Dog Diaries: Valley Fever

Well, it was disappointing news on the latest blood work for Tux, but I can't say I'm surprised. Fluconazole is just ineffective against whatever strain of fungus the dog has. Her cocci titer is still 1:164, unchanged for many months. I am relieved that it hasn't gone up though, as she was clearly going downhill until I started the Terbinafine in dry form. The sores that covered her leg are completely cleared up now, she is eating again and has the best stools (solid) since this saga began.

I was given the OK to try Itraconazole again, in addition to the Terbinafine. Itraconazole initially knocked her titer in half so who knows what will happen with the two drug combo. We stopped it when the sores broke out thinking they were caused by the medication, but clearly that wasn't the case. I'm pretty sure it is the disseminated fungus, now in her skin and possibly bones, which isn't a good thing. The delay in taking her off Fluconazole in that first round probably allowed it to spread. Poor dog. Her liver values are slightly high so all these drugs are starting to take their toll. She'll need liver and kidney function tests again in three months and a cacci titer in six.

If there is no change in the titer in six months we will have to figure out the lowest dose of azole meds that will hold it steady and just live with the disease for the rest of her life. She's certainly doing well now, despite it. She's happy and active and doesn't look sick at all.

So, the dosage plan is to start with 200mg once a day for three days, then drop to 150mg, continuing the Terbinafine as I'm currently doing. That's slightly aggressive. The high dose resulted in vomiting and diarrhea when we first started using it and I dropped to 150mg after 5 days. I might just go to 150mg right off the bat. Going back and forth on that. But that big dose might have been what was so effective in knocking down the titer by half. The vet is pretty much letting me do whatever I think is right at this point. I guess that means she's thinking it's as good as it's going to get.

UPDATE:
The vet tech just called with results of the blood work (unaware that I'd been in the clinic earlier today) and I am happy to say I misheard the tech I was talking with earlier. Seems Tux's titer is actually 1:64 not 1:164, so this is much better than I thought. I was baffled by how good she is looking and feeling with no improvement in the titer! Anyway, I will go less aggressive with the Itraconazole now, or maybe even stay on the current course. Need to think about this a bit.