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.
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:
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.
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.
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!