Endocarditis.  You’ve probably heard the name, many of you may have had relatives or friends diagnosed with this debilitating infection but did you know that our beloved canines can also contract this disease.

There isn’t a lot written about this disease for the layperson but fortunately there are many Veterinary Cardiovascular Specialists and Veterinary Medical Specialists who are able to provide an overview that is easier to understand.

The literature I’ve read states that this disease is more common in large breed older dogs (usually over the age of 5 years) and male and the survival rate is less than 50%.  The treatment for this disease is aggressive, prolonged and massively expensive so many owners opt to have their animals euthanised because they just can’t meet the expense of the treatments involved or follow the rigorous treatments and strict timetables that they have to undertake as part of the treatment program for their dog.

The following is my account of what happened to one of my beautiful dogs that contracted this disease.  I’m no novelist, but I hope you find this story interesting and informative.

This is the story of my beautiful Murphy, who, at the tender age of 2yrs had a huge future ahead of her both in and out of the show arena.  Then, she contracted Endocarditis.

The Symptoms
The year is 2002 and the hotter weather is just ending so our Bullmastiffs and us are getting ready for the show circuit once again.  The year starts off very well for our girl Murphy.

Alter that year, in September, she took ill, she had a fever of 40.1 and was very lethargic.  I quickly rushed her off to our vets who assessed that she had some sort of infection so prescribed her a 5-day course of oral antibiotics (500mg clavulox) and sent us home.  After a few days she was pretty much back to her old self, but after only 5 days off the antibiotics she came down with a fever once again, and once again I rushed her up to the vets who thought that perhaps this time she was bitten by a spider as there was a swelling on the hock on her left hind leg and that perhaps she was bitten the first time, so they treated the suspected ‘bite’ wound and supplied another course of antibiotics.  We went home and used spider spray on everything to make sure that she wouldn’t get bitten again and we kept her inside until we were sure that any spider in that area was dead.  Again, after a few days of meds she was back to her old self and was fine for a couple of weeks.  During her stint inside she was standing near the edge of our bed greeting us one morning and wagging her tail so fast she was hitting it on the wardrobe.  A few hours later she couldn’t raise her tail, we thought that perhaps she’d bruised it so again went to the vets and they put a drawing cream (to help get the bruising out) and bandaged it. 

Two days prior to the commencement of the National show Murphy was favouring her left hind leg again, there were no obvious signs of any trauma so we thought that she’d hurt a muscle and just rested her (we knew there weren’t any spiders left).  On the day that she was to be shown, we went to the kennels and there she was, on her bed not getting up.  We tried to coax her and she tried so hard to move, but she was in a lot of pain and there was a tremendous amount of swelling on her left hind hock (first thing that crossed my mind was Osteosarcoma).  We felt her ears and they were burning up, so we took her temperature, it was 40.2 so my husband carried her to the car and I drove her to the vets.  This time I told them that they were to keep her there until they found out what was causing these fevers and the swelling of her leg.

I had to go to the National show for the day being on the committee and being the last day, but my mind was always on Murphy.  I must have called about 10 times that day to see how she was, there had been no change so she stayed in over night.

I went in to visit her the next day, the vets were busy so one of the nurses took me through to see her.  I took one look at her and just burst into tears, her left eye was totally white, not an ounce of colour, her front right leg was now swollen at the wrist and she was still quite lame on the left hind leg.  They were using some drops in her eye to try and stop any permanent damage from occurring, but they had no answers as to why this was happening and what was causing it.

After a week of scans, blood tests and oral antibiotics (Clavulox and Baytrol) they managed to get her fever down, but they still couldn’t find the root of the infection that was plaguing her beautiful body.  They referred me to a specialists clinic that deals with very rare and difficult cases.  I drove her straight there and waited to see the specialists (both a Medical specialist and an Ophthalmic specialist).

The Diagnosis
The Ophthalmologist said that my vet had administered the correct type of drops and that there was a high probability that there would be no scarring of the eye (at last, some good news).  Then the Medical specialist came in and asked about her history, gave her a complete physical and then asked me ‘…. How long has she had a heart murmur for?’ to which I replied, ‘… she’s never had a heart murmur’ ‘she has now, about a grade 2’ he said.  I was dumfounded, how could something like this happen to such a healthy girl! 

His preliminary diagnosis was Endocarditis, but to be sure he had to perform a colour Doppler scan on her heart and the rest of her body so that he could rule other possibilities out.  I left her at the specialists and went home to await his phone call, by this time, I was sick to my stomach with worry.

Late that Friday afternoon the phone rang, it was the specialist with his findings.  I held my breath as he gave me the devastating news that it was indeed, Endocarditis and that the scan had picked up a clot on the Mytral valve of her heart that measured 1cm in diameter!  We spoke in length about how she could have caught it and he basically said that it was just ‘bad luck’ (a huge understatement in my books).  We then discussed her symptoms such as lameness and the eye and he said that these conditions were caused from bits of the infected clot breaking off in the heart and moving through the bloodstream and lodging in various parts of her body causing inflammation and deterioration (in her case her rear left hock, her rear left hip, her front right wrist and her eye).  We also discussed any possible treatments, the costs and her prognosis with and without it. 

The Decision & The Treatments
The Specialist advised that with no treatment the clot would get bigger and either cause her to have a heart attack or a large piece could break off and lodge in her body somewhere else and eventually cause her death (we were already seeing clinically the results of smaller parts of the clot breaking off and what that was doing to her body). 

High doses of oral antibiotics can be given, but they only give very temporary relief and eventually, as without treatment, parts of the clot would break off and could kill her or cause her major organ damage.

The prescribed method of treatment was an intense course or intravenous antibiotics, given at 4 hourly intervals, around the clock for 7 days straight (these antibiotics were Gentamycan and Ticarcillin).  She would then be put on Heparin injections, which would be administered 3 times a day, and given large doses of Baytrol (3 x 500mg once daily), Clavulox (1 ¾ x 500mg twice daily) and Aspirin (2 ¼ x 100mg once daily).  She would also, in the short term, need to have a scan done on her heart every week, stretching out to fortnightly if there was improvement and then monthly and so on. 

He explained the reason for this regime.  The bodies normal defence mechanism is to surround an area of infection and try to stop it from spreading so an area of blood will form around the infection.  If more infection is in the dogs system then that can form over (the now blood clot) and so on and so on.  So the clot is made up of layers of infection and blood.  The high doses of antibiotics are to fight the infection and make sure it doesn’t reoccur.  The Heparin injections and Aspirin are to stop the bodies natural defence mechanisms (in other words slow her clotting speed down considerably) by doing this it’s stopping the formation of more clot around the infection.

He then anticipated that if she were to respond well to this treatment we would be looking at around 3 months to get her back to next to normal.  The cost of the initial treatment was going to be around A$5000.00 so he told us to discuss it and then give him a call back as he knew it was a large amount of money and he was giving us no guarantees of the outcome.  I was so upset, and my husband just wanted to console me, even though it was a lot of money my husband said to tell them to go ahead with the treatment.  We called back and it started.  I guess the one thing that stuck in my mind is that the specialist said that if she were his dog he’d give her the treatment, she’s young and was fit so that might give her the strength she’d need to help her system fight this infection.

I went and visited her every day she was there, she was so happy to see me, and they said that she was a marvellous patient, never barked and was always wagging her tail when anyone walked past her cage.  She wasn’t eating well (guess the antibiotics were making her feel yuck) so I would take in a roast chicken every second day for her to have (do you have any idea how hard it was to wean her off that once she got home!!!).

After a week of intravenous antibiotics the specialist called us to say that she could now go home on a strict regime of injections and medications and weekly scans on her heart, as they had to monitor the size of the clot and make sure that it was diminishing in size.

The Homecoming
We were so excited to see her and her us.  Poor thing looked like a patchwork quilt as she’d been shaved under her neck, both sides of her chest, her abdomen and 3 of her 4 legs (for the intravenous infusion of the antibiotics).  While she was in there they also took a scan of her right front wrist, as it was still very swollen.  The specialist said that there were obvious signs of inflammation on the tip of the Radius but with the treatment that should short itself out.

The first week went by and she was such a trooper, never grizzled with the 3 injections a day or the masses of meds she had to consume.  She loved the 24/7 care and the fact that she was permanently an inside dog, only going out briefly to relieve herself.  If it were at all possible we grew even closer.  The time arrived for her first scan since her stay at the specialists.  I dropped her off in the morning, went to work and then went back in the afternoon to see the specialist and pick her up.  We’d done every thing that was expected of us yet the news he gave me was not what I expected.  The clot had grown from 1cm to 1.5cm!!!!!  That was a massive clot to have in a chamber of the heart.  The medications weren’t doing the trick so he upped her Heparin dose to 8ml!!!  They also re scanned her front wrist and that too had got worse.  In the matter of only 7 days it had gone from simple inflammation to having a bone chip floating just below the tip of the Radius.   I was so upset and disappointed I couldn’t help but cry, especially too as it was my birthday and I so wanted good news this time.  The specialist was such a caring man and was forming a very special bond with Murphy, he crouched down next to her and told her that she had to try harder next time to give me a better result and that I had to put off celebrating my birthday a while until a better result came in.

We went home and started yet another week of injections and meds.  This time, due to the volume of the Heparin she was crying a little with each shot and as the liquid is quite thick, it would sometimes leave large lumps under her skin that even with massaging wouldn’t go away.

Well, time had arrived for the next scan.  Same routine as before dropped her off and in the afternoon picked her up.  This time there was a glimmer of hope that the medication was starting to take effect.  The clot had decreased by .4 of a millimetre!  That was a wonderful result and we were all just so happy.  But there was a long way to go and the clot was still at deadly proportions.  Still no improvement on her front leg, but the back leg was getting better and her eye was much better, almost normal and she could definitely see out of it.

So the regime continued for another month, then two months, finally I said that I just can’t go on giving her these massive injections as she was so sore and lumpy.  So the specialist sourced a higher strength Heparin, the Human variety, so instead of 8mls of 1000iu it was 1.6mls of 5000iu.  That was so much more comfortable for her and I didn’t feel as guilty giving it to her either.

On one of her scans the specialist found that one of the small strands of fibrous tissue that stop the Mytral Valve from flipping back and forth against the wall of the heart had broken due to the pressure of the blood being pumped through her heart because of the size of the clot on the edge of that Mytral Valve (there are 3 of these small strands).  He said that this in itself isn’t life threatening, but if another one were to break, well, we didn’t even what to contemplate that.  So we just had to concentrate on reducing that clot ASAP.

An Ancient Aid
At the same time as Murphy’s treatment I was getting Acupuncture done by my local vet on my oldest girl Abbey who has arthritis.  It was really helping her and so I asked the question whether this might be some use on Murphy’s leg (due to the Heparin she was not aloud to take oral anti inflammatories only topical).  My vet thought that it could do some good, so we had both girls receiving Acupuncture and remarkably we could start to see some improvement, both in her mobility and in the size of the swelling on that front leg.

We went back every week for treatment and it was amazing to see these two girls just lay there and enjoy the treatment and to see it work it’s magic, especially on Murphy.

A Significant Change
It had now been 3 months since Murphy had started her treatment so we approached her specialist to see how much longer she might need to be kept on this regime as the clot had now diminished to .6 of a millimetre.  He advised that now it was possible to start reducing the amount of Heparin she was receiving to see if there was any dramatic change in the size of the clot and that he wanted this reduce rate to be administered for 1 month at the end of which, she was to go back for another scan to monitor what the clot had done.

We followed his advice and at the end of that month we took her back for another scan.  The result was no change at all in the clot.  I was really disappointed and asked that the medication go back up so that the clot can continue to get smaller (this was the first time since the first week of treatment that the clot hadn’t got smaller).  The specialist agreed to put the medication up, but only for 1 month to see if that did make any significant change.  Well, after a month and another scan, no change again.  It was at this point that the specialist told us that what was left could perhaps be scar tissue from the clot, but that he’d need to see this result for at least another 2 scans before he’d feel confident in this diagnosis.  I asked if there was a way to know for sure if what they were seeing on the scans was indeed just scar tissue.  He told me that the only definitive way was to open up her heart, which was not going to happen, so, back to the scans.

Murphy’s Heparin shots were reduced each month from 1.6mls to 1.2mls to .6mls to .3mls.  The reason for this was that you have to have them weaned off Heparin, it can be too dangerous to stop cold turkey.  By December, the specialist told us that if we wanted to, he could see no reason why Murphy couldn’t start to go on walks, not during the heat of the day, just to get her muscle tone back and her endurance levels up.  So every afternoon at dusk, Murphy, Anthony and I would go for a walk around our neighbourhood.  The first couple of times, Murphy had to sit down part the way back as she was getting tied, but, after a week she was pulling us home, so we knew she was finding the going much easier.  He also said that if we really wanted to, we could perhaps enter her in a dog show or two, just to see how she goes.  We did this and she one her class of got Intermediate In Show at an Open Show.  Not bad for her first time back in the ring for 6 months.

It was now March 2003, and Murphy went in for another scan.  We went to pick her up and the specialist looked at us and smiled, the clot hadn’t changed and this was the 3^rd scan that it hadn’t changed size.  Murphy was also showing no clinical signs of any infection, actually, she was almost back to her old self.  Finally the news we had been waiting to here for 7 months, MURPHY CAN COME OFF ALL MEDICATIONS!!! 

You can’t begin to imagine our total joy at this news.  No more injections, no more masses of antibiotics or Aspirin, just a normal life.  She could now go and spend time with her other Bullmastiff friends and have a game with them.  She could spend her days outside in the fresh air and not cooped up inside by herself.  And she could continue her love of showing and making new friends at the shows, both K9 and human.

Ongoing Treatment
The Specialist spoke to us about on going checks and precautions that we’ll have to follow to try and make sure that nothing can re occur.  She needs to go back for a scan in 3 months to monitor the heart and see if there is any change in the clot / scar tissue (of course if there are any other changes for the worse in the mean time she is to go back ASAP).  She must also go onto oral antibiotics each time she has any type of bacterial infection or there is a possibility of an infection, such as getting a hot spot (pyoderma), a cut, an operation, a mating, during her seasons and so on.

The reason for all this is because, now that Murphy has had this condition, she has a weakness in her heart so any bacterial infection, no matter how mild, could find it’s way to that area again and re infect it, thereby setting up conditions that could cause her to get Endocarditis again.

Having said that, the specialist was quick to point out that this doesn’t mean that she is more susceptible to infections, just that if she does get one it can have more serious repercussions due to the legacies she has been left from the Endocarditis. 

Where To From Here
The specialist believes that her prognosis from here is very good and that there is no reason why she shouldn’t go on to live a long, happy and productive life.

So Murphy did what many wonderful K9’s haven’t been able to do, she survived Endocarditis.

We are just taking every day as it comes and trying to treat her as normally as possible.  She has just come into season for the first time since the Endocarditis and so is back on her antibiotics until a week post their completion.  She is now back in the show ring.  And she is back out in the kennels during the day keeping everyone there on their toes again, then back inside at night to keep us company and make us laugh with her antics.

Some Special Thanks
At this point I hope you can indulge me in letting me thank some very special and remarkable people.  To all the vets and staff at Quakers Hill Veterinary Clinic for trying your best to help Murphy in her initial stages of this disease and then, knowing when you were beaten and referring us on.  To all the specialists and staff and The Animal Referral Hospital who gave Murphy round the clock care during her stays there, she loved coming back for visits. 

But special mention and thanks has to be given to two people, firstly to my wonderful husband, who married into this life of dogs and who stood by Murphy and I to make this happen, I love you so much for this.

Secondly, to Dr. Nigel Swift, who’s dedication above and beyond helped Murphy and us to understand, treat and live with this disease over many months and who’s genuine love of Murphy herself made leaving her there, at times, so much easier to bare.

Since her recovery, Murphy has won numerous Shows and delivered a healthy litter of 11 puppies to frozen semen.

And thank you all for reading this article.  I hope you found it informative and perhaps it might help you to ask more questions if ever one of your beloved animals ever has similar symptoms as these.

By Kim Rogers.