ahicks51

From the Merck Veterinary Manual: Pathogenesis: The mechanism of toxicity is unknown. Affected dogs develop anuric renal failure within 72 hr of ingestion of grapes or raisins. Estimated amounts of grapes associated with renal injury in dogs are ~32 g/kg; amounts of raisins associated with signs range from 11-30 g/kg. Back to top Clinical Findings: Most affected dogs develop vomiting and/or diarrhea within 6-12 hr of ingestion of grapes or raisins. Other signs include lethargy, anorexia, abdominal pain, weakness, dehydration, polydipsia, and tremors (shivering). Oliguric or anuric renal failure develops within 24-72 hr of exposure; once anuric renal failure develops, most dogs die or are euthanized. Transient elevations in serum glucose, liver enzymes, pancreatic enzymes, serum calcium, or serum phosphorus develop in some dogs. Back to top Diagnosis: Diagnosis is based on history of exposure, along with clinical signs. Other causes of renal failure (eg, ethylene glycol, cholecalciferol) should be considered in the differential diagnosis. Back to top Treatment: Prompt decontamination of significant ingestion of raisins or grapes is recommended. Emesis can be induced with 3% hydrogen peroxide (2 mL/kg; no more than 45 mL), followed by activated charcoal. With large ingestions or in cases where vomiting and/or diarrhea has spontaneously developed within 12 hr of ingestion of grapes or raisins, aggressive fluid diuresis for 48 hr is recommended. Renal function and fluid balance should be monitored during fluid administration. For oliguric dogs, urine production may be stimulated by using dopamine (0.5-3 µg/kg/min, IV) and/or furosemide (2 mg/kg, IV). Anuric dogs are unlikely to survive unless peritoneal dialysis or hemodialysis is performed, and even then the prognosis is guarded. So- 32 g/kg for a 66 pound (33 kg) greyhound works out to over a kilogram (2.2 pounds) of grapes. Someone check my math on that, but that's a LOT of grapes if my math is right.

On the news tonight: U of A doing research with nikkomycin Z for treatment of "Valley Fever" in humans: http://uanews.org/node/15940 "Orphan" drug status has granted U of A some bucks to work with the drug. And for a change, this isn't a treatment- they're looking at nikkomycin as a *cure* for VF. Works as a curative in mice, anyway. Maybe dogs and humans next?

VF is nasty, but it doesn't physically manifest. In other words, you can't see it grow- unlike this booger. Plus, there's no neurological stuff going on. Coco continues to improve. No coughing! I'll pry open his mouth later this evening and see if there are any mushrooms in there. Dangit. Now I want a mushroom burger.

A quick update! There's been no hacking cough for over 12 hours now. A quick inspection of the mouth last night showed the left lateral aspect of the tongue has less of the white material than before- parts of it have detached from the tongue itself. It's on the run, and FAST. Doc wanted a check-up in 7 days, and I'm going to ask if we can take him off the antibiotics; we haven't seen any bad side-effects, and I doubt she'll say yes, but in my opinion it's the anti-fungal that is doing the trick. Haven't had a chance to inspect any pavement products, but he's on raw food so I'm not too worried about the runs.

Itching can also be environmental allergies, so you might have more than one problem going on. The itching may be unrelated to the teeth, in other words.

This can be one of a number of disorders, but a minor infection is possible. The vet will probably prescribe ear drops, along with a cleaning regimen. Our vet offered up this possibility just yesterday (Coco's right ear sometimes gets a little dirty), and one option was to check the swab under the microscope. She recommended ear drops made with 1:4 vinegar in water. Sounded a little harsh, so I haven't tried it yet.

Our vet recommended 1:4 vinegar in water solution. I used to use this as a kid to ward off ear infections, but never heard of it being used with dogs. It sounds a bit harsh, really.

The gorgeous dog in question: The speckled hindquarters of the lovely Lexie:

If you can email an image, I can post it for you. ahicks51 (at) cox.net

Hi! Any chance you have a picture you could post?

Actually, it works in the opposite way. The price is no deterrent for basic research on how useful the drug is for treatment of tumors. If the data from basic research shows that it is a useful drug, then it will start to be routinely used in a clinical setting. The more it is used, the more drug that is manufactured, and then the price starts to come down (also with the help of generics). What I was referring to was the initial cost of using it clinically. Not very many people are going to be able to afford such a treatment at the outset, particularly if it is in combination with any other drugs that are expensive. Carboplatin, as an example, will never be much (if any) cheaper, as it is a platinum compound. That means it will likely be a long time before a drug that like Gleevec is used routinely in pets (if it ever is). Drugs produced by recombinant DNA technology (like Procrit and Neupogen). aren't going to get cheaper any time soon either - and those could potentially be useful in dogs for more reasons than just chemotherapy. I like what I'm seeing with the new-ish cancer vaccines for melanoma: administer it for free (in the trial stages), and watch its use proliferate. Once well-established in veterinary use, migrate to human applications and make some REAL money. I'm betting if someone approached Novartis and asked for enough Gleevec for trials involving osteosarcoma in dogs, they might be amenable to free product, or at least greatly reduced cost. I seem to recall that Dr. Cuoto's research has implications for pediatric osteosarcoma- that's a pretty big "in." But that's just my opinion. I know nothing outside of vaccine trials in animals. BTW: Carboplatin is about 1/2 platinum by weight (195 grams out of 371 per mole). At 500 mg/dose, a spot price of $1304 per troy ounce (about $42 per gram, current as of today), that 250 mg of platinum works out to $10.50 worth of platinum metal per dose. Not sure how much a dog gets, or how many doses are required. (And, yes- I've worked in industry and chemistry research- I know that $10.50 quickly becomes a much larger figure once other factors are considered- especially for medicine!)

No changes, really; the coughing is about the same- at least it's no worse- and *maybe* slightly less white material visible from the sides. I'm more concerned about that which grows further back on the tongue, and it's difficult to impossible to visualize by getting his mouth open as the tongue retracts as well. I'm much more confident that it is fungal (based on the rate of growth as well as the odor), and that if the fluconazole doesn't work, there'll be a second-line anti-fungal to use.

I'm not sure how long the dose period in conjuction with chemo would be. My Dad was told it would be something he had to take for the rest of his life. Dunno if that helps either... That's true- but as chemo is to literally poison the undesirable cells, using drugs that slow or halt growth of the same tissues, a 1-2 punch sort of thing- that could be valuable. If not Gleevec, then perhaps some of the anti-angiogenesis drugs, that sort of thing. Stuff with relatively low toxicity.

He's crackerjack at the stuff that breaks dogs, but I'm in need of an infectious diseases kind of person right now. Don't know how he is in that category. (BTW- if you were at the Gilbert vet clinic today with the greyhound, we bumped into you and yours!) This just in: (MEN! AVERT YOUR EYES! Read further at your own peril!) I have been informed that his halitosis has taken on that same odor that is characteristic of certain... problems of a yeasty nature. I speak not of the Pillsbury Dough Boy! We all have 'em- just a question of why they go on a rampage. If this is the case, I'm a-thinkin' the fluconazole is going to help a LOT. Now we need to figure out the underlying cause.

Nope. The only thing that would predispose towards knocking the usual flora or immune system out of whack is the 5 mg of pred given three times a week. I managed to get his mouth open again tonight, and didn't see much; it's very difficult to see even under good circumstances. It only showed up because he was panting, after all, so it's easiest to see after exertion. I think this is a relatively new development (versus a slower growing thing like a tumor) because he didn't start coughing until today. No difficulty with breathing just yet- but there is the occasional deep cough- presumably a tickle from the growths. ETA: Nothing to make us suspect diabetes, although we've never given him a test specific to blood sugar or urine sugar. The last blood panel we have for him is over a year old, but there was nothing to indicate his sugar was out of whack.

I was going to email it to one of the pathologists at the Arizona veterinary school (at U of A), but figured I'd give the treatment regime a day or two to work first. I hate bugging people like that.

I'd considered lipoma as well, but there's SO MUCH of it- it's on both sides of the tongue, and it seems to "bridge" the tongue towards the rear. I actually managed to get it between my fingers yesterday when I thought it was a wad of paper. The populations appear to be disjunct, and unconnected. Phew. I have no idea what to make of it. Hopefully it'll get smaller FAST and convince me I made the right choice.

Okay- back from the vet; managed to snag a 9:30 appointment. Just got back from filling the script they either didn't have or thought I could get cheaper at the store (memo: ~$16 for fluconazole at Fry's supermarket versus $39 at Costco!). The vet is as stumped as I am. Her recommendation was $800+ worth of tests including gas anaesthesia and a biopsy. Two of those tests included a blood panel (which would show he has low white cell counts, same as every other greyhound, or he had an infection- which we can pretty much guess from the appearance of the mouth) and a thyroid panel (which will show that either IDEXX doesn't have the resolution at that level, or that MSU does or does not have their thyroid-by-dialysis test online). I figure something like this could be physiological in origin, parasitic, or pathogenic. If it's a parasite, I think we're all in trouble because it's nasty. If it's purely physiological (like a tumor), it sure had a sudden onset and got worse fast (he wasn't coughing yesterday). That leaves viral, bacterial, and fungal. I'm going to say "not viral," and guess bacterial or fungal- probably fungal. Which leaves one course of action- antibiotics and antifungals. With antifungals, there's not a big selection- conazole-class antifungals, amphotericin ("amphoterrible"), and griseofulvin, terbinafine. So, for $200, it was an exam and antibiotics (Clavamox), and another $16 at the pharmacy for fluconazole. Much as I'd like Coco to be treated like a lab rat and biopsied, I'm going to skip that for now as I figure the benefits of a change in treatment venue are outweighed by the risk, stress, and expense of gas anaesthesia. And he's also off the pred- so I need to find something to keep his environmental allergy under control, probably Claritin. Meanwhile, feeding time around here consists of individual bowls which are then thrown in the dishwasher with a slug of bleach. Water is provided regularly, using the same conditions. On the bright side, the left lateral aspect of his tongue (the one in the image) looks better than it did yesterday. I'm betting this is some fungal infection gone nutso, possibly complicated by the (tiny dose) prednisone. Between the antifungal, the antibiotic, and some good, solid rest, I'm hoping he'll improve quickly. ETA: He can't be feeling all that bad; he ate three photocopied pages from a plant tissue culture manual that were lying on the floor. Strangely, he stopped at the paper underneath (Harvais, 1974)- much more important to me as I'd not yet harvested the information from it that I needed. After that, he still had room for breakfast, which I'd withheld seeing as we were going to the vet and all.

I don't have any experience in the dog dept, but that is what my Dad was taking, and holy cow it is expensive. His bill without insurance was over $30k per year, and luckily Novartis provided it for him until the insurance kicked in. It probably has reduced in cost, but it would not be an option for treatment for a lot of people. Even though the side effects are not terrible compared to a lot of products, there were still some very uncomfortable ones for my Dad. Another thing that can happen, is the Gleevec resistance that is where the cancer mutates enough to get around the specific enzyme inhibitor, and the cancer comes back twice as fierce. Not to be a negative Nellie or anything, but thought you might want some info from the human end. I know it's horribly expensive. Out of curiosity, I poked around on some Canadian pharmacy sites- apparently there is a "generic" version (probably illegal as Novartis still has it under patent- they wouldn't allow a generic on the market) presumably made in India. I played around with a few numbers, and figure it'd probably run about $500-1000 per month for a dog-sized dose. But if used in conjunction with chemo, maybe only a few weeks' worth of the drug might improve survivability? I dunno.

I was an EMT for about ten years, and a volunteer firefighter- including in East Texas and New Mexico- and my rule of thumb has always been that the worse it gets, the colder the water should be. Ice and really cold water will cause vasoconstriction in the skin, reducing the amount of cooled blood getting back to the core. But if it's bad enough that the animal is so overheated that the next step is unconsciousness or death, then to heck it with it- crash cooling is required before the ol' proteins start denaturing and the animal starts to die. The one part I tend to focus on is the "undercarriage" between the rear legs. There's little to no hair there, and two wonderful arteries (you can palpate them when they roach- they should be about the size of pencils and because of the high blood pressure in greys, they will be very firm) feed those hypertrophic thigh muscles. Get the hose up under there first, and flick back to it now and again while getting the thorax, the legs, the neck, and eventually the back. You want that water to sop up the heat, and then get flushed away with a new pulse of water. Careful about not getting any water in the face or mouth; if panting heavily, they might get some water down into the throat (all it takes is a drop) and you can get coughing and laryngospasm. If in the shower, sit on the side of the tub and get a knee under the "tuck" in case they collapse- one knee under the body, and the opposite hand under the neck or head, or holding the martingale.

If it is it's contagious. Make sure you wash your hands thoroughly after touching. Thrush was the first thing that came to mind; I set up my brother-in-law's medical billing system, and it was a running joke with thrush: treat one, then treat the spouse. I'm sure the medicos will get the connotation. So, yes- I'm a little neurotic about disinfection to begin with. I'm just not sure how to handle the communal water bowl. I may have to withhold water and provide separate bowls as required, yes? The evil thing about this is that it's *fleshy*. I thought he'd somehow gotten a wad of wet paper in his mouth, but thought he'd surely be trying to get it out with his tongue. I was shocked to find it all the way back on his tongue, as well as both sides. There's a *lot* of it- and although I seem to recall thrush can form secondary structures, I've never seen a picture in which there's so dang MUCH of it. When I asked the e-vet what thrush looks like in the canine, they said it's more of a problem in horses. Not helpful. It doesn't seem to bother him. It's not pseudomembranous, as it won't wipe off. It must be some sort of leucoplakia. He's on pred, 5 mg three times a week. I know prednisone can be an immunosuppressant, but it's such a low dose for such a big dog.

Wow! Thanks, grey_dreams! If it comes up, that'd be great. I'd feel guilty about emailing the guy, as I'm sure he is a busy, busy man.

We're taking him in to the vet tomorrow (the emergency vet clinic, based on the description, said it could wait), but- ACK! Anyone know what this is? The white slimy stuff is on both sides of the tongue, as well as growing on the back of the tongue, too. You can't see it unless he's panting (even with his mouth open, looking for it, it doesn't show until he sticks his tongue forward). No changes in diet, no problems breathing. Anyone know what this is? Please?

I've seen a couple of trials in progress with Gleevec (imatinib) for use with osteosarcoma, mainly in small children. Gleevec works by knocking out an enzyme (tyrosine kinase), and was originally developed for a certain type of stomach cancer that is very difficult to treat. Later it turned out to work well enough to label it for use with a certain type of leukemia. Of course, the cost is awful- but it comes with side-effects that make it preferable to other forms of treatment. Anyone know if imatinib has ever been tried- singly or in conjunction with other chemo- on osteosarcoma in dogs?

Do you have any blood panel results- any white cell counts to substantiate the suspicion of infection? In fact, if you have blood results and can post them here (or at least any elements that are out of the normal), that would be helpful. Baytril is a fluoroquinolone antibiotic, same class as Cipro (ciprofloxacin). Metronidazole (Flagyl) is an antibiotic that is also effective against some types of parasites. If you have reason to suspect tick-borne diseases, beginning treatment *may* be merited before you get results back. See also: http://www.vet.ohio-state.edu/2099.htm