Locality: Cheboygan, Michigan
Medical Diagnosis of Blastomycosis?: Yes
Where Caught: We live on a lake in northern Michigan and our house is also near a marshy area of the lake and Timber would sometimes go down to that area and sniff around. Timber also like to bury and dig up bones in our yard, both in the mulch and outside of mulch. Timber also went hunting at a local bird preserve and he also went hunting in the upper peninsula of Michigan. Our street is surrounded by woods and I used to walk Timber each morning and he would run in and out of the woods. I do not know exactly where he contracted Blastomycosis, but I believe it may be in our yard somewhere.
Symptoms: Timber began with sneezing and coughing. I thought it was just a cold, but as the sneezing and coughing got worse, I took him to the veterinarian and he was put on Amoxicillin 500 mg and Chlorpheniramine, 4 mg. He did not improve in two weeks' time. Timber did not show signs of energy loss until he began to not want to walk as far and would stop and look at me and not want to go further on our walk. This energy loss took some weeks to develop. One night while asleep, I felt Timber shaking and I knew there was something very wrong because he just was curled up and didn't want to move. Timber was taken to the vet (emergency visit) at midnight on an early Sunday morning. It should be noted that Timber's left eye also looked abnormal, his third eyelid slightly elevated OS.
Treatment: On December 3, 2011, Dr. Howard did an examination of Timber and also performed a heartworm test, which was normal. A CBC was done and that was normal. He was given a subcutaneous fluid injection and he was prescribed Baytril, 136 mg. Timber was sent home.
On December 4, 2011, Timber was very lethargic and seemed to be getting worse and we, again, went back to Dr. Howard. Dr. Howard performed a progress exam, a SMAC Comprehensive, a radiograph and Timber was given Drontal Plus K-9 Large, 136 mg. The radiograph showed a single pulmonary nodule. Timber's temperature was normal at this time. All bloodwork looked normal. No diagnosis at this time. We were to check back in a couple days if there was no improvement.
Timber continued to be extremely lethargic, did not want to really eat nor drink and had to be taken outside because he would not get up. I, again, took Timber back to Dr. Holly on December 6, 2011. Dr. Holly performed a progress exam, another chest x-ray and a check of electrolytes. Timber's temperature was normal, but it was obvious he was much more depressed. He was given Doxycycline tablets, 100 mg. and Rimadyl, 100 mg. Dr. Howard suggested taking Timber to an internal medicine specialist downstate, which we agreed to, and an appt. was made to see Dr. Sharpe the next day at Michigan Veterinary Specialists.
At 4:30 a.m. on December 7, 2011, I took Timber to Grand Rapids to see Dr. Sharpe. An exam was done; an ultrasound; metastatic and interpretation radiograph; metastatic radiograph (3 views); interpretation of radiographs; radiographs reviewed by radiologist; SChem/UA (SA020+ADD220AT); ACTH Response (pre and post (AT-T440); ACTH Gel/Acthar Gel (40u/ml); Injection, IM or SQ; Blastomyces Antigen; Panacur (fenbendazole) granules; Doxycycline 100 mg. tablets. Timber's physical exam abnormalities was an abnormal left eye, coughing, decreased appetite, vomiting of water once in the past week and diarrhea for the last week, and weight loss. Timber's diagnosis was undetermined with the diagnostics. His blood work revealed minimal abnormalities. A 4Dx in-house snap test was performed and was negative (heartworm, ehrlichia, anaplasma, Lyme disease.) Doxycycline therapy started for possible tick-borne infection. Panacur was started for possible lung worm infection. Timber and I headed back to Cheboygan around 2:00 p.m. On 12/8/2011, Dr. Sharpe called and we were told that Timber's urine Blastomycosis antigen test was positive. It was suspected that Timber had a systemic (primarily pulmonary) blastomycosis that was the cause of his clinical signs. Sporonox, 100 mg. twice daily was recommended. Monthly blood tests, repeat radiographs in six weeks and treatment continued for at least one month beyond resolution of clinical signs and radiographic changes. Treatment should be continued for a minimum of 90 days and may need to be continued for six months or more. Strict rest is recommended over the next 14 days and close monitoring for respiratory difficulty. Continue doxycycline until gone.
I elected to put Timber on itraconazole (generic of Sporonox) when I found out the cost of the Sporonox. The pharmacist had told me that other dogs who had contracted Blastomycosis were doing fine on the generic. Timber was on the itraconazole for two weeks. Timber did get worse before better and he slept for two weeks and we would help him outside and also bring him his water and food. Timber improved and regained energy and was playful. His left eye still looked strange. We elected to change his meds to fluconazole because Dr. Sharpe felt the fluconazole was better than the itraconazole. Timber was taking 200 mg. fluconazole twice daily. He continued to improve and have more energy and was eating and drinking. On January 1, 2012, we noticed that Timber again was lethargic and wanted to sleep. On January 2, 2012, he did not want to move at all and was refusing all food, even bacon. I tried to give him water and he tried to drink but choked. When I went to help Timber off the bed to go to Dr. Howard's, he could not stand and fell over. My dad carried him to the truck and we took him to Dr. Howard that afternoon and he was examined and additional x-rays were performed and the nodule was still there, but a bit smaller. A CBC was performed and a PAP + 3. He had a slight fever and was extremely lethargic and kept falling over when he would try to stand. Dr. Howard called Dr. Sharpe and Dr. Sharpe recommended fluids, hospitalization and a bile acid test for liver failure. I elected to leave Timber overnight and have them perform the bile acid test. I called the next morning, January 3, 2012, and Timber was still alive but had deteriorated. His legs were rigid and he was drooling profusely. He could not stand with his back legs. My husband and I went to visit him and he was suffering and his respirations were heavy. Dr. Howard consulted with a neurologist and it was felt the Blasto had gone to Timber's brain and the prognosis was poor. My husband and I elected to have Timber euthanized.
Cost of Treatment: Over $3,000.00.