Author Topic: Australian (Sydney) case of Blastomycosis ORHistoplasmosis -VET says zero chance  (Read 76 times)

Offline Roubi

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Hi everyone, I came across this forum couple of days ago.

I am currently residing in Australia (Sydney), my baby's name is Ella. She is a beagle cross G.shepherd 11.5 years weighing currently 15.72kg (usual weight of 16.9 thereabouts). Ella last Saturday had an X-ray which came up as a "snowstorm" X-ray. The VET immediately told us that cancer has invaded Ella's lungs and that we should be considering when is the right time to say good bye by this week as Ella's is probably having great difficulty to breathe.

From Saturday since I was told until Monday, my world was completely shattered, I could not believe I was about to have to make a difficult decision this week. However, on Monday I have no idea how I came across Histoplasmosis and Blastomycosis- I started digging into it and realising that based on what the VET told me, putting Ella down this week OR giving Itraconazole a try. On Tuesday I had an appointment with a VET that has been following Ella all along when we first thought lung cancer was back for Ella in June, I thought it was necessary for her to give me her opinion of the Xray. When I saw her, she told me the same thing as the Saturday VET, unfortunately its not looking too good and Ella is in final stage (days/weeks) and I will have to decide when is the right time since quality of life is important. So, I immediately made mention of Histoplasmosis and Blasto to her- She immediately dismissed the idea, telling me that Blasto/Histoplasmosis is virtually non existent OR rare so rare in Australia specially Sydney. She then advised she will talk to the oncology specialist and get back to me that day.

The reason I thought Ella had/has Blasto or Histoplasmosis is because of ALL the symptoms Ella showed:

- June 17 Ella started having the occasional cough, from 1 to 2 at night- As soon as we heard 2 coughs, we decided we need to go see the VET as lung cancer could be back. On an Xray at the VET, she said unfortunately based on Ella's history she saw pleural effusion and what she thinks is a sign that the cancer is back. Ella was referred to a specialist oncology where numerous tests were done, as well as aspirate of nodules and aspirate of the pleural effusion. The report came back as pulmonary carcinomas for the nodule and no cancer cells in the pleural effusion. We were then told Ella now can start Palladia which is the new "chemo" drug for dogs. It will pretty much delay the inevitable. So, we did. Ella tolerated everything pretty well, the chemo, the anti-inflammatory (Piroxicam) - I managed to limit her nausea with slippery elm bark, so she was having a normal life, happy/playing etc.

- In Aug- when I was suppose to go in for a blood check, the day before I noticed Ella's lymph node felt thicker/enlarged. I made mentioned of it while at the VET, they decided to take an aspirate of the lymph node to check for cancer cells (since they kept putting everything to lung cancer) and said that to them it seems that the cancer is spreading. The results came back negative, BUT the VET kept saying that even so the result came back negative usually with aspirate we cant really rule out cancer completely. I can't remember why but we somehow went back again and more aspirate was done, sent to a lab for testing- and again no cancer cells but kept pointing that it is unfortunately cancer spreading according to them. While we were out, we saw Ella pinning her head down to scratch her mouth, which made us believe she might have a tooth infection or something. We were prescribed antibiotics as I decided well if it was cancer, nothing we can do and if it isn't lets try antibiotics as I believe that then we will see a change. While on the antibiotics the lymph node kept doing up and down, but stayed there- so when the antibiotics ran its course, it was literally a couple of days after, the lymph node became like a ball size FULL of puss- it was soo big and had fluid in it- Ella could not sleep that night and the puss started coming out- she was in so much pain and discomfort- the very next day I went in for the VET to drain the abscess, which she did.
After the surgery, she called and advised that the surgery was a bit more difficult than anticipated as the skin where the abscess was kept dying, like it was becoming black and explained that it was skin necrosis and now the concern is that if the skin even after the drain continues like that- Ella will have to be put down. Ella recovered fine from the drain/her skin healed really well. After recovery time, Ella started Palladia again.

- Her blood through out Palladia was somewhat really good, no noticeable concern. Only 1 complete blood panel when was done to check for liver/kidney- the VET advised there was some enzymes elevated which was concerning when on Palladia specially and Piroxicam so we should check urine- I took some sample straight away, then I was told they need to take sample straight from Ella- so with a needle she extracted some sent to a lab. After 1-2 days the results came back which she said she thinks could have been dehydration BUT to be prudent stop the Piroxicam continue Palladia. So, we did for 2 weeks and rechecked the blood/Urine- ALL were normal level- so we restarted Piroxicam attributed to dehydration. Ella bounced back that Saturday and was super happy.
Again another test done after 1 week to make sure and now revealed enzyme elevated again, the VET decided that perhaps some kidney damage and therefore we need to consider perhaps stopping Piroxicam. So, I asked if there was another one we can try that is less damaging to the kidney- Previcox was mentioned and we decided to get some- the VET said we need to remove all Piroxicam off her system for 5 days then start Previcox.

On 1st of November 2017- Straight after this was decided (stop Piroxicam wait for 5 days), Ella was a little flat- so I told the VET as Ella went to the bathroom and had a semi hard semi soft poop (muscusy-glossy poop) then later on while walking her she had another tiny one completely no shape diarrhoea. I advised her than her general demeanour was off and just not the normal Ella- she was a little picky with food which is strange for Ella.I asked if she thought Ella had an infection or that the same infection from the abscess perhaps came back? OR if anything was giving any indication of infection from her blood. The VET replied that if she is eating and just showing mild diarrhoea and slight disinterest in food, may be she is feeling nauseous but she wouldn't be suggesting antibiotics at this point. However, later on things took a turn, Ella went to the bathroom and did more diarrhoea- she was straining to go and then did small diarrhoea and one was only blood- like fresh blood. I immediately panicked and took her to the clinic (my VET was away) and someone else looked after Ella and advised that they thought Ella had colitis and that Flagyl should clear it over 1 week. So she was prescribed for twice a day. After the course of Flagyl, Ella had somewhat hardish poop, no blood happened again- so we thought it was colitis- only to realise we are back to soft poops by 1 day after we stopped Flagyl. So, the VET decided to do another 10 days of Flagyl.

On the 11th of November - Since alongside all of the above, we noticed Ella was panting more- and heavily. For a while we attributed it to heat, stuffiness in the house since summer starting in Sydney. However on the 11th we thought it seemed more alarming now as her respiratory rate while resting was between 40-50 breaths, which is quite alarming. As soon as we said the rate, the VET on call said based on Ella's history- she wants to do an X-ray. So on the 11th of November (6 days ago) the VET told us that there is quite a bit of fluid build up in Ella's lungs showed/expressed by the "greyness" of the image. The Xray looks exactly like the "snowstorm" mentioned in Blasto. We were told she is struggling to breathe, therefore quality of life we need to think what to do. Please bear in mind at that point Ella was still full of energy, bouncing around, running etc eating normally etc etc. We were prescribed some bronchodilators "Neulin" tablets to give her some relief- However by Monday although she was happy she ended up having an upset stomach- like chronic diarrhoea- somehow different to what looked like colitis- more like kept thinking she has to go and very watery poop- to a point one of her straining poop was ONLY water/muscusy- Ella was otherwise still the same, energy level up- super keen on food etc. So, I mentioned the poop to the VET who prescribed the Neulin, she said since Ella has lost 1 kg in the past 1.5 weeks (from what we thought was colitis or what not) she is worried that the diarrhoea will make her lose more weight. So we stopped Neulin and at that point I was seeing my regular VET on Tuesday to know her opinion of the X-Ray and thats when I mentioned Blasto.

- After speaking to the specialist oncology who apparently advised that there is basically zero chance for Blasto- I continued to argue with my VET that the alternative to trying is you guys telling me to bring Ella to put her down, so whats the harm in trying. She finally agreed to write me a script and I started Itraconazole.

To me, since we have an unexplained abscess, which was put to "freak infection"- we will never know what it was. Another symptom is the GI tract unstable (mucus, blood and watery poop), Ella also has an ocular discharge which I never ever questioned or thought was a symptom for anything. She suddenly lost weight as soon as the colitis or what we thought was colitis as well as loss appetite, she became somewhat exercise intolerant, she also became lethargic, quiet.Only playing when enticed and finally rapid breathing. All the symptoms somehow tick a lot of boxes for blasto - and since it is often not diagnosed but attributed to something else, then may be it is simply NOT diagnosed not that it is sooo rare in Australia.

So Tuesday 14th of November 2017, I started with the first dose of 150mg. By today Friday 17 of November 2017, Ella has had 3 doses of Itraconazole and 1 dose of Previcox (since she is on Previcox every second day)- We did notice a slight improvement in interest and demeanour today- perhaps because Palladia is completely out of her system ( we stopped Palladia and Flagyl) OR that something is working? Not sure.
Today on Day 2 - I think perhaps her breathing increased a bit to 50-60 breaths- which I am bracing myself after reading everything on this forum.

I am in early stage, if she does have Blasto but I thought I will share the whole process we went through and me thinking its Blasto whether its wishful thinking or not- I dont know BUT I had to give my baby every chance.

I just think if there was no unexplained abscess I probably would not even be here right now, but the abscess and the GI tract, and me constantly throughout the whole thing since the swollen lymph node, I had a feeling something was just brewing there and not the cancer.

I hope someone here can relate or talk about any experience in Australia perhaps?

I guess my VET even she wrote the script does not support this theory and I am unsure how much she will help or be involved, she did not tell me when to check in OR what I should do from now- so I am literally going by this forum and other research done. I thought hopefully with some signs of improvement while on Itraconazole, I can then go back to the VET and hopefully she will help if I can prove that I was right IF Ella improves.

My schedule at the moment is :

- 8am - Breakfast - A little bit of food with slippery elm bark (trying to help her GI tract)
- around 10am IF it is Previcox day, I give her Previcox with some more food (a little at this point to take the medicine)
- At 12.30pm- Lunch/full meal size- I decided to give her the equivalent of a full meal at 12.30pm to allow acid build up for later that night for Itraconazole.
- 8.30pm - Small fatty meal with Itraconazole

The reason she has Itraconazole late is because by the time I got the script on Tuesday from the VET was late, and by the time we went to the chemist etc and I really wanted to start on Tuesday itself.

Also, I saw people say "fatty meal" - Is a meal - an actuall full meal OR a snack meal size ok? Like just getting "some" liverwurst wrapping the pill through giving enough? OR does Ella need to actually eat properly after, does she need to have a full stomach.

When should I expect to see her breathing get better? OR any sign that if this is what she has then she is improving?

Offline Harleys Mom

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Sorry to hear about your Ella feeling poorly, sounds like she's been thru quite a lot already.

Some added fat in the diet is supposed to help absorb the Itraconazole, but I don't think a whole meal of fat is necessary. My Harley had his usual dry dog food meals with a glob of peanut butter on top for extra fat. The added bonus was I could stick his Itra pills in the peanut butter and he'd gobble it right down without even noticing the pills. I saw other posters on this site who gave a fatty food in addition to the regular meal as a treat or to entice their dogs to take the medication.

Timelines for improvement seem to differ depending on the severity of the fungus. Unfortunately, most people have posted that breathing and coughing seem to get worse before they start improving. I don't know if there's any scientific backing, but some have speculated as the drugs start working against the fungus, it takes a bit for the dog's system to catch up with absorbing the dead fungal material in the lungs. There does seem to be some logic to that line of thinking.

I don't recall seeing anyone mention Blasto in Australia, but there was 1 person a few years ago who had an indoor cat diagnosed with Blasto and had no idea where the kitty could have been exposed to it. The suspicion was maybe potting soil from a houseplant but wasn't able to confirm the source.

Hope things get better for Ella

Offline Roubi

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Thank you for your response.

Today Ella seems in good spirit still- she is still eating which is great! a little picky but so long as it is things she likes she eats well. This morning she seems happy/alert/ grabbed her toy when I pressed the squeaky and played a little.

So, from what you said re-fatty meal- it is only a fatty thing (liverwurst/peanut butter/etc) to give the medication , and then regular food? I just wanted to understand whether she requires like her normal amount of food after the medication has been given OR just a small fatty meal for the medication to absorb (if I am making sense). Because I give Ella like a proper size meal at 12:30pm equivalent to dinner- so that she can not have anything for 8 hours before her medication to allow for acid build up for absorption (I read this somewhere). In saying that, this morning she had some bile, which makes me think may be TOO much acid with the medication perhaps caused bile. So may be I should give her a bit more food when giving medication. I also remove water 1 hour before and 2 hours after Itraconazole (I read this as well) As soon as I put the water back for her at 10:30pm she drank sooo much! and during the night also she drank a bit.

She is I guess on Day 3 of Itraconazole now, I have not seen the "it gets worse before it gets better" yet. I am bracing myself.

Also, I wanted to ask anyone in regards to milk thistle- since Ella was on Palladia (chemo) and Piroxicam and anti biotics etc- I thought may be I should support her liver even at early stage like now? OR what are your thoughts? I did read that milk thistle can affect itraconazole absorption or something.

This forum is such a great resource and I am grateful and feel surrounded which is great, considering everyone probably in Australia seem to think Blasto is non-existent.


Offline Harleys Mom

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Glad to hear Ella's having good days!

Seems like everything varies from 1 dog to another, but there are a lot of similarities. A lot of owners found their dogs wouldn't eat, but sounds like Ella's doing well in that regard.

I didn't use milk thistle, but lots of others on this board did. It does provide extra liver function support and impaired liver function can be a problem on the antifungal meds. You may want to consult your vet to make sure it will not conflict with any of the other meds Ella is taking.

As far as Ella getting worse before better, that can vary too. My Harley had no coughing whatsoever, so it was hard to tell if his condition deteriorated a bit before turning around or not. Other owners posted about their dogs needing to be force-fed because they stopped eating or setting up fans to blow on them to help relieve some of the breathing distress.

I don't think there are standard steps to take in caring for a dog when they're ailing, just address the symptoms as best we can to help them thru. Sounds like you are doing a good job of that with Ella!

Offline Roubi

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Thank you HarleysMom,

I am considering Milk thistle as I believe Ella after chemo etc would have a low immune and her liver would have had it.

In regards to milk thistle here in Australia- I am finding that at the pharmacy all of them are high concentration, super boost ones- so the mg is wayy to high.

Which brands what type were people using it getting?

 

anything