Monty's Story

Little gets a veterinarian's attention faster than a person running in the door screaming, "Please help me! My dog collapsed in the parking lot! I think he's dead!!"

One of my colleagues and two of our nurses jumped up and ran out to help. A minute later they came back in carrying a medium sized mixed breed dog on a stretcher. He was not dead. His name was Monty Jacobs and while he was not dead he was clearly in trouble. His breathing was laboured and his gums were pale. Mrs Jacobs was freaking out. My colleague is a very calm person and she was able to reassure her that we would do our best to stabilize Monty and get to the bottom of whatever was going on as quickly as possible. 

Sure enough, 15 minutes later we had a chest xray. The heart looked enormous. 

"Oh no, it's another right atrial hemangio," I said when I was asked to look at it. I was referring to a common cancer that can cause bleeding on the outer surface of the heart. The blood becomes trapped under the pericardium - the membrane that wraps around the heart - which causes the entire heart shadow to appear enlarged on xray.

"Do you have time to do an ultrasound to confirm?" my colleague asked.

"Yeah, I can squeeze it in. Sadly for the dog it's going to be quick as these are really easy to see."

But I was wrong. It was not quick and Monty did not have a bleeding cancer. Monty had dilated cardiomyopathy. Dilated cardi... what? I'll break it down for you. Dilated means what you think it means - stretched out. Cardio means heart, myo means muscle and pathy means disease. Put it all together and you have a disease of the heart muscle causing it to become so weak that it becomes baggy and stretched out.

This made no sense. We only see DCM (the easier to remember abbreviation) in a small handful of specific breeds because it is a genetically determined disease. Monty was maybe terrier, mixed with maybe husky, mixed with maybe German shepherd, mixed with maybe... who knows? A classic "Heinz 57". I was stalling for time by describing some of the less important things on the screen before getting to the inevitable 'why' question when suddenly a little (metaphorical) bell rang inside my head. Bing.

I turned to the owner and asked, "What do you feed Monty?" She named a brand of food I hadn't heard of before and said that it was grain-free. Now I knew.

Last year reports began to bubble up of dogs developing something that looked like DCM but who did not fit the usual breed profile. Individual private practitioners did not detect a pattern because they would only see one or two cases, but cardiologists did see a pattern. All of these dogs had been on "BEG" diets - "boutique", "exotic ingredient" or "grain-free" diets. 

To expand on this a little, by "boutique" we mean relatively small batch foods produced by companies that do not have a certified animal nutritionist on staff and who are not able to do proper scientific feeding trials. "Exotic ingredient" refers to lentils, chick-peas, fava beans, tapioca, alligator, kangaroo, ostrich, pomegranates etc etc. Please know that this is a tiny sample from the list of exotic items that are popping up in pet foods. Unfortunately until this gets figured out everything that was not traditionally fed to dogs needs to be considered "exotic" and viewed with suspicion. "Grain-free" is self explanatory, but read on. 

I know that grain-free diets are enormously popular at the moment, but I have no hesitation in saying that this is a fad built on two fallacies. The first fallacy is that allergies to grains are common. In fact, allergies to grains are quite rare in dogs. Moreover, when there is a grain allergy it is usually to a single type of grain, such as wheat for example, not to all grains. The second fallacy is that dogs are essentially wolves and therefore should not eat grains. Your dog is no more a wolf than you are a Neanderthal (mind you, I'm making an assumption about you). We now know that evolution works much faster than we used to think it did. A lot has changed in their and our biology since those good old wolf and Neanderthal days.

I apologize for the digression. Back to BEG.

Many theories have been put forward as to why some BEG diets are damaging the heart, but as of now (February 2020), nobody knows with absolute certainty yet. Is it the absence of a key nutrient that is in the traditional foods? Is it the presence of too much of something new that was put in to replace the traditional ingredients? The leading theory currently is the latter. There does seem to be an association between high levels of peas, lentils or potatoes and this problem. These have been put in to balance the protein and carbohydrates when the grain is taken out, but may be throwing off the metabolism of specific amino acids.

We expect that only a small number of BEG diets are involved, however that list is growing so we cannot be sure yet that any specific BEG diet is safe. So although there may be many fine diets under the BEG umbrella, at this time we have to recommend that you feed a traditional diet from a well-established company that has a solid footing in nutritional science. Ask your veterinarian for a list of these companies. And please don't panic if you are feeding a BEG diet, this problem is not that common, but you really should talk to your veterinarian about switching. And please don't feel guilty either, many of the BEG diets are particularly good at marketing in a way that appeals to our desire to do the right thing. 

There are good drugs for DCM and most patients can be stabilized if it is caught early enough, but the terrible thing is that there can be no warning signs. Monty had just been a little weaker for a few days prior to the collapse and had been breathing a little harder. This is typical. We expect that by changing his diet we can stop further heart damage from occurring and we hope that maybe even some of the damage can be reversed. 

I have seen a few dozen more cases since Monty. Two tragically didn't survive, but Monty is doing ok. And he likes the new food.