histopathology – 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!

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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

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!

“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!

Tripawd Day 6

I do believe we’ve recovered from the fireworks! Once again, San Jose PD has totally let me down when it comes to preventative community policing. Good to know they’ll show up if theres a body involved, maybe I should have lobbed a bottle rocket at one of the gang bangers down the street. That’ll get the cops here, in celebration, but that’s better than nothing.

And yes, Sheba pooped yesterday. Cowpie, but who cares, its poop and our vet says cowpie is ok. While I was in class, Ruth took Sheba in for a new fentanyl patch. By the way, removing the old one was a total nightmare last night, but its way better than the staples we had after the TPLO patches. Dr. Appel did a once over, incision looks good and stitches will come out next Wednesday.

Histopathology came in today: definitely NOT cancer, definitely YES its infectious. Still waiting on the fungal identification and susceptibility. Why can’t they make the little hyphae grow faster!!! I hated doing fungal cultures in microlab, these people must really love their jobs because I’d just shoot myself!

fentanyl patch kickin' in — fentanyl patch kickin’ in