8 Months in Remission; 4 Month Post-Chemo

Month 7 of Remission

Margarita had an exciting and busy month. She traveled all the way to Iowa on an 11-day trip to cheer on her brothers and sisters at the DockDogs World Championship.

Rita also checked-off another one of her adventure list items! We took Margarita to The Library II for a specially-selected cut of filet mignon! Click HERE to see her special-cut steak!

We also did our part to participate in National Canine Lymphoma Awareness Day, by publishing a post to help others understand this disease and to learn how to check your dog for signs of cancer.

4 Month Check-Up with the Cardiologist

Back in July 2019, Margarita was diagnosed with Dilated Cardiomiopathy, thought to be caused by Doxorubicon (Adriamycin) toxicity. Rita’s heart was enlarged, and she had a grade 3 heart murmur with ventricular premature contractions. On November 5, 2019 Margarita saw her cardiologist, Dr. Bossbaly for her 4-month re-check.

Rita waited patiently for Dr. Bossbaly:

Who’s that pretty girl staring back at me!?

Dr. Bossbaly did a a recheck EKG and echocardiogram. Rita’s heart murmur was graded as a 2 out of 6. The murmur was described as a wispy band shaped holosystolic murmur at the left apex, and audible only faintly on the right. Her heart rate was 118 bpm and regular, and her lungs were also clear. Additionally, there was also no arrhythmia recorded at this time on a long-recorded EKG as well as during the entire echocardiogram.

This means that Margarita’s heart disease is it stable on the current medication. Even though Margarita’s heart showed improvement, Dr. Bossbaly wants her to continue with her current medication and supplements until we have the next scheduled cardiology appointment in 6-8 months. Margarita’s current medication and supplement schedule will remain as follows:

  • Pimobendan: 5mg eery 12 hours
  • L-Carnitine: 1 gram twice daily with food
  • Taurine 500mg twice daily with food
  • Coenzyme Q10: 30 mg once daily
  • CAS Options: 1 tablet twice daily

With the indication of Margarita’s marked improvement last month, I must admit that I neglected to continue monitoring her sleeping respiratory rate (SRR), thinking it wouldn’t be necessary considering she was making such great improvements. I was incorrect. Dr. Bossbally instructed me to resume tracking Rita’s SSR. Dr. Bossbaly explained that even when improvement is noted, taking Margarita’s SSR is extremely important for anticipating fluid shifts and the onset of congestive heart failure. For those of you wondering why it is important to monitor your pup’s sleeping respiratory rate and how to count/track it, here is the information I was given:

  • Why monitoring your Pup’s respiratory rate is extremely important:
    • The sleeping respiratory rate is a subtle and sensitive indicator of changes in your fur-kid’s condition.
    • Increases in the sleeping respiratory rate may indicate the development of heart failure in your pup.
    • Your doctor will want to know if your pup’s sleeping respiratory rate goes above 30, or if there seems to be an upward trend (a steady increase in rates heading towards 30) . The point is to catch the change in the sleeping respiratory rate before it reaches 40 or 50 and could become an emergency situation.
    • Is important to note that he small increase in this sleeping respiratory rate may not be accompanied by any other changes such as an increased effort to breeze, excessive panting, coughing, or restlessness. These are important to note but it is likely that once you see the signs, the sleeping respiratory rate will already be elevated.
  • Why count the sleeping respiratory rate?
    • If your pup has been diagnosed with heart disease, it is unfortunately a progressive disease in most cases. Monitoring it on a regular basis will help avoid a health crisis; It will help avoid an emergency visit to your veterinarian, hospitalization for multiple days, and the sudden increase in financial responsibility occurring with emergency hospitalization.
    • Tracking sleeping respiratory rates every now and then is not ideal, as this number can change overnight. Additionally, just “watching” or “eyeballing” is not accurate enough.
      • **EXAMPLE: Say your pup’s sleeping respiratory rate is 24 (in 15 seconds you count 6 breaths). Now let’s say that your dogs sleeping respiratory rate increases to 32 (in 15 seconds you counted 8 breaths). The difference between the two instances is only a breaths per minute – a hard thing to notice if you’re not actually tracking the breaths. Additionally, 32 is an elevated and abnormal sleeping respiratory rate.
  • How to count the respiratory rate:
    • Count the respiratory rate by watching your dogs chest go up and down (each “up” and “down” equals one breath cycle). Use a clock or a watch with a second hand, count the number of full breaths in 15 seconds, and multiply that by 4 to get the respiratory rate for one minute. Log these results on a computer, in a journal, on your calendar, or on a note in your phone.
    • ***NOTE: We have found it easier to download a sleeping respiratory rate app. The app will help you keep count of the breaths, and also save the results and display them in a graph that you can email or share with your pup’s doctors. The two most helpful apps we have found are:
      • Cardalis: This app is free and will help you to measure your dog’s respiratory rate, record it as a graph. This results graph can be e-mailed to your dog’s doctors. Cardalis is best if you have only one fur-kid with heart disease, as it only allows for tracking of one dog/cat.
      • Maolife: This app is also free, and allows you to track the respiratory rates of multiple dogs/cats. Results are recorded in a graph. The Maolife app also allows multiple people to manage the same fur-kid. Additionally, this app has the capability to share your recorded results with others.

Lastly, I discussed the possible removal and biopsy of Rita’s mammary mass with Dr. Bossbaly. Doctor Bossbaly explained that Rita is still at a higher risk. If it becomes necessary for the mass to be removed and biopsied, Dr. Bossbaly’s suggestion is to have it done at VSEC were a board-certified anesthesiologist can monitor the protocol that Dr. Bossbaly recommends. If we would rather have the mass removed by our primary veterinarian, Dr. Campbell, the procedure can be sent over to Dr. Campbell for her to decide if she is comfortable doing the surgery along with the recommended protocol.

Monthly Check Up with Oncologist

On November 15 Margarita had a visit with her oncologist, Dr. Risbon. Rita’s physical examination was normal, and there was no evidence to suggest recurrence of lymphoma. Dr. Risbon could not hear a heart murmur today, and reported that Rita’s heart rhythm is normal. Dr. Risbon also evaluated Rita’s mammary mass and said she thought the thickened tissue portion appears to feel smaller. However, the small mass (approximately 3-5 mm) seems unchanged from previously. Dr. Risbon shared that she is pleased with Margarita’s progress, and feels as though she is doing well in maintaining her remission.

Patiently waiting for Dr. Risbon

First Day Back “on the Job” since Lymphoma Diagnosis

Margarita made a very short surprise-visit with me at my school and made some students extremely happy!

We kept the visit with the kids to only 30 minutes. The visit was perfect and did not exhaust Rita.

Margarita overseeing the students’ “Math Fact War” game
Margarita overseeing the students’ “Math Fact War” game
Margarita snoozed while the students completed their online Math assignment.
This student was so happy Rita decided to use her as a “pillow” during her nap.

Monthly Check Up with Primary Veterinarian

On November 22 Margarita visited with our primary veterinarian, Dr. Campbell for her monthly post-oncology appointment. Dr. Campbell said she was very pleased with the improvement in Margarita’s heart murmur, as well as her Lymphoma remission. While the original mammary mass was being checked, Dr. Campbell found a second tumor on a different gland.

Mammary tumors are extremely common in female dogs – especially those who were spayed later in life. Spaying a female after the first or second heat cycle significantly reduces the risk of the dogs developing a mammary tumor. Since Margarita was not spayed until we took her in as a foster at age 6-ish, we knew mammary issues were a possible issue. If you are reading this and are immediately thinking, “Why is the vet not aspirating the mass to look at the cells?”… then you are not alone. I immediately asked Dr. Campbell if we could aspirate the original mass when it was discovered. Dr. Campbell explained that unfortunately a fine needle aspiration of the mass usually has a very low diagnostic value when it comes to discerning between malignant or benign tumors. Unfortunately, the only way to diagnose a mammary tumor as benign or malignant is to surgically remove them and send the mass out for a biopsy.

The good news is that Dr. Campbell explained that approximately 50% of mammary tumors are benign. My immediate response was, “What if the masses are malignant?” Dr. Campbell informed me that even if the masses are removed and found to be malignant, there is no proven effectiveness of chemotherapy for the treatment of malignant mammary tumors in dogs. If deemed necessary, the tumors would be removed and the biopsy would tell us a more detailed story of what treatment (if any) would be needed.

I have many other questions about these tumors – such as the prognosis if they are found to be malignant. I know the best prognosis is directly associated with early detection. I decided it was best to not ask any other questions until I “have” to, and to do my best to remain positive that Margarita will be lucky enough to be included in the “50% benign” grouping. In the meantime, I am focusing on the many good days we have celebrated with Margarita, and extremely thankful that I have Dr. Campbell as such a patient and informative teacher during this process.

Margarita will continue to see Dr. Campbell on a monthly basis so that both Margarita’s oncologist and Dr. Campbell can keep a close watch on the mammary masses in order to determine the best plan for Margarita moving forward.

This Month’s Treat

Margarita enjoyed a few bites of a grilled cheese from Panera Bread!

Epilepsy Awareness Month

November is Epilepsy Awareness Month for both people and dogs. This life-long condition has no cure and is extremely unpredictable, which is why it is important to continue to educate, spread awareness, and support continued research.

Most dogs will show signs epilepsy between the ages of 1-3. It is nearly impossible to know exactly when a dog might have a seizure.

Seeing a dog have a seizure can be very unsettling. The dog may fall over, become stiff, convulse, drool, and become vocal. Dogs may lose control of their bladder and/or bowels and sometimes will also vomit.

Seizure recovery can vary from dog to dog. Some may recover very quickly, and others could take 24 hours or more. After a seizure the dog may be disoriented, pace back and forth, or exhibit extreme thirst.

Epilepsy is a diagnosis of exclusion. Your veterinarian will first need to rule out that your dog doesn’t have a different disease or condition that causes the seizures. The doctor may do blood tests, x-rays, an MRI, and/or a spinal tap. Once the veterinarian rules out the other possible diagnoses, they can conclude that a dog has epilepsy.

Want to learn more? Here are a few informative links:

http://pethealthnetwork.com/dog-health/dog-diseases-conditions-a-z/canine-epilepsy

http://www.canine-epilepsy.net/basics/basics_index.html

#Paws4Purple

EpilepsyAwarenessMonth #purpleforporter #caninepilepsyawareness #pawsforpurple

National Canine Lymphoma Awareness Day

November 7th is National Canine Lymphoma Awareness Day. This day is meant to educate and create awareness about this disease.

Margarita at 7.5 months in remission

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Lymphoma is one of the most common cancers in dogs. Any breed of dog, at any age, can get lymphoma. Although lymphoma can attack any organ in the body, it most commonly presents itself in the organs of the immune system such as the lymph nodes, spleen, and bone marrow.

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The cause of lymphoma is not well understood. However, it is believed that there are environmental contributors to lymphoma such as chemicals and pollutants.
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National Canine Lymphoma Awareness Day reminds PAWrents to stay vigilant and to check your fur-kids regularly.

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Be their eyes. Be there ears. Be their voice. Be their HERO. Chase Away K9 Cancer provides great resources on how and when to check your pup for possible signs of cancer. 

Canine Epilepsy

Explanation

“Epilepsy” is a general term for neurological disorders that are characterized by recurrent seizures. In some cases, the seizures are caused by trauma, a toxin, a brain tumor, an infection, or an issue with your dog’s blood, kidneys, or other organs. At other times, the epilepsy is referred to as “idiopathic,” which simply means that there is no identifiable, underlying cause.

Seizures commonly fall into two categories: generalized (grand mal) or partial (focal). Generalized seizures commonly appear as involuntary jerking or twitching movements of all four limbs with loss of consciousness. Partial seizures may involve one limb, side of the body, or face. Partial seizures may progress to generalized seizures. Seizures may also result in abnormal behavior, vocalization, salivation, chomping/chewing, and involuntary urination and defecation.

Dogs with idiopathic epilepsy typically have their first seizures between the ages of 6 months to 6 years. Though idiopathic epilepsy can occur in any breed, it is considered an inheritable disease in many breeds and in some breeds a genetic basis has been identified. Therefore, dogs diagnosed with idiopathic epilepsy should not be used for breeding. Commonly affected breeds include:

  • Labrador retrievers
  • Golden retrievers
  • Poodles
  • Keeshonds
  • Beagles
  • German shepherds
  • Dachshunds
  • Irish setters
  • Cocker spaniels

Is a seizure painful or dangerous to the dog?

Despite the dramatic and violent appearance of a seizure, seizures are not painful, although the dog may feel confusion and perhaps panic. Contrary to popular belief, dogs do not swallow their tongues during a seizure. If you put your fingers or an object into its mouth, you will not help your pet and you run a high risk of being bitten very badly or of injuring your dog. The important thing is to keep the dog from falling or hurting itself by knocking objects onto itself. As long as it is on the floor or ground, there is little chance of harm occurring.

A single seizure is rarely dangerous to the dog. However, if the dog has multiple seizures within a short period of time (cluster seizures), or if a seizure continues for longer than a few minutes, the body temperature begins to rise. If hyperthermia (elevated body temperature) develops secondary to a seizure, another set of problems need to be addressed.

Symptoms
Prolonged seizures lasting more than 5 minutes or two or more consecutive seizures without full recovery are referred to as status epilepticus. This is a true emergency and you should seek immediate veterinary care for your pet. Two or more seizures in 24 hours are referred to as cluster seizures and are an indication for beginning anti-seizure medication.

In dogs, seizures often occur in three distinct phases:

  • The first is called the aural phase and the most common signs are behavioral changes. These changes may be subtle and include restlessness, attention seeking or anxious behavior. 
  • The second phase, called the ictal phase, is when the seizure itself takes place. A seizure can last from just a few seconds to several minutes.
  • The final phase is called the postictal phase, which occurs after the seizure. During this phase, your dog may seem restless, uncoordinated and/or disoriented. Occasionally, temporary blindness, deafness or other neurologic abnormalities may occur.

It may be difficult to watch your pet have a seizure but most are of short duration and cause no permanent harm. Avoid being bitten by keeping your hands away from your pet’s mouth during a seizure. If it can be done safely, provide padding and move your pet away from stairs to prevent injury.

Diagnosis
Your veterinarian will take a complete history and perform a thorough physical and neurological exam to determine if there is an identifiable, underlying cause of your dog’s seizure.

In order to do so, the following tests may be recommended:

  • Chemistry tests to evaluate kidney, liver, and pancreatic function, as well as sugar levels and electrolytes
  • A complete blood count to screen for infection, inflammation, anemia, and other blood-related conditions
  • Urinalysis
  • PCR testing and/or serology to evaluate for infectious diseases that may cause seizures
  • Referral to a neurologist for advanced testing including MRI and cerebrospinal fluid analysis
  • Cultures, PCR testing, and other specialized tests that can identify if specific parasites or diseases could be the cause

Treatment 
Epilepsy cannot be cured, but it can usually be controlled with anticonvulsant drugs. If your veterinarian determines that your dog’s epilepsy is idiopathic, one or more of the following medications may be prescribed:

  • Phenobarbital helps reduce the frequency of your dog’s seizures and is the most prescribed medication for dogs with idiopathic epilepsy. It is generally a well-tolerated drug.
  • Potassium bromide is another seizure medication that may be added to your dog’s treatment, if she does not respond well to phenobarbital alone.
  • Levetiracetam (Keppra)

With these medications, as with all drugs, some patients experience side effects. In order to make sure an adequate dose is being given, and to monitor for side effects, it is important that blood levels of each medication as well as complete blood counts and blood chemistry profiles be monitored periodically. Liver function tests may also be indicated. Your veterinarian will advise what monitoring needs to be done and how often. Medication dosages should not be changed without talking to your veterinarian.

Dogs diagnosed with idiopathic epilepsy may require treatment for life, and sometimes more than one drug is needed for adequate seizure control. And while many dogs are well controlled, some are not despite multiple medications. In addition, adequate seizure control does not necessarily guarantee that a dog will be entirely seizure free. The degree of seizure control may need to be balanced against potential side effects of the medications. 

Management 
Besides medication, there are many ways for you, yourself, to help manage your pet’s epilepsy:

  • Maintain a seizure log that lists date, time, length and severity of seizures as well as videotape and share this with your veterinarian
  • Do not change or discontinue medications without consulting your veterinarian
  • Have blood work and other lab work done when recommended by your veterinarian
  • Consult your veterinarian whenever you notice a change in your pet’s condition
  • Put a medical alert tag on your pet’s collar so that if he becomes lost, whoever finds him will be aware of their seizure disorder and need for medication.

Several treatments are available for pets with epilepsy. By working closely with your veterinarian, you can maximize the chances of controlling the disorder and giving your pet a long, happy, and comfortable life.

If you have any questions or concerns, you should always visit or call your veterinarian – they are your best resource to ensure the health and well-being of your pets.

This is information is reposted from: http://www.pethealthnetwork.com/dog-health/dog-diseases-conditions-a-z/canine-epilepsy and https://vcahospitals.com/know-your-pet/seizures-general-for-dogs

✔️ #10 Eat a Fancy Steak from Our Area’s Best Steakhouse ; The Library II, Voorhees , NJ

Margarita checked off another Adventure List item!

Everyone red meat-eater has their favorite steakhouse, right? Well, Brian’s preferred high-end steakhouse is a a place called The Library II . Now I don’t eat meat at all, but I must say, this place is one of my favorites too… for their famous (and huge!) all-you-can-eat salad bar!

The Library II has been in business since 1942. This restaurant has long been a New Jersey landmark and neighborhood favorite with its distinctive “library” atmosphere and unique serving style. They are well-known for their steaks, surf-and-turf, and salad bar.

Photo credit: yelp.com

The Library II has won awards from the Courier Posts‘s Best of South Jersey, Philadelphia Magazine‘s Best of Philly, South Jersey Magazine Best of the Best, and also boasts a rating by Zagat.

When ordering here, you meet your chef at the kitchen window, where he/she will help you select the perfect cut of steak, or your choice of lobster tail.

Not a meat or seafood eater? No problem! The Library has one of the largest salad bars I have ever seen…and best of all: The salad bar is “all you can eat!” Beyond the “normal” salad bar items, the Library II salad bar has an extensive assortment of fruits, vegetables, artisan breads, and gourmet cheeses!

Margarita’s filet mignon:

Margarita enjoyed her fancy steak!