# Advancing Heart Disease :-(



## LisaT

Of all the things in this world that I could live without, I cannot imagine living without Indy









Just had Indy's follow-up with the cardiologist. Her grade II murmur has progressed to grade IV. And while that doesn't mean that her heart has worsened, in Indy's case, it does.

One of the "thingees" that holds her heart valve in place snapped, which is why the murmur progressed so rapidly. It was only 5 months ago that she was at a grade 2. The echocardiogram shows that she has passed mild heart disease, and now is in a low to moderate disease state. We recheck in 6 months to see if she has progressed to Congestive Heart Failure.

So those supplements I started to help the cartilage in the valve because her murmur became so loud, were started too late.

I hate facing the fact that she is mortal, and at this potential end stage, I have spent no time with her, due to circumstances that I can't control. Her world has become so small lately, it breaks my heart.

The cardiologist said it is most likely genetic, and since most that know Indy think that she has some whippet in her, that very well might be were it came from.

Tomorrow we run a blood panel for a baseline, and then start her on the ACE inhibitor Enaparil. I'm just crushed that it has advanced so quickly.


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## angelaw

Gsd's can have heart issues too, so who knows where it came from. I'm sorry to hear how she's deteriorated so fast. What does the Enaparil do?


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## LisaT

right, it could be either. The mitral valve stuff, from what I can read, is really common in the smaller dogs, terriers and such









THe Enaparil is supposed to somehow strengthen the contractions in the heart. She says sometimes it can contract the heart and reduce some of the enlargement, but I get the impression that that's not common. 

_To increase cardiac output or efficiency, an After-Load Reducer (ALR) such as enalapril is used. Enalapril has many mechanisms, but its primary action that we utilize is the relaxation (dilation) of
arterial smooth muscles that decreases the resistance of blood flow out of the LV and into the Aorta, thus increasing blood supply to the body. ALR’s increase cardiac efficiency by decreasing resistance. Enalapril is the only drug proven to increase the life expectancy of humans and animals with MR.
http://www.seasidevet.com/InfoFiles/Mitral%20Murmur.pdf
_


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## BowWowMeow

Lisa, I am so sorry. I understand how you feel having spent all my time with Chama and now Cleo is so very ill.


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## LisaT

I know you do Ruth







, thank you. I was thinking that I need to use you and Chama as a role model -- I need to find a way to make that time to get her out and about and enjoy the time with her. I don't know how I'm going to do that, but we both need it.


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## littledmc17

I am so sorry 
hate it when crap like this happens to them you just want to make everything right for them


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## LisaT

Thank you Dawn. We've dodged so many bullets, but I don't think that we can dodge this one.


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## GSDTrain

I am so sorry to hear about Indy.


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## jaggirl47

Lisa, I am so sorry to hear about this. Hopefully, her new med will help her and she will not progress any faster. Kisses to Indy from my family.


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## LisaT

Thank you both. We will do what we can to beat the odds, and delay what we can.


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## Fee

I am so very sorry to hear this!!! I assume a chordae on the mitral valve ruptured. Hawthorn helps with CHF (google it) but not sure what other drugs she is on so check for interactions. We have a 15 year old senior here too so I understand. Hoping that sweet Indy will be comfortable, her situation managable and she'll stay a while longer with you!!! Tons of positive vibes for Indy and you.


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## LisaT

Thank you Fee! I had Indy on Hawthorn for awhile, but I was afraid it would make the murmur worse. I will be looking at all the CHF supplements and seeing what I need to do for her.

Yeah, that's it! A ruptured chordae tendineae. She said she could see it flipping around in there. I will get a copy of her report when she writes it up.

I dunno, I guess I should be posting in the senior section. I'm not even used to her being a senior, and now this


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## djpohn

Sorry to hear about the diagnosis Lisa. Unfortunately for you there is no dodging this bullet. The leaking mitral valve allows the blood to back up which then enlarges the heart causing damage and arrhythmias. This happened to Rainer and once the heart starts to swell, the mitral value is then forced open more. Rainer was on the Enaparil, lasix and then had to go on a drug to slow down his heart rate. I thought he was pretty stable, but inside the damage continued pretty quickly. Despite being told they can live a long time with Congestive Heart Failure, Rainer died a month and a half after being diagnosed with mild to moderate heart disease and slight deterioration of the mitral value. 

The one thing I was not told, but read when I researched stuff was "sudden death" is very common. You can think everything is fine and in a second they are gone. Had I known, I may have been better prepared when he died. I was told it is not painful and the heart just stops. He just died in his sleep. He didn't look like he suffered at all which took away some of the pain of feeling like I failed him. Unselfishly, this really was the best exit I could have wished for him.

I hope you have a lot of time with Indy and know each day is a gift.


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## VectorSketcher

Oh no Lisa! I am so sorry to hear this news about your girl, it is horrible when the ones we love are not doing well, you have sent my boy Riddick and I so many good vibes during his condition, we are sending them back to you and your family. Hang in there!


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## aubie




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## LisaT

> Originally Posted By: GS MomSorry to hear about the diagnosis Lisa. Unfortunately for you there is no dodging this bullet. The leaking mitral valve allows the blood to back up which then enlarges the heart causing damage and arrhythmias. This happened to Rainer and once the heart starts to swell, the mitral value is then forced open more. Rainer was on the Enaparil, lasix and then had to go on a drug to slow down his heart rate. I thought he was pretty stable, but inside the damage continued pretty quickly. Despite being told they can live a long time with Congestive Heart Failure, Rainer died a month and a half after being diagnosed with mild to moderate heart disease and slight deterioration of the mitral value.
> 
> The one thing I was not told, but read when I researched stuff was "sudden death" is very common. You can think everything is fine and in a second they are gone. Had I known, I may have been better prepared when he died. I was told it is not painful and the heart just stops. He just died in his sleep. He didn't look like he suffered at all which took away some of the pain of feeling like I failed him. Unselfishly, this really was the best exit I could have wished for him.
> 
> I hope you have a lot of time with Indy and know each day is a gift.


Awfully difficult to read this, but thank you.








for your loss, I'm glad that it was a peaceful passing. I guess I can only hope as much for Indy. I don't know how I will bear it....


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## LisaT

Thank you vectorSketchor and aubie.

I have to pull myself together and get into town now....


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## Fee

Oh Lisa, you don't have to be posting in the senior section. Not yet anyways. Yes, ruptured chordaoe tendianeae. I understand only too well as my husband had it (after falling off a roof). He had successfully surgery (valve repair) 3 years ago and is on no meds and in perfect health (knock on wood. 

Unfortunately in dogs it can't be fixed








I really doubt at this point that the hawthorn could make the murmur any worse but this is best for you and the doc. to decide. The important thing is (for humans at least) to keep blood pressure down and watch for arrtythmias with the murmur. The mitral valve is prone for this. Is she on probiotics? I would just be careful if she receives any open cuts/wounds. Be very digilent to disinfect right away as with her valve defect. Open wounds can get infected and it would travel right to her heart, leading to endocarditis. This is just a precaution.

I am very sorry I don't have any words of wisdom for you







I am sure Indy will do her best to stay with you as long as possible! Hang' in there!!


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## Mary Jane

The Havanese that lives down the street has been treated for congestive heart failure for about a year now. She has an excellent quality of life. I don't know the specifics of her disease or treatment, but I do know that she is a happy pretty dog that bounces up to my knees whenever I see her. (It's a whole different experience than a GSD.)

Take everything day by day.

best wishes
MJ


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## Barb E

I have no big words of wisdom, but I do have a lot of







s and a ton of thoughts which I'm sending south.


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## LJsMom

Yes the word that starts with "f".

You must feel like you have been kicked in the gut. I'm so sorry that is happening to Indy. Your baby girl. 

I don't have anything to offer - just that I don't want you to have regrets. If you love Indy just as you would a child, those around you will understand your need to shift some priorities.

I'm sitting here shedding tears for you and Indy (and Max too).


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## GSDTrain

to Lisa and Indy


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## djpohn

> Quote:Awfully difficult to read this, but thank you.


No way to sugar coat it and I wish someone had told me. It wouldn't have changed the outcome, but maybe I would have done things differently the last few days. I know I would have taken more pictures and probably videoed him doing his everyday things that I found so cute and so him. I never realized how borrowed our time was.

Enjoy Indy each and every day. I didn't tell you this so you would start to morn, there will be plenty of time for this later. Instead make sure that at the end of each day it is your "best day ever" and things you want to do with Indy are not put off. I hope you have lots of best days together. This is where you find the comfort to help you go on. 

We are "gifted" our fur kids for only a short time. The bond and love that grows so strong in this short time is the same that brings us such joy today and will break our heart tomorrow. I pray that Indy is one of the lucky ones who live a long time. You will both be in my thoughts and prayers.


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## jaggirl47

http://www.dog-health-guide.org/CongestiveHeartFailureinDog.html

I don't know if this link will help, but it has several other links on it as well that may be informative to you. My prayers are with you Lisa.


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## aubie

Well, if you need anywhere to rant, rave, cry, talk or ramble bring it on! We're all here for you and Indy.


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## rover51

Sorry to hear about your Indy. As bad as it all sounds, at least you can try to do what you can for her.

We have a cat with a mild heart murmur. All he does is lay around. His IS a couch potato. I suspect his lack of movement may be related? He's getting up there in age too.

Anyway, good luck


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## Karin

I'm so very sorry to hear this, Lisa. Indy is such a cute and sweet little girl. The way she was running around and enjoying herself last Saturday, we never would have known that anything was wrong. Our hearts go out to you all.


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## WiscTiger

Lisa,

It seems like life is just beating you up right now. 

I know absolutely nothing about heart disease. But I wanted to post and send strength and longevity vibes for Indy and comforting vibes to you.

and lots of









Val


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## TG

I'm sorry about Indy's diagnosis. I hope the progression is slow and that you will have many wonderful days ahead with her.


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## arycrest

Lisa & Indy
















It seems like when it rains it pours. Sending positive vibes to both you and Indy!!!


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## DancingCavy

Awww I'm so sorry to hear this, Lisa. I really admired the pics of Indy eating the berries and having fun on the beach. I have no advice to offer or anything. Just some *HUGS* and support if you need it.


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## spartshep

Lisa~~I am so sorry to hear about your dog's diagnosis. As many people on this board know...I am a nurse who works with congenital heart disease in newborns and children. We do surgery for about everything and we have a huge success rate. Lisa, your diagnosis is all too familiar to me in kids. My question is why can an animal not explore the surgical option of a valve repair or replacement. I wonder if a place like MI State can or will attempt.

Prayers your way,
Connie


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## Fee

I was told that dogs valves can't be replaced but I do remember now being told about a dog who had mitral valve repair. I believe it was done in MI. Can't remember the breed but it was a much younger dog and a year later was still doing fine according to my vet. It was also very expensive. Not an easy surgery.

Lisa, hope you and Indy get some good night's rest. One day at a time! I had a friend with a Keeshond who was given only two months to live (cancer) - she lived two more years in good health. So, I hope you get a miracle (of sorts at least) with Indy!


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## Fee

I just googled and found this. Mitral valve replacement is possible, especially in larger dogs but unfortunately the long term prognosis is not great. I think it would be difficult to have a dog on anti-coagulation.
http://www.ncbi.nlm.nih.gov/pubmed/15882001

Lisa, found this site with supplements suggestions. 
http://www.2ndchance.info/conghtfaildog.htm


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## Kayos and Havoc

Oh no I am so sorry Lisa!























May Indy's remaining time be happy and painfree.


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## LisaT

Thank you so much everyone. I came home, took the dogs for a very long walk, and then we all fell asleep for awhile. I am so distraught









I figured her murmur had progressed, we (her vet and I) could hear it. I can see the differences in her breathing. It's the broken part that, to me, says her time is shorter than it should be, and scares me. 

It's been almost exactly 10 years ago when she was so sick from her vaccines. She couldn't walk much at all, I had to carry her up and down the stairs. There was a span of time where she had seen 8 or 9 different vets to make her better, with mostly not much luck. I remember Mom trying to prepare me, that Indy wouldn't be around much longer. 

It was day by day, until Indy forced me to learn about things I never knew existed, in order to make her feel better. I said back then, that every day was a bonus, and to be thankful for each extra day. And the days,thankfully turned to years. 

And now we have come full circle. She is my heart dog. She is also the first dog that I have been through this stage of life with. 

It will take me some time to regroup, if I can. Thank you everyone for the caring and support, and good wishes. I will be looking at all the links and modifying what I can. I so wish we had her regular vet here, that has been with us for so many years, and knows and loves her. 

Any ideas or intuitions on how much exercise is too much? I know that exercise has to be important, but overexertion can't be good? As she was running across the grass today on our walk, I had a pang of fear - I just don't know.


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## sleachy

Lisa









I used to have a GSD named Joobie who was the first dog I ever raised on my own. She was fantastic and I still miss her to this day. People used to tell me that I shouldn't let a dog hang their head out the window while driving but Joob was forever trying to stick her snout out the window. One day, I said "life's too short!" and opened up the window for her. I lost her at the young age of 4 yrs old and, to this day, I am glad I let that pooch have the wind in her hair!

So, if Indy wants to bound thru the grass, I say let her! Try not to have those pangs...I know, easier said than done. Just smile with her. Our time with friends is precious and never long enough.


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## natalie559

> Originally Posted By: GS MomI hope you have lots of best days together.


I hope so too!! 








This news just stinks!! I am so sorry Lisa!


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## aubie

I agree with sleachy...let her enjoy life like nothings wrong! She doesn't know her limitations or condition. I'm not saying take her for a cross country trek or anything, but if she wants to run a little, let her. That's why I love dogs...they live life to the fullest no matter what's going on--oblivious to their own problems and wanting to spend time with the ones they love!


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## JeanKBBMMMAAN

"CTR is associated with a higher overall survival time than previously supposed."
http://www3.interscience.wiley.com/journal/120715431/abstract?CRETRY=1&SRETRY=0

Hoping Indy will prove that right!

Wasn't sure if the vet you saw was a cardiologist-but maybe check UC Davis to see if their cardiology service has anything new they are trying out? 
http://www.vmth.ucdavis.edu/cardio/cases/
http://www.vetmed.ucdavis.edu/vmth/small_animal/cardiology/default.cfm

And beyond that, I know that this will just make her more special to you, and enhance her already quality-filled life (even with the things that have been going on-they know, they understand) even more. 

Still, big ouch.


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## spartshep

In human medicine, valve replacements happen at all ages. In animal medicine, I don't know those facts. I would think that it depends on the overall state of well being for any individual as to whether surgery is an option. In my experience, anticoagulation is used for mechanical valve replacements as opposed to pig valves, so there are options. It also depends on the quality of the valve already there as to whether a repair can be done. Exercise will depend on how Indy responds to her medical treatment. Obviously, her limitations are different, but she can certainly enjoy life within those limits...and you will know when enough is enough. I wish you all the best!

Connie


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## djpohn

Lisa,

I know how you feel, I was feeling the same way a few months ago.







Indy doesn't know she has anything wrong with her which is good. Try to see her this way and not let her condition be the target of your focus. Let her do what she wants and enjoy the time you have left. Try not to worry (I know this is hard) and let her continue to live her life as before. I know you want to do everything you can for her and loving her and letting her love you back and live her life with you is the best thing you can do. Take care of yourself, this is really important for you and both your dogs. Hugs to you and Indy!









Here is some information on heart research that CSU is currently doing. There are new breakthroughs everyday!
http://csuvets.colostate.edu/heartcenter/research/mvd/index.shtml 

http://csuvets.colostate.edu/heartcenter/research/crl.shtml


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## LisaT

I haven't even googled anything, so you know that I must be off my game! I tried to reply last night, but just couldn't finish. I feel better with some sleep.

Jean, an encouraging article, that there is some hope that she could be around for a bit. I ran into her backup-chiro when I got her blood draw yesterday. The vet said that she has known some dogs with this rupture that "hung in there for awhile". I don't exactly know what that means, but I will do what I can for her....take more walks, make sure that we enjoy what time she has left. No regrets is what I am working towards.

The UCD links gave some good info on valve repair/replacement. A replacement at $10,000-12,000, it's very risky, and I suspect that Indy couldn't tolerate any more foreign tissue in her. A repair I suspect will only delay this, since whatever the process that is causing the valve to degenerate hasn't been stopped, and I don't want her remaining days to be spent recovering. And the repair sounds as risky, though I might ask the cardiologist about it, just to be sure.

After I get the blood results back, I'll look at her supplement schedule again. (Some weird things about serotonin in the CSU links?) For now, she's back up on the bed with me at night (lol, in the morning, it's Max's turn), and how can I get mad at her barking me awake nowadays????? 

GS Mom, I will try to remember your advice throughout this next journey with her. Sleachy, aubie, and all others, your advice too. Thank you









Fee, when your husband had this rupture, could he feel anything? The doc said she saw the ruptured tendon flipping around in there -- how can that not tickle or something?


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## Kayla's Dad

> Originally Posted By: KarinI'm so very sorry to hear this, Lisa. Indy is such a cute and sweet little girl. The way she was running around and enjoying herself last Saturday, we never would have known that anything was wrong. Our hearts go out to you all.


I echo Karin's comments. Indy was full of life on the beach. My heart goes out to you and your pack. Hope that there will be more days that Indy's spirit will shine through. And really hope that you can find some more time through all these challenges for your dogs and yourself.


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## LisaT

Thank you Samuel. Indy was a bit out of her element, but I am so very glad that we could make it. I do hope to give her (and Max of course) more days like that. Thanks to Calone and the rest of you for making that day happen for us.

Karin and Dave (Dave especially







) were so sweet with Indy. It makes that picture that Dave got extra special!

Hey Samuel, if you read this, I think it's your pic that I cropped so I have a new pic of Indy and Max in my sig. Thanks!


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## LJsMom

I just read in my Prescription for Herbal Healing book, under Congestive Heart Failure and Herbs to Avoid - turmeric and curcumin.

Lisa, do you have this book? It also talks about heavy metals.


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## LisaT

I have the book, but I was too lazy to get up and get it, and found this:

_Excessive use of turmeric should also be avoided in people with congestive heart failure. The curcumin in turmeric activates a gene called p53. This gene deactivates cancer cells, but it also deactivates damaged cells in the heart._
http://www.nutritionalwellness.com/columnists/heller/

Guess I better go look at the p53 thing, with respect to heart disease. 

Thanks Joanne, I need to find that study about the mitral valve too.

ETA: p53 is what activates programmed cell death, which is absent in cancer cells, which allows them to grow and not die. Will have to spend more time on this.


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## LisaT

Here is what I have saved, but don't have a link:

_Preventing heart disease is just one of the many health benefits of this spice. The healing properties of the plant Curcuman Longa have been used for thousands of years in both the Indian and the Chinese cultures.

Ancient protection

Long before NSAID's were invented the ancient civilisations of Asia have been enjoying potent protection against many diseases by using safe and natural herbs and spices. It is believed that Indians have the lowest rate of Alzheimer's disease in the world and this low number has been put down to their diet because it is rich in spices that contain turmeric curcumin.

The phyotchemical that are in this plant are normally extracted once the rhizomes have been dried out and crushed. Extracts have been used by scientists for clinical studies to study their effect upon different organs of the body.

Clinical Results

One area of these tests have been to do with the heart muscles and the results that have come back on the cells and lab animals that were tested have been the following:

It prevented heart failure in two rodents by

1. By stopping the heart walls thickness and diameter from enlarging 2. Prevented deterioration of systolic function (pressure at which blood is pumped from left the side of the heart)

It is believed that it is able to do this by turning off certain genes that actually cause the heart to enlarge and that also causes scarring.

The result is then that it has shown not only prevention of heart failure but also repair to damaged heart tissue._

Right now I am only giving it 3 times a week, at night.


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## Karin

> Originally Posted By: LisaTKarin and Dave (Dave especially
> 
> 
> 
> 
> 
> 
> 
> ) were so sweet with Indy. It makes that picture that Dave got extra special!


There was just something very sweet about her. Dave was especially taken with her. He has a soft spot for sensitive dogs.

He cleaned up the picture a bit in Photoshop. Here's the new and improved version. If you want a hi-res version, let me know and I'll email it to you.


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## DancingCavy




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## Fafhrd

I'm sorry to read this, Lisa. It's so hard to watch a canine best friend decline. The best I can say is that Tuco surprised us and enjoyed many more months of good life than vets or common sense predicted. Hope Indy also has many more months of good life in front of her, but enjoy each day with her (and help her to enjoy each day) as if it could be her last. Best wishes for both of you.


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## LisaT

Thank you Karin -- I sent you a pm. Wow, you can even see the "Live Strong" on her name tag. She is a cancer survivor you know









Fafhrd, thank you. I hope that Indy surprises us all, as Tuco did. And I know, in the process of helping Indy enjoy what time she has left, it will also help me a lot too, still teaching me as she goes through her life.


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## middleofnowhere

Lisa,
Barker the Elder's been on Vetmedin for a heart murmur for 2 or 3 years now. She was put on it when the vet first heard it. Hopefully Indy will do well on her meds.


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## Brightelf

Ohhh Lisa, that picture of Indy!! Soulful, wistful, sweet, such a dear expression and a loving-life personality that photo shows. Wishing there was something that I knew about heart issues and valves. I am just wishing good vet care for Indy, and that she remains as stable as possible for as long as possible. She is such a loved dog, so cared for, a central part to your home pack and she knows it. I am hoping that she has more good days than bad. Positive, strong, stable-heart vibes being sent for lovely Indy!


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## raysmom

<span style="color: #000066">Lisa -

I hadn't seen this thread until now! You bring a whole new meaning to "having a full plate" - yours is overflowing with all that is going on in your life!

Indy is beautiful!! I don't have any advice as far as Indy's heart condition - but I hope you're able to take some time for yourself and to enjoy her as she continues to live each day to the fullest. Dogs are such amazing creatures - they live in the present without concern for what might lie ahead - what a great way to live!

As far as wondering whether or not Indy can feel the ruptured chordae tendinae flipping around in her heart - I don't think she can. I don't think the actual inside of the heart has any pain or perception receptors, so I don't think she'd be able to feel it. </span>


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## Karin

i just emailed you the full-res photo, lisa. I didn't know that indy was a cancer survivor. 

sending positive thoughts that indy will respond very favorably to the treatment and that you will have a long, happy time with her.


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## LisaT

Middleofnowhere, I will have to ask the cardiologist about that med. I remember my vet mentioning it once, and it sucks because my vet isn't around for awhile. 

Patti, thank you







Indy is very sensitive to energetic stuff - she will feel those healing thoughts!

Karin, Thank you for the pic, and the good thoughts. I now have a great portrait shot of both Indy and Max from that day - very special. 

Raysmom, I think full plate is an understatement???

I hope that she cannot feel that thingee. If anyone could, this sensitive girl would be the one. Oddly enough, she really reacts when the stethoscope is place at the point where the murmur is the loudest. And during the ultrasound, she was very squirmy on that left side, as compared to the right. Just kinda odd, and Indy has always been a wise and sensitive girl. 

There are a number of things that Indy won't be able to tolerate as she ages - she doesn't do drugs well, and also many different kinds of supplements. We were lucky with the cancer, as the surgery was what was curative and I followed up with just a few supps. 

Years ago I promised her no more human induced trauma. I will do what I can, with the supps and the meds, and let her continue to teach me, and in the end, hope that the end is peaceful. And I will learn from her, and I will be true to the promises that I made her. I really had thought it would be a good 5 years before I had to face anything like this. 

But you can bet that before she reaches that end, I will fight like heck!


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## LisaT

kidney values increasing (BUN elevated at 36, creatinine at top of range at 1.6), and there isn't much room for changing stuff in her diet. 

Heart meds are filtered through the kidneys. 

I'm trying to think of what changes she can tolerate...

Life just keeps gettin' better around here!


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## Brightelf

Oh my Lisa. When did you find out the creatnine and BUN levels? What does your vet think may be a next viable step? Do dogs with kidney issues go on sub-Q fluids? My dog needed that for a while, and he was barely aware of the treatments, as they did NOT stress him at all.

Has Indy had Reiki treatments? I am not sure what I have read.. trying to remember what she has already been through, what you have already tried with her.

I wish I had more med knowledge right now. All I can offer is warm, healing thoughts going out to Miss Indy, the sensitive, sweet girl with the soulful eyes and precious face. Lots of love and good vibes coming your way, Indy!


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## BowWowMeow

> Originally Posted By: LisaT kidney values increasing (BUN elevated at 36, creatinine at top of range at 1.6), and there isn't much room for changing stuff in her diet.
> 
> Heart meds are filtered through the kidneys.
> 
> I'm trying to think of what changes she can tolerate...
> 
> Life just keeps gettin' better around here!


Lisa,

Can you try this stuff? I've heard very good things about it from people with CRF cats. http://medi-vetrx.com/B000MSVR66/M/B000MSVR66.htm


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## LisaT

Shortly before I posted earlier, the vet filling in for my regular vet called me to let me know the results of yesterday's blood draw. I should get a hard copy in the mail in a couple of days. Indy is also not concentrating urine well.

The cardiologist wanted a blood draw and urinalysis before starting the heart meds. I suspect the plan will be to modify the diet, if possible (Indy is tricky), start with half-dose of heart med, and retest soon. Sub-Q fluids if they continue to rise. The vet is going to call the cardiologist tomorrow and put a plan together.

Ruth, that stuff looks like a cool idea, and I can't see a reason why Indy couldn't tolerate it, it really is just probiotics:
http://www.drugs.com/vet/azodyl.html
http://www.vetoquinolusa.com/pages/pro_azodyl.html
Amazing it can be so powerful, if it really does work.

I know what did this to her kidneys -- it's her stupid immune malfunction -- her lyme vaccine site has been very swollen for awhile (yes, after 11 years), and that means that she is creating immune complexes, which filter through the kidneys. And finally, the kidneys can't handle it after so many years of this. I will have to find a way to suppress this action.....

She has been a very happy girl these past few days


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## BowWowMeow

Here's the other stuff I've found. Maybe she could take one of these too?

Kidney Terrain http://www.naturalhealthyconcepts.com/kidney-terrain-t12-p-renal-urinary.html
Renalix http://www.askariel.com/product_details.asp?itemid=canine_chronic_renal_failure
VetriScience Renal Support http://www.onlynaturalpet.com/products/Vetri-Science-Renal-Essentials-For-Dogs/125028.aspx


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## LisaT

They all look like good stuff, well, for "normal dogs".

The Kidney Terrain has alcohol in it -- Indy can't use anything with alcohol in it because it flairs her pancreas.

The Renalix might work -- I can't find any alcohol in it.

The vetriscience product almost looked perfect, but it has some immune enhancers in it, which will increase the immune complexes, which will be bad for the kidneys. Stupid vaccines....

Spirulina is very good for the kidneys....but that also is an immune enhancer.

Aaargh.

Thank you Ruth -- I"m still googling!!


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## Qyn

Lisa, our maltese (Buddy) was put on Vetmedin for his grade 4 murmur and it really made a difference to him - it's not cheap but it was worth every dollar to us. He did pass away in his sleep four months after he became severely symptomatic but it was peaceful and he was active and happy right up to that point. There is a chewable form and a capsule. He was on the capsule as he was sometimes a fussy eater so the capsule was easier even it he was not always willing but we managed. I would recommend it if she is able to take it.

Best wishes to you and your gorgeous girl.


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## LisaT

Thank you Alison! I asked the vet to talk with cardiologist about it. I hope she remembers.I hope to keep Indy running around happy while she is here, as you were able to do with Buddy.


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## RebelGSD

I am so sorry to hear about Indy's worsening heart murmur.
Angelina had a heart murmur that sounded pretty bad to the vet, but she does not seem to be bothered by it. She sailed through the spay surgery too. 
I have a heart murmur myself, mitral valve. When I was 20+, my doctors made a drama out of it, limited sports etc. I did not exactly listen to them and I am glad. I still don't feel major problems, many years later.

In my experience congestive heart failure usually progresses slowly.
One of my fosters came to me looking like pregnant (he was a boy) due to the fluid accumulation that accompanied the congestive heart failure. It was probably caused by the heartworm and the vet felt that he was too sick to treat (he would not have survived the treatment). He got to live two months with me and was managed with medication. He was a sweet and happy young guy.


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## LisaT

Thanks Rebel, I was resigned to the slow progress, but with the rupture of the chordae (sp?), that adds another layer to the disease process, and says that the structure that holds the valves in place, in addition to the valves themselves, are compromised. 

I so hope that we can get Indy to the slow progression stage.


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## jaggirl47

Lisa, I don't know if this may do anything, but there are several vets in California certified to do stem cell therapy. It has been used for arthritis but they are exploring using it for other "tissue" of the body. Maybe you could check and see if it is worth while for Indy to try something like that.


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## LisaT

What an interesting idea.

If the cardiologist ever emails back, I will ask her. If I have any time before that, I should be able to give UCD a call.

The vet we are working with is out till Thursday, so we are in a holding pattern, except for the diet tweaking that I can try.


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## LisaT

Got a quick note from the cardiologist. What Indy has is *myxomatous degeneration of the mitral valve*: _Myxomatous degeneration of the mitral valve is more common in males, and is more common in advancing age. It is due to a genetic abnormality that results in a defect in the collagen that makes up the mitral valve. This causes a stretching out of the leaflets of the valve and the chordae tendineae. The elongation of the valve leaflets and the chordae tendineae prevent the valve leaflets from fully coapting when the valve is closed, causing the valve leaflets to prolapse into the left atrium, thereby causing mitral regurgitation._
http://heart-disease.health-cares.net/mitral-regurgitation-causes.php


and from here:http://www.histopathology-india.net/ValvDi2.htm
*
Floppy Mitral Valve / Mitral Valve Prolapse / Barlow's Syndrome - (Myxomatous degeneration of the mitral valve) :* 

_One or both mitral valve leaflets are enlarged, myxomatous and floppy and they prolapse into the left atrium during systole causing midsystolic click and mitral valve insufficiency.

The disease occurs in the age group of 20 to 40 (human) years and may be due to developmental anomaly affecting connective tissues (as it is common in Marfan syndrome).

Clinical presentation : This is usually asymptomatic and discovered only as a midsystolic click on auscultation. It may be associated with atypical chest pain, dyspnea, fatigue or psychiatric symptoms like depression, anxiety etc.

Patients have an increased risk of infective endocarditis, congestive heart failure, arrhythmias and sudden death.

Gross : Most commonly the posterior leaflet or both the valve leaflets can be involved. Valve tissue is increased with the leaflets being larger, thicker and spongy in consistency. There is often ballooning of the leaflet tissue between the attachment of the chordae. Hooding, redundancy or prolapse are terms applied to the valve appearance.

The chordae are also thickened, elongated and may rupture, so careful examination of the chordae and papillary muscles must be made in floppy valve diease. 

Microscopic features : There is thinning and degeneration of the fibrosa layer (on which the strength of the leaflet depends), and myxomatous thickening of the spongiosa. Similar changes can be seen in the chordae.

Secondary changes due to injury to leaflets include :

i) Fibrous thickening of valve leaflets especially at the point of contact .

ii) Thickened left ventricular endocardium at sites of friction from the prolapsed leaflets or elongated chordae.

iii) Atrial thrombosis behind the prolapsed cusps.

iv) Calcification of the mitral annulus._



We will probably start the enalapril Thursday or Friday, after the vet comes back and I pick up the meds.

Enalapril (generic for Encard): http://www.drugs.com/vet/enacard-tablets-for-dogs.html


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## Brightelf

Lisa, a diagnosis, a name to call it by and do net research over.. a med to start her on. All positives and hopeful, even as worrisome as I know that this must be for you. Remember, Indy has a great vet, and so many in her fan club here pulling for her!! Prayers are going out for you and for Indy. Your sensitive, soulful girl. may the therapy help her on this med, may the vet really have good ideas for supporting her and you through this. Prayers for Indy beaming out across the waters now...


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## LisaT

Thank you Patti!

I think folks are going to see me and start walking the other way pretty soon, I seem to be a magnet lately. 

Can a dog cough sound a bit like reverse sneezing?


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## LisaT

> Originally Posted By: BowWowMeowLisa,
> 
> Can you try this stuff? I've heard very good things about it from people with CRF cats.
> http://medi-vetrx.com/B000MSVR66/M/B000MSVR66.htm


I've been looking at this alot. Found some info about it:
_
Kibow Biotics is composed of naturally occurring beneficial probiotic strains: S. thermophilus (KB-19), L. acidophilus (KB-27), B. longum (KB-31), combined with a dietary fiber (psyllium husk). Presented in an enteric-coated, gluten-free, vegetarian gel capsule, each serving of Kibow Biotics contains a total of 30 billion colony forming units (CFU)._
http://investing.businessweek.com/research/stocks/private/snapshot.asp?privcapId=8172330

It's a probiotic???? But seems legit?
http://www.kibowbiotech.com/pdf/PROBIOTIC_THERAPY_UREMIA.pdf
http://www.kibowbiotech.com/pdf/abstract%203.pdf


This is what I've been using, but not recently:
http://thompson-nutritional.com/product/49300/source-naturals/
I guess I could email the azodyl people and ask them about the differences, strains, etc.

Hmmm...probiotics and kidney failure....
http://www.informahealthcare.com/doi/abs/10.1185/03007990903069249?cookieSet=1&journalCode=cmoc
http://www.ncbi.nlm.nih.gov/pubmed/16127597
http://www.patentstorm.us/patents/6706287/description.html


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## LJsMom

The Kibow probiotic one looks very interesting. Its not that expensive and has a money back guarantee. And it sounds safe.


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## LisaT

I agree. I contacted them about the shipping process, which I'm sure will increase the cost. It might be that this product isn't that special, compared to some products that I can get locally. 

But I will start with this one.


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## LisaT

Indy started a half dose of the enalapril on the 11th. 

Wow, what a huge difference. She has been more energetic, and downright perky. 

She has a leg that is stiff, and the day after starting, she was biting at it high on the leg, and the next day at the paw, and nibbling her toes. 

I think the drug might be helping get circulation to some places. She is stretching more (play bow type of stretching). She was getting so unstable in her hind end - can't tell you how many times I asked the chiro if she could be getting cuada equina syndrome. She seems to be standing more square too. 

It's not completely clear (from existing studies) if this med will prolong her life, but if she can handle the med digestively and if it doesn't raise her kidney values(will be checking them soon), it sure looks like it is making her feel better


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## jaggirl47

Lisa, that is so good to hear. I hope it keeps working for Indy and she keeps feeling better.


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## LisaT

Thank you Kendra! LOL, now she keeps looking at me like, "what are we going to do now", and unfortunately, it's either sleep, or something else completely mundane. She has even been trying to play with Max more









I've been meaning to ask someone about the stem cell thing, but keep forgetting. 

I think her heart was in such good shape before (before Max, long off-leash walks nearly everyday), that as it started deteriorating, we underestimated the extent of the damage. Wish I had been paying more attention







, but sure am happy she's feeling so much better


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## WiscTiger

Lisa that is good new for Indy. 

Even if it doesn't really prolong her life, right now she has a better quality of life.

PS hindsight is always clear.

Val


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## LisaT

Thanks Val, for both thouights


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## LisaT

Indy has been on doxycycline for the last couple of weeks, and stopped last wednesday, and I can see that she is already feeling crummy. I will keep her off until her blood draw on Friday, and then I think I will keep her on it permanently, for quality of life issues. 

Awhile back, she had stopped eating all of her breakfast. I'm still not sure why. BUT, I have raised her food bowl, and she hasn't left anything in the bowl since. I'm thinking that she was too sore in the morning. 

I raised Max's about 6 inches too. I know that the most recent studies link it with bloat, but he bloated without it raised, and, as he ages, this just has to be more comfortable.


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## Brightelf

I agree that the doxy for quality of life is a good choice. Indy will be feeling better, and that is what counts.

I think raising the bowls is sensible. Ouchy dogs may find it easier with the raised bowls, so i think you're doing the right thing. I also think we have no real idea with bloat. Earlier, it was NOT having raised bowls that we thought caused it, so then everyone had raised bowls. Then some still bloated, and people blamed the raised bowls. I don't think it matters. I just think you are doing an exclellent job in making sure they can both get their food without feeling ouchy. 

Sending good vibes to Indy, and wishing for good results from her blood draw on Friday.


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## LJsMom

I also agree that the doxy is a good choice. I know LJ does better when she's on antibiotics. Makes we wonder just what is really going on with her.

I hope you get some answers for Indy with the blood draw.

I spent some time checking out the new link in your signature. Good find. Maybe lyme is what happened to my brain?


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## WiscTiger

Lisa, When my first GSD got to a point that it was difficult for him to eat out of the dish on the floor I raised his dish. I think that being able to eat comfortably verses not eating at all because it is painful or just plain uncomfortable is worth the probably slight risk of bloat. 

I also believe in using ABX or low dose Predisone to add to quality of life for our seniors. Quality of life at this point is very important.

Val


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## middleofnowhere

I'm with Val on this issue. When they reach a certain age, you overlook possible issues with drugs that would give you pause in a younger dog. 

So far as eating from a raised dish -- I fed out of raised dishes for a while (before the bloat info was out there). Then I lowered them. Guess what? The dogs laid down to eat. You might consider trying that after a while and see if they do that.


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## jaggirl47

I am with you on the raised bowls. I just recently raised Zappa's bowls because of his arthritis in his neck. He has actually slowed down on his eating instead of wolfing it up in two seconds and seems more comfy. 
I'm glad the doxy works well for Indy and I also agree that if it helps her and makes her more comfortable, then do it to extend the quality of life.


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## LisaT

Thanks everyone. The raised bowls really do make sense. LOL, I could see Max laying down to eat, but not Miss Indy - I guess maybe if a put a nice comfortable mat for her







the floor is too dirty and too hard for a girl like her!

I'm pretty convinced that a tick disease is what is finally doing my girl in - one that she has probably had for a decade. I'll send a sample off to North Carolina State Univ tick lab, if everything falls into place. Of course, always a chance we get a false negative too - so I guess let's hope for a positive? Immediately after the draw, she will be back on abx. 

Also we will check the kidneys. Sure hope she is tolerating the heart meds









Joanne, about that tick issue of yours







, you never know...Wow, I just changed my sig yesterday (I think, brain fog too) - you are quick!

So *I have turned into a paranoid dog owner, officially*. Took the dogs for a walk down to the river. Max gets over-excited, decides to ram/t-bone Indy, hard, right in the spot where I can hear her murmur the loudest. Didn't make her heart stop, but sure made mine stop. 

So then the question, what the heck do I do if her heart gives and we are so far from the car? I am going to have to figure that out. I guess I could carry her over my shoulder, it's not like there is anyone close for me to call anymore










I really hate this. 

And on a much happier note, until she got hit by Max, she sure had a great time. I'm hoping to do more of that. 

Middleofnowhere, I asked the vet about Vetmedin, and she said the cardiologist said that it speed up her valvular disease? I have to follow-up on that.


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## LisaT

Joanne, about LJ. I think there are all sorts of things out there that fleas, ticks and mosquitos carry that we will never know about. And, call me paranoid, I think that those live virus vaccines that these dogs get (and maybe even the killed ones) can introduce all sorts of things into the body that we don't know are there. 

I used to be very hesitant to use abx. But with my dogs' experience, and those on the tick list, I'm the first one to recommend some of the safer abx. Some abx do scare me - the heavy hitters. 

It's hard enough knowing what's going on with the dogs we've had since birth, double hard if you haven't had them forever, like Steel, Max, LJ, etc. 

I'm going to try to get Max tested for this too. Might explain his nasal problems, which seem to be returning.


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## LJsMom

> Originally Posted By: LisaTI'm pretty convinced that a tick disease is what is finally doing my girl in - one that she has probably had for a decade. I'll send a sample off to North Carolina State Univ tick lab, if everything falls into place. Of course, always a chance we get a false negative too - so I guess let's hope for a positive? Immediately after the draw, she will be back on abx.


I was trying to get caught up on the tick board Saturday morning when I read your posts. I have to re-read a lot of it to make sure I get it. Can I ask the cost of the blood test through the NCSU tick lab?





> Originally Posted By: LisaTSo *I have turned into a paranoid dog owner, officially*. Took the dogs for a walk down to the river. Max gets over-excited, decides to ram/t-bone Indy, hard, right in the spot where I can hear her murmur the loudest. Didn't make her heart stop, but sure made mine stop.


I know I'm paranoid. My vet knows I'm paranoid. Its all good.











> Originally Posted By: LisaTSo then the question, what the heck do I do if her heart gives and we are so far from the car? I am going to have to figure that out. I guess I could carry her over my shoulder, it's not like there is anyone close for me to call anymore


How much does Indy weigh? In an emergency you'd get that rush of adrenalin. I'm sure you could carry her. I used to carry Wooly Bear down a flight of stairs every morning. All 50 furry pounds of him.


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## LisaT

Indy's only 34 pounds. But if we are a mile out, that worries me. You're right about the adrenaline though. Just something I've been thinking about. Occasionally I try to figure out what I would do if Max got hurt - geez, I should carry a sling with me! Guess I'm in good company about the paranoa thing









The cost for the Bartonella culture is $100, which covers I think 3 species of Bart. That requires the dog to be clipped and a surgical scrub before the draw. The blood tests are $20 and there are two species for those (so $40). It's not clear if I need to run the blood serology if I'm doing the culture. So it's either $100 or $140. I don't know if this vet will charge for the draw. 

If the vet office sends it in, then they put their markup on top of that. If I send it in, then I pay for the packing and overnight delivery. I am opting for the latter. I did that when I sent blood off to Protatek, and also the study Max was in. 

And of course, I'd really like to test Max too...and of course I'm broke, but I'll find a way for this.


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## LisaT

Hey Val, you out there???

Where do you get the Knox gelatin?


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## middleofnowhere

Not Val and she'll have maybe a better answer but try the grocery store.


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## LisaT

Huh, that easy, eh? Silly me









Thanks!


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## LJsMom

> Originally Posted By: LisaTHey Val, you out there???
> 
> Where do you get the Knox gelatin?


At least the Knox is cheap!


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## LJsMom

The price for the Bartonella testing isn't too bad - I know my vet would charge for the blood draw!


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## LJsMom

Have you taken a doggie CPR class?


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## LisaT

No, I haven't









I guess I was thinking more like the valve actually busting, with no more ability to pump. I've read that that is what typically causes the sudden death









With any luck, she will be sleeping, if that ever happens. It is supposed to be very quick, and perhaps the best way to go, at least down the road. I just hope it's not any time soon, she needs to be here *a lot* longer


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## littledmc17

How is Indy doing?

I am so sorry I have been bitching about runny poop 
anything I can do let me know


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## jaggirl47

Lisa, I hope Indy has alot of time left with you. I also hope that when it is her time, she takes it out of your hands and just goes to sleep on her own and it is peaceful and painless. She has had a good life and she knows you love her. Just make the rest of the time you have with her special for both you and her. You two remain in my prayers.


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## LisaT

Thank you Kendra









Dawn, I know how frustrating the "days of runny poop" are -- we had a lot of problems with Max probably his first couple of years here. I guess, when he gets older, we will revisit that. For now, it's always


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## littledmc17

thanks!

hugs to you all hope Indy is doing better


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## LisaT

Thanks Dawn


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## littledmc17

anytime


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## LisaT

*Re: Advancing Heart Disease/kidney update*

Today's news is good. 

Previous BUN was high at 36, creatinine was at the top of the scale at 1.6 (was 1.1 on her previous test), and her urine specific gravity was low at 1.021. 

Today's results, after being on the enalapril: BUN still high at 36, creatinine at 1.2







, and specific gravity was way high, over 1.045 (that's all their machine measures to).

So creatinine is great news. It says that she will tolerate the meds, and the medicine probably is what increased blood flow to the kidneys and allowed them to recover a bit. 

The BUN and SG do mean that she is very dehydrated, so I will have to make sure I add lots of water. I don't know if we are talking fluids later or what. 

Tomorrow I am sending some blood off to North Carolina State Univ for both Indy and Max - the last testing, shot in the dark, for both of them (Bartonella). After we get the results of that back, then the vet said that we will put together a more formal plan for Indy. 

Right now, I'm very relieved. Two for two between Max's anal gland and Indy's kidneys, I can breath for a few more days!!


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## LJsMom

*Re: Advancing Heart Disease/kidney update*

Yay!!


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## Jazzstorm

*Re: Advancing Heart Disease/kidney update*

<span style="color: #3333FF"> Hi Lisa. I obviously have been away for awhile. I just read the news about Indy...I am sorry to hear this.

I am glad you have good news today though!
Hang in there!!!</span>


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## LisaT

*Re: Advancing Heart Disease/kidney update*

Thank you Jazzstorm. I had noticed that you hadn't been around. 

In preparation of the new school year, I have set my alarm to the most annoying of noises. Indy hates it, and the more I snooze, the more she tries to bark me awake...can't tell you how many times she has saved me







I think it's that terrier and high pitched noise thing







Max just rolls his eyes and goes back to sleep









Sadly, I am paranoid enough to wonder if that exuberant barking is bad for her - but I think not - paranoa has set in!!! I'll just think of it as exercises for all the stuff she uses to bark with (lungs, etc)!!


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## allieg

*Re: Advancing Heart Disease/kidney update*

Are you using the Azodyl? Jasmine's numbers are back to normal but we won't know if it is the med or life until we take her off it for a month or so and retest.If her numbers go back up then I will be convinced on the med..


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## LisaT

*Re: Advancing Heart Disease/kidney update*

I was sporadically using it. I was also giving a small amount of spirulina, which is kidney protective (but an immune booster). 

I noticed that Indy felt better when I gave her the Azodyl.now that I'm giving abx, I have to remember to find a time to give some of the Azodyl.

The doctors believe that it was the meds that helped those kidney values go down. After she started the meds, you could see how she was getting better circulation everywhere.

Glad to hear that Jasmine is better.


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## LisaT

*Re: Advancing Heart Disease/back and nerve issues*

Sometimes I think Indy is more GSD than my GSD is.....

She's been getting more unstable in the hind end -- pretty wobbly, and kinda tripping. Part of that might be low blood pressure from the meds, which I'll have to follow up on when we get the most recent bloodwork back.

But last week, she woke up, and her hind paw was flipped over. The good thing was that she was aware that it was flipped over, the bad thing is that she was having trouble righting it. It took her several tries. It scared me quite a bit actually.

I've got her back on doxycycline and she seems much more stable, but still some wobbles here and there. What I find odd, is how much more stable she is after only about 3 days on these antibiotics. Hopefully in a couple of weeks, she will even be better....


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## LisaT

*Re: Advancing Heart Disease/back and nerve issues*

Our regular vet is back from an extended absence from the vet clinic and we got to see her for the first time today. It's also the first time that she has seen Indy since the ruptured chordinae. It was very touching, it made me cry. 

She said that Indy is the only dog she has known with such a rupture that lived. Wow. So, with that encouraging study Jean posted back around pg 1, I am so hoping to keep her around a lot longer, with any luck. 

I really missed this vet, was kinda lost without someone to bounce stuff of that knows the dogs and knows how to deal with me too









Overall, indy is doing well. She is losing a lot of muscle mass, and the Enalapril causes her digestive issues and makes her a bit stumbly, but it's certainly better than the alternative. She's barky, full of herself, and more stubborn then ever. 

Folks used to say that I spoiled her, when in fact, this was not true, she was just well taken care of. But now? Now she is getting spoiled - I let her get away with so much more, and I'm okay with that


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