Do you read your dog medication inserts? You should, and let me tell you why.
On January 28, 2014, Jet was diagnosed with mitral valve insufficiency via cardiac ultrasound. We began him on 20mg of Enalapril daily.
On May 15, 2014, Jet’s heart murmur had increased from a grade 2 to a grade 3. We doubled his Enalapril to 20mg twice daily.
On January 29, 2015, Jet had a syncope episode.
On October 27, 2015, Jet’s cardiac ultrasound revealed weakening of the heart’s contractions. We began him on 7.5mg Vetmedin twice daily in addition to his 20mg Enalapril twice daily.
On February 28, 2016, Jet had a syncope episode.
On May 19, 2016, Jet had a syncope episode.
On June 19, 2016, Jet had a syncope episode.
On July 17, 2016, Jet had a syncope episode.
On September 8, 2016, Jet had a syncope episode.
On September 26, 2016, Jet had a syncope episode.
On October 16, 2016, Jet had his latest syncope episode.
By the end of October, we were due for a cardiac ultrasound and by the grace of God and some very amazing friends, we were able to make that appointment.
When I Realized That I Should Have Been More Vigilant in Reading Jet’s Dog Medication Inserts
Before we went in for our appointment on November 2, 2016, I sat down and charted Jet’s syncope episodes. I charted their increasing frequency. I charted what happened before the syncope. I charted when it began. I charted checkups and appointments in between. And then I made a few notes.
If you know me in person, you know that I document everything with spreadsheets and notes. This is mostly due to my poor memory and anxiety, both of which cause me to lose my ability to vocalize important information when needed most.
So, I made my spreadsheet and I jotted down my notes to pull everything together in a single succinct document to reduce the time demanded of our vet.
And then, as I sat there, the night before our appointment, staring at the dates in front of me, it occurred to me to look up the insert that comes with Vetmedin. I squinted at the tiny print and scanned line by line until I saw it…
Just a note – This image has been cropped to isolate specific information and does NOT reflect full prescribing information or warning information. You can find the full prescribing information for this medication here.
If I had read the full insert for Vetmedin, I would have seen this a LONG time ago.
Jet’s First Episode of Syncope
When Jet had his first syncope episode and we went to the vet, we discussed the frequency of his heart disease cough and a recent episode of vigorous barking at a door to door salesman in our neighborhood.
We talked about the culmination of these factors and came to the conclusion that Jet’s syncope episode was likely the result of coughing exacerbated by irritation from barking. There was no indication that anything else was in play so we treated the irritation and Jet recovered with no long-term concerns.
At this time, Jet was NOT taking Vetmedin at all.
It would be one year and one month before the next episode of syncope. During this time Jet had an ultrasound and was prescribed Vetmedin after weakening of his heart’s ability to pump blood efficiently.
Jet’s Second Syncope Episode
Jet’s second episode of syncope was on February 28, 2016.
We visited the vet after this episode and once again talked about Jet’s coughing.
Now, this time Jet hadn’t been barking at the neighbors, but he had been coughing due to his heart disease.
Syncope is not uncommon for dogs with heart disease, particularly when those dogs have the characteristic heart disease cough. This cough can cause a syncope episode when it causes rapid changes in blood pressure. That rapid blood pressure change results in passing out.
As an aside, the same thing can happen in people after vigorous coughing fits. Interestingly, it happens more often in human males than females.
So, due to Jet’s coughing, the fact that it was only his second syncope episode in over a year, and the fact that he had had a syncope episode before he began Vetmedin, it made sense that we were once again looking at coughing being the culprit.
So, when Jet began to experience syncope once monthly, I was concerned, but not overly concerned.
In hindsight should I have been more proactive about following up with our vet after other syncope episodes? Yes, but my financial situation and our prior experience told me that things would be okay until we could afford another vet visit.
A “No New Information” Ultrasound
So, on November 2, 2016, Jet went in for his most recent cardiac ultrasound.
By this time, according to the calendar, he was about due for another syncope episode. They were coming once every two weeks almost like clockwork.
The ultrasound showed no significant change in Jet’s heart structure or function.
Jet’s vet, ultrasound technician and I discussed possible causes of Jet’s increasing episodes of syncope. The ultrasound technician suggested a cardiologist consultation and equipping Jet with a halter monitor to see what his heart is doing when he experiences syncope episodes.
Now, if you have followed me for a while, then you know that we have been going through some real financial struggles. This meant that the very thought of a cardiology consultation made me cry. I wanted to give my boy everything, but when we had to accept the help of two amazing friends to get Jet’s ultrasound done, there was just no way we could even consider a cardiologist consultation. So, we left the vet that day with his promise to look into things for us.
And then something happened…we ran out of money.
The Part I’m Not Proud of…
I know, I said before that we were broke, but here is what you need to know – when some people say that they are broke, they still have a few hundred dollars minimum in their bank account, when I say I am broke, I mean that I HAD $2 in my bank account which the bank subsequently claimed for a monthly maintenance fee.
We were so far past being broke it wasn’t even funny.
What this meant was that the Vetmedin medication that we had left was all we had until we could come up with $95 a month that wasn’t covering the very very basics.
What I did next is something I am not proud of, it is not something I would EVER advise anyone to do themselves and it is something that I likely wouldn’t be sharing if the outcome hadn’t been what it was.
I cut Jet’s daily Vetmedin dose in half.
I need you to understand that I did this because I had no option. I had NO option.
I didn’t want Jet to be without medication completely and have to go “cold turkey”, so I started him on 7.5mg once daily instead of the 15mg.
And something happened…the syncope stopped.
From Jet’s past syncope activity and the details we had noted, he was projected to have another syncope episode in the first few days of November.
It has been one month and eight days since Jet’s last syncope episode. Not only that but Jet is a much healthier looking dog overall.
And do you know what?
If I had looked in the insert for Jet’s medication sooner, I would have seen that there is a possibility of it causing syncope.
Would it have rung bells for me when it didn’t ring bells for his vet? I can’t help but think that perhaps it would have. If our vet had been aware of every incidence of syncope, it may have rung bells for him too.
The Final Takeaway
So, I guess what I’m saying is that not only should you be reading your dog medication inserts, but you should also keep in contact with your vet as regularly as possible when your dog is experiencing something “out of the norm.” Your vet can only do so much with limited information, but with full disclosure and your feedback on your dog’s condition (who knows your dog better than you?) you can work together to put together ALL the pieces of the puzzle and do what is best for your dog.