Week 15 Recap and Oncology Visit #16
“You can’t get back what you’ve lost.
What’s Important Now is what it is that you still have.” ~Jimbei
Week 15 Recap
As of last week, Margarita is officially done her CHOP chemotherapy treatments. Unlike many other unfortunate dogs, Margarita made it completely through her entire round of chemo, and we’re taking that as a WIN. However, as with many other warriors, she did not end this battle without acquiring some battle wounds. Some of this damage is temporary…Margarita’s hair on her face and belly should begin to grow back, and the dark pigment on her nose and muzzle should eventually fade to reveal her signature pink-piggy-nose …But a cardiology evaluation revealed a devastating battle wound that will scar her permanently.
July 1, 2019
After a heart murmur was discovered during Margarita’s Emergency Room visit, we scheduled a Cardiologist appointment with Dr. Bossbaly at VSEC. Dr. Bossbaly is the cardiologist Limoncello sees as well. During that appointment, we received some shattering news. Margarita, like our Limoncello, was diagnosed with Dilated Cardiomyopathy. However, Margarita’s case is much more severe. She also has a grade 3 heart murmur (the blood is not flowing properly through her heart, particularly the mitral and tricuspid valves) as well as a significant cardiac arrhythmia (irregular heartbeat in the form of ventricular premature contractions).
So what does this all mean for our Sweet Reet? Below is the information conveyed to us by Dr. Bossbaly:
Dilated cardiomyopathy (DCM) is a disease where the heart muscle becomes a weak and has difficulty pumping blood out of the heart throughout the body. Because of this weakening, the heart chambers become enlarged, one or more heart valves may leak, and signs of congestive heart failure (fluid in the lungs) may develop. The cause of dilated cardiomyopathy is not known; however, given the prevalence of this disease in certain breeds there is a suspected genetic basis for this condition. Occasionally, DCM-like heart muscle dysfunction develops secondary to identifiable causes such as toxins or an infection. More recently, it has also been thought to be connected to grain-free diets due to the fact that legumes in grain-free kibble block the body’s taurine absorption. In Margarita’s case, it is believed the DCM is caused by the toxic effects of the chemotherapy drug, Adriamycin.
Early in the disease process there may be no clinical signs detectable, which is why this was not discovered in Margarita earlier. As the disease progresses, a heart murmur or other abnormal heart sounds and or irregular heart rhythm can be detected upon physical examination, as when the ER doctor heard Margarita’s murmur during her ER visit. The presence of heart muscle may weaken and her ventricular arrhythmias may result in weakness or lethargy, exercise intolerance, or fainting episodes for Margarita. I am finding this hard to type, but Margarita is also at risk for sudden death. As the heart’s pumping ability worsens, the heart enlarges and pressure builds up within the heart. When the heart is unable to compensate for the disease further, fluid may accumulate in the lungs, in the chest cavity, or in the abdomen. These are signs of congestive heart failure. The presence of fluid in these areas can cause difficulty breathing or coughing, so we will have to monitor Margarita for those symptoms.
The prognosis with dilated cardiomyopathy is guarded. Despite medical therapy, this disease will continue to progress with further weakening of the heart muscle. Margarita is at risk of developing congestive heart failure and is unfortunately at risk for worsening of the ventricular arrhythmias. Periodic echocardiograms and a halter monitor (if warranted) will help keep an eye out for disease progression and can dictate changes in medications which can help Margarita continue to have a good quality of life. Often, with the discontinuation of the chemotherapy, the heart may partially recover.
Dr. Bossbaly placed Margarita on a daily dose of Pimobendan. This is a medication used in Dobermans with dilated cardiomyopathy. This medication improves the strength and efficiency of the heart and dilates blood vessels to promote blood-flow out to the body. Side effects are very rare, although it is possible that Margarita could have some G.I. upset. It is not known if Pimobendan helps with toxicity-induced cases of DCM, however Margarita’s heart is significantly enlarged and the contractility is severely compromised, so we are hopeful that this medication will help our Sweet Reet’s heart get strong again. Margarita also has major activity restrictions. She is not allowed to run freely, and should not be put in any situation where she is upset.
Like Limoncello, Margarita’s sleeping respiratory rate (SSR) will have to be monitored on a daily basis for the rest of her life. The sleeping respiratory rate is a subtle indicator of changes in Margarita’s condition; increasing trend may suggest the development of congestive heart failure. Normal sleeping respiratory rate should be less than 30 breaths a minute, so we will be tracking her SSR along with Cello’s using the app, Cardalis. Unfortunately, this app only allows for tracking one patient, so we have to chart the results ourselves. We will be in search for another app that allows for easier tracking of multiple patients, if possible, and welcome any recommendations our family, friends, and followers may have. Increases in respiratory rate and effort while sleeping will be reported to both Rita’s primary veterinarian (Dr. Campbell) as well as her cardiologist (Dr. Bossbaly) immediately.
Margarita will return to VSEC to be re-evaluated by Dr. Bossbaly in 4 months, and will also have an exam scheduled with our primary veterinarian, Dr. Campbell, in approximately two weeks.
We wholeheartedly do not regret our decision to get chemotherapy for Margarita, as it did help her WIN this round against Lymphoma. Had we not chosen that path, Lymphoma would have taken Margarita from us months ago, as Lymphoma patients generally only survive 1-3 months when left untreated. Considering the rough life Margarita unfortunately was forced to live prior to us knowing her, we were confident that she deserved a second chance at living a (longer) happy life. All that being said, the news of Rita’s severe cardiac disease on the last week of her chemotherapy plan sure felt like a punch in the gut.
We understand that just because Margarita is done with chemo doesn’t mean she is done with Lymphoma, as 90% of dogs with this disease will relapse. We are remaining optimistic about her cardiac issue and focusing on being grateful for the WIN that others have not been so fortunate to celebrate – the WIN of our little warrior taking a big bite out of Lymphoma, and making it to the end of her chemotherapy treatments. As we celebrate that WIN, however, we will also focus on the W.I.N. This “end” is really just the beginning of a new chapter. What’s Important Now is that we remain positive and help Margarita become healthy and strong so that she can combat her heart disease. What’s Important Now is celebrating each and every day that we are blessed to still have her in our lives.
We will also start planning some of those escapades on that Adventure List of hers!
This Week’s Treatment
Week 16: The Final Week of the CHOP Protocol
Hey, Lymphoma…Guess What …You LOSE!
No chemo this week (YAY!), as Margarita completed all of the CHOP treatment plan. Instead of chemotherapy drugs, Margarita had an abdominal ultrasound, blood test, and physical exam. I also had the opportunity to sit down with Dr. Risbon and discuss the plan for long-term monitoring.
No abnormalities were found during Rita’s ultrasound.
Margarita’s white blood cell count was a bit low, so she was placed on an antibiotic as a preventative.
Rita’s physical exam was good. Her mammary gland still feels like there is abnormal tissue present, so this will have to be closely monitored.
Discussion with Dr. Risbon
Dr. Risbon explained that Margarita is a special case, which is very concerning. Lymphoma usually resurfaces in 90% of patients in the same manor it did before chemo. However, now that Rita’s spleen is removed, it is not known how or where the Lymphoma will show itself. We will have to be very observant, and vigilant in regular check-ups at Rita’s veterinarian as well as Rita’s oncologist. She will be seen once a month by the oncologist for the next year, and more frequently by her primary veterinarian. Even with Rita’s current heart issue, there are treatment options if relapse occurs, if she is deemed healthy enough at the time to receive those treatments.
Dr. Risbon said that preventative medications (flea/tick/heart worm) are fine to continue, but it is recommended to hold off on vaccinations in order to reduce unnecessary stimulation of the immune system.
This Week’s Treat
WINner WINner, chicken dinner! After Rita’s WIN in her first battle with Lymphoma, she sampled the Big Chicken Deluxe sandwich (minus the lettuce and tomato) at Checkers !
I will continue to post updates with any visits to the veterinarian, cardiologist, or oncologist.
As always, thank you for joining Margarita in her journey to take a bite out Lymphoma.