(This update would have been brought to you much earlier this week had it not been for our internet problems.)
You will recall that it was a week ago that we took Hazel to see a specialist and I posted Hazel’s Probable Disease. That evening our vet friend, Jim, brought over a supply of Prednisone tablets with the instructions to stop the Fluconazole treatment and switch to Prednisone. We started at a dosage of one 20mg tablet every 12 hours.
Hazel enjoying the cool floor of our bathroom yesterday afternoon.
Within twenty-four hours the Prednisone had stimulated a return of Hazel’s appetite and for the last seven days she has been eating very well. Plus she has regained an interest in the world around her and now comes out for walks with the other dogs.
Jim and I went for a short hike yesterday afternoon and we were discussing Hazel. Jim reminded me that while the lung pictures and the other evidence were pointing to it being cancer the actual tumour still hadn’t been found.
If there is no noticeable decline in, say, three or four weeks then it may not be cancer. Certainly, Jim said, if it is cancer then Hazel will not live out another three months.
I’m writing this post at 5pm yesterday (Tuesday) shortly after we returned home from collecting Hazel from Lincoln Road Vet Clinic following her earlier examination by Dr. Parker using his mobile sonogram.
Hazel at the clinic shortly before she was taken in by the staff.
The good news is that Dr. Parker did not find any sign of trauma or life-threatening illnesses in Hazel’s body especially focusing on her abdomen.
Dr. Parker to the left being assisted by clinic staff as he examines Hazel ultra-sonically.
(I should be quick to say that I left my camera with one of the technicians and wasn’t present. Indeed, Jean and I did not get to meet Dr. Parker.)
Dr. Parker, who is a board-certified veterinarian doctor, came to the conclusion that the most likely cause of Hazel’s illness was the fungal lung infection, as Dr. Codd and the radiologist supposed.
Nothing frightening seen!
To try and narrow down the exact fungal infection a further blood sample was taken and the lab results should be known in three or four days time.
Dr. Codd, in his briefing to Jean and me when we collected Hazel late afternoon, said that his recommendation based on the lack of any notable findings from the scan could be summarised as follows:
Regard treating the fungal infection as the number one priority,
Hold off from treating the tick fever in the interim,
Dose Hazel with 100mg of Fluconazole twice a day even if she is eating hardly anything,
The measure is whether Hazel, with a very small food intake, can take that dosage without vomiting,
Add a B12 tonic to her diet with immediate effect,
Give Hazel appetite stimulant medicine,
Consider the hemp oil (as queried by me) if the proper dosage can be determined.
(Petspeopleandlife: Hazel’s current weight is 53 lbs (24 kg). Any advice?)
Back home again albeit still feeling a little drowsy!
Thus while we have not yet got to the bottom of what precisely is the nature of Hazel’s infection at least we know there isn’t anything else silently killing her.
Thank you so much, dear readers, for taking so much interest in Hazel and for sending your love and caring wishes – it’s working! 🙂
The powerful combination of good medicine and unconditional love.
In the last post on Hazel’s condition, back last Thursday, I passed on Dr. Codd’s observation, “… that by not having Hazel on her meds we were, of course, letting the fungal infection continue its damage.”
Dr. Codd also recommended reducing the dosage of the Fluconazole to lower its side effect of suppressing appetite.
So since then, with outstanding care and patience, Jean has been coaxing Hazel to eat just sufficient food for Hazel to be able to take the Fluconazole, for her fungal infection in her lungs, and Doxycycline, for her tick infection. (Mind you, Hazel is still a long way from eating reliably.)
Yesterday, (Saturday) Hazel was showing clear signs of feeling better but still having to be hand-fed by Jean.
Then this morning (Sunday) she really was perky and readily came out for a walk with the other dogs.
First time in recent days when Hazel has shown an interest in the world around her.
oooo
A return of a head gesture unique to Hazel that we haven’t seen in ages! 🙂
More generally, Dr. Jim was trying to track down supporting details to the observation made by Dr. Russ:
Namely, that there was evidence that fungal infections can lay dormat for quite long periods of time.
Jim sent me the following email:
Paul …
The following article is the one and only reference I have found so far that refers to the possible dormancy of this fungal infection. In paragraph 2 (Clinical Disease) I have highlighted it in red. I have to admit, I was skeptical.
Jim
The article was:
Coccidioidomycosis (Zoonotic) Last updated on 2/4/2011.
Contributors:
Rhea V. Morgan DVM, DACVIM, DACVO
Synonyms:
San Joaquin Valley Fever
Valley Fever
This is that domancy aspect from that paper that Jim highlighted (in red):
The incubation period in the dog is 1 to 3 weeks.1,2Â The organism can remain dormant, with exposure preceding the onset of clinical signs by 3 years or more.1,3Â Although people may acquire the disease from the same sources as domestic animals and the mycelial forms are highly infectious, with one exception the disease has not been transmitted from animals to people. One published report exists of transmission to a veterinary assistant via the bite of an infected cat.15
Meanwhile, over in Brandy’s corner, he has very quickly healed after his neutering operation last Thursday. It was fair to say that he was not a happy chappy when he arrived home that day.
Didn’t like that!
oooo
And I can’t even lick my balls!
But his cone was off by Saturday and he is back to the wonderful, bouncing dog we all love so much. (Can’t believe that last Saturday was only the second week that Brandy had been with us; he has so quickly woven his way into all our hearts.)
Checking out the stables yesterday (Sunday) morning.
oooo
Behind that placid expression is the most docile, loving brain and heart one could ever wish for!
Returning to Hazel we are still some way from knowing that she has returned to a fully fit dog but the love and caring sent her way by all of you out there has been precious beyond imagination.
So said Sophocles. But too slow a decision, or no decision is, of course, a decision in its own right.
Last Tuesday in my update on Hazel Of art, and science I wrote:
It seemed to make sense that until we had confirmation of whether or not Hazel had a lung fungal infection, for which taking Fluconazole would be an excellent course of action, we should pause in her dose until the results were in.
At 08:45 this morning we had to take Brandy in to Lincoln Road Clinic for his neutering operation (that we heard a short time ago has gone well with no complications – he will be collected in about an hour). Dr. Codd asked after Hazel and we said that she was brighter but still not eating sufficient for her to be taking her medications.
Dr. Codd then made the eminently sensible observation that by not having Hazel on her meds we were, of course, letting the fungal infection continue its damage.
In response to the query as to why a fungal infection from either Mexico or Arizona had taken so long to appear, Dr. Codd added more sense to the situation. Namely, that there was evidence that fungal infections can lay dormat for quite long periods of time. Possibly in Hazel’s case the trigger for the infection becoming active was the additional stress on Hazel’s body systems from her recently contracting an Ehrlichia Infection from a local tick.
The final element for the argument of not delaying any longer Hazel’s healing medications was that the titre results would only be a result of one particular ‘brand’ of fungal infection. Dr. Codd said that it may well have been one of many other fungal infections that took hold of Hazel’s lungs.
So the decision was made to try Hazel on an oral anti-nausea med that would be much easier to administer. It is Ondansetron Orally. Also to cut down the dosage of the Fluconazole so that it doesn’t dampen Hazel’s appetite for food, a known side effect of Fluconazole, in quite such a dramatic fashion. (Note: Fluconazole is the least appetite suppressant compared to alternatives.)
So there we are.
We hang on to the fact that Hazel is still with us and coping with what is ailing her, albeit with a heightened stomach sensitivity that is complicating eating. Time is on our side.
A thousand thanks to all of you that have shown so much love and concern for our dear hazel.
Dear people, I must add this: CAUTION: The following is offered by way of information reaching out to other loving dog owners. Please do not assume I have any specialist veterinarian knowledge and please do not take the following as a replacement for seeing your own vet.
Finally, Mike Shannon is my guest blogger with a lovely post for Earth Day 2016 that will be published in a little under 10 hours time. That is why this post has been published now.
The learning and healing journey continues with Hazel.
The title to today’s post came from Dr. Jim Goodbrod, DVM. When he and I were taking a walk yesterday Jim mentioned that diagnosing exactly what an animal is suffering from is as much an art as it is a science.
Jim and Janet are close friends and neighbours who live a couple of roads away. Jim also attends the Lincoln Road Vet Clinic on a part-time basis. Off his own volition he has been speaking with Dr. Codd (Russ) about the situation with Hazel and the pair of them are showing incredible devotion to getting to the bottom of what is happening.
So, like yesterday’s post, today is being offered to you in the spirit of information. Forgive me if I repeat the caution from yesterday. (This is being written at 4pm on April 19th, 2016.)
CAUTION: The following is offered by way of information reaching out to other loving dog owners. Please do not assume I have any specialist veterinarian knowledge and please do not take the following as a replacement for seeing your own vet.
Late on Sunday afternoon Hazel was becoming so weak and lethargic that Jean and I feared that she wouldn’t make it through the night. So it was wonderful to see that she was alive and still connected to the world at 6am yesterday; Monday. Nonetheless, Hazel had not eaten since Saturday afternoon and was only drinking very small amounts of water. We made the decision to ring the Clinic as soon as they opened on Monday at 8am. They recommended that Hazel be brought in to go on to an IV drip to boost her anti-fungal intake and also to receive an anti-nausea intake to help her regain an appetite. But there was the question hanging over everyone that if this was a fungal infection, as in Coccidioidomycosis, that is not present in the Oregonian soil but is found in the drier parts of the USA and Mexico then why had it been such a long time before it brought Hazel down?
Jean also had this suspicion that Hazel might be suffering from a form of ‘Tick Fever’ that is very common in Mexico.
So off we went to the Clinic again. There were discussions about the whole situation.
Dr. Codd (RHS) speaking with Jean at the Clinic.
Dr. Codd took a quick blood test and, bingo, it revealed that Hazel was showing that she had, or had had in the past, an Ehrlichia Infection; a tick-borne infection.
The lower of the left-hand spots is the indicator of a past or present Ehrlichia Infection.
The cure for that was a course of Doxycycline.
So now we are looking at battling two separate diseases.
The blood that was taken from Hazel last Friday, when she also had radiographs taken of her lungs, had been sent for a ‘titre’ that would confirm one way or another if her lungs were suffering from a fungal infection. Those results will be available on Wednesday or Thursday of this week.
One of the radiographs taken of Hazel.
Back to Hazel’s lack of appetite. One of the side-effects of Fluconazole is that it depresses appetite. Getting Hazel eating again was becoming a priority. It seemed to make sense that until we had confirmation of whether or not Hazel had a lung fungal infection, for which taking Fluconazole would be an excellent course of action, we should pause in her dose until the results were in. To speed up the return of an appetite Dr. Jim prescribed a short course of Mirtazipine.
So that’s about it for the time being. Except for Jean and me to say how much we appreciate the art and the science that is being so skillfully offered by the Clinic. (As of 19:00 PDT yesterday Hazel was eating again! 🙂 )
Great team effort!
Their “Special Love of Animals” comes over in spades!
CAUTION: The following is offered by way of information reaching out to other loving dog owners. Please do not assume I have any specialist veterinarian knowledge and please do not take the following as a replacement for seeing your own vet.
About three or four weeks ago we noticed that Hazel’s bark was changing, almost as though she had a sore throat. In every other way she continued being the happy, lively dog that she is.
Then very suddenly last Thursday she started sicking up white, foamy bile and went off her food. Hazel rapidly became lethargic and lacking any vigour. Last Friday we took Hazel to our local Lincoln Road Vet Clinic and she was seen by Dr. Russ Codd, DVM. He took xrays that showed that Hazel’s lungs were far from being as clear as they should be. Potentially, Dr. Codd said that we could be looking at one of three things:
Some form of bronchial pnemonia,
A fungal infection of the lungs,
Cancer.
In view of the fact that Hazel hadn’t been coughing that ruled out 1.
Dr. Codd forwarded the xray pictures to a specialist. Later came the information that the spherules in her lungs, as seen on the xray pictures, were not as would be expected with a cancer diagnosis. Dr. Codd concluded that Hazel was indicating a fungal lung infection. Especially as this is commonly found in hot, drier parts of the USA and Mexico. Hazel was an ex-rescue from Mexico and for a couple of years we lived in Payson, Arizona.
The medical term for the disease is Coccidioidomycosis and I republish a little of what may be read over on the Pet MD website:
Coccidioidomycosis in Dogs
Mycosis is the medical term for any disorder caused by a fungus. Coccidioidomycosis comes from inhalation of a soil-borne fungus which normally affects the dog’s respiratory system. However, it is known (even likely) to spread out into other body systems.
The fungus spores begin in the lungs as round spherules, and live in a parasitic stage in the lungs until they grow large enough to rupture, releasing hundreds of endospores, which then begin a parasitic stage in the tissues, growing and rupturing, spreading out (disseminating) into the body perpetually. Endospores can also take a faster route through the body by way of the lymphatic and blood vessel systems, resulting in systemic infection — meaning the entire body will be affected. Coccidioidomycosis sets in from 7 to 20 days after exposure, though some dogs can develop immunity and never show any symptoms, especially younger dogs.
Dogs that are susceptible to the infection can become ill from only a small amount of the Coccidioides fungus, and fewer than 10 fungus spores are needed to cause the disorder. And though uncommon, Coccidioidomycosis is a deadly disease that originates mainly in the arid, hot regions of the western and southwestern regions of the U.S., and in several Central and South American countries. Coccidioidomycosis affects many different types of mammals, but tends to occur more commonly in dogs than cats. This infection is also known as valley fever, California fever, Cocci, and desert fever.
The condition or disease described in this medical article can affect both dogs and cats. If you would like to learn more about how this disease affects cats, please visit this page in the PetMD health library.
Dr. Codd recommended getting Hazel on a course of antibiotics with Fluconazole being his first choice. That commenced on Friday afternoon.
Early today (Monday) Dr. Codd will be seeking to narrow down the diagnosis with further analysis of Hazel’s blood being undertaken because while he was confident that it is a fungal infection he wanted to confirm precisely the nature of the infection.
I will publish more information as it comes to hand and close with these photographs taken yesterday afternoon.
Hazel taking a very slow walk outside.
oooo
But most of the time she just wanted to be left on her own in our bedroom.
We are holding Hazel very close to our hearts just now.
Learning from Dogs 