Batman’s story

A cautionary tale of diet and nutritional Dilated Cardiomyopathy (DCM)

October 20, 2019

The day we lost Batman to nutritional DCM (Dilated Cardiomyopathy).
He was only 10 years old.

Why we are sharing this story

There has been a spike in canine DCM across a wide range of breeds including many not predisposed to DCM. It’s suspected that many of these cases are linked to particular types of diets containing a high proportion of legumes/lentils, peas, and potatoes, often with exotic protein sources. While some cases reported are grain inclusive formulas, the majority are grain-free.

The goal:

Help raise the awareness of the potential risk of diet and nutritional DCM
Get people to rethink the diets they may be feeding their beloved canine family members until the FDA and other agencies have a full understanding of this complex connection
Outline some of the potential but very subtle signs that may signal something is wrong, based on our experience

We knew of this potential link but justified that the benefits outweighed the risk (524 reported cases at the time of the FDA announcements vs thousands upon thousands of dogs on these diets). The classic “it can’t happen to me” thinking. I can tell you with a heavy heart that I wish we would have gone the cautious route. This diet that was recommended to help potentially alleviate some of Batman’s allergies and reduce his itchiness, was not worth the risk.

What we are not trying to do

Tell you what or how to feed your dog. I am not a canine nutritionist. It’s not a debate on kibble vs. raw vs. home cooked vs. custom mail ordered meals. All dogs have different needs and different diets work for different dogs and their owners. I have included links at the end from some reputable sources. But it’s for you to read, understand, and determine what is best. This is about awareness.

It should be noted that while kibble formulas have the highest reported cases to the FDA, there are cases reported for almost every type of diet, including raw. Considerations should be taken that the high instance of kibble based cases is likely driven by the volume of kibble diets versus other formulations.

A little bit about Batman
After losing our dog Angus in October 2010 to a brain tumor, we decided it was time to adopt another dog (pending MInka approval of course). In July 2011, Matt spotted Batman (then Travis) on Petfinder and said that’s the one! He looked crazy in his adoption photo (seriously crazy) and was dog particular but got along perfectly with Minka, so we took a chance on him. He was two years old and turns out he was Matt’s spirit animal, Minka’s best friend, and my handsome man. He was probably the coolest dog we ever had and ever will. His personality was as big as his blocky head. He loved blueberries and zucchini and laying in your arms like a baby every chance he got, especially at night when we went to bed. His presence in our lives was huge.

This is Batman’s story

Early 2014
A few years after adopting Batman his allergies started to show in a big way (scratching, skin infections, itchy feet and skin, all the usual pibble problems). After a visit to our primary vet, we decided to see a specialist. We took him to the University of Pennsylvania Dermatology and tests showed he was allergic to life. Literally everything. He was started on Apoquel and Immunotherapy, and was recommended to try a novel protein grain-free diet, Kangaroo was suggested. Chicken was the one food we knew was a real issue but thought maybe grain-free and kangaroo would help even more. Turns out there are not a ton of options for a Kangaroo diet, so we went with California Naturals Kangaroo and Lentil.

Mid-2016
We were alerted by Chewy that they were no longer going to carry California Naturals and suggested a similar formula Zignature Kangaroo and Red Lentil, we made the switch. Curious as to why it was no longer being carried, I did a little googling to see if I could find out why. It seemed it was going off the market and I stumbled on a story of a woman who lost both her dogs. She had been feeding them California Naturals. It stuck in the back of my mind.

July 2018
The FDA made the initial investigation announcement and that story came back into my mind. BUT with only a few hundred cases, we justified that the number of cases compared to number of dogs on the diets, the risk was still minimal. We decided to not rock the allergy boat but “keep an eye on it”. Around that time, Batman was starting to gain weight and slow down. Not entirely unusual for a dog approaching 8 or 9, but we started wondering if possibly it could be the Apoquel. He had been on it for 4 years, and while it seemed like it really was a minimal side effect drug, we figured you never know. Plus, it seemed like the effectiveness was fading. It seemed like a good time to see what alternatives there were. In August, we spoke with one of our primary care vets about that concern and in agreement, we switched off of Apoquel and immunotherapy and started Cytopoint injections. The Cytopoint seemed to work well.

Symptoms:
Weight gain
Slowing down
Sleeping more

October 2018
This is probably when we really started to notice him slowing down (not sure we would have described it as lethargic, but he was definitely showing signs of exercise intolerance). On a short walk during a trip to the Catskills, he was incredibly winded to the point we thought he would need to be carried back to the house. We thought we’ve been letting him “be lazy” for too long, and he was in need of getting more exercise. We joked he was like an athlete in the off season. I now wonder if this was the first signs of DCM.

Symptoms:
Continued weight gain
Slowing down
Sleeping more
+ Exercise intolerance

April 2019
His allergies were fairly well maintained since the switch in meds. But in late March early April, Batman started having diarrhea and he seemed to be gaining more weight (but it really was only in his abdomen). We tried all the home remedies but nothing was working. He also started becoming less interested in meal time. He would eat but it took coaxing him to the kitchen. This was weird, he loves food. This started a series of vet visits with no answers. Initial stool samples showed no issues, he was given Cefpodoximean an antibiotic for GI with no improvement.

Symptoms:
Continued weight gain + bloated abdomen
Lethargy (definitely a more noticeable version of slowing down/sleeping more)
+ Diarrhea
+ Loss of interest in eating (but he would eat once you got him to the bowl)
+ Restless during the night (often changing positions and getting up)

Early May 2019
Another vet visit. We expressed concerns that he is still having diarrhea and his abdomen looks very bloated as well as he had started regurgitating water after drinking. Subconsciously, I had a feeling something was wrong. Having lost two previous dogs to tumors, it’s always a first thought. But based on some of his symptoms, we asked about Cushings. They tested - it was negative. They suggested Thyroid (which has similar symptoms to Cushings). They tested - it was low/normal, not a number to be concerned with. At this point, we also mentioned the grain-free diet concerns. The vet didn’t seemed concerned. He was given Protegrity GI Chews. To “ease our worry” about his bloating, they took an aspiration of his abdomen and said it was fat deposits. My thought (and response), “he may have put on some weight but he doesn’t look fat he looks bloated….” Bloating or a distended abdomen can appear in Cushings, Thyroid issues and apparently DCM.

Symptoms:
Continued weight gain + bloated abdomen
Lethargy
Diarrhea
Loss of interest in eating
Restless during the night
+ Regurgitation (water and sometimes food)
+ Increased panting

Mid May 2019
Vet visit number two for the month. After almost two consecutive months of continuous diarrhea, we we back at the vet and he is prescribed Tylan powder. We again mention the bloated look of his abdomen which doesn’t seem to raise concerns with our vet as well as the continued regurgitation and reduced appetite.

Symptoms:
Continued weight gain + bloated abdomen
Lethargy
Diarrhea
Loss of interest in eating
Restless during the night
Regurgitation
Increased panting

Mid July 2019
He is 76.6lbs, up from 70lbs. The diarrhea seems to be somewhat under control from the Tylan powder. But he is still coughing up water (sometimes right after drinking, other times hours later). Again, concerns about the grain-free diet are brought up. Once again, they didn’t seem concerned but offered to perform an EKG. No abnormalities were detected. They again brought up the possibility of Thyroid, telling us sometimes those tests are inaccurate. They suggested we could do a few week trial medication to see if there was any change. He was prescribed a Thyroid meds and recommended Pepcid-AC for possible acid reflux, to explain the regurgitation.

Symptoms:
Continued weight gain + bloated abdomen
Lethargy
Loss of interest in eating
Restless during the night
Regurgitation
Increased panting

At this point, we should have made the decision to take him back to UPenn. But with no real source of the issue, we didn’t know what specialty to make an appointment with. But go with your gut when you aren’t getting any answers. Find someone who will look outside the obvious.

Late July 2019
By the end of July he was 78lbs. At this visit, we again mentioned he looked so bloated (it was really only his abdomen that was bigger). Having lost a previous dog to a pancreatic tumor, we were really starting to worry it was a tumor rapidly growing and time was slipping by. So they said we could do an ultrasound if we wanted to rule out anything in the abdomen.

Symptoms:
Continued weight gain + bloated abdomen
Lethargy
Loss of interest in eating
Restless during the night
Regurgitation
Increased panting
+ Coughing

August 2019
With the nagging feeling something was really wrong, we decide to try an ultrasound. Five months of vet visits, costs were adding up, and we still had no answers. We called for the ultrasound appointment. With schedules and the holiday, the next appointment was Sept 9th.

Sept 2019
Sept 9th
The ultrasound appointment. Several days prior, he began coughing more and spitting up more food and water. He also started to pant more often (and at random times). Increasingly worried, and still assuming he was full of tumors, we asked if they could also check his chest and throat while he was in for the ultrasound. In addition the the ultrasound (which was normal), they did a radiograph and found his heart was enlarged. No fluid was seen in the abdomen or lungs. His heart was 13 on the VHS scale (vertebral heart scale, published range for a normal VHS is 9.2-10.3 on a lateral radiograph). They recommended he be seen by a Cardiologist within the week. I called three places and the soonest was Sept 25th with Metropolitan Vet Hospital, it seemed like an eternity away. All three places recommended that if we saw even the slightest change to bring him in through their emergency. It was the first time we heard a real sense of urgency from anyone.

Symptoms:
Continued weight gain + bloated abdomen
Lethargy
Loss of interest in eating
Restless during the night
Regurgitation
Increased panting
+ Increased coughing (cough was starting to sound severe)

Sept 13th
Batman awoke at 5am with an elevated respiratory rate and seemed very restless. The woman’s voice telling us if anything changed bring him through emergency came to mind. We headed to Metropolitan Vet Hospital. The ER quickly determined he was in Congestive Heart Failure. He was admitted and spent 2.5 days on oxygen and IV medication (Lasix). His weight was 83lbs.

Their initial prognosis was 6-12 months. Typical for DCM at this stage with CHF. The news was devastating.

An Echocardiogram confirmed the DCM diagnosis.

Sept 15th
The amazing vets at Metropolitan were able to get him out of the CHF and get him stabilized so he could come home. They asked about diet and immediately recommended he go off the grain-free diet. He was put on Lasix, Benasepril, Pimobendan, Spironolactone, with Taurine and L-Carnitine supplements.

Sept 25th
Our follow-up cardiologist appointment and he was doing incredibly well and really acting like his old self, something we had not seen in the past 6-9 months. Our cardiologist was very happy with his progression and even thought they saw a very small reduction in the size of his heart. They wanted to do his follow-up in four months. We were hopeful and looking forward to the appointment in January.

It should be noted that Batman’s Taurine levels were tested by UC Davis and he was found to not be Taurine deficient.

Symptoms:
No new symptoms
Showing signs of improvement on all previously listed symptoms

Oct 20, 2019
Sunday morning like any other, Matt had just gone upstairs and I had headed into the kitchen. Batman and MInka were taking a post breakfast nap on the couch. I heard Batman get up from his nap and bump the coffee table. Then I heard the most terrible moaning sound. I ran back in to find him on his side, he had collapsed. Matt rushed back downstairs and attempted CPR. We could only get two gasps and he was gone. We couldn’t save him.

He passed away in our arms less than 2 months after the official DCM diagnosis.

Were the preceding symptoms in 2018 the early stages of DCM? I don’t know. I only know we found ways of explaining them away, he’s getting older, gotta get him moving more, napping is his favorite past time. This is something I have read in many similar stories.

I have spent a lot of time wondering what we could have done different, what we could have changed in this timeline. What would have happened if I listened to my gut during those many vets visits in 2019? Would that have been early enough to have changed the course for Batman? Since October 20th, I have read stories of dogs surviving with earlier detection and some with almost complete reversal of symptoms. It’s not an easy or cheap disease. The signs of DCM can be incredibly subtle until it’s very late in the game. The larger consensus is that there are potentially a lot of undiagnosed dogs out there.

I have read a lot of comments of vets recommending that rice or oatmeal be added to grain-free diets to help mitigate the risk. In our case, our vet didn’t make any recommendations at all. They didn’t seem concerned about the diet. Both of these scenarios are concerning. More conversations need to happen. Until the diet/dcm link is better understood, vets and owners should proceed with more caution.

Going forward

In the month prior to October 20th, we had made the switch to a Lamb and blueberry grain inclusive formula (still avoiding chicken for Batman). In that month, there was really not a noticeable increase in Batman’s allergies. The allergies that were the whole reason we ended up on this grain-free nightmare.

I am still incredibly torn on what to feed our surviving pup, Minka, who is almost 14 years old and an incredibly picky eater. Not to mention what we will feed our future dogs. I have always tried to not be swayed by marketing and fancy packaging, only what I interpreted as quality ingredients. Long before ever feeding a grain-free diet, I had done hours of research to better understand what many of the ingredients actually were. in 2009 I had put together a white paper to wrap my head around the mountain of info and it was scary. But now I am having to rethink everything and possibly accept brands I would have never ever considered in the past.

The FDA as well as many other large organizations are working to figure out just what the link is with these diets. Until someone figures it out, we will be playing it very safe and staying away from anything with legumes/lentils, peas, potatoes, and exotic protein sources.

Links that may be of help to start your own education and research

Facts and Resources from Tufts University

The latest FDA investigation announcement

Report a case of nutritional DCM to the FDA - For those who have a pet that has been diagnoses. (requires documentation)

WSAVA - World Small Animal Veterinary Association. Brands that follow these guidelines are the only brands some groups are currently recommending. The WSAVA also has a FAQs and Myths regarding nutrition.

Petfoodology - Tufts University Veterinary Nutrition

Taurinedcm.org - Facts and information on DCM supported by veterinarians and concerned dog owners. Includes a really good outline in the FAQs about DCM symptoms

For those itchy dogs, help on understanding how shampoo can help or make things worse - https://yourdogadvisor.com/best-dog-shampoos-for-itchy-skin/
(please note that there is a link within this article regarding food and nutrition that I personally am not aligned to based on my personal concerns around suspect brands and dcm)