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DCM and us

Our journey with DCM (dilative cardiomyopathy)

Laika is not typical. She never has been. Nothing about this dog is normal, and in a way being "normal" would be entirely un-Laika-like. So just like I felt it may or may not be useful to describe our journey through hypothyroidism I felt that maybe some good might come out of describing our journey with DCM.  

Every doberman owner knows (or should know) that DCM, dilative cardiomyopathy is the major risk in the breed besides cancer. It is a disease highly hereditary and inevitably leading to premature death. Of course I knew that when I got Laika. Of course I had in mind that doing regular cardiological exams would be the responsible thing to do. Her breeder even made sure to remind me (and her siblings families) of this when she turned three years old. Well,.... like most people walking around a war zone I half knew and half hoped that I (or rather my dog) is "bullet proof". Resistant to DCM or any other ill. Of course, I am not naive. I knew that this was wishful thinking only. 

In winter 2011/2012 I knew something was wrong. I did not know what was wrong. But I do know that dobermans can get cancer at that age and I do know they can get heart disease. At that point I felt "safe" that hypothyroidism was not the issue. A fool I was - indeed. There is nothing anyone can do to prevent cancer and no foolproof test to rule out cancer. So cancer was the dark shadow looming above I could not rule out. But I noticed something was not right with the instinct of someone who is very close to their dog. I always sensed when something isn't right with Henna. I do the same with Laika. Many people told me nothing is wrong, but deep down I knew something isn't right with my "little nonsense". She was no longer little, but most importantly, she lost the nonsense. She no longer played, she got tired easily,... So in January of 2012 I decided to get an appointment with Dr Kresken in Duisburg. After all, he is one of the most respected veterinary cardiologists in Germany. 

 

I do not recall the exact date, but I do recall it was only a few days prior to Laika's fifth birthday that we went to our appointment. And unfortunately Dr Kresken confirmed my worst fears. Laika showed very unequivocal signs of occult stage DCM. Enlarged left ventricle, a part of the heart that seemed to be thinned and "not contracting", enlarged E-Point seperation (a measure that is usually raised even slightly prior to any actual signs of heart disease) and quite noticably decreased contractions of the heart. Her heart was not pumping right and it was too large. There was nothing to question this result. Nothing at all. Dr Kresken did not give me a definitive life expectancy. He said we will know more in six months. But I could see in his face and in the way he did not give me replies that he did not really believe that she would see her sixth birthday. He would not say it would not happen, but he would not say it would happen based on the resutl either. He prescribed the ACE-inhibitor "Ramipril". At the time the only class of drugs clinically proven to prolong life in dogs with occult stage DCM. 

In restrospect I think the prescription of this drug probably saved Laika's life. I was devastated. In my mind I slowly prepared myself that still having the little fool around at christmas was just not very likely. It was possible, of course, but was it likely? Probably not. I had known of and heard about too many dogs who died young from DCM and who did not live very long after a diagnosis such as this.

Within 24 hours of receiving her first dose of Ramipril Laika "collapsed". She was too weak to get up on her own, she was apathetic (which is entirely un-Laika-like), would not get up to greet people getting home, would not manage to get up the stairs, would not go for walks, was entirely lethargic. So I took her to our GP vet to have a blood check done. And this vet has my eternal gratitude for many reasons, her actions in face of this situation are only some of them. By the time we had an appointment at her clinic Laika had recovered somewhat. Was back to "normal Laika". She took two actions: she took a complete blood count, did a clinical exam and prescribed Vetmedin. Vetmedin was a "wonder drug" for Laika. A short while after receiving her first dose she was more energetic, more capable of running and exercising, playing with Henna. She was "my Laika" a little bit more than she had been for a while. It seemed to confirm the diagnosis. Being quite aware of doberman hepatitis I was hoping her liver would be ok. I wanted to savour every minute she was like this knowing full well that it would not last forever and in the face of her disease might end abruptely and soon. Her breeder was full of compassion and support. Not blaming, not searching for excuses, just being supportive. She knew that in a doberman this could always happen. And I believe she knew that I also knew this. I never blamed her for presumably "bad" decisions leading to this and never will.

On the day my Henna was spayed I received Laika's result as well. She was perfectly healthy,... but,... but her thyroid was not ok. Very low T4 (not measurable), very high TSH. Classical hypothyroidism. The vet believed that low dose supplementation was warranted since hypothyroidism would protect the heart, to a point. After all the information in the packaging of thyroid pills warns that substituting dogs with latent heart disease can lead to accelerated heart failure. 

We started Laika on pills and - oddly enough - she started to develop classical signs of hypothyroidism such as skin problems, behavioru problems and all the rest after starting supplementing. To this day I can't quite work that out. Her skin issues were so bad at some point (she had no skin problems at all when first seeing the vet) that we suspected it could be bad, could even bei leishmaniosis, even though it seemed strange this would happen. After all, the furthest south she had been in her life was somewhere on the lifetime was Cologne, Germany. At any rate. It all healed.

Half a year later she saw another cardiologist in Northern Germany. The progression of her heart disease confirmed what we expected. Most parameters had worsend. It did not look good. By that time the heart had developed severe fibrosis further restricting the hearts action. So we added Prilactone to her Vetmedin.  But it was at least possible she would see Christmas that year after all. This cardiologist gave me a very sincere hint. "Check her thyroid. Make sure she really, really is well substituted." And I did. And maybe he saved her life. After this I had her thyroid levels checked. I contacted some of the very few researchers of canine endocrinology in the world. And I decided on her treatment scheme based on what I learned there. 

From then on her heart function improved.  A bit over a year after her very, very dramatic results that lead to a revised scheme for thyroid substitution most functional values determined on ultrasound were normal. Her heart was clinically free of signs of DCM. I could not believe it. I honestly and sincerely could not believe it, even though we had it "on paper". I was one very happy person hoping I would have many years with my dog now. 

Unfortunately this was not to be, but for different reasons. The ultrasound that was taken five days prior to her death did not show a heart disease in any way like what we had seen over previous years. The cardiologist categorically ruled out that her heart problem had "returned" we were facing a new, nameless enemy. But one thing I can say with absolute certainty today: my doberman did not die from hereditary doberman DCM. We had suspected as much by the progression of the disease. It was not "typical". But histological examinations of her heart muscle confirmed that she had neither the "fatty infiltrate" degenerative type nor the "attenuated wavy fibre" type DCM. She had lesions indicating inflammatory processes throughout her heart. 

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