amputation – The Ongoing Adventures of Sheba

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

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!

“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!