– DCM is Not a 4-Letter Word –

July 15, 2002 – This is the fourth installment in our series on dilated cardiomyopathy (DCM) in the Great Dane. Installment #1 introduced you to the topic with the story of Phlash, a fawn who was lost to DCM at the age of five. Installment #2 presented a harlequin named Harley, another DCM fatality. We also covered basic information about dilated cardiomyopathy in the Great Dane and discussed diagnosis, treatment and possible causes. Installment #3 asked the burning question, "Is DCM an inherited disease?" We took a look at some preliminary pedigree research which strongly suggests dilated cardiomyopathy is passed from parent to offspring via an X-linked recessive gene. We then explored the implications.

This week we'll hear from a breeder who was shocked to discover DCM in her line. What did she do about it? What advice does she offer? This is her story:

By Joanne Blair Hank was born and died in my house, with me by his side. His mother was my first show quality Great Dane and Hank was out of my first litter. He developed into a handsome boy, reaching 170 pounds and 37" at maturity. Finishing his championship title at 18 months, he went on to earn approximately 20 Best of Breeds and 10 group placements – all these accomplishments with me at the end of the lead, which makes Hank’s success all the more remarkable! He also earned a TD (Tracking Dog) title. Hank was a fine, healthy, athletic dog. He adored swimming, taking long walks and running in the pastures with his other dog buddies. He was also my best friend; when we were together he never let me out of his sight. There was something eerie about Hank – he would often just stare at me as if he was looking into my head or something. In May 1998, when Hank was 3.5 years old, we were in the group ring at a show in Iowa. I noticed that Hank was not his usual exuberant self. He wasn’t very interested in the bait and he just stood there. Usually, he would stand tall and alert. He loved to move out with the other dogs. This day he was different. I attributed his lackluster attitude to the long drive to the show site and the high humidity. Back home Hank seemed more himself. Two weeks later, though, I heard him in the other room, making a sound like he was trying to retch. I thought, "Oh no, Hank has kennel cough again!" That’s exactly what this gagging sound reminded me of – kennel cough. Dilated Cardiomyopathy (DCM) That night, I could not sleep. It seems I knew something was seriously wrong with Hank. I recall sitting up in bed with the realization that Hank had cardiomyopathy. I’m not sure how I knew this. I had never even seen another dog with DCM, but I knew that’s what he had. The very next day we were at Kansas State University Veterinary Teaching Hospital and I heard what I already knew – dilated cardiomyopathy, with atrial fibrillation and pulmonary edema. Hank’s disease was already in the severe stage. He was diagnosed by physical examination, blood tests, x-ray (which showed a grossly enlarged heart), cardiac ultrasound and electrocardiograph. Hank was immediately admitted to the ICU for supplemental oxygen, IV Lasix, and 24-hour monitoring. He was started on oral Digoxin and Lisinopril. After his edema was under control, Hank came home with a bucket of pills, home care instructions a mile long, and the stern warning that exercise could lead to a heart attack at any moment. I told my vet that despite the warnings, I would not restrict my outdoor-loving dog’s activity in the least. If Hank had a sudden heart attack and died while running his pasture, then that would be preferable to wasting away on the couch. She agreed with my decision. It was the right one – for Hank. Coping with the news While dealing with the shock that my beloved dog was soon going to die, learning to give the right medications at the right time, while keeping his weight up and paying the approximately $250 in medical bills per month, I also had to consider the genetic implications of this disease on my budding "line." Obviously, I would not allow Hank to be bred further. I had the unfortunate task of calling up the owners of several bitches who were to be bred to Hank, and telling them he was no longer available – and why. I also had the gut-wrenching chore of contacting the six people who owned littermates of Hank and the six people who had sons and daughters of Hank, to inform them their puppies were at increased risk for DCM. At that time, not much was known about the inheritance of DCM in Great Danes. The KSU vets could only tell me that Hank’s offspring were at increased risk and should be thoroughly examined for early symptoms, at least once a year. Maintaining the patient During the remaining 9 months of Hank’s illness, we tried a few experimental "treatments" to improve his qualify of life. I believe they paid off, but they certainly aren’t proven. We used supplements such as Coenzyme Q-10 in fairly high doses (1 mg per pound body weight, 2 times per day), milk thistle to help with liver function (cardio meds may cause problems with the liver), dandelion root as a natural diuretic, Vitamin E, B-complex, and Ester C. Hank also received acupuncture treatments to help with the atrial fibrillation. The acupuncture-certified veterinarian who treated Hank said that while acupuncture is not indicated for DCM, it might prove helpful with the irregular heartbeats. The cumulative effects of the appetite-suppressing drugs, increased respiration and edema caused Hank’s appetite to take a dive. We "tweaked" his meds, which helped. He had not lost appreciable weight, in fact, Hank never looked very thin, but I wanted to keep it that way . It is important that DCM dogs eat – their bodies need more calories than healthy dogs. Because intact males commonly stop eating when around bitches in season, I wanted Hank neutered before his young daughter came in season. Our KSU vet said, "No way, it’s too risky." Our acupuncture vet, who had performed C-sections using nothing for anesthesia but acupuncture needles, suggested we contact a vet at Colorado State University who was a board-certified cardiologist AND was certified in acupuncture. After reviewing Hank’s records, the CSU vet said he could do it using minimal sedation and acupuncture needles for anesthesia and pain control. So off to CSU we went. Hank was neutered and he recovered fully. When his daughter came into season a couple of months later, he could have cared less. We had our share of crises in those 9 months. The edema would build up and Hank’s breathing would be labored and he would start gagging. We’d rush to the hospital where his meds would be adjusted, his liver function checked, and his DCM evaluated. Hank was worsening, but slowly. The vet staff was impressed with Hank’s condition and attitude. When I told them it was due to all the running he did in the pasture, their faces paled. DCM is not a 4-letter word Hank continued to go to shows with us when I exhibited his daughter. I would walk him around the show site and people would ask why he wasn’t being shown. When I told them about his DCM, most people would become silent. I knew I was breaking the "code of silence" but frankly, that didn’t matter a bit to me. I felt it was important to be open, honest and not to feel guilty because I owned and had bred a "faulty" dog. I did not take the DCM personally; no one tries or wants to breed an animal that is going to die prematurely from an inherited disease. And I certainly was not going to hide Hank away. So we went to shows, even to the GDCA National. Time to say good-bye Eventually, the fluid buildup, decreased pumping ability of his heart, and the side effects of all the drugs caught up with Hank. On his last night, he attempted to get off my bed. Instead, he collapsed on the floor. He just lay there on his stomach, taking rapid, shallow breaths. I petted him and kissed his handsome face. I knew this was it. It was midnight and I couldn’t bring myself to wake my vet, ask her to drive out to my rural house and euthanize Hank. So I lay on the floor with him until dawn. During the night he had several bouts of black, smelly diarrhea – a symptom of liver damage I was later told. I cried until my eyes nearly swelled shut. Hank was only 4 years old. He had lived 9 months since initial diagnosis; 6 months beyond the vet’s prediction. And now he was dying right before my eyes. He had such a good quality of life up until that night. I guess I ought to be more thankful for that. My vet came at 7:30 the next morning. I held Hank’s huge head while she freed him from his torment. Advice to other breeders... I told Ginnie that I was over this, as it has been a good 3 years since Hank’s death. After writing this piece, I guess that was lie; I don’t think I am over this and likely never will be. I don’t think any of us who have experienced this horrific disease will ever "get over it" totally. So what do we do? How do we justify the short lives of our devoted companions, our show dogs, and our breeding stock? How? By helping to support research into finding a genetic marker for DCM in Great Danes. I don’t see any other fix for this problem due to the recessive nature of its inheritance. As discussed in last week's DaDane, current preliminary research shows that DCM in Great Danes follows an X-linked recessive inheritance. Under this theory, affected males bred to normal females produce 100% carrier females and 100% normal males. When these carrier females are bred, the cycle begins all over again, producing more DCM males and more carrier females. What can breeders do until a genetic marker is available? Study pedigrees carefully. If you own a bitch and are looking for a male to breed to, ask how old the male’s parents and grandparents were when they died, and what they died of. If the male’s owner does not know, find out! Look carefully at the male’s maternal grandsire. How old was he when he died? If he died at age 2 from gastric torsion, you cannot rule out cardio, as many cases of DCM are asymptomatic until the dog is older. Breed to older males. This may require stud dog owners to take advantage of semen freezing. Having a male who is alive and producing viable semen at 10 years is likely unusual, so having frozen semen available allows us to use dogs who have lived to a ripe old age. Screen your dog before breeding. If you own a stud dog, have him DCM-cleared immediately prior to a breeding; if you are a bitch owner, insist that any male you breed to is cleared prior to breeding. Don’t breed to that dog if the owner refuses. With this said, do NOT place total blind faith on a cleared dog. Be open and honest regarding your own dogs’ history. Don’t start or perpetuate rumors, but be willing to tell those involved when you have a dog diagnosed with DCM. This is especially important for people who have puppies out of your dog or who have bred females to your dog. — By Joanne Blair

Closing comments
I want to thank Joanne Blair for coming forward to tell her DCM story from a breeder's perspective. DCM is a terminal disease – almost certainly inherited – and there's plenty of it out there. Countless Great Danes, along with their owners, have experienced the anguish of DCM. Many more will do so. This trail of death will continue from generation to generation unless the shroud of silence that surrounds DCM is lifted. Make no mistake about it, if you are breeding "cardio," you are breeding broken hearts. And it doesn't have to be that way.

Thanks to the ongoing research by Dr. Kate Meurs at OSU, the Great Dane community has been given the remarkable opportunity to do something about DCM – besides just whispering behind closed doors. Let's not blow it. If you have owned or bred a DCM dog, please make your dog's medical report and pedigree available to Dr. Meurs for further study. Your information and your identity will be held in the strictest confidence.

Copies of pedigrees and medical reports (for verification of DCM diagnosis) should be sent to:
Dr. Kate M. Meurs
Ohio State University, College of Veterinary Medicine
Dept. of Veterinary Clinical Sciences, Cardiology
601 Vernon L. Tharp Street
Columbus, Ohio 43210-1089.
Email: meurs.1@osu.edu

Please support this effort. You can say "no" to cardio, simply by saying "yes" to research.

— ©2002 by Ginnie Saunders

Installment #1  ||  Installment #2 || Installment #3