Xena's Diagnosis & Days 1-11 of Treatment

Here's our story: ((I have to say in advance, that while reading this please know that Xena is still fighting hard and doing a little better every day although she has her ups and downs. And -- sorry for the heartbreaking photos)).

Here is the story of our 1 year old puppy and her ongoing battle against this awful blastomycosis infection.

Xena, just 1.5 weeks shy of her first birthday, started having a droop in her eyelid and a raised 3rd eyelid, called a Horner's Syndrome. This is usually benign but can also be a sign of a number of things. We took her to our amazing primary vet who did an eye exam and cleared us to just keep an eye on it. Two days later her Horner's Syndrome was gone but her eye was slightly clouded over. Again, back to the vet. Eye pressure check and a pupil scan and she's still clear with no issues. 

hazy eye

eye at its worst

Over the next 2 days her eye because so inflamed and the pressures soared to over 60mmHg (25 is normal) and this lead to the detaching of her retina. Devastated by this news, we were looking to move forward to manage the eye symptoms with the opthalmologist. Our primary vet was concerned that in a dog this young this should not have escalated so quickly and recommended once the eye was under control that we investigate any kind of auto immune related disease as the cause. 

increased pressure = detached retina

support from her bestie -- sir lexicon, the cat

One week into her eye treatment of steroids, eye drops and antibiotics her eye pressures dropped to 26mmHg. We celebrated this news and her 1st birthday. Three days later she began limping out of no where and appeared to be in no pain with palpation or stretching. I spoke to the primary vet and she suggested a neuro exam. We scheduled the appointment. With it being the July 4th holiday we would have to wait a few days. Over these few days Xena also started limping on the back left leg also. 

limping

Finally, we saw a neurologist who cleared her entirely but said her back leg was mildly tender in one spot and asked if we wanted an ortho consult. Not sure what else to do for her, I agreed to his consult and x-rays. He saw fluid around her joints on the xrays and said we could aspirate to run screens on it.  They only do procedures in the afternoon so I would have to leave her there and pick her up later (as I had to be at work from 1-4). 

I got the call from the vet specialist about an hour after I got to work. He said that we did a gram stain of the fluid and we've confirmed that she has Blastomycosis.  Blasto for short. (Not sure what blasto is? Neither did I, read the link for full details). Okay, well what does this mean? His response was along the lines of that we needed to think long and hard about the road ahead for our puppy.  That if we wanted to do treatment it would be a long and expensive road and she might not survive. Of dogs that do start treatment only 70% survive the first 10 days and that if you can make it through the meds and fight it off, then there is still a 25% chance she could relapse. 

So our options were to ignore it and have her decline (he said that within 3 weeks she would likely die from respiratory failure even though she had no labored breathing yet but that death was inevitable without treatment), admit her to the ICU and start her anti-fungal meds tonight, or let her go peacefully. Being that she's so young and an all around badass puppy we decided we had to give her a chance to fight this. I had no idea what we were up against.

 I got home the first night of her stay in the ICU and after hours of reading negative google searches on blasto I came across a message board site (blastomycosis.ca) and it completely renewed my hope that we were making the right decision  to try to fight such a terrible disease that is taking over my beautiful puppy's eye, lungs, and joints.  Armed with hope and the knowledge that our team of vets, from Xena's primary to the ophthalmologist to the neurologist to the internal medicine vets, they have all been amazing. I am fortunate enough to live 0.1 miles from the 24/7 animal hospital that treats all the severe cases in Atlanta.

Typically blasto pups present in the hospital with labored breathing. Xena had her strange eye fiasco then started limping. Below are the signs of possible blasto ... she only had two of them despite this disease taking over her entire body. 

 Lethargy
 Persistent fever of 103 degrees or more
 Anorexia
 Vomiting
 Persistent, usually non-productive cough
 Exercise intolerance
 Respiratory symptoms, fungal pneumonia
 Ocular infection, sudden blindness
 Depression
 CNS symptoms: twitches, stumbling gait, loss of coordination
 Skin ulcerations, non-healing lesions
 Lumps, nodes, swellings
 Weight loss
 Hair loss
 Lameness, fungal arthritis
 Hematuria 

Xena did well with her first few days of treatment .. it was days 4 and 5 that were the scariest. 

 right before we got to the vet on first day

 after the aspiration with her shaved legs

Night 1: She was admitted to ICU to start her meds for the 2-3 day die off period of the spores in her chest. She is on itraconazole (antifungal meds) and did a loading period where they double the medication for 3 days with along with steroids for just the 3 days to help keep the inflammation in her lungs down. When admitted she had fever, no respiratory distress, poor eye quality, limp  still in both legs. Eating great. 

Day 2: Fever roller coaster up and down all day. Eating great. Breathing great. Her fever hit 105.4 at one point and the lowest was 103.0 (normal in a dog is 100 - 102.5).

Day 3:  Fever roller coaster. Breathing faster. Her fever high was 105.2 and the lowest was 103.8. Not interested in food so I took her 2 boiled chicken breast and she ate both of them in minutes. Eye was looking a little looking better. 

Day 4: Eye better and limp completely gone. They released her to come home with instructions on breathing rate, sound and specifically if she would not lay down due to breathing. We get home and all she wants to eat was shredded cheese -- okay, whatever gets the meds down. 3 hours into being home she had tried laying on every surface to sleep. She just kept popping back up and gasping for air -- which was new. I monitored her for a while took her temp in her axilla (it was 104.6 and the vet said to they add 1.0 to the axilla reading) then decided she needed to be looked after medically. Took her back to the ER and they readmitted her and put her on oxygen. Her fever was 105.6 in the ER, her breathing was labored and her oxygen saturation levels were low, and she was hard pressed to get comfortable so they gave her a sedative in her IV line. 

The phrases that come with dealing with blasto are "it gets worse before it gets better" and "one day at a time". 

Day 5: Vet calls me at 8am to say that she's not doing great and they're concerned about if she gets worse (as she had yet to improve from the night before). Says if she does get worse we don't have any other options to save her and that her body just might not be able to handle the meds. Her temp was down to 104.9 in the AM. I went to go sit with her and she looked so awful. She would drink water, but wouldn't touch food. Her body was weak and frail and she was fighting so hard just to breath, let alone stand up. (She still was having a hard time breathing laying down). It was so upsetting. I came home so defeated and re-read every post on the blastomycosis.ca blog. The vet called and her oxygen levels dropped to 90% so they had to up her oxygen to 4%. When she was first diagnosed I was relieved that she was breathing normally and her lungs sounded great (chest x-ray was still a 'snowstorm' of spores) so I never imagined her breathing being an issue.  I rearmed myself with positive thoughts for my pup (which was not easy), some puree pumpkin, bacon and eggs and went back to visit with her. She was 10x better than when I had seen her 8 hours ago -- which mind you was still not great. Got to be with her for over 2 hours and managed to ''force feed" her the pumpkin by putting it on the roof of her mouth with a tongue depressor. Her O2  stats were still pretty crummy when she was off the oxygen for her potty break and exam, but she was FEVER FREE! 102.4! They still have her on the sedative but waited almost a full 2 hours longer than they though she would need it. It was piece of mind for me to have her sleeping laying down and soundly when I left for the night -- even it was drug inducted. 

 

<--- morning of day 5

                                   evening of day 5 --->

 More day 5 pics:

tafter her MAJOR pain meds, (she was asleep 2 minutes later)

cooler of foods for Xena

Day 6: Drastically better than day 5. This morning Xena's still fever free, ate a little bit of the eggs I left for her when offered. When I got to the hospital our primary vet was sitting with my sweet puppy keeping her company (she works for a different company but does ER rotations 1-2x a month at the hospital). Just goes to show again how fortunate we are to be were we are when this awful thing began. At noon they took her oxygen back down to 3% and her O2 stats were still 92%. I went in to visit her at lunch and brought every option of food I could think of. She ate like a champ today -- hot dog, turkey sausage dog food and lamb/rice food I got from Petco, tablespoon of peanut butter and a cup of chicken broth to wash it down. Huge change from me forcing her to eat pumpkin last night. I know we are in for many more ups and downs, but we both needed a victory today. 

day 6 

 Day 7: Today we were able to get off the oxygen! Two hours afterward her oxygen saturation was 100%. She's eating hot dogs and turkey when offered by almost anyone. Vet re-did her chest xrays and didn't see much change this morning-- it's only been 2 days since the last set. She seemed concerned that she didn't see progress that Xena may be not responding to treatment. She does have a small fever tonight after being fever free for 36 hours, but as long as she's fighting this nasty stuff I expect it to go up and down. (104 currently). Vet says if she's doing well tonight and tomorrow during the day then she might be ready to come home tomorrow night. I realize that we have many more ups and downs in the days to come, but I'm excited -- and terrified -- at the thought of at least getting my puppy home and letting her rest in her own loving space.

DAY 8: Xena is home from ICU! Her oxygen levels stayed great even though she's spiked a little bit of fever over the course of the day (104.. It seems to be coming back down -- I just took it and got 102.7 then added +1 to it since it's in the axilla -- so 103.7.) She ate more hot dog and turkey this morning and also for dinner. It's still not as much as I'd like, but it's food. She's also drinking a lot of water -- which other than her needing to go up and down a flight of stairs to go to the bathroom is great! She's trying to rest now and doing well with that it seems. Since blasto is not common in GA our team of vets are really trying to stay up to speed with this one. Today they had a round table discussion of Xena's case with the Blasto Doc from Univ of Tenn. He agreed that she's on the right meds and he told them "sometimes they just have to get worse before they can get better".  They asked us to come back in on Friday to check her vitals -- which THRILLS me that they have confidence that we will be stable from now till Friday! I know that seems silly, but I'm trying not to jump the gun and plan ahead while also trying to stay positive. Not sure any of you have met a beauceron before, but they are SUPER mood sensitive and my girl needs all the positive she can get! Today was another victory and we will arm ourselves with as many of those as we can.

at least the ICU people liked her enough to put a heart on her bag of meds

 real rest for the 1st time in days

still not herself and still struggling with normal paced breathing

Day 9: 

My younger, amazing, sister volunteered to come and puppy sit for today and the next 2 work days for me -- which takes a TON of stress off of my constant worry about Xena's breathing. Last night this 1 yr old puppy drank so much water that she had to pee every 5 minutes. (Which is great until its 12am and 2am and 4am and she can't hold it long enough to get out the door). She ate 1/2 a container of turkey lunch meat at 2am. Then this morning threw up water after our trip outside to potty. She didn't eat for the majority of the day, but did get some more meat in there at some point. It's now time for her meds and she refuses to go near anything that she thinks has pills in it now. She's too smart for her own good and I've tried everything I can think of. Our primary vet called to check on us today and recommended an appetite stimulant and called the internal med docs and got it set up for us to go pick up anytime tonight .. but I still need to get her to take her horse pills (the itraconazol is huge!) Otherwise Xena's still SUPER tired, but is panting less (still breathing rapidly but through her nose now), less drool, fever up and down still but she's starting to be able to regulate her body temp faster. What used to take 5 hours to decrease her temp now takes 1. Thankful for another day with my beautiful pupster -- now time to pull out all the stops to get these meds in her.

Day 10: She did eat better today -- probably because I've resorted to feeding her steak. She does get a mild fever 2 hours after she takes her meds every night but is sleeping it off in an hour or so still. This morning her limp was back a little, but it didn't take long for it to disappear. Her breathing has eased tremendously. She's closed mouth breathing and rarely pants unless after coming in from outside from her multiple potty breaks. It's 90 degrees here in Atlanta and humid as it gets in the dead of summer, so the house is staying at 70 and she has 2 fans blowing on her spot on the bed, as well as a water bowl on my nightstand.  

Day 11:   HOLY CRAP WE MADE IT THROUGH THE FIRST 10 DAYS

When we heard about blasto for the first time 11 days ago everything we read said the first 10 days was the hardest and roughest on the dogs body.. and it's been no picnic for Xena or us but we are here and still continue to show signs of improvement. We had a quick vitals check at the vet today. Temp was 100.5 but she's lost another 2lbs. Most cases I've read the dog looses 15-20 lbs during all of this, so right now our 7-8 aren't so terrible, but needless to say she needs to eat more. She was a healthy skinny before all of this and now she's SUPER slender.  She must have gotten the memo because without giving her the appetite stimulant she ate a cup of dog food, a small can of wet dog food, and a 4oz steak (that had her meds hiding in it). I'm exhausted, Xena's exhausted and we still have a long way to go but I'm thankful for everyday and especially the positive days. 

skinny puppy

love my puppy snuggles while I type this

To continue to read about Xena's progress, click here for the next blog post update.