Long day at the vet for Sheba. We went in for MRI at 8:30am. Doc called around 11:30 to tell us she was awake and to please come by between 1 and 2 to pick her up and speak to the neurologist and internist. When we got there the neuro showed us the MRI. She has 3 lesions, the one big one between the dorsal spinal processes between her shoulder blades, then two smaller ~1cm lesions in the vertebral spaces further down the thoracic spine.
Then we waiting a bit to see the internist regarding meds. He’s thinking even though the histopath says Penicillium spp. it could still be Aspergillus spp. and since that has a better prognosis and similar treatment with more empirical evidence, we’re going to pretend its Aspergillus. He also ordered a galactomannan test which would be helpful to judge drug response if it is Aspergillus. So, we’re going to double up on the itraconazole for a month. Then redo the MRI and galactomannan to see her response. Because we can only be on that increased dose of itraconazole for a month or so we will need to either begin amphotericin B infusions (potential kidney failure and other nasty side effects) or restart the terbinafine (MAJOR diarrhea!). Terbinafine also doesn’t work as well in dogs as it does in humans or petri dishes. With the spinal lesions we also have to worry about compression of the spinal cord and fracturing vertebrae. At least the neurologist told us our Ruffwear WebMaster with BrushGuard is probably the best harness to have with her specific location of lesions!
And for those of you wondering, yes, Sheba’s medical costs are throught the roof (over $10k so far)! But we’re not rich, we just happen to have insurance for her that pays 90% with no cap. $72 a month sounded pricey when we signed her up at 9 months, but it has definitely paid off!
Here’s another MRI view marking the lesions:
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