new antifungal medicine, aggressive treatment for Mika ??

[carolh]

Hi Folks,

Had a chat with our vet yesterday.  He said there is a new antifungal on the market, even more expensive (sorry, I didn't get the name of it).  He said the good news is that when that happens, the "old medicine" such as itracvonazole, drops in price.  Hooray.  THought you would like the heads up.

We talked about putting Mika on ampiterrible.  Kash, I know you said you thoguht this was a very good idea when a dog first starts getting treated.  How about almost a year into treatment?  He also suggested we up her itraconzaole dosage to 300 or more a day.  Eva, I know this is working for Marge (congratulations to you and Marge.  You deserve every bit of good news you get!)  Mika goes in for routine check up, liver/kidney function tests in a  bit over a week.

Any thoughts, suggestions on upping the amount of medicine we pump into little Mika?  ANy input appreciated.

Thanks, Carol

[evayola]

Amp b is an extremely strong drug so please do your research and make sure that you are 100% positively comfortable with it. Marge did one treatment of it and was knocking on deaths door. I know others have had good luck so I am not saying it doesn't have its benefits but for us the chances of Marge passing were very great if we continued with it. How much does Mika weigh? Marge is at 155 and was on 600 mg daily for 3 months which is a high dose. Then we did her bone xray and reduced from there. Do you have any idea where this blasto is? Lung, bone, eye? Its very interesting to me that her numbers are so high but you haven't pinpointed the location of it. I think somebody did mention before the new antifungal coming out but don't remember who it was. Let us know how Mikas appt goes.
Eva

[carolh]

Hi Eva,

Thanks for your reply.  Mika is 45 pounds.  The blasto seems to be centered in her left eye (now her blind eye).  We haven't done a full body check but there is clearly no lung involvement, no lesions, no limping.  It could be hiding in a bone somewhere ??  She gets the 200 of itra plus a bit of itra in her eye salve that she gets twice a day.

I went on the human blasto side and read that ampiterican B can be hugely painful to some humans and that some people apparently are allergic to it.  Wow, I hadn't known that before.

I'll let you know how her kidney/liver functions test out.

Carol

[Kash-]

My Knighty did fair well using Amp-b.  However, there are several additions to that.  First of all, I've been told that amp-b + itra is good for breaking the high fever that often comes with the onset of acute symptoms.

I don't think anyone would argue that  Itra takes a while to build up an effective dose in the blood to start killing off yeasts.  Amp-b, being an IV drug starts at the time of administration.  I've also been told that both drugs together have a synergistic effect.  Two pronged attack, so to speak.  Also with the addition of Itra, a lesser amount of Amp-B can be used.  Amp-b is metabolized by the kidneys, Itra by the liver, so that's in our favor too.

Our routine was to deliver amp-b every other day, and then on alternate days, test for kidney functions.  Testing must be done, regularly, consistently and constantly.  We ran this therapy for about 7 doses of amp-b, on a schedule of 10 doses.  A full dose therapy of amp-b would have been more like 20 doses. 

Knighty's fever broke after about 2 weeks and the amp-b treatments were beginning to show.  The IV had slipped out of the vein and a large bolus of saline+amp-b was deposited under his front leg's skin.  It ulcerated and was pretty ugly for a long time.

I can't say if amp-b would work in your situation.  I do think it's a good and valuable therapy for dogs late along the diagnosis curve and close to, well, you know what happens to late Dx'ed dogs.  Knighty was a very strong and healthy dog when this happened, he didn't have any other health issues, he had lots of mental and physical reserves.  I think this is probably what helped him as much as anything.

You've got a complex situation.  Talk to your vet.  Bring up Amp-b and see what they say.  Thinking it's a miracle or ruling it out off hand, based on a few anecdotal comments is probably not the way to go.  Get a real, live vet's opinion.  Itra is no doubt preferred.  It is tolerated better, but it's no easy thing either.  A dog's underlying health issues, age, fitness and probably tons of other things should be dictating what therapy is right for you.

I can tell you that a coworker was treated with Amp-b+Itra for blasto just a few years ago. I think it was 5 years ago in Marquette Michigan.  So I can't see how Amp-b should be lumped in with leeches and other medieval medical practices. (Although in the U.P. that might be cutting edge!    )

It's my opinion that amp-b is not necessarily worse than Itra at all.  Both drugs are harsh should be given respect.  The long and high dose of Itra flaked out Knighty's Liver enzyme numbers for the rest of his life.  They never really totally rebounded to the "normal" range.  Let's face it, If we were fighting cancer, these drugs would be called "chemotherapy".  Hell, they are chemical therapies, therefore they are chemotherapy, just for something else besides cancer.  Sometimes I think that we all think of Itra and a benign miracle drug.  Yes, it does save plenty of dogs (humans too probably) and the result of not taking it is certain death, so just about any side effects are considered "good".  Yet every other post here is "how do I get my dog to eat during itra therapy?"  We can all list off plenty of crappy side effects for all these drugs. 

Wish I had a better answer for you than all that crud above.

Kash

[Wilson3]

Carol that is such a hard choice .. for me though I would not not use it but that is me
 everyone I know that did use it the dog did not make
Wilson was also in top shape! he was winning at frisbee competitions, agility,fly ball and in herding there was nothing stopping him he loved it ,only blasto could stop him for awhile
( reason why they think it took so long for it to really take hold of him)

Wilson weighed around 50 to 53 pounds the highest dose that they felt was safe for him was 175mg which he started at 100mg 2x's a day for 10 days (they really only wanted to do it for 7 days but I begged for a few more days hoping the higher dose would get into him faster/attach faster the vet made it clear no more then 10 days to high of a dose could kill him also so after that went to 125 mg for 3 months then he seemed to be staying /not improving so increased to 175 mg but they would not go any higher  they did say that maybe we would have to change the type of meds he was on but the increase worked

does the vet or you see any improvement since Mika started treatment again? I now that at work they do not like to use the amp-b unless they have no choice /not responding to itra

it is old school they say to use it but you know sometimes old school is best do not know
I think Teddy's family used it  on the humans and it worked I'd have to go back and look

kash is right talking it over with your vet is best

sit down right out the pros and cons of an way of treating
you would know within the first few days i would think if not to use it again but it may be to late  very tuff call

sorry not much help
wilson3

[carolh]

Thanks, Kash and Kristin for your replies.  Good stuff in your messages.  Yes, I will definitely talk to the vet.
Kash, you made SUCH A GOOD POINT re this itra really is chemotherapy.  You're right.  We do think of it as benign.  Every time I talk to vet, I ask him, mostly to remind myself, "This will shorten her life, won't it?"  It's my way of trying to stay real as Mika is symptom free.  Actually, it's that that causes me to think perhaps we have to be more drastic because Mika has been on this high dose for just under a year!  I can see from Eva's response and dosage for Marge, and Wilson's response and doseage for WIlson, that she has been receiving an extra high dose (200/day; she is 45 lbs) all this time.  Still we're not seeming to lick the disease.  She is doing well, never experienced loss of appetite, loss of energy, no lesions, no spread to the other eye.

Kash, the UP is doing just fine.  So beautiful.  And I would guess your vets are as adept at treating blasto as almost any city vet -- same as here in NW WI.  They see lots of it.
Carol

[evayola]

Carol,

I know exactly what you are going through. My vet was told by the leading blasto specialist in the us that the blasto cannot hide in the eye once the retina is detached. If I were you, I would be looking to see where else the blasto can be?! For Marge, she let us know where the blasto was by licking constantly which lead to the bone xray of her leg. The blasto can lodge itself so deeply somewhere that it can be a bear to get rid of. Have you tested Mika again with miravista? Being on such a high dose I would think that it would be on its way out. Have you thought about maybe seeing another vet for maybe another course of treatment or just another pair of eyes? My vet referred us to a holistic vet who also does traditional medicine and she was very familiar with blasto. Hearing her take from the traditional side and also the holistic side made sooooo much sense. These herbs that she put Marge on were like a miracle drug I swear. Marge was on them for about 2 months and then switched to another set of herbs. The vet told me that because blasto thrives on damp heat we needed to get that out of her systems so essentially cool her down. She was put on quin yin tang (sp?) which is meant to cool the blood. We also were to change her diet to chicken or turkey since they are drying meats naturally and to stay away from warm meats (duck, venison, lamb). We also have to feed her veggies everyday to help keep her immune system running strong. For a blasto dog she recommends brocolli, cauliflower, spinach (marges fav), sweet potatoes, green beans, or even green leafy lettuce. All I do is buy frozen and warm in  the microwave for a few minutes and then I also warm water for her and add that to her food. It has done miracles. She is so much more comfy now! Theres my two cents. Hope they help.

Eva

[carolh]

Thanks Eva,

Since you wrote about your holistic vet, I've been warming Mika's food (and your suggestion to get a meat thermometer was a good one as she is VERY sensitive to anything more than the most slightly warmed anything).  I like the veggie component.  Eva, I'm not sure how to go about finding where else to look for the blasto.  Just do a full body panel of x-rays?  WOuld that pick it up?  I would love to talk with your holistic vet, even to bring Mika to her if possible.  I trust my vet up here very much but he is pretty traditional.  I think I wrote that Mika seems the opposite of Marge in that she is showing more cold than usual rather than more warm.  Usually, even though she has not much of a coat, the sub-zero temperatures have not bothered her.  But lately, she's showing a certain eagerness to end walks fairly early on very cold days and when I cover her with her little blanket, she doesn't get up and move right away -- even sometimes stays with it over her the whole night.  ?? 

THanks for your support and advice.  The four animals go in for checks this coming Friday.  As soon as we learn anything, I'll let you know!
Carol

[evayola]

Where do you live? It may be worth the drive to see my holistic if you aren't terribly far and Mika is good in the car. My vet is in Schaumburg, IL so maybe map it. The initial consult is very lengthy, something like 2 hours. Dr Mitchell Knollwood Hospital for Pets. Look it up. Let me know what else I can do. I would do xrays if I were you. Yes you can see the blasto on xrays, I have seen it with my own eyes.

[carolh]

Hi Eva,

Thanks for info.  Yes, I'm far from Schaumberg and right now have car issues (oh no!  I bought the most reliable brand just to avoid these car issues as I live out in the country).  But once I get another car (probably end of March, April), I'll be up for a trip.  Mika is okay in cars.  She gets bored but she'll do fine.  So we'll get full body x-rays.  We need to know exactly what we're fighting here!
Thanks, Carol

[evayola]

How is Mika doing now???

Eva

[carolh]

Hi Eva,

Thanks for your interest.  Here is what the vet recommends.  Her test came back fully normal -- no kidney or liver problems.  He said knowing exactly where the blasto is doesn't help anything (but he disagrees that it would not still be in the blind eye).  He recommends that we wait a few weeks as we so recently did the Mira Vista test, take another Mira Vista test then and see if the antigens are declining.  If so, he thinks we should keep on keeping on as we have been... only this time, stay on course until we get a fully negative reading from Mira Vista (he has three dogs who just recently achieved that!  I'm jealous and so happy for them.).  If her numbers are not significantly lower, then he recommends we up the itra.

I've added spinach and brocolli to the dogs diets.  Mine are not as pleased with the additions as Marge seems to be but they'll eat it.  I'm also giving Mika cut up apples (a bit more to her liking). I think I will wait until the Mira Vista test in a few weeks and if those numbers are not way reduced, will plan a trip to Schaumberg.  I thank you SO MUCH for that contact.  How do you feel about the vet saying it is not useful to find where the blasto is now?  I think he may be sensitive to the size of our vet bills which are growing like topsy.  Meanwhile, Mika continues to be high-spirited, energetic, no loss of appetite, no lesions.
Carol
 

[evayola]

I am so glad to hear that Mika is doing well given the circumstances. That is great! Even when Marge was at her worst we thrived on seeing her physical improvement. Given that Mika is handling the meds well, even better.

I understand what the vet is saying about not needing to know exactly where the blasto is BUT for me, it would give me great piece of mind knowing what I need to look for in the future in case of a relapse. Also, I would like to know if it is infecting a major organ. All in all does it matter? Thats an answer only you have. About the eye, I was only relaying what the number one blasto specialist in the us said at a medical conference. She said that in eye that have a FULLY DETACHED retina it will not and cannot hide in there. I am not a vet and have had no medical training so for all I know, I am wrong.

Homer definitely didnt take a liking to the veggies like Marge has. He is more picky with what we feed him than she is. She is like a dumpster, she doesnt say no to anything the first time. Ours love apples but we were told not to overdo it because of the high sugar content. We took Homer in to the holistic vet as well for the first time and he has started his herbs for his tummy and his behavior problems. The vet felt something wrong with his legs so we took him back to our regular vet for xrays and found that he has soft tissue damage in his knee so he needs to rest now. Also found out our maine coon cat has hip dysplasia. Its been a rough week.

Keep us posted on Mika! Give her a hug from us.

Eva

[Wilson3]

I am so glad Mika and Marge are both doing well! 
It has to be very hard treating for this long!
Good thing they have fighters for owners! 
wilson3

[carolh]

Thanks again Eva and Kristen,

It is SO hard when we get contradictory information.  I like your point about having a baseline in case of relapse -- knowing where to look.    I'm SO sorry about your Maine Coon cat having hip dysplasia.  Shows what I know.  I didn't think cats could get that.  Wow, this holistic vet must be something, able to spot that soft tissue damage in Homer's knee.  Phew.  Good thing to know about!  (Our Hale Bopp has had three ACL repairs -- one didn't work out well, hence three on two knees) so we're sensitive to knee problems.  Good news is that there has been no recurrence of problems in nine years!  Can anything be done for a cat with hip dysplasia?

Kristen, thanks for your kind words and always present support.  This forum has some mighty fine, caring people!

Carol