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Doberman Pinscher Dilated Cardiomyopathy (DCM) Simplified

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Doberman Pinscher Dilated Cardiomyopathy (DCM) Simplified

Doberman Pinscher Dilated Cardiomyopathy (DCM) Simplified
Written by John Walter Updated on July 26, 2019

DCM-in-Dobermans-Large.jpg


Reviewed by Donald Buchanan, DVM

There has been a lot of confusion, and even panic, surrounding dilated cardiomyopathy (DCM), also known as simply “an enlarged heart”, within the Doberman community lately. Unfortunately, instances of Doberman’s diagnosed with DCM seems to be increasing in recent years.

To make the panic worse, the FDA has released a list of dog foods that have been linked to DCM in canines. So what does this all mean? Before you panic, let’s simplify all of this so the average owner (like you and me) can get a better grasp on things.

What is DCM in Dobermans? Dilated cardiomyopathy (or DCM) in Dobermans, also known as an enlarged heart, is a condition where chambers of the heart have become enlarged and the walls of the heart have become thinner. As a result, the heart is no longer able to pump blood as efficiently to the rest of the body.

After discussions with other owners, reviewing the most recent studies possible, and consulting with various veterinary professionals, I’ve compiled this information specifically for Doberman owners who are concerned about, or dealing with, DCM. My goal is to make this disease easier for the average dog owner like you and me to understand.


Table of Contents [hide]


Symptoms
I think it’s very important that we discuss the signs and symptoms to look for in your dog. Besides discussing just the general symptoms, I want to designate which of these symptoms are most likely to show themselves during the early stages of DCM because catching this condition early will make managing the disease much easier, and can often result in better outcomes.

Early Stages
Unfortunately, dilated cardiomyopathy is very difficult (or impossible) to detect during the early stages. However, the symptoms listed below are usually the first to show up and may still be detectable during the early stages. Of course, these are certainly more noticeable during the later stages. These early signs can include:

  • Decreased tolerance to exercise.
  • Unusual heart sounds or murmurs.
  • Irregular heart rhythm or arrhythmias.
In the early stages of this disease, these symptoms may not be detectable at all. A qualified veterinarian with the correct test equipment will be much more likely to detect these issues. A subtle heart arrhythmia, for example, may only be detectable through the use of a 24-hour, wearable, electrocardiogram (or ECG) device called a “Holter monitor.” These devices record the electrical activity of your dog’s heart. Think of it as a recording of your dog’s heartbeat.

An ECG done at the veterinarian may not always detect the issue. This is because the arrhythmia may not be constant throughout the day. So your dog can test normal during a 5 minute long ECG test at the vet, but still have an arrhythmia and possibly even DCM. That’s why a take-home, wearable, ECG device like a Holter monitor will often detect these issues where an ECG done at the veterinarian may miss them.

DCM-Heart-Diagram-Large.jpg


Later Stages
As this disease progresses, the signs and symptoms become much more apparent. All the early signs listed above are usually present, but more apparent. There are also many additional symptoms during the later stages of DCM. These signs can include:

  • Lethargy (even less tolerance to exercise)
  • Unusual heart sounds or murmurs
  • Irregular heart rhythm or arrhythmias
  • Increased heart rate
  • Weakness
  • Sudden collapse/fainting
  • Loss of appetite
  • Weight loss
  • Coughing
  • Faster and more labored breathing
  • Abdominal swelling
  • Pale gums
  • Sudden death
Unfortunately, if the issue isn’t detected until the later stages, intervention is usually minimally successful (if at all).

If you suspect that your dog may have DCM, it’s important to get him to a qualified veterinarian as soon as possible. Early diagnosis is key to successful treatment.

“Many cardiac cases in large breed dogs present to me as lameness cases. Large dogs that are slow to get up out of bed, weak (especially in the hind end), or intolerant of normal exercise should be considered as possible cardiac patients.”

– Donald Buchanan, DVM
Diagnosis
Dilated cardiomyopathy in your dog should only be diagnosed by a qualified veterinarian or specialist. There are many tools and techniques they may use to help diagnose your dog, but an echocardiogram (or echo test) of the heart is the most definitive method. Below are some of the tools or techniques that your veterinarian may use to help them diagnose DCM.

  • Echocardiogram (echo test): Your veterinarian may also refer to this test as a transthoracic echo (or TTE). This is the most definitive method of diagnosis. This is simply an ultrasound of your dog’s heart. It’s painless and provides a detailed image of the heart, it’s valves, and most importantly the chambers of the heart (also known as “ventricles”) using soundwaves. This makes it possible to measure the muscle wall thickness and pumping ability of the heart.
  • Electrocardiogram (EKG or ECG): This test measures and records the electrical activity of the heart through small electrodes that are attached to your dog. During this test, your vet will be looking for signs of unusual heart activity such as arrhythmias.
  • Holter Monitor: This is basically another form of electrocardiogram (ECG), however, this device is wearable for an extended period. A Holter monitor is typically carried by your dog in a specialized vest and a few adhesive pads are attached to monitor your dog’s heart. Heart arrhythmias may not be consistent throughout the day, so often a wearable ECG device such as this is best to identify any arrhythmias that are present. This may only provide a possible indication of DCM, however, since it’s certainly possible for your dog to have an arrhythmia without having DCM.
  • Thoracic Radiography (x-ray): An x-ray may be used to help evaluate the size of the heart and the condition of the lungs. Your veterinarian will most likely also be using this as a way to gauge fluid accumulation in, or around, the lungs—another sign of DCM.
  • NT-proBNP Blood Test: This simple blood test checks for the amount of a certain protein that is associated with hormones that the heart produces. The heart will produce these in larger quantities when it’s needing to work harder. That means it can provide insight into whether or not the heart is struggling to pump blood to the body.
  • Troponin Blood Test: This test checks for the levels of troponin T or troponin I proteins in the blood. These proteins are released when there is damage to the heart. The greater the damage, the higher levels of these proteins will be present.
  • Other Blood Tests: Other blood tests may be used to help determine if there are any dietary deficiencies as these can lead to the development of nutritionally-linked DCM. One of the most common is a test to check taurine levels (an important amino acid). Normal whole blood taurine concentration is generally considered to be 266 ± 5.1 nmol/ml (source).
All of the tests listed above are tools that your veterinarian may use to help them to make a decision on a DCM diagnosis. Each one provides a piece to the puzzle. Your vet may not need to perform all of these tests. Instead, they’ll make a DCM diagnosis once he or she is confident that your dog is affected by this disease.

Treatment
Treatment for DCM is tailored to the individual dog and is rarely the same from one dog to the next. This is because every case is different. So it’s fairly difficult to outline what your veterinarian is likely to recommend for your specific case. However, below are some of the common approaches us Doberman owners see for this disease.

Most commonly treatment plans will involve the use of certain medications meant to help reduce the workload of the heart and allow blood to pump more easily, as well as medications to improve the pumping action (or contraction) of the heart. Medications such as pimobendan can be used for this. In Dobermans, pimobendan has shown to be beneficial in prolonging lifespan when started at the time of diagnosis of DCM, as opposed to waiting until clinical heart failure is realized.

“Unfortunately, even well managed dog on heart medications can rapidly decompensate. Owners of pets with DCM should be prepared to call their veterinarian’s emergency line at any time, especially dogs in later stages of the disease.”

– Donald Buchanan, DVM
Diuretics (such as furosemide) may be used to reduce fluid buildup in the lungs or abdomen. There are some side effects of using diuretics though, so often medications such as enalapril or benazepril, which are “angiotensin-converting enzyme” (or ACE) inhibitors, may be used to reduce the harmful side effects of the diuretics. ACE inhibitors also help improve general blood flow, which is another benefit for a dog suffering from DCM. A procedure to physically remove the buildup of fluid in the dog’s abdomen or chest cavity may be used for DCM cases that are more severe.

Additional medications might be used to help control heart rate and arrhythmias (if present). These medications can be injected in an emergency situation, however, they’re most often given orally to dogs who are in a more stable condition. Dietary supplementation may also be used in an attempt to help support the heart. This often includes the use of L-carnitine, taurine, and omega-3 fatty acid supplements.

DCM tends to be progressive and is usually not reversible in Dobermans. This is because the Doberman breed is pre-dispositioned toward genetically linked DCM. Therefore the number and quantities of medications tend to need to be increased with time. The exception to this is DCM that is the result of dietary deficiencies (such as low taurine levels) which may be reversible if caught early enough. DCM caused by low taurine levels can be identified by a blood test to check for the presence of a taurine deficiency. Unfortunately, most DCM cases in Dobermans are of the genetic type and are not reversible.

Update on Possible Treatments
The results of a new study suggests that DCM may, in fact, be an autoimmune disease (source). This is possibly very good news for Doberman owners since there are drugs known to suppress autoimmune reactions in humans. Basically, this study means that a medication that actually prevents DCM (or stops it from progressing) may not be far off. For an in-depth explanation of this, see the article DCM in Dobermans is an autoimmune disease on the Better Bred website.

Doberman-at-the-Vet-Large.jpg

Early diagnosis is key for successful treatment ensuring the longest possible lifespan.

Lifespan After Diagnosis
Once diagnosed, if a Doberman is already showing signs of congestive heart failure, they are most likely to die within about 6 months. However, some may live as long as 1 or 2 years in ideal situations and with proper intervention.

If your veterinarian determines that your dog is one of the rare few to have DCM due to a dietary deficiency (such as a taurine deficiency), and you caught it early enough, there is a possibility of reversing the disease. However, this is exceptionally rare, especially with Dobermans.

“DCM in Dobermans is a fatal disease. In this breed, nearly one-third of all deaths due to DCM are in the form of sudden death, not congestive heart disease”

– Donald Buchanan, DVM
Exercising After Diagnosis
Always speak to your veterinarian about your dog’s activity levels if he or she has been diagnosed with DCM. In general, your vet will likely be working with you to find ways to reduce the strain placed on your dog’s heart. This includes finding ways to reduce strenuous exercise and general activity levels.

Lower physical exertion means less stress is placed on the heart. So strenuous activity is not recommended for a dog with DCM.

Preventing DCM
Sometimes there isn’t much you can do to prevent DCM, especially in dogs who are genetically predispositioned to have the disease such as Dobermans. However, quality diet and regular exercise are key to ensuring your dog has a strong heart.

If you are considering getting a Doberman puppy and are concerned with DCM, make sure you find a reputable breeder who performs genetic testing on their dogs (and puppies) to see if the dogs carry the gene mutation that is known to cause DCM.

Genetic Testing
There are currently two genetic tests available that look for a specific genetic mutation that is linked to DCM. These tests are called “DCM1” and “DCM2” and look for mutations in what’s called the “PDK4” gene. This gene mutation has been identified as being linked to DCM. If a dog is affected by this mutation, their likelihood of developing DCM sometime in their life greatly increases, and their pups also have a chance of inheriting this mutation.

DCM1 was the original test for the genetic mutation that has traditionally been linked to the disease. More recently, however, a second genetic mutation has been linked to the development of DCM in Dobermans. This has lead to the creation of the second test called DCM2.

If you want to be as thorough as possible with the testing of your dog, you should get both the DCM1 and DCM2 genetic tests performed. This will give the most complete picture currently possible as to your dog’s risk level of developing the disease. Below are a few companies that offer this testing online.

  • VetGen: This company performs both DCM1 and DCM2 genetic testing. Their Doberman specific DNA testing section can be found here. On that page, look for the test labeled as “DCM1 and DCM2”. This is their genetic testing for DCM in Dobermans and costs around $100.
  • VNC State Veterinary Hospital: This company offers both DCM1 and DCM2 testing. Their Doberman DCM testing page can be found here. At this time of this article, these tests can be purchased individually for around $50 each, or $70 for both tests. They also offer discounts if you are testing an entire litter of dogs, which is a great idea if you’re a breeder.
  • AnimalGenetics.us: It appears that this company only offers DCM1 testing at this time. Their DCM genetic testing page can be found here. At the time of this article’s writing, tests cost around $45.
  • Paw Print Genetics: This company appears to only offer DCM1 testing at this time and it currently costs around $80. Information about their DCM genetic testing services can be found here.
Another option is to simply as your veterinarian. This actually may be easier since a lot of times vets will not only have access to a reputable genetic testing service but will collect and ship off your dog’s DNA sample for you. Then you also have the added benefit of having a veterinarian discuss the results with you and answer your questions once they come back.

Another great option is the Doberman Diversity Project, a non-profit dedicated to the betterment of the Doberman breed. This company not only offers DCM testing, but depending on your dog’s current status, you might even qualify for free testing with them. This is because their team is not only testing dogs but conducting research. If there is a need for further study of dogs like yours, you just might qualify for free testing. They also offer other wonderful options such as Holter monitor rentals, whole litter testing, and even their Embark Veterinary’s Breeder’s DNA Kit which will test your dog for a long list of potential Doberman specific disorders. From everything I’ve heard, they are a great non-profit doing wonderful things for the Doberman breed.

Please note that I am not affiliated whatsoever with any of these genetic testing services or foundations listed here. These are simply some examples of the services available and since I haven’t used them myself, I cannot vouch for these companies.

The results of DCM testing will indicate if your dog has one or two copies of the gene mutation. You can use the table below to better understand the three possible results of the test.


Possible Results of PDK4 Mutation Testing (DCM Testing)


Gene 1 Gene 2 Risk What it Means
Mutated Mutated At Risk Your dog has two copies of the mutated PDK4 gene. This means they are at the highest risk for developing DCM in their lifetime. Having two copies of the gene doesn’t mean your dog is certain to develop DCM in their lifetime, however. They will also certainly pass this mutation onto their offspring.
Non-Mutated Mutated Low Risk/Carrier Also called a “positive heterozygous” result. This means your dog has only one copy of the mutated PDK4 gene, and one copy of the normal gene. Their risk of developing DCM is low, although they can still pass the mutation on to their offspring.
Non-Mutated Non-Mutated Clear There is no mutation of the PDK4 gene detected, your dog’s risk is even lower, and they will not pass a PDK4 gene mutation on to their offspring.

If you are considering breeding your Doberman, please get genetic DCM testing performed prior to mating and only breed dogs who are clear of this mutation. It’s important that all breeders take it upon themselves to help ensure a healthy future for the Doberman.

Reversing or Curing DCM
Unfortunately, dilated cardiomyopathy is almost always a lifelong disease, especially in the Doberman breed. Typically, the best that can be done is careful management of the disease and its symptoms in an attempt to extend life as much as possible.

On rare occasions, DCM caused by nutritional deficiencies (such as taurine deficiencies) can be reversed. A 1997 study of Cocker Spaniels affected with DCM as a result of taurine deficiency showed that supplementation of taurine and l-carnitine partially or completely reversed the disease (source).

However, DCM as the result of a taurine deficiency is rare in the Doberman breed. A qualified veterinarian can help to determine if the DCM is likely the result of a taurine deficiency through the use of blood testing and other means.

Recent information from the FDA however, does seem to suggest that many breeds who are genetically susceptible to developing DCM may actually do so due to a combination of genetic and dietary influences.

Dog Foods Linked to DCM (Diet Associated DCM)
It has been long known that diet plays a role in the develope of DCM in dogs, although the extent of this is unclear. In the publication “Diet-Associated Dilated Cardiomyopathy in Dogs: What Do We Know?”, written by Lisa M. Freeman DVM, Ph.D., Joshua A. Stern DVM, Ph.D., and others who are well known in the field, they note that pet food marketers have outpaced science and “owners are not always making healthy, science-based decisions even though they want to do the best for their pets.” They also state “there appears to be an association between DCM and feeding BEG, vegetarian, vegan, or home-prepared diets in dogs…” (source).

TIP:

“BEG” stands for boutique, exotic and grain-free foods.

In June 2019, the U.S. Food and Drug Administration (FDA) released information regarding their investigation into a potential link between certain dog foods and DCM. To see this information, take a look at the FDA DCM investigation here.

This investigation has sparked a lot of conversation among Doberman owners, mainly because of two things. For one, the investigation is very specific and groups diagnosed DCM cases by (among other things) the brand of food that the dog was on. Secondly, it shows a drastic increase in reported DCM cases in recent years.

The Number of Reported DCM Cases
In 2014 and 2015 there was one case of suspected diet-linked DCM reported each year to the FDA. In 2016 there were 2 cases, and in 2017 there were 3 cases. In 2018, that number jumped to an astonishing 320 cases and in 2019 it was 197 cases. This is a very sharp, and somewhat alarming increase.

It’s very important to point out that this really has little to no bearing on how many diagnosed cases of DCM are occurring in dogs. This is only a reflection of which cases were reported. This report itself states, “the vast majority of the reports were submitted after the agency notified the public about the potential DCM/diet issue in July 2018.” This means simply that people were more likely to report the issue to the FDA after the department made that announcement than they were previously, therefor the numbers increased drastically. Reporting DCM to the FDA is a process that is completely voluntary for both owners and veterinarians, so awareness of the issue certainly has a strong impact on the number of reports made.

Also, of the 524 cases reported, only 15 involved the Doberman breed. This also shouldn’t be seen as an accurate reflection of the occurrence of DCM in Dobermans as it relates to other breeds. There are just too many other factors, including (as the report itself notes) efforts made by certain breed communities to increase reporting of their breed’s cases of DCM to the FDA. The report states “FDA has observed a reporting bias for breeds like Golden Retrievers due to breed-specific social media groups and activities that have raised awareness of the issue in these communities…”

In fact, Dobermans may be underrepresented in this report. As noted by Lisa M. Freeman, DVM, PhD, DACVN in her article Diet-Associated Dilated Cardiomyopathy (DCM): Update, July 2019, many veterinarians don’t think to report Doberman DCM cases since the breed commonly develops non-diet (genetic) associated DCM.

So it’s important that this information is taken in context since it’s far too easy to look at this sharp increase and believe that this, in and of itself, means there is an epidemic of DCM occurring. Of all these reported cases, only 15 were cases that involved the Doberman breed but yet it’s well known that instances of DCM in Dobermans are far more common than that each year in the United States. This is because reporting of DCM to the FDA is not commonly done. Also, in this case, it’s only done if it’s believed to be diet-related DCM, which is uncommon for the Doberman breed—they are more likely to suffer from genetically linked DCM.

Dog Food Brands Named Most Frequently in DCM Reports
This investigation also included detailed statistics about which brands of food these dogs were consuming. The study mentions that while many DCM cases are likely to be genetic in origin (such as is common with the Doberman breed), many are nutritionally related or even a combination of nutritionally related and genetically related.


It’s likely that some Dobermans who develope DCM do so from a combination of dietary factors and a genetic predisposition for the disease. Although you can’t control the genetic side of things once your dog’s born, you certainly can have an effect on the dietary side.

Common Characteristics Among the Brands Linked to DCM
There are some common traits of the dog foods that the FDA has identified in this list. Namely, that legumes, pulses (which are legume seeds), and/or potatoes were listed as a main ingredient in the food. According to the FDA, an ingredient is considered a “main ingredient” if it’s listed within the first 10 ingredients of the dog food, and before any vitamin or mineral ingredients.

The majority of foods that have one of these ingredients as a main ingredient are labeled and sold as “grain-free” dog food. Grain-free and other “BEG” foods have gained in popularity in recent years which may be partially to blame for the increase in DCM.

Dobermans in the FDA’s Investigation
The entire list of DCM reports to the FDA is available here. It’s worth searching the document and looking for instances of Doberman specific DCM. It’s an interesting document with many notes from the veterinarians for each dog. After careful study, there are some interesting cases that really help us to better understand DCM. Here are some of the cases involving Dobermans in this document.

https://www.fda.gov/media/128303/download


  1. A 7-year-old Doberman Pinscher diagnosed with DCM had been eating Blue Buffalo Basics salmon and potato dry food for many years however the owner rotated between regular and grain-free versions of the food. Taurine levels were checked and found to be 29 nmol/ml. Remember that 266 ± 5.1 nmol/ml is considered normal, so this dog’s taurine levels were very low. At the direction of the vet, this dog was placed on cardiac medications, taurine, and fish oil supplements. Follow-up information about the dog’s progress after these changes are not available.
  2. A 5-year-old Doberman Pinscher was diagnosed with DCM. Veterinarians initially assumed the issues were genetically related due to the breed. However, they noted he had been eating ACAN grain-free dog food. The owner put the dog on Purina Pro Plan Bright Minds in May 2018. A recheck of the dog was done on August 14, 2018 and a significant improvement in his DCM was noted in both his clinical signs and diagnostic imaging. This owner has a second Doberman in the house that was also diagnosed with DCM and also improved when the dog was taken off of the grain-free diet.
  3. A 3-year-old Doberman Pinscher was on Natural Balance Sweet Potato and Bison diet (which is a grain-free food). He began getting finicky with his food. Three days after going on a hike he threw up and was rushed to the veterinarian. He was in congestive heart failure (CHF), which is common during the later stages of DCM. Vets were unable to stabilize his condition and he died.
  4. A 10-year-old Doberman Pinscher who was being given ACANA Free-Run Poultry Grain-Free Dog Food was taken to the vet due to lameness issues. He was diagnosed with DCM and was already in congestive heart failure. He was started on medications (furosemide, enalapril, and pimobendan). He was seen again 10 days later and had improved clinically, but still had significant DCM and associated congestive heart failure. A heart arrhythmia was also noted. He was given gabapentin, fish oil, and taurine supplements. No follow-ups of this dog’s condition were provided. Another Doberman living in the same house has been eating the same food and has no signs of DCM.
  5. A 10-year-old Doberman Pinscher being fed Taste of the Wild Pacific Stream dry dog food (a grain-free dog food) was diagnosed with DCM and congestive heart failure. The owner did not change the dog’s diet after diagnosis. On re-check there were no improvements in the dog’s condition.
  6. A 9-year-old Doberman Pinscher eating Earthborn Holistic Weight Control Grain-Free dry dog food for the past 5 years was diagnosed with DCM, congestive heart failure, and atrial fibrillation (heart arrhythmia). No follow-up information is available as to the dog’s condition.
  7. An 11-year-old Doberman Pinscher on an unbalanced home-cooked diet developed a heart arrhythmia. He was seen again about 20 days later and was diagnosed with DCM and two specific forms of heart arrhythmias. Whole blood taurine level was measured at 419 nmol/ml. The owner had already started taurine supplementation. The vet recommended the owner change the dog’s diet and re-check in 3 months. No follow-up information as to the dog’s condition is available.
  8. A 9-year-old Doberman Pinscher on Orijen Grain-Free Original dry dog food was diagnosed with DCM and congestive heart failure in the emergency clinic. He was started on various medications including furosemide, diltiazem, digoxin, and pimobendan. No follow-up information is available.
  9. A 9-year-old Doberman Pinscher on Taste of the Wild grain-free dog food for the last 4 years developed a cough and was taken to the emergency clinic after three days. He was diagnosed with DCM and died at the hospital from heart failure. This owner reported that she had a Doberman previously who died at 8 years of age, also from DCM, and who was also on the same dog food.
  10. A 9-year-old Doberman Pinscher on Taste of the Wild dog food (different varieties of this food were given on rotation—all grain-free) went to his vet for lameness issues. During his checkup, an intermittent heart arrhythmia was noted. This dog had a history of dental disease. No other typical symptoms of cardiac disease were noted by the owner—no unusual coughing, sneezing, vomiting, or diarrhea. No excessive urination or increased thirst. Appetite and activity levels are normal. He was diagnosed with DCM. The dog was started on the following medications: Pimobendan, Benazepril, Spironolactone. The vet discussed adding Taurine and L-Carnitine supplementation with the owner. The vet recommended transitioning off of the grain-free diet. A repeat echocardiogram and 24-hour Holter monitor every 6 months was recommended. No follow-up information is available.
  11. An 8-year-old Doberman Pinscher on Blue Wilderness dog food (unknown variety) or Wellness Core (grain-free) dog food. The dog had an on-going cough which eventually lead to changes in respiration. The dog was diagnosed with DCM and in congestive heart failure. He was put on the following medications/supplements: Furosemide, Enalapril, Vetmedin (Pimobendan), Spironolactone, Taurine, and L-carnitine. The vet recommended a 24-hour Holter monitor to check heart rhythm, but the owner declined. The vet discussed the unlikely potential for a taurine deficiency secondary to a grain-free diet and taurine testing (whole blood/plasma), but the owner declined. No follow-up information is available.

Please Note: These are not all the cases involving the Doberman breed in the FDA’s document cited above. I did not include some entries which appeared to be repeat reports (sometimes both the veterinarian and the owner will make a report for the same dog). I also didn’t include reports with very little details that did not appear helpful to better understand this disease.


It’s too easy while reading through these cases to come away with a strong belief that DCM in Dobermans is all too tightly linked to the dog’s diet. However, it’s important to remember that DCM in Doberman Pinschers is still believed by experts to be mainly a genetically related issue. Veterinarians who see cases of genetically linked DCM would not report them to the FDA for this study. Only those cases which are suspected of being diet-linked are typically reported.

So remember that these are only cases that are “suspected” as being linked to the dog’s diet in some way. A case may be genetically related in reality, and the dog just happens to be on a grain-free diet. Or it could be a combination of a genetic predisposition towards the disease and dietary influences. Or it may be entirely diet-related—it’s impossible to tell from this study. The only way veterinarians can determine for sure if a specific case of DCM is diet-related is to change the diet and see if the dog improves.

An update in regards to this study was released by the FDA here: Vet-LIRN Update on Investigation into Dilated Cardiomyopathy. This article discusses an interesting case study of two Doberman’s living in the same household (see table 4 in that article). Both dogs had one copy of the PDK4 genetic mutation, which is a mutation that’s common in Dobermans and believed to be linked to the development of DCM (see the genetic testing section of this article for more on that mutation). They were also on grain-free diets. After switching to non-grain-free food. At a 3-month checkup, both dogs had improved significantly.

How Many Dobermans Have DCM?
A recent study showed that 58.2% of Dobermans will have DCM at some point in their lifetime (source). This is widely believed by experts to largely be the result of a genetic predisposition towards the disease in the Doberman breed.

DCM seems to become more common in Dobermans as they get older. The same study found the prevalence of DCM in Doberman Pinschers at various age groups to be as follows.

Prevalence of DCM in Dobermans by Age

Age Group Prevalence of DCM
1 - 2 Years 3.3%
2 - 4 Years 9.9%
4 - 6 Years 12.5%
6 - 8 Years 43.6%
Over 8 Years 44.1%

This study showed that there was about an equal occurrence of DCM in male versus female Dobermans. However, affected male Dobermans showed earlier detectable changes in the heart than females.

For a well-researched article about the prevalence of DCM in Doberman Pinschers, including breakdowns by age of the affected dog, see Prevalence of Dilated Cardiomyopathy in Doberman Pinschers in Various Age Groups.

As mentioned earlier, the FDA’s report on DCM should not be considered an accurate reflection of the prevalence of DCM in the Doberman breed. Unfortunately, the disease is still very common in Doberman’s and genetic testing by breeders is imperative in reducing the occurrence of this disease.

Final Thoughts: What Can Doberman Owners Do?
Hopefully, as a Doberman owner, you now have a better idea about DCM and what is currently known about the disease. With the recent release of the DCM investigation information by the FDA, there are a lot of concerned owners out there. Remember that the FDA’s report is only a very small snapshot of certain occurrences of the disease. If you are still concerned about this report, take a look at the FDA’s Question and Answer article in regards to this report.

There are only a few things that we have control over as Doberman owners. That being said, the following actions are about the best we can do:

  1. Perform genetic testing of your Dobermans to determine their risk level. This is especially important of breeders to perform prior to selecting breeding partners. Then check all puppies in the litter. This incredibly important to help reduce the occurrence of DCM in the Doberman breed.
  2. Provide plenty of exercise in a healthy manner to improve the strength of your dog’s heart.
  3. Feed your dog a quality grain-containing diet.
  4. Get regular check-ups at the veterinarian that include checking heart functions and blood work to identify any dietary deficiencies or early signs of DCM.
  5. Bring your dog to the veterinarian immediately if you notice anything unusual about your dog or their behavior.
If Doberman breeders and owners stay responsible in the way in which we’re handling this disease, we may be able to make a significant impact in reducing the prevalence of DCM in this wonderful breed.
Related Questions
Is DCM painful in dogs? While dilated cardiomyopathy (DCM) is not painful or uncomfortable in and of itself for a dog, sometimes the symptoms can be. These symptoms can include coughing, abdominal swelling, labored breathing, exercise intolerance, and sudden collapse or fainting.
 

LifeofRubie

Active Member
scary stuff!

Instead of waiting for the DPCA Nationals in October of 2020 for an echo, the breeder I borrowed the Holter from informed me of one happening this November in St Charles, IL. It's about twice the cost of nationals, I think, but Dingo will be four in December. eek.

If anyone is near St Charles, IL and wants the info, lemme know!
 

Vinnie's Mom

Hot Topics Subscriber
LOTS OF INFO HERE!

Doberman Pinscher Dilated Cardiomyopathy (DCM) Simplified

Doberman Pinscher Dilated Cardiomyopathy (DCM) Simplified
Written by John Walter Updated on July 26, 2019

DCM-in-Dobermans-Large.jpg


Reviewed by Donald Buchanan, DVM

There has been a lot of confusion, and even panic, surrounding dilated cardiomyopathy (DCM), also known as simply “an enlarged heart”, within the Doberman community lately. Unfortunately, instances of Doberman’s diagnosed with DCM seems to be increasing in recent years.

To make the panic worse, the FDA has released a list of dog foods that have been linked to DCM in canines. So what does this all mean? Before you panic, let’s simplify all of this so the average owner (like you and me) can get a better grasp on things.

What is DCM in Dobermans? Dilated cardiomyopathy (or DCM) in Dobermans, also known as an enlarged heart, is a condition where chambers of the heart have become enlarged and the walls of the heart have become thinner. As a result, the heart is no longer able to pump blood as efficiently to the rest of the body.

After discussions with other owners, reviewing the most recent studies possible, and consulting with various veterinary professionals, I’ve compiled this information specifically for Doberman owners who are concerned about, or dealing with, DCM. My goal is to make this disease easier for the average dog owner like you and me to understand.


Table of Contents [hide]


Symptoms
I think it’s very important that we discuss the signs and symptoms to look for in your dog. Besides discussing just the general symptoms, I want to designate which of these symptoms are most likely to show themselves during the early stages of DCM because catching this condition early will make managing the disease much easier, and can often result in better outcomes.

Early Stages
Unfortunately, dilated cardiomyopathy is very difficult (or impossible) to detect during the early stages. However, the symptoms listed below are usually the first to show up and may still be detectable during the early stages. Of course, these are certainly more noticeable during the later stages. These early signs can include:

  • Decreased tolerance to exercise.
  • Unusual heart sounds or murmurs.
  • Irregular heart rhythm or arrhythmias.
In the early stages of this disease, these symptoms may not be detectable at all. A qualified veterinarian with the correct test equipment will be much more likely to detect these issues. A subtle heart arrhythmia, for example, may only be detectable through the use of a 24-hour, wearable, electrocardiogram (or ECG) device called a “Holter monitor.” These devices record the electrical activity of your dog’s heart. Think of it as a recording of your dog’s heartbeat.

An ECG done at the veterinarian may not always detect the issue. This is because the arrhythmia may not be constant throughout the day. So your dog can test normal during a 5 minute long ECG test at the vet, but still have an arrhythmia and possibly even DCM. That’s why a take-home, wearable, ECG device like a Holter monitor will often detect these issues where an ECG done at the veterinarian may miss them.

DCM-Heart-Diagram-Large.jpg


Later Stages
As this disease progresses, the signs and symptoms become much more apparent. All the early signs listed above are usually present, but more apparent. There are also many additional symptoms during the later stages of DCM. These signs can include:

  • Lethargy (even less tolerance to exercise)
  • Unusual heart sounds or murmurs
  • Irregular heart rhythm or arrhythmias
  • Increased heart rate
  • Weakness
  • Sudden collapse/fainting
  • Loss of appetite
  • Weight loss
  • Coughing
  • Faster and more labored breathing
  • Abdominal swelling
  • Pale gums
  • Sudden death
Unfortunately, if the issue isn’t detected until the later stages, intervention is usually minimally successful (if at all).

If you suspect that your dog may have DCM, it’s important to get him to a qualified veterinarian as soon as possible. Early diagnosis is key to successful treatment.

“Many cardiac cases in large breed dogs present to me as lameness cases. Large dogs that are slow to get up out of bed, weak (especially in the hind end), or intolerant of normal exercise should be considered as possible cardiac patients.”

– Donald Buchanan, DVM
Diagnosis
Dilated cardiomyopathy in your dog should only be diagnosed by a qualified veterinarian or specialist. There are many tools and techniques they may use to help diagnose your dog, but an echocardiogram (or echo test) of the heart is the most definitive method. Below are some of the tools or techniques that your veterinarian may use to help them diagnose DCM.

  • Echocardiogram (echo test): Your veterinarian may also refer to this test as a transthoracic echo (or TTE). This is the most definitive method of diagnosis. This is simply an ultrasound of your dog’s heart. It’s painless and provides a detailed image of the heart, it’s valves, and most importantly the chambers of the heart (also known as “ventricles”) using soundwaves. This makes it possible to measure the muscle wall thickness and pumping ability of the heart.
  • Electrocardiogram (EKG or ECG): This test measures and records the electrical activity of the heart through small electrodes that are attached to your dog. During this test, your vet will be looking for signs of unusual heart activity such as arrhythmias.
  • Holter Monitor: This is basically another form of electrocardiogram (ECG), however, this device is wearable for an extended period. A Holter monitor is typically carried by your dog in a specialized vest and a few adhesive pads are attached to monitor your dog’s heart. Heart arrhythmias may not be consistent throughout the day, so often a wearable ECG device such as this is best to identify any arrhythmias that are present. This may only provide a possible indication of DCM, however, since it’s certainly possible for your dog to have an arrhythmia without having DCM.
  • Thoracic Radiography (x-ray): An x-ray may be used to help evaluate the size of the heart and the condition of the lungs. Your veterinarian will most likely also be using this as a way to gauge fluid accumulation in, or around, the lungs—another sign of DCM.
  • NT-proBNP Blood Test: This simple blood test checks for the amount of a certain protein that is associated with hormones that the heart produces. The heart will produce these in larger quantities when it’s needing to work harder. That means it can provide insight into whether or not the heart is struggling to pump blood to the body.
  • Troponin Blood Test: This test checks for the levels of troponin T or troponin I proteins in the blood. These proteins are released when there is damage to the heart. The greater the damage, the higher levels of these proteins will be present.
  • Other Blood Tests: Other blood tests may be used to help determine if there are any dietary deficiencies as these can lead to the development of nutritionally-linked DCM. One of the most common is a test to check taurine levels (an important amino acid). Normal whole blood taurine concentration is generally considered to be 266 ± 5.1 nmol/ml (source).
All of the tests listed above are tools that your veterinarian may use to help them to make a decision on a DCM diagnosis. Each one provides a piece to the puzzle. Your vet may not need to perform all of these tests. Instead, they’ll make a DCM diagnosis once he or she is confident that your dog is affected by this disease.

Treatment
Treatment for DCM is tailored to the individual dog and is rarely the same from one dog to the next. This is because every case is different. So it’s fairly difficult to outline what your veterinarian is likely to recommend for your specific case. However, below are some of the common approaches us Doberman owners see for this disease.

Most commonly treatment plans will involve the use of certain medications meant to help reduce the workload of the heart and allow blood to pump more easily, as well as medications to improve the pumping action (or contraction) of the heart. Medications such as pimobendan can be used for this. In Dobermans, pimobendan has shown to be beneficial in prolonging lifespan when started at the time of diagnosis of DCM, as opposed to waiting until clinical heart failure is realized.

“Unfortunately, even well managed dog on heart medications can rapidly decompensate. Owners of pets with DCM should be prepared to call their veterinarian’s emergency line at any time, especially dogs in later stages of the disease.”

– Donald Buchanan, DVM
Diuretics (such as furosemide) may be used to reduce fluid buildup in the lungs or abdomen. There are some side effects of using diuretics though, so often medications such as enalapril or benazepril, which are “angiotensin-converting enzyme” (or ACE) inhibitors, may be used to reduce the harmful side effects of the diuretics. ACE inhibitors also help improve general blood flow, which is another benefit for a dog suffering from DCM. A procedure to physically remove the buildup of fluid in the dog’s abdomen or chest cavity may be used for DCM cases that are more severe.

Additional medications might be used to help control heart rate and arrhythmias (if present). These medications can be injected in an emergency situation, however, they’re most often given orally to dogs who are in a more stable condition. Dietary supplementation may also be used in an attempt to help support the heart. This often includes the use of L-carnitine, taurine, and omega-3 fatty acid supplements.

DCM tends to be progressive and is usually not reversible in Dobermans. This is because the Doberman breed is pre-dispositioned toward genetically linked DCM. Therefore the number and quantities of medications tend to need to be increased with time. The exception to this is DCM that is the result of dietary deficiencies (such as low taurine levels) which may be reversible if caught early enough. DCM caused by low taurine levels can be identified by a blood test to check for the presence of a taurine deficiency. Unfortunately, most DCM cases in Dobermans are of the genetic type and are not reversible.

Update on Possible Treatments
The results of a new study suggests that DCM may, in fact, be an autoimmune disease (source). This is possibly very good news for Doberman owners since there are drugs known to suppress autoimmune reactions in humans. Basically, this study means that a medication that actually prevents DCM (or stops it from progressing) may not be far off. For an in-depth explanation of this, see the article DCM in Dobermans is an autoimmune disease on the Better Bred website.

Doberman-at-the-Vet-Large.jpg

Early diagnosis is key for successful treatment ensuring the longest possible lifespan.

Lifespan After Diagnosis
Once diagnosed, if a Doberman is already showing signs of congestive heart failure, they are most likely to die within about 6 months. However, some may live as long as 1 or 2 years in ideal situations and with proper intervention.

If your veterinarian determines that your dog is one of the rare few to have DCM due to a dietary deficiency (such as a taurine deficiency), and you caught it early enough, there is a possibility of reversing the disease. However, this is exceptionally rare, especially with Dobermans.

“DCM in Dobermans is a fatal disease. In this breed, nearly one-third of all deaths due to DCM are in the form of sudden death, not congestive heart disease”

– Donald Buchanan, DVM
Exercising After Diagnosis
Always speak to your veterinarian about your dog’s activity levels if he or she has been diagnosed with DCM. In general, your vet will likely be working with you to find ways to reduce the strain placed on your dog’s heart. This includes finding ways to reduce strenuous exercise and general activity levels.

Lower physical exertion means less stress is placed on the heart. So strenuous activity is not recommended for a dog with DCM.

Preventing DCM
Sometimes there isn’t much you can do to prevent DCM, especially in dogs who are genetically predispositioned to have the disease such as Dobermans. However, quality diet and regular exercise are key to ensuring your dog has a strong heart.

If you are considering getting a Doberman puppy and are concerned with DCM, make sure you find a reputable breeder who performs genetic testing on their dogs (and puppies) to see if the dogs carry the gene mutation that is known to cause DCM.

Genetic Testing
There are currently two genetic tests available that look for a specific genetic mutation that is linked to DCM. These tests are called “DCM1” and “DCM2” and look for mutations in what’s called the “PDK4” gene. This gene mutation has been identified as being linked to DCM. If a dog is affected by this mutation, their likelihood of developing DCM sometime in their life greatly increases, and their pups also have a chance of inheriting this mutation.

DCM1 was the original test for the genetic mutation that has traditionally been linked to the disease. More recently, however, a second genetic mutation has been linked to the development of DCM in Dobermans. This has lead to the creation of the second test called DCM2.

If you want to be as thorough as possible with the testing of your dog, you should get both the DCM1 and DCM2 genetic tests performed. This will give the most complete picture currently possible as to your dog’s risk level of developing the disease. Below are a few companies that offer this testing online.

  • VetGen: This company performs both DCM1 and DCM2 genetic testing. Their Doberman specific DNA testing section can be found here. On that page, look for the test labeled as “DCM1 and DCM2”. This is their genetic testing for DCM in Dobermans and costs around $100.
  • VNC State Veterinary Hospital: This company offers both DCM1 and DCM2 testing. Their Doberman DCM testing page can be found here. At this time of this article, these tests can be purchased individually for around $50 each, or $70 for both tests. They also offer discounts if you are testing an entire litter of dogs, which is a great idea if you’re a breeder.
  • AnimalGenetics.us: It appears that this company only offers DCM1 testing at this time. Their DCM genetic testing page can be found here. At the time of this article’s writing, tests cost around $45.
  • Paw Print Genetics: This company appears to only offer DCM1 testing at this time and it currently costs around $80. Information about their DCM genetic testing services can be found here.
Another option is to simply as your veterinarian. This actually may be easier since a lot of times vets will not only have access to a reputable genetic testing service but will collect and ship off your dog’s DNA sample for you. Then you also have the added benefit of having a veterinarian discuss the results with you and answer your questions once they come back.

Another great option is the Doberman Diversity Project, a non-profit dedicated to the betterment of the Doberman breed. This company not only offers DCM testing, but depending on your dog’s current status, you might even qualify for free testing with them. This is because their team is not only testing dogs but conducting research. If there is a need for further study of dogs like yours, you just might qualify for free testing. They also offer other wonderful options such as Holter monitor rentals, whole litter testing, and even their Embark Veterinary’s Breeder’s DNA Kit which will test your dog for a long list of potential Doberman specific disorders. From everything I’ve heard, they are a great non-profit doing wonderful things for the Doberman breed.

Please note that I am not affiliated whatsoever with any of these genetic testing services or foundations listed here. These are simply some examples of the services available and since I haven’t used them myself, I cannot vouch for these companies.

The results of DCM testing will indicate if your dog has one or two copies of the gene mutation. You can use the table below to better understand the three possible results of the test.


Possible Results of PDK4 Mutation Testing (DCM Testing)


Gene 1 Gene 2 Risk What it Means
Mutated Mutated At Risk Your dog has two copies of the mutated PDK4 gene. This means they are at the highest risk for developing DCM in their lifetime. Having two copies of the gene doesn’t mean your dog is certain to develop DCM in their lifetime, however. They will also certainly pass this mutation onto their offspring.
Non-Mutated Mutated Low Risk/Carrier Also called a “positive heterozygous” result. This means your dog has only one copy of the mutated PDK4 gene, and one copy of the normal gene. Their risk of developing DCM is low, although they can still pass the mutation on to their offspring.
Non-Mutated Non-Mutated Clear There is no mutation of the PDK4 gene detected, your dog’s risk is even lower, and they will not pass a PDK4 gene mutation on to their offspring.

If you are considering breeding your Doberman, please get genetic DCM testing performed prior to mating and only breed dogs who are clear of this mutation. It’s important that all breeders take it upon themselves to help ensure a healthy future for the Doberman.

Reversing or Curing DCM
Unfortunately, dilated cardiomyopathy is almost always a lifelong disease, especially in the Doberman breed. Typically, the best that can be done is careful management of the disease and its symptoms in an attempt to extend life as much as possible.

On rare occasions, DCM caused by nutritional deficiencies (such as taurine deficiencies) can be reversed. A 1997 study of Cocker Spaniels affected with DCM as a result of taurine deficiency showed that supplementation of taurine and l-carnitine partially or completely reversed the disease (source).

However, DCM as the result of a taurine deficiency is rare in the Doberman breed. A qualified veterinarian can help to determine if the DCM is likely the result of a taurine deficiency through the use of blood testing and other means.

Recent information from the FDA however, does seem to suggest that many breeds who are genetically susceptible to developing DCM may actually do so due to a combination of genetic and dietary influences.

Dog Foods Linked to DCM (Diet Associated DCM)
It has been long known that diet plays a role in the develope of DCM in dogs, although the extent of this is unclear. In the publication “Diet-Associated Dilated Cardiomyopathy in Dogs: What Do We Know?”, written by Lisa M. Freeman DVM, Ph.D., Joshua A. Stern DVM, Ph.D., and others who are well known in the field, they note that pet food marketers have outpaced science and “owners are not always making healthy, science-based decisions even though they want to do the best for their pets.” They also state “there appears to be an association between DCM and feeding BEG, vegetarian, vegan, or home-prepared diets in dogs…” (source).

TIP:

“BEG” stands for boutique, exotic and grain-free foods.

In June 2019, the U.S. Food and Drug Administration (FDA) released information regarding their investigation into a potential link between certain dog foods and DCM. To see this information, take a look at the FDA DCM investigation here.

This investigation has sparked a lot of conversation among Doberman owners, mainly because of two things. For one, the investigation is very specific and groups diagnosed DCM cases by (among other things) the brand of food that the dog was on. Secondly, it shows a drastic increase in reported DCM cases in recent years.

The Number of Reported DCM Cases
In 2014 and 2015 there was one case of suspected diet-linked DCM reported each year to the FDA. In 2016 there were 2 cases, and in 2017 there were 3 cases. In 2018, that number jumped to an astonishing 320 cases and in 2019 it was 197 cases. This is a very sharp, and somewhat alarming increase.

It’s very important to point out that this really has little to no bearing on how many diagnosed cases of DCM are occurring in dogs. This is only a reflection of which cases were reported. This report itself states, “the vast majority of the reports were submitted after the agency notified the public about the potential DCM/diet issue in July 2018.” This means simply that people were more likely to report the issue to the FDA after the department made that announcement than they were previously, therefor the numbers increased drastically. Reporting DCM to the FDA is a process that is completely voluntary for both owners and veterinarians, so awareness of the issue certainly has a strong impact on the number of reports made.

Also, of the 524 cases reported, only 15 involved the Doberman breed. This also shouldn’t be seen as an accurate reflection of the occurrence of DCM in Dobermans as it relates to other breeds. There are just too many other factors, including (as the report itself notes) efforts made by certain breed communities to increase reporting of their breed’s cases of DCM to the FDA. The report states “FDA has observed a reporting bias for breeds like Golden Retrievers due to breed-specific social media groups and activities that have raised awareness of the issue in these communities…”

In fact, Dobermans may be underrepresented in this report. As noted by Lisa M. Freeman, DVM, PhD, DACVN in her article Diet-Associated Dilated Cardiomyopathy (DCM): Update, July 2019, many veterinarians don’t think to report Doberman DCM cases since the breed commonly develops non-diet (genetic) associated DCM.

So it’s important that this information is taken in context since it’s far too easy to look at this sharp increase and believe that this, in and of itself, means there is an epidemic of DCM occurring. Of all these reported cases, only 15 were cases that involved the Doberman breed but yet it’s well known that instances of DCM in Dobermans are far more common than that each year in the United States. This is because reporting of DCM to the FDA is not commonly done. Also, in this case, it’s only done if it’s believed to be diet-related DCM, which is uncommon for the Doberman breed—they are more likely to suffer from genetically linked DCM.

Dog Food Brands Named Most Frequently in DCM Reports
This investigation also included detailed statistics about which brands of food these dogs were consuming. The study mentions that while many DCM cases are likely to be genetic in origin (such as is common with the Doberman breed), many are nutritionally related or even a combination of nutritionally related and genetically related.


It’s likely that some Dobermans who develope DCM do so from a combination of dietary factors and a genetic predisposition for the disease. Although you can’t control the genetic side of things once your dog’s born, you certainly can have an effect on the dietary side.

Common Characteristics Among the Brands Linked to DCM
There are some common traits of the dog foods that the FDA has identified in this list. Namely, that legumes, pulses (which are legume seeds), and/or potatoes were listed as a main ingredient in the food. According to the FDA, an ingredient is considered a “main ingredient” if it’s listed within the first 10 ingredients of the dog food, and before any vitamin or mineral ingredients.

The majority of foods that have one of these ingredients as a main ingredient are labeled and sold as “grain-free” dog food. Grain-free and other “BEG” foods have gained in popularity in recent years which may be partially to blame for the increase in DCM.

Dobermans in the FDA’s Investigation
The entire list of DCM reports to the FDA is available here. It’s worth searching the document and looking for instances of Doberman specific DCM. It’s an interesting document with many notes from the veterinarians for each dog. After careful study, there are some interesting cases that really help us to better understand DCM. Here are some of the cases involving Dobermans in this document.

https://www.fda.gov/media/128303/download


  1. A 7-year-old Doberman Pinscher diagnosed with DCM had been eating Blue Buffalo Basics salmon and potato dry food for many years however the owner rotated between regular and grain-free versions of the food. Taurine levels were checked and found to be 29 nmol/ml. Remember that 266 ± 5.1 nmol/ml is considered normal, so this dog’s taurine levels were very low. At the direction of the vet, this dog was placed on cardiac medications, taurine, and fish oil supplements. Follow-up information about the dog’s progress after these changes are not available.
  2. A 5-year-old Doberman Pinscher was diagnosed with DCM. Veterinarians initially assumed the issues were genetically related due to the breed. However, they noted he had been eating ACAN grain-free dog food. The owner put the dog on Purina Pro Plan Bright Minds in May 2018. A recheck of the dog was done on August 14, 2018 and a significant improvement in his DCM was noted in both his clinical signs and diagnostic imaging. This owner has a second Doberman in the house that was also diagnosed with DCM and also improved when the dog was taken off of the grain-free diet.
  3. A 3-year-old Doberman Pinscher was on Natural Balance Sweet Potato and Bison diet (which is a grain-free food). He began getting finicky with his food. Three days after going on a hike he threw up and was rushed to the veterinarian. He was in congestive heart failure (CHF), which is common during the later stages of DCM. Vets were unable to stabilize his condition and he died.
  4. A 10-year-old Doberman Pinscher who was being given ACANA Free-Run Poultry Grain-Free Dog Food was taken to the vet due to lameness issues. He was diagnosed with DCM and was already in congestive heart failure. He was started on medications (furosemide, enalapril, and pimobendan). He was seen again 10 days later and had improved clinically, but still had significant DCM and associated congestive heart failure. A heart arrhythmia was also noted. He was given gabapentin, fish oil, and taurine supplements. No follow-ups of this dog’s condition were provided. Another Doberman living in the same house has been eating the same food and has no signs of DCM.
  5. A 10-year-old Doberman Pinscher being fed Taste of the Wild Pacific Stream dry dog food (a grain-free dog food) was diagnosed with DCM and congestive heart failure. The owner did not change the dog’s diet after diagnosis. On re-check there were no improvements in the dog’s condition.
  6. A 9-year-old Doberman Pinscher eating Earthborn Holistic Weight Control Grain-Free dry dog food for the past 5 years was diagnosed with DCM, congestive heart failure, and atrial fibrillation (heart arrhythmia). No follow-up information is available as to the dog’s condition.
  7. An 11-year-old Doberman Pinscher on an unbalanced home-cooked diet developed a heart arrhythmia. He was seen again about 20 days later and was diagnosed with DCM and two specific forms of heart arrhythmias. Whole blood taurine level was measured at 419 nmol/ml. The owner had already started taurine supplementation. The vet recommended the owner change the dog’s diet and re-check in 3 months. No follow-up information as to the dog’s condition is available.
  8. A 9-year-old Doberman Pinscher on Orijen Grain-Free Original dry dog food was diagnosed with DCM and congestive heart failure in the emergency clinic. He was started on various medications including furosemide, diltiazem, digoxin, and pimobendan. No follow-up information is available.
  9. A 9-year-old Doberman Pinscher on Taste of the Wild grain-free dog food for the last 4 years developed a cough and was taken to the emergency clinic after three days. He was diagnosed with DCM and died at the hospital from heart failure. This owner reported that she had a Doberman previously who died at 8 years of age, also from DCM, and who was also on the same dog food.
  10. A 9-year-old Doberman Pinscher on Taste of the Wild dog food (different varieties of this food were given on rotation—all grain-free) went to his vet for lameness issues. During his checkup, an intermittent heart arrhythmia was noted. This dog had a history of dental disease. No other typical symptoms of cardiac disease were noted by the owner—no unusual coughing, sneezing, vomiting, or diarrhea. No excessive urination or increased thirst. Appetite and activity levels are normal. He was diagnosed with DCM. The dog was started on the following medications: Pimobendan, Benazepril, Spironolactone. The vet discussed adding Taurine and L-Carnitine supplementation with the owner. The vet recommended transitioning off of the grain-free diet. A repeat echocardiogram and 24-hour Holter monitor every 6 months was recommended. No follow-up information is available.
  11. An 8-year-old Doberman Pinscher on Blue Wilderness dog food (unknown variety) or Wellness Core (grain-free) dog food. The dog had an on-going cough which eventually lead to changes in respiration. The dog was diagnosed with DCM and in congestive heart failure. He was put on the following medications/supplements: Furosemide, Enalapril, Vetmedin (Pimobendan), Spironolactone, Taurine, and L-carnitine. The vet recommended a 24-hour Holter monitor to check heart rhythm, but the owner declined. The vet discussed the unlikely potential for a taurine deficiency secondary to a grain-free diet and taurine testing (whole blood/plasma), but the owner declined. No follow-up information is available.

Please Note: These are not all the cases involving the Doberman breed in the FDA’s document cited above. I did not include some entries which appeared to be repeat reports (sometimes both the veterinarian and the owner will make a report for the same dog). I also didn’t include reports with very little details that did not appear helpful to better understand this disease.


It’s too easy while reading through these cases to come away with a strong belief that DCM in Dobermans is all too tightly linked to the dog’s diet. However, it’s important to remember that DCM in Doberman Pinschers is still believed by experts to be mainly a genetically related issue. Veterinarians who see cases of genetically linked DCM would not report them to the FDA for this study. Only those cases which are suspected of being diet-linked are typically reported.

So remember that these are only cases that are “suspected” as being linked to the dog’s diet in some way. A case may be genetically related in reality, and the dog just happens to be on a grain-free diet. Or it could be a combination of a genetic predisposition towards the disease and dietary influences. Or it may be entirely diet-related—it’s impossible to tell from this study. The only way veterinarians can determine for sure if a specific case of DCM is diet-related is to change the diet and see if the dog improves.

An update in regards to this study was released by the FDA here: Vet-LIRN Update on Investigation into Dilated Cardiomyopathy. This article discusses an interesting case study of two Doberman’s living in the same household (see table 4 in that article). Both dogs had one copy of the PDK4 genetic mutation, which is a mutation that’s common in Dobermans and believed to be linked to the development of DCM (see the genetic testing section of this article for more on that mutation). They were also on grain-free diets. After switching to non-grain-free food. At a 3-month checkup, both dogs had improved significantly.

How Many Dobermans Have DCM?
A recent study showed that 58.2% of Dobermans will have DCM at some point in their lifetime (source). This is widely believed by experts to largely be the result of a genetic predisposition towards the disease in the Doberman breed.

DCM seems to become more common in Dobermans as they get older. The same study found the prevalence of DCM in Doberman Pinschers at various age groups to be as follows.

Prevalence of DCM in Dobermans by Age

Age Group Prevalence of DCM
1 - 2 Years 3.3%
2 - 4 Years 9.9%
4 - 6 Years 12.5%
6 - 8 Years 43.6%
Over 8 Years 44.1%

This study showed that there was about an equal occurrence of DCM in male versus female Dobermans. However, affected male Dobermans showed earlier detectable changes in the heart than females.

For a well-researched article about the prevalence of DCM in Doberman Pinschers, including breakdowns by age of the affected dog, see Prevalence of Dilated Cardiomyopathy in Doberman Pinschers in Various Age Groups.

As mentioned earlier, the FDA’s report on DCM should not be considered an accurate reflection of the prevalence of DCM in the Doberman breed. Unfortunately, the disease is still very common in Doberman’s and genetic testing by breeders is imperative in reducing the occurrence of this disease.

Final Thoughts: What Can Doberman Owners Do?
Hopefully, as a Doberman owner, you now have a better idea about DCM and what is currently known about the disease. With the recent release of the DCM investigation information by the FDA, there are a lot of concerned owners out there. Remember that the FDA’s report is only a very small snapshot of certain occurrences of the disease. If you are still concerned about this report, take a look at the FDA’s Question and Answer article in regards to this report.

There are only a few things that we have control over as Doberman owners. That being said, the following actions are about the best we can do:

  1. Perform genetic testing of your Dobermans to determine their risk level. This is especially important of breeders to perform prior to selecting breeding partners. Then check all puppies in the litter. This incredibly important to help reduce the occurrence of DCM in the Doberman breed.
  2. Provide plenty of exercise in a healthy manner to improve the strength of your dog’s heart.
  3. Feed your dog a quality grain-containing diet.
  4. Get regular check-ups at the veterinarian that include checking heart functions and blood work to identify any dietary deficiencies or early signs of DCM.
  5. Bring your dog to the veterinarian immediately if you notice anything unusual about your dog or their behavior.
If Doberman breeders and owners stay responsible in the way in which we’re handling this disease, we may be able to make a significant impact in reducing the prevalence of DCM in this wonderful breed.
Related Questions
Is DCM painful in dogs? While dilated cardiomyopathy (DCM) is not painful or uncomfortable in and of itself for a dog, sometimes the symptoms can be. These symptoms can include coughing, abdominal swelling, labored breathing, exercise intolerance, and sudden collapse or fainting.
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Doberman Pinscher Dilated Cardiomyopathy (DCM) Simplified

Doberman Pinscher Dilated Cardiomyopathy (DCM) Simplified
Written by John Walter Updated on July 26, 2019

DCM-in-Dobermans-Large.jpg


Reviewed by Donald Buchanan, DVM

There has been a lot of confusion, and even panic, surrounding dilated cardiomyopathy (DCM), also known as simply “an enlarged heart”, within the Doberman community lately. Unfortunately, instances of Doberman’s diagnosed with DCM seems to be increasing in recent years.

To make the panic worse, the FDA has released a list of dog foods that have been linked to DCM in canines. So what does this all mean? Before you panic, let’s simplify all of this so the average owner (like you and me) can get a better grasp on things.

What is DCM in Dobermans? Dilated cardiomyopathy (or DCM) in Dobermans, also known as an enlarged heart, is a condition where chambers of the heart have become enlarged and the walls of the heart have become thinner. As a result, the heart is no longer able to pump blood as efficiently to the rest of the body.

After discussions with other owners, reviewing the most recent studies possible, and consulting with various veterinary professionals, I’ve compiled this information specifically for Doberman owners who are concerned about, or dealing with, DCM. My goal is to make this disease easier for the average dog owner like you and me to understand.


Table of Contents [hide]


Symptoms
I think it’s very important that we discuss the signs and symptoms to look for in your dog. Besides discussing just the general symptoms, I want to designate which of these symptoms are most likely to show themselves during the early stages of DCM because catching this condition early will make managing the disease much easier, and can often result in better outcomes.

Early Stages
Unfortunately, dilated cardiomyopathy is very difficult (or impossible) to detect during the early stages. However, the symptoms listed below are usually the first to show up and may still be detectable during the early stages. Of course, these are certainly more noticeable during the later stages. These early signs can include:

  • Decreased tolerance to exercise.
  • Unusual heart sounds or murmurs.
  • Irregular heart rhythm or arrhythmias.
In the early stages of this disease, these symptoms may not be detectable at all. A qualified veterinarian with the correct test equipment will be much more likely to detect these issues. A subtle heart arrhythmia, for example, may only be detectable through the use of a 24-hour, wearable, electrocardiogram (or ECG) device called a “Holter monitor.” These devices record the electrical activity of your dog’s heart. Think of it as a recording of your dog’s heartbeat.

An ECG done at the veterinarian may not always detect the issue. This is because the arrhythmia may not be constant throughout the day. So your dog can test normal during a 5 minute long ECG test at the vet, but still have an arrhythmia and possibly even DCM. That’s why a take-home, wearable, ECG device like a Holter monitor will often detect these issues where an ECG done at the veterinarian may miss them.

DCM-Heart-Diagram-Large.jpg


Later Stages
As this disease progresses, the signs and symptoms become much more apparent. All the early signs listed above are usually present, but more apparent. There are also many additional symptoms during the later stages of DCM. These signs can include:

  • Lethargy (even less tolerance to exercise)
  • Unusual heart sounds or murmurs
  • Irregular heart rhythm or arrhythmias
  • Increased heart rate
  • Weakness
  • Sudden collapse/fainting
  • Loss of appetite
  • Weight loss
  • Coughing
  • Faster and more labored breathing
  • Abdominal swelling
  • Pale gums
  • Sudden death
Unfortunately, if the issue isn’t detected until the later stages, intervention is usually minimally successful (if at all).

If you suspect that your dog may have DCM, it’s important to get him to a qualified veterinarian as soon as possible. Early diagnosis is key to successful treatment.

“Many cardiac cases in large breed dogs present to me as lameness cases. Large dogs that are slow to get up out of bed, weak (especially in the hind end), or intolerant of normal exercise should be considered as possible cardiac patients.”

– Donald Buchanan, DVM
Diagnosis
Dilated cardiomyopathy in your dog should only be diagnosed by a qualified veterinarian or specialist. There are many tools and techniques they may use to help diagnose your dog, but an echocardiogram (or echo test) of the heart is the most definitive method. Below are some of the tools or techniques that your veterinarian may use to help them diagnose DCM.

  • Echocardiogram (echo test): Your veterinarian may also refer to this test as a transthoracic echo (or TTE). This is the most definitive method of diagnosis. This is simply an ultrasound of your dog’s heart. It’s painless and provides a detailed image of the heart, it’s valves, and most importantly the chambers of the heart (also known as “ventricles”) using soundwaves. This makes it possible to measure the muscle wall thickness and pumping ability of the heart.
  • Electrocardiogram (EKG or ECG): This test measures and records the electrical activity of the heart through small electrodes that are attached to your dog. During this test, your vet will be looking for signs of unusual heart activity such as arrhythmias.
  • Holter Monitor: This is basically another form of electrocardiogram (ECG), however, this device is wearable for an extended period. A Holter monitor is typically carried by your dog in a specialized vest and a few adhesive pads are attached to monitor your dog’s heart. Heart arrhythmias may not be consistent throughout the day, so often a wearable ECG device such as this is best to identify any arrhythmias that are present. This may only provide a possible indication of DCM, however, since it’s certainly possible for your dog to have an arrhythmia without having DCM.
  • Thoracic Radiography (x-ray): An x-ray may be used to help evaluate the size of the heart and the condition of the lungs. Your veterinarian will most likely also be using this as a way to gauge fluid accumulation in, or around, the lungs—another sign of DCM.
  • NT-proBNP Blood Test: This simple blood test checks for the amount of a certain protein that is associated with hormones that the heart produces. The heart will produce these in larger quantities when it’s needing to work harder. That means it can provide insight into whether or not the heart is struggling to pump blood to the body.
  • Troponin Blood Test: This test checks for the levels of troponin T or troponin I proteins in the blood. These proteins are released when there is damage to the heart. The greater the damage, the higher levels of these proteins will be present.
  • Other Blood Tests: Other blood tests may be used to help determine if there are any dietary deficiencies as these can lead to the development of nutritionally-linked DCM. One of the most common is a test to check taurine levels (an important amino acid). Normal whole blood taurine concentration is generally considered to be 266 ± 5.1 nmol/ml (source).
All of the tests listed above are tools that your veterinarian may use to help them to make a decision on a DCM diagnosis. Each one provides a piece to the puzzle. Your vet may not need to perform all of these tests. Instead, they’ll make a DCM diagnosis once he or she is confident that your dog is affected by this disease.

Treatment
Treatment for DCM is tailored to the individual dog and is rarely the same from one dog to the next. This is because every case is different. So it’s fairly difficult to outline what your veterinarian is likely to recommend for your specific case. However, below are some of the common approaches us Doberman owners see for this disease.

Most commonly treatment plans will involve the use of certain medications meant to help reduce the workload of the heart and allow blood to pump more easily, as well as medications to improve the pumping action (or contraction) of the heart. Medications such as pimobendan can be used for this. In Dobermans, pimobendan has shown to be beneficial in prolonging lifespan when started at the time of diagnosis of DCM, as opposed to waiting until clinical heart failure is realized.

“Unfortunately, even well managed dog on heart medications can rapidly decompensate. Owners of pets with DCM should be prepared to call their veterinarian’s emergency line at any time, especially dogs in later stages of the disease.”

– Donald Buchanan, DVM
Diuretics (such as furosemide) may be used to reduce fluid buildup in the lungs or abdomen. There are some side effects of using diuretics though, so often medications such as enalapril or benazepril, which are “angiotensin-converting enzyme” (or ACE) inhibitors, may be used to reduce the harmful side effects of the diuretics. ACE inhibitors also help improve general blood flow, which is another benefit for a dog suffering from DCM. A procedure to physically remove the buildup of fluid in the dog’s abdomen or chest cavity may be used for DCM cases that are more severe.

Additional medications might be used to help control heart rate and arrhythmias (if present). These medications can be injected in an emergency situation, however, they’re most often given orally to dogs who are in a more stable condition. Dietary supplementation may also be used in an attempt to help support the heart. This often includes the use of L-carnitine, taurine, and omega-3 fatty acid supplements.

DCM tends to be progressive and is usually not reversible in Dobermans. This is because the Doberman breed is pre-dispositioned toward genetically linked DCM. Therefore the number and quantities of medications tend to need to be increased with time. The exception to this is DCM that is the result of dietary deficiencies (such as low taurine levels) which may be reversible if caught early enough. DCM caused by low taurine levels can be identified by a blood test to check for the presence of a taurine deficiency. Unfortunately, most DCM cases in Dobermans are of the genetic type and are not reversible.

Update on Possible Treatments
The results of a new study suggests that DCM may, in fact, be an autoimmune disease (source). This is possibly very good news for Doberman owners since there are drugs known to suppress autoimmune reactions in humans. Basically, this study means that a medication that actually prevents DCM (or stops it from progressing) may not be far off. For an in-depth explanation of this, see the article DCM in Dobermans is an autoimmune disease on the Better Bred website.

Doberman-at-the-Vet-Large.jpg

Early diagnosis is key for successful treatment ensuring the longest possible lifespan.

Lifespan After Diagnosis
Once diagnosed, if a Doberman is already showing signs of congestive heart failure, they are most likely to die within about 6 months. However, some may live as long as 1 or 2 years in ideal situations and with proper intervention.

If your veterinarian determines that your dog is one of the rare few to have DCM due to a dietary deficiency (such as a taurine deficiency), and you caught it early enough, there is a possibility of reversing the disease. However, this is exceptionally rare, especially with Dobermans.

“DCM in Dobermans is a fatal disease. In this breed, nearly one-third of all deaths due to DCM are in the form of sudden death, not congestive heart disease”

– Donald Buchanan, DVM
Exercising After Diagnosis
Always speak to your veterinarian about your dog’s activity levels if he or she has been diagnosed with DCM. In general, your vet will likely be working with you to find ways to reduce the strain placed on your dog’s heart. This includes finding ways to reduce strenuous exercise and general activity levels.

Lower physical exertion means less stress is placed on the heart. So strenuous activity is not recommended for a dog with DCM.

Preventing DCM
Sometimes there isn’t much you can do to prevent DCM, especially in dogs who are genetically predispositioned to have the disease such as Dobermans. However, quality diet and regular exercise are key to ensuring your dog has a strong heart.

If you are considering getting a Doberman puppy and are concerned with DCM, make sure you find a reputable breeder who performs genetic testing on their dogs (and puppies) to see if the dogs carry the gene mutation that is known to cause DCM.

Genetic Testing
There are currently two genetic tests available that look for a specific genetic mutation that is linked to DCM. These tests are called “DCM1” and “DCM2” and look for mutations in what’s called the “PDK4” gene. This gene mutation has been identified as being linked to DCM. If a dog is affected by this mutation, their likelihood of developing DCM sometime in their life greatly increases, and their pups also have a chance of inheriting this mutation.

DCM1 was the original test for the genetic mutation that has traditionally been linked to the disease. More recently, however, a second genetic mutation has been linked to the development of DCM in Dobermans. This has lead to the creation of the second test called DCM2.

If you want to be as thorough as possible with the testing of your dog, you should get both the DCM1 and DCM2 genetic tests performed. This will give the most complete picture currently possible as to your dog’s risk level of developing the disease. Below are a few companies that offer this testing online.

  • VetGen: This company performs both DCM1 and DCM2 genetic testing. Their Doberman specific DNA testing section can be found here. On that page, look for the test labeled as “DCM1 and DCM2”. This is their genetic testing for DCM in Dobermans and costs around $100.
  • VNC State Veterinary Hospital: This company offers both DCM1 and DCM2 testing. Their Doberman DCM testing page can be found here. At this time of this article, these tests can be purchased individually for around $50 each, or $70 for both tests. They also offer discounts if you are testing an entire litter of dogs, which is a great idea if you’re a breeder.
  • AnimalGenetics.us: It appears that this company only offers DCM1 testing at this time. Their DCM genetic testing page can be found here. At the time of this article’s writing, tests cost around $45.
  • Paw Print Genetics: This company appears to only offer DCM1 testing at this time and it currently costs around $80. Information about their DCM genetic testing services can be found here.
Another option is to simply as your veterinarian. This actually may be easier since a lot of times vets will not only have access to a reputable genetic testing service but will collect and ship off your dog’s DNA sample for you. Then you also have the added benefit of having a veterinarian discuss the results with you and answer your questions once they come back.

Another great option is the Doberman Diversity Project, a non-profit dedicated to the betterment of the Doberman breed. This company not only offers DCM testing, but depending on your dog’s current status, you might even qualify for free testing with them. This is because their team is not only testing dogs but conducting research. If there is a need for further study of dogs like yours, you just might qualify for free testing. They also offer other wonderful options such as Holter monitor rentals, whole litter testing, and even their Embark Veterinary’s Breeder’s DNA Kit which will test your dog for a long list of potential Doberman specific disorders. From everything I’ve heard, they are a great non-profit doing wonderful things for the Doberman breed.

Please note that I am not affiliated whatsoever with any of these genetic testing services or foundations listed here. These are simply some examples of the services available and since I haven’t used them myself, I cannot vouch for these companies.

The results of DCM testing will indicate if your dog has one or two copies of the gene mutation. You can use the table below to better understand the three possible results of the test.


Possible Results of PDK4 Mutation Testing (DCM Testing)


Gene 1 Gene 2 Risk What it Means
Mutated Mutated At Risk Your dog has two copies of the mutated PDK4 gene. This means they are at the highest risk for developing DCM in their lifetime. Having two copies of the gene doesn’t mean your dog is certain to develop DCM in their lifetime, however. They will also certainly pass this mutation onto their offspring.
Non-Mutated Mutated Low Risk/Carrier Also called a “positive heterozygous” result. This means your dog has only one copy of the mutated PDK4 gene, and one copy of the normal gene. Their risk of developing DCM is low, although they can still pass the mutation on to their offspring.
Non-Mutated Non-Mutated Clear There is no mutation of the PDK4 gene detected, your dog’s risk is even lower, and they will not pass a PDK4 gene mutation on to their offspring.

If you are considering breeding your Doberman, please get genetic DCM testing performed prior to mating and only breed dogs who are clear of this mutation. It’s important that all breeders take it upon themselves to help ensure a healthy future for the Doberman.

Reversing or Curing DCM
Unfortunately, dilated cardiomyopathy is almost always a lifelong disease, especially in the Doberman breed. Typically, the best that can be done is careful management of the disease and its symptoms in an attempt to extend life as much as possible.

On rare occasions, DCM caused by nutritional deficiencies (such as taurine deficiencies) can be reversed. A 1997 study of Cocker Spaniels affected with DCM as a result of taurine deficiency showed that supplementation of taurine and l-carnitine partially or completely reversed the disease (source).

However, DCM as the result of a taurine deficiency is rare in the Doberman breed. A qualified veterinarian can help to determine if the DCM is likely the result of a taurine deficiency through the use of blood testing and other means.

Recent information from the FDA however, does seem to suggest that many breeds who are genetically susceptible to developing DCM may actually do so due to a combination of genetic and dietary influences.

Dog Foods Linked to DCM (Diet Associated DCM)
It has been long known that diet plays a role in the develope of DCM in dogs, although the extent of this is unclear. In the publication “Diet-Associated Dilated Cardiomyopathy in Dogs: What Do We Know?”, written by Lisa M. Freeman DVM, Ph.D., Joshua A. Stern DVM, Ph.D., and others who are well known in the field, they note that pet food marketers have outpaced science and “owners are not always making healthy, science-based decisions even though they want to do the best for their pets.” They also state “there appears to be an association between DCM and feeding BEG, vegetarian, vegan, or home-prepared diets in dogs…” (source).

TIP:

“BEG” stands for boutique, exotic and grain-free foods.

In June 2019, the U.S. Food and Drug Administration (FDA) released information regarding their investigation into a potential link between certain dog foods and DCM. To see this information, take a look at the FDA DCM investigation here.

This investigation has sparked a lot of conversation among Doberman owners, mainly because of two things. For one, the investigation is very specific and groups diagnosed DCM cases by (among other things) the brand of food that the dog was on. Secondly, it shows a drastic increase in reported DCM cases in recent years.

The Number of Reported DCM Cases
In 2014 and 2015 there was one case of suspected diet-linked DCM reported each year to the FDA. In 2016 there were 2 cases, and in 2017 there were 3 cases. In 2018, that number jumped to an astonishing 320 cases and in 2019 it was 197 cases. This is a very sharp, and somewhat alarming increase.

It’s very important to point out that this really has little to no bearing on how many diagnosed cases of DCM are occurring in dogs. This is only a reflection of which cases were reported. This report itself states, “the vast majority of the reports were submitted after the agency notified the public about the potential DCM/diet issue in July 2018.” This means simply that people were more likely to report the issue to the FDA after the department made that announcement than they were previously, therefor the numbers increased drastically. Reporting DCM to the FDA is a process that is completely voluntary for both owners and veterinarians, so awareness of the issue certainly has a strong impact on the number of reports made.

Also, of the 524 cases reported, only 15 involved the Doberman breed. This also shouldn’t be seen as an accurate reflection of the occurrence of DCM in Dobermans as it relates to other breeds. There are just too many other factors, including (as the report itself notes) efforts made by certain breed communities to increase reporting of their breed’s cases of DCM to the FDA. The report states “FDA has observed a reporting bias for breeds like Golden Retrievers due to breed-specific social media groups and activities that have raised awareness of the issue in these communities…”

In fact, Dobermans may be underrepresented in this report. As noted by Lisa M. Freeman, DVM, PhD, DACVN in her article Diet-Associated Dilated Cardiomyopathy (DCM): Update, July 2019, many veterinarians don’t think to report Doberman DCM cases since the breed commonly develops non-diet (genetic) associated DCM.

So it’s important that this information is taken in context since it’s far too easy to look at this sharp increase and believe that this, in and of itself, means there is an epidemic of DCM occurring. Of all these reported cases, only 15 were cases that involved the Doberman breed but yet it’s well known that instances of DCM in Dobermans are far more common than that each year in the United States. This is because reporting of DCM to the FDA is not commonly done. Also, in this case, it’s only done if it’s believed to be diet-related DCM, which is uncommon for the Doberman breed—they are more likely to suffer from genetically linked DCM.

Dog Food Brands Named Most Frequently in DCM Reports
This investigation also included detailed statistics about which brands of food these dogs were consuming. The study mentions that while many DCM cases are likely to be genetic in origin (such as is common with the Doberman breed), many are nutritionally related or even a combination of nutritionally related and genetically related.


It’s likely that some Dobermans who develope DCM do so from a combination of dietary factors and a genetic predisposition for the disease. Although you can’t control the genetic side of things once your dog’s born, you certainly can have an effect on the dietary side.

Common Characteristics Among the Brands Linked to DCM
There are some common traits of the dog foods that the FDA has identified in this list. Namely, that legumes, pulses (which are legume seeds), and/or potatoes were listed as a main ingredient in the food. According to the FDA, an ingredient is considered a “main ingredient” if it’s listed within the first 10 ingredients of the dog food, and before any vitamin or mineral ingredients.

The majority of foods that have one of these ingredients as a main ingredient are labeled and sold as “grain-free” dog food. Grain-free and other “BEG” foods have gained in popularity in recent years which may be partially to blame for the increase in DCM.

Dobermans in the FDA’s Investigation
The entire list of DCM reports to the FDA is available here. It’s worth searching the document and looking for instances of Doberman specific DCM. It’s an interesting document with many notes from the veterinarians for each dog. After careful study, there are some interesting cases that really help us to better understand DCM. Here are some of the cases involving Dobermans in this document.

https://www.fda.gov/media/128303/download


  1. A 7-year-old Doberman Pinscher diagnosed with DCM had been eating Blue Buffalo Basics salmon and potato dry food for many years however the owner rotated between regular and grain-free versions of the food. Taurine levels were checked and found to be 29 nmol/ml. Remember that 266 ± 5.1 nmol/ml is considered normal, so this dog’s taurine levels were very low. At the direction of the vet, this dog was placed on cardiac medications, taurine, and fish oil supplements. Follow-up information about the dog’s progress after these changes are not available.
  2. A 5-year-old Doberman Pinscher was diagnosed with DCM. Veterinarians initially assumed the issues were genetically related due to the breed. However, they noted he had been eating ACAN grain-free dog food. The owner put the dog on Purina Pro Plan Bright Minds in May 2018. A recheck of the dog was done on August 14, 2018 and a significant improvement in his DCM was noted in both his clinical signs and diagnostic imaging. This owner has a second Doberman in the house that was also diagnosed with DCM and also improved when the dog was taken off of the grain-free diet.
  3. A 3-year-old Doberman Pinscher was on Natural Balance Sweet Potato and Bison diet (which is a grain-free food). He began getting finicky with his food. Three days after going on a hike he threw up and was rushed to the veterinarian. He was in congestive heart failure (CHF), which is common during the later stages of DCM. Vets were unable to stabilize his condition and he died.
  4. A 10-year-old Doberman Pinscher who was being given ACANA Free-Run Poultry Grain-Free Dog Food was taken to the vet due to lameness issues. He was diagnosed with DCM and was already in congestive heart failure. He was started on medications (furosemide, enalapril, and pimobendan). He was seen again 10 days later and had improved clinically, but still had significant DCM and associated congestive heart failure. A heart arrhythmia was also noted. He was given gabapentin, fish oil, and taurine supplements. No follow-ups of this dog’s condition were provided. Another Doberman living in the same house has been eating the same food and has no signs of DCM.
  5. A 10-year-old Doberman Pinscher being fed Taste of the Wild Pacific Stream dry dog food (a grain-free dog food) was diagnosed with DCM and congestive heart failure. The owner did not change the dog’s diet after diagnosis. On re-check there were no improvements in the dog’s condition.
  6. A 9-year-old Doberman Pinscher eating Earthborn Holistic Weight Control Grain-Free dry dog food for the past 5 years was diagnosed with DCM, congestive heart failure, and atrial fibrillation (heart arrhythmia). No follow-up information is available as to the dog’s condition.
  7. An 11-year-old Doberman Pinscher on an unbalanced home-cooked diet developed a heart arrhythmia. He was seen again about 20 days later and was diagnosed with DCM and two specific forms of heart arrhythmias. Whole blood taurine level was measured at 419 nmol/ml. The owner had already started taurine supplementation. The vet recommended the owner change the dog’s diet and re-check in 3 months. No follow-up information as to the dog’s condition is available.
  8. A 9-year-old Doberman Pinscher on Orijen Grain-Free Original dry dog food was diagnosed with DCM and congestive heart failure in the emergency clinic. He was started on various medications including furosemide, diltiazem, digoxin, and pimobendan. No follow-up information is available.
  9. A 9-year-old Doberman Pinscher on Taste of the Wild grain-free dog food for the last 4 years developed a cough and was taken to the emergency clinic after three days. He was diagnosed with DCM and died at the hospital from heart failure. This owner reported that she had a Doberman previously who died at 8 years of age, also from DCM, and who was also on the same dog food.
  10. A 9-year-old Doberman Pinscher on Taste of the Wild dog food (different varieties of this food were given on rotation—all grain-free) went to his vet for lameness issues. During his checkup, an intermittent heart arrhythmia was noted. This dog had a history of dental disease. No other typical symptoms of cardiac disease were noted by the owner—no unusual coughing, sneezing, vomiting, or diarrhea. No excessive urination or increased thirst. Appetite and activity levels are normal. He was diagnosed with DCM. The dog was started on the following medications: Pimobendan, Benazepril, Spironolactone. The vet discussed adding Taurine and L-Carnitine supplementation with the owner. The vet recommended transitioning off of the grain-free diet. A repeat echocardiogram and 24-hour Holter monitor every 6 months was recommended. No follow-up information is available.
  11. An 8-year-old Doberman Pinscher on Blue Wilderness dog food (unknown variety) or Wellness Core (grain-free) dog food. The dog had an on-going cough which eventually lead to changes in respiration. The dog was diagnosed with DCM and in congestive heart failure. He was put on the following medications/supplements: Furosemide, Enalapril, Vetmedin (Pimobendan), Spironolactone, Taurine, and L-carnitine. The vet recommended a 24-hour Holter monitor to check heart rhythm, but the owner declined. The vet discussed the unlikely potential for a taurine deficiency secondary to a grain-free diet and taurine testing (whole blood/plasma), but the owner declined. No follow-up information is available.

Please Note: These are not all the cases involving the Doberman breed in the FDA’s document cited above. I did not include some entries which appeared to be repeat reports (sometimes both the veterinarian and the owner will make a report for the same dog). I also didn’t include reports with very little details that did not appear helpful to better understand this disease.


It’s too easy while reading through these cases to come away with a strong belief that DCM in Dobermans is all too tightly linked to the dog’s diet. However, it’s important to remember that DCM in Doberman Pinschers is still believed by experts to be mainly a genetically related issue. Veterinarians who see cases of genetically linked DCM would not report them to the FDA for this study. Only those cases which are suspected of being diet-linked are typically reported.

So remember that these are only cases that are “suspected” as being linked to the dog’s diet in some way. A case may be genetically related in reality, and the dog just happens to be on a grain-free diet. Or it could be a combination of a genetic predisposition towards the disease and dietary influences. Or it may be entirely diet-related—it’s impossible to tell from this study. The only way veterinarians can determine for sure if a specific case of DCM is diet-related is to change the diet and see if the dog improves.

An update in regards to this study was released by the FDA here: Vet-LIRN Update on Investigation into Dilated Cardiomyopathy. This article discusses an interesting case study of two Doberman’s living in the same household (see table 4 in that article). Both dogs had one copy of the PDK4 genetic mutation, which is a mutation that’s common in Dobermans and believed to be linked to the development of DCM (see the genetic testing section of this article for more on that mutation). They were also on grain-free diets. After switching to non-grain-free food. At a 3-month checkup, both dogs had improved significantly.

How Many Dobermans Have DCM?
A recent study showed that 58.2% of Dobermans will have DCM at some point in their lifetime (source). This is widely believed by experts to largely be the result of a genetic predisposition towards the disease in the Doberman breed.

DCM seems to become more common in Dobermans as they get older. The same study found the prevalence of DCM in Doberman Pinschers at various age groups to be as follows.

Prevalence of DCM in Dobermans by Age

Age Group Prevalence of DCM
1 - 2 Years 3.3%
2 - 4 Years 9.9%
4 - 6 Years 12.5%
6 - 8 Years 43.6%
Over 8 Years 44.1%

This study showed that there was about an equal occurrence of DCM in male versus female Dobermans. However, affected male Dobermans showed earlier detectable changes in the heart than females.

For a well-researched article about the prevalence of DCM in Doberman Pinschers, including breakdowns by age of the affected dog, see Prevalence of Dilated Cardiomyopathy in Doberman Pinschers in Various Age Groups.

As mentioned earlier, the FDA’s report on DCM should not be considered an accurate reflection of the prevalence of DCM in the Doberman breed. Unfortunately, the disease is still very common in Doberman’s and genetic testing by breeders is imperative in reducing the occurrence of this disease.

Final Thoughts: What Can Doberman Owners Do?
Hopefully, as a Doberman owner, you now have a better idea about DCM and what is currently known about the disease. With the recent release of the DCM investigation information by the FDA, there are a lot of concerned owners out there. Remember that the FDA’s report is only a very small snapshot of certain occurrences of the disease. If you are still concerned about this report, take a look at the FDA’s Question and Answer article in regards to this report.

There are only a few things that we have control over as Doberman owners. That being said, the following actions are about the best we can do:

  1. Perform genetic testing of your Dobermans to determine their risk level. This is especially important of breeders to perform prior to selecting breeding partners. Then check all puppies in the litter. This incredibly important to help reduce the occurrence of DCM in the Doberman breed.
  2. Provide plenty of exercise in a healthy manner to improve the strength of your dog’s heart.
  3. Feed your dog a quality grain-containing diet.
  4. Get regular check-ups at the veterinarian that include checking heart functions and blood work to identify any dietary deficiencies or early signs of DCM.
  5. Bring your dog to the veterinarian immediately if you notice anything unusual about your dog or their behavior.
If Doberman breeders and owners stay responsible in the way in which we’re handling this disease, we may be able to make a significant impact in reducing the prevalence of DCM in this wonderful breed.
Related Questions
Is DCM painful in dogs? While dilated cardiomyopathy (DCM) is not painful or uncomfortable in and of itself for a dog, sometimes the symptoms can be. These symptoms can include coughing, abdominal swelling, labored breathing, exercise intolerance, and sudden collapse or fainting.
As always supper informative thank you for sharing!
 

strykerdobe

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FDA’s latest DCM update: No news is ... status quo? | PetfoodIndustry.com

FDA’s latest DCM update: No news is ... status quo?
January 30, 2020
Debbie Phillips-Donaldson

It’s difficult to characterize anything related to the Food and Drug Administration (FDA)’s ongoing investigation into canine dilated cardiomyopathy (DCM) and grain-free products as good news, particularly its alerts and updates about the situation. They have definitely impacted grain-free pet food sales, which in turn has affected many people, both in and out of the pet food industry.

However, I suppose it’s a positive development that, in its latest presentation to an industry audience, an agency representative said there was no new information from the investigation to announce, and they don’t foresee any announcements happening in the near future. The representative was David Edwards, Ph.D., an officer with FDA’s Center for Veterinary Medicine’s Office of Surveillance and Compliance, speaking at the 13th Annual Pet Food Conference organized by the American Feed Industry Association (AFIA) during the International Production & Processing Expo on January 28 in Atlanta, Georgia, USA.

FDA public updates: ‘none planned at this time’
I had been hearing rumors from various people in the industry that a new investigation update from FDA was imminent. It’s not an understatement to say everyone was rather concerned, bracing for another possible bombshell announcement like the one the agency made in June 2019, in which it named pet food brands implicated in its investigation.

That’s probably why the AFIA conference had a record turnout of more than 300 people. In fact, with Edwards as the last presenter of the day, the audience was still fairly sizable in the afternoon, compared to what can typically happen at all-day conferences. He even ramped up the anticipation by having the DCM investigation as his last topic of several.

Thus, Edwards’ comments about the investigation were rather anti-climactic – though I don’t think anyone was complaining. “As for public updates, there are none planned at this time,” he said, even repeating the statement and adding that the agency was still waiting until it had new information to report.

Instead, most of the DCM part of Edwards’ presentation was a history of the investigation and rationale behind FDA’s announcements. He commented that, while he had spent most of the day in another meeting, a few of his colleagues had been at the pet food conference all day and told him DCM had been a topic of several other presentations. Perhaps that’s why he came off sounding rather defensive.

‘We may never figure this out’
The other conference presentations that Edwards alluded to included a U.S. pet food market update from Maria Lange, vice president of strategic verticals pet and cannabis for Nielsen, in which she provided data showing the decline in grain-free pet food sales, tying it to FDA’s announcements. In addition, a panel of three pet nutrition experts talked about the impact of the FDA investigation and announcements, plus their insights and possible directions for future nutrition research.

Joe Bartges, DVM, Ph.D., professor of medicine and nutrition in the Department of Small Animal Medicine and Surgery at the University of Georgia, led off the panel with some frank views and statements, most critical of FDA’s investigation and information issued by a few groups of veterinarians:

  • He said he “loathes” the term BEG (boutique, exotic proteins, grain free) diets, coined by one of the veterinary groups. (A few people in the audience applauded that statement.)
  • “When you only look for what you want to see, you will only see what you wanted to look for,” he commented, referring to the data and analysis issued by FDA and some veterinary groups to date.
  • His own analysis of data released by FDA showed a huge jump in cases in 2018 – because FDA told veterinarians and owners to report cases, he said. Plus, the majority of cases were in dog breeds with either a familial association or genetic predisposition to DCM.
  • He also shot holes in FDA’s June 2019 announcement naming pet foods that had been implicated in the cases, saying some on the list were specific products, while others were entire brands or even companies, making it difficult to assess if there truly were issues with certain products.
  • “Vets are bad at taking down data,” he said, explaining that most of the cases did not have a complete diet history for the dog, and other things consumed could be playing a role.
Bartges’ bottom-line statements were not positive. “Not all grain-free diets are bad, and the ones implicated just have a loose association.” But he added that it's difficult for a vet to tell an owner closely attached to and concerned about his or her dog that the data only shows so much. His advice to owners would be, if you’re worried, then feed a food with grain. And not from a brand on the FDA list. “Sorry,” he said to the audience, “but that’s all I have to go on.”

Probably most concerning of all were his closing remarks. “We may never figure this out,” Bartges said. “It may be nature AND nurture,” which is very complex. However, this is not going away, he added, because it’s not easily explained the same way that toxins, contaminants and imbalances related to pet food typically are. Meanwhile, owners think their dogs are having “heart attacks” related to diet. They understandably want answers.

Focus on amino acids, protein quality, peer-reviewed research
Another panel member, Kate Shoveller, Ph.D., assistant professor in the Department of Animal Biosciences at the University of Guelph, suggested pet nutrition research areas to explore – if not just to find a definitive cause for these DCM cases, then at least to better understand many elements of formulations and nutrition.

Specifically, she focused on amino acids and protein quality. “I have said before, and I still believe, the pet food industry needs to come up with a way to measure protein quality,” she commented. Those measures would need to look at protein content, amino acid composition, protein and amino acid digestibility for the species eating the food. Shoveller referred to a new research paper coming out soon with data from Kansas State University’s pet food processing lab, which she said will corroborate data released by the companion animal nutrition program at University of Illinois in 2019.

Considerations for pet food formulators, she added, included:

  • Amino acid requirements are greater than the minimum regulatory guidance, and you should have targets, at minimum, for lysine, threonine, methionine and tryptophan.
  • Peas and most legumes are limiting in methonine and completely lack taurine and L-carnitine.
  • Methyl-donating and -accepting nutrients should be included in diets to spare methionine for protein synthesis and the synthesis of metabolites such as taurine.
George Collings, Ph.D., president and general manager of Nutrition Solutions and the third panelist, discussed how this current DCM situation is demonizing yet another category of pet food ingredients (joining corn, byproducts and others), which further complicates the formulation of complete and balanced pet foods that also meet market and consumer demands.

Besides the request to “stop demonizing ingredients,” other recommendations from Collings included the need for more complete science. “We need to tell consumers what we know to be true,” meaning not issuing data or information based on incomplete science or the lack of peer review. “We also need to engage in genetic and nutrition research,” he said and adjust nutrient profiles if necessary.

“Above all, communicate the importance of an overall balanced food regimen” for pets, he concluded.

dphillips@wattglobal.com

Debbie Phillips-Donaldson is editor-in-chief of Petfood Industry. Email her at dphillips@wattglobal.com.
 

MyBuddy

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Not all grain-free diets are bad
But...but...

You know, I'm just as confused as everybody else about this issue. I read, and read and really don't understand totally. But from what I remember reading, it's the grain-free Foods that, to be grain-free, have to include peas and legumes to make up for it and that, in turn, leads to a lack of taurine. Which can cause DCM? It may not be that simple, but isn't that the gist of it??

Peas and most legumes are limiting in methonine and completely lack taurine and L-carnitine.

But then again, if that's true, then why is it mostly Dobermans that are dying of this?

“Above all, communicate the importance of an overall balanced food regimen” for pets, he concluded.

Isn't that what we've been taught for ourselves since we were children? Everything in moderation! But balanced. In some ways I feel that's what I've been doing all along. Feeding a good kibble and topping it. The day I saw this video
I felt like I was finally doing something right! That video was the best eye opener I ever seen.
 

strykerdobe

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@MyBuddy

I'm confused also! But until they figure this out I would try and stay away from foods that have these suspected ingredients.
Or supplement with Taurine, L-Carnitine, CoQ10.
 

strykerdobe

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The Aptamer BC 007 for Treatment of Dilated Cardiomyopathy: Evaluation in Doberman Pinschers of Efficacy and Outcomes - PubMed

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. 2020 Mar 24. doi: 10.1002/ehf2.12628. Online ahead of print.
The Aptamer BC 007 for Treatment of Dilated Cardiomyopathy: Evaluation in Doberman Pinschers of Efficacy and Outcomes
Sabine Werner 1 , Gerd Wallukat 2 , Niels-Peter Becker 2 , Katrin Wenzel 2 , Johannes Müller 2 , Ingolf Schimke 2 , Gerhard Wess 1
Affiliations
Abstract


Aims: Aptamer BC 007, a 15-mer single-strand DNA oligonucleotide (5'-GGTTGGTGTGGTTGG-3'), was developed to neutralize functional autoantibodies that bind to the extracellular domains of G protein-coupled receptors (GPCR-AAB), leading to the modulation of receptor-mediated signalling cascades that induce pathophysiological states. Among the GPCR-AAB, there are those directed against the β1-adrenergic receptor (β1-AAB) that are highly present in patients with dilated cardiomyopathy (DCM) and are increasingly accepted as disease drivers. Using Doberman Pinschers (DP) with DCM, which possess similarities with human DCM among these β1-AAB positivity for that the disease-driving role in DP DCM was demonstrated, the safety of BC 007, efficacy for neutralizing β1-AAB, and the DP's outcome were investigated.

Methods and results: Fourteen client-owned β1-AAB-positive DP with electrocardiographically and echocardiographically indicated DCM were treated with BC 007. For controlling, two groups were created: 14 β1-AAB-positive DP with DCM not treated with BC 007 (Control 1) and 14 DP with DCM closely matched to the BC 007-treated DP (Control 2), retrospectively selected from the institutional database of DP. After treatment, DP were monitored both echocardiographically, and for β1-AAB, and survival curves were calculated. Based on clinical and laboratory examination, no adverse effects associated with BC 007 treatment were observed during the study. Forty-eight hours after treatment, the DP's blood was free of β1-AAB, which led to a reduction or stabilization of left ventricular end-systolic volume (ESVI) during β1-AAB free time in 10 of the treated DP. In one DP, where β1-AAB returned after 3 months and ESVI worsened again, a second BC 007 treatment after 9 months again cleared the blood from β1-AAB and improved the ESVI. Compared with the controls, DP treated with BC 007 showed a significantly longer survival time [572 days, interquartile range (IQR) 442-840 days] vs. Control group 1 (266 days, IQR 97-438 days; logrank: P = 0.009) and Control group 2 (229 days, IQR 174-319 days; logrank: P = 0.012).

Conclusions: Treatment with BC 007 for β1-AAB neutralization was safe, resulted in a long-lasting reduction of β1-AAB combined with improved cardiac function and prolonged the survival of DP with DCM. Using a natural large animal model of DCM considered superior to small animal models of immunization-induced cardiomyopathy, combined with a study design comparable with clinical trials, we believe that our results provide the basis for optimism that treatment with BC 007 might also be effective in human patients with DCM.

Keywords: Anti-beta1-adrenergic receptor antibodies; BC 007; Cardiomyopathy; Doberman Pinscher; Heard failure; Treatment.

© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

Similar articles
References
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    1. Smith BR, Pyle GA, Petersen VB, Hall R. Interaction of thyroid-stimulating antibodies with the human thyrotrophin receptor. J Endocrinol 1977; 75: 401-407.
    1. Sterin-Borda L, Cossio PM, Gimeno MF, Gimeno AL, Diez C, Laguens RP, Meckert PC, Arana RM. Effect of chagasic sera on the rat isolated atrial preparation: immunological, morphological and function aspects. Cardiovasc Res 1976; 10: 613-622.
    1. Jahns R, Boivin V, Lohse MJ. Beta 1-adrenergic receptor-directed autoimmunity as a cause of dilated cardiomyopathy in rats. Int J Cardiol 2006; 112: 7-14.
    1. Limas CJ, Goldenberg IF, Limas C. Influence of anti-beta-receptor antibodies on cardiac adenylate cyclase in patients with idiopathic dilated cardiomyopathy. Am Heart J 1990; 119: 1322-1328.
 

strykerdobe

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Very good article by Dr. Judy Morgan, DVM

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Treating Heart Disease: Holistic Prevention vs Pharmaceutical Band-aid
by Judy Morgan December 30, 2017

Treating Heart Disease: Holistic Prevention vs Pharmaceutical Band-aid

As an owner of Cavalier King Charles Spaniels and past owner of Doberman Pinschers, I am always on watch for any symptoms of heart disease.

Both breeds are prone to cardiac problems, although not the same type. Cavaliers are genetically prone to mitral valve disease, or MVD, while Dobermans are genetically prone to dilated cardiomyopathy, or DCM. Other breeds prone to MVD include Dachshunds, Pekingnese, Pugs, Chihuahuas, Maltese, Yorkies, Papillons, Bichons, and small poodles and terriers. Most breeds susceptible to MVD have an adult body weight of less than 9 kg (20 pounds). DCM tends to be a disease of larger breed dogs, including Boxers, Great Danes, Greyhounds, Irish Wolfhounds, Afghan Hounds, and Saint Bernards. Feline breeds genetically prone to cardiomyopathy include Ragdolls, Maine Coons, Persians, and American Shorthairs.

While there are no proven methods to decrease the risk of heart disease in a breed genetically prone to its development, there are nutritional, herbal, and other therapeutic supplements that may support healthy heart function. Recent studies have shown deficiencies of taurine and carnitine may contribute to development of heart disease in dogs. It has been known for many years that taurine deficiency in cats will lead to dilated cardiomyopathy. Carnitine and taurine are amino acids found in high concentrations in heart muscle. Nutritional sources with high levels of carnitine include red meat (beef) and heart muscle meat of any source. Nutritional sources with high levels of taurine include shellfish such as mussels, scallops, and clams, dark meat poultry, and goat milk. Goat milk also contains GABA (ƴ-aminobutyric acid), a neurotransmitter, with diverse physiologic effects, such as modulation of blood pressure, immune function, insulin sensitivity and stress.

MVD is an inflammatory condition, as evidenced by studies showing increased circulating inflammatory markers in dogs suffering with this disease. Based on this assumption, I have treated my dogs with supplements to support decreased inflammation.

From a Traditional Chinese Medicine perspective, heart failure and heart enlargement are related to Heart Qi Deficiency and Blood Stagnation. When designing a diet to support optimum heart function, I include Qi tonics and ingredients to resolve stagnation that keep the blood moving.

How can you proactively treat heart disease?

Typical supplements I recommend for my dogs and my patients (this would apply to cats with cardiomyopathy) include:

  • CoQ10 - antioxidant, recommended doses are 1 mg per pound of body weight. I dose my dogs and patients much higher, at around 5 mg per pound once daily.
  • L-carnitine - 500 mg for small dogs up to 2,000 mg for large dogs daily
  • Taurine (found in Rx Vitamins Feline Essentials and Rx Vitamins Formula HL) - 250 to 750 mg twice daily
  • Hawthorn - increases cardiac muscle contraction strength, found in many herbal formulations of differing strengths
  • Omega 3 fatty acids decrease cardiac inflammation, decrease triglycerides, and decrease muscle wasting. Give 30 mg per pound of body weight daily, along with 1 to 2 IU of vitamin E per pound of body weight
  • Calcium - the diet needs to have adequate calcium, particularly when formulating home prepared diets
  • Selenium - trace mineral that supports cardiac function - found in fish, chicken, beef, and pork
  • Chromium - trace mineral that supports cardiac function - found in broccoli and mushrooms
  • CBD oil - anti-inflammatory and anti-anxiety effects; generally recommended dose is 1 mg per 10 pounds body weight 2 to 3 times daily
Nutritional additions for my pets and patients include:

  • Fermented raw goat milk - high in taurine, medium chain triglycerides, and vitamins essential for cardiac function; Yin tonic to decrease inflammation
  • Species-appropriate meat-based diet, preferably raw, that includes heart muscle meat
  • Qi tonic foods - beef, dark meat poultry, rabbit, tripe, pumpkin, squash, sweet potato, and Shiitake mushrooms
  • Foods to resolve stagnation and help eliminate fluid build-up - celery, watermelon, dandelion greens and roots, and parsley
  • Blood tonic foods - egg yolks, sardines
Any pet suffering from degenerative heart disease of any type should be under the care of a veterinary cardiologist. An ultrasound, called an echocardiogram, is the best method to determine stage of heart disease and heart function. Medications are available that will increase longevity and help keep pets comfortable. A diagnosis of heart disease is not an immediate death sentence. Many pets will live for years after diagnosis when given a high quality diet and supplements.

I am NOT a fan of the prescription heart diet foods. Most are made with inferior ingredients that have been highly processed, with synthetic chemical additives. My patients have performed much better when fed real foods that contain the necessary ingredients. For more information on heart disease, see my books From Needles to Natural, Learning Holistic Pet Healing, and Yin & Yang Nutrition for Dogs, Maximizing Health Using Whole Foods, Not Drugs.

About Dr. Morgan

Dr. Judy Morgan is a nationally renowned author and veterinarian certified in acupuncture, food therapy, and chiropractic care for dogs, cats, and horses. As a sought after speaker, Dr. Morgan shares her insight here with blogs and videos.

 

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