I met Amelia on a Saturday in July of this year. She is a sweet, 4-year-old, 40-pound, mixed-breed dog. Amelia was very sick that day. Her family was so very worried about her and feared that if her illness wasn't treated soon, she might not make it. Amelia had a few hurdles to overcome, and had a big to-do list ahead of her, but this was different. Today's symptoms were moving fast, and Amelia was worsening each day.
Upon entering the exam room and taking a first glance at this girl, it was obvious that she did not feel well. Amelia came as close to talking to me as a dog could possibly come. Her eyes pleaded for help, her body weak, unwilling to carry her across the floor to say, "Hi." I could tell she wanted to talk to me. She was glad to see us, but unable to show it.
I began my exam with gentle palpation: where did she hurt, what should I concentrate on? The swelling below her jawline quickly directed my attention to Amelia's lymph nodes. They were swollen -- almost all of the lymph nodes that I can feel from the outside of the body were enlarged and firm. Amelia had a couple of skin lesions that appeared as swollen, weepy wounds. She was hot to the touch because of a fever. Amelia's eyes were shut, as if they were painful to open. Her joints were sore and it was difficult to move around.
Her symptoms were such that I immediately worried that hers was a worst-case scenario. We may not be able to fix this. As with all sick patients, my mind made a quick list of possible diseases, needed testing, possible treatment, and words I could use to explain how serious this was without making it seem hopeless. I had to be honest. I had to tell Amelia's family that there was a good chance their sweet girl had cancer. That was the most likely cause for her symptoms.
Amelia's mom knew it before the words entered the air. She had dreaded hearing them, and it was almost too much to bear. She needed a moment to process her biggest fear. Then, like all great moms, she focused on action. What could we do today? We made a plan together. There were many tests we could do -- eye tests, X-rays, blood work, etc. Amelia's mom just needed an answer -- a diagnosis. She couldn't wait any longer. So, I took samples from Amelia's lymph nodes. If she had cancer, it was likely to be lymphoma, a very aggressive cancer involving the lymph nodes. I submitted the samples to a veterinary pathologist. It was Saturday and we would have to wait for results. So, we got busy with pain management and eye medication to keep her comfortable until we knew more.
Four days later, the pathology report was in. I called Amelia's mom to tell her I had good news, and I had bad news. The good news is that Amelia does not have cancer! She does not have cancer. And there's a chance we can treat her and help her past her illness. The bad news is that it is still very serious. Amelia's disease was diffuse -- it affected her eyes, her bones, possibly her lungs or GI tract. It would be difficult to treat. She may have long-term effects from the disease or from the medication. But, there was hope -- a 50-70% chance that we could fix this. Amelia has blastomycosis.
Blastomycosis is a fungal infection. Dogs are much more likely to get "Blasto" than cats or humans. The disease is introduced into the body by inhaling fungal spores. These spores thrive in wet areas, near water, and after heavy rainfall. Male dogs, age 1-5 are the most common victims of Blasto, and the respiratory tract is the most common organ system affected. Based on everything we know about blastomycosis, Amelia's case was a rare finding. Her location, gender, and affected body systems are all in the "less common" categories.
The treatment for blastomycosis is systemic antifungal therapy. So, Amelia is taking a daily dose of antifungal medication, which she will continue for several months. She also is given eye medication, and other treatments as needed to keep her comfortable. Amelia has shown improvement beginning 48 hours after starting treatment! Her mobility has greatly improved. Her skin lesions have almost completely resolved. Her lymph nodes are improved at least 75%. However, her eyes continue to be a concern. She has been referred to a veterinary ophthalmologist for consultation and treatment recommendations, but even with all that we can do, she may face permanent vision loss or even loss of an eye.
Amelia's family is dedicated to her healing process. They are so supportive of their girl and have become fierce advocates for her health and comfort. With their love and the help of modern medicine, Amelia has a chance at a happy life.