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Possible beginning of occult DCM

5K views 34 replies 10 participants last post by  brw1982 
#1 ·
So I’ve just got Mika’s latest holter result back (her echo was normal). 15 PVCs which is still within normal range (compared to 2 PVCs two years ago). However the cardiologist also found 2 couplets and 1 triplet, and she say she doesn’t like seeing those in the result and it could mean she’s starting to develop DCM. Her heart rate is normal, 60bpm when resting and 80-90bpm when excited. Cardiologist said no medication or treatment is needed at this stage, but a recheck in a year is needed, and she will be doing a more detailed echo then. But if during this time there’s any changes eg lack of exercise intolerance or increase heart rate etc then bring her back for a recheck.

I’m so depressed, she’s almost 7 years old, been on raw all her life, no vaccines after puppy vaccines (I titer test her), no chemicals etc.

What’s everyone’s thought on this? Should she be starting on any medication or just follow the cardiologist and do a recheck next year?
 
#3 ·
Cost is the least of my worries now. I’d do anything for her.

I did asked the cardiologist and she said unless she’s showing any signs of increase heart rate or breathing rate, or exercise intolerance, she doesn’t feel that recheck in 6 months is needed, especially as she gets really anxious, she say she might need slight sedation next time cause she’s just so anxious. I’ll contact the cardiologist again in 6 months time to double check again. But I just not sure if doing nothing at the moment is the best thing, shouldn’t she be on some sort of medication to stop the progress? I don’t know, I’ve never dealt with DCM before.
 
#4 ·
Again, I'm sorta making this up.....but without symptoms and still basically normal results, I wouldn't think medication would be indicated. You need to balance the possibility of side effects of the medication with its possible slowing down of any progression towards DCM, which you don't really have nailed down as a diagnosis. I think the balance tips in favor of no medication at this point.

I hope someone else here will chime in who actually knows something. :( Maybe tomorrow (our tomorrow); it's fairly late here.
 
#5 ·
Healthy dogs can have arrhythmias, so it's not always indicative of DCM, but the couplets and triplets are concerning. You could do another holter right now and she might not have any (or just a few singles again). I would want to do another holter in 6 months though, and if something is worrisome in those results, an echo too.

Do you have a doberman club or kennel club or local breeder who may rent a holter out? I don't know how it works on the other side of the world but here it's inexpensive and easy to rent one and then have the results sent via email. You don't have to bother with a cardiologist appointment and all.
 
#7 ·
Thanks, the couplets and triplet are also what’s concerning me after doing some online research. I’m really not sure about places that sells or rent holter monitors here, as it’s really not usual practice here in Australia to get holter done, in fact there’s only one animal cardiologist in my state (the one I’m seeing), and I think only about 6 cardiologist in Australia. My local vet hadn’t even heard about holter testing for Doberman when I first told her as I need a referral to see the cardiologist. I will ask around and see if there’s any place I can borrow one, as the cardiologist is like an hour drive away, so it will be great if I can put one on her at home. If not then I’ll get in touch with the cardiologist after 6 months to ask for another holter done.

Does couplets and triplets always lead to DCM?
 
#6 ·
I agree with GK and Mel, I would want to do another echo and holter in 6 months just to err on the cautious side. If it were only singles, then it would be OK to go a year but showing signs of couplets and triplets, would be a concern. Take it from someone who dealt with early DCM and dealt with it for 8 years with meds, the earlier the diagnosis, the better chance. Please keep us updated.
 
#8 ·
I've got a couple of comments on this. First of all none of the cardiologist I've ever had see my dogs (4 of them) would consider medicating a dog for anxiety when they are being holtered--it can skew the results and usually does.

The appearance of doublets and triplets does not necessarily mean that the dog is beginning to show early signs of DCM--it can but it isn't always the case.

Even with a Holter that showed (was it for a full 24 hours?) 15 PVC's and included 2 doublets and one triplet most cardiologists that have seen my dogs would not start treating for anything with meds. Generally most of the cardiologists use the 50 PVC as the "within normal limits" if there isn't anything that shows up that would indicate otherwise.

My 13+ year old male had one Holter when he was around 4 which had 80 PVC's and no couplets. At the suggestion of the cardiologist I increased the amount of fish oil he was getting (and the cardiologist reminded me that while fish oil will NOT prevent abnormal cardiac conditions it can be helpful if abnormalities are discovered). I give all my dogs, over six months, fish oil and Vitamin E--but it's primarily for skin and coat at that point. We did another Holter in six months (with the fish oil and Vitamin E doubled) and that Holter was normal. I've done both Holters and Echo's on him twice a year since then and over time he's had a few Holters where there were VPC's greater than 50 in 24 hours and they were all singles.

His most recent Holter (and echo) were in late May and it showed 45 VPM's all singles.

One of the cardiologists would put a Doberman showing over 50 VPC's on benazepril (or enalapril) but other cardiologists don't.

Good luck in checking it out--at one time between my dogs and a friends dogs we had 8 dogs and two of them were elderly cardio cases with abnormal Holter results and we bought a Holter from Alba Medical Systems, Inc.--they are in New Jersey and probably are the most common Holter supplier in the US.

In my area we have been very lucky that the Mt Hood Doberman Pinscher Club has a program for renting Holters to club members at very reasonable prices. But even with that program in place is was less expensive to buy a refurbished Holter monitor from Alba with that many dogs and two of them were being monitored every two months.

dobebug

I'll quote a little comment in a study done by the European Society of Veterinary Cardiology--concerning screening guidelines for DCM in Doberman Pinschers.

"Fewer than 50 single VPC's in 24 h are considered to be normal in Dobermans, although detection of any number of VPCs is cause for concern. Greater than 300 VPC's n 24h or two subsequent recordings within a year showing between 50 and 300 VPC's in 24 h, is considered diagnostic of occult DCM in Dobermans regardless of the concurrent echocardiographic findings."
 
#10 ·
Thanks so much for this! I’ve been worrying sick about the result.

The holter was indeed on her for a full 24 hours, and she was so uncomfortable in it as they used those medically sticky bandage and wrapped all around her chest, not just where the electrodes are. So when she lays down her chest expands, pulling on her fur, and she couldn’t really sleep that night. I did not sleep at all, and had to comfort her since she sleeps with me. She only managed to have a few 1-2 hrs sleep as she was so tired from all the anxieties etc.

As for the sedation the cardiologist mentioned, because she gets so anxious, the cardiologist said she feels bad for her, she’s mostly fine with the holter, it’s the car ride (she gets super excited) and the echo she is stressed about as she had to be pushed down on the padded table and she doesn’t like that. I did questioned the use of sedation stuffing the holter result but the cardiologist said she will let my vet know which sedation to use, and it will only affected her heart a little (she say the sedation is so weak that it probably won’t even do anything) for about 3-4 hrs, so not the whole 24 hr holter results will be affected.

But I was thinking maybe I should make two different appointments, one for holter and one for the echo, so that she can have that light sedation for the echo, and then holter another day. Although the cardiologist is quite far from me (an hr drive), but whatever is best for Mika.

As for supplements, as she’s been raw fed all her life, she gets fresh sardines and organic raw egg daily, and dehydrated green lipped mussels which are packed with omega 3. She also gets ACV, probiotic powders and I make her dehydrated jerkies myself as treats. I recently started her on golden paste and hemp seed oil (we can’t get CBD oil here without prescription) as she’s starting to show some early sign of arthritis. I’m now wondering if I should be adding CoQ10 and L-carnitine for heart support?
 
#9 ·
I really have to agree with everything Dobebug said! I would not worry over much with those results. My 11 1/2 year old male last did a 24 hour holter the month he turned 10 - I think he had a total of 30 singles, 2 couples, and one run of 4. Holter's stress him out, and I decided not to do anymore. He does get a cardiac Ultrasound with an EKG strip every September and is due the end of this month - his last one was normal. At his age, I'm just glad for each day. He is healthy and happy. Harvard showed PVC's for the first time when he was 7 1/2, I did one 4 years in a row - each time a few more..... but still under the 50 total. He gets a fish oil every day, and is on a low dose of thyroid. Other than a joint supplement & more recently a bladder supplement, that is all he gets.

If your cardiologist feels comfortable with doing another 24 hour holter in a year, then I would probably go with that. It would be good if you could do a ultrasound in 6 months.
 
#12 ·
Perhaps a different way to do the holter next time may help.

I use the sticky bandage tape only on the area around the electrode pads, not the entire chest being wrapped with the sticky tape. I use VetWrap around the chest to secure everything - including across the chest to ensure things do not slide back. Then i put on the holter vest on that. They are comfortable and I can check to see things are still where they are supposed to be during the 24 hrs.

I have not had any issues with my method.
 
#13 · (Edited)
That’s what I heard cardiologist do in the US. I’ll definitely mentioned it to my cardiologist next time. I did comment on the need for the sticky bandage on our first visit when Mika was 2 years old, and the cardiologist told me that it’s necessary to keep the electrodes in place. She does also get the vest outside aswell, so it’s like double uncomfortableness. As you can see the pic below, the sticky bandage is all around her, it’s such a pain taking it off as it grabs on the fur and she keeps twitching when I slowly peels it off.


 
#14 ·
I’ve emailed my cardiologist with some additional questions regarding supplements and the need for medication, this is her reply:

“The arrhythmia just gives us warning that she may be developing DCM. She does not actually have it yet though so there is no indication for medication.

CoQ10 does nothing to help this disease and is unnecessary.

L-Carnitine and Taurine supplementation is only helpful in dogs whom develop DCM due a deficiency in these amino acids (ie it is dietary related). In most Dobermans, DCM is hereditary, not due to deficiency in these amino acids. Also, as stated above, she does not actually have DCM yet. ”
 
#18 ·
Yes, DCM 1 and DCM 2 are DNA tests--but very recently they have issued information that the DCM2 is a "modifier"--or in some way a part of the DNA 1 test but shouldn't be regarded as separate from the DCM1 test. So any dog who tested clear for DCM1 would also be clear for DCM 2. Usually you order the test swabs from a genetic testing laboratory. The same places that do vWD testing often also can do the DCM1 and DCM2 testing. Although based on the most recent information I wouldn't do DCM2.

Also you should know that those two tests are really regarded as preliminary information on the genetic causes for DCM in Dobermans and alone don't predict anything. There is a similar cardiac disorder in people that they've been looking at for years for exact causes--so far they have over 26 separate genetic markers and say they are far from complete--in dogs there are only 2 (and now it sounds as if one of them--the DCM 2 is really part of DCM1).

I'll be repetitious and tell you that there is NO absolute test for impending cardio--what works best is regular testing yearly on young dogs and twice a year on older dogs or dogs who are showing signs of DCM by the overview of the test results. Early identification and treatment (and there are some very effective meds that can be used for treatment of DCM in Dobermans) are the best way to insure that even with cardio a possibility in any Doberman--they have a reasonably long life.

Also, before the next echo/holter I'd have a long talk with the cardiologist about not being allowed to be present while the echo is being done. The room that is used for echo's by my dogs cardiologist is tiny and very crowded--when this cardiologist first started doing the clinics for the Mt Hood club she didn't want the owners in the room either--it didn't take her long to learn that she could easily dispense with one of the assistants because most owners are very good at calming the dog and helping place them on the table.

Despite the tiny space when one of my dogs is being done there is the necessary equipment, the cardiologist, the vet assistant, me and a friend who has closely related Dobes to mine and runs my dogs in all performance events and has good reason to want to know exactly how their cardiac function is at any given time.

I understand that you don't have the option of choices of cardiologists that I do (Portland has 5 now--very good cardiologists in the immediate Portland and near outlying areas--and that's not counting the cardiologist down at the Oregon Vet School.
But I'd at least talk to your cardiologist and I really , really would do anything I could to convince her that your presence would probably eliminate the need for sedation.

dobebug





dobebug
 
#19 ·
To add to Bug's post about holtering....I was having some trouble with Sypha's holter, getting leads to stay on, and was advised to NOT do any vet wrap or anything. Dawn Danner, who is kind of the guru of Doberman holtering at Alba, said to simply put a little bit of tape over the electrodes themselves, and then NO tape, NO nothing all the way around the chest, and that I'd have much better luck that way, and low and behold, she was correct. Now I do not do anything except a simple strip of tape over the electrodes, and that's it. No vet wrap or anything around the whole chest - she said it's more likely to cause slippage of the electrodes. We just do the vest over the top, and that's enough.
 
#20 ·
LOL and where do you think I learned to do Holters, Meadowcat? From Dawn--she's the rep for Alba now (has been since heath issues caused Judy Donier to retire from that job).

She's a member of Mt Hood DPC and was part of the group that first set up the cardio clinics. When she put the first Holter equipment on one of my dogs (back when it was analog not digital and when the vests were slippery nylon with lace up adjustments like an old timey corset) the one thing she emphasized to me was to NOT to try to secure the pads and electrodes with anything that went all the way around the chest of the dog--she said, that it allows the tape to pull at the pads as the dog breathes and is unecessary and irritating to the dog because it pulls on the hair and skin.

There is also unfortunately, floating around the internet some instructions on holtering that show how to set up a holter on a dog where there is no vest available for use--but you can't successfully use it WITH a vest. Somewhere in the archives is a query from a member about problems she was having trying use that set of instruction with a vest. A couple of us who had learned from Dawn told her how to do it with a vest and without endless tape and Vet Wrap around the body and across the chest.

Trying to make something immobile which is being used on a living breathing creature just isn't very successful and a great example of how less is often more.

dobebug
 
#24 ·
I wouldn't necessarily worry based on the current report, but I will be doing a holter twice per year on all Dobes once they hit 7 yrs of age that I own from here on out. So, if she were my dog, I'd be re-doing it in 6 months anyway. It can show up any time, but it does seem to appear often between 7 and 8 years of age. Maybe I'm paranoid after my experience with Fiona but a holter is minimal cost and it will make me feel better, so that's my plan.
 
#25 · (Edited)
Thanks everyone for the helpful responses! Will definitely get another holter done on her in 6 months time, and an echo if needed based on the holter result. Will also talk to my cardiologist about the tape thing, as it was really uncomfortable for Mika.
I would also like to start her on fish oil, she’s on hemp seed oil and omega blend oil at the moment, but does get fresh fish daily. But my vet say additional fish oil won’t harm. Anyone know what’s the recommended dose? I want to give her this fish oil: https://www.blackmores.com.au/products/pet-health/joint-care/paw-fish-oil-500-veterinary-strength
 
#26 ·
I'd check with your vet, of course, by my vet recommended my dogs get 1000 EPA of fish oil daily, and 400 IUs of vitamin E with that.
 
#27 ·
Hey everyone, just received the full report from the cardiologist:

monitor results: 24 hr reading
QRS complexes: 105775 Sinus beats: 105760
HR
Average HR: 73 bpm Max HR: 196 bpm Min HR: 36 bpm
VPC's: 15
Single VPCs: 8
Bigeminy episodes: 0
Trigeminy episodes: 0
Couplets: 2
Runs: 0
Idioventricular episodes (<160bpm): 1, consisting of 3 beats.
Supraventricular ectopic beats: 0
Tachycardia episodes (>180bpm): 1, totalling 22.4 seconds. While Holter was being placed (Mika very stressed)
Pauses (>3s): 1, lasting 3.0 seconds.

Outcome
Assessment: While the number of ventricular premature contractions remains well within normal limits (<50/ 24 hrs is normal), the presence of 2 couplets and one idioventricular run is concerning. No treatment is required at this time but a recheck echocardiogram and 24 hr Holter in 12 months (sedation WILL be required for the echocardiogram) is recommended.
 
#32 · (Edited)
Hey guys... I might be a bit paranoid... but just now while sleeping, Mika suddenly starts to cough (sounds dry), she did 3-4 coughs and ended with a gag. Did this two times, switched a position and went back to sleep... her sleeping breathing rate is still normal - 16-18bpm.

Coincidently yesterday morning she had a bout of nausea (hard swallowing and grass eating, and also coughed once during the swallowing episode) which I contribute to either the sudden lunge she made the night before when she saw a cat on our walk, thus jerking on her collar, or the addition of fish oil the night before (I probably added too much too quickly), contacted vet who say it could be throat inflammation from the acid reflux or from the collar jerking and that it should heal with time. The hard swallowing lasted till about noon yesterday, and then slowly subsided. She was all good today, and then the cough happened, she was also doing a few hard swallow/gulps again just now, maybe it was due to the throat inflammation? It’s been exactly one month from our cardiologist visit, is it too early to start worrying about possible CHF cough?

P.s she had a similar episode about 3 months ago one night, woke up in the middle of the night, cough and gagged for a minute, and was all good since.
 
#35 ·
Hey guys... I might be a bit paranoid... but just now while sleeping, Mika suddenly starts to cough (sounds dry), she did 3-4 coughs and ended with a gag. Did this two times, switched a position and went back to sleep... her sleeping breathing rate is still normal - 16-18bpm.

Coincidently yesterday morning she had a bout of nausea (hard swallowing and grass eating, and also coughed once during the swallowing episode) which I contribute to either the sudden lunge she made the night before when she saw a cat on our walk, thus jerking on her collar, or the addition of fish oil the night before (I probably added too much too quickly), contacted vet who say it could be throat inflammation from the acid reflux or from the collar jerking and that it should heal with time. The hard swallowing lasted till about noon yesterday, and then slowly subsided. She was all good today, and then the cough happened, she was also doing a few hard swallow/gulps again just now, maybe it was due to the throat inflammation? It’s been exactly one month from our cardiologist visit, is it too early to start worrying about possible CHF cough?

P.s she had a similar episode about 3 months ago one night, woke up in the middle of the night, cough and gagged for a minute, and was all good since.

I'll be honest - this would worry me. I'd want an echo done (preferably without sedation) as soon as possible. IME, DCM stimulated coughing and gagging doesn't necessarily go on endlessly. If it is the beginnings of CHF, it can pop up seemingly out of nowhere but they'll shift positions, stand up, prop themselves up or whatever and they're able to go back to sleep. That she's also shown recent nausea sets off alarm bells for me.

Once DCM has been indicated, its my belief that its never too early to start watching for CHF. I'm not saying that you should stress yourself out looking for things that aren't there, but remain aware of what you're dealing with and try not to downplay additional signs of disease. Meaning, you don't need to treat your dog like they're made of glass but don't get too comfortable either.

The disease progresses at different rates in different dogs. IME, the disease itself can develop rather suddenly and CHF can be quick to follow, even when you medicate (because there are some very unlucky dogs who don't seem to respond much at all to treatment).
 
#33 ·
My previous post has disappeared for some reason :frown3:

I used cbd with my old gal when she got older and had some arthritis in her legs. Her vet was aware and was fine with it.

What's very important when using cbd is that it must be non-psychoactive so there is absolutely no thc in it. It was hard for me to get here in Canada but I had my supplier. The holistic vet will be able to get you the appropriate source.

What is also worth noting is that it is not cheap if you buy a very concentrated amount. You want the highest concentration you can get so it is the most effective. A very small bottle with a dropper cost me $125 Canadian but a little goes a long way.

Hope this posts this time.
 
#34 ·
Thanks for the info. I will have a look online to see what’s available. My holistic vet also recommended CBD oil, he said it’s good for “everything” including her arthritis. He told me he recommend either an Australian based brand, NuLeaf or Charlotte Web (the pet version for NuLeaf and CW brands), but they all contain less than 0.3% THC.

P.s another update as per my previous post - no more coughing since last night’s episode, so I guess she just choked on her saliva or something... playing and eating normally. I’m just so paranoid when it comes to her lol.
 
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