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[Winterpinegoldens]

My golden was started on Ampho - B today, and I am really scared about this. The vet recomended that he start this because he has not been eating and in order for the antifungals to work properly they need to take them with food.

Has anyone had experience with this drug while getting the first treatment for Blasto??

This vet said that he has treated a lot of dogs with blaso because it is so prevelent in the area of Wisconsin. So he is not new to this type of disease/infection.

I am just really worried that maybe the drug will kill him before the blast itself??

Please comment if anyone has had any experience with this Ampho-B

Thanks

[Jen]

Treatment with Ampho-B doesn't seem to be used so much anymore; it's a very harsh way to start.
I can't think of many who have actually used it or had success with it.
You might ask about better options.
If a dog is not eating, they can be treated with Itraconazole in liquid form.
It's prepared already suspended in a fat emulsion so that it doesn't have to be given with food.

Itraconazole capsules do need a bit of fatty food with the dose, but it's safer.  It usually means hiding it and/or forcing it down.  I did a lot of that.   
It also makes them anorexic, and they will lose weight: quickly.
Force-feeding often becomes necessary, and it takes a lot of determination and dedication. 
Don't be fooled into thinking this treatment is anywhere near being easy or quick.

Check our newsletter: http://blastomycosis.ca/forum/index.php/topic,256.0.html

It has a lot of information about treatments, care, feeding, and where to get the medications affordably. There is a wealth of experience here, and these people have been where you are.  They'll be here with help, advice, and support.

Best-
jen

[evayola]

In no way, shape, or form do I want to alarm you but from my experience with the amp b I would highly recommend AGAINST it. Marge did one days worth of treatment and she nearly died. She went blind in her eye shortly after the treatment was started. I would never put her through that again. It was way too harsh for her and she is 150 lbs! It may work for some but after my vet even saw what Marge went through, she regretted suggesting the treatment. It is a pretty wicked strong treatment. Like Jen said, force feeding will most likely be necessary. We force fed Marge for a long time. She hated us for it but it didnt matter. We would pack her mouth with food and hold it closed until she finally had to swallow. You really need to stay strong for pup because they will be looking to you for comfort. This is going to be a really hard time for both of you. Commitment is key. We never left Marge alone and had a daily journal of everything we were giving her... meds/food. We ordered her pizza, hamburgers, chicken, anything you can possibly think of. Ultimately the decision to stay on the amp b is up to you but if I could change some things with Marges treatment, that would be #1 because I think it may have saved her eye. Hang in there. We are all here for support. We have all been there and faced the same scary things you are.

Eva

[Wilson3]

boy I am surprised they still use it.
it is wonderful you did start treatment though

what area are you in?
if you can I would ask about using the itra or the flo
It is more affordible and easier on the dogs
but buy no means is any treatment easy on them (you have made the choice of a VERY LONG AND HARD journy many ups and downs to come as my vet said "a very loooong haul!)(it is well worth it,for wilson it has been almost 2 yrs of being blasto free)
many loose lots of weight stop eating and do not look good at all
at this point feed what ever you can get your golden to eat
go and get a nice steak from the butcher cook up bacon get foods that have a stronge smell that really gets them going
people food works best it seems at this point
my boys LOVE tripe (but it smells really bad)
lots of great info on this board!!! (great people also!)
good luck and keep us posted
wilson3

[Winterpinegoldens]

I live in the Upper Peninsula of Michigan.

Yes the vet gave the first dose of Ampho - B on Tuesday afternoon. The vet called me 3 times today to keep me posted on how my Golden "Dakota" was doing.

He said that he handled the treatment really well over the night and he is getting a lot of fluids as well. So that was good to hear.

They drew blood late this afternoon, and he said that the  blood results were very good so they are going to give 1 more dose of Ampho - B tomorrow morning, and let the fluids runs again tomorrow for 24 hours.

He still is not eating at all. They force fed him about 2 tablespoons of canned dog food, but Dakota did not pursue to eat anything after that. Although, he did keep that food down.

I am cooking him some hamburger and rice tonite, and a family member is going to see him tomorrow (he is hospitalized an hour away from where I live) so hopefully by seeing the family member tomorrow and getting some good hamburger, he will eat and be able to come home on friday or saturday.

The vets said that this is a long haul to treat this disease, but he said that Dakota got no worse over night. So that was the good news for the day

[Wilson3]

I am really glad that the treatment went well!!
I do know the sooner Dakota can be home the better. Ithink we all agree on that one.
It must be hard being so far away.
Think in your mind about him and send positive thoughts his way!!
He will know!!
The feeding gets harder you mUST do what every it takes to get food and liquids down Dakota. The meds work better and he meds his strenght
wilson3

[Kash-]

Knight was treated with ampho-b back in 2002 in conjunction with Itraconazole.  Back then it was said that the two drugs together had a synergistic effect.  When my Vet conferred with some successful blasto Vets, the opinion was that using Ampho-b until the dogs fever broke was the preferred treatment.  It's my opinion, from my vet, that renal functions should be monitored all the while ampho-b is being used.

Originally, my vet was only going to proscribe Intraconazole orally to treat the blasto.  I dug around and found some successful vets in Wisconsin using Ampho-b in conjunction with an "-azole".  I referred my vet to a vet in Tomahawk that was touting the combined therapy.  My vet agreed and we put Knight on every other day ampho-b and alternating days renal blood work up.

Additionally, a few years ago a coworker caught blasto in the UP of Michigan.  They used Ampho-B and Itraconazole on him at that time as well.  Both my dog, Knight, and my Coworker survived.

I do know that ampho-B is called amphoterrible for a good reason.  It is harsh.  During Knight's treatment, a catheter pulled part way out and a bunch of ampho-b laden saline solution filled up the space under his skin on this foreleg, at the site of the IV cath.  I caused an ugly ulcer about the size of a dime.

Current wisdom might have changed, but if your vet is using Ampho-b as a stop gap measure and using it in conjunction with one of the "-azoles" AND monitoring renal functions often, then it's been known to work and is even used in humans. (at least up to a couple years ago).

It's always been my opinion that ampho-b isn't a poor choice because it's ineffective, but rather it's harsh.  At some point, you have to weigh the pro's and con's of using a harsh drug.  It might be harsh, but then it might be the last trick up your Vet's sleeve.  I'm here to tell ya, that used wisely, it can save lives.  Of course that depends on the situation, and one thing I've learned, every situation is different when it comes to blasto. 

FWIW, Itraconazole is less harsh, but it stress's the liver, where it's metabolized.  High dose Itra over a long time can cause liver issues.  Read the packing insert and contraindications that come with an Itra script.  None of these drugs are without side effects and they all have their down sides.

[Wilson3]

Amph-o does work but very out dated
flucanazole was made but showed to  still be hard on there systems but not as hard as Amph-o
itra was then approved and much easier on there bodies
dogs and humans can survive still with that treatment but very hardly ever used anymore
If it where me I would be concerned if my vet wasn't up to date on things and what treatments are better now. It has been around long enough now to prove which work.
Like with the pee test it has now been around more then a year so my vet has been more open minded about it. But he was well awhere of it beeing used. He just wanted to make sure who it was working.
Now Wilson was said that he when never survive and if we would have used the Ampho-o he would have died for sure it is a very stronge drug.it is worse then chemo on a cancer patient
The vets here in Wis really do not use that at least the ones that stay updated with things.
with ever drug there is always side effects.
It is SOOOOOOO very important to find a vet that you trust and that will listen to your concerns and to the things you have found of interest

[carolh]

Reading around a few sites, ampho is used in some cases at first even by up-to-date vets.  But yes, it is known even by the vets as amphi-terrible.  We lost a dog in 1994 to blasto and the vet told us from the beginning, chances were slim and it would be a toss up whether the medicine or the disease took her out. 
THE KEY QUESTION (after monitoring kidneys/liver - a must) is "How long on amphi-terrible and what treatment after that period.  If your vet is planning on just ampho-terrible, then run away.  If it is a stop-gap measure in an already advanced case, then maybe, with the monitoring, and then beginning on itraconazole or fluconazole.

From reading the posts, it is amazing how many of us are in this upper MidWest area -- UP, NW WI, WI.  I would like to see all of us take a pro-active stand and begin getting letters to the editor about blasto and how to avoid it and what to look for so if an animal (or human) catches it, treatment begins early.  I got the head of our Humane Society to write a column about it and will follow up with a letter to the editor.   
In peace, Carol

[Kash-]

 
THE KEY QUESTION (after monitoring kidneys/liver - a must) is "How long on amphi-terrible and what treatment after that period.  If your vet is planning on just ampho-terrible, then run away.  If it is a stop-gap measure in an already advanced case, then maybe, with the monitoring, and then beginning on itraconazole or fluconazole.

This is the key, I appreciate it being stressed.  A therapy of ampho-b only is an outdated idea.  However, I think (at least at the time) using ampho-b sparingly, until the high fever broke, was the kicker.  Once the patient is well enough to have a normal-ish appetite the oral meds have a good chance of doing their job right.  The 'azole type drugs are great, but at best we have to admit they work slowly.

If I recall correctly, my dog was scheduled for 10 ampho treatments over 20 days.  His high fever broke after two or three treatments and his temp was normal after 6 ampho treatments.  At that time my vet pulled the plug on the last 4 and we continued with the oral sporanox for months afterwards. ( we actually started the sporanox a day before the titer confirmed it was basto).  To be totally fair, Knight was a very fit athlete with tremendous will and strength and reserves.  A much sicker dog, or one older may not have tolerated the ampho with such aplomb. 

From reading the posts, it is amazing how many of us are in this upper MidWest area -- UP, NW WI, WI.  I would like to see all of us take a pro-active stand and begin getting letters to the editor about blasto and how to avoid it and what to look for so if an animal (or human) catches it, treatment begins early.  I got the head of our Humane Society to write a column about it and will follow up with a letter to the editor.   
In peace, Carol

I'm in central WI right now and the overall knowledge base is really pretty good.  My town has a "green circle" trail and several cases of blasto have been reported and linked to this recreation area.  Signs are posted and I'd say awareness is pretty high.

On the opposite end of the spectrum, for a while I lived north of Marquette Michigan and there isn't any state mandated reporting of blasto cases, awareness is low among the population and many vets just offer an oral Flucanazole therapy with a "this may or may not work" approach.  My vet in the UP was fantastic, knew about blasto and was immediately suspicious that my dog's symptoms may have been blasto.  At best in the UP it's a mixed bag.

Not to suggest everything in Wisconsin in a purely rosy picture either.  My wife's cousin was horribly misdiagnosed and died as a result of blasto.  Her aunt has a chronic blasto infection they can't seem to weed out.

All we can do for sure is keep the conversation open and the exchange of information flowing.

Kash

[Wilson3]

the midwest is a HOT SPOT, Great Lakes area.
Wisconsin is really bad! The Gov. even sent out an alert to all human Drs. this past year.
The central area should have alert aigns out.. that is a very bad area. If they didn't I would think something was wrong.
Wilson was very fit also when he got Blasto. He has titles in Agility,herding,fly ball and disc first place ones to boot his body is as hard as a rock  and you would never know he was almost 8 years old He can still jump a 6 ft fence in a blink of an eye even though his vision is now failing him.
I hope anyone using ampho-b is very cautous Every dog ever treated that I know died from it. Every dog treated with itra or the flucon lived which that really doesn't say much but amph0-b is worse then chemo and I know what chemo does to a dog first hand
like kash said maybe using it once or twice but I would still question the vet on the choice. They really only use this way of treatment on dogs when it involes the nervous system. Even on people.
sorry to keep on with this type of treatment.. It just is SOOOOO hard on the dogs
and is it really worth it?
with the new drugs out that is why more are survivng not like the old days
wilson3

[Kash-]

Not to beat the dead horse, but when I was living in the U.P., I knew several dogs that died from blasto when the only treatment given was Flucanazole. 

I'm  not saying that a flucan based therapy is bad, but there's more to it than just what drugs are prescribed.  How advanced the disease is probably makes more difference as to survival than what choice of drugs are used. 

I hate to use the word "lucky" in conjunction with Blasto, but my dog was probably lucky.  He came down with the cutaneous infection in his paw, and it bolted to his lungs.  This probably gave us more time to get him on the therapy, than if it had been a straight pulmonary infection.  Again, more variables in the blasto equation.  I know cost is a major factor in treating pets as well.  Some vets probably opt for a cheaper therapy figuring that some treatment will have some positive results as opposed to offering an expensive therapy that may succeed and having pet owners reject it out of hand based on cost.

[Jen]

The only real consideration is that Itra and Fluconazole don't do an equal job of treating eyes and other areas.  Itra doesn't cross the blood/brain barrier as well as Fluconazole.  Luckily Dirtbike had no eye or CNS dissemination, and Itra was the right treatment for her.
   Marge and some others have had the eye involvement, and Fluconazole was the best choice to treat them.  I believe that Eva actually had consult w/Dr. Legendre, which was pretty sweet.

Not all azoles are created equal, like no 2 cases are the same.

[paintubturner]

Gunner was on Itra for over a year and had went blind in the beginning stages of Blasto.  We were never given any other option except the Itra.  He has been off meds 3 weeks tomorrow and still doing great!

[Kash-]

Winterpines...

I should have said this from the get go, but in rereading this thread, I realized I left out some advice I probably should have mentioned.

You said you're in the UP.  That's kinda a big place and depending where you are, getting around can be time consuming.  But, I'm going to give out a referal for ya.  If you're near Marquette, specifically Gwinn Michigan.  (Down near the old air base) there's a vet there at Gwinn-Sawyer Vet clinic named Dr. Jean Wilcox.  She saved both my pointers and knew what blasto was from the get go.  (906) 345-3528

Knight had the cutaneous version and she recognized it, sent out for a fungal titer and culture and got him on sporonox asap.  She saved him, and then a year latter made a difficult Dx on my other dog (she has addisons.)

Anyway, I hope you're near Gwinn, or near enough to get to her.  You tell her Knighty sent you. 

If you're not near her, and you're unsure if your vet his handling your case the way you like give Dr. Wilcox a call and see what she thinks of your dog's therapy.  She's successfully treated blasto and probably has more damn common sense than any other 10 vets I've met.

The worst thing about leaving the UP was moving away from my best Vet ever.