcohol in it and I don't like the taste. Dad says people should buy it from drugstore.com or some other online pharmacy. Local ones charge way too much.

Mom and Dad took me for a ride in my wagon today, but my ancient older sister Bella decided she wanted to ride in it, too! She convinced Mom and Dad it was too hot to walk any further. She is such a manipulator! So then we meet Max and his dad when we're walking back. I can't believe he saw me riding with my sister! It's ok...I humped her this evening so we're even.

Somebody told Dad about a place to order pimobendan online, called Globaldrug.tv. They were about half price of the first place, so Dad ordered some. I think they're in Australia, but someone on this Yahoo! group! called! MVDincavaliers! told! us! about! it!

I've been rather lax about posting the last two days, but that's because everything is pretty much status quo, and Dad says that's very, very good. I still have to cough every so often, but I feel so much more active and alert.

I had my electrolytes and kidney values checked yesterday and everything was right in the middle of normal, except for my chloride, which was 100 (rather than 102). My triglycerides were 24 (Dad says that's the least of his worries about me!) and my magnesium which was 1.4 rather than 1.5. The vet said it really couldn't get any better for a dog that's peeing so much!

Mom and Dad say I'll probably be on electrolyte solution for the rest of my life. If my numbers stay this good, they say it's well worth it.

I tried to run down the stairs again today but Dad stopped me before I could get very far. I just wanted to see what Bella and Twyla were doing outside with Mom. I made Dad take me out at 3AM this morning cause I really had to pee. I also made him take me back out around 6AM. Mom slept all night and woke late. I guess she doesn't have to pee so much.

My good friends Mike and Tamela come over for dinner and Tamela brought me a toy, but Twyla stole it and has been dragging it around ever since. It's OK, even if the toy was intended for me. I guess she needs it being the baby of the family and all.

It will be good to have the cardiologist back this coming week; Mom and Dad want to ask about my coughing. It's more frequent than it was last week, but I seem to be much better so they're confused about how much they should worry about the cough.

This morning I did yoga with mom. Mainly I stayed in what she calls child's pose. I like to think of it as puppy pose. Twyla's favorite is downward-facing dog (also known as a play bow), and Bella prefers shivasana, as it's best suited for getting tummy rubs.

I must really be feeling better! Yesterday Mom brought me back in from peeing and I trotted up the stairs before she could stop me. Of course, both Mom and Dad watched me like a hawk the rest of the night to see if I was going to collapse. Dad checked my respiration rate every 10 minutes (it seemed like it anyway). My breathing did feel a little labored but I was fine (told them so). I'm still going through that electrolyte solution like crazy, but at least I held everything through the night. I hope that lasts; Dad is so sleepy when he takes me out, I'm afraid he'll fall down the stairs.

We walked (I rode in the wagon) around our condo complex last night. It was good to get out of the house. I even got to pee in a different spot than usual. It's pretty cool just riding around while everyone else has to actually exert themselves. Twyla likes to walk right next to the wagon and she gets so close it looks like she's going to get run over. I think she wants to ride, too. She wants to do whatever it is I do. Little sisters can be such pests!

My enalapril dose gets changed today from 5mg QD to 3.75mg BID per Dr. Barrett. QD is once a day and BID is twice a day for the latin-challenged among us (Twyla!)

A correction about my meds: the diuretics are to remove the fluid from the inside of my lungs, not from around my lungs. Too bad; if the fluid was just around my lungs they could remove it with a small needle, but because it's inside my lungs they have to use drugs which are more inefficient, take longer to work, and hurt my kidneys. The cardiologist said that each dog is different and gets fluid buildup in different areas. She said one dog got fluid in its abdomen and everyone just thought it was getting fat!

It was kind of boring yesterday. Everything was pretty stable. Mom and Dad both worked and I couldn't get nearly as many treats as I was trying for. They seem not to notice the mental directions to give me treats I direct into their brains. I did get into the bed by myself this morning. Dad put a step stool in front of the chair he puts by the bed and it looked so much easier I had to try it.

I really seem to feel much better, lately. My lasix has only been increased since Saturday night but I don't seem to be having as many coughing spells as I was. I'm going to keep my paws crossed. I have been having trouble holding my pee throughout the night with the increased lasix, but at least last night I was able to locate a rug with rubber backing. I won't dare use the rug and pee pads that Mom and Dad laid down; they put so much work into it I don't want to ruin it.

Wow, was I busy yesterday! First, Mom and Dad walked everyone to Starbucks and Dad pulled me in the wagon (he finally got that leash). I was so good; I didn't try to jump out even once. We saw an old friend there who used to have a 13 year old rottweiler named Rudy. Lots of people pointed at me from Starbucks' window. I guess they hadn't seen dogs ride in wagons before. Bumpkins!

Then I spent the rest of the day at the cardiologist in Santa Monica. Good thing, too, since she saw that my lungs weren't clear enough. "Darcy's acting much better than she ought to ," she said. (Ha!) So now my Lasix dose is higher, 20mg up from 15, three times a day, and my enalapril may increase in a few days. And I am feeling better; I'm more alert, more active (which is not necessarily good for me, but it's a good sign) and I'm not coughing as much as I was on Friday and Saturday. I sure hope this clears my lungs. I don't want to go back on oxygen again; Mom and Dad get so upset and they're much more fun when they aren't worried.

Dad got me a wagon so I can go places with the rest of the family, but he still needs to get me a special leash so I won't jump out. I wish he'd hurry; I'm really getting cabin fever.

Some things I miss:

• Chasing my sisters
• Fetching my hedgehog from the bottom of the stairs
• walking to Starbucks® and meeting (licking) all sorts of new people
• humping Bella (well, I still get away with this sometimes)
• Seeing our neighbors. I really like our neighbors, Jen and Chicken Man (Jim), Cathy and Glenn, Bud, Mary Lou (she always makes me squeal).
  

I think I'll list all my meds so you'll know what I'm on.

1. enalapril - for blood pressure, once a day. An ACE inhibitor.
   
2. hydralazine - more blood pressure, twice a day. An alpha antagonist.
   
3. spironolactone - a diuretic to remove fluid from around my lungs, twice a day.
4. lasix - another diuretic to remove fluid from around my lungs, three times a day.
5. pimobendan - a canadian drug that opens up the blood vessels returning blood to the heart which reduces pressure on my heart. Twice a day.
6. aspirin - My blood is pooling in the backwash from my valve failure and aspirin keeps my blood from clotting. Twice a day.

Luckily, Mom and Dad have adjusted the times so that now I get most of them at the same time. When I came home from the hospital my meds where due all around the clock and I hated having to take them almost all day long. Now it's not so bad. Also, they went to a compounding pharmacy that mixed some of the drugs into a chicken-flavored liquid and I like taking those.

My new med seems to make me only a tiny bit more loopy; I couldn't immediately find the banana this morning. I'll have to try harder. I didn't have any trouble finding the tangerine and apple, though. I guess I'm getting all these fruits to try to keep my potassium levels up. The lasix and spironolactone are trying to do a number on my kidneys and I have to pee like crazy, so my electrolytes need some help staying balanced. My humans have been giving me electrolyte solution and so my sodium and chloride levels are good. Plus the fruit makes the meds stay down.

I had a worse than normal day yesterday. I coughed more than usual, and seemed slightly more tired, perhaps because I was quite active yesterday. Luckily, I had an electrolyte recheck (Na and Ka values are fine) and a followup ultrasound scheduled for today. The vet put me on a sixth med hydralazine (not to be confused with hydroxyzine). We are to increase my lasix dosage if necessary. Mom and Dad worry about me constantly; am I too excited? Am I getting enough exercise? How many coughs has that been today? Do they let me walk back from peeing or should they carry me all the way back? I of course only care about licking their faces. I wish they'd do the same.