Post Op – The Ongoing Adventures of Sheba

Our Princess Has Moved On

Sheba a crossed to the other side today. She had been doing ok, starting to eat again (mostly baby food and deli meat), but something just wasn’t right. She had bee having increasing difficulty getting around the house and outside to potty. Last night she needed help every time she wanted to get adjusted in bed. We didn’t sleep much and she was constantly panting. This morning she got up OK for her car ride (highlight of the day), but by the time I got home around 3 and went to take her out to potty she was knuckling on the remaining rear leg and was unable to bear any weight on it at all. I called the vet’s office to let the neurologist know we had symptoms. He said we could bring her in or wait til the morning. Sheba was adamant about getting into the car so we took her over to the vet’s office. On exam Sheba had very little reflex in the remaining rear leg and cried out when he barely tapped her with the mallet. Neuro said her symptoms were consistent with spinal cord infiltration. Just yesterday we learned UofTexas identified the fungus as Rasamsonia spp. which looks and acts like Aspergillus and Penicillium but grows a lot faster. With all this overwhelming information, we made the decision to end her suffering. She fell asleep peacefully in our arms around 5pm. A big thank you to everyone who has offered support and encouragement for the last few months, we really appreciate it!

Save

What do you mean I need to get out of the car?

Car Ride

I think we’ve unlocked the key to Sheba eating: BABY FOOD! She love the turkey with gravy and beef with gravy, haven’t tried the chicken yet though. She also seems to like freeze dried liver treats, ostrich hearts, cheese, and goats milk. We’re going to have a TON of baby food jars!

Since she stated coming up lame in February, Sheba has been getting car rides instead of walks. Recently, we’ve had difficulties convincing her to get out of the car.

Finally got her out after an hour.

And half a bag of liver treats!

Obviously another moment of teenage rebellion

MRI results – 3 fungal lesions

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.

MRI sag

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:

MRI Markers

Consult, take 4!

Sorry its been so long (2 weeks) since my last post, work has been crazy and so has home!

We’re now 48 days post-amp if I did the math right. 8/2 follow up with surgeon went well, amputation site looks like its totally healed up and the hair has already grown over enough to hide the scar. Lab work shows her kidneys and liver are handling the itraconazole well, all other abs were also normal. Unfortunately, what looked like a bit of arthritis pre-amp appears to be fungal in origin. So we’ve got a neurology consult tomorrow morning to determine a further course of action. Sheba has already out lived all the dogs in the literature we’ve scoured and she’s got a lot of fight, but there’s no precedent for surviving disseminated fungal infections past 6 months to a year. And if the Penicillium spp. diagnosis sticks we could have far less time. Yes, we’re still waiting for a complete ID!

In the meantime, we’re back on gabapentin to control the spinal pain, and she refuses to eat. We’ve stocked up on can food, dehydrated raw food, and Honest Kitchen’s Popper Toppers. Dang brat won’t even touch the ground meats we’ve prepared: bison, venison, rabbit, chicken…at least Buster has been able to enjoy the exotic meats! Feeding her just about every hours, or at least trying. We may resort to baby food soon. She must be eating just enough because she’s only lost pound in 2 weeks. More to come after tomorrow’s appointment!

Happy Sheba doesn't come out too much anymore :( — Happy Sheba doesn’t come out too much anymore 🙁

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!