brooke testing for blasto

[amy_in_mna]

Hi!  I posted yesterday about the best way to test for Blasto. 
Brooke my lab has many Blasto symptoms, though she was tested a number of weeks ago (aspirate of cyst was "looked at") and based on whatever kind of test that was, it was determined that Brooke did not have blasto.
Back at the vet today, armed with info, a urine sample, even the required lab forms for Miravista.
If you are interested, I have put a history of this "illness" below

Current symptoms (seem to have started late Nov and are progressively getting worse)

lethargic (doesn't even want to get up to go potty)
lack of appetite/drink
drooling
shaking
lymph nodes that seem pretty big on and off
she feels physically tense/rigid when we pet her and also, you know that
ridge of fur along the back that some dogs raise when they are on "high
alert"?  Brooke raises that ridge (when she is not feeling well) often when
she has to go up or down the stairs or do any other moving.
lower eyelids really pull down/droop, lower eyelid mucosa visable and red/swollen
stiff limbs
acts like it is painful to climb stairs, seems unsteady on her feet, no
desire to "go outside" which usually gets her dancing around.
Also, seems a little uncoordinated?
seems fragile
there are more I am sure- the closer I study her, the more I see
**Brooke's symptoms seem to cycle.  She will be very sick for 3-4 days and then seems to feel better and will eat and move around better, have more energy, no drooling etc. for a week or so, and then back to feeling very poorly.

Vet visit today:
Vet was easy to convince to send the urine sample and she also wanted to
send a serum sample to another lab as well.  She was excited to learn about
the urine test for antigens.
We are the first truly possible case that our clinic has seen.  I think we
are learning right along with them.  When I initially started talking about
Blasto, testing and treating NOW, the vet was thinking she would need to
send us elsewhere and have IV antifungals (can't think of the med name
offhand).  I persisted with the Intraconazole and she went and did some
research and found that it is not the case- (IV meds).
Part of me thinks we should go elsewhere for care- but at this point, vet
seems to be allowing me to call the shots, so I will learn from those who
have been there and let her learn too.  Going elsewhere would be much more
$$ than I think my husband will go for.  I really can't stand the thought of
ending this for Brooke without a fight and I will have to fight whatever
this is she has with the vet we already have if my husband is going to stand
by us.


So vet visit:
High fever- 105.9
Brooke is down another couple pounds.  A good weight for her is about 68ish-
down to 55 today.  Vet found a icky looking sore spot near the back of her
mouth!  And we found a couple more lumps under her skin.  These lumps appear
and disappear- last time we were in she had some lumps by a shoulder that I
pointed out to vet- I have not been able to find them for a while and vet
could not find them today.
She got some subq fluids and a IM med for nausea.  Ran a urine (negative
aside from crystals)

Treating now for Blasto with ketoconazole (200mg 2x/day), Rimadyl for a few
days to help with fever and obvious pain, also using Fortiflora powder
(probiotic but has helped in the past get Brooke to eat- supposedly the U of
Minnesota vet school is using it to make food more palatable)
We did not start on itraconazole since by the time we actually had some in
our hands, the results of the tests would be in.  I was going to have to
purchase an entire bottle since the vet doesn't carry it.  I would rather
purchase the entire bottle knowing I needed to vs. on a hunch.  She also did
a little research for me concerning a compounding pharmacy- if it turns out
that Brooke is positive I think that is the route we will go- have to do a
little looking into that whole thing.  Hoping that the keto will be
effective if she is blasto positive until we can get some intra.
Now, if I can just keep the Keto down.  Brooke took some turkey (not much)
and some processed cheese (again not too much) but was done so I forced down
the med- we are now about 2 hours later with no vomiting. (I think the Keto is
maybe harder on the tummy?)  If she keeps it down, in another couple hours
we will try the rimadyl and see if we can't get her a bit more comfy. 

So, this is where I really need some help from all of you:

1  For the time being, is Keto a poor choice?  It was suggested by a friend that we might try Fluconazole instead as it might be less hard on organs and may also be better with CNS symptoms.  Or should I push for a rx for Intra NOW to fill online?

2  How can I get this girl to eat??  What have your sweet dogs eaten when eating is the last thing they want to do?  What can I do to intice her to eat?

3  Any supplements I might want to have on hand?  Do you all worry about their livers with these strong medications? 

4  What should I expect these first few days (if in fact this is blasto)?  I have heard that the first week is bad... and I thought things were bad now  : (

5  I will look at past posts concerning generic Intra, Spornax and compounding pharmacies- I understand that it can be a difficult subject here?

We are hoping that this is not Blasto, but in my heart I know it is.
I thank you for any suggestions, ideas, thoughts, wisdom you might have to share with us right now
Love
Amy in MN with Brooke

History of Brooke's illness since November 2009:
Brooke is an 8 year old black lab
Seemed fine prior to hunting season 2009
She hunted for 3 weeks in southern Minnesota this fall/early winter, hunted
a week in both north and south Dakota this fall/early winter.
We do use front line but she did have attached ticks this fall/early winter.
We are not really sure when this all started. Looking back it seems that
there might have been symptoms that were less severe in early November? but
as time has gone on they have become more pronounced.
We know she was not herself at Thanksgiving time with episodes of vomiting
and diarrhea and lack of appetite.
Then a day or two later she seemed fine (there may have been other symptoms
and we only noticed the obvious ones??)
Then a week (?) or so later her lack of appetite was back, so I made a
gradual food change thinking maybe that would entice her to eat?  She had
been on Canidae grain free and we changed to NOW (grain free) and she made
the gradual change and seemed fine for a couple of weeks and then went down
hill.
At this point (12/14) we brought her in to our local vet- Brooke had a fever
of 106, very lethargic, obvious lymph nodes, would not eat or drink, stiff
limbs/limp, loose stool, mattery eyes, she appeared "fragile".  Vet seemed
very concerned.
Vet did a chem profile (all values within normal ranges) a CBC with
platelets low, and a 4Dx (heartworm,lyme, E.canis and A phagocytophilum).
Brooke was neg for lyme but vet suspected Anaplasmosis (though did not show
up on the 4Dx, I think??) and put Brooke on Doxycycline (200mg every 12 h).
She also had sub q fluid and something for nausea (Vet thought all of the
drooling might be related to being nauseated?)
Two days later (12/16) I noticed a large cyst like deal on Brooke's cheek.
Brought her in and vet aspirated fluid out of it and looked at it "in
house".  Vet thought it looked like yeast and worried it was blastomycosis.
Reaspirated the cyst to send a sample to another lab.  Meanwhile put Brooke
on Clindamyacin along with the Doxycline.  At this point, Brooke did seem to
be feeling better.  Less stiffness, eating again, no more drooling, seemed
less "fragile", more alert/not as lethargic... so it was assumed that Brooke
had in fact had anaplasmosis (since she seemed to be feeling better after a
few days of the doxy).
Monday 12/21 we learned that the lab that ran the test on the fluid from the
cyst did NOT feel that Brooke had blastomycosis (cheers all around!)
Brooke continued on the doxy (discontinued the Clindamyacin) and she would
be fine for a week or more and then fall back into this funk of lethargy,
lack of appetite, loose stool( not watery diarrhea- more pudding-like),
stiffness, fragile appearance, drooling.  Would act like this for 3 days and
then literally overnight be fine again- but never really recovers to her
wellness level before all of this began.
Brooke became ill again on 1/5 evening(more significant that the last few
times), and we made another appointment with vet- this appointment is now
1/8 and of course overnight she snapped out of her lethargy and other
symptoms and was relatively okay- still went to vet:
She was dehydrated but fever free.  Had lost about 5 pound since last visit
(which was a redraw of fluid from the cyst).
Chem panel was still within normal limits and (though I don't have in front
of me) it seems that the blood work was more within normal limits than when
drawn 12/14.
When taking her temp, some blood was noticed so vet did an internal rectal
exam and found a little more blood/mucus(sp?).  Stool sample negative for
intestinal parasites.  Vet was beginning to feel that this might be some
kind intestinal disturbance - colitis for now and since brooke was somewhat
close to finishing the doxy, she had us discontinue it since it might be
adding to the intestinal trouble.  She put brooke on Metronidazole for 7
days and an antinausea medication for 5 days.  Brooke continued to improve
though nothing close to how she acted and appeared prior to the start of all
of this.  Now I did notice that it seemed Brooke was peeing way more than
usual- hard to really know if she is drinking more than seems normal- urine
seems a normal light yellow color.

That brings us to 1/8/10 where she went downhill again- same symptoms and to our vet visit today

[Kash-]

High fever, anorexia, yucky sores, lumps coming and going? 

My unprofessional, hundreds of miles away, internet diagnosis says BLASTO.

1) Asking us if Keto is a poor choice?  That's really a vet question, but I'll venture out on a limb here and bet that everyone answering will say, "Put that puppy on Itra!"

2)  How can I get this girl to eat??   Good question.  Do what every you have to do.  If she's not drinking, make sure to have the vet give a subQ bolus of electrolytes.  My dog only responded to being commanded to eat.  He never was a big eater at any time, but he did listen well.  Mostly... :-)

3) Do you all worry about their livers with these strong medications?   Short answer?  Yes.  My dog's liver numbers never returned to normal, but he did live seven more years despite the wonky liver enzyme readings.

4  What should I expect these first few days (if in fact this is blasto)?  It seems as if the anti fungal meds actually make the anorexia worse.  Also, once the yeast die off begins, it really seems as if the dog is getting worse as they flush out the dying yeasts.  Expect tears.  Expect to doubt if what you're doing is the right thing.  Be strong and be comforting.  Be a pain in the neck of your vet, if you're not getting what you need.

5  I will look at past posts concerning generic Intra, Spornax and compounding pharmacies-  Just shop smart.  Everyone here has different experiences and reasons for believing  that one of the other is better or worse.  Truth is, each case is so damn different that making any gross over-simplifications on the efficacy of any drug vs a similar compound is nothing but speculation based on a single case study and raw emotion.

You're paying for vet advice, I'd say take that over internet advice from someone who never has seen your dog.  Despite the fact that you give remarkably good history!


Good luck.  Let us know how things are working out.

[evayola]

I dont know if anyone can tell you what medication is the right choice for your dog but you should be able to make a good decision with your vet based on Brooke specifically. When Marge was first diagnosed we put her on itra since this is the new drug of choice. Marge also had one round of amp b (iv med). Marge did not respond well to the itra what so ever. I felt like she went downhill in a matter of hours. Marges eye got so bad overnight that we knew she was going to go blind. We switched her to fluconazole since it is better at penetrating the CNS and we didnt want that blasto moving to her brain since the tissue between the eye and brain is so thin. Marge did so well on the fluconazole. I do not know how the keto is processed but I do know that with itra you NEED to give the pill with fat. I would check with your vet about that with the keto because that may be why Brooke is feeling so hot. What we do is put the pill in a huge glob of peanut butter.

We fed Marge anything and everything when she was sick. It seemed as though if she agreed to eat something once she was not going to eat it again. We made her chicken, steak, ground beef, liver sausage, you name it. The vet agreed that we should feed her anything that she will eat even if it was pizza or cheeseburgers. I know it is not what we want to give them but they need calories so desperately. Keeping Brooke hydrated is KEY. We gave Marge pedialyte popsicles and I know some here have given pedialyte in a turkey baster. You have to be careful how you give it with the turkey baster so that she doesnt choke. The vet showed us how to give subq fluids at home so we were doing that everday or every other day depending on her mood.
The first week is in fact extrememly hard due to the fungus dying off. You may experience hacking and coughing from her if her lungs are filled. With Marge she was just very restless and could not get comfy. It was the peak of summer so we had to keep the house nice and cool for her so she could breathe easier.The best advice I can give is to stay positive. I know I say it all the time but these dogs really know how we are feeling. We spent many days just reading to Marge to make her feel better. You dont want to ignore her because then she will think that something is her fault. Keep your head up and please ask us any questions. I dont know what I would have done without everyone here!

Eva

[Jen]

   I agree with Kash & Eva - their advice is as good as it gets.  Keto or Itra, they both work.
Both need to be given with food.  As long as she's at least getting a good dose of an antifungal, either is a good start.  Then concentrate on Breathing, Hydration, Eating, Comfort - in that order. 
   Any worries about the liver can be assuaged by considering that, for one thing, while there is some risk, there's not a HUGE risk of damage from these meds.  For another thing, the liver can regenerate and heal to an extent, even if badly damaged.
 
   Blasto, on the other hand, is 100% deadly- never doubt it.  I lost 3 dogs because we didn't know what was killing them. Our neighbors lost 2.  During that time, I also contracted a respiratory infection and an arthritis that has almost crippled me.  It was almost certainly from an order of commercial mulch that I used on all 3 of our garden projects.  My mom has been debilitated from a fungal pneumonia as well.
 
   Dirtbike lived, and is a fat healthy fabulous hound, but only because she was diagnosed and treated quickly - and because I was lucky enough to find the good people here.  I used a compounding pharmacy for generic Itraconazole, and Dirtbike was treated for a little more than 6 months.  I was lucky.  We're hoping the best for you too.   

Jen