Kheper's Story with his Dilated Cardiomyopathy & What we tried to hold off heart failure and sudden death.

Make sure to view his daily happy blog , keeping tabs on how we made each day count!!!

IF YOU HAD/HAVE ONE OF KHEPER'S LITTER MATES (C LITTER AT LEIDENSHAFT KENNEL BORN 5/3/2004) PLEASE CONTACT ME. We are trying to research his siblings for two studies, any information would be appreciated. I hope your dogs are still with you. Please let me know, as well if any heart test have been ran. Thanks for your time! Janna Janna@Gruseldog.com

09/23/2009 Khep's Echocardiogram & Holter Test

On Sept 23, 2009 I found out my 5yr 4mo old Doberman, Kheper, was at the beginning of the occult phase of DCM. We took him in for testing after learning his out of his father's litter, Anja died at 6, sudden death. Atlas (father) died at 8 CHF, Argus died at 7.5 CHF, Atlas's sire (Kheper's grand father, Bigno Germania died at 6 sudden death).

Kheper's echo was clear. There was trivial mitral valve regurgitation, which was considered to be congenital (he was born with it). There was no enlargement and no diastolic dysfunction.

His 24 hour Holter test revealed 14 PVC (premature ventricular contraction), 5 of those were couplets, 1 was a triplet. I kept a event log during his holter study. The PVC's were very random, so he was not put on exercise restriction.
    Dobermans with normal echocardiograms, with their holter test showing:
    • >50 VPCs per 24hrs = 100% chance
    • >10 VPCs per 24hrs = 94% chance
    • with couples or triplets of VPCs = 94% chance
    of developing echocardiograph evidence of DCM within 1 year.

Khep was started on Carvedilol

They have started Kheper on a newer one called Carvedilol. It's a beta blocker than has been doing wonders with humans with DCM. Carvedilol is a non select beta and alpha blocker that has oxygen radical scavenging capabilities and reduces endothelin release. The drug in addition to sparing the heart the effects of the sympathetic nervous system, it is a vasodilator and antioxidant. It will reduce the heart rate a little which I have to keep an eye on. Khep's heart rate prior to his throid meds was already low (70bmp resting), but that was seen normal because he is physically fit. After getting his hypothyroid undcontrol, his average is now aroun 84 bmp resting. Carvedilol has some antiarrhythmic properties too because it improves how the heart functions, hopefully it will have Khep's heart pumping more efficient, which will discourage the left ventricle to increase. This prolongs the onset of DCM = longer life :)
Neurohormonal Aberration : Carvedilol 0.1-.2 mg/kg s.i.d PO, increasing to .5-1mg/kg b.i.d. over 6 wks
It's not good to use if CHF has already set it, that is where Pimobendan comes into play.

We brought Kheper on this drug very slowly, and kept an eye on his heart rate and daily activity levels. After slowing increasing over two+ months he is now tolerating 25mg twice a day! Our chances of holding off his heart enlargement are better. He is scheduled for his next echo in March 2010.

With the Walgreens RX plan, his full dose only cost us $10/month instead of $193!!!

Kheper we just found out (10/01/09) has hypothyroidism. The cardiologist said she was glad we tested for this, it could have made his heart worse faster, which is something we don't want.

Kheper was put on .8mg Thyrosin for 1 month, his levels increased, but were still not normal. We switched brand names instead of increasing the dose. Differnet brands absorb differently. After 1 month on Soloxine he's level were within the normal range.


I also have him on the following supplments, as suggested by his cardiologist:
  • CoQ10 - 120mg then 60mg daily (w food)
  • L-Carnitine - 500mg twice a day (w food)
  • Tarine - 500mg twice a day (w food)
  • Salmon oil = 1000mg twice a day (w food)

  • I feed my dogs Solid Gold's Barking at the Moon. It has salmon oil, fish meal, tarine, vit B and C, among other great ingrediedents. It is also high in protein which is recommended by some heart studies.

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    03/29/2010 Follow up Echocardiogram & Holter Test

    March 29th, Kheper was back up at U of W for his 6 month echo check up. They results were not as good as we hoped :( His left ventricle is now showing signs of enlargement. Normal is 46.9 to 52, he is at 61.1.
    His left atrium is not dilated
    Wall thickness is normal
    His wall muscles are not contracting as well as his first visit 6 months ago.

    The suggested course of action is to add Pimobendan to his daily Carvediol. Pimobendan has low side effects, and helps the hearts contractions making it easier to pump.
    He is no longer in the occult phase, Kheper is no considered to have DCM (I'm in tears! WHY him!!!)

    Pimobendan

    Pimobendan, a newer phosphodiesterase 3 inhibiting inotrope, better termed an inodilator (inotrope and mixed vasodilator), has shown significant promise in the management of dilated cardiomyopathy and probably mitral regurgitation. This drug, currently being used widely at 0.2-0.6 mg/kg divided BID (given 1 hour before feeding) in Europe and Australia, is thought to work, in part, by sensitizing the troponin C complex to calcium. The aforementioned association between postive inotropes and sudden death has not been recognized with pimobendan, reputedly because there is less or no increase in intracellular calcium and because of its arteriolar dilating capacity, which unloads the ventricles. A prospective study by Fuentes, et al. demonstrated improved survival in Doberman pinschers with dilated cardiomyopathy and the PiTCH study prospectively showed improved clinical outcomes in dogs with DCM and mitral regurgitation, as compared with ACE-Inhibition. A retrospective study, comparing pimobendan to historical controls treated standardly, by Gordon and colleagues in dogs with mitral regurgitation showed improved survival, vertebral heart score, heart and respiratory rate, and left atrial size, without evidence of arrhythmogenesis.
    Diminished contractility :: Pimobendan 0.25 mg/kg b.i.d. PO

    Our plan of action

    Khep was started on Pimobendan March 31, 2010. I ordered his Holter monitor from Pet Cardiology, and he took it 4/7-/4-8. Results should be in 4/11/2010
    His next check up at 4 months will really help us see how fast this diseases is or is not progressing.

    What's been a happening so far...
    internal diamenter of the left ventrical
    9/23/09 47.91
    3/29/10 61.1 (normal would be 49.2 to 51.2)
    left ventrial ejection
    9/23/09 50% (50 to 60 is normal) he was low normal
    3/29/10 42%

    The heart is not contracting like it should, so there is extra build up in the heart that should have been pushed out. As a side effect from this, the left ventricle is enlarging.

    The goal is to get the heart to contract better, leading to less build up, leading to less left ventricle enlargement.

    Changes in the heart muscle causing it to not be as effective with contraction, not pushing out as much blood, extra blood volume is staying in.
    We hope to delay the adverse remodeling of the muscle. We will try this by adding Pimobendan to current meds. It should help the heart contract better, leaving less back up, ending in less dilation, we hope :)
    Good news is his atrium and wall are still normal. According to another Cardiologist, Kheper is still at the early stages.

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    I also have a call into the Stem Cell study to review all our options. They have a 2nd study going on with Pimobendan, however my boy can't be in a plesbo group. I need to gather some information. My brain is swimming now and I'm just crying and crying. I need settle down and spend some time with my boy. I can make the calls while playing frisbee tomorrow :)
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    Holter results came in.

    He only had 26 random, single, VPCs. It's so great to see those as all singles and still random. So far holding off CHF seems to be the focus.
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    It is now apporaching the end of July.

    Kheper has been doing great on his meds. I just have not been able to bring myself to make the follow up yet. I'm so scared. After talking with a cardiolgist in Florida, I feel a little better bout giving pimo. He said it seems to not make the numbers worse, but not make em better. We'd take that. I'm worried 4 months is to soon to catch if it was going to enlarge and it would be another 4 months before we'd look again. A part of me says wait till 6 months, then that would be a good period of time to see how the medicines are working. Unfortunaly there is not much we can do if they are not. The stem cells, but I have mixed feelings and scared about the surgery to do it. I'm not sure what to do yet, 4 mo vs 6 mo. I just really want my boy with me for a long time!!!
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    July 20 Worst Day!

    I lost my boy today. It was sudden. No warnings. Him and I had shared a cheese sandwich. Next thing I know my lil girl is barking and barking. I called his name, and he did not come. I ran to the side yard (we have a doggy door) and he was laying on his side in the yard. It had just happened when I got to him. Saya came in to get me, she had my attention within a minute. I tried CPR but he would not come back. His last holter was only 26 VPCs. I had thought we would be fighting off CHF. My sudden death worry hand subsided a little. It was just a typical a day the dogs and me. He left me around 11:30 today. This pain and shock is almost too much! I have to be strong for my husband and two girls. Kheper meant the world to us. I was going to make his follow up appt for around the 22nd, but could not bring my self too. I'm just so hurt. Hearing some great advice on the medical side helps. His heart could have looked the same. Really, who knows how this f*cking disease works. I feel like a part of me has been ripped away. I did give him the best life I could. I work from home to be there with my dogs. I have no regrets, he will just be missed terribly. I try to count how many ear rubs I did today, I think just one but I've done so many in the past, with butt scratches. I had a slight headache and was laying on the couch. He came up to me a couple times, once tried to lay at my feet. Last night when I came up to bed, he was on my side, I squeezed in behind him and got to hold him for a few. Usually that is only a winter thing after he wants under the blanket. I can barly see to type. My body just hurts. I wanted to let everyone know now in an attempt to move on. This was so out of my control, I just really really miss him. he meant the world to me. Hug your dogs morning noon and night!!!! List was the last photo I took of my boy. He watching his sisters play.


    Click here to view how we made sure to make ever moment I had Kheper count. He was a very happy dog, who was always similing. I miss my boy terribly, but I never missed a moment when I had him.

    Personal gathered DCM information after finding out my boy could develop DCM.

    Kheper's Pedigee: Sire Atlas v. Leidenschaft, Dam: Blitz vd Burgstatte.


    **** I'm not a vet or even close to an expert on this. I've just spent a lot of time reading online trying to figure out what I can do for my boy. Above is the best information I could find.
    If you have a story you'd like me to post, either to share with friends, or to cut back on what you need to remember in this hoctic times, please feel free to email me and I can get your pup a page.
    If you have any questions, feel free to contact me at janna@gruseldog.com

    Updated 07/20/2010
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