Penicillium – The Ongoing Adventures of Sheba

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 🙁

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!