Fluconazole Treatment

[jefndebbacon]

Hi, our Golden Retriever Winter, was sick since Thanksgiving of 2009.  She was put on  antibiotics, steroids and nothing seemed to help.  Finally, when sores broke out on her body in January, our vet suggested that she may have Blastomycosis.  A smear from an open sore was sent to Marshfield, WI clinic, and it was confirmed that she had Blasto.  Our vet put her on Fluconazole, 150 mg, 2x day.  Her sores have healed, however, she still has a cough (not nearly as bad as in the beginning), a fever, and she shakes her head.  She prefers to sleep in an unheated dog run that leads to an outside run.  As we are in WI, this is a very cold spot for the winter, but it is her preference!  We are on our 2nd 45 day treatment of Fluconazole, plus a small dose of Prednisolone to keep Winter comfortable and to help her eat.  I have noticed small improvements, but nothing that makes me feel like we are out of the woods.

Does anyone have any suggestions?  Should I be noticing a drastic improvement, or should I be happy with small steps?  Was she diagnosed too late?

I am happy to have her eating, and she is starting to gain a small amount of weight.

Any help would be greatly appreciated.

Thanks!

Debbie

[carolh]

Hello Debbie,
So sorry to hear about Winter.  That her lesions have healed and she is eating, that's wonderful news.  No one can guarantee Winter will make it but these signs are very hopeful.  One thing you should know, Debbie, is that 45 days of treatment is not realistic.  Six months typically is a mionimum.  Perhaps the vet meant six months at 150 mg twice a day and then go to a different dosage? My Mika is going on a year of treatment.  This is one weird disease and no one ever knows how it will progress.  At the end of treatment period, you should consider getting a Mira Vista test.  This is an analysis of urine for blasto antigens.  It's a pretty good indicator of whether treatment should go on or not (though not foolproof).

One person on Blasto Forum, Eva, has won over a tenacious case of blasto.  She treated her dog a long time with antifungals and also went to a holistic vet who noted the significance of her dog's desire for cold.  Read Eva's reply to my recent posting about new antifungal medicine.  THere is a load of good info in the responses Eva, Kash and Wilson sent to me.
I'm in WI too, in Hayward. We're a hot spot.  The only good thing about this being a hot spot is that our vets know how to spot blasto and how to treat it.  You should pepper your vet with questions (length of time to treat, dosage, signs of improvement to look for). You need all the info you can get.
Congrats for finding this forum.  The folks here are very helpful.
Carol

[evayola]

Hi Debbie,
I have a few questions...

Have you had a chest xray? Does Winter show any blasto in her eyes? How much does she weigh? Why did your vet suggest fluconazole?

I am asking these questions because if Winter is still coughing and she is not presenting any signs of blasto in her eyes then itraconazole may be a better drug for her. We started Marge off on the fluconazole because she was going blind in one eye and the fluconazole is better able to penetrate for central nervous system involvement. What concerns me about Winter (obviously I am no vet, just spent nearly 3 years with this dreaded disease.) is the head shaking. It is so fantastic that her sores have cleared up and that she is eating. A lot of us here spent 45 days just force feeding our dogs. Like Carol suggested, arm yourself with a list of questions and ask away. The vet works for you and Winter and too many dogs have died because of the lack of communication/interest from the vets. Everyday that I had a question for my vet I would write it down and either call her or wait for our follow ups.

Marge too would seek very cool places because there is so much damp heat going on inside of her that she needs to cool herself down. Maybe you can keep your house cooler than normal so that she is not spending time by herself? When she is sick you want her to think things are as normal as possible and nothing is her fault. Do expect to be on treatment for at least 6 months and maybe longer. Marge has been on treatment for 2.5 almost 3 years.

I highly recommend doing the miravista urine test to see how much blasto Winter really has in her system. Hang in there and if you can think of any other questions, ask away.

Eva

[Wilson3]

So sorry to hear about Winter! Glad to hear though that they diagnosed it faster then some!
Carol and Eva are right you really never do know when it comes to blasto. This site has great info on it and many many people that care and willing to help in any way!
Eating and lesions healing up is a great sign but the head shaking concerns me very much.
Itra does work better if there is no eye involvement but some have had very good luck using the fluconazole
blasto is very slow healing for the dogs Wilson was on treatment for 8 months (almost 2 1/5 yrs. free of the nasty stuff now  )
every week we would see very small amounts of improvement
I agree wright down all your questions I mean all of them (there is no stupid ones) I also agree the vet is working for you guys and needs to understand that. The more you ask the better you will feel and understand what is going on with Winter.
Please ask the vet about shaking head it could be as simple as the dose may to high 

Stay strong and positive like
Eva said keep things a normal as possible in the home.

where are you from? How long has Winter been on treatment?
you guys will be in my thoughts
wilson3

[jefndebbacon]

Dear Caro, Eva and Wilson3,
Thank you so much for your responses!  I have never had to fight something like Blasto!  I have had dogs with cancer, but nothing like this!  We are in Eagle, WI.  We have a 100 year flood plain behind our home, with a slow moving marshlike stream, but we have been here for more than 20 years, and none of our dogs have been diagnosed with Blasto. We also camp in Hatfield, WI on Lake Arbutus, which is part of the Black River.  Also, I walk our dogs along the a tributary called Jericho Creek that feeds into the Mukwonago River (where we also walk) that feeds into the Fox River.  Who knows where Winter picked up this fungus?  I noticed that we had more than an unusual amount of mushrooms this spring and summer and fall.....

We started Fluconazole on Jan. 4, 2010, after trying several antibiotics since Thanksgiving.  Winter would get better, then relapse.  Finally with the Marshfield clinic sending back a diagnosis within one day, we were sure that it was Blasto.  My vet said that her lung xrays were clear.  Plus, her blood smear did not show the yeast from Blasto, so glad that I spent the extra money to have the smear sent to Marshfield clinic, or we may still have been undiagnosed.

My vet chose Fluconazole, as she has had good success with it.  She has been with us every step of the way, and cried with us when Winter showed signs of improvement.  We seem to go up and down, on a roller coaster of coughing, not coughing, fever, no ferver, feeling better, then not.  Hiding (as Goldens do) then coming to be with us.  But lately, she is hiding more than not, in her COLD dog run, and she is panting and shaking her head. Plus, she has 2 new bumps on her body. She is eating, but the weight gain is slight....

Her eyes seem ok, but what should I watch for?

What else should I watch for?

Is Prednisolone a good or bad thing to be on?

We take small walks, but she is compromised in her breathing. 

She is definitely not the dog that she was.  She is 11, so I am thankful that we have had her for this long, as Goldens do not live longer than 10-12 years on average.

Thanks all for your input!

I am glad that I found this site!

Blessings to all of our beloved animals,!

Debbie

[Kash-]

I don't really have anything to add, but to reiterate the above good advice;

Itraconazole

Mira Vista antigen test.

Second 45 day therapy?  Twice that would not be uncommon. 

You asked about pred.  Generally, pred can also buff up the fungus as well, so it can be contra-indicated.  But, as with so many things, often the good it can do for the dog outweighs the contra indications.

My own two cents would be to advise that you keep the dog in the warm, despite their inclinations to the cold dog run.  What calories you do get into your pup should be spent on fighting the good fight, not burnt to stay warm.  But that's me.  In general it sounds like you're working the program correctly.  Flucan Vs. Itra is pretty much a vet's choice based on many factors that we might not know about.  It's probably good to bring up during your next visit, maybe you'll get a good explanation why you're on Flucan therapy instead.  I'd bring up the Mira vista test too.  Sure, you've got your Dx, But MV might be a good way to determine antigen levels and see if you've got the blasto on retreat.  Many people here use the MV test to determine when enough is enough, when it comes to ending the anti fungal medicine.

[jefndebbacon]

Thanks Kash. I will be speaking with our vet tomorrow on our weekly telephone consultation. Winter was worse this week, hiding, panting, shivering, small bumps on body, just not herself.  I am not sure if we should change meds, or stay on Fluconazole for a while longer. It is difficult to watch a dog suffer.   I know there is no quick cure, I just don't know what is normal and what should be considered abnormal?  I have no past experience.  I will ask the vet many more questions this time around - thanks to everyone's input.

Winter is 172.8 pounds.  She lost about 8 pounds since November, 2009.  She was diagnosed with Blasto on 1/4/10 and has been on Fluconazole and Prenisolone.  She does eat now, not at the beginning, sometimes reluctantly and may not finish all food, she goes for walks both am and pm, but has been compromised in her breathing, so we don't go too far....  She mostly seeks the shelter of cold - today laying in the mud/snow outside of her dog pen for hours.  The fever has not subsided.  Any ideas on how to get the fever under control?  She still coughs, not as bad as before meds, and still shakes her head like she has an ear infection. Ears are clear. Eyes seem to be clear - what should I watch for with the eyes.

Thanks.

Debboe

[evayola]

172 lb golden retriever! wow! Based on that weight, it seems as though your dosage is too low. Marge weighs about 150ish and she was on 300 mg 2x daily to really kill that blasto.

If Winters lungs are clear I would think that there should be no coughing and also no need for the prednisone. Have you seen the chest xray yourself? Where is your vet saying the source of the blasto is? Is it possible to bring Winter inside and keep her comfy? I would also recommend asking for something to break the fever. I had Marge on Deramaxx which is a pain reliever but helped break her fever. We were also told to put cold compress on her pads of her paws and her tummy to keep her cool. As far as the eyes go, you would notice a change in color of the actual eye. The shaking of the head is very concerning to me and I would bring this to your vet asap! I do not want to alarm you but the blasto can reach the central nervous system which can cause the head shaking. Again I am not a vet but just speaking from others past stories and my own experience. There is nothing "normal" about this disease and everyones case can be different. If I were you I would put a rush on that phone call and maybe bring her in for another visit. Has she been drinking fluids?

[carolh]

Hi Debbie,
My dog has blasto in the eye.  What we noticed was that she was holding her mouth strangely and seemed as if eating hurt her.  So we rushed her to the vet thinking it was a problem with a tooth or a displaced jaw.  Turns out muscles around the eye are also attached to the jaw.  If only it had been a bad tooth!  It was blasto.  Vet pointed out that you could see the symmetry of one pupil was off, and that's where the blasto proved to be.  We gave Mika painkillers, previcox, for one week at vet's suggestion.  When we stopped, she skidded into pain fast so we kept up the painkillers for almost a month.  After that, she was fine without them.
You've had 20 years of luck given marshy area and living in Eagle River.  Eagle River is a hot spot.  Your vets should be knowledgeable about the disease because they probably see plenty of it.  Every place you mentioned you take Winter is a hot spot. 
Please let us know what your vet says about the head shaking, the hot/cold, the pred, the flucon versus itraconazole.  All the information we can add to this board helps us and helps the next person who is entering the fight with his/her dog and blasto.

I detected a bit of resignation on your part (not wanting Winter to suffer and Winter's advanced age).  You will know how much you and Winter can handle.  This is not a fight for the faint-hearted.  You should know that many people here have fought through some tough times with their dogs when they wondered if their dog was suffering too much --- and their tenacity has been rewarded by a recovered healthy dog.
Good luck to you and Winter.
We are pulling for you.
Carol

[Pando]

Hi Debbie...sorry to hear about Winter.  Miracles do happen with our pets, but you have to go with what is in your heart.  It will be a roller coaster!  To give you some hope, here is Pando's story...

Our dog Pando was diagnosed Oct. 2007.  Quick history...he had symptoms in his eyes, lungs, skin lesions and joints when he was finally diagnosed.  He was initially started on itra, but then switched to fluconazole, prednisone, and flurbiprofen (eye drops).  He is still on 100 mg of fluconazole today!  He gets a complete blood count and organ function blood work every 3 months. He just had it done last weekend and everything looks great!! Hopefully in June (if his eyes look as great as they did in Dec) they will finally wean him off of his meds.  He also had to go through a surgery to removed a saliva gland and a mucocele removal fall of 2008 (b/c it was infested with the infection).  The moral of the story is, that it may take some time to get the right dosages/right medications.  Don't give up!  I know I wanted to at times, but I look at Pando every day and call him my miracle pup!

Hang in there!

[jefndebbacon]

Dear All on this Website,

Today we put  our Winter to sleep. After x-rays yesterday which showed a huge mass on her lungs/heart.  Her x-rays were sent to a cardiologist, who could not tell if if the Blasto had penetrated the heart and/or lungs, without doing a MRI. She had progressed so fast from feeling much better to feeling so bad.  Our vet advised that if her heart was infected, and the mass burst, she could bleed to death., but it would be quick  However, if the lungs were infected, and the mass burst, it would be a slow and painful suffocating death.  Winter had deteriorated so quickly in the past few weeks, we did not want her to suffer any longer.  Today she could barely walk, could not go up 3 steps, and was just suffering.  My husband and I took off of work this afternoon, and spent time with her, short walk, petting/massage, chew bone, popcorn (her favorite!), and lots of love.  I cannot tell you how difficult this decision was.  We fought this from November. 2009, diagnosis on January, 4, 2010, and ups and downs from then until today, March 2, 2010.  I thank all of you for your input.

Deb

[Wilson3]

Deb
I am sorry.. never look back and truely know Winter loves you and is with lots of new friends young and free of pain
wilson3

The Journey



When you bring a pet into your life, you begin a journey - a journey that will bring you more love and devotion than you have ever known, yet also test your strength and courage If you allow, the journey will teach you many things, about life, about yourself, and most of all, about love. You will come away changed forever, for one soul cannot touch another without leaving its mark.

Along the way, you will learn much about savoring life's simple pleasures - jumping in leaves, snoozing in the sun, the joys of puddles, and even the satisfaction of a good scratch behind the ears.

If you spend much time outside, you will be taught how to truly experience every element, for no rock, leaf, or log will go unexamined, no rustling bush will be overlooked, and even the very air will be inhaled, pondered, and noted as being full of valuable information. Your pace may be slower - except when heading home to the food dish - but you will become a better naturalist, having been taught by an expert in the field.

Too many times we hike on automatic pilot, our goal being to complete the trail rather than enjoy the journey. We miss the details - the colorful mushrooms on the rotting log, the honeycomb in the old maple snag, the hawk feather caught on a twig. Once we walk as a dog does, we discover a whole new world. We stop; we browse the landscape, we kick over leaves, peek in tree holes, look up, down, all around. And we learn what any dog knows: that nature has created a marvelously complex world that is full of surprises, that each cycle of the seasons bring ever changing wonders, each day an essence all its own.

Even from indoors you will find yourself more attuned to the world around you. You will find yourself watching summer insects collecting on a screen. (How bizarre they are! How many kinds there are!), or noting the flick and flash of fireflies through the dark. You will stop to observe the swirling dance of windblown leaves, or sniff the air after a rain. It does not matter that there is no objective in this; the point is in the doing, in not letting life's most important details slip by.

You will find yourself doing silly things that your pet-less friends might not understand: spending thirty minutes in the grocery aisle looking for the cat food brand your feline must have, buying dog birthday treats, or driving around the block an extra time because your pet enjoys the ride. You will roll in the snow, wrestle with chewie toys, bounce little rubber ballstill your eyes cross, and even run around the house trailing your bathrobe tie - with a cat in hot pursuit - all in the name of love.

Your house will become muddier and hairier. You will wear less dark clothing and buy more lint rollers. You may find dog biscuits in your pocket or purse, and feel the need to explain that an old plastic shopping bag adorns your living room rug because your cat loves the crinkly sound.

You will learn the true measure of love - the steadfast, undying kind that says, "It doesn't matter where we are or what we do, or how life treats us as long as we are together." Respect this always.

It is the most precious gift any living soul can give another. You will not find it often among the human race.

And you will learn humility. The look in my dog's eyes often made me feel ashamed. Such joy and love at my presence. She saw not some flawed human who could be cross and stubborn, moody or rude, but only her wonderful companion. Or maybe she saw those things and dismissed them as mere human foibles, not worth considering, and so chose to love me anyway.

If you pay attention and learn well, when the journey is done, you will be not just a better person, but the person your pet always knew you to be - the one they were proud to call beloved friend.

I must caution you that this journey is not without pain. Like all paths of true love, the pain is part of loving. For as surely as the sun sets, one day your dear animal companion will follow a trail you cannot yet go down. And you will have to find the strength and love to let them go. A pet's time on earth is far too short - especially for those that love them. We borrow them, really, just for awhile, and during these brief years they are generous enough to give us all their love, every inch of their spirit and heart, until one day there is nothing left.

The cat that only yesterday was a kitten is all too soon old and frail and sleeping in the sun. The young pup of boundless energy wakes up stiff and lame, the muzzle now gray. Deep down we somehow always knew that this journey would end. We knew that if we gave our hearts they would be broken. But give them we must for it is all they ask in return.

When the time comes, and the road curves ahead to a place we cannot see, we give one final gift and let them run on ahead - young and whole once more.

"Godspeed, good friend," we say, until our journey comes full circle and our paths cross again.

~ Crystal Ward Kent

[jefndebbacon]

Thank you Wilson3 - what a beautiful story of love and devotion.  My heart, and Winter's, is with all of you...  Deb

[carolh]

So sorry, Debbie,

I have tears in my eyes as I read your last message.  Thanks for sharing all the information you did with us.  I loved reading that you and your husband could take an afternoon off to be with Winter and that Winter got the favorite popcorn, lots of love and attention.  I KNOW Winter appreciated that! (We adopted a 10 year old "junk yard"dog who was with us for two years.  Mort's favorite was greenies so he got one on what we knew was his last day.  He is buried on our land with that greenie in his mouth and we still smile when he think of him grinning as we gave it to him.  I hope you will be able to smile at the lovely afternoon --- and the lovely life -- you gave Winter.  What a difficult decision!  You fought the good fight, so did Winter.  Winter was lucky to have you and your family!
Carol

[jefndebbacon]

Hi Carol,

Thank you for your message and for sharing Mort's story!  Made me smile!  Hope your other dog is doing well?  We still have our 3 year old black lab mix, our first shelter rescue, so the house is not totally quiet without our Winter.  I wish Winter could have been diagnosed sooner, maybe that would have given us a chance. But I feel peace in that we did not let her suffer any longer - there are signs when you know that enough is enough. She was the most beautiful, loving, trusting, sweetest dog that we have ever owned - that's for sure.   And we miss her....

Good luck to you and to others on this site with the battle against this dreaded fungus disease.

I will be praying for all of you!

Debbie