Heart Disease Cases

My almost 15 year old Gracie has congestive heart failure and was diagnosed with Lyme. Her c6 was 158 in January after I had given her Ledum for a tick bite. She just recently tore her CCL and now I’m wondering if it’s related? She never had a fever or loss of appetite but did tear her other CCL a few years ago. Also, can I give her glucosamine chondroitin with kidney disease? She’s on pimobendan, furosemide and sildenafil for her heart which is causing her kidneys to decline. Her BUN is 90, phosphorus 5.3 and creatinine 1.6. No protein in the urine. She also has a very sensitive digestive system and does not tolerate a ton of medications and supplements. Currently on phos bind, turmeric, homeopathic hawthorn, enzymes, gut soothe, coq10, cardio boost, and balance it k plus for homemade fish and sweet potato diet. 

Thank you,

Dr. Steve's Advice - the propensity to Lyme, heart disease and cruciate tears are all linked in that they stem from the same underlying constitutional weakness. In Chinese medicine, that is termed Shao Yang disharmony. Treating that Shao Yang disharmony would be expected to produce improvements in all three problems as well as kidney function. I would start simply by adding Voltrex (https://goldstandardherbs.com/products/Original-Voltrex-85g-p647327438) from Gold standard Gold Standard Herbs, since it has potential beneficial effects on all those problems. You can read more about its benefits in #dogcruciatetear

As for the glucosamine and chondroitin, those are fine to use in a dog with kidney disease.

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I have a 5 pound Chihuahua that is 13 years old and she currently has a grade 5 to 6 heart murmur, enlarged heart and enlarged left atrial and mitral valve disease.  She is not in heart failure and her resting heart rate ranges from 18 to 20. She saw the cardiologist today for an echocardiogram and she has been taking Vetmedin and Ubiquinol for about 4 months now prescribed by her regular vet. It is taken a while to get her in to see this cardiologist  He wants me to add spirolactone  but she doesn’t have fluid or high blood pressure. He says he’d like to add this just to keep her from going into heart failure as a preventative.  please give me your opinion if you think this is a good idea I’ve been reading conflicting stories that they shouldn’t go on a diuretic if they don’t have fluid. thanks so much!  This is Chica!

Dr. Steve's Advice - Chica is very cute, Tracy Leath Broughton! I looked into the spironolactone, but cardiologists disagree whether it can do anything to halt progression in heart disease. It's considered a weaker but safer cousin of Lasix, and it can't prevent progression either.

That does not mean you're helpless, though. The heart findings signal a backing up of blood into the left side of the heart, and your cardiologist is worried it will progress from there into the lungs, causing pulmonary edema. There are two main causes to that kind of back pressure problem: (1) the vessels the heart is pumping into are too constricted; and (2) the heart is remodeling and dilating, such that the valves don't close properly anymore, impairing its ability to pump blood out of it. 

Regarding the former issue, that is called endothelial dysfunction, and a JAVMA study in 2012 found it present in every dog with congestive heart disease that they checked. This manifests as hypertension when it's more severe. Some cardiologists have speculated you can prevent things progressing to hypertension by using spironolactone, but most now do not agree it won't. That's not a big surprise, because the problem is often diet. It's hard for a few mgs of a drug to counteract the pounds of food that dog's eat each day.

The first thing you can do that will work better than spironolactone is to change your dog's diet to a real food diet, if you haven't done so. The cause of the vessel narrowing problem known as endothelial dysfunction is a diet that raises insulin levels too easily and then keeps them high, because the diet is too easily absorbed. In other words, too processed. If your dog eats real food, then it is broken down much more slowly, insulin levels stay relatively low, and the condition eventually reverses. That means the heart can pump and empty itself more easily.

Problem 2 is interesting. Most veterinarians probably believe that the heart just passively dilates as blood accumulates inside it, stretching it out. Studies have shown that the process is active, however, mediated by a compound called calcineurin, and that if you inhibit that compound, the heart can remodel back to normal. I've seen this many times in clinical practice, as evidenced by a reversal of changes seen in previous echocardiograms. It has also been confirmed in laboratory studies.

The Chinese herbal formula called Minor Bupleurum contains compounds that inhibit calcineurin. Meanwhile, it counteracts endothelial dysfunction. You can obtain it as Harmonize the Qi from Kan Essentials (sometimes online) or from Natural Path (via your vet) as Xiao Chai Hu Tang (Minor Bupleurum). I usually pair it with another Kan Essentials formula called Blood's Palace, sold as Xue Fu Zhu Yu Tang (Persica and Carthamus) from Natural Path. Likewise, it counters endothelial dysfunction and helps support renal perfusion to prevent development of full on hypertension.

These two formulas should do what your cardiologist is looking for, especially if you change the food to a real food diet. I would not be surprised if the murmur starts to fade in intensity down to a 3 or 4 out of 6 after a few months on this protocol. Hopefully that helps you out!

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Looking for some help with our Ollie (not a recent photo) almost 16 yrs old, Shih Tzu/Tibetan Spaniel. Early March he experienced 2 syncope episodes, 5 days apart, during times of (happy) excitement. This led us to vet visits and lab work where we were told he has mitral valve disease/heart murmur, was started on Vetmedin mid-March, not long after, his appetite significantly decreased, along with his energy level. More bloodwork, work up with cardiologist, urinalysis, and now rapid escalation in kidney markers (which we feel was accelerated by Vetmedin.) Quality of life went down, he wasn’t eating, giving him Entyce for appetite stimulant, he’s eating a little now, although very limited, including jarred baby food. We took a break from Vetmedin to see how he did without the side effects, & his quality of life has improved, eating a little, even taking some very short walks. I’m giving him a little bit of hemp oil, & golden paste (homemade cooked concoction using turmeric), by syringe. I know not to expect a miracle cure, but what can I do to quieten things down and improve Ollie’s quality of life, with heart and kidney disease? I want to know that I’m doing all I can to keep him comfortable and help him feel better. Your feedback is much appreciated.  In the comments, I’m posting lab results from 3/11, 3/31 & 6/1. Thank you SO much.

Dr. Steve's Advice - to improve renal blood flow and reverse some of those laboratory findings, you probably need to institute a couple of herbal formulas quickly. I would go with Rehmannia Eight by Kan Essentials, which you can often find online at Amazon in the US; and Blood's Palace by the same company. Dose each according to the table at https://nphc.ca/using/dosage. Give the amount in the table for your dog's weight twice daily. 

For the heck of it, I would add Lift the Qi by the same company. Dose the same way. We normally don't use that in kidney failure. Not that you couldn't though. It combats hypotension and syncope. If the Pimobendan worsened your dog, it would have had to have been through induction of profound hypotension. If that is true, then Lift the Qi will address it.

Hopefully all three of those together will rally poor little Ollie!

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Hello Dr. Steve, I'll try to be as brief as possible. 12yr old 10.5 lb. Pico's 01/23 labs Indicated BUN/UREA OF 39, CREA 1.7, SDMA 15. Repeated 07/23 - BUN 50, CREA 3.2, SDMA 35.1,  Precision PSL 673 and Urine/Protein Creatine Ratio 0.3 He was being fed 2 tbsp. HK with 4.5oz home cooked BID. Replaced HK with  2 oz. My Perfect Pet low phos lamb and 3 oz. homecooked, added 1 tab Kan E Rehmannia Eight Combination and started 1.25mg Vetmedin SID for enormous heart and 5/6 murmur.  Repeated "short panel" 2 mo. later - BUN 48, CREA 3.0. Would you recommend adding Voltrex for heart support and or any other supplements. Always grateful.

Dr. Steve's Advice - I would suggest Blood's Palace from Kan Essentials rather than Voltrex, only because of the low UPC value. That tells us we need increased renal perfusion by improving cardiac function. Voltrex can boost cardiac function but is a renal decongestant. I'm thinking Blood's Palace can fill both requirements. If it works well, but the heart needs a bit more help, then a small amount of Voltrex could be added at that point.

Hope that helps!

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I have a 13 yo, 26lbs corgi jack russell mix who has been on home cooked/raw mix with vegetable puree and fruits the past 5yrs since we adopted him. He gets very little carbs (occassional small amount of oat at dinner for acid reflux).

Recently diagnosed with a grade 3 murmur and last week echocardiogram showed he has enlarged heart (~16%), result is attached for your review. No meds needed for now per the cardiologist but I would like to start him on the treatment you usually use. Any idea what could've caused the heart enlargement? He's quite active and we walk 2.5-3 miles total daily.

He just had 7 teeth removed 2 days ago and is currently on Rimadyl 25mg and Gabapentin 100mg (both twice a day).

Should I start him on these asap?

• Harmonize the Qi from Kan Essentials or Cessorex from Gold Standard - which one should I give?
• Blood's Palace Xue Fu Zhu Yu Tang
• Hawthorne (berries and leaves)
• Should I add taurine if he already gets raw liver daily?

Anything else I shoud give him? He gets good fish oil, vit E 133IU, 100mg Ubiquinol for CoQ10, sardines.

Thank you so much. I appreciate you and what you do for all of us 

Dr. Steve's Advice - It looks like you've caught the heart condition very early, and that there's just a bit of mitral valve damage. The most common cause of that is 'wear and tear', though that can be compounded by bacterial infections that, in turn, come from the teeth, so I'm glad you got the teeth cleaned. 

They mentioned hypertension as something to watch for, and it's fine to check. More information is never a bad thing. Note, though that dogs on a healthy real food diet don't really get hypertension. Additionally, we'd expect to see left ventricular changes with hypertension but those are not in evidence. At this point, then, it's a valve issue.

Starting your dog on that protocol is fine. Even that maybe overkill. You could just go with Cessorex (https://goldstandardherbs.com/products/Original-Cessorex-85g-p647327434) from Gold Standard Herbs for now, in addition to the Hawthorne, CoQ10, fish oil and vitamin E. That should be an excellent start.

If a cough one day develops, we could step up our game with XFZYT and XCHT. It may not, though. The entire problem may just stay as a grade III murmur, thanks to the excellent care you've been giving

Hope that helps!

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I have a 9 year old Great Dane female just diagnosed with stage 2 A/V block. She has fainted with exercise and in the last week or so is pale. We were told the only thing conventionally is a pacemaker, no medication. We aren’t likely to do a pacemaker. She is a very sensitive girl, easily nervous and anxious and honestly crate rest for 30 days along with all the necessary checkups would not be the kind of life she’d want. 

But homeopathy, herbs, Chinese herbs, food as medicine are. Guidance? Information? Pitfalls? I’m looking for all of it. Our conventional vet is also running labs to see if she has an immune mediated derangement of her blood or if she has bacteria from anaplasmosis of which she was positive along with Lyme in April. We do have a homeopathic vet and access to a canine herbalist and a human Chinese Medicine herbalist. She’s been on 100 mg CoQ10 daily for about a year and a hawthorn combo blend phytoembrionic tincture for about that same length of time as we had some hunches there were heart issues but a cardiac work up had a 7 month wait list. 

She’s raw fed, as a young pup, before she came to us, was over vaccinated. None since 15 months old when she came home 

Thank you for your thoughts! This is Minnie

Dr. Steve's Advice - Since Minnie was Lyme positive, I think the place to start is Minor Bupleurum. I prefer the Natural Path source of this as it is organic, twice as concentrated as any other granular extract, and tweaked to fit an animal's physiology. 

DO NOT use Minor Bupleurum versions that do not contain Panax Ginseng. Minor Bupleurum contains two herbs, Scutellaria and Ginseng, which inhibit calcineurin. Most vets assume that changes in the heart muscle associated with cardiomyopathy (and which cause the heart block) are passive and degenerative. The reality is that they are deliberately created by the heart through the actions of a compound called calcineurin. Inhibition of calcineurin has been shown in laboratory studies to cause hearts afflicted with cardiomyopathy to revert to normal shape and function. I've seen that happen in both my human and animal practices, so there's a lot of hope here. Indirect proof of that will be if the EKG you've had done reverts to normal over the next few months.

If you have a veterinarian doing acupuncture for you, they can confirm this is the right thing to do. The pulse will feel "Full", which most vets will interpret as "strong and Wiry". It will soften once GB 34 is needled (or massaged using acupressure) with a "sedating" technique.

There are other herbs we can add in, but this is likely the place to start, along with perhaps an anti-Lyme protocol containing serrapeptase and Cat's Claw.

Lastly, as she is on raw, make sure she is on a probiotic containing Lactobacillus and/or Bacteroides, along with a source of fermentable carbohydrates and soluble fiber.

Along with all the other good things you're doing for your dog, I'm pretty sure you can get Minnie feeling substantially better. Please let us know how things are going, so I can suggest other things if you're still struggling.

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 Dear Dr. Steve,I’m writing this post-letter to resolve the issue with my dog. He is very sick, and I’d like to help him as much as possible. Below you can find his medical history and the medication that he is given.

Salto, a cavalier dog is 6 years old. He comes from a certified dog breeding but he is suffering from typical conditions for this breed:

- Food allergy and recurring diarrheas, which were cured with amoxicillin antibiotic, and inflammatory bowel disease. After gastroenterologist’s consultation, his condition improved since he eats Hills Z/D protein hydrolysate veterinary food,

- Dry eye syndrome- he is given cyclosporin drops,

- He has a heart disease – a chronic degenerative bicuspid valve disease- medication that he is given: Cardisure ¼ 10 mg twice a day, UpCard (torasemide) 3 mg - given ½ pill once a day, Entresto 49/51 mg- this medication is not veterinary approved in Poland yet, but the cardiologist introduced this drug into the treatment and we give it to Salto in the dose of 49/51 mg- twice a day (1 pill). The current heart condition indicates that Salto won’t leave a few more years, but he has only few more months to go and we’d like to make his life as comfortable as possible,

- Chiari malformation and syringomyelia- diseases identified by the symptoms such as strong pain near the neck and head, difficulties while moving. For a few nights before giving him the efficient medication, he couldn’t sleep from acute pain. The symptoms began two months ago- Salto started to limp and didn’t want to walk. He was in a strong pain and he whimpered badly while trying to pick him up. Before pain symptoms, he became to do a phantom scratching, rubbing his muzzle against objects, but we thought it was an allergy. After the neurologist consultation, an x-Ray under anesthesia was commissioned. Unfortunately, Salto’s heart condition excludes him from such an examination, because there is a high risk that Salto won’t awake from anesthesia (as his cardiologist states). That’s why we try to treat his symptoms.

- Salto had a spine x-Ray, but it didn’t show any changes or disabilities of bones or discopathy.

- Currently Salto (weight 11,5 kg) takes the medication prescribed from his neurologist: Gabapentinum 3 times a day (200 mg), Predinicortone steroid 5mg, 2 times a day, CBD oil 15% , Diuramide (acetazolamidum) ¼ 200 mg once a day, Omeprazolum 10 mg x 2 times a day, and there is a plan to introduce the Memantine (memantini hydrochloriudum) 20 mg ½ twice a day.

There are days when Salto is feeling better and do not feel any pain, but he is not as agile and happy as before. His functional status is now 60% of what it was before the onset of symptoms. He is not barking anymore, it is visible that he is scared, as barking increases the pressure in his skull and leaves him in pain.

Before that, we could go on long walks, but now we are limited only to take care of the basic needs on short walks. After longer walks the pain begins to intensify. There are days that we need to give himj an injection of comfortan (methadone) because the pain is so strong.

Please give me some advice about the other possible treatment procedures that are used for treatment of recurring neuropathic pain in cases of Chiari malformation and syringomyelia?

Blood results and biochemistry are under continuous control and are normal.

Dr. Steve's Advice - the syringomyelia sounds like it is a presumed diagnosis because of the symptoms and breed. A more common problem, however, is simply a chiropractic fixation of the atlas and neck region. That can produce the same symptoms, including nerve root impingement that results in forelimb lameness. It can also lead to trigeminal and facial nerve irritation, producing the face rubbing.

Atlas fixations do not show up on X-rays in dogs that size unless (1) they are extreme, and (2) the vet is trained to look for them (which is exceedingly unlikely). An exam by a chiropractor would reveal if the fixation is there quite quickly, and treatment can produce almost immediate improvement. So, for me, that would be step 1.

Something you can try that would work if this is a neck fixation rather than syringomyelia would be muscle relaxant herbs for the neck. One example is Valerian root extract, which you can likely source locally in Poland. Give robust doses (as it won't interfere with all the drugs you have on board): 0.2 ml per 5 lbs body weight of the liquid extract given perhaps four times a day. If you see some improvements, you'll have your answer. At that point, finding a chirorpactor would be imperative. Even a human one may serve the purpose if they have an Activator and are willing.

Hopefully this helps you out! Let us know how it goes

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Dr Steve,
My precious rescue boy is 3 years old and diagnosed with a “grade 1-2” heart murmur. I am devastated. I lost my last rescue to dilated cardiomyopathy at only five years old. This sounds like the same road we’ve been down before. Is there a Chinese medicine combination that would be beneficial to him?  I want to prolong his life and as I understand it we need to cater to the calcium channels in his heart. He also has horrible seasonal allergies. Scratched himself bloody and bald. He’s on a white fish (cooling) based diet and I use Dr Harvey’s Canine Health food which is dehydrated goodness. I’ve tried everything I could holistically to manage his allergies with no luck so he’s back on the dreaded Apoquel. What else can I do to help his heart and allergies? I do give him golden paste and the three supplements pictured. Just to note we did do Michigan state’s full thyroid panel and it was negative.

Dr. Steve's Advice -  please have a read of the posts at #cessorex and #skindiseasedogs to understand my particular approach to skin disease. I'll just add a few comments here to specify how they apply to your dog.

The products you're using are focused on reducing histamine, which might be somewhat palliative, but is akin to trying to deal with an overflowing sink by bailing it out, versus just turning off the taps. Dealing with allergies at the level of leaky gut and the microbiome is akin to turning off the tap.

To know the microbiome is the issue, you'd need to see the problems persist when feeding fresh real food. Even dehydrated foods are pro-inflammatory, since their content of AGEs is much higher than fresh food. For some pets, simply avoiding any heat treated foods at all may be enough to resolve their inflammation.

You might already be feeding a real food, but even if not yet, I think it's worth proceeding to the next step, which is to introduce Cessorex (https://goldstandardherbs.com/products/Original-Cessorex-85g-p647327434) by Gold Standard Herbs. The reason why is that I have used the herbs in that product to halt and reverse heart muscle damage in both humans and dogs.

Two other changes I'd suggest:
- Stop the Golden Paste, as it contains warming herbs which will aggravate itch tendencies
- Add in probiotics like Lactobacillus or Bacteroides. If you make the switch to fresh food, ensure that 15% of it or so contains soluble fiber and fermentable carbs, such as fruits and vegetables

Hope that helps!

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 Hi there! New to the group- I have been doing some reading, but need some guidance with comorbidities.

My pup is 13 or 14. She has been on vetmedin for CHF (got off lasix over a year ago and fluid hasn't come back...) and only in stage B2.  Just recently I noticed her urine was really light, so we went to the vet and got dx w/Kidney failure- Currently stage 2 they said.  She had an ultrasound to help with staging, and she has a few kidney cysts (the largest is about 1.5 cm, the rest are tiny) and ultrasound showed decrease in fx which is consistent w/kidney disease.  They also however found a large 3cm tumor on her right adrenal gland, and an enlarged left.  She was at the vet for 2 days receiving an IV flush to help our her kidneys (approved by cardiologist) and they ran a cushings test, that I should be getting the results of tomorrow. She is receiving 5 back to back days of fluids, then we will be going to 1x a week to start.

So I guess the big question is- what can i do holistically to support MVD, her kidneys, and her adrenal glands?  She is showing signs of kidney disease with decreased appetite (we were feeding honest kitchen, but now I am using some of the weruva formulas, HK, Dr Harveys base mix, My Perfect Pet low phos, and JFFD renal- whatever she will eat!) and she occasionally vomits.  I have been looking into some of the NVH formulas, Standard Process, and the PetWellbeing, but just become really overwhelmed, then I add on what I read in her about chinese herbs.  THANKS.  I'll be at the thing at Dexter's today.  Timing couldn't have been more perfect 

Dr. Steve's Advice -  

nice to meet you at Dexter's on Sunday. Any word on the results of those tests? And I can't remember how you said she did on the fluids. I think I suggested Rehmannia Eight provided the IV helped her blood work and maybe even her energy and appetite.

If the ACTH stim test came back positive for Cushing's, add in Three Seeds Combination, which helps reverse metabolic syndrome, which is the driver of both heart disease and Cushing's in dogs. It enhances the efficacy of Rehmannia Eight in treating renal failure.

Diet is the ultimate cure for Metabolic Syndrome. Try to keep her diet as unprocessed as possible to undermine both her tendency to heart disease and her tendency to adrenal gland hyperfunction.

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Hi Dr. Steve, so happy to be in this group.

Around the time my daughter was born 3 years ago, my dog Blue started struggling with incontinence issues - leaking when he is resting. He also started drinking a lot of water and had dilute urine. Our vet at the time run a bunch of tests for Cushing's, Diabetes, Kidney Disease, etc., he saw an internalist specialist and couldn't find anything so called it an anxiety-based behavior (he's struggled with separation anxiety since we got him at 2).

In the spring of last year, he was diagnosed with hypothyroidism and level 1 heart mumur and put on thyrotabs. He started to get back to a healthy weight, but since has started losing even more muscle mass and now weighs less than when we got him as a pup.

This year has been his hardest year with a few benign cysts removed, a stay at the ER vet for raisin ingestion, and what seems like pain in his back and hips. Most recently, I found a mysterious puncture wound on his side, where he got some blood work and fecal test done revealing his Amylase and PSI levels are high, liver enzymes are low, but other than that, everything, including kidney and thyroid looks OK. The vet wants us to do an echocardiogram and ultrasound of his abdomen but I just can't afford the tests at this time. The only thing that concerns me about waiting is that his gums have been paler than usual. They go from pretty pale pink to bubble gum pink but never to healthy red. He does have some periodontal disease that he's had since we rescued him. He's been getting slower on our walks and just feels like it isn't right for his breed, despite being 10 but eating, drinking, and otherwise seems himself.

I would love any suggestions you have. Thank you for all that you do.

Dr. Steve's Advice -kudos to you for hanging in there with Blue and trying to solve this problem, as it is one of the most difficult ones people for people to tolerate, especially when they have young kids.

Do you have a holistic vet near you? Acupuncture and chiropractic can cause immediate improvements on occasion, while the associated physical exam findings can help sort out which of many potential solutions can help your pet.

Based on the history of stress, strong thirst causing dilute urine, hind end weakness, pallor, pancreatitis, and low liver enzymes, I would suggest you try two different herbal formulas together. If your vet is willing to obtain them, they are Bu Zhong Yi Qi Tang (Ginseng and Astragalus) and Xiao Chai Hu Tang (Minor Bupleurum) by Natural Path, available from A Time to Heal Herbs in the US and www.nphc.ca in Canada.

If you don't have a vet to support you in this, you can sometimes find the Kan Essentials equivalents of Lift the Qi and Harmonize the Qi online at Amazon in the US. Dose according to the guidelines at https://nphc.ca/using/dosage

The two together will hopefully work well. If they don't, let us know how things have changed. Even if they do help, I would still seek out chiropractic and/or acupuncture for Blue

Hope that helps!

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Hello Dr Marsden

We have a 16 yr old rat terrier, Cowboy, diagnosed several yrs ago with a level 5 heart murmur, mitral valve.  He takes vetmedin 1.25 mg 2X daily, Mercolas Heart Health, cardioMax and curcumin.  He has been fed commercial raw for the last five years. He started leaving food at mealtime so We took him in for a senior profile recently, kidney values are elevated. . Recommendations for helping our little guy?  (Labs included). Thank you for your consideration

Dr. Steve's Advice -there are a couple of things you can try. It would be great if your veterinarian was willing to support you to obtain these.

The first is Xue Fu Zhu Yu Tang (Persica and Carthamus) by Natural Path (https://nphc.ca). It helps the heart pump more effectively by lowering peripheral vascular resistance. That means increased delivery of blood to the kidneys so they have the nourishment and oxygen they need to concentrate urine more effectively.

You could try using a hypotensive drug like benazepril, but there are additional bone marrow stimulating and kidney supporting effects of the formula not possessed by the drug.

The second recommendation is Rehmannia Eight (also by Natural Path). This formula likewise ensures the kidneys are getting an ample enough blood supply to concentrate urine properly.

I'd use both formulas until the kidneys improve. If your vet is unwilling to source them, you can sometimes find them on Amazon in the US, as Blood's Palace and Rehmannia Eight, both by Kan Essentials

This should help. Check the bloods again in a few weeks. Dose according to the guidelines at https://nphc.ca/using/dosage

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Hi Dr Steve! Hoping for some clarity on my dog Riley’s labs. He was dx with stage B2 heart disease about a month ago during a vestibular episode. That day he was very dehydrated, drinking excessively and peeing/leaking all day and night. The labs on the left are from the week after he started peeing excessively and had started Pimobendan. I then switched him to dr Harvey’s low protein diet and added fish oil supplements for the past 3 weeks. The updated results are on the right. Also his urinalysis used to show trace protein in urine and most recently it no longer does. Am I on the right path or should his blood work have improved more? I also don’t want to ignore the heart disease. I’m getting very mixed suggestions on what to do. Would appreciate the help! Thanks so much 

Dr. Steve's Advice - the labs look like they are improving. If the symptoms are also improving, then you must be on the right track. If the body is healing generally, and without any pharmaceuticals forcing improvements, then good things are probably happening for the heart as well. 

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Hi Dr. Steve!  I was referred to you by Cyndi at Lionel’s Legacy.I have a 10 yr old Carinpoo who has had a grade 6 heart murmur

8 months ago.

He is currently taking 3.75 of Vetmedin per day , a monthly Cytopoint shot and 5.4 mg of Apoquel.  Cyndi mentioned that Apoquel is not a preferred drug.

She said you have holistic medicine that would be better for him.

Can you tell me if he needs to be on both allergy medications or if you have an alternate suggestion.  Thank you in advance!

Dr. Steve's Advice - you're right that there are other ways of treating dermatitis than simply reaching for Cytopoint and Apoquel. Check out these posts (https://www.facebook.com/groups/1158575954706282/search/...) for an overview of my approach, or look at some selected posts on the Ask Dr. Steve website: https://askdrstevedvm.com/

In a nutshell, job 1 is to move away from kibble or canned to a real food diet. Laura of Lionel's Legacy may offer real food for purchase at a very fair price, using a recipe I created for them. Ask Cyndi about that.

If diet change doesn't resolve the issue quickly, the next step is to introduce Cessorex (https://goldstandardherbs.com/products/Original-Cessorex-85g-p647327434) from Gold Standard Herbs. I'd also suggest a Lactobacillus based probiotic like Gussys Gut (https://gussysgut.pxf.io/c/4643206/1738316/19832). The two supplements often make significant headway into resolving itch and allergies. If they still need some help, depending on what you're dealing with, there are other formulas mentioned in the Facebook posts on the site and in this group that can help.

Hopefully this helps you out, Debby!

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Hi Dr. Steve,

I have a 13 yo, 26lbs corgi jack russell mix who has been on home cooked/raw mix with vegetable puree and fruits the past 5yrs since we adopted him. He gets very little carbs (occassional small amount of oat at dinner for acid reflux).

Recently diagnosed with a grade 3 murmur and last week echocardiogram showed he has enlarged heart (~16%), result is attached for your review. No meds needed for now per the cardiologist but I would like to start him on the treatment you usually use. Any idea what could've caused the heart enlargement? He's quite active and we walk 2.5-3 miles total daily.

He just had 7 teeth removed 2 days ago and is currently on Rimadyl 25mg and Gabapentin 100mg (both twice a day).

Should I start him on these asap?

• Harmonize the Qi from Kan Essentials or Cessorex from Gold Standard - which one should I give?
• Blood's Palace Xue Fu Zhu Yu Tang
• Hawthorne (berries and leaves)
• Should I add taurine if he already gets raw liver daily?

Anything else I shoud give him? He gets good fish oil, vit E 133IU, 100mg Ubiquinol for CoQ10, sardines.

Thank you so much. I appreciate you and what you do for all of us  

Dr. Steve's Advice - sorry for the long wait. It looks like you've caught the heart condition very early, and that there's just a bit of mitral valve damage. The most common cause of that is 'wear and tear', though that can be compounded by bacterial infections that, in turn, come from the teeth, so I'm glad you got the teeth cleaned.

They mentioned hypertension as something to watch for, and it's fine to check. More information is never a bad thing. Note, though that dogs on a healthy real food diet don't really get hypertension. Additionally, we'd expect to see left ventricular changes with hypertension but those are not in evidence. At this point, then, it's a valve issue.

Starting your dog on that protocol is fine. Even that maybe overkill. You could just go with Cessorex (https://goldstandardherbs.com/products/Original-Cessorex-85g-p647327434) from Gold Standard Herbs for now, in addition to the Hawthorne, CoQ10, fish oil and vitamin E. That should be an excellent start.

If a cough one day develops, we could step up our game with XFZYT and XCHT. It may not, though. The entire problem may just stay as a grade III murmur, thanks to the excellent care you've been giving

Hope that helps!

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Looking for suggestions. My 11 year old Basset Hound, Ranger(Big boy at 70 lbs.) who is in perfect health except for a mild heart murmur diagnosed as a "watch" last fall had an episode of rapid breathing. Went to the ER diagnosed as heart murmur with pulmonary hypertension, possible pneumonia(they are not cardiologists). Blood work normal. Sent home with antibiotics (Enrofloxacin & Amoxicillin) plus Vetmedin & Sildenafil. Follow up with local Veterinarian( we are out of town for the summer) who prescribed a month’s worth of Vetmedin & Sildenafil. Stopped anti-biotics at 10 days as no signs of breathing issues, discharges or coughing. Best appointment for cardiologist is 2 weeks away. So, he seems absolutely normal now, energetic and resting respiration of 18-20, eating fine. He is also on ubiquinol, Dr. Mercola Heart health, curcumin, probiotics and eats a balanced homemade raw diet(based on Dr. Becker’s formula). I started adding Voltrex a week ago. Should I continue the 2 meds and wait for the cardiologist visit or do you think ordering/adding Harmonize the Qi & Essential’s Blood Palaces would be a bonus? Thank you!!! 

Dr. Steve's Advice - you might as well just roll with what is currently working for your right now until you can get to your home turf, where it will be easier to manage any instability as you start to tweak medications.

If the pulmonary hypertension is somehow confirmed, then Voltrex plus Blood's Palace (Kan Essentials) should suffice. Harmonize the Qi isn't needed as Voltrex is already covering that base for you.

Hopefully this problem just fades away as a bizarre isolated incident, and you're able to eventually reduce the reliance on the drugs. But if he's tolerating them well, then there is no strict need to discontinue them.

Lastly, remember that hypertension is more likely to occur on kibble. If you haven't made the move to fresh food, now would be a good time

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I just want to thank you and wish you a Merry Christmas. I posted months ago regarding my boy 11 year old Ranger's heart murmur. He's always been on a fresh, homemade balanced diet(thanks to Dr. Becker) and per your advice I have him on Bloods Palace, Harmonize the Qi, Voltrex, dandelion tincture and also Dr.Mercola Heart(has hawthorne, taurine, etc), Ubiquinol. He doesn't cough at all(his past episodes are gone) and although the murmur is still there he is in fine shape. My Vet was impressed and we've reduced his Vetmedin to a minimum. Thank you again and I love your very valuable posts and easy access to resources! 

Dr. Steve's Advice - thank you so much for the update on how herbs are helping your dog's heart concerns. Things should only improve from here, with the heart muscle even slowly changing shape back towards normal! Let's hope!

Meanwhile, Happy 2024 to you and yours, and thanks again for the update!

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Hello Dr Marsden. Thank you very much for your time and expertise.

Axle is an 18-year-old, 4lb chihuahua with multiple issues that I am hoping to address.

Diet/supplements: Lightly cooked fresh diet (Small batch brand, 18% veg), Probiotics, Omega 3, CoQ10.

2015 diagnosed with Mitral valve regurgitation, 6/6 heart murmur

Rx: Vetmedin/Pimobendan

June 2023, he had 2 seizures about a week apart. Treating with Heal CBD oil only and no seizures since.

Kidney function is deteriorating and would like your advice on what herbs can be used to improve the condition (please see latest blood work attached).

His vision is getting worse, left eye seems to be sensitive to light. He wears goggles when going outside. Any advice to support eye health? He did see an ophthalmologist on 9/25/23. The left eye has lens instability that has resulted in uveitis and keratitis. He was placed on Diclofenac drops. Indefinitely. 

He just recently started seeing a chiropractor to help with stiffness and mobility. His back end has lost strength and is very stiff when walking and sometimes falls over.

Please advise if Lumbrex would be advised considering the kidney/heart issues?

Thank you for all your help and advice.

Dr. Steve's Advice - Lumbrex (https://goldstandardherbs.com/products/Original-Lumbrex-85g-p647327437) is fine to try for that stiff weak ataxic hind end, and offers kidney support to boot, so it's worth a try.

It's always important when evaluating for kidney disease to get a urinalysis done, and to make sure it includes a urine protein:creatinine ratio. If blood parameters are off, but urine concentration is good, then things aren't as bad as you think. A urinalysis can also rule out a kidney infection, which should be addressed with antibiotics and a Chinese herbal formula called Rehmannia Six.

Regarding the UPC ratio, when you get it done, if it less than 3, then Lumbrex is definitely the way to go. For the eyes and heart, I would add in Blood's Palace from Kan Essentials. If your vet doesn't stock it, you can source it from Aleksandra Topic using the instructions she posted here: https://www.facebook.com/groups/1158575954706282/posts/1420037418560133/

If, on the other hand, the UPC is over 5, then to address the eyes, heart, kidneys and potentially the low back, I would try Cessorex and Voltrex together. These are two Gold Standard Herbs formulas. I only mention that for completeness. I'm suspecting it will be less than 3.

If it is less than 3, but the two formulas mentioned above aren't enough to resolve the kidney issues (although they should have improved), then you can add in Rehmannia Eight from Kan Essentials.

One of those plans should work and comprehensively improve your dog. Let us know how it goes!

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UPDATE: I am happy to report that, day 3 of the protocol suggested by Dr Steve Marsden and the coughing has STOPPED, he's excited to eat a mealtime -  he barks at me to hurry up getting it ready , the pacing at night has STOPPED, and he just seems to be more peppy and happy overall.  I am SO SO SO grateful for your suggestions and will continue for a few more days and taper off to see how he does. THANK YOU THANK YOU THANK YOU!

Hello and thank you for all that you do!  
I am at my wits end with my 10yo shitzu Chuy.  He was diagnosed with a heart murmur several years ago (2017 I think), it has progressed and now it is rated a 6 of 6.  He has occasional seizures (maybe one per month), the new holistic vet believes these are due to lack of oxygen due to the murmur.  His x-rays show enlargement of his heart.  It was suggested by our former (non-holistic) vet to begin giving him Zonisamide as an anti-seizure medication, I gave this to him once and he was comatose and refused to eat.  He already seems under weight (around 10 lbs) so I did not continue the anti-seizure medication. I recently found-out about the dangers of heart worm medications so, he has not had those since August. I detoxed him with milk thistle and he seemed to be thriving until now.
He currently takes Pimobendan (Vetmedin) 1.25mg and Benazepril HCl 5mg both twice daily - I also give him one Formula CV as suggested by my holistic vet and an anti-seizure homeopathic tincture from Prana Pets.
He has been fed lightly cooked for most of his life, switched him to Nulo kibble and canned for a few months per my non-holistic vet, he was not interested in kibble so I switched back to cooked. I am not sure about switching him to raw due to his age.
Currently, he is refusing to eat especially, in the mornings.  Occasionally, I can get him to eat if I make him scrambled eggs and oatmeal but even that is a challenge some days.  In the mornings, he has begun to cough and wheeze.  In the afternoon, he's excited to go out on a short walk with his dog buddy but he can only go for a few minutes and then I have to put him in a carrier and carry him the rest of the way.  At night, he is anxious and paces most of the night.  He was also diagnosed with chronic dry eye and prescribed a gel that I cannot afford.
I feel like at this point, it's about quality of life.  I really do not want to fill him with a lot of medications so, I'm searching for some tips to help me to encourage him to eat in the mornings and to rest at night.  Watching his decline has been heart-wrenching, I just want to help him to enjoy the life that he has left.  Any suggestions are welcome!

Dr. Steve's Advice - I still think there are some important steps you can take that might help your dog significantly. I think there is a reasonable chance of your dog feeling much better because of all you've done to this point in the way of providing a healthy real food diet.
To go further, I would obtain Kan Essentials Settle the Yang and Six Gentlepets. Better yet, if your holistic vet is willing, get the more powerful Natural Path versions of those formulas, which are Chai Hu Jia Long Gu Mu Li Tang, and Liu Jun Zi Tang, respectively. Your vet can find them at www.atimetohealherbs.com. The former should help make the heart pump more effectively and get rid of the night time pacing and insomnia. The latter will build on the benefits of CHJLGMLT and help reduce further the exercise intolerance. The two together should reduce coughing substantially.
If your vet doesn't want to supply those products to you, you can source the Kan Essentials versions of those in the US at Amazon or via Diana Hermann and the instructions she has provided in Featured posts above.
There are more things you can do, but I would start there. Let us know how it goes!

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