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.

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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