Cavalier Health

What to worry about when buying a Cavalier . . . and how to reduce your risk



For Cavaliers, basically all genetic problems are trivial – reasonably rare or not very severe – except mitral valve disease and (probably) syringomyelia.


MVD has been known and worked with a lot longer than SM.  But it’s a pretty nasty problem in the breed.  The average age for a Papillon at death is seventeen, Toy Poodles routinely make it into their early twenties, and what’s the average for Cavaliers?  Around eight or ten (although some do make it into their late teens).  Still, as an average, this is pretty terrible.  It's hardly better than you expect of Bernese Mountain Dogs or the other big guys.  It's MVD that kills them young.


If you go to a chat list that emphasizes pet owners (as opposed to show breeders) and lurk, you’ll find that at least half of all Cavalier owners on the list have had at least one dog affected by severe MVD.  This should make anyone interested in Cavaliers uneasy.


The breeder from whom I bought my first Cavalier puppy says that in 27 years as a breeder, she’s seen about ten Cavaliers that did not eventually develop a heart murmur.  This does not mean that all affected Cavaliers go on to die young, just that they experience at least the early stages of MVD.  Developing a grade one murmur at the age of nine is not a cause for concern, but for celebration!  That dog not only beat the averages for the breed, it is also unlikely ever to experience symptomatic heart trouble.


But if you’re looking into the Cavalier as the breed for your family, you really need to know what risks you’re taking and how to reduce those risks as much as possible.  MVD should be your highest priority in health.  And the highest health priority of the breeder from whom you eventually buy a puppy.  There are two things you can do to give your own personal pet the best possible chance of living a long healthy life free of congestive heart failure:


    Find a breeder who's serious about breeding for health and longevity.


    And once you have a puppy, keep the weight off!


All the care you use in selecting a breeder and a puppy can be thrown away if you allow your pet to carry excess weight.  Pet owners are NOTORIOUS for allowing their dogs to become overweight.  Pet owners are NOTORIOUS for failing to notice when their dogs are overweight.  Pet owners are NOTORIOUS for refusing to believe breeders or vets when it is suggested to them that their dogs are overweight.  You don't want a dull coat barely covering staring ribs, but if your dog doesn't have a noticeable waist -- if you can't feel a trace of ribs and hip bones even if you pet him firmly -- if he looks like you inserted a bicycle pump and blew him up, like a cartoon character -- then he is heading straight for an early grave and there's no point blaming the breeder when he eventually waddles up to the edge and topples over.




I cannot believe that pet owners will buy a puppy for $2000 or so and then let it become obese.  To me, that seems rather like buying a new car and then whacking it with a hammer every time you walk by . . . except that a car can't suffer when it is abused, and the dog will.  So kindly don't do that!


It’s also important to keep your Cavalier’s teeth clean.  Bacteria from bad teeth can easily enter the bloodstream and compromise all organ systems, especially the heart.  It’s a good idea to give your Cavalier antibiotics both prior to and following professional cleaning of the teeth to minimize the risk of bacteria getting into the bloodstream.  It’s an even better idea to brush your Cavalier’s teeth daily in order to prevent the development of tooth problems and the need for professional cleaning.  This takes me about one minute per dog per day as part of the normal morning routine – less time than it takes to make the bed.  But I have to add, it's a whole lot easier to brush the Papillons' teeth than the Cavalier's.  Cavaliers seem to have a lot more mouth in the way!  But brushing the teeth is good for the pocketbook – professional cleaning is expensive.  You might also try feeding Science Diet t/d as part of your pet's diet -- that food is especially formulated to help clean the teeth and it seems to contribute to good teeth.


 Incidentally, there are good ways and bad ways for a vet to clean teeth – it’s best if you make sure your vet is using ultrasonic cleaning equipment, not just scaling tarter off with a scraper.  Just scraping the teeth clean can apparently lead to worse tarter build up faster than you saw the first time around!


However, once you have committed to doing your part by keeping your dog at a proper weight, and keeping its teeth in good shape, in order to protect yourself as a buyer, you might want to look for a breeder:


            a) who has heart checks done by a board-certified cardiologist on all her dogs every

                year or two, at least the ones she breeds but preferably all of them (because they are

                all related to dogs that she is breeding), and


            b) who less often than average produces dogs that needed medication to control their

                heart conditions when kept at a proper weight (and keeps track of the puppies

                she sells as she can so she can estimate this), and


            c) whose dogs in general seem to live longer than average for the breed, and


            d) has a buyer’s contract that specifically compensates you for the early death from

               MVD of your dog.  If the breeder isn’t willing to put her money where her mouth is,

               you’d be wise to go somewhere else.


All those things should ideally be true for a breeder before you even ask about the price of her puppies.  Obviously it is not easy to determine how close to these ideals a breeder is coming.  It's hard for the breeder herself to know how long on average Cavaliers live or exactly what's going on breed-wide with regards to MVD.  If the breeder tracks the puppies she produces and does the best she can to stay aware of how they do, heart-wise, that's a good sign.


NO responsible breeder will guarantee that a puppy you buy from her will NOT develop MVD eventually.  Most Cavaliers will.  What she should be aiming for, and what you should be hoping to get, is a puppy that will develop MVD so late in life that it will never experience problems due to its heart and will instead die of something unrelated, preferably late in life.


The breeder should “feel” trustworthy to you, obviously.  Chat in person or on the phone and don’t be nervous about asking tough questions.  If the breeder is really serious about reducing the incidence of MVD in Cavaliers, she’ll very strongly encourage you to check the heart of any puppy you purchase from her, at least a couple of times, and let her know if (when) a murmur appears (if you keep checking, the odds are that one will, eventually).  Information about the sibs of breeding animals is essential if breeders are going to reduce the severity of MVD in Cavaliers for future generations.  If you’re interested in why, take a look here.


More on MVD


But MVD is not the only possible problem you may find if you get into Cavaliers.  Here are some others: 



1.  SM (syringohydromyelia, hydromyelia, syringomyelia, syrinx, Chiari malformation) – A defect of the skull that causes spinal fluid to back up in the spinal cord.  This eventually causes various symptoms, usually but not always by 18 months to 2 years of age, and is most often diagnosed by obsessive scratching at the neck and shoulder region, often without making physical contact, and shown particularly when touched in those areas, on leash, or excited.


Affected dogs may also seem to experience pain if touched in the head/shoulder/neck region and may sometimes cry or yelp for no obvious reason; some may hold their heads oddly when sleeping or eating.


The dog is sometimes lame, apparently because of interference with the transmission of nerve impulses between foot and brain.  An affected dog may stand with its foot folded under as though it is unaware it is standing incorrectly.  Dogs may have trouble with balance and coordination and often stumble and fall.  The gait may be wobbly or strange.


SM can cause considerable pain to the affected dog, unfortunately, although it varies in severity and some dogs with SM can lead pretty normal lives.  The later in life SM appears, the less severe the problem is likely to be and the more likely the dog is to able to live with it.  If severe enough, surgery may be used to try to correct the problem.  SM may be becoming more common in the breed, or more likely is now being recognized a LOT more frequently than it was in the past, and it is probably very widespread in the breed.  Some breeders believe it is rare; others believe it is quite common but still frequently undiagnosed.  We do not know the incidence for sure at this time.  A UK survey an other studies that are being set up may shed light on this question, hopefully soon.


There are ongoing investigations into the genetics behind this problem.  It apparently is suspected by some researchers that SM is caused by a multiple-gene system of two or three recessive genes.  In fact, it seems to me unlikely that SM is caused by a purely recessive two-gene system, given the clinical presentation of the problem.  Heaven knows what genetic system we're going to eventually figure out.


Syringomyelia is no fun.  However, please keep in mind that all dogs scratch sometimes!  It's very easy to assume that your dog has whatever problem you've been reading about lately, but probably it doesn't.


More on SM



2.  Patella luxation (or subluxation or slipping stifles) – A polygenic trait that can be late-onset.  Dislocation of the knee cap in one or both hind legs; relatively common and widespread in the breed (this is typical for most small breeds and a few medium-sized or large ones).  Any decent vet can check for patella luxation.  Genetically-based patella luxation is almost always medial in toy dogs; if you find that your pet has been diagnosed with lateral luxation, you have reason to suspect traumatic injury instead of heritable factors (but any form and severity of luxation can be trauma-induced). 


Most often patella luxation causes no pain or symptoms of any sort (grade one), but can occasionally require surgery (grades three or four).  I would get a second opinion before I had surgery done on any dog of mine for patella luxation – I’ve heard of vets recommending surgery for grade one luxation and that’s insane, imho, and should be a cue to find a different vet.  Signs of patella luxation include the dog “hopping” or “skipping” or holding a hind leg off the ground when it walks or trots.  Usually patella luxation is painless, even if the dog is carrying a leg.  (Pulled muscles or a torn cruciate can also cause a dog to carry a hind leg, and neither problem is rare, so don’t instantly assume patella luxation until you check).  Obesity will exacerbate any existing patella problem, obviously.


Patella luxation is more a problem for breeders to worry about than for pet owners to lose sleep over.  It's rather unlikely that patellas will cause any problems for any Cavalier you buy, even if it has low-grade luxation.  You just want your breeder to take patellas seriously in order to keep the problem minor in the breed.




3.  Hip dysplasia – Another polygenic trait that is often late-onset.  More common in Cavaliers than it ought to be in a toy breed, but Cavaliers are built along lines that tend to correlate with hip dysplasia (big boned, round bodied, clumsy movers), as reported by Isabell in her excellent book on genetics and breeding.  Hip dysplasia in Cavaliers is perhaps both rarer and less likely to be serious when it occurs than patella luxation.  Manual manipulation of the hips cannot determine whether the hips are sound, and hips cannot reliably be assessed before the dog is two years old, although preliminary hip x-rays correlate quite well with later x-rays, according to the OFA website (  I've heard of both vets and breeders who thought they had some special magical ability to tell by touch whether a four-month-old puppy had hip dysplasia.  My response:  Sure, and I've got this neat bridge for sale . . .


Breeders should take care with hip quality (OFA or PennHip), but as with patella luxation, few Cavaliers suffer clinical symptoms of hip dysplasia, even if their hips are radiographically dysplastic.  This is probably because they don’t carry the weight on their hips that a German Shepherd Dog or Saint Bernard does.  A PennHip score that means trouble for a GSD may not signal bad news for a Cavalier, for this reason.  It’s important to keep excess weight off your Cavalier to minimize problems caused by any orthopedic or structural problem.  Otherwise, don't put this in your top-ten list of things to worry about.




4.  Juvenile cataracts – Exactly what it sounds like.  Reportedly rare and localized to some lines.  Cataracts are inherited in different ways in different breeds -- sometimes as a straight autosomal recessive, sometimes as a dominant with incomplete penetrance.  I don't think it's known how cataracts are inherited in Cavaliers.




5.  Retinal dysplasia – There are mild (retinal folds), moderate (geographic dysplasia) and severe (retinal detachment) forms.  These forms may well reflect different underlying genetic mechanisms.  At least some forms are thought to be autosomal recessive.  Dominance with incomplete penetrance has also been suggested.  In Cavaliers, more severe forms are even rarer than minor forms, but none is common. There are indications that retinal folds rarely or never affect vision, which makes this a "trait" rather than a "problem" in my book, since retinal folds seem genetically independent of more severe retinal dysplasias.  Breeders should CERF their dogs.  If you want to CERF yours, there are eye clinics at most CKCSC shows where you can have it done for a reasonable fee.




6.  Epilepsy – Rare and usually controllable.  There are lots of different forms of epilepsy, which is really a symptom rather than a disease and can occur for a lot of reasons.  The odd "fly-biting" syndrome is one form that definitely occurs in Cavaliers, but any dog of any breed, or random breeding, could develop some kind of seizure disorder.  In Cavaliers this is probably localized to some lines.  Given the occurrence of "fly-biting" syndrome in Cavaliers, I would not encourage Cavalier puppies to chase spots of light off laser pointers or mirrors, since according to Nicolas Dodman sometimes that kind of game can trigger the onset of weird obsessive seizure disorders similar to "fly-biting" syndrome.  There is also a kind of "episodic falling syndrome" which resembles epilepsy in some ways.  In this syndrome, excitement or exercises causes the dog to collapse.  This may be alarming, but does not seem to harm the dog.  Episodes last about ten minutes.  The problem can be controlled via medication, but resistance to the medication may build up over time, unfortunately.  As far as I know, the genetic mechanisms behind these syndromes is unknown.




7.  This and that, including black hair follicular dysplasia, microphthalmia, PRA – all relatively rare and / or probably localized to some lines within the breed.  Ichthyosis has been described for the breed, but I get the impression it's vanishingly rare.




Start your health queries with MVD and SM.  Breeders who are trying to keep the breed going while still retaining breed characteristics know that MVD and SM are the worst problems facing the breed today.  Both are late-onset polygenic traits -- the worst kind of trait to deal with in a breeding program.  The other health concerns mentioned below are not as serious in this breed at this time as MVD or SM.  It is perfectly reasonable -- in fact, it is unavoidable -- for a breeder to prioritize health concerns.  If a breeder decides to keep in her breeding program an animal with grade one patella luxation, borderline hips or retinal folds, this is quite likely to be a defensible, sound decision.  If a breeder decides to keep and breed an animal that she knows is carrying microphthalmia or PRA or episodic falling syndrome, that too may well be a good decision.  If all animals known to be or suspected of carrying any negative trait were removed from the gene pool, there were be very few Cavaliers left -- and all of them would be carrying something else, something unknown.  Every animal on the planet is carrying something.


You do the best you can to select a breeder who is doing the best she can, and then you cross your fingers.


The Cavalier Premier site offers information on what real hip and eye clearances should look like, by the way, as well as extensive information about issues in Cavalier health: is a good site with a fair bit of information about Cavalier health. is a site maintained by someone who is not a breeder and who is looking for perfection, and failing to find it.  It has a lot of good information and some information that is not so good.


Also look at:, which has some good health information, particularly on syringomyelia.


The good news is that there are a some problems you can expect to avoid by buying a Cavalier.  Cavaliers do not have, or have at an unusually low frequency:


Hypothyroidism.  At least one study (by Bell) has indicated that Cavaliers are among the 10 least affected breeds for this otherwise very common condition.


Sebaceous adenitis.  Cavaliers are not known to get this fairly awful skin condition.


Van Willebrand’s Disease and other forms of hemophilia.  Common in some breeds, these conditions are vanishingly rare for Cavaliers.


Atopy.  Those super-annoying skin allergies so common in so many breeds are rare in Cavaliers, thank the Lord.  I detest trying to cope with chronic skin allergies – it's hard on both pet and owner.  Cavaliers are also a LOT less prone to ear infections than Cocker Spaniels – Cockers apparently have a unique epithelium in their ear canals which predisposes them to ear problems.  Cavaliers fortunately don’t share this ill luck.




Structural Health and Your Cavalier


I’m sufficiently connected with the real world to be aware that the average person couldn’t tell a steep shoulder from a double-jointed hock and doesn’t much want to try.  And that’s okay, I guess.  If what you want is a sweet dog to lie on the couch and walk around the block with you, it doesn’t matter.  Much.  I guess.


On the other hand, if you want to enjoy more active activities with your Cavalier, such as:

            Higher level competitive obedience                    Flyball

            Agility                                                               Hunting

            Jogging                                                             Hiking


Then you will need a dog sufficiently sound to do those things without breaking down.  A structurally correct dog is also likely -- as Pat Hastings comments --  to be more beautiful, age more gracefully and suffer fewer problems throughout its life.  Once you learn to see correctness in type and structure, you’re also going to want a dog you can really enjoy looking at, even if the dog is “merely” a pet.


Incorrect structure does cause physical stress and health problems for a dog.  If you find someone who points to a particular structurally-incorrect working dog and says, “Look!  He’s a fantastic worker!” you’ll need to keep in mind that the dog is working in spite of his fault, not because of it; and he’ll break down faster than a dog who is correctly put together.  Like a horse finishing a race with a broken leg, he’s working on heart, and heart isn’t enough over the long haul.


So, structural problems.  You can simply tell the breeder that you’re interested in agility and that you enjoy hiking.  If she’s trustworthy, she’ll select a puppy for you with, for example, a less-than-ideal head but very sound structure, and you’ll be fine.  If you ask about the structural strengths and weaknesses of a puppy, the breeder ought to be able to tell you what they are, and how they will affect the puppy’s ability to do the things you’re going to want it to do.  There are plenty of puppies with excellent structure that are sold as pets because of an unwanted white marking, a narrow muzzle, light eyes, a slightly undershot bite, low-set ears, or some other trivial failing that won’t in the least affect their ability to be great pets and performance dogs.  That’s what you should look for in a quality pet.


If you want to learn about structure yourself, you might consider starting with Pat Hasting’s outstanding video, The Puppy Puzzle, which is the greatest thing since sliced bread, especially for a beginner.  Robert Cole's wonderful book is also a splendid reference.  You might also glance at the site below: -- a real-life demonstration of why it matters.