Great Dane: DaDane 05/12/08

Created: 05/12/08

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— PIMOBENDAN —
Dilated Cardiomyopathy Treatment

May 12, 2008 — I received a note last week from Cheryl Haugo, one of my favorite people in the audience. This lady is "way cool" and I always like hearing from her, which is not often enough. A practicing veterinarian in Yuma Arizona, Dr. Cheryl owns and loves Great Danes. That's two points for Cheryl. She occasionally treats swans at her clinic and over the years she's given me good swan advice — another point. Cheryl also loves and owns geese — still more points. You get the idea...

I first heard from Dr. Cheryl back in 1999 shortly after she found her African goose suddenly "beakless" after some sort of altercation with God-knows-what. Cheryl fashioned a new beak out of orthopedic pins and acrylic. Said goose is now 18 years old, no less cranky and still parading its artificial beak. Okay, so when Cheryl talks, I listen — and with interest. Who wouldn't? What she has to say is worth sharing, especially after last week's discussion:

— PIMOBENDAN & CHLOE —

I noticed you are again discussing DCM on the DaDane of DaWeek. Awhile back I promised you a Pimobendan story and here goes:

Pimobendan ... then
A few years ago the veterinary cardiologists began to recommend a new drug, Pimobendan, to our treatment of referred DCM patients. At that time, this drug was not available in the US and we general practitioners had little information about it. I found myself asking many questions and finding few answers. When we attempted to get the drug, it sometimes took weeks or months to obtain, if we could get it at all. The general consensus of the cardiologists I talked to was that the medication also took quite some time to begin to work. Many of our candidates were so critical that they never even received Pimobendan before they died or were euthanized. I had few positive thoughts about this drug.

After attending many conferences and trying to learn more about this new "wonder drug" I had more to wonder about than ever. Some said it was only for dilated cardiomyopathy (DCM) patients, others said all congestive heart failure patients; some said it worked within days, others that it took weeks or longer. With so little information to go on, I remained skeptical.

Pimobendan ... now
Pimobendan, also known as Vetmedin, is a drug that has been used with success in heart failure patients in Europe and Canada for quite some time now. It is what we veterinarians call a "positive inotrope" which means that it improves the ability of the heart muscle to beat with greater force. It also has some vasodilation activity which means that it enlarges the blood vessels which in turn can improve blood pressure. It does these things by improving the heart's ability to respond properly to calcium in the blood. Calcium is necessary for contraction of the muscle.

Pimobendan has been shown to be compatible with all of the other heart medicines we use and many of the other common drugs our Great Danes might be on. One of the problems with testing this drug here in the US is that over time it can cause a normal patient's heart to become diseased, so it can only be tested on patients with diseased hearts already. Such patients are sick and often die in spite of all we would do for them, so then how do researchers know if the drug is helping or not? It is challenging, but studies have demonstrated delayed death, improved x-ray evidence, improved energy levels, and reduced need for other drugs.

First-hand Experience
So, does it really work? It took my own experience with my own Dane, Chloe, to convince me. Chloe will turn 13 on May 10, 2008. She started to slow down after she turned 11. Around that time my friend, Dr. Grych, was studying advanced ultrasonography in which you can take a sonogram of the heart, measure the walls, the contractility, the valves and other items, to see if there might or might not be a problem. He needed some big dogs to practice on. Chloe and her younger housemate, Solveig, volunteered. Solveig was quite young and fit. While Chloe was older, I only had a mild suspicion that there could be early trouble. I was in for a surprise: Chloe was already well into the early stages of Dilated Cardiomyopathy and her heart was barely contracting at all. Her blood pressure was high and she was trouble just waiting to happen.

Dr. Grych suggested Atenolol and Pimobendan. Again, I was skeptical. When he said I would see improvement in DAYS rather than weeks or months, I was even more skeptical, but this was, after all, MY Chloe. I decided to try it. The medicine had to be specially made at a compounding pharmacy. We began right away.

Chloe's Treatment
I noticed improvement in Chloe's energy levels within days and she has been on this medicine ever since. Though she is not going to be with us much longer, I feel that Pimobendan has given Chloe many extra months of good, quality life she would otherwise not have had. This drug, Pimobendan, is now one I reach for early in the treatment of DCM and other heart failures.

Thanks for the opportunity to help other Dane owners.

— Cheryl Haugo, DVM

For more information on Pimobendan check out this link and visit the drug's website.

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