18 months ago Rita was diagnosed with stage 4 sub-stage A Large B-cell Lymphoma. If left untreated, she was given 1-2 months to live.
In March 2019, Rita began the CHOP-based chemo protocol. With her intestinal and liver diseases, it was uncertain she could even make it through her chemo plan. Her oncologist said with this treatment Rita would survive 12-18 months.
Despite the fact that her other health issues gave her a lesser chance than most, Rita made it through her chemo, and also reached every remission milestone that research said she most likely wouldn’t: 6 months, 12 months, and today…18 months!
We hold on to the faith and hope that she will not only continue to beat the odds and join the small percentage of dogs with Stage IVa Lymphoma who live 2 years, but that she also will defy “the norm” of her cancer prognosis even further!
This July we have smiles …literally for miles… 32.68 to be exact! Once we got the go-ahead from Margarita’s medical team a few months back, I have been slowly increasing her activity level while continually checking in with the doctors to make sure Margarita is exercising at a safe level. Margarita now walks on any good-weather / safe-temperature days. Some of these miles also involved participation in 5K events that benefit different non-profit organizations to help others in need. I don’t focus on recording a fast time on our walks – in fact – I make it a point to let Margarita set the pace, and to let her enjoy every second of the walk, sniffing whatever she pleases. We take water breaks, take selfies, and most of all, take our time – something I am grateful to still have with this angel. Our walks have already created some pretty amazing adventures…and yes, I truly smile every mile! I am looking forward to logging more miles and memories with Rita in August!
Cardiology Check Up
Margarita saw her cardiologist, Dr. Bossbaly, at VSEC on July 29th for her scheduled echocardiogram and bloodwork recheck for her chemotherapy-induced Dilated Cardiomyopathy. Dr. Bossbally reported that she was able to detect a 2/6 whispy band shaped holosystolic murmur at the left apex. This is a great improvement from her original diagnosis. Margarita’s heart rate was 118 BPM and regular. Her lungs are also still clear, and she is breathing normally.
Margarita’s bloodwork did show some elevated liver enzyme levels once again, as she has had in the past.
Overall, Dr. Bossbaly said that Margarita’s heart disease is stable on her current medications, and added that there was no arrhythmia recorded during the entire echocardiogram. Dr. Bossbaly wants us to continue Margarita’s heart medication. She would also like us to continue tracking Margarita’s sleep respiratory rate (SRR). This is extremely important in anticipating fluid shifts and onset of congestive heart failure. Dr. Bossbaly added that she would like Margarita to be on her cardiac medication for the rest of her life in order to maintain her progress. Margarita will have another cardiology re-check in 6 to 8 months.
Monthly Check-Up with Primary Veterinarian
Margarita’s primary veterinarian, Dr. Campbell, at Old York Veterinary Hospitalalso examined Rita on July 29th. She was pleased with Margarita’s overall health and her cardiology report. Dr. Campbell also did a full exam, and checked Rita’s mammary tumors, which have had no significant changes. Margarita does not have any signs of a Lymphoma recurrence at this time. However, Dr. Campbell was not happy with the elevated liver enzymes, and would like to re-test Rita’s levels in 3 months.
Margarita also checked-off another adventure list item and enjoyed a picnic with her 2-legged cousin, James! Click HERE to see the full picnic post.
During this 5K, our miles were completed (earlier this week before the heat wave hit) at Island Beach State Park in Berkeley Township / Ocean County, NJ… one of the few remaining undeveloped barrier beaches on the north Atlantic coast. It’s one of my favorite places in NJ!
Margarita also loves it here as there are many birds for her to point, and one of the only places where she will go in the water on her own!
For this 5K, a donation was made and split evenly among the following organizations:
It was time for Margarita to have an abdominal ultrasound re-check. Margarita may have these periodically due to her Lymphoma originating in her spleen. This was the first visit back to VSEC since Covid, so I was not able to go inside with Margarita.
Liver: mild generalized hyperechoic enlargement (consistent with steroid hepatopathy), two small (4-5mm) hypo echo with nodules identified in the left medial lube. ( The doctor was not concerned with these). The previously noted 1-2cm nodule seen in December 2019 is no longer present.
Bladder: Non-dependent gas bubble noted in the bladder lumen
Due to the gas being consistent with Emphysematous cystitis, an ultrasound-guided cystocentesis was done in order to obtain a sterile sample of the bladder. The sample came back showing signs of E. coli. Margarita treated with enrofloxacin for this.
There were no abnormalities found in her gallbladder and biliary Tree, kidneys, adrenal glands, stomach, Intestines, colon, pancreas, peritoneum, mesentery, and lymph nodes!
Margarita’s mammary mass has been changing increasing and decreasing in size, and also producing a clear discharge. This has been watched closely both daily by me, and monthly at her primary veterinarian and oncology visits. Due to the continued changes, our primary veterinarian, Dr. Campbell wanted to check Rita’s estrogen levels. An estrogen level blood test would indicate if perhaps during her spay, something was missed, causing her to have partial cycles. On May 4th we received the results. Rita’s estrogen level was 64.3, which is within the normal range for a female with no cycling. Although this provided a sigh of relief, it also does not provide an answer to why that mammary mass is acting the way it is. We do not want to put Margarita through any other stressful procedures, so we will be monitoring the mass and its changes along with continued communication with Dr. Campbell. Rita had blood work done as well. Dr. Campbell reported that the results showed that Margarita’s liver values continue to improve.
This month Rita continued to increase her activity and has been more vibrant than ever!
Rita enjoyed the homemade Agility course in our yard:
Coronavirus Relief 5k
Those of you that have known Rita from the start know that she used to run 5k races prior to her Lymphoma diagnosis. For the first time since her diagnosis, Margarita completed a 5k! Rita participated in the Coronavirus Relief virtual race hosted by Virtual Strides . We walked this 5k, but it was just as fun as all the others we’ve completed together!
Run of the Pets
Margarita participated in “Run of the Pets” which was hosted by Virtual Strides .
A portion of the entry fee was donated to Best Friends Animal Society. The mission of Best Friends Animal Society is to bring about a time when there are No More Homeless Pets. They do this by helping end the killing in America’s animal shelters through building community programs and partnerships all across the nation.
This month we had to once again skip our monthly-treat dues to Covid-19. Although some restaurants are now offering take-out, Brian and I have decided to not do anything outside our home to be extra safe.
Margarita has been doing wonderfully, and added another month of remission to her journey!
This month during the Covid-19 Quarantine, Margarita has been increasing her activity level to help boost her immune system and further increase her quality of life. We have also made sure her schedule allows time for relaxing activities out on the lake.
Monthly Oncology Check-Up
Rita’s monthly check up with her oncologist, Dr. Baez, at C.A.RE.S has been postponed to May due to the Covid-19 outbreak. Both Dr. Baez and Dr. Campbell, our veterinarian, agreed this would be safe and appropriate since Margarita is showing no clinical signs of Lymphoma.
Monthly Veterinarian Check-Up
Margarita saw Dr. Campbell at Old York Veterinary Hospital for her monthly check-up. Dr. Campbell was thrilled with Rita’s progress. Rita’s mammary masses were reported to have little-to-no changes. Margarita’s heart murmur also sounded to have no change. Her liver values were re-checked through blood work, and all of her values continue to improve! Margarita will stay on her current regimen of medications and supplements:
Pimobendan for her heart disease caused by the chemotherapy
Prednisone for her liver disease (hepatitis)
CAS Options – an antioxidant and immune support supplement
First and foremost I hope that everyone is staying healthy during this uncertain time with the Covid-19 outbreak. All schools in the state of New Jersey have been shut down at this point and I am teaching remotely from home. Due to the statewide quarantine measures that are in place, I did not take Margarita to any special stores or restaurants to celebrate this day. Once it is deemed safe to do so, I definitely plan to make it up to her!
1 Year in Remission
Margarita reached a major milestone: Officially a SURVIVOR at 1 Year in Remission as of March 19, 2020!
When Margarita began chemotherapy one year ago today, the oncologist told us that without treatment, Lymphoma patients such as Rita usually have a survival time of less than 2 months. The doctor also told us that with chemotherapy treatment, the survival times for patients with Margarita’s type and stage of Lymphoma is 1 year to 18 months, with many patients not surviving the 16 weeks of chemo. I am overjoyed and overwhelmed with tears at the same time as I type this post. Margarita’s bravery, strength, resilience, and demeanor through her Journey has been extremely inspirational and astounding. She is a SURVIVOR!
What does “remission” really mean? In Rita’s case, it means that tests, physical exams, and scans show there is no evidence of cancer. However, this does not mean she’s cured. What it does mean is that the chemotherapy knocked down the cancer cells to a level undetectable by tests or microscopes. Margarita’s next milestone will be in October 2020 (the 18-Month Mark). I would be lying if I said I wasn’t worried about recurrence, and the unknowns that lie ahead. However, I am choosing to focus on Rita’s accomplishments and the positive choices and mindset that helped carry her through the last year with hope-filled days. Moving forward I will do my best to have optimistic thoughts only – there’s no time to waste worrying about the things I cannot control… so onward we go on this Journey together.
Lessons from Lymphoma
Rita is a SURVIVOR – there are far too many who weren’t fortunate enough to celebrate this – so CELEBRATE!
In my opinion, one year ago today when Margarita was fully diagnosed, she became a cancer survivor. She conquered each day with such grace.
Each day with her is a gift, so I made sure to do fun, meaningful, and memorable things with her such as her Adventure List. I made sure we celebrated in some way each and every day so that I didn’t remain focussed on the past, or on the disease itself, as I knew my negativity would effect Margarita.
Don’t be afraid to share your pup’s Journey – and your feelings about their story! Cancer is a part their history, but don’t let it define their future, or your emotional state. Have faith that God has a plan, and will guide you and your pup through this. I truly believe His plan was for Margarita’s Journey to help others.
Keep a journal or start a blog about your pup’s journey. Each post that was written after Rita’s weekly chemo treatment included uplifting things that happened to Rita including nice gestures from others and special food treats she had that week. Doing happy activities and sharing those moments helped me celebrate all things big and small with Margarita.
Embrace help from others and pay it forward when you can.
It takes a great deal of strength, positivity, and resilience to support your fur-kid through cancer and not have a daily major melt-down. Let others help you when they offer – accepting assistance or gifts is not a sign of weakness. People who care about you and your pup are upset about the diagnosis and may find it healing to offer their help, or to give meaningful gifts.
At the same time, don’t be angry with those who can’t be there for you. Not everyone is capable of sharing their emotions, and not everyone feels the way you do about your 4-legged child.
Use your knowledge and experiences to help others who are on a similar Journey by sharing your story. If you hear of others on the same Journey as you and your pup – reach out and let them know you are there for them.
By no means am I grateful that Margarita has Lymphoma. I am, however, beyond appreciative for the people and pups that were brought into my life as a result. Both my life and Margarita’s have been enhanced by these amazing people in our extended family.
Be thankful for EVERY day and for EVERY moment you have with your pup. Feelings are contagious and dogs are sensitive to your emotions. A positive attitude and a happy heart transfers to your fur-kid. Choose to be happy for every second your pup is alive!
Let your faith win over your fear.
Some days were very difficult – both for Rita and for me. Having faith instead of worrying about what was out of my control helped me get through the toughest of days.
I needed something to keep me occupied and focussed and that made me feel like Rita and I were helping others who were on the same journey, so I started this blog! Each chemo treatment post referenced a powerful and meaningful quote or mantra. These words gave me the strength to help Rita through that week.
You can’t take care of your pup if you don’t take care of yourself !
Mental and physical health is important on this journey for both you and your pup. A healthy canine body has a better chance of taking a bite out of cancer. A healthy human body has more strength to carry a canine cancer patient on their Journey. Good nutrition and healthy exercise (to whatever level is appropriate for you and your fur-kid) helps keep the mind and body alert and strong. Stay optimistic and keep moving!
Never, EVER give up!
Research and explore all doable options
Monthly Primary Veterinarian Visit
On March 3 Margarita had her liver values tested again – and we are thrilled to report that all values are continuing to decrease and get closer to normal levels! Margarita will have her liver enzyme levels tested again on May 4, 2020. Because her liver is doing well, Rita’s current doses of Prednisone and Denamarin will remain the same for now.
I am currently exploring changing Rita’s probiotics from Fortiflora to Visbiome, as our primary Veterinarian, Dr. Campbell suggested Visbiome may be a better choice for Margarita’s Irritable Bowl Disorder. In addition, I am actively researching a Holistic Doctor and Nutritionist in hopes when all calms down from the Covid-19 virus, we can explore those further options with intentions to support Margarita in the most well-rounded methods possible.
Things of Note This Month
Double Digit Birthday!
Click HERE to see the post of her birthday activities
One year since the detailed results came back that told us:
the type of Lymphoma Rita had (Diffuse Large B Cell Lymphoma)
We had the most special Valentine’s Day ever when the Medford Lakes Police Department came to the house to help Sweet Reet check off another Adventure List item (take a ride in a police car)!
February 21st was one year since Rita’s splenectomy. While it may seem silly to celebrate having an organ removed, had her spleen remained, Rita wouldn’t be here with us today.
How about your own National Day to help celebrate 11 months in remission?! National Margarita Day was celebrated February 22nd.
At Rita’s last oncology visit, Dr. Baez (Margarita’s new oncologist) cleared her to do whatever activities she pleases. We have been incorporating longer walks into our schedule, and this month Margarita took her first hike since her diagnosis last year.
Margarita, Porter, and their cousin Clyde enjoyed a nice hike together!
Margarita has accompanied me at school many times this month. At least once a week I come home for lunch, and after all the pups go potty, Rita will head back to school with me for an hour visit with the students. The students are thoroughly enjoying her company, and Margarita is soaking up all the love, pets, and belly scratches!
February 27th was one year since we found out Margarita had Lymphoma. We are truly blessed to be able to “celebrate” this one-year mark, as we know many dogs are not as lucky as our Sweet Reet to have made it this far. She is truly a Lymphoma Warrior!
Monthly Primary Veterinarian Check-Up
On February 4th, 2020 Margarita saw Dr. Campbell and had her blood work drawn again to retest her liver enzyme levels.
The results were as follows:
ALT Normal Range: 18-121
Rita’s ALT Values:
AST Normal Range: 16-55
Rita’s AST Values:
As you can imagine, we were thrilled! Dr. Campbell instructed us to increase Margarita’s Denamarin and have her blood work retested in 4 weeks. Rita will visit with Dr. Campbell again March 3rd to have this test done.
Current Liver medication and supplement dosage:
5 mg in AM
1 tablet twice daily (increased from the prior 1 tablet daily)
Dr. Campbell also suggested that we contact Margarita’s cardiologist, Dr. Bossbaly, in hopes to have her chemo-induced-DCM recheck appointment moved up, and also to inquire about the possibility of taking her off of the cardiac medication, Pimobendan. The less medication Rita is on, the better…this way her liver is not overworked with processing medications.
I was not able to get a sooner appointment with Rita’s cardiologist, Dr. Bossbaly, but I was able to speak with her. Dr. Bossbaly wants Margarita to stay on the Pimobendan at least until the appointment in June because she is doing so well on it. Dr. Bossbaly does not feel this medication will have any effect on Rita’s liver values. She also said that she was concerned that if Rita’s heart disease got worse, it would have even more of effect on her liver.
Monthly Oncology Check-UP
I was surprised to find out upon her exam that she gained over 2 pounds. Last oncology visit she was 52 pounds, and this visit she weighed in at 54.8 pounds. This could be a side effect of the Prednisone, and I plan to discuss this at our next monthly veterinary appointment with Dr. Campbell. On exam, Margarita’s heart rate and rhythm were normal and Dr. Baez could detect a low-grade heart murmur. Rita’s peripheral lymph nodes were normal and she was in good body condition.
Dr. Baez said Margarita looked fantastic! I shared with Dr. Baez that I was interested in exploring nutritional options for Rita and possibly adding in some holistic care to maximize all the treatment options for her. Doctor Baez provided me with some referrals for both a holistic vet as well as a nutritionist. I plan to discuss this information with our primary veterinarian, Dr. Campbell, at our next monthly appointment.
Although I rehearsed in my head many times, the next part of my conversation with Dr. Baez was very difficult for me to say out-loud. After careful consideration of Margarita’s current level of liver disease, intestinal disease, and heart disease, Brian and I feel as though if her Lymphoma resurfaces, another round of chemotherapy would not be a fair option for our Sweet Reet. However, if those diseases improve, and she is deemed healthy enough, we would absolutely explore chemotherapy again as an option. In the meantime, we are inquiring about any and all ways we can support Rita in hopes to keep her in remission for as long as possible.
If Margarita’s liver values decrease with her next blood test, we are going to hold off on her abdominal ultrasound until June (which would be 6 months since her last ultrasound). If her liver values increase with the next test, we will order the abdominal ultrasound to be completed ASAP.
With the “1 Year in Remission Anniversary” approaching, Margarita’s oncology visits will also now change from every month to every two months until she reaches her “18-months in Remission Anniversary.” At that point we will then increase the time between oncology visits to quarterly, (every 3 to 4 months). Dr. Baez asked us to continue to monitor Rita as we have been doing, and to reach out if we have any concerns. Margarita will have her next oncology visit with Dr. Baez in April.
This Month’s Treat
This month Margarita enjoyed a small taste of Bacon, Egg and Cheese Tacos with a side of Mac-n-Cheese from TGI Fridays !
We are looking forward to March – we have some pretty amazing milestones to celebrate!
With the help of Medford Lakes Police Department’s Chief of Police, Margarita checked off Adventure List item #2 on Valentine’s Day 2020!
A HUGE thank you to Medford Lakes Police Department ’s Chief Dugan for helping Margarita check off #2 on her Adventure List! (Take a ride in a Police car 🚔). Chief Dugan was nice enough to come to our house to pick up Sweet Reet and take her for a nice long ride around town!
I have to admit, at first I thought this past month was a bit of a let-down – that the elevated liver enzyme result discovered last month was a set-back for Margarita. I found myself losing a bit of hope – until I spoke to a friend who asked how Margarita was doing. When I explained to my friend what you will soon read in this month’s post, I quickly realized just how grateful I should be. Speaking with my friend reminded me just how lucky we are, as my friend had recently lost multiple 2-legged and 4-legged family members to cancer – all within a short time frame of each other. All of those family members lost their battle with cancer in much less time than Rita has been in remission. In addition, Margarita’s new oncologist instilled even more appreciation in my heart. This past month wasn’t a setback for Margarita at all … it was just a setup for an even greater comeback, as well as a reminder for me to put some gratitude in my attitude and celebrate each and every day!
This past month Margarita visited Chimney Rustic Ales , had fun playing in the yard, and enjoyed destroying stuffies in the house on rainy days.
Margarita also visited my school twice this month, bringing joy to both children and adults.
This medication has potential to prompt the Lymphoma to come out of remission
laparoscopic surgery for liver biopsy to gain definitive diagnosis
There is concern that even though this procedure would be less invasive than her splenectomy, this would still be a difficult procedure for Rita to endure so soon after everything she has been through in the past year, and given her liver and intestinal diseases
If this route is chosen, Dr. Chapman also noted that he would opt not to remove Margarita’s two mammary masses during this procedure due to the prolonged anesthesia creating a greater risk
Dr. Chapman also did a blood test while we were at this appointment and submitted a mini liver panel to see if Rita’s liver ALT value was still elevated. The test revealed the following:
ALT Normal Range: 18-121
Rita’s ALT Values:
Even though her ALT number dropped, 924 is still very elevated considering the normal ALT range is 18-21
ALP Normal Range: 6-160
Rita’s ALP Values:
Even though her ALP number dropped, 444 is still very elevated considering the normal ALP range is 6-160
Now to do our best to make the most appropriate decision for Rita….
A Difficult Decision
Although nothing about Margarita’s Lymphoma Journey has been easy, we were not expecting such a difficult decision in choosing which option is in Margarita’s best interest. After much thought and long discussions with Margarita’s medical team, we have decided to treat Margarita with Prednisone and Denamarin. Denamarin is a nutritional supplement containing the antioxidant Silybin used to improve liver function by increasing liver glutathione levels.
Dosages are as follows:
5 mg twice daily
1 tablet daily
It was easy to decide Cyclosporine is completely off the table since it has the tendency to bring Lymphoma out of remission. That part of the decision was a no-brainer.
We immediately wanted to know if Rita’s lymphoma has returned, as we are well aware that chemotherapy knocks the disease down, but does not completely rid her body of the cancerous cells. We knew that since the lymphoma originated in her spleen, the return of this disease could be difficult – and maybe even impossible – to catch in time. Although we feel the need to know if the Lymphoma is resurfacing, we don’t want our strong desire for clarification to override what is best for Margarita. Her needle biopsy with Dr. MacLeod was negative. Although the needle biopsies are sometimes not as precise as the full biopsy that laparoscopic surgery can provide, we are praying it was accurate. Putting Rita through another surgery will be a last-resort option.
If in fact we put Rita through the laparoscopic surgery and it was determined that the Lymphoma was back, Margarita would immediately be put on Prednisone anyway – so that is what we decided to try first. Margarita began Prednisone (5 mg twice daily) on January 21, 2020. We need to be vigilant in watching for any changes or additional symptoms since the Lymphoma has a higher chance of going undetected with the use of Prednisone. A recheck of her bloodwork to see if the Prednisone lowered her liver enzyme values is scheduled for February 4, 2020 with our primary veterinarian, Dr. Campbell.
Margarita’s medical team is quite confident that Rita’s elevated liver values are caused by liver disease, and not Lymphoma. We put our faith and trust in this team and are certain we made the right decision for Margarita.
The unknown is the most difficult part of this. In addition, just because it more likely to be liver disease is not a reason to be completely relieved. Liver disease could also be a life-threatening issue for Margarita. One thing we are certain of is that Margarita is a fighter. We are praying that whatever may be causing Rita’s liver values to be elevated is something that we can help her overcome.
The Start of Prednisone
Januaty 25, 2020
On the 5th day of being on Prednisone, Margarita began to exhibit some of the common side effects:
increased hunger, thirst and urination
However, she also was extremely unsettled – very upset and pacing. We put a call in to our primary veterinarian, Dr. Campbell. She instructed us to reduce the Prednisone to 5mg in the morning and to stop Rita’s nighttime dose to see if it would settle her down. Luckily Margarita did not mind wearing doggie diapers, as her bladder was releasing beyond her control.
January 26, 2020
Margarita’s bladder emptied throughout the night without her realizing. She woke up Sunday not interested in food and acting lethargic. We monitored her extremely closely throughout the day. However, by that evening, Margarita was stabilized on the reduced Prednisone dosage, gained interest back in food, and did not need to wear the doggie diapers any longer.
6 Month Post-Chemo Check-up with New Oncologist / 10 Months in Remission
Margarita and I met her new oncologist, Dr. Jennifer Baez , at the Center for Animal Referral and Emergency Services (CARES) on January 28th. Dr. Baez entered the room, and immediately following introductions, smiled and said, “She’s a survivor! She’s one of the lucky ones – not everyone can celebrate that.” I immediately burst into tears. It was like Dr. Baez somehow knew I needed a little gratitude-refresher! I was overwhelmed with appreciation and happiness that we are approaching what will be one more year of being lucky enough to have Margarita in our lives.
Dr. Baez was extremely compassionate and thorough. After reviewing Margarita’s case, Dr. Baez suggested to continue monthly physical check-ups with her, and for Margarita to have an abdominal ultrasound when she reaches her “1 year in remission” date.
10 Months in Remission Check-Up with Primary Veterinarian
Margarita skipped this visit for the month of January for a couple of reasons. First, she had seen our primary veterinarian, Dr. Campbell, earlier in the month. Secondly, she will see Dr. Campbell in just a few days for the two-week blood work re-check on her liver values, where Dr. Campbell will also do a physical exam on Margarita. With Dr. Campbell’s blessing, we decided that it was best not to stress Margarita with another doctor’s appointment this month.
Since her last monthly check-up, Margarita had another remarkable month. She visited my school again, and made some students extremely happy!
The weeks that followed this classroom visit, however, have been an emotional rollercoaster ride.
Monthly Check-Up with Oncologist
On December 6, 2019, Margarita saw her oncologist, Dr. Risbon, for her recheck for lymphoma. During her appointment, I noticed that Margarita was drooling slightly while she was with the doctor, but I didn’t think much of it at the time. Her physical exam was normal and there was no evidence to suggest recurrence of lymphoma. Doctor Risbon could not hear her heart murmur on this day, and Rita’s heart rhythm was reported as normal. Dr. Risbon evaluated Rita’s mammary mass and shared that the thickened tissue portion was similar, and the mass that she could feel seems to have had no change from previously. Dr. Risbon also confirmed that she felt the new small nodule noted by Dr. Campbell during her last visit. Dr. Risbon was pleased with Margarita’s progress and deemed her to be about 9 months in remission. I was very grateful for this good report, but sad and fearful at the same time. This was Margarita’s last appointment with this oncologist, as Dr. Risbon is going on maternity leave, and then transferring to a facility that is out of driving range to our home. Dr. Risbon assured me that the new oncologist will take great care of Margarita, and also told me I could reach out to her at any time with questions on any new findings. We are very thankful to Dr. Risbon for seeing Margarita through her chemotherapy, and wish her the best while adding to her family and continuing her practice at a new location.
Monthly Check-Up with Primary Veterinarian
On December 9, 2019 Margarita had a visit with our primary veterinarian, Dr. Campbell. This visit was her monthly check up, as well as her yearly therapy dog examination. In addition, this appointment was also for bloodwork that Rita’s cardiologist, Dr. Bossbaly, requested at Rita’s last visit to test her kidney function because of the heart medication she is currently taking. Dr. Campbell examined Rita’s mammary tumors and reported that they have not changed since last visit. When Dr. Campbell asked me how I thought Rita was doing, I shared that her appetite and energy were both great. I also explained that I noticed Rita drooling slightly at her oncology appointment, and that was something I had never observed before. I almost didn’t even bring it up – but so thankful now that I did. Dr. Campbell then looked at Rita’s gums and said that they didn’t look super pale, but she just wasn’t 100% happy with the color she saw. Dr. Campbell suggested we do some additional blood work beyond the tests Dr. Bossbaly requested for kidney function. I didn’t worry too much about Rita’s gum coloring, and honestly didn’t expect much to come of the bloodwork that Dr. Campbell sent off for testing.
On December 10, 2019 Dr. Campbell called us with the bloodwork results. Much to our dismay, Margarita’s liver values were through the roof. Dr. Campbell explained that the drooling could likely be caused from nausea if something was abnormal in her biliary tract. Rita’s liver values are below:
ALT Normal range: 18-121
Rita’s ALT value: 1,155
GGTNormal range: 0-13
Rita’s GGT value: 22
ASTNormal range: 16-55
Rita’s AST value: 146
ALPNormal range: 5-160
Rita’s ALP value: 447
Dr. Campbell had us schedule the first appointment we could secure with Chief of Diagnostic imaging, Dr. Alexander “Sandy” MacLeod at VSEC. The first available we could schedule was December 19, 2019. Brian and I were nervous to wait that long, so Dr. Campbell had me bring Margarita to her office that evening to do a brief abdominal ultrasound. Dr. Campbell observed that Rita’s liver and gallbladder were somewhat enlarged. She shared that this may be cholestasis caused by the “backing up” of chemo drugs. She started Rita on a low dose (125mg once daily) of Ursodiol in hopes that we’d see a marked difference at the time of her abdominal ultrasound at VSEC.
Abdominal Ultrasound with Dr. MacLeod
If you have been following Rita’s Lymphoma Journey from the beginning, you may be thinking that “Dr. Macleod” sounds familiar. That’s because Dr. Alexander “Sandy” MacLeod’s wife, Dr. Jennifer MacLeod is the doctor who performed Rita’s splenectomy.
Dr. Sandy MacLeod performed an abdominal ultrasound on December 19, 2019. Despite the Ursodiol Margarita was taking, there had been no difference in Rita’s condition. His findings were as follows:
Liver: Hypoechoic, mildly enlarged. 1-2 cm hypoechoic nodule in ventral left medial lobe
Gallbladder and Biliary Tree: Gallbladder moderately dilated with anechoic bile, no wall thickening or duct dilation
Kidneys: no abnormalities identified
Arenal glands: no abnormalities identified
Uriniary bladder: no abnormalities identified
Stomach: Mild thickening of pyloric wall. Mild fluid dilation of pyloric antrum
Intestines: no abnormalities identified
Colon: no abnormalities identified
Pancreas: no abnormalities identified
Peritoneum: no abnormalities identified
Mesentery: no abnormalities identified
Lymph Nodes: no abnormalities identified
Diagnosis and Recommendations:
Although I was thrilled that her lymph nodes were normal, I was devastated to hear the word “nodule.” Dr. MacLeod explained that the liver findings could be due to hepatitis , toxic insult, infiltration (recurrence of lymphoma) or other hepatopathy. Dr. MacLeod was most concerned that the findings could be the Lymphoma reappearing with a new disguise, so he recommended a guided needle aspirate of the liver nodule and its surrounding tissue for cytologic analysis, which was done during that same appointment. Dr. MacLeod shared that the mild stomach thickening and dilation is most consistent with gastritis.
We received a call from Dr. MacLeod on December 21, 2019. The first thing Dr. MacLeod said was “It’s not Lymphoma.” To say we were relieved was an understatement – hearing this was THE best Christmas gift ever! BUT…what WAS causing the high liver values, enlarged liver , thickening of the stomach, and enlarged gal bladder? This remains unknown. Dr. MacLeod suggested that we do the same bloodwork again with Dr. Campbell to compare Margarita’s liver values in a few more days to see if they corrected themselves now that Rita has been on Ursodiol for a longer period of time. He added that if the liver values do not improve, it would be time to see an Internal Medicine Specialist.
On the morning of December 26, 2019 I took Rita to or primary veterinarian’s office. Dr. Campbell drew Margarita’s blood, and sent the sample out to the lab. Later that evening, Dr. Campbell called us with the results. Margarita’s liver values had increased yet again, despite the Ursodiol she had been taking. The results are below:
ALT Normal Range: 18-121
Rita’s ALT Values:
GGT Normal Range: 0-13
Rita’s GGT Values:
AST Normal Range: 16-55
Rita’s AST Values:
ALP Normal Range: 6-160
Rita’s ALP Values:
These were obviously not the results we were hoping for. Dr. Campbell directed us to stop the Ursodiol and suggested we make the first available appointment with Dr. Klag , the Chief of Internal Medicine at VSEC. Dr. Klag is the Doctor that first saw Margarita in January 2019. Margarita has an appointment set with Dr. Klag for January 16, 2020 (his first available). I also requested to be put on a cancelation list in hopes of getting a sooner appointment. However I was told they do not do a waiting/cancelation list for the Internal Medicine department. I explained that we have been put on a waiting/cancellation list at VSEC in the past for other doctors and departments – such as Dr. Bossbaly in the Cardiology department. I expressed my frustration and disappointment to the staff member making the appointment. The woman I was speaking to informed me that Dr. Klag would return to the office from his Holiday Break on January 2nd. Additionally, I sent an email directly to Dr. Klag to inform him of the events and multiple diagnoses that have taken place since he last saw Margarita in order to explain the urgency behind our request for a sooner appointment. Lastly, I will be calling VSEC 2-3 times a day leading up to the scheduled appointment in hopes of catching a cancellation that would otherwise go unannounced due to the department’s lack of waiting list.
Although these past few weeks have been an emotional roller coaster for us, I am grateful for every single day that Rita is still riding. Brian and I entered the front seat of this roller coaster prepared for the peaks of celebrations, the abrupt falls, and the mysterious turns Lymphoma would throw at us. Positivity and vigilance are key. Although it is a scary ride, I will be keeping my eyes wide open. Had I neglected to mention that little bit of drool to Dr. Campbell, Rita’s roller coaster could have spun out of our control before we knew what hit us. I am embracing the highs and lows of this scary ride. I celebrate and appreciate each peak – and I’m accepting the plummeting falls as more knowledge that I hope will not only help Rita continue to take a bite out of Lymphoma, but also assist other pups and PAWrents in the future.
Keep those prayers coming – and buckle up – we may be in for a rough ride ahead.
This Month’s Treat
Following her monthly appointments, Margarita enjoyed a small portion of a beef and cheese quesadilla from Wawa.
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:
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!
November 7th is National Canine Lymphoma Awareness Day. Founded in 2015 by agility dog trainer, Terry Simons, this annual event seeks to educate and create awareness for one of the most common types of malignant cancer in dogs. Terry’s beloved dog, Reveille, was diagnosed with Lymphoma in 2011, and despite many great efforts, his dog passed away a year later. In response, Terry founded the Canine Lymphoma Education and Research (CLEAR) Foundation to provide education and guidance to pet owners whose dogs have lymphoma.
💖 Lymphoma is one of the most common cancers in dogs. The term “lymphoma” refers to several types of cancer derived from lymphocytes — one of the five types of white blood cells. 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. Any breed of dog, at any age, can get lymphoma.
💖 The cause of lymphoma is not well understood. However, it is believed that genetic and environmental factors may play a role in bringing about this disease. Exposure to chemicals, pollutants, and toxic substances like herbicides are thought to be culprits. Subjection to radiation or electromagnetic fields may be another factor. 💖 National Canine Lymphoma Awareness Day reminds PAWrents to stay vigilant and to check your fur-kids regularly.
💖 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.
What To Do If You Think Your Dog Could Have Lymphoma
The symptoms of canine lymphoma vary widely based on the type. In my opinion, it is always best to err on the side of caution. If your dog has symptoms that persist for more than a day or two, or if you have any reason to suspect that your dog could have a serious illness, I would encourage you to contact your veterinarian immediately.
Margarita had her monthly checkup at her primary veterinarian as well as with her oncologist…and I’m happy to report that’s there’s not much to report!
Primary Veterinarian Visit
On 10/16 Rita saw Dr. Campbell, her primary veterinarian at Old York Veterinary Hospital for her monthly check up. I reported our observations of increased energy and appetite. Dr. Campbell listened to Rita’s heart and said that she could not detect a murmur! We are very anxious to get to the cardiologist next month to see what the echocardiogram reveals. Dr. Campbell examined the mammary mass and said that she said that she did not feel as though it has changed from the last visit. I was very pleased with this checkup!
On 10/18 Margarita saw Dr. Risbon, her oncologist at Veterinary Specialty and Emergency Center (VSEC). Dr. Risbon listened to Rita’s heart. Like Dr. Campbell, said that she did not hear a murmur and reported that Rita’s heart rhythm is normal! Dr. Risbon also agreed that the mammary mass did not feel as though it has changed from the last visit. Dr. Risbon shared that she is very pleased with Rita’s progress and that she is doing well as she enters her 7th month in remission. Wait… SEVEN months??? I was confused. I explained that Rita had finished her last chemotherapy treatment in July, so my understanding is that October would only make 3 months in remission. Dr. Risbon explained that they count remission months from the date of diagnosis (Rita’s Lymphoma diagnosis date was March 13, 2013) when chemo is started immediately and no signs of reoccurrence are present…so this month, Rita is considered to be in her 7th month of remission!! I also learned that Dr. Risbon will be leaving VSEC as of December 6, 2019. She and her husband are having another child, so she will be relocating to a hospital near her home in order to be in closer proximity to her family. Although I very much respect that decision to relocate and am very happy for Dr. Risbon and her family, we are disappointed that we will not be able to continue Rita’s Lymphoma follow-up care with her. Brian and I will have to make a decision to travel close to 2 hours a month to continue to see Dr. Risbon, or to find another oncologist to continue following Margarita’s case. We will be discussing our decision together along with our primary veterinarian, Dr. Campbell.
This Month’s Treat
This month Margarita enjoyed a treat from Smashburger after her oncology appointment.
She had a cheeseburger topped with a fried egg!
Margarita also enjoyed some crispy Brussels sprouts!
Margarita will see both Dr. Campbell and Dr. Risbon again next month.
I am extremely happy to report that his past month has been everything we could hope for. Margarita regained her appetite, strength and desire to run and play in the yard. Her hair has filled in nicely, and her “piggy pink” pigment is returning.
Brian and I are overwhelmed with gratitude as love and support from family and friends continues to fill our hearts. I received this most thoughtful gift box from a very a special friend.
🐽Pig toy because I always say Rita has a piggy nose
💎 crystal guardian angel charm
⛺️Yappy camper magnet for our RV
🍪bags of yummy treats
🧦 GSP socks for me
📖 🦖T-Rex handbook since I always say Whiskey is a cross between a T-Rex / Velociraptor!
Since out last post, Margarita also received this amazing gift basket from the office manager at VSEC who is one of the sweetest gals we have met!
We also had the pleasure of spending time with friends at a dock diving event who passed on a very personal and special gift. The weekend that Margarita ended up in the emergency room we were supposed to attend at dock diving competition. We of course had to instead stay home that weekend. Friends of ours had brought a gift for us that weekend. This past week while we attended a competition at Hog Dog Productions, we met up with our friends who gave us this very meaningful gift.
This couple got a set of these glasses because they also had a dog who had cancer, who sadly passed. We are beyond honored to have been gifted this glass, and plan to make many toasts to Margarita during her journey. The man who makes these beer glasses has a Golden Retriever named Indiana Jones, who unfortunately was diagnosed with osteosarcoma just days after his seventh birthday. You can view Indy’s Facebook page by clicking HERE where Indy’s dad shares his beloved pup’s story of cancer.
1 Month Recheck
On August 8th, Margarita saw her oncologist, Dr. Risbon for her 1 month re-check. Her physical examination was normal and we are extremely grateful that there was no evidence to suggest recurrence of the lymphoma. However, the abnormal tissue felt during her emergency room visit now has developed what seems to be an additional mass of about 5mm.
Although this was not at all what I wanted to hear, I knew that Margarita would be predisposed to mammary tumors because she was not spayed until after 6 years of age when she came to us as a GSP Rescue of NJ foster dog. Dr. Risbon explained that mammary tumors have a 50% chance of being benign and a 50% of being malignant. Ideally, the mammary gland should be removed and submitted for biopsy. In many cases, even if the tumor is found to be malignant, Dr. Risbon explained the recommendation is for surgery alone (no chemo). The prognosis is 2-3 years if the tumor is found to be malignant. Due to the Dilated Cardiomyopathy brought on by the chemotherapy drugs, if surgery is to be performed, Margarita would need clearance from her cardiologist, Dr. Bossbaly. Margarita will see our primary veterinarian next week where we will discuss whether or not surgery is an option, or if we will continue to monitor the mass each month.
I am not going to loose faith, or diminish our hope for Margarita to have many more years ahead to enjoy life as she deserves after what she endured prior to her adoption. She has survived through more situations and illnesses than most dogs are able to endure. Even through her toughest times, she has met each challenge with such grace and courage. Even if what is thought to be a mass turns out to be malignant, we are confident that Margarita will once again be victorious.
Margarita will see Dr. Risbon again next month for a recheck.
1 Month Re-check with Rita’s Primary Veterinarian
On August 14, Margarita saw our primary veterinarian, Dr. Helen Campbell at Old York Veterinary Hospital. I am thrilled to report that the murmur discovered along with the Dilated Cardiomyopathy during week 15 of her chemotherapy plan sounds to Dr. Campbell like it has significantly improved to the point of not being heard with a stethoscope! This originally was thought to be permanent damage, so we are overjoyed to hear this news! This is also great news in the event the mammary mass is removed. We have put a call in to Margarita’s cardiologist, Dr. Bossbaly, at VSEC to see if we can get a sooner appointment than the original 4-month check up scheduled with Dr. Bossbaly in November in hopes to verify her improvement and hopefully reduce or stop her heart medication, Pimobendan. We have to keep a close eye on the mammary mass. If we do not see any changes in the mass in the meantime, Margarita will see Dr. Campbell again next month for a re-check.
Margarita’s had her first “post chemo” check-up with Dr. Campbell, our primary veterinarian on July 24, 2019. Dr. Campbell listened to Margarita’s heart with a stethoscope. Those of you who have been following along know that she had a grade 3 murmur at the end of her chemo treatments. However, today it was classified as a grade 2!
Margarita has been cleared to spend more time outside, run at her own will in the yard, take some longer leisurely walks, and to swim more regularly! We are overwhelmed with happiness and gratitude today! She will see Dr. Campbell again in 3 weeks, and her cardiologist again in 4 months.
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.
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.
“Once you choose hope anything is possible.” ~ Christopher Reeve
“Have Only Positive Expectations.” I have never had a fur-kid with canine lymphoma before, and although Margarita is the one going through THE toughest battle, it certainly was a challenge for me as well. This rollercoaster-of-a-time has included “lows” of gut-wrenching fear, as well as many “highs” of extensive hope. I realized that especially for Margarita’s sake – if I wanted her to have THE best chance at taking a bite out of cancer and making it though all 16 weeks of the chemotherapy plan, I had no choice but to choose hope over despair, focus on positivity, and start believing something good will come of this unfortunate situation. But HOW was I going to Have Only Positive Expectations as my beloved fur-child is battling her way through Lymphoma? Here’s how hope helped me:
Finding the courage to put my trust in Rita’s medical team and the science behind chemotherapy promoted my hope for a favorable outcome.
Maintaining hope encouraged me to not take one single second of any day for granted, and celebrate the little things every day, creating happy memories to look back on in the future.
Finding hope in the desire to make sure Rita still did the things she loves (when she was feeling up to it of course) fostered productive thoughts for her life-after-chemo.
Talking with others who have canine cancer survivors built-up my hope and boosted my capability to have constructive notions about Rita’s destiny.
Having hope that each day would be better than the one before and that each sunrise would bring Rita closer to taking a huge bite out of cancer cultivated promising beliefs.
Planning future adventures for Rita provided me with hope and encouraged me to have feelings of optimistic possibilities.
MOST importantly, hope fueled my positive attitude, which ultimately helped Rita feel protected during a difficult, confusing and insecure time for her.
Lastly, I hope that sharing both human and canine experiences, the information and resources I found to be beneficial, and the strategies that helped me stay positive will assist someone else in walking their pup through a difficult journey.
I have not been strong – or positive – or even hopeful – every moment during these past 15 weeks. I have never cried so much and so hard as I have in the last few months. Yet the number of times I smiled overpowered my tears thanks to the support, generosity, and continuous acts of kindness from the wonderful people in my life – some I have known for a long time, and others I have met more recently through our fur-kids. It’s absolutely amazing to me how dogs bring people together, strengthen family bonds, and create new friendships.
This week I received several more very special gifts from friendships forged by Cello’s Corner.
The first was from a friend whose dog was also diagnosed with cancer. We have been corresponding regularly about our experiences, supporting each other through this difficult process. It just so happened that this gal’s pup is being treated at the facility where we have been taking Hooch to use the underwater treadmill. At Hooch’s last appointment, there was a gift bag waiting for me…Within the note, our friend included, “Your attitude towards these challenging times is very Zen!” …and in the beautiful gift bag was an adorable ceramic pup in the half-lotus pose.
This pup even looks like our Sweet Reet!
This half-lotus-posed-pup will surely help me maintain serenity in our home as we move forward to life-after-chemo with Margarita.
The second wonderful surprise this week was from my friend who made Margarita’s Lymphoma Awareness collar. I have even been lucky enough to meet this gal and her wonderful pups in person as they began their obsession with dock diving at the end of last year’s season! This friend sent personalized decals that she made herself for Brian and I to put on our vehicles!