aspergillosis

Re: aspergillosis

Rachael_24 — Fri, 23 Aug 2013 20:39:19 GMT

Yes, I agree that the trephination sounds traumatic but in all honesty, I don't think it's anywhere near as bad as it sounds. They seem to cope extremely well with it and the repeat treatments are very straight forward and quick.

We always tend to give methadone as part of our standard pre-med but we find that buprenorphine is adequate post-op. They are usually quite head shy post-op as it must be a very odd sensation to have your frontal sinuses and nasal cavities full of cream but they never seem to be painful.

As Stu said,the initial treatment takes about an hour so IV fluids are important and they do get cold quite quickly. Just the usual GA stuff really.

I hope that's of some help xxx

Re: aspergillosis

Stuart Ford-Fennah — Fri, 23 Aug 2013 12:46:42 GMT

If he was mine, i would try and go for the less invasive flush without the trefine. ive seen a pretty good tolerance with this and a reasonable good sucess rate. should be about an hours GA (make sure you give him fluids!! and pre ga bloods etc), there are obviously riskes but i think it would inprove quakity of life - even if the first one eliviated symtoms a bit. They do sneeze a lot after though and some can panic a bit in recovery if you let them wake up really quickly - lots of good analgesia!

Let me know what you decide, and how you get on if you go for it

Re: aspergillosis

littlehays — Fri, 23 Aug 2013 12:27:05 GMT

i guess what i'm saying is i'm trying not to be selfish and do the right thing for my lovely boy!

Re: aspergillosis

littlehays — Fri, 23 Aug 2013 12:23:59 GMT

thanks stu. if it was your dog, would you go for these treatments? he is 12, but otherwise so happy and his normal self, apart from the reverse sneezing/sneezing episodes and discharge. i really feel he deserves a chance at fighting this but i don't want to put him through something that's going to be too much at his age...

Re: aspergillosis

Stuart Ford-Fennah — Fri, 23 Aug 2013 10:00:38 GMT

Dear Littlehays,

We have two techniques for dealling with apsergillosis depending on the clinician, one is the trephine technique whihc they cope with premendously well we just use jamshidi needles in the sinus's then flush through with clortimazole (canisten) then squirt the cream in, the other is to block of pahynx and narea with foles and instil the canesten up the nares using catheters and rote athe patient with 15mins in each possition 'topping up the nasal cavity

Ive seen both techniques work well if some take 4-6 treatment. Hope this helps you decide...

Best wishes,

Stu

Re: aspergillosis

littlehays — Wed, 21 Aug 2013 22:52:14 GMT

thank you rachael...the trephination just sounds so traumatic i'm not sure i could put him through it...vet did say to try antifungal oral drugs first (but warned of only 50% success rate) then the trephination if no improvement. but he did also say could put catheter into nose and put the treatment in that way, although warned it isn't as effective.

arghhh just don't know what to do! other than the sneezing/reverse sneezing he's so happy and bright, eating/drinking/etc normally, wanting to play and go for walks...how do you decide...so bloody hard :-(

Re: aspergillosis

Rachael_24 — Wed, 21 Aug 2013 12:32:46 GMT

I work in a referral hospital and we treat aspergillosis fairly often.

We usually CT scan them prior to treatment to ensure that the cribriform plate is intact and to check for any other causes of the clinical signs. We then perform rhinoscopy and can very often visualise the fungal plaques. If we do see any then we collect samples to confirm aspergillosis.

First treatment usually involves trephination into the frontal sinuses and a clotrimazole (caneston) soak. I think the norm is to soak for 1 hour, turning the dog every 15 minutes so that the whole area is treated. We then apply clotrimazole cream and because it is so viscous it tend to stay in the area for a long while. Be warned, patients sneeze a lot and the cream gets everywhere!

We then do repeat treatments. It's normally once a week for 3 more treatments after the initial soak but this does vary between patients. These are far less invasive! The trephination holes are already there so we sedate with medetomidine/butorphanol and inject clotrimazole cream into the frontal sinuses.

I hope that your dog is doing ok! Best of luck x

Re: aspergillosis

littlehays — Tue, 20 Aug 2013 21:38:11 GMT

thank you very much amy. well we got the culture results back on friday - negative, but the blood antibodies came back today as positive. in a way it is good news as the only other likely thing it could have been was a tumor (which still can't 100% be ruled out) and there's nothing we could do for that. my vet is phoning a referral practice to seek advice on reliability of diagnosis/treatment options. think i'm with you on the surgical treatment tho, from what i've read it does sound very traumatic...i'm just hoping there are some good medical management strategies that will help ease his symptoms to make him more comfortable for the rest of his days. any advice gratefully received xx

Re: aspergillosis

Amy Homer. RVN. NCert A&CC — Sat, 17 Aug 2013 10:53:43 GMT

hey there. it does sound alot like it. i have seen aspergillosis quite a few times as i used to work in medical referral, but we recently had a case in th epractice i am in now. if it is that, it is a bugger to treat. the case i was recently involved with had 3 or 4 repeated trephinations and flushing with canastan solution. fortunatly it has seemed to of worked but it doesnt always. i guess it depends on how you feel about it, but personally, i wouldnt put an elderly dog through that treatment as its not nice.hopefully it will be something else. x fingers crossed x