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Lily Was Diagnosed with Dilated Cardiomyopathy

Discussion in 'Emotional Support' started by LilianaLove, Mar 20, 2013.

  1. LilianaLove

    LilianaLove GRCH Dog

    It seems I haven't updated this for quite a few months, I've been so busy and so rarely home and on a computer, so I figured I'd catch anyone up who was wondering. Nothing really changed between September and December. No improvements, but also no significant degeneration, so we were still in the clear as of December.

    The only concerning factor was her kidney values were increasing, enough so that we decided to decrease her benazepril. Benazepril is used to dilate the blood vessels, making it easier for the heart to pump blood (think of a normal vessel as a straw, and think of a vessel medicated with benazepril as a hose, a hose is much easier to get water through than a straw). The problem with this is that it can increase the strain on the kidneys (too much blood per surface area of the kidneys in very laymen's terms). The cardiologist originally wanted to cut the benazepril dose in half (from 10mg twice a day to 5mg twice a day). Because I'm a very cautious person, and because I know Lily reacts in extremes to medication changes, I asked her if it was ok to decrease it by 25% instead of 50% (from 10mg twice a day to 10mg AM and 5mg PM). She said that was fine. She had been doing so well that I didn't want to 'fix what ain't broke' as far as her heart was concerned because, in my mind, if she doesn't have a heart, her kidneys are the least of her problems. But I understood that if she goes into renal failure, we're screwed (treatment for renal failure involves increasing fluid intake, which is contraindicated in heart disease). So we're walking a fine line right now. So far so good in the kidney department over the past couple months.

    Since December she's battled about a month of giardia and bloody diarrhea, low total proteins, some strange spider bite(?)/facial swelling/allergic reaction, and a raging ear infection. She really is just the picture of dog with the shittiest immune system. At last check her WBC count was low, which may be nothing, may be something, who knows. We'll recheck it in a couple weeks. If it stays low, we'll just keep doing what we're doing trying to keep her in a bubble, but, even so, it's obvious this dog's just a magnet for infection/illness/disease/etc.

    Nothing's hurt her spirit though! Right now she's playing with her stuffed sheepy upside down rolling around like a fool. She doesn't run around too much anymore and doesn't really want to play with other dogs too much, it makes me worried that it's a decrease in her exercise tolerance, which means she may be getting worse.

    So, on March 20th she has her 1 year post-diagnosis recheck. I'm pretty nervous for it. I'm really hoping for at least 'stable' news. I'm not sure how to handle it if it's not. Her original prognosis was 1-2 years before going into congestive heart failure, and then maybe another 9 months after that, and right now she's not showing any signs of that, so we're looking good there. We'll be rechecking a blood pressure, echocardiogram, chest x-ray, and ECG.

    I'm always a worrier though. Hopefully we'll keep getting more 'stable' news come her appointment, and maybe I'll be able to scale back the frequency of visits and save some money. If not, she's worth every penny. There's nothing I wouldn't do for her. This dog means everything to me.
     
  2. WithHope

    WithHope Big Dog

    Reading that update was so touching, sad, and hopeful all the same. Sending hugs your way. :bearhug:
     
  3. LilianaLove

    LilianaLove GRCH Dog

    Thanks. We recently diagnosed a dog with CHF and put it on pimo, and the owner was sad. But that dog is almost 12 years old. I don't know, I felt so selfishly jealous of her. Lily's not even 5. I hated that I felt like that.

    I've been a lot better after the first few months, but it's still hard sometimes to look at her and know her time with me is going to be cut so short. It's not as terribly depressing as it was, but it's still pretty hard some days. I try not to think about it too much, which may be one of the reasons I haven't posted about it in a while, but when I do, it just tears me apart.

    Lily is so special to me, she really is more than just a dog to me, and with all the dogs in my life, she's touched a place in my heart that no other dog has ever or will ever get to.

    I'm just trying to do right by her, keep her happy and comfortable and unselfishly extend her time with me for as long as possible. I wouldn't be who I am today without her.
     
  4. Jazzy

    Jazzy GRCH Dog

    What she said because she said it so well.

    Sending you 2 hugs and good karma!!!!
     
  5. LilianaLove

    LilianaLove GRCH Dog

    So an AWESOME UPDATE!!!!!!!!!!

    Lily is IMPROVED!

    Check it out:
    [​IMG]

    Her FS (Fractional Shortening) is up to 31.8%! The lower limit is 25%. She has made a 46% increased change in her heart function! That is incredible! She went from barely there to doing alright!

    Dr's notes:
    - Stable to improved dilated cardiomyopathy
    - Mild, stable mitral valve regurgitation as cause of heart murmur [sidenote: it was 'very soft' today]
    - Mild, stable tricuspid and pulmonic valve regurgitation
    - Normal, stable left atrial chamber dimensions
    - Improved left ventricular chamber dilation
    - Improved near normal left ventricular contractility/heart muscle function
    - History of atrial tachycardia- controlled
    - Hypoaldosteronism- managed with Florinef
    - Mild increase in kidney values

    Here are the echo pictures for comparison:
    1) This is a measure of her contractility (how well her heart muscle contracts). Imagine each peak/trough to be a heart beat, with larger peaks/troughs as better contractility. The first is from 3/20/13, when she was diagnosed with DCM. The second is from 3/20/14 (today's echo) and shows the improvement in contractility noted by the above number indicators (a 46% improvement).
    3/20/13
    [​IMG]

    3/20/14
    [​IMG]

    2) This is her measure of mitral valve regurgitation (the colors are the regurgitation).
    3/20/13
    [​IMG]

    3/20/14
    [​IMG]

    3) This is her left ventricle (you can see it's a bit more rounded in the first picture).
    3/20/13
    [​IMG]

    3/20/14
    [​IMG]

    --

    Bottom line is that things are looking up. Hopefully we keep moving in the right direction.

    Here are her current medications/supplements for anyone interested:
    Pimobendin 5mg 1 every 12 hours
    Sotalol 80mg 1/8 every 12 hours
    Benazepril 10mg 1 AM, 1/2 PM
    Florinef 0.1mg 1/2 AM, 1/4 PM
    Taurine 500mg 1 every 12 hours
    Vitamin B-50 Complex 1 every 24 hours
    CoQ10 30mg 1 every 24 hours
    Omega-3 Fatty Acids: EPA 750mg, DHA 500mg every 24 hours
     
    1 person likes this.
  6. Beret

    Beret Bullyflop

    This is absolutely amazing. So happy for you both. If anyone deserved this stroke of luck, it was Lily!
     
  7. Jazzy

    Jazzy GRCH Dog

    That is absolutely awesome LL; I am sooo happy to hear that the news was good!
     
  8. phillysmom

    phillysmom Good Dog

    Wow! That's pretty amazing, yay for Lily!
     
  9. Cofla

    Cofla Big Dog

    I'm very very happy to hear the great news.
    Great work and care that you are doing with Lily.
    Hugs and kisses for Lily!!!

    Eddy
     
  10. LilianaLove

    LilianaLove GRCH Dog

    Thanks for the kind words guys :). I've really appreciated the support thru all of this. She's such a special girl, I agree, she really does deserve this. She's just such a good dog. I love her so much.

    Here's to continued good news. :cheers:
     
  11. WithHope

    WithHope Big Dog

    :party: Terrific news. So glad to hear it! You BOTH deserve this.
     
  12. Beatrix Kiddo

    Beatrix Kiddo Good Dog

    yay glad she is making improvements! I'm sure it's a huge sigh of relief. congrats on the great news :)
     
  13. RockitShip

    RockitShip Puppy

    Great news! What a relief!! I hope she continues to improve! :party4:
     
  14. LilianaLove

    LilianaLove GRCH Dog

    Just wanted to update this a bit.

    Her heart:
    Function is down a little bit and dilation is slightly increased. We're experiencing a little backslide but hopefully we can remedy it. We recently got stem cells in our practice- if we can figure out how to extract the sample and administer it (remember- not an anesthetic candidate), it may be something we can do. I'm not going to hold out too much hope, but we'll be performing our first stem cell treatment next month on a different dog (joint injection), so it's definitely something that's back on the table. The internist believes we can increase her benazepril again and watch her kidney values (she's currently on 5mg BID). He says 10-20% changes in the creatinine are not something to be overly concerned about, and if the higher dose of benazepril was helping her heart function, increasing it something we can consider. I'll be speaking with the cardiologist this week.

    Her lungs:
    We went to see the internist this week (on my birthday of all days). He says her lungs do look worse than when we first began getting worried about them. His words:
    "The lung patterns are largely unexplained. It is not a bronchial pattern and the cough does not fit for a bronchitis. She has no pulmonary hypertension or crackles on auscultation of her lungs. I am suspicious of pulmonary interstitial disease but we have very limited options for diagnostics and treatments."

    We discussed possible treatments options. He wants me to get a couple serial pulse-ox's (before, during, and after exercise), if normal, we don't have to worry about treatment just yet. If she does have a decrease in blood oxygenation, we will start a Flovent inhaler with her (at $200/actuator, I'm hoping to hold off on this, as it would be ~$100/month).

    Her face:
    I posted a while ago about Lily's possible spider bite:Lily Medical Problem- Any Ideas? *Picture Heavy*
    His words:
    "The swelling has very gradually been improving but is still able to be seen. There were what appeared as possible lyphatic tracts distended at one point along the face. Oral cavity examination is not remarkable. Peripheral lymph nodes (prescapular, cervical, submandibular) are unremarkable. The salivary glands (parotid in particular) are not swollen or painful. For now, I do not see a reason to go further in testing. The owner feels improvement is slowly improving. Liliana also is a risk for anesthesia or systemic corticosteroid use that would otherwise be considered. I suspect there was a toxic insect bite with local necrolytic effect and that affects to local lymphatics or venules is permanent."

    I'll post pictures of her echo and her lung x-rays when I get them uploaded.

    The only other consideration right now is possibly testing for Chagas disease-
    http://tvmdl.tamu.edu/wp-content/uploads/2012/07/BACKGROUNDER-chagas-disease-in-dogs.pdfhttp://agrilife.org/livestockvetento/files/2014/06/canine-Chagas-disease-2.pdf

    I will likely send out a test, just for the hell of it. It may be a false negative, but at least I can say I did it. It'll probably be less than $100 with shipping.

    So that's what we're up to. The story continues, thankfully.
     
  15. Beki

    Beki Good Dog Premium Member

    You mention Chagas/ kissing bug disease.
    I've heard there are quite a few military k-9's getting washed out because of this.
    What is the treatment for that if there is a positive diagnosis?
     
  16. Jazzy

    Jazzy GRCH Dog

    :hug:

    Just praying for the best for both of you. I know Lily is in good hands.
     
  17. LilianaLove

    LilianaLove GRCH Dog

    Treatment for a positive diagnosis is anti-parasitics in the acute phase. Once out of the acute phase, it's simply supportive management of the affected organ systems. If she is positive, it won't change what we're doing, but it WOULD give us a reason.

    Right now, our current conclusion is that this is all genetic (the internist's words were she has the lungs of a 10-12 year old dog). Typically this type of interstitial disease is idiopathic and/or genetically based. A conclusive diagnosis would require a lung biopsy, which she wouldn't survive.

    So this is kind of my last-ditch effort as some kind of diagnosis that isn't crap genetics.


    Thanks :). She actually was just laying here making the most ridiculous dreaming noises, like she was in an argument with a bunny :lol:. She's always trying to keep my spirits up!
     
    Last edited by a moderator: Aug 9, 2014
  18. LilianaLove

    LilianaLove GRCH Dog

    Lily got a relatively clean bill of health from the cardiologist. We have been struggling with random dependent edema throughout her body (throat, chest, thighs, and abdomen). Thus far it seems idiopathic and self-resolving. An abdominal ultrasound found nothing remarkable. I repeated a full tick titer to NCSU, all negative. I tested her for Chagas Disease through UT, that was also negative (the cardiologist said she was going to suggest it but saw I had already run it :lol:). So right now, we're just calling her Ms. Idiopathic- idiopathic dilated cardiomyopathy, idiopathic primary pulmonary interstitial disease, idiopathic vasculitis. :no2:

    All in all she is relatively stable. She is NOT enjoying the frigid temperatures, but is coping ok with her winter blankies. We are not planning to recheck anything until her 2-year recheck in March, which I am very excited about. She is an absolute trooper, and she is beating the odds every day. Thank you all for your continued support, Lily sends her love :).
     
  19. Michele

    Michele Chi Super Dog Staff Member Super Moderator

    Thanks for updating:sonn_u11:
     
  20. kbell6987

    kbell6987 Little Dog

    that's great to hear
     

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