July 2016 – The Ongoing Adventures of Sheba

Almost there!

stump

Tomorrow is day 28 – 4 weeks pot amp, and 4 weeks on the antifungal. But I’ve got a final and work, so probably wont have time to get online. Maybe Ruth will celebrate with them while I’m out of the house! Aside from the split incision that had to be stitched back up, Sheba’s amputation site is looking really good! The fur is growing over it so you can barely even see the emergency vet’s stitches. She did note that there could be a delay in healing due to the underlying systemic fungal infection, so we’ll be seeing Sheba’s surgeon Tuesday before having the stitches taken out. We also felt a funny bump on the princess’s chest so they’ll be taking a look at that as well. Fungal ID is expected by the end of the week , so hopefully we have more of a treatment plan and prognosis. Otherwise we’ll just keep chugging along with the itraconazole and monthly labs/x-rays/ultrasounds. It was not helpful to hear of a few local cases of canine disseminated Aspergillosis that were vary quickly fatal. No more talking to people!

As I’m sure is true in most of the rest of the country, its hot (almost) as Hades out here (88 with 42% humidity I’m sure sounds like whining to the rest of you!)! In another moment of teenage angst, this dork goes out in the middle of the day, about 90 degrees air temp, Dog knows how hot the cement was, and she lays on the cement, IN THE SUN!! I had a fit and made her come inside, what a poopy head! I know being skinny makes her cold, but if that’s the case she can ask for her blankie, she does NOT need to sit on the dirty cement. Where Bruddah Zia barfed during his bath yesterday! Double EWWW! I’m glad Zia is her waiting for his daddy to recover from surgery. Sheba has been getting into the funks and its hard to pull her out. She’s also been starting to have bedtime agitation again so we’ve pulled the Xanax back out. I’m not sure if she’s tiring more easily or just being too active, but the stiffness and fatigue that she didn’t have a week or two ago is worrisome. Hopefully it’s all nothing!

3 Weeks!

Its been 3 weeks since Sheba’s amputation! She’s been getting along quite well, but we’re still on a lot of meds to keep her mellow. Unfortunately, yesterday her incision split open about 1.5″ and we had to take her to the emergency clinic. We saw the same vet who was on duty when she spent the night after surgery. The doctor said it looked like Sheba had a seroma that burst. After 1 staple attempt the vet realized that would be too traumatic for the amount of staples so we gave her the OK to sedate and stitch it back up. So now we’re back to the cone and on antibiotics. She’s pissed about it too, showed Ruth that she can take the cone of if she wants too. GSD teenager in revolt!

Just pick a fungus and be done already!

Tripawd Day 18

I am soo frustrated with the world of pathology! We started the terbinafine on Saturday and had some problems – panting, racing heart, agitation, etc. so we stopped the med went to ER, they said sorry, we think you should wait to talk to your internist on Monday. Fine. I’m perfectly capable of making important medical decisions! Doc left a message while we were gone that she wanted to talk about the terbinafine and some results that had come in. Ok, so I called her back.

First, the juicy stuff…PATHOLOGY! Its NOT Aspergillus spp after all, after further testing its looking like Penicillium spp. But the lab doesn’t feel confident continuing so they’re sending it out to Texas for species identification and drug susceptibility. Well holy $%#@ people, just pick a fungus and be done with it!! At this rate I could have snagged a sample and done the identification and susceptibility testing at school as a summer project…might still be a good idea for fall.

The great thing about our new fungus, terbinafine probably isn’t necessary, so its ok that we discontinued it. And, even better, Sheba is pooping normal again!

cruisin’ the back yard, huntin’ fo FLIES!

Maaaa! I told you not to take my picture!

Tripawd Day 13

My brain has been fried from lack of sleep and migraines, but I think I’m almost caught up on sleep! Now that the firework are (mostly) over. Her last fentanyl patch came off Sunday, we’re doing ok on 150mg Tramadol every 8 hours. Poop is still very loose (think chocolate sauce for ice cream, minus the ice cream), and she’s not on the antibiotic anymore so we’re decreasing the Gabapentin with a plan to take he off by Friday. The crying has finally stopped, after consulting with our vet a few times she decided the confinement period is over. Sheeb is now allowed to roam about the house, cushion hopping, though we’re still keeping a close eye on her and helping her when she goes potty. She has a hard time keeping balanced when she squats. Probably the pain meds plus sedatives.

Stitches came off yesterday, but she started licking and chewing the incision so the cone’s not going anywhere! Abdominal ultrasound was clear, but we did find out the sentinel node biopsy that they took when they thought it was cancer turned out to have Aspergillus spp. in it, so this is no longer an isolated osteomyelitis, but systemic disease. Because she is a female German Shepherd and therefore more prone to more severe incarnations of the infection, her prognosis is very guarded and will depend on how she responds to treatment. Once it spreads to the spine and she shows signs of paralysis or paresis she will need to be put down.

WTF!? We were supposed to have a consult with a new internist, apparently her staff forgot to tell her that so she was very unprepared. Didn’t even have Sheba’s records from across the office. She showed us how to check her lymph nodes, symptoms to look for and agreed to add terbinafine, and antifungal that is commonly used in conjunction with azole antifungals when there is systemic disease. She’s supposed to give me a call with the microbe ID and susceptibility results (shouldn’t be back yet) when it does finally come in. At least its not infectious to the other dogs, but we’re looking at 2-3 years not that we know there’s lymph node involvement. That microbe ID will give a better clue as to the growth speed of the fungus and give us an idea of how long it’ll take to spread globally.

Sheba was getting kinda depressed, but her brother-from-another-mother, Monsta Man Zia came up for a visit and snap her right out of it! You just can’t say no to the energy of an Australian Shepherd!

“Ruff” night! Tripawd Day 7

Last night around bedtime Sheba started whining/crying inconsolably. The fentanyl wasn’t going to peak until 10am today so I gave her tramadol and an extra trazodone (as directed). No luck, she cried off and on all night, played musical beds and eventually ended up in my bedroom. Ruth called the vet this morning to ask the surgeon what we should do because by then she was maxed out on all her pain and anxiety meds. Doc recommended a short walk and a car ride. It sorta helped, but she’s still crying intermittently. I think she’s finally realized her leg is not coming back and is depressed. She went to sleep with a leg, then woke up and it was gone. I don’t think it would be unreasonable at first to think it might reappear the same way. Poor brother Buster is worried and tries to console her, even though she doesn’t always appreciate it.

Buster is trying to be supportive, but Sheba doesn't appreciate being breathed on! — Buster is trying to be supportive, but Sheba doesn’t appreciate being breathed on!

We finally have an ID on the fungus – Aspergillus spp. which GSDs are known to be susceptible to, the surgeon was already worried about spinal cord involvement prior to surgery. Because its not in the nasal cavity (the usual location of infection) she could not give us a prognosis. When we go in for future removal on Tuesday we’ll consult with the infectious disease specialist as well. We already knew she’d require monthly monitoring and potentially months to years of antifungal treatment. Unfortunately I can’t find much information about disseminated aspergillosis that doesn’t already involve the lungs (Sheba’s are clear). Bedtime meds seem to have kicked in and Sheba finally stopped crying, hopefully we’ll sleep better tonight. I’ll leave you all with some puppy pics!