Sabre’s Legacy…New Perspectives on Inflammation By Deb Zilisch
Sometimes life throws us an unexpected curve, and we need to draw on all of our reserves to get us through. That’s the case with two of my dogs that were diagnosed with Blastomycosis. First Vada, in December of 2011, and then again near the end of December 2012 when she relapsed; followed by Nik, in the middle of December 2012. Yes, I had two Blasto dogs being treated at the same time!
Blastomycosis is a fungal infection that is very often fatal if not caught and treated in its early stages. Its spores are typically inhaled, where they settle in the lungs as a yeast infection, before spreading systemically. Blasto is treated with anti-fungal drugs…usually beaded Itraconazole (Sporanox) or Fluconazole (Diflucan). The literature, and many vets, will tell you that the treatment lasts 90 days and/or 30 days after symptoms resolve. In my experience, and as many on the Blastomycosis.ca site can tell you, that is not necessarily the case…and was probably a guideline written before the development of the MiraVista urine antigen test for Blastomycosis.
While many dogs “appear” cured within a couple of months, it took a full year for Nik to hit an undetectable level on the antigen test. He's got one more month of meds, so he will be on the medication for 14 months. Vada was initially treated for 10 months, was off the drugs for a little over 2 months and then relapsed, so needed an additional 5 months of medication to try to completely clear her system and prevent another relapse. Both dogs have had elevated liver enzymes because of the use of the drugs, so both have been on milk thistle in order for us to successfully complete their treatment without destroying their livers. It’s been a long journey, that we are glad to see coming to an end. But this isn’t about Blastomycosis, it’s about Sabre’s legacy and how it very probably saved Vada’s life.
About eight months or so into Vada’s treatment, I noticed a distinct difference in the smell of her poop, though the consistency and color remained normal. It was the same “fermented” smell that Sabre developed prior to becoming so ill, so I immediately suspected a bacterial imbalance. Since stopping the anti-fungals was not an option, and everything else was normal, we had to wait it out and hope that her digestive system went back to normal once the drugs were stopped.
I routinely give my dogs probiotic supplements at a low maintenance level, but as time went on Vada became more sensitive to foods and her probiotic supplement, with occasional bouts of diarrhea. We persevered until the end of May, when her diarrhea became more troublesome. She had achieved a negative antigen test 6 weeks earlier, so I elected to stop her medication and work on re-balancing her GI tract. I started her on the supplements that I had such good luck with in the past and she seemed to get better, but every 7-10 days she’d have a “blow-out”. These episodes were preceded by a day of not eating. Once her system purged itself, she’d go back to normal for another week or so, and we’d start all over again. The vet wasn’t sure this was due to the Fluconazole, but felt that her system would eventually right itself now that the drug was stopped, if that was the cause. A month or so later, he suggested trying Metronidazole. I told him I had already ordered Tylosin…my reasoning was that Tylosin is easier on the liver than Metro and she had a recent history of elevated liver enzymes from the anti-fungal drug.
The Tylosin was a huge help with the blow-outs. However Vada continued to have anorexia, gas, and intermittent soft stools. I was soaking her food and adding enzymes to ease her digestion. She was also getting L-glutamine, Slippery Elm, B12, probiotics, arabinogalactan and DGL. We tried ginger and even a short course of prednisone, which did seem to help to some degree. But as time went on she started eating less and less food and more and more snow.
From the middle of November until the middle of December I was lucky to get a cup of food per day in her…needless to say she was losing weight and I was running out of ideas on how to deal with the obvious pain she was in. I was starting to suspect a food intolerance, because her diarrhea seemed to correspond with her meals. So I ordered some Purina HA hydrolyzed soy food…bad idea, it went right through her. A friend of mine spoke with her vet, who has also dealt with many Blasto cases. He confirmed my suspicion about the anti-fungal drugs causing inflammation in her GI tract…that bit of information gave me the confidence to continue looking for answers. I decided to simplify her treatment and in doing so came up with the answers I was looking for.
We continued the Tylosin to control the Clostridia Perfrigens toxicity that I am convinced caused the cyclical 7-10 day blow-outs. We added Simethicone to help with gas, per the vet’s suggestion…but honestly, it didn’t really seem to resolve the underlying issues that kept Vada awake and pacing the floor at night. I recall that Sabre did well with the supplement, Acetylator, so I replaced the L-glutamine with 750mg of NAG (N-acetyl glucosamine) twice a day. I discontinued the probiotics, which she was having trouble tolerating. And I stopped the DGL and the arabinogalactan. However, something was still causing intermittent diarrhea. And then it hit me…she’d go off her food, have a softer stool, and then a day or two later might have a day where she’s be really hungry and eat a “normal” 2 cup meal. Soon after she’d go from a perfectly normal poop to diarrhea. With more observation and reviewing our journal, it became clear that her system could not tolerate more than a cup of food at a time. No matter how much she felt like eating, I had to limit her intake to 1 cup of kibble soaked with enzymes and Slippery Elm, and feed her more frequently.
Over the course of all of this it appeared that I had finally discovered all of the pieces to the puzzle behind her diarrhea... 1) inflammation, most likely caused by the drug she was on, and the resulting bacterial imbalance and sensitivities she developed; 2) presumably an unconfirmed Clostridia perfringens overgrowth was behind the 7-10 day cycle of intermittent diarrhea...we controlled it with Tylosin; 3) any change at all in what she ate...she needed to stay on a very strict diet of Natural Balance LID kibble, soaked and mixed with a bit of canned food…NO other treats or taste tempters 4) probiotics...even a tiny pinch set her off, so I had to stop them until the inflammation decreased, which went against all that I thought I knew about resolving inflammation in the GI tract; 5) too much food at one time...she could have no more than 1 cup of food , soaked and treated with enzymes and slippery elm...I ended up feeding her 4 times a day.
Within a week of starting the NAG, she was eating 2 cups of food per day. I could tell we had finally turned the corner when I got up one night to check on her and found her sleeping contentedly on her back.
She's now eating about 1-1/2 cups of food 3 times a day, still getting 400mg of SE and 1/2 capsule of Pancreatin with her food, still on the Tylosin and NAG twice a day...has fantastic poops and is putting on weight....and better yet, sleeping through the night!!!
Now that she appears to be stable, I started adding a small amount of Kyo-dophilus every other day. So far so good. I'm taking it slow until I'm sure she can handle it. I plan to discontinue the SE shortly, but will continue the Pancreatin, NAG and Tylosin until I can get her up to a full 2 billion CFUs of probiotics per day, then we’ll see how she does without their support.
Funny how life throws this stuff at us...testing us to see how much information we retained from our prior experiences...and then adding a few additional twists so that we end up learning even more!
I hope this accounting of Vada’s treatment helps some of you that may be dealing with a dog that has been difficult to stabilize.
CH. Vada von der Sauk, CGC, TT, HIC-s, VCC…one tough little chick!