Thursday, June 10, 2010

the long haul...

Well, we've been back to the dermatologist for a re-check. She agreed that the sores looked worse and did a cytology tape to look at what is in the sores. Gracie has alot of staph and the yeast infection is back. I love this doc because she writes a discharge LETTER. It is so detailed and complete in diagnosis and instructions. So, here is Gracie's official diagnosis (alot of big words, some of which I'm familiar with now, thanks to Google):

Malassezia dermatitis (moderate) - relapsed of Keto
Interdigital folliculitis/furunculosis (deep pyoderma)
culture showed S. intermedius with minimal resistance
Open for pruritus / predisposing factor for infection
Differentials: Atopic dermatitis more likely. Food allergy less likely.
Tape Cytology reveals clusters of cocci bacteria and a relapse of Malassezia (cluster of 6-10 found).

Dr. Liska changed her meds and they are now as follows:
1) Restarting Ketoconazole - this is for the yeast infection
2) Doxycycline - this antibiotic replaces the Cephalexin
3) Pentoxifylline - this is the anti-scar tissue med
4) Prednisone - steroid to reduce inflammation and give her some comfort

We are on the antibiotic and Keto for awhile. Everything I've read says the treatment with antibiotics is long term to completely get rid of the bacteria. I didn't really want to do another round of steroids, but it is a short course and we are doing them to make Gracie comfortable. I can't stand to see her in pain and she was. In fact, with just 3 doses in her, I'm seeing improvement in the inflammation. She's not favoring her front paw anymore. That alone is worth being on steroids again.
We are continuing the epsom salts baths 2X/day. Poor Gracie is about done with standing in the tub for 10 minutes per soak. She is all legs EVERYWHERE when you are putting her in the tub but settles down pretty quickly. Then, she is very patient and just stands there. After about 5 minutes, she starts to whine and whimper a little bit. We pet her and talk to her the whole time so that helps. We aren't doing the benzoyl soap for a few days because it was stinging when I put it on. Another challenge with giving her medications...she has become a spoiled brat about her food. She often refuses to eat her dry food unless something is mixed in with it. At first, warm water would work, but now she is holding out for better things...like little pieces of chicken or hamburger. If she doesn't want to 'settle' for the dry kibble, she will stand at her bowl and bark 2 times. She waits and if you don't respond, she barks 2 times again. This can go on and on and on. She is very patient. Yes, I've created this monster...just like David said.

I've started to write down everything just to keep up with it all. When you've got 2 people caring for her, med administration / foot soaking can get confusing! Plus, I'm keeping track of how her feet look day to day so the doc has a good idea of how the meds are working and when there are changes. Dr. Liska kept asking questions about 'when'...when Gracie was off the antibiotics, when the sores came back, when she got back on meds... She can't help us if we can't give her good information, so this is my solution. I'm sure David thinks I'm going overboard, but this is the best way I know of to keep track of all this information. He suggested we get a pill box dispenser and put her meds in that. It's a great idea, so I'll be picking one of those up today!

Anyway, this is getting long and I'm sure you all have things to do other than listen to me ramble. I really want to get some good pictures of Gracie to post. She's gotten so big! She's still on the smaller side of the breed standard, which is fine with us. She's a petite little girl. I'm assuming that might be due to her being so malnourished and ill when she was so young. I'll get some pictures soon and post them. Maybe even a video of Miss Gracie!
Ya'll take care!

2 comments:

Michele said...

Wow, what a precious puppy. Bless you guys for taking such great care of little Gracie...and what a perfect name.

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