Daisy's heart murmur

[MattB]

I hope this isn't too rambling but here I go:

About 6 weeks ago, coinciding with losing one of our hounds, Daisy (12yo girl) became really sick. First thing that happened was a lot of blood coming from her mouth - rushed to emergency vet who couldn't find anything but prescribed tranexamic acid and antibiotics to cover a potential tooth abscess but thought that unlikely as Daisy has very good looking teeth. The vet asked me if I was aware she had a heart murmur which I was - I've been told at every check up but always advised not to do anything unless she was symptomatic or it got worse. This has followed several recent appointments to try to get Daisy's incontinence under control where she's been examined but no mention of a heart murmur.

 

Following the bleeding Daisy stopped eating - next vet spotted some ulcers in mouth and hypothesised she might have some in throat and stomach which contraindicated her Previcox so desired with paracetamol. It took a month of being hand fed steak and chicken too get Daisy back to normal, she would only eat soft foods initially but has built back to to nearly normal again now, however the most recent vet told me her heart murmur was grade 4 and I needed to see a cardiologist ASAP. 

I booked an appt but apparently covid has caused a backlog so it was 2 months before I could see someone - frustrating system but I had to give a deposit to get on their list and give an answer immediately so it's difficult to shop around. In the meantime, prompted by the fact that of three vets, only one has said Daisy needs urgent assessment, and while I waited for an appt, I booked in with a greyhound specialist vet who rang me up on the day of my appt and told me things looked very bad for Daisy from her notes as heart murmurs are very rare and very serious in greyhounds and I shouldn't be asking him to second guess another vet and he wouldn't see us (I guess that was me told!).

 

So I'm waiting now for another 2 weeks but the thing is, Daisy is really really well - she's jumping around again telling me she wants a walk, she's raiding the treat drawer and, other than being a bit tired, is the same as she's always been. For her assessment I've been told that she may need sedation which carries a risk and instinctively I don't feel I want this - very keen to have an assessment but it feels excessive for a very happy old girl to be sedated if this carries risk - realistically what could treatment do for an asymptomatic elderly greyhound.

 

It's also probably relevant to mention that Daisy is a spook, she is happy with me and my immediate family but anyone else is an absolute ordeal.

 

Sorry this got really long but would really appreciate any thoughts. I only went to act in Daisy's best interests!

[HeyRunDog]

What a dilemma you've got. In your situation if I let my head rule and with the risk to greyhounds from being sedated I'd cancel the appointment and let her live the life she enjoys and if it is as serious as one of the vets indicates and the worst does happen at least you've given her an enjoyable one.

[MattB]

1 hour ago, HeyRunDog said:

What a dilemma you've got. In your situation if I let my head rule and with the risk to greyhounds from being sedated I'd cancel the appointment and let her live the life she enjoys and if it is as serious as one of the vets indicates and the worst does happen at least you've given her an enjoyable one.

Thank you for taking the time to read my 'essay'!

I think there might be a slight compromise in that the cardiologist hopes to be able to do tests without sedation - so I could say if you can, great, but if not we'll leave it.

[macoduck]

I've had several greyhounds with a low grade heart murmur and they never needed any meds.  My current italian greyhound, Charlie, has a 3/5 heart murmur along with extremely low thyroid (on meds for that). He has been on Vetmedin for his murmur. The challenge has been finding it in stock before I get low on it. Dogs who were fed grain-free kibble developed murmurs in massive numbers and the pharmecutical com[any was struggling to keep up the production with the need.

Charlie did not need sedation for his echocardiogram. Are they saying the Daisy would?

And are the vets familiar with greyhounds usually having a larger heart? 

[racindog]

A vet told me that heart murmurs were fairly common in greyhounds and not usually any big deal.  I have had 2 or 3 greyhounds that had murmurs and just like the vet said it was essentially meaningless because the murmurs in no way harmed or caused any observable symptoms.  None of them rec'd any meds for it and most were seen by different vets from time to time that said the exact same thing as the first vet: "Not to worry/no big deal for a greyhound." I will be the first to say you can't always believe what a vet says but in this case they were right.  I suspect the alarmist vet that cancelled your appointment might not be as knowledgeable as he thinks he is about greyhound hearts. Probably a blessing the appointment got cancelled! 

Edited April 12, 2021 by racindog

[oldrunners]

My Penny had DCM (probably from being fed grain free).  Vetmedin is compoundable, if the pharmacy can get the main ingredient.  She did not need to be sedated for the echo.  There is a supplement that is often prescribed to go along with the vetmedin, and maybe I'll remember its name after I've had my tea.  I bought it at The Vitamin Shoppe.

[MP_the4pack]

My girl Pearl was diagnosed with heart disease at age 5. She also had hypertension.  Diagnosed by a canine cardiologist who knew about greyhounds.  Pearl was put on vetmedin and some BP meds and lived to 12. When cancer got her. 

I wish you were over here, I love my cardiologist. I would send you to her in a heartbeat. 

[MattB]

4 hours ago, oldrunners said:

My Penny had DCM (probably from being fed grain free).  Vetmedin is compoundable, if the pharmacy can get the main ingredient.  She did not need to be sedated for the echo.  There is a supplement that is often prescribed to go along with the vetmedin, and maybe I'll remember its name after I've had my tea.  I bought it at The Vitamin Shoppe.

Is there a link between grain free and heart issues? I have never heard this? 

Although Daisy isn't grain free we have tried grain free off and on as she's struggled a lot with itching - so she'll have had some grain-free phases over the past 2-3 years. 

[MattB]

1 minute ago, MattB said:

Is there a link between grain free and heart issues? I have never heard this? 

Although Daisy isn't grain free we have tried grain free off and on as she's struggled a lot with itching - so she'll have had some grain-free phases over the past 2-3 years. 

Just checked and her current food is a 'sensitive' food which has added taurine - I'm assuming that's because taurine seems to be the missing nutrient of concern? 

[Remolacha]

My first greyhound had heart disease, and like the others have said, did not need anesthesia for her echocardiogram. Maybe since Daisy is a spook, just a little Xanax or something like that to calm her would be enough. If not, I would agree with saying no. Sugar started on lasix and enalipril, then moved on to vetmedin as she got worse. All of this lasted about 3 years, then I lost her to kidney failure.

The grain free food/heart disease issue is fairly new over here. Some tests have shown a possible link, and since most dogs don’t really need grain free it seems sensible not to go there. The issue seems to be (this is all still very early in testing) not so much the lack of grain as the often exotic things they replace the grain with. Sugar is the only dog I have ever had with heart disease, but I got her at age 7 from a not so great situation, so she probably didn’t get good care earlier in her life. All my dogs have been mostly raw fed.

Edited April 12, 2021 by Remolacha

[greysmom]

I agree with everyone above - only do the exam if knowing what's wrong will change how you treat her.  She's 12 - a good age for a greyhound - and while it can be useful to know exactly what the issue is, it may not make any difference to her or your life.  If she seems to be over whatever was going on with her before, I would probably not do the cardiology exam. 

Watch for any coughing or retching, prolonged recovery time after exercise, elevated heartbeat and respiration, extended periods of mental confusion, even vomiting and diarrhea *can* indicate a heart issue.  You may end up taking her to an emergency vet since regular vets/specialists are so booked up due to the pandemic.  Start researching now for the closest ones (if you haven't already).

I've had three greyhounds have echocardiograms and none of them have needed to be sedated.  If that's what this vet says he needs to sedate her for.  It can also - usually, over here - be done by an ultrasound specialist right in your regular vet's office and read by a competent technician like an xray.  No cardiologist needed if there's no abnormality found.

Greyhounds do usually get diagnosed with a "heart murmur" at sometime in their life.  I've been told it's not actually a murmur, but more of an echo or increased level of noise from the valves due to how much larger than a normal dog their hearts are.  Unless a vet is very used to listening to greyhound hearts go about their business, it can sound really alarming.

There is at least one thread in the Food section here about Diet-Mediated DCM.  It's not something that is much on the radar outside of the US and Canada, so your vets may not be informed/aware of it.  Most of the time, when a dog has this, it can fix itself once the dog is switched off the grain free diet to one cantaining whole grains.  The peas and legumes used to add protein into dog food are what is believed to be the culprits.

[oldrunners]

When I adopted Penny, the grain -free thing was all the rage, and, since many of the adoption groups were recommending it, I happily jumped on that bandwagon, until I brought her in for a UTI, and the vet heard the heart irregularity.  She took Penny to the back and consulted with another vet, who confirmed.  They called the nearest specialty hospital and got Penny in as an emergency the following day.  Not quite a year and a half later, she suffered a traumatic fall in the yard and dislocated her hip.  The trip to the evet at 11 at night, in the pouring rain, knowing she wouldn't be coming home with me, was awful.  But, up until then her heart at first showed some improvement, then stabilized.  The vets were all content with that at that time.  She was a month past 12 when she went to the bridge.

I believe the FDA attempted to look into the grain free issue, but couldn't reach a conclusion one way or the other because so many of us didn't  know the complete food history of our dogs, or even the exact age, or medical history.  This wasn't just greyhounds---think of how many dogs are adopted from shelters!

I'm back to feeding Pro Plan, which is what I fed 24 years ago when I adopted my first greyhound.  The World Small Animal Vet Assoc. recommends 5 food brands, Pro Plan being one of them.  

Lastly, the supplement Penny took with her vetmedin was L-Carnatine, as recommended by her cardiologist.  I have no idea if this is still recommended.  There was a FB group dealing with this issue, but I haven't visited there in over a year, so I don't know whether it is still active or not.

[MattB]

Thanks so much everyone, really appreciate your thoughts. Very interesting re diet; I feel really ignorant having never heard of this.

 

Re: the need for sedation, this isn't definite but a possibility if Daisy won't cooperate I think (my understanding). So fingers crossed she won't need it. But I think like everyone has agreed, if there is no advantage to the tests then I will suggest we leave it. It would be horrific to lose her from complications from a test that wasn't necessary.

[tbhounds]

Just wanted to chime in and comment what a jerk that vet was..he/she sounded so rude...there’s no place for that-it’s never a bad idea to get a second opinion. You might start by just getting a few chest x-rays and an ecg-super simple and no need to sedate.  There’s also a specific blood panel that can be done-again super simple.

[MattB]

4 minutes ago, tbhounds said:

Just wanted to chime in and comment what a jerk that vet was..he/she sounded so rude...there’s no place for that-it’s never a bad idea to get a second opinion. You might start by just getting a few chest x-rays and an ecg-super simple and no need to sedate.  There’s also a specific blood panel that can be done-again super simple.

Hey thanks for the support and the info re: ecg. I'm not sure if it's a UK thing but I've never known anyone do x-rays without sedation. 

Don't get me started on vets being jerks. I'm not sure where you are but it always sounds to me like there's a different culture in the USA in terms of being a lot more customer focused and the acknowledgement that, however long they have trained or how much knowledge they have, they are providing a service for paying customers. Honestly the amount of times I've been spoken to by rude receptionists and nurses too! Perhaps I shouldn't generalise too much - the practice I'm with is the best I've experienced, just seems that the admin isn't great - at the moment I'm in some odd groundhog loop with them only giving me 2 week's worth of meds at a time and every time I point out that it's long term and the vet said I could have 3 month's worth then they say they'll sort for next time and then I arrive to pick up another... 2 week's worth. I digress!

Daisy's appt is on Thursday - I'm so scared.

[Remolacha]

 for Daisy on Thursday. 
 

I have never had a vet be rude or dismissive, but I did leave one practice in part because the new office staff was so bad.

[greysmom]

There is definitely a difference between UK and US vets.  We see it here all the time.  Not only with attitudes, but with trying new techniques or sticking with old training.  The biggest one, I think, is about the use of anti anxiety meds.  Most UK vets won't even discuss using them - still, in this day and age - and believe it's all a behavioral issue.

Sedation for xrays is another.  It's mostly for the vet's ease of doing the test, not because a dog actually needs sedation for xrays.  I'm sure there are dogs out there that do need them, but almost none of them are greyhounds!    My vet knows I prefer to do whatever is necessary with as little sedation as possible, so she always tries is without first.  Sometimes, it takes just a very light dose of propofol and a local.  The only time we really use the whole protocol is for full dentals or major surgery.  

Good luck to you on Thursday!

[macoduck]

MattB, which medicine is it that your vet will only issue 2 weeks at a time?

[MattB]

Sorry I went off on a tangent but it's paracetamol. Daisy was very ill with a suspected stomach ulcer so previcox is contraindicated but she has arthritis in her front legs (since she was 5) and recently a very stuff back. She is on propalin but they are happy to give me a huge bottle of that.

[MattB]

Just an update: Daisy is home!

 

Just got off the phone with the cardiologist. Daisy has a very loud heart murmur but surprisingly little showing up on the imaging - a small mitral valve leak or 'boring' as he put it. He said he doesn't need to see her again - this is good. 

The less good part: I mentioned that Daisy drinks a lot of water - they have done full-bloodwork and another test for kidney function - blood is ok - other test shows raised levels of creatinine - but not urea.... (is this possible). So the suggestion is likely early stage kidney disease, she's having urine tests to check this out further and then we will take it from there and think about how we manage it. 

The excessive thirst seemed to coincide with using the propalin and I've been reading about propalin needing to be 'used with caution' with kidney disease - I'm going to scour the greytalk archives for previous discussion about this.

 

Thanks for your support everyone. 

 

Oh - the PS. I was quoted £200 for today's appointment ($276) and it came to £1150 ($1500) I don't resent the price at all - just refer back to my comment about practice admin and information! 

 

[Remolacha]

Good news on Daisy’s heart! Not unusual for older dogs to have slightly elevated kidney values, but since she is drinking more water, good idea to get it checked out. Val has been drinking more water lately, but so far her kidney values are just high normal so 

[MattB]

2 minutes ago, Remolacha said:

Good news on Daisy’s heart! Not unusual for older dogs to have slightly elevated kidney values, but since she is drinking more water, good idea to get it checked out. Val has been drinking more water lately, but so far her kidney values are just high normal so 

Thanks - that's helpful to know. What has puzzled me is that she has had 3 lots of urine tests recently (last 2 months) all with normal results - and the last vet I spoke to said that the urine tests will provide some more info about kidney function - although she said that they would take cultures and send the sample away - so this must be a different test to the instant one they did in-house. I hope Val is ok.

[MerseyGrey]

51 minutes ago, MattB said:

Thanks - that's helpful to know. What has puzzled me is that she has had 3 lots of urine tests recently (last 2 months) all with normal results - and the last vet I spoke to said that the urine tests will provide some more info about kidney function - although she said that they would take cultures and send the sample away - so this must be a different test to the instant one they did in-house. I hope Val is ok.

It sounds like they are trying to rule out a UTI for Daisy’s aberrant creatinine since her other kidney function results are normal. The in house tests are probably dip stick tests or the electronic version, whereas a culture will need to be incubated over a couple of days. It all sounds quite positive, great news for Daisy and her humans.