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[thiskidsdun]

Just a warning to be cautious about low (or even zero antigen levels) because they do not mean the blasto is gone.

We now have two cases of blasto in our house.  Our St. Bernard Chad had a horrible case of blasto two years ago.  Brought him into the vet with a swollen hind leg and a fever.  We started him on the intra before any test results were in because my vet felt almost certain that it blasto.  Within two days he was unable to breath and spent three weeks in the emergency vet on oxygen (with mom sleeping on the floor), another month at home on oxygen.  The major involvment was lungs and bones.  Fortunately our vet (who is an absoulte saint) had treated several cases of blasto before us and was able to diagnose quickly and Chad is fine with no apparent after effects.  We have been on the intraconazole for the two years.  We took him off after one year (antigen levels of zero) and within 14 days he was symptomatic and had antigen levels of 31.4 (the first time around they were in the high sixties).  For the last several months of year two we used a "pulse method" - we went down to every other day and then every two days and back to every day at the first sign of symptoms in an attempt to encourage Chad's immune system to take over the fight without allowing the blasto to get another good hold on him.  Chad has now been off the intra for 14 days, tested and levels are at 1.26 which is good but in my vet's opinion not at all good enough and he will start back on treatment as soon as his new meds get here.  All liver and kidney function tests continue to be perfect (thank goodness) and we have seen no symptoms, temperature remaining normal and he is feeling fine which is wonderful.

Our Leonberger Frieda started dragging one of her rear feet a little bit ago and there was some swelling in the pads.  We made an appointment for a hip x-ray since being a giant breed and just turning seven we thought maybe there was some arthritis starting.  At the vet Monday and it is blasto.  Her antigen levels are quite low 2.27 but scapings of a lesion on her pad do show blasto to be present.  No other symptoms and lungs, bones and eyes are all perfectly clear which is wonderful - though in retrospect I was thinking she was just ever so slightly off color a few weeks ago though she is now 100% back to her bouncy, jouncy self at the moment. 

I am curious about the different monitoring of antigen levels talked about on this board.  Our vet did not ever recommend testing for antigens except to diagnose and to check whether to take Chad off the itra.  He told us to anticipate a minimum of one year and perhaps much, much longer before the blasto was actually gone.  He did recommend monitoring temperature (with Chad it was initially several times a day and then decreased to taking his temperature very infrequently unless there was something which caused us to be concerned).  Was there a reason for monitoring antigen levels more often?   And has nayone else had experiences with antigen levels being at zero (or very close) and the blasto immediately storming back once the medication was stopped? 

[Teddy]

We have 2 cases of Blasto in our household too Well three actually! Only one is our dog  Ted and the other my husband. My neice who does not live with us but spends a great deal of time with us at our summer home also is being treated...we have had a triple beat down by the Blasto hammer. We met with the Infectious Disease Specialist the other day for a two month follow up. We had a conversation about antigen testing in fact.  One of the interesting things he said was that in many of the human blasto cases he has treated many patients have negative antigen test results and never show positive on the blood test that can be done. He has had patients that the only place the blasto shows up is in:
The sputum sample they test if one can be gotten
Or speciman tests from a brochial scope or of the testing of tissue from Blasto leasions.
He cautioned us about stopping treatment for our human patients or our pet Ted based on an antigen test.
Just as a side, my father has symptoms simular to our dog and to my husband Chuck, his antigen test has come back with a .45 result, considered negative. Because of his symptoms and the situation of other members of our family a CT Scan with be done and then based on the result a tissue sample from his lungs will be tested. He has a mark on the lung resembling Blasto.

I think depending on antigen level results is risky business in some cases, dog and human...Thank you for your post it has given me more confidance in how to proceed with Ted. Thanks

[Teddy]

excuse my spelling in the last post...it's late.

[carolh]

Thanks for the warning re low antigen levels not necessarily meaning the blasto is gone.  Mira Vista testing told me that a reading less than 4 means the blasto is most probably gone.  However, there have been a few cases written about on this forum that have detailed low reading but blasto still present. 

You mentioned in yoru post the "pulse method."  Forgive me if I'm being dense but what exactly is that?

Thanks for adding to our information base on this board!  GOod luck with the critters!
Carol

[Jen]

Hi guys -
   This is something I'm pretty curious about, but haven't been able to do actual follow-up or get actual verification.  When we see multiple cases in the same location, i.e. 2 or more dogs and then one or more humans infected, I'm curious as to why doctors who are treating the humans don't seem to consider the dogs as canaries in the coal mine, so to speak. 
   Doesn't it seem pretty obvious that everyone was infected by their environment?  That the dogs only happen to be closer to the source?  And shouldn't that factor interest an infectious disease specialist, considering how "rare" this is supposed to be?  I'm a bit perplexed at how they seem practically bored by the whole idea.  To me, it is intensely interesting, and I wish I were able to study it myself.  Case studies could save lives.
   During mom's illness, only one doctor took an almost "House"-like interest. She did diagnose a fungal infection, but it was a common one and she wanted to do a tracheal wash for a better look, because she suspected a different fungus.  She also wanted to send a team to her house and check into mom's environment. ( That would have kept them busy for weeks.)
   This doctor also treated mom with Ampho-B as an emergency measure.  She was promptly thrown off the case and banished, we did not see her again. 
   But if not for this doctor, mom would never have been tested or treated for anything but COPD.  We were told that this was "how a smoker dies", and that we should let her go.  Eyes rolled at the mention of antigen testing, nobody had heard of MiraVista (only 50 miles away!) and I was treated like a pesky annoyance.   

    All in all, it worked out temporarily.  Mom was treated with Fluconazole, she's been home for almost 2 months, although now greatly debilitated.  But seriously - this was a case that could have been studied to provide so much more information about the environmental sources and the effects on someone who lives in a high-risk area for any fungal infection.
   Look how much better we are at treating our dogs now than we were 2 years ago, not to mention awareness and at least some attempt at prevention.  This is all because WE put our shoulders to the wheel, then did the work ourselves.

   Meh, well.  I guess I didn't mean to go off on a rant.  Thanks for indulging someone who sees boogers behind every tree and bush.  Those of us here have good reasons to jump at shadows.

Good luck to you guys-
Jen
   
   

   

[Teddy]

Hey Jen,
We have had mixed reactions from our medical providers. Our vet very quickly diagnosed Ted, he is in fact treating 6 other cases at this time from dogs all over the county...not neccessarily in our neighborhood. Ted had a chest x-ray and a blood test that diagnosed his case. It is quite rare that the blood test shows positive. He truly was our family's canary! But only because WE insisted his case be considered in our "humans" situation.
My neices doc, was very VERY resistant to the idea that she may have Blasto. He kept saying how rare it was, how unlikely she had. Like your story she was treated by a "locum" doc immediately in the ER with antibiotics and an initial dose of intraconozole. The next morning her local doc put an immediate end to the treatment and continued with treatment for pnuemonia. We never saw that locum doc again...he's probably been sent to the "Cowboy Doc Clinic in Antartica." Not until she had a brocial scope and tissue tested was she finally treated for Blasto. My husband's doc an Infectious Disease Specialist seems to treat Blasto as though he sees it very regularly. We asked if we should be testing the soil, trying to figure out the source. He didn't laugh, but almost, what he said was, that we may never find it. It could have been in the wind blowing by in a cloud that they happened to have encountered, or it could be everywhere. What then? I am told that creating an environment free of Blastomycosis may be impossible that is why docs and vets need to consider, always, the possibility that even given negative test results from one form of testing may not mean a person or dog does not have it.
What I am now concerned about given how this disease is such a trickster to diagnose and to exterminate is how and when to cease treatment.  I appreciate the info about testing your dog Chad's temperature, this is something I will watch in Ted as we make the decision to take him off of his Intra in the future.Although, as long as he is tolerating the meds I think I will treat it with overkill and keep him on for at least 9 months.
We lost a dog to Blasto 20 years ago and I know at least two people who have died from this disease, diagnosed via autopsy. It is not rare and it can be deadly.

[thiskidsdun]

Carol as far as the "pulse method" what my vet and I worked out was a very slow decrease in the itra.  We did this after the first year and nine months because the first time we took him off the blasto even though the antigen levels were zero, the blasto re-appeared almost immediately.  What we did as first go to giving him the full dose every other day.  At first when we started this we could see symptoms beginning to return within the first week or two.  When we saw symptoms or any increase in temperature (within reason not .6 degree but up to 102 or 102.5 as Chad is generally at 101 when he is normal) then we would go back to the full dose every day until the temperature decreased and they symptoms abated.  Then back to every other day.  Once he was tolerating that with no increase in temperature or any indication that any symptoms were returning we went to every third day and followed that same concept -- back to every day when we saw any increase in termperature or symptoms (at this point we were not seeing any symptoms but would still see increase in temperature).  Once he was tolerating this we went to 50% of the dosage every day and again back to full doses if there was any cause for concern.  Then down to 1/2 dose every second day and so on.  We also put him on some immune boosting supplements.  The idea was to get his own immune system to start fighting hard against the blasto and take over at least some of the battle because obviously we don't want him on the intra for eternity.  Seems to be helping tremendously because he has now been off for over 14 days (though will be back on again on Monday - ish) and is showing no symptoms though slightly raised antigen levels.  It is somewhat nerve-wracking and you have to watch carefully but I believe that this has really helped.

[thiskidsdun]

Jen, my vet showed me research that showed that in almost every single case of human blasto where there was a dog in the house the dog was diagnosed with blasto before the human case.  Can't for the life of me remember where it was because it was now several years ago.  He has also cautioned our family to be aware that we can be infected and to watch ourselves for signs.  As to "human" doctors - they do not listen at all.  My husband ended up on life support shortly after our dog was diagnosed - when I told his doctors that our dog had blasto and maybe they should consider it they definately rolled their eyes.  Wasn't blasto but I do think that doctors should not be so quick to write it off, especially where there is obviously blaso in the area.  Guess in general anyone who has a dog with blasto should watch themselves and their family for potental symptoms and not take no for an answer if you doctor ignores your concerms. 

[evayola]

What you have going on with your saint chad sounds almost identical to my saint, marge. She has now been on fluconazole/itra for 2 years. The poor thing, she is 4.5 years old and half of her life she has been on medication. When seeing our holistic vet we were told that we will be haunted by blasto for the rest of Marges life. Is it true? I dont know. I would love to think not. We currently have Marge on 600mg itra daily. After about one more month we will be scaling her back to every other day and then every two days. With Marge, it wasnt that her antigen #s were getting higher at all. She has stayed at the same negative #s for over a year now. The reason that we are treating again is because once we take her off the meds she starts chewing on the pad of her paw and you can smell the yeast coming from it. We are pretty sure that the bone has blasto lodged pretty deep. When you say that Chad has bone involvement where did you see it and how was he reacting to it? I pray that one day my baby can go off her meds and just be HAPPY. We continue to check her kidney/liver functions every 3 weeks. So far so good. We did have one test that showed elevated kidney #s however we were able to get them back down to her "normal" range. Thank you so much for sharing your stories, it gets my mind racing. I hope that what we are doing is going to get that blasto monster.
Eva

[Wilson3]

sometimes I think that if they `warned people to much they put a scare out there kind of like with the H1N1 deadly for some
the amount of people that come through teh ER at work "thinking" they have it because of the scare on TV
people panick when H1N1 first was announced on TV our hospital made the news the line to get into the Er was out the door down the street and around the corner 2 1/5 hr wait to just register

blasto is so unpreditable here today gown tomorrow back in a month
I also feel it is not so "rare" any more because man is now disturbing the land more then ever. They are destory the land,building where ever then can the spores become air borne
People want to live but the river or lakes now first the want the big cities then oh what about country living I am guilty I love living 3abotu 4 blocks from lake michagan so I take the risk we love camping once again the risks are there

also they say a dog that has a stronge immune system can have blasto for very long if not all its life time there immune system keeps it at bay they will have it and we will never even know,until the immune system gets stressed
 
way to many "IFS" with blasto so I think they want it kept quite until they know more  and look at the drs. now adays. They can hardly speek the lang here so what do they really know

I do feel here anyways that the vets and people drs. are becoming more aware that yes blasto is not so rare any more I wish they would in other places


Chad was VERY lucky his vet new about the pee test with it being so new then.

and very lucky to have you also!

wilson was tested many ways for blasto
and really the main way we watched him was buy me being with him and watching how he was acting and just really knowing him
blood tests to see how much his white blood count was fighting once it was down he was on treatment 2 more months.
I would think using a few different ways of monitoring and testing is all we really have now. They have come SO far since Wilson was sick.
I believe in that they will even improve more. I have read in one of the studies done here in Wis. that yes the dogs are our canaries to this so they are coming along slow but they are
i also think everyone on this board has had somthing to do with the drs and vets doing studies they see our fight for our loved ones and them fighting and the great DRs. see this and one day blasto will not be so scarey for us

just my thoughts

this is really good food for thought as they say
wilson3

[thiskidsdun]

Eva - Chad and Marge are indeed twins.  He is just over 4 1/2 years old too.  We found him dumped along a highway in VA with parvo (the rest of his litter mates were there too though already dead).  As to the bone involvment you can see it on an x-ray.  My vet has taken x-rays of the affected areas throughout the treatment to monitor progress.  Baseline x-rays were taken of the affected area (where his hind leg swells) when he was first diagnosed.  You can see the blasto as the bone has a spiderwebbed look where the infection is lodging (perhaps not the best explanation but that is what comes to mind).  As progress has been made, you can see the bone seeming to repair itself.  For Chad it is easy to find the spot as he had severe skin lesions and swelling in the leg where the infection is lodged in the bone.  Hope that helps a bit.  When he was younger (before diagnosed) he had random incidents of lameness every few months or so of very short duration on that leg with perhaps very slight swelling but not always.  It was always resolve in a day or so and he would be back to 100% so we wrote it off as "growth pains" or just over-exhuberant playing.  In retrospect, it is obvious that the blasto was there for some time and he was fighting it off.  I imagine had we known or suspected that something more was going on back then we would have had a much easier battle with the blasto.  When Chad was first diagnosed, my vet also told me that many dogs have at least one relapse and sometimes more before the blasto is successfully eliminated from their system.  I guess I have always expected this would be a long-term thing so it has not been a big surprise to me.   I actually am feeling pretty okay right now because this re-occurence is so, so much milder than the last one that I am really hoping that in another year or so Chad might actually be blasto-free. 
Terri   

[carolh]

Thanks for explaining the pulse method.  Best of luck to Chad and Marge,  Kristin is right.  These dogs found their saints!

Carol