Torteval Irish Wolfhounds

A few lessons we've learned . . .

. . . get your dog heart tested.
In the UK, take advantage of the regional heart-testing sessions organised by the Irish Wolfhound Health Group which are open to everyone. By having your wolfhound thoroughly screened annually you stand a good change of identifying and treating any problems early, before the dogs becomes serioulsy ill.

. . . be assertive with your vet.
Even though you may have a competent, experienced vet, the effectiveness of your dog's treatment may depend on your knowledge and experience, your contacts in the breed and your assertiveness as much as it does on the skill and training of your vet. If your wolfhound should ever become suddenly ill with an unexplained high temperature, and especially if he is lying or standing with his head extended out from his body, you should seek urgent veterinary advice - but be prepared to challenge your vet and insist (politely) that the dog be treated as if he has pneumonia until proved otherwise.

. . . get an extended course of the right antibiotics.
With regard to antibiotics there seems to be differing opinions even amongst the experts, as to the best ones to use. In the US, cefiofur (Excenel) is widely used, but isn't licensed in the UK. Clindamycin seems to be the drug of choice here, combined with a cephalosporin, but when we suggested this to Mark Patteson he said that in his experience marbofloxacine was better. What there seems to be no doubt about is that penicillins alone are not effective, and that a six - eight week course is needed.

. . . get the best insurance you can afford.
Darcy's cardiac drugs cost approximately Ł200 ($300, $220) a month, and continued for the rest of her life. The scans and investigations done by Mark Patteson cost in excess of Ł900 ($1,400, $990). All of this was paid promptly and without question by our insurer, Petplan, with lifetime cover. Over the years that our dogs were healthy we frequently questioned the wisdom of paying out ever increasing premiums for a good level of insurance cover, but it's worth every penny not just for the financial benefit, but because the question of cost does not have to be considered when deciding on appropriate investigations and subsequent treatment.

Background
Until the age of seven-and-a-half, Darcy's only health problem had been two episodes of bloat (gastric dilation), both of which were successfully treated before progressing to torsion (volvulus). After the second episode she successfully underwent gastropexy (surgical fixing of the stomach to the abdominal wall) to prevent any recurrence.

Although we knew regular heart-testing to be crucial in identifying cardiac problems early in wolfhounds, Darcy had never been tested. There were several reasons for this: as far as we knew, there was no particular history of heart disease in her line; testing only provides a snapshot on the day and is no guarantee that the dog won't develop heart disease next month or next week; 'private' heart-testing is expensive at approximately Ł300 ($450, $330) and can only be done locally at the time of the cardiac vet's annual visit to Guernsey; our trips to the UK didn't necessarily coincidence with the regional testing sessions organised by the Irish Wolfhound Health Group which, at Ł40 ($60,$44) are more affordable, and when they did it was Hogan, who did have a poor family history, who took priority; Darcy hates being 'interfered' with and would find testing very stressful; etc, etc, etc . . .

June 2009 ~ The Big Scare
Saturday 6th
Our complacency was abruptly punctured during a stay at our second home in Somerset. We had been at a dog show that Saturday. Although Darcy isn't keen on shows it had been a relaxed, open air event at no great distance from our home, and she seemed to tolerate the day with her usual placid resignation and without any undue stress. She won her veteran class, and the judge's critique read "Seven years bitch, beautifully feminine, lovely head, very well put together, attractive silhouette, super fit for her age and she moved like a three year old." No hint there of any problems to come.

That evening though, she was restless. We couldn't put our finger on what was wrong. There were no specific symptoms to justify a call to the vet - she just didn't settle as she normally would. We were concerned and puzzled rather than alarmed, but throughout the night she remained unhappy and fidgety. It was most unlike her, as she's a dog who takes her sleep seriously.

Sunday 7th
By Sunday morning, she was exhausted but still unable to settle. It seemed she couldn't get comfortable lying on her side, but opted for a sternal position (lying 'up' on her elbows). She was drinking and weeing as usual and her temperature was normal, but our internal worry-meter was rapidly edging into the red zone. When she refused her breakfast the needle went off the scale - this was flashing-red-lights-and-sirens time.

We noticed that as well as not wanting to lie in a lateral position, she was extending her head and neck forward in a strange posture. Although we hadn't experienced this before, the position had a familiar ring to it and we remembered having read about it relating to pneumonia in wolfhounds. We phoned Jo Braine, a good friend who we knew had had pneumonia in her own dogs. From our description of Darcy's symptoms Jo was convinced that pneumonia was the problem. She advised us to get Darcy to a vet urgently and to ask that she be given specific antibiotics: clindamycin (Antirobe) and cephalexin (Cefaseptin). If Jo was right, Darcy would need at least a six week course of both.

The on-call vet responded quickly, and with our local surgery only twenty minutes away Darcy was soon undergoing a thorough examination. Nothing untoward was found in her lungs on examination, and x-ray showed both lungs to be clear. However, the vet was receptive to our concerns about pneumonia and prescribed a five-day course of the antibiotics we requested.

He made it very clear though, that he believed Darcy's problem to be cardiac, not pulmonary. Her heart rate was elevated, her pulse not as strong as he would expect in a fit dog of her size, there were occasional dropped beats and a heart murmur.

Initial ECG interpretation confirmed these findings, and Darcy was commenced on pimobendan (Vetmedin) to strengthen the heart's contractions and frusemide (a diuretic) to decrease the volume of fluid and reduce the workload of the heart. She was to stay at the surgery overnight and be reviewed the next day by a vet with a special interest in cardiology.

Monday 8th
Repeat ECG showed a dramatic deterioration. She had developed a supraventricular tachycardia (SVT) - a rapid and abnormal rhythm that begins in the upper chambers of the heart, with a rate of 320 beats per minute. The normal heart rate in wolfhounds is similar to ours - 70-80 bpm. Her rate then changed to ventricular tachycardia (VT) - a more serious arrhythmia originating in the ventricles, with a rate of 240. The vet was preparing to inject her with her lignocaine to prevent this developing into ventricular fibrillation and possibly sudden death when the rhythm reverted to SVT.

Although the heart itself was not greatly enlarged, the septum (which divides the chambers of the heart vertically) was dilated, and early dilated cardiomyopathy (DCM) was diagnosed. Darcy was commenced on sotalol (Beta-Cardone) to regulate her heart rate and we were allowed to take her home later that day.

Tuesday 9th - Thursday 11th
Her heart rate was a slightly less scary 180, but she was still listless and clearly feeling unwell, and it was another two days before she was herself again. We knew she'd turned the corner when her appetite returned - with a vengeance! Her heart rate was now down to 70, with a much improved volume. Frusemide was discontinued as she was no longer in failure, and benazepril (Fortekor) was added to the cocktail of drugs that she would be taking for the rest of her life. Benazepril is an angiotensin-converting enzyme (ACE) inhibitor which reduces the workload of the heart.

All thoughts of pneumonia as a diagnosis were put aside. Both the vets who treated Darcy at this time were adamant that her lungs showed no signs of infection and that all her symptoms were due to her heart condition. She completed the five-day course of antibiotics as prescribed and we thought no more about pneumonia.

June - November 2009
Throughout the rest of the summer, Darcy remained stable. She was active and enjoying life, and if she wasn't quite as lively and high-spirited in herself we put it down to the fact that she was now a lady of advanced years who was entitled to slow down a little.

Our thoughts and concerns were almost entirely focused on Hogan's poor health at this time. He had developed a chronic degenerative condition of his spine which seriously affected his movement, and in August he too was diagnosed with DCM. The course of his heart condition was much more erratic than Darcy's, with repeated episodes of acute heart failure, and there's no doubt that our worry-meter was fixed on him rather than Darcy.

November 2009 ~ A Black Week
Monday 23rd
Hogan lost his final battle with DCM was put to sleep at the age of five.

Friday 27th
Darcy suddenly had no interest in her afternoon walk. This was more than just an old lady's preference for a gentle amble - she was physically struggling to walk and our usual route had to be dramatically shortened and taken at a snail's pace. Once home, it was clear she was very poorly. She was in a state of semi-collapse, with a temperature of 104 F (40 C) (normal for a dog is 101/38). Again, she refused to lie on her side, extending her neck and head neck to aid breathing.

The on-call vet visited, but dismissed with some disdain both my suggestion that she might have pneumonia and my request that, just in case, she should have antibiotics as recommended by Jo in June. He informed me that her lungs were clear, though the surgery notes I subsequently obtained state that pulmonary congestion was developing and her chest sounds were dull. Perhaps my recollection of events is inaccurate. He gave Darcy frusemide, and treated her high temperature an intramuscular injection of clavulanic acid (Synulox) and a five day course of amoxicillin (Clavaseptin). He refused to be drawn as to what might be causing her pyrexia - it was just "an infection somewhere".

Again we waited and watched through the night, trying to prepare ourselves for the grim prospect of losing two dogs in five days, but by morning we could heave a sigh of relief as she was much improved.
Saturday 28th
She was reassessed at the surgery by the same vet, with clinical examination showing no evidence of pulmonary congestion. Her heart was more stable with a stronger pulse, but her temperature was still 103.5 F (39.7 C). ECG showed partial heart block (an arrhythmia) and the vet explained that her atria and ventricles were operating independently of each other. He felt she might need a pacemaker for which he would refer her to a veterinary cardiologist in the UK.

Darcy was reviewed again by the same vet four days later, when she appeared to have made a full recovery, with no evidence of arrhythmias. She had a normal, coordinated pulse and normal capillary refill time (CRT). We were to reduce her frusemide gradually over the next nine days.

Sighs of relief all round . . .

December 2009 ~ Uh-ohh, here we go again!
Wednesday 16th
Three weeks later, she suddenly developed exactly the same symptoms all over again: lethargic, refusing food and walks, temperature 104 F (40 C). This time we saw our regular vet, who noted (but didn't tell us) that she had congested lungs. By now I had given up trying to tell vets that she had pneumonia. Heart and pulse were OK apart from a marked sinus arrhythmia. She was put back on frusemide and given another week's course of amoxicillin.

She recovered quickly, and as we had an appointment with the UK cardiologist for a week's time we just hoped she would keep well until then.

Wednesday 23rd
So, the day before Christmas Eve we made the trip to Dursley in Gloucestershire to see Mark Patteson at Vale Referrals. He took the most detailed and thorough history I've ever known a vet ask for (or a doctor, for that matter). Clinical examination showed a variable heart rhythm, with sinus rhythm interspersed with premature beats and some pauses. He found no murmur or gallop sound, normal lung sounds, a slow CRT and a slightly weak pulse.

At this stage Mark told us that he strongly suspected that Darcy was suffering from pneumonia. To say it was music to our ears isn't quite right, as we would much have preferred that she not have pneumonia, but it was very hard not to punch the air with a "Yessss!!!". At last we had found a vet who recognised pneumonia as a major cause of morbidity and death in wolfhounds. According to Mark, a high percentage of wolfhounds referred to him for cardiac assessment have nothing wrong with their hearts but are suffering from undiagnosed or incompletely treated pneumonia. We asked why it is that vets in general practice seem to be unable to recognise and/or unwilling to treat the condition, and he pointed out that without specialist equipment and training diagnosis is very difficult. There is also the question of cost. With a six week course of the necessary antibiotics costing Ł500-600 ($700-900, $550 - 660) even vets who do recognise the danger of pneumonia in wolfhounds may be reluctant to treat a condition that they cannot be sure exists.

We left Darcy at the surgery to undergo echocardiography, Doppler echocardiography, ECG and thoracic ultrasonography. When we collected her Mark pointed out on the scan several very distinct dark lesions in the periphery of lungs which were the site of the pulmonary and pleural infection.

By this time, Madame was extremely put out, as well she might be, since she was now strapped up in yards of cling bandage underneath which was a cardiac monitor. She was to wear this for 24 hours, during which time we had to record all her activities. Incidentally, when she returned the next day to have the contraption removed the bandage was in pristine condition - unlike the Irish setter we met at the surgery, who was trailing his muddy, bedraggled bandages like an unravelling Egyptian mummy!

The final diagnosis was "Mild left atrial enlargement, no significant changes in left ventricle dimension. Mild mitral regurgitation and arrhythmias indicate early DCM. Recent clinical signs relate to pleuro-pneumonia."

For the DCM, Darcy was to continue on pimobendan, benazepril and an increased dose of sotalol (120 mg twice daily). For the pneumonia, she was prescribed a six week course of marbofloxacine (Marbocyl or Zeniquin) and amoxicillin. We were given an emergency supply of marbofloxacine to give in the future immediately there should be any signs of pyrexia, difficulty in breathing or thoracic pain.

The final chapter
Mark Patteson had warned us, "She may have a couple of years or she may drop dead tomorrow." But that's true of all eight year old wolfhounds. What was important to us was her quality of life, which was greatly improved once the pneumonia was properly treated.

For several months, she was bright and lively, with a spring in her step and a gleam of mischief in her eye, and every day that she was well and happy was precious. In the end she succumbed, not to heart disease or pneumonia, but to a probable perforated ulcer brought on by the anti- inflammatory drugs she needed for her arthritis.