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!
Thursday, June 10, 2010
Gracie needs some prayers...
First of all, let me apologize for the length of time between posts. I'm really trying to keep up but 'life' keeps interrupting! So, unfortunately this post is not great news. We have been
dealing with this issue since last fall, but recently it has gotten alot worse. It started with a couple of toes on her front paw being swollen. The way she bumps into things and uses her front paw as a 'feeler', we just figured she had hit it on something. This progressed to sores in between her toes and a few of them opening. Over the months, we have been to our vet 3 times and done several rounds of steroids and tried a couple of different antibiotics. Finally, he sent us to a dermatologist...ironically enough, just one floor up from the opthamologist we went to see last year!
dealing with this issue since last fall, but recently it has gotten alot worse. It started with a couple of toes on her front paw being swollen. The way she bumps into things and uses her front paw as a 'feeler', we just figured she had hit it on something. This progressed to sores in between her toes and a few of them opening. Over the months, we have been to our vet 3 times and done several rounds of steroids and tried a couple of different antibiotics. Finally, he sent us to a dermatologist...ironically enough, just one floor up from the opthamologist we went to see last year!Anyway, Dr. Liska at the Animal Dermatology Referral Clinic was AWESOME! She doesn't think it's an allergy so we aren't doing all the allergy testing, which I hear is expensive, unless we have to. Dr. Liska came back with a diagnosis of Interdigital Folliculitis and also Malassezia Dermatitis. The folliculitus is what we are fighting. It causes scar tissue the longer you have it and is deep in the tissue of her paw, making it harder to fight off. Her having it on her feet is also making it worse because there isn't alot of room in the tissue there to swell. So any sw
elling is causing issues for her. Dr. Liska took a sample from some of the open sores and sent it to a lab in Arizona to be cultured. This was supposed to take 1 week but it took 2. The reasoning behind doing this was to find out what drugs the infection was resistant to and what would kill it. She had put her on Cephalaxin as a starter antibiotic with the thought that if it wasn't responsive, we would switch her, but if it worked then we would be ahead of the game. She is concerned about Gracie being resistant to some antibiotics since she's been on so many. The bacteria came back responsive to the Cephalaxin so we are supposed to be on this as a long term treatment...like 2 months. We are also putting her on an anti-scar tissue med. We've also been doing 10 minute soaks in Epsom Salts and washing her feet with a benzoyl soap. You can imagine how much she loves that! Last night she kept trying to sit down while standing in the tub soaking and every time she did her butt would touch the water and she stood right back up. Funny, but sad, too!
elling is causing issues for her. Dr. Liska took a sample from some of the open sores and sent it to a lab in Arizona to be cultured. This was supposed to take 1 week but it took 2. The reasoning behind doing this was to find out what drugs the infection was resistant to and what would kill it. She had put her on Cephalaxin as a starter antibiotic with the thought that if it wasn't responsive, we would switch her, but if it worked then we would be ahead of the game. She is concerned about Gracie being resistant to some antibiotics since she's been on so many. The bacteria came back responsive to the Cephalaxin so we are supposed to be on this as a long term treatment...like 2 months. We are also putting her on an anti-scar tissue med. We've also been doing 10 minute soaks in Epsom Salts and washing her feet with a benzoyl soap. You can imagine how much she loves that! Last night she kept trying to sit down while standing in the tub soaking and every time she did her butt would touch the water and she stood right back up. Funny, but sad, too!So, it initially went away (just like every other time) but came back because we wer
e off the antibiotic for several days while waiting for the culture results. Back on them now but they are still swollen and some are open. And, yes, it is painful to her. She favors the front paw that has had the most problems and holds it up alot. The skin has split in one area due to the swelling, I think. I've got a call in to Dr. Liska on what we can do at this point. Just needing some good thoughts for my little girl. We are coming up on a year since her arrival in our hearts and home and I really thought we were done with all the medical issues!
e off the antibiotic for several days while waiting for the culture results. Back on them now but they are still swollen and some are open. And, yes, it is painful to her. She favors the front paw that has had the most problems and holds it up alot. The skin has split in one area due to the swelling, I think. I've got a call in to Dr. Liska on what we can do at this point. Just needing some good thoughts for my little girl. We are coming up on a year since her arrival in our hearts and home and I really thought we were done with all the medical issues!
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