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Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 28532
Experience:  University of California at Davis graduate veterinarian with 45 years of experience
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Ello, i am in Paris, france My dog 1,7 years old has been

Customer Question

ello, i am in Paris , france
My dog 1,7 years old has been diagnosded by a Cryptoccocus on the 30th September (she had some 2 seizure on the same day before the verdict).
She has started the treatement with Fluconazole , at first 150 Mg (milligrams) per day, and now 200 Mg / day
Her type of Cryptococcus concerns probably her brain ,as she had an ulcere above the left eye, and she had the front bone destroyed (they discovered it when they extracted the cells to send them to the lab).
So from 30th September she has had 7 days of Treatement, but around the day 3 or 4 , her mobility went down, and now she can't move. when i help her to stand up, she is still alert and recognizes me, licks my hand, etc.. but she can't move since Saturday 3rd October. On the other hand she is week but still conscious and have good periods. At the moment she is at the vet clinic since Saturday for intensive care more or less. I can visit her several times a day.
Cryptococcus is extremly rare in france
Submitted: 1 year ago.
Category: Dog
Expert:  Dr. Michael Salkin replied 1 year ago.

I'm sorry to hear of this with Brystole. You're correct - cryptococcosis is more common in cats but does occur in dogs who are more likely to be systemically ill and always have a guarded prognosis for recovery. The treatment of choice is, indeed, fluconazole because it crosses the blood-brain barrier but it's important to recognize that central nervous system infections as you've described in Brystole can be difficult to clear. Dogs such as she may also need surgical removal of infected tissue (cytoreduction of large granulomatous lesions). I regret to tell you that her paresis (weakness)/paralysis at this time is a very negative prognosticator for her eventual recovery. Please respond with further questions or concerns if you wish.

Customer: replied 1 year ago.
if the cryptococcus has crossed the blood brain barrier, is it too late? Let's say the fluconazole is starting to act, is it possible she starts to get better and walks again ?
Tomorrow they are planning to make a scanner to her with a very light anesthesia, and she is planned to be "awake".
I am really worry if they can save my dog or if it's too late. She looks okay more or less when i see her and speak to her but about this mobility problem i am worried
Customer: replied 1 year ago.
i mean let's say she survives 5 or 10 more days and some signs that she gets better arrise , is it possible she walks again ?
Expert:  Dr. Michael Salkin replied 1 year ago.

It's not necessarily too late but treatment would necessarily be quite protracted and the prognosis for functional recovery must remain quite guarded. Yes, if damage to her brain isn't permanent she can recover the ability to walk. It's difficult to predict how long that might take, however. The brain scan will tell you how involved her brain is in this infection. If multiple granulomas are found, Brystole won't be able to recover. If granulomas can't be seen in the scan, she has a chance!

Customer: replied 1 year ago.
ok i will keep you updated with Tomorrow's scanner, in any case. i am quite afraid for her now.
Last thing for today, and i don't disturb you , let's say that no granulomas are found , then is it wiser to keep her some more days at the clinic, or is it fine to take her back with me. I ask this because it's starting to be quite costly (100 euros per day to keep her there, + blood test that i have to add ,etc.. ) ?
Expert:  Dr. Michael Salkin replied 1 year ago.

I understand how costly this can become and there's no way to know how long treating her would be necessary. The husbandry necessary to care for these dogs can be lengthy and intensive and so home care - while possible - must be thought through carefully by you. Paralyzed dogs often require 24 hour care.

Customer: replied 1 year ago.
Thks a lot doctor, i will keep you updated tomorrow about Brystol's health
Expert:  Dr. Michael Salkin replied 1 year ago.

I appreciate it. I'll watch for your next post.

Customer: replied 1 year ago.
Hello again, Scanner said that the crypto has passed the encephale ... Is there any chance left?
Expert:  Dr. Michael Salkin replied 1 year ago.

I'm sorry to hear of this. Unless you've prepared for months of intensive care and considerable expense, euthanasia is a reasonable option for Brystole. What have her vets told you now that she's been scanned?

Customer: replied 1 year ago.
The vets said that as it's the 7th day of anti-fungus, and maybe it's worth to try a few days more in order to see if the anti-fungus works or not because it's not yet at its pic of action (normally it's 10 to 15 days that it takes to start to show some signs of actions).
When we took her from the Scanner place, back to the veterinary in the afternoon, at some point she started to shout very loud while travelling her from the car back to the clinic. The vet said it's due to post-anesthesia...
I join you some photos of the scanner
I don't know what to do, if to try few more days or to euthanasian her
Expert:  Dr. Michael Salkin replied 1 year ago.

Thank you for the images. I'm not qualified to interpret these scans but even I can see the extensive bony destruction caused by the fungus. If the fungus has, indeed, invaded her brain, euthanasia might well be a kindness. I can't expect your being able to care for a paralyzed patient for the extended time necessary for a positive response to therapy much less cure. Treatment typically is given for months and will be quite expensive. I understand that you have a very difficult decision to make.

Customer: replied 1 year ago.
i will think and will keep you updated.
Expert:  Dr. Michael Salkin replied 1 year ago.

Thank you. I'll watch for your next post.

Customer: replied 1 year ago.
Hello Doctor Salkin ,
Today I went to veterinary, and a bit he finds her mind slightly deteriorated since tuesday as she didn't react by clicking the eye when he did put a strong light near her left eye. Myself i looked at her, and i had the feeling she was the same than the previous days. She a bit reacted to my presence but as usual not much. Her Ears stood up but she had no energie to turn her head, but when i took her head she started to lick a bit my end.
On the other hand, it seems that the ulceria/oedeme lost 30% of his mass, and her left eye was a bit "more normal " than yesterday. So maybe anti-fungus starts acting!?
With the vet, we gave ourselves between 2 and 4 days where she will stay at the clinic and we will closely watch the evolution. If it's negative, then probably i will have to let her go, while if it's stable or a bit better, it will then be possible to bring her home and continue anti-fungus treatement from home.
Also I said him no blood test until extremly necessary, because all teh time it's between 200 to 300 USD for 17 Electrolytes, which is not nothing at the end ... On this he agreed.
I have also gotten the CD with the scanner, i will try to send you some of the pics (that are much more precise than the photos I sent you yesteday) .
Expert:  Dr. Michael Salkin replied 1 year ago.

Thank you for the update. That all sounds reasonable to me. It's too early to see a meaningful response to that drug. Because of its long half-life, fluconazole doesn't reach steady state plasma levels for 6-14 days after beginning therapy. Depending upon response the dosage may be increased for refractory cases. Treatment will be required for months and generally should continue for 1-3 months after resolution of clinical signs.

Customer: replied 1 year ago.
Hello !
I went to see brystole today afternoon too (so it's my second time today), she is like in the morning and other days , but her temperature is a bit down today. Normally in france by celsius, for a dog it should be between 38,2 and 38,6 , my dog had 36,8 in the morning (around 10,30) 36,4 in the afternoon (around 13,30) and later in the afternoon (at 16;30 paris time) she had 36,1°.
I came , gave a bit some food, she licked my fingers and took my food, then i stayeed a bit with her and let her sleep. But i don't know , to me she looked like the other days , not better not worse, only this temperature things a bit worries me. They putted a bit some covers on her
Expert:  Dr. Michael Salkin replied 1 year ago.

Thank you for the update. Normal body temperature ranges between 38 and 39.2C. 36+C is worrisome and might indicate her brain unable to regulate her body temperature efficiently, drug toxicity, or a failing patient. You're correct to be worried.