Beating the Odds Six Ways to Sunday

A dog that’s cheated death as many times as Jakes has should have been a cat. Tied to a tree in the heat of a Texas border town until he was roughly four years old, he’d been starved, burned, and abused. The humans in his life had pulled many of his teeth so they could use him as defenseless bait for dogfighting. Jakes had a rough start.

Kelli Lipson and her husband, Jorn Santegoeds first met Jakes when they fostered him through Rescue Dogs Rock NYC. This gritty group seeks to save the most difficult, urgent, and seriously injured dogs, rescuing them from many places, including south Texas.

“We fell in love with Jakes and decided to adopt him,” said Kelli. “We treated his mange, got him the softest bed we could find, and just loved him back to health.”

Jakes was thriving for the first time in his life. A few years passed, and a routine vet exam revealed T-zone lymphoma, an uncommon, yet slow-growing cancer. A year later, they found a mast cell tumor, which was surgically removed.

“I was now micromanaging Jakes’ health care,” said Kelli. “I’d talked to canine oncologists at the Animal Medical Center (AMC) here in New York, as well as doctors in Canada and at Colorado State University’s Flint Animal Cancer Center to make sure we covered every possible angle for treatment. Fortunately we also had Lemonade pet insurance for Jakes, which has been an important part of his story.”

Now 11, one March afternoon Jakes was with Kelli on the subway and was noticeably unhappy. He normally loves to travel, and he had happily journeyed around the U.S., to Europe, and Aruba. But today, he was miserable. Kelli took him straight to the AMC emergency room.

The ER team noticed a slow heart rate and immediately moved him to the cardiology team, where he was diagnosed with heart failure. He needed a pacemaker, now. Kelli immediately said yes to the pacemaker, but how does a dog move from being fine in the morning to acute heart failure within six hours?

The AMC cardiology team advised that a pacemaker would keep him alive, but eventually his heart would deteriorate further. Kelli wanted more answers. Jakes’ cardiologist remembered briefly hearing about Chagas disease in vet school, although the hospital had never seen a dog with it. They took blood and sent it to Texas A&M, and in a few days, the diagnosis came back. It was Chagas.

Treatment options were limited. Texas A&M advised that they could treat with benzonidazol, although it had poor results in treating canine patients, especially older dogs who had probably had chronic Chagas for several years.

So Kelli decided to dig deep, looking for someone with significant experience with Chagas and found Dr. Madigan on a Facebook forum. Dr. Madigan offered a treatment option using itraconazole and amiodarone that not only would help Jakes get better, it could potentially even reverse the heart damage.

Consulting again with the AMC cardiologist, the options were clear. Kelli could try the benzonidazol, even though chances were poor. Or she could try Dr. Madigan’s option, which Texas A&M said wouldn’t work either. With nothing to lose, Kelli trusted Dr. Madigan’s confidence, and Jakes’ treatment began.

Treatment began in April, with Kelli staying on top of Jakes’ demeanor and dosage management. As summer started, Jakes experienced several fainting episodes. Back to the cardiologist they went, and the recommendation was to turn up the pacemaker. Kelli also called Dr. Madigan, and they adjusted the dosage. The fainting episodes stopped, and in August Kelli and Jakes flew to San Antonio to meet with Dr. Madigan. While there, Kelli asked him to also look at a skin condition on Jakes, because after four cytology tests the lesion had not been definitively diagnosed and wasn’t improving. He recommended having it biopsied.

Once back home, Jakes was significantly improved. No fainting, and at his next cardiology appointment, the cardiologist said, “Kelli, I’ve never seen a heart get better, but Jakes is only relying on his pacemaker about 80% of the time. This is truly incredible.”

At his next visit in February, he was only relying on the pacemaker 49% of the time.

“I’ve never seen this” said the cardiologist. “It’s unheard of. The pacemaker should last another nine years.” At the same time, the biopsy on Jake’s skin lesion that Dr. Madigan suggested turned out to be skin cancer, which was surgically removed.

After completing Jakes’ Chagas treatments, Kelli has shared his story across online communities, encouraging other people get their dogs tested, just like they get tested for heartworm. A number have tested positive for Chagas.

“He’s 13 now, and his whole personality has changed,” said Kelli. “We were lucky that Jakes’ incredible cardiologist had heard about Chagas and that we found Dr. Madigan. Now the entire cardiology team at AMC has seen the treatment work.”

After early years of abuse, T-zone lymphoma, mast cell cancer, Chagas disease, a pacemaker, and squamous cell carcinoma, any other dog would have given up. Not Jakes.

Bouncing Back Strong

Teddy was diagnosed with Chagas disease at just six months old after becoming critically ill from severe heart disease caused by the infection. At one point, he was experiencing over 50,000 premature heart contractions on his Holter monitor, putting him at constant risk for life-threatening arrhythmias and heart failure. Thanks to early testing through a simple blood test performed by his veterinarian, Teddy was diagnosed in time and immediately started on cardiac medications, diuretics, and treatment for Chagas disease.

In just six months, Teddy is out of heart failure, gradually weaning off many of his heart medications, finishing treatment for Chagas, and back to living a happy, energetic life. His story is a powerful reminder that early Chagas detection matters, treatment can save lives, and screening pets for Chagas disease—especially in endemic areas like Texas—can make all the difference.

Our Chagas Veterinary Seminar is Now Available on YouTube

Dr. Madigan presented a three-part seminar on Chagas disease to colleagues as part of Lone Star Veterinary Academy’s continuing education webinar series. Seventy-six veterinarians attended the virtual presentation and enthusiastically participated in the question-and-answer sessions after each module. The entire presentation is now available on YouTube.

Dr. Madigan’s presentation outlined three knowledge components that are important for veterinarians in identifying, diagnosing, and treating canine Chagas patients:

Chagas Disease: History and Epidemiology: Cause of Chagas, disease vector and species, geographic distribution, path of transmission, history of Chagas disease, canine prevalence, and environmental control
Chagas Disease: Recognizing the Signs: Pathogenesis, progressive fibrosis and heart failure, and clinical symptoms, oral transmission and increased clinical response, symptoms in felines and humans, public health implications, diagnostics, arrhythmias
Chagas Disease: Treatment and Follow-up: Treatment length, drug options, efficacy, drug synthesis, monitoring, supportive care, case studies, and testing

Chagas disease in dogs is widespread across the US and across companion, working, and shelter dogs.

Although diagnoses of Chagas disease in dogs are outpacing cases of heartworm and tick-borne diseases, awareness of Chagas disease is low among dog owners. Many veterinarians have not encountered Chagas disease in their patients—or had the information and tools to correctly identify and diagnose it when it’s present. Because symptoms can range from lethargy, a swollen limb, or decreased appetite to heart disease or sudden death, it can masquerade as other, more well-known pathologies.

The seminar series also includes case studies of actual canine patients, along with Dr. Madigan’s approach to diagnosis and treatment for each. Although the presentation was originally developed for veterinary continuing education, breeders, rescue organization staff, and pet owners will also find the series fascinating and valuable for their own canine families.

Testing Every Rescue

In 2007, a rescue dog, Max, presented us with our first case of Chagas disease. Although Max succumbed to the disease, his death launched us on the journey to find a cure.

Thirteen years later, the tables are turning. Tracy’s Paws Rescue is the first (that we know of) rescue organization to test incoming dogs for Chagas disease. Located in Hondo, Texas, Tracy’s Paws rescues dogs with pending euthanasia dates from shelters across the state. Dogs are rehabilitated and rehomed with loving adopters across the country.

“In 2020, we lost several dogs to sudden death,” said Tracy’s Paws founder, Tracy Voss. “Necropsies showed Chagas disease. We were devastated. We had never seen this before in the 10 years we have been rescuing dogs.”

The Tracy’s Paws team immediately began educating themselves about Chagas disease. Today, they have implemented an education program on the disease and treatment protocol for staff, volunteers, and adopters. And every dog coming into the program is tested—and treated if necessary—for Chagas. Chagas-positive dogs remain in their care and under treatment for 45 to 60 days before becoming adoptable. During this time, they are monitored by the vet and started on medications. Adopters must agree to continue treatment for 12 months and are provided with care instructions and information for their veterinarian.

Here’s a big shout-out to Tracy’s Paws and the fabulous work they do for dogs! Watch the video.

From Chagas to Coronavirus: Our Own Dr. Paniz-Mondolfi Tackles a Coronavirus Mystery in Children

Vida Pharmacal’s Clinical Research Director of Human Health, Alberto Paniz-Mondolfi M.D., Ph.D, has been immersed in Covid-19 research this year. In 2019, he joined the Mount Sinai Icahn School of Medicine in New York as assistant professor of pathology, molecular, and cell-based medicine after fleeing Venezuela with his family earlier that year. His years spent fighting infectious diseases in South America placed him on the front lines of treating seriously ill children in New York soon after coronavirus hit.

Most children who catch the coronavirus only experience mild symptoms. But a few months after the coronavirus struck New York, Mount Sinai hospital began treating a small number of seriously ill children, most of whom had been infected with Covid-19 weeks earlier. The condition came to be known as multisystem inflammatory syndrome in children, or MIS-C.

As of September 3, 2020, the Centers for Disease Control and Prevention had received reports of 792 MIS-C cases in the United States and 16 deaths; 20 have been treated at Mount Sinai as of Aug. 27. Of those nearly 800 cases, more than 70 percent have been either Black or Latino. A C.D.C. study published in August found that the rate of hospitalization for Black children with Covid-19 is five times higher than it is for white children, and the rate for Latino children is eight times higher.

Dr. Paniz-Mondolfi and his colleagues suspect the problem is multifaceted. It’s also possible that susceptibility has a genetic component. The doctors hope that by identifying risk factors, they will be able to prevent MIS-C or at least make it more treatable.

Dr. Paniz-Mondolfi earned a master’s degree in parasitology and tropical diseases in 2006 and completed fellowships around the world in microbiology, molecular genetics, and skin disease, as well as a second residency in the United States in pathology. He then returned to Venezuela, where he studied and treated patients with diseases like dengue, Chagas disease, chikungunya, and Guanarito virus, a mysterious hemorrhagic fever that kills nearly one in three people it infects. In 2018, Dr. Paniz-Mondolfi and his team were among the first in Venezuela to identify the Madariaga virus, a mosquito-borne pathogen that can cause fatal brain infections.

However, the research also highlighted problems in Venezuela with re-emerging and endemic infections. It’s believed that the Venezuelan government interpreted the research as a conspiracy. Dr. Paniz-Mondolfi began receiving anonymous threats over the phone and social media in 2019. With colleagues and friends warning him to leave the country, he and his family escaped to New York, where he joined the faculty at Mount Sinai.

We’re blessed to have Dr. Paniz-Mondolfi as a critical part of the Vida Pharmacal team, and we’re thankful for his safe arrival in the U.S. Read the entire New York Times story at https://www.nytimes.com/2020/09/09/parenting/children-coronavirus-sickness.html.

A Best Friend’s Worst Enemy

Check out our new video! Learn more about Chagas disease and how Dr. Madigan first encountered Chagas disease in his practice. See how it affects dogs’ hearts and learn more about treatment.

Yikes. What’s in That Drink?

Animals and humans most commonly acquire Chagas disease through the bite of a kissing bug infected with Trypanosoma cruzi (T. cruzi). But that’s not the only way to become infected. In a new study, authors warn of outbreaks of orally acquired Chagas disease in Brazil, Venezuela, Colombia, Bolivia, and French Guyana. In these cases, people became infected through beverages or foods contaminated by kissing bug feces. Orally transmitted infections are acute and potentially fatal.

Drinks or foods can be contaminated when a kissing bug is attracted to, and gets into, a fruit drink or food. When a human host drinks or eats the food, it might contain an entire insect, a crushed one, or its feces, and the T. cruzi protozoa can survive many hours at room temperature or even when refrigerated. The result is a whopping dose of T.cruzi flagellates—more than 600,000—able to infect whoever eats or drinks the substance.

Orally transmitted Chagas has more severe symptoms than vector-transmitted Chagas disease. It has a much shorter incubation period and it bypasses the body’s skin-level defenses. The skin’s dendritic cells induce a primary immune response by capturing antigens from invading bodies. They also move to lymph tissue to help shape the body’s adaptive response. Oral ingestion allows the protozoa to completely bypass dendritic cells and move into the bloodstream directly from the GI tract.

Often, there is a cluster of cases in a single household from sharing contaminated food. Victims experience early heart disease including cardiac arrhythmias, congestive heart failure, buildup of excess fluid around the heart, and excess fluid in the lungs. In vector-transmitted cases, when a bug bites the patient, the mortality rate ranges from 5-10%. In orally transmitted cases the mortality rate is 8-35%. There is often swelling of the face and lower extremities, accompanied by symptoms similar to gastroenteritis.

Travellers to South America should avoid risky beverages, like fruit juices including guava juice, bacaba, babaçu and palm wine (vino de palma), açai pulp, and sugar cane juice, as well as wild animal meats that may be contaminated with T. cruzi. Even when you’re not planning to travel, pay close attention to products containing these substances and be sure to keep containers sealed.

Canine Heartworm and Chagas Disease in Highest-Risk States

Dogs owners have become much more aware of heartworm, the potentially deadly parasite carried by mosquitos. In 2019, more than 13 million dogs in the US were tested for heartworm with 166,817 cases testing positive.

Already this year, as of April 8, 2020, 45,760 cases of heartworm disease have been diagnosed in the US. More than 3.5 million dogs have been tested, resulting in an infection rate of 1.3%, but rates vary depending where you live. In the southeastern states, infection rates are higher. In Texas, out of 318,698 dogs tested for heartworm, 9,784 tested positive for a 3.07% infection rate.

Although numbers of canine Chagas cases are not yet tracked, early evidence indicates the incidence of Chagas disease in dogs might be far higher than heartworm infection. A repeated, cross-sectional study was conducted in shelters across Texas over 18 months and concluded 18.1% of shelter dogs were infected by T. cruzi. Other studies from Texas, Louisiana, and Oklahoma demonstrated infection rates ranging from 3.6% to 22%. Targeted studies on working dogs in Texas kenneled outdoors found rates as high as 57.6%.

The 10 states with dog populations at highest risk for heartworm and Chagas disease are roughly the same. Using statistics from the US Census and the Companion Animal Parasite Council (CAPC) and calculations from the American Veterinary Medical Association (AVMA), we compare infection rates for both diseases in the highest-risk states, shown in Table 1:

That’s a lot of pups. Certainly, not all dogs in all states are tested for heartworm, and few dogs to date across the country have been tested for Chagas disease, simply due to lack of awareness. But even if you reduced number of dogs estimated to have Chagas disease by 90%—the numbers still far exceed heartworm cases.

With International Chagas Day on April 14, it’s clear that much needs to be done to increase awareness of the disease in dogs and to begin tracking Chagas testing and positive cases. If you live in a high-risk state for heartworm, it would be a good idea to have your dog tested for Chagas disease too.

Greatness in Disguise

“Everybody can be great, because everybody can serve. You don’t have to have a college degree to serve. You don’t have to make your subject and your verb agree to serve. You don’t have to know about Plato and Aristotle to serve. You don’t have to know Einstein’s theory of relativity to serve. You don’t have to know the second theory of thermodynamics in physics to serve. You only need a heart full of grace, a soul generated by love.
You CAN be that servant.”
—Martin Luther King Jr.

I love this statement by Dr. King, because I see it lived out in so many places. Serving often comes from a compelling desire to make something better—right now. Recently, one of our team went to Tractor Supply to buy a replacement for her property’s front gate, which had broken in half. The store had a 16′ gate in stock at a great price. There was just one small problem. The 16′ gate had to travel home in the back of a short-bed (5′) pickup. Fortunately she always carries straps, so the store associate helped strap it down, but he wasn’t satisfied that was going to be enough. He took two more straps from his own truck and further secured the gate. He didn’t have to do that. He didn’t know if he’d ever get those straps back. But he saw a way to serve and he did.

The desire to make things better is what launched our effort to cure Chagas disease. I was frustrated that our first patient died and frustrated that there was no way to prevent it. I hit nothing but dead ends looking for answers. Until God’s still small voice offered me a simple choice—you can just let it go and chalk it up to “an incurable disease” and someone else will find a cure. Or you can serve, starting with what you do have. The choice was easy.

The journey? Not so much. I can make subjects and verbs agree, and I know a little about physics but that wasn’t much help here. I didn’t know where to even start to develop a drug. I had no idea how to get a drug through the FDA. There was no roadmap. It didn’t matter. God has revealed and supplied everything we’ve needed—one step at a time and only just in time. Much of what we’ve needed has been—and continues to be—supplied through people being willing to serve right where they are with what they have. There’s greatness all around. It’s just disguised as service.

Roy Madigan, DVM

Summer, Storm, and Aspen

Aspen (above left) and Storm (above right) faced close calls with Chagas disease. Their dam, Summer (above middle) whelped seven strong, healthy puppies on Easter Sunday 2017: Storm, Rain, Cassie, Rhythm, Cairo, Zoe, and Aspen. The breeding had been meticulously researched and planned, everything went well, and there was no indication that anything was wrong.

Twelve weeks later, Cassie threw up and was unusually quiet. Thinking she had an impaction, Lori took her to the vet. X-rays were negative but her heart rate had skyrocketed to over 300 beats per minute. After medication and observation, they transferred Cassie to an emergency clinic. She made it through the night but took a turn for the worst the next day and passed away. When Lori got home that night, another puppy, Rhythm, was limping with no visible sign of a wound. Lori kept an eye on her. The next day she received a phone call from a family that had adopted Rain—he had passed away suddenly the night before. On Monday, Lori took Summer and the four remaining puppies for Chagas testing. Rhythm’s heart rate was escalated, and in the meantime, necropsy results showed that the first puppy had died from Chagas. Multiple local veterinarians began looking online to find a treatment to no avail. Meanwhile, Rhythm became worse and Zoe’s heart rate suddenly went up. The situation looked hopeless. Within several days, test results for all of the dogs came back positive for Chagas and Zoe passed away. One local vet suggested that Lori contact Dr. Madigan. He immediately started Summer, Storm, Aspen, and Rhythm on medication, but for Rhythm, the disease had done too much damage.

Today, Summer, Storm, and Aspen are completing treatment. All three dogs are energetic and happy to play outdoors—or comandeer the living room sofa for a nap. Storm likes to play keep-away with his favorite rock, Aspen stalks and ambushes him, and Summer joins in for a rumble. Thanks to Vida Pharmacal, these dogs have long, happy lives ahead of them, and they have alerted many other breeders to the presence of Chagas disease so that other dogs might also be saved. Many thanks to Lori, her husband Tom, and the dogs’ co-breeder.