It’s Not Just Grain-Free: An Update on Diet-Associated Dilated Cardiomyopathy

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You may have read my June 4 post, “A broken heart: Risk of heart disease in boutique or grain-free diets and exotic ingredients.”  This post had more than 180,000 page views in the first week and continues to get more than 2000 page views a day.   So, I’m pleased that people are interested in this important issue and trying to learn about it.  But I’ve also found a tremendous amount of confusion and misinformation in the past 5 months including people who doubt that this is a real issue, some who still haven’t heard about it, and people who mistakenly think it’s just grain-free diets or that it’s only related to taurine.

As a result of the continued confusion, some of my cardiologist colleagues and I wrote an article which was published in the latest issue of the Journal of the American Veterinary Medical Association.  This article provides a summary of our current understanding of diet-associated dilated cardiomyopathy (DCM), how to recognize it, and a recommended protocol for veterinarians to follow when they see dogs with DCM.

To be sure this information reaches as wide an audience as possible and to clear up confusion, I thought I’d provide some updates to address the most common misconceptions I’m hearing:

  1. It’s not just grain-free. This does not appear to be just an issue with grain-free diets.  I am calling the suspected diets, “BEG” diets – boutique companies, exotic ingredients, or grain-free diets.  The apparent link between BEG diets and DCM may be due to ingredients used to replace grains in grain-free diets, such as lentils or chickpeas, but also may be due to other common ingredients commonly found in BEG diets, such as exotic meats, vegetables, and fruits.  In addition, not all pet food manufacturers have the same level of nutritional expertise and quality control, and this variability could introduce potential issues with some products.

  1. Most dogs being diagnosed with DCM do not have low taurine levels. Some owners continue to feed a BEG diet but supplement taurine thinking that this will reduce their risk for heart disease.  In our hospital, we currently measure taurine in all dogs with DCM, but more than 90% of our patients with DCM in which taurine has been measured have normal levels (and the majority are eating BEG diets).  Yet some of these dogs with DCM and normal taurine levels improve when their diets are changed.  This suggests that there’s something else playing a role in most cases – either a deficiency of a different nutrient or even a toxicity that may be associated with BEG diets.  Giving taurine is unlikely to prevent DCM unless your dog has taurine deficiency.  And given the lack of quality control for dietary supplements, you can introduce new risks to your dog if you give a supplement without evidence that she needs it.

  1. Raw diets and homemade diets are not safe alternatives. Out of concern, some owners are switching from BEG diets to a raw or home-cooked diet.  However, we have diagnosed DCM in dogs eating these diets too.  And raw and home-cooked diets increase your dog’s risk for many other health problems.  So, forego the raw or home-cooked diets and stick with a commercial pet food made by a well-established manufacturer that contains common ingredients, including grains.  If your dog requires a home-prepared diet for a medical condition or you feel strongly about feeding one, I strongly recommend you consult with a Board-Certified Veterinary NutritionistTM (acvn.org).  However, because home-cooked diets are not tested for safety and nutritional adequacy like good quality commercial diets, deficiencies could still develop.

Current thoughts on DCM

Currently, it appears that there may be three separate groups of dogs with DCM (although this may change as we learn more). I am listing them in the approximate frequency that we are currently seeing them in our hospital:

  1. Diet-associated DCM with normal taurine levels. While this form of the disease was first identified in dogs of breeds not predisposed to DCM that are eating BEG diets, it appears to also occur in dogs of typical DCM breeds that are eating a BEG diet.

  2. Primary DCM in predisposed breeds that is unrelated to diet. This is the traditional, genetically-related DCM in typical breeds, such as the Doberman Pinscher, Boxer, Irish Wolfhound, and Great Dane.

  3. Diet-associated DCM with taurine deficiency: This is the least common form we are seeing in our hospital. This appears to happen both in breeds predisposed to DCM and breeds that are not predisposed to DCM.

Common questions

We still have a great deal to learn about diet-associated DCM.  However, I’m providing answers to some common questions I’ve been getting based on what is currently known:

  1. What’s causing diet-associated DCM in dogs? For the vast majority of dogs, we do not yet know what is causing this disease. There are definitely some dogs with DCM that have low taurine levels, many of which will improve with taurine supplementation and change of diet.  For dogs that have normal taurine levels, however, other nutritional deficiencies may be present. Some nutritional deficiencies can affect the heart’s normal function, so an insufficient amount of these nutrients (or reduced bioavailability) in the diet could cause heart disease.  Diet-associated DCM could also be due to an ingredient in the food that is toxic to the heart.  The FDAand many researchers are actively studying this issue so that it can be solved as quickly as possible.

  1. My dog was diagnosed with DCM. What should I do? Ask your veterinarian to measure taurine levels and give heart medications as directed by your veterinarian. If your dog is eating a BEG diet or other unconventional diet (including vegetarian, vegan, or home-prepared diets), I recommend following the steps outlined in my previous post, including switching to a non-BEG diet.  Three updates to my previous post are:

    • Taurine supplements: Consumer Lab is expected to release a report on independent quality control testing of taurine supplements in late 2018. Given the lack of quality control for dietary supplements (human and pet), having these results will be very useful to find good quality products for dogs that require taurine supplementation. Your veterinarian or veterinary cardiologist can help you determine an optimal dose for your dog.

    • Other dogs in the household: We are now recommending that other dogs in the household of dogs with DCM that are eating the same BEG diet be screened by their veterinarian since their hearts could also be affected (even if they are showing no symptoms).

    • Outcome: Not all dogs with DCM will improve and improvements in the echocardiogram, when they do occur, can take a long time (often more than 6 months).

  1. If my dog is eating a BEG diet but has no symptoms, should I test for DCM or switch to a different diet? It’s unlikely that most dogs eating a BEG diet will develop DCM. However, given the fact that we don’t yet understand why BEG diets are affecting some dogs and because DCM is a life-threatening disease, I recommend you reconsider your dog’s diet until we know more.  Contrary to popular belief, there are no health benefits of grain-free or exotic ingredient diets except in the rare case of food allergy. If your dog is a part of your family and you want to feed him the very best, be sure to base this important decision on more objective factors than marketing and the ingredient list (see our post).

    Be sure to watch for early signs of heart disease – weakness, slowing down, less able to exercise, shortness of breath, coughing, or fainting. If you notice any of these, get your dog checked out by your veterinarian who will listen for a heart murmur or abnormal heart rhythm (although not all dogs with DCM have any changes that can be heard with a stethoscope). Your veterinarian (or a veterinary cardiologist) may do additional tests, such as x-rays, blood tests, electrocardiogram, and ultrasound of the heart (echocardiogram – the test of choice to diagnose DCM).Tell your veterinarian what you’re feeding your dog. You can help your veterinarian by bringing a list of everything your dog eats to every appointment.

    If your dog has no symptoms, additional testing is really up to you.  Some owners have measured plasma and whole blood taurine levels or scheduled an echocardiogram to check their dog’s heart size and function.  However, given the cost of an echocardiogram, other owners have elected to have their veterinarian do a blood test called NT-proBNP, which goes up when the heart is enlarged.  While a normal value doesn’t guarantee your dog has no heart disease, a high level suggests your dog’s heart should be evaluated further.

  2. Has diet-associated DCM been seen in cats? The association between BEG diets and heart disease has only been reported in dogs so far. However, that doesn’t mean cats are immune.  If your cat is diagnosed with DCM and is eating a BEG, vegetarian, vegan, or home-prepared diet, I recommend following the same protocol as described for dogs with DCM.

Lastly, if your dog has been eating a BEG diet and has been diagnosed with DCM, please don’t feel guilty. I’ve talked to owners who feel terrible because they wanted to provide the finest care for their dog by feeding them the best diet possible. They often spent a lot of money buying an expensive boutique diet and now that same diet may be associated with their dog’s heart disease. Trying to decide what is really the best food is confusing and difficult because of the many different products available, nutrition fads, and compelling marketing. My hope is that the one bright side of this serious situation is that it will shine a light on the complexities of making safe and nutritious pet food and the importance of nutritional expertise and quality control, rather than just what is new and trendy.

Valley Animal Hospital is proud to "howl" about our great reviews!

 
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Every day, Valley Animal Hospital pledges to provide “5 Star Service” to our clients and their pets!

It looks like we’re living up to that pledge, because Valley Animal Hospital of Merced has been voted “Best Veterinary Hospital” for the past 3 years (2016, 2017, 2018.)


 
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Valley Animal Hospital has earned 4.8 Stars on FaceBook and 4.7 Stars on Google Reviews!


Unfortunately, Yelp! has chosen to “filter” Fifty Seven (57) of our Five-Star Reviews, which means that 57 Yelp User’s votes DID NOT COUNT toward our Star Rating.

Why doesn’t every vote count, Yelp?

(BTW- every vote counts on Google Reviews & FaceBook— just sayin’)

Furthermore, Yelp! has not counted any of the eleven Five-Star Reviews we received in 2018!?

What’s up with that, Yelp?

Well, at VAH, we believe that democracy works best when every vote counts, so here are those ‘filtered’ (i.e. “Yelp censored”) reviews going back to 2015.

VAH is proud to “howl” about our great reviews. Valley Animal Hospital of Merced says “Thank You” to our fantastic clients for your kind words.

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Dr. Michelle Sheffield Joins Valley Animal Hospital of Merced

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Valley Animal Hospital of Merced is pleased to  announce that Dr. Michelle Sheffield has joined Our Team!  Her practice is focused on the well-being of dogs and cats. Dr. Sheffield is married with two children and numerous pets (of course.)

Valley Animal Hospital's vaccine prices beat the "Low Cost Clinics" again!!

Below are the latest published prices of the "low cost parking lot" vaccine clinic's individual vaccines compared to Valley Animal Hospital's prices--

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As your neighborhood veterinary clinic, we really want a lifelong relationship with you and your pets!
— Dr. Klingborg

     Now, we want to be totally straightforward-- our vaccines are a lot less expensive than those other guys,  but we do charge a $48 exam fee each time we see your pet for vaccines. 

Why do the Doctors at VAH insist on examining your pet? Because there's more to puppy and kitten health than just 'getting their shots.'  

Vaccines are important, but so is flea and intestinal worm treatment, heartworm control, checking your pet's weight to make certain he's growing properly, discussing your pet's nutrition and hair coat quality, working through issues with house training or chewing or biting, and maintaining a medical record of your pet's overall health, growth and more!  How much of that information do you get standing in line at a parking lot clinic?  None!

Your pet is going to be a member of the family for many years, and deserves the high quality and affordable health care that we are happy to provide.

Besides, if your pet has a problem after that traveling clinic has packed up the van and driven away-- who are you going to call?  Us!! And we'll be here!

Valley Animal Hospital of Merced has amazing prices on Puppy Vaccine Packages and Kitten Vaccine Packages-- with huge discounts on our vaccine services that include all of the necessary vaccines + worming medication + heart worm control + microchip + fecal exam and more---> and it's all included in the packages!!

Call us at 209.384.PETS for more information or to schedule an appointment.

The Dog Who Wouldn’t Eat

            When we heard that Yummers was refusing to eat, everyone in the clinic got worried.  It was with relief and confusion that we saw Yummers bound into the clinic—as plump as ever.  For a dog that wasn’t eating, Yummers appear to have plenty of meals ‘stored’ away.

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            “This is just terrible,” said his worried owner.  “He hasn’t eaten anything in two days.”  The round dog sat up and started begging as the owner spoke.  I ignored his not-so-subtle glances toward the Treat Jar.  Deciding that I must be stupid, Yummers gave up and jumped in his owner’s lap.  She let out an audible “ugh” as Yummers landed—he is a “stout” little fellow.

            “So, Yummers isn’t eating?” 

            “He refuses to eat his new dog food, unless I ‘flavor’ it with a little chicken, beef, lunch meat, water, or milk.  Sometimes, for variety, I’ll add cheese, too.”

            “How long ago did you change to the new dog food?”

            “Six months ago.”

            “Have you considered that maybe he should just eat dog food—and dog food only. After all, those extra flavors your adding are making him---“

            “—big boned,” interrupted his owner.  “Yummers isn’t fat, because I only feed him once a day.”

            “Even once-a-day eaters can get fat—especially if they don’t burn any calories in between meals.  What does Yummers do, besides eating, I mean?” 

            “Wait for snack time.”

            “Do you take him for a walk?  Does he play?”

            “No, Yummers doesn’t like walking or playing.”

            This was not a medical mystery, Yummers was too fat to comfortably walk or play. Unfortunately, eating had become the fat dog’s only source of entertainment. 

            The owner continued, “I don’t want him to starve.”

  

          “Do you really, really think that Yummers will starve if you don’t put some extra ‘flavor’ in his food?”

            “Oh, I’ve tried. For two days, I’ve given him nothing but dog food, and for two days, he won’t eat.  Besides, he stares at me and makes me feel guilty if he doesn’t like the flavor of his food.”

            “Let me ask you again. If Yummers had a choice—eat dog food or starve to death, do you really think he’d choose starvation?”

            “Well . . . probably not. But he won’t eat dog food.”

            “Yummers has trained you to feed him people food.  He knows that after two days you’ll give in to his demands.  This plump little dog has you wrapped around his plump little paw.”

            The owner looked embarrassed when she realized this was the truth.  “But if I don’t feed him what he wants, then he’ll think I don’t love him.”

            “Not true. Yummers is just trying to get the tastiest food possible. If he no longer has a choice between dog food or all of the extra “flavors” that you add, then he’ll gradually adjust.  If you really love Yummers and you want him to live a long and healthy life, then you need to change his eating habits now. Starting today.”

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            “I do love him and I do want him to live a long time,” said the owner.

            “Then are you ready to do what it takes?”

            The owner thought for a moment of how her life would be without Yummers.  Then she nodded resolutely, “Just tell me what to do.”

            In the end, Yummers’ transition from people food to dog food really wasn’t that difficult.  Yummers still got to cheat with occasional vegetables and fruit, but he didn’t get any more meat, chicken, milk, cheese, potato chips, etc.

            As Yummers lost weight, he became more playful and enjoyed going for walks again. Yummers’ happiness was no longer measured by the fullness of his dish.  Instead, a slimmer and more energetic Yummers got to go places and do fun things with his favorite person.  Now that’s a happy ending!

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Introducing the Rover Rewards Program for our Loyal Clients

Dear VAH Loyalty Rewards Member: 


  Our new Loyalty Rewards program will be called Rover Rewards.   You will earn 2 points for every dollar spent, and those points may be redeemed for discounts on products and services, donations to specific rescue groups, one free night of boarding, baths, free nail trims and more.

    There will be NO ANNUAL FEE!  This program is now FREE!  

    You will continue to earn rewards points on veterinary services, including exams, vaccines, surgeries, lab work, x-rays and ultrasound.

   Points are redeemable for purchasing any product, good or service that is located within the clinic. (In other words, online pharmacy and online food sales have been excluded and will continue to be excluded.)

      What else is New?  You will earn Points when you refer a new client to us.  There are going to be many more ways to redeem those Points than with the previous system.

    Your Points will expire if you haven’t used them within fourteen months. (We’ve extended that by two months— points used to expire after one year.)

    A new App (PetDesk) will be used to track your points. It also has abunch of other cool features such as giving you the ability to:

  • Request an Appointment

  • Confirm an Appointment

  • View what Vaccines/Test are Due

  • Refill medication

    Over the next few weeks, we will be converting your existing Rewards Points over to the Rover Rewards Program. 

    We think you’re going to LOVE the new system for booking and confirming appointments, being reminded of upcoming vaccines, exam and tests, as well as the ease of refilling medication with the PetDesk app!

    Thank you for being a loyal client of VAH!

   <3,

            The Doctors & Staff!

About Valley Animal Hospital of Merced

 Valley Animal Hospital of Merced is a full-service animal hospital that offers pets ‘preventative care’ and vaccines, spaying & neutering, soft tissue and orthopedic surgery, chemotherapy, ultrasound and radiology, in-house laboratory, pet lodging and care, an online discount pharmacy, and so much more!

    We make our patients and clients comfortable with a beautiful veterinary facility. Our doctors will give you straightforward answers and we offer a number of resources that enable you to learn about how to take better care of your pets. 

     Valley Animal Hospital is the only veterinary clinic in the Greater Merced area that offers a Loyalty Program-- our clients earn "Rover Rewards" (2 points for every $1 spent) and those points may be redeemed for $$$ off of services or products, a FREE night boarding or even a free Office Exam.

    98% of our clients recommend us to their friends and family, which is why we have a 4.8 stars (out of 5) rating on Google Reviews and FaceBook!

    Please call us today to get started on a lifetime of wellness care for your pet-- 209.384.7387.

Sincerely,

Jon Klingborg, DVM

Christine B. McFadden, DVM

Adam Lauppe, DVM

What's Included in a Spay or Neuter surgery at Valley Animal Hospital of Merced?

At Valley Animal Hospital of Merced, our Spays & Neuters include:

1) Physical Exam before Surgery 

2) Pre-Surgery Blood Work to check for signs of hidden diseases, anemia or other problems that might increase the risk of surgery.  

3) Pain medication is given before we've even started surgery!  Studies have shown that going a dose of pain medication prior to surgery reduced the overall post-surgery pain that an animal feels.  

4) A surgery nurse monitors every patient with a Pulse Oximeter (blood oxygen concentration and heart rate.)

5) Pain medication is given during surgery while your pet is still asleep.  

6) The fee includes the surgery which is performed by the Doctor (of course!)

7) Pain medication after surgery.  For dogs, this is usually three days of a once or twice a day pill.  For cats, we usually give a long acting pain injection that lasts for 3 days.  

8) Pets go home the same day as the surgery. No overnight stays needed because pets recover more quickly in their own homes.  

9) We use all "absorbable" sutures that will dissolve away on their own. You and your pet won't be inconvenienced by another trip to the vet just to get the stitches out.  

10) Spay and Neuter surgeries qualify for our Loyalty Rewards Program. If you enroll in the program, you'll earn 5% of the total cost toward you next visit!

For Dogs:  Our prices range from $150* to $195*-- it depends on the size and gender of your dog, because bigger dogs require more anesthesia and pain medication and a spay surgery (females) is more complicated than a neuter (for males.) 

For Cats: Our prices range from $105* to $140* depending on the gender of your cat.  

*There are additional fees for females that are pregnant, in heat or lactating (breast feeding).

*We will charge $15 -$20 for a flea treatment (that lasts 30 days) if your pet has numerous fleas-- because we don't want any of our patients to go home with fleas!

 

Please call if you need more information or to schedule your pet's surgery  

(209) 384-7387

Note:  Spay & Neuter surgeries provided through discounted programs such as New Beginnings for Animals or  Merced County SNAP program do not include blood work or post-operative pain medication. However, you may purchase these services for a small fee! Discounted Spay/Neuter and other procedures performed during a discounted spay/neuter do not qualify for our Loyalty Rewards Program.

 

More Facts about Spay and Neuter
The Spay and Neuter services provided by Valley Animal Hospital of Merced are permanent birth control against unwanted litters of puppies and kittens. 

Spaying: Ovariohysterectomy of females: Did you know that statistically  25% of female dogs will develop malignant breast cancer if they aren't spayed?

The research is clear--- dogs that are spayed or neutered are less likely to develop cancer, run away & get lost, or have behavior problems.  

Animal birth control is a plus in a nation where only 1 in 5 puppies or kittens are expected to find permanent homes – if you love your pet, have her spayed by 6 months of age or as soon as her planned breeding has completed.

Neutering, for male dogs and cats, has additional benefits as well, as it has been proven to prevent testicular cancer and infections or cancer of the prostate in males. If you have questions about our spay and neuter services, we would be happy to answer them for you and schedule a visit for your pet.

We cooperate with several local area Rescue groups and participate in the Merced County Animal Control sponsored Spay Program to provide reduced-fee spay and neuter surgeries for families of need. 

Knee Injuries: The Ruptured Anterior Cruciate Ligament (ACL) in Dogs

     Unfortunately, the Doctors at Valley Animal Hospital routinely diagnose dogs with a "ruptured ACL." This is a common knee injury in young/athletic or older/overweight dogs.  A dog's knee is designed a lot like a human's knee-- with two ligaments inside the joint that cross (the ACL and the PCL) to stabilize the lower half of the leg.

Dogs are very good are hiding pain and in many cases, the only sign of “pain” that you’ll see is that the dog is limping.

     Whether the cruciate ligament partially tears or completely ruptures, this causes a wobble in the lower half of the leg every time the dog is bearing weight on the limb. (A reminder that dogs only have "knees" in their back legs, so this injury can only happen on a rear leg.  The front leg is designed like a human's arm-- with an elbow joint and the bones + ligaments you'd expect in a person.)

     Once the ACL ligament is torn or ruptured, the knee joint is unstable and the body attempts to 'heal' the joint by producing bone spurs that limit the wobble in the knee. It's a great idea that has very bad consequences. Anyone who has ever had a bone spur knows how painful they can become. Dogs are very good are hiding pain and in many cases, the only sign of "pain" that you'll see is that the dog is limping.  In other words, if your dog isn't using his leg like he used to (i.e. walking with it) then it means it hurts to walk normally!

    Most dogs that have ruptured their ACL will be very painful for the first few days and then will seem a little more comfortable after that. This is just like any of us with an injury-- drop a brick on your toe and it hurts a bunch at first and then settles down after that.  Except that a ruptured ligament will not heal on its own, and the longer the knee is unstable, the more likely it is that your pet will suffer from muscle atrophy and bone spurs.

   Dogs with a ruptured ACL will usually "toe touch", so the leg isn't held all the way up, but instead the foot is just tapping the ground. We may see these dogs try to use the leg when walking on good footing-- such as carpeting or the grass-- but will quickly pull the leg up as soon as they get on slick footing such as linoleum or hard wood floors.

    Though you may find splints or other gizmos on the internet to "repair" a ruptured ACL, they really don't work that well. The way to repair this problem and restore function is through surgery. There are several surgeries for this problem and they all have advantages and disadvantages-- just like every other choice we have to make in life!

     At Valley Animal Hospital of Merced, the Doctors routinely diagnose this injury and perform surgery to stabilize the knee.  We primarily use the Extracapsular Technique to stabilize a knee with a ruptured ACL.  With the Extracapsular Technique, two false ligaments are implanted at an angle to 'replace' the torn ligament.    

     We have done hundreds of these surgeries over the years with excellent success rates and return to function. 

     Diagnosis of your pet's knee problem will likely require an Exam and Sedation (to manipulate the knee without hurting your pet.)  It may also require X-Rays. We've seen where some dogs rupture their right knee's ACL ligament because the left hip has a problem-- causing the dog to shift more weight onto the right knee. Understanding all of a dog's orthopedic (bone & joint) issues helps us to determine what is the best surgery and course of action for that dog.

     After the dog's workup, we'll discuss the various surgeries, their costs and advantages/disadvantages of the techniques. From there, the choice is yours whether we refer you to someone who performs a different type of surgery or we use the Extracapsular technique on your pet!

     The Doctors and Staff at Valley Animal Hospital of Merced hope that this information helps you to understand a little bit more about ACL injuries in dogs.  We've helped hundreds of dogs by repairing the ruptured knee ligament with our affordable Extracapsular surgical technique.

-- Jon Klingborg, DVM