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July
30, 2001 – Jabber and his brother, Merlin, had a very lovely weekend.
It was especially nice because unlike last weekend, we weren't worrying
about whether or not Jabber has terminal cancer. If you visited us last
week, you know that that we were nervously waiting to hear the results
of a critical blood chemistry test.
Here's a little background
Jabber underwent TPLO surgery early last March at VSS, Veterinary Services
of the Southeast. (VSS is a state-of-the-art veterinary diagnostic and
treatment facility in Charleston, SC. It was established by Jabber's
TPLO surgeon, Dr. Paul Shealy.) Jabber's surgery
failed. Surgical repair was attempted which also failed. A third
operation saved Jabber's leg but we have struggled with post-surgical
complications and health problems ever since. Jabber has finally begun
to walk without assistance but he has a drug-resistant E. coli infection
in his urinary tract which could eventually kill him. The problem was
first diagnosed in April by the University of Georgia School of Veterinary
Medicine shortly after we transferred Jabber there for three weeks following
25 days of post-surgical treatment at VSS. Despite several months of
various antibiotic treatments, Jabber's E. coli infection persists.
It is now resistant to all but two antibiotics, Amikacin and Tobramycin.
Both of these antibiotics are "last choice" drugs because
they can cause kidney failure.
 Where
we are now
We've been trying to determine why Jabber is unable to fight off the
E. coli infection. It was theorized that he may have bladder stones,
which could be harboring the bacteria. Eleven days ago (July 19) Jabber
was transported to VSS in Charleston to have his entire urinary tract
examined. Dr. Shealy's associate, Dr. Abigail Kaufman, performed ultrasound
on Jabber's prostate, bladder, kidneys and spleen. Afterwards Dr. Shealy
informed me that certain irregularities suggested that Jabber may have
hemangiosarcoma,
a deadly form of cancer. A blood specimen was taken and sent off to
AnTech Diagnostics in Farmingdale, New York, to help determine a diagnosis.
The report was due back the very next day. Dr. Shealy told me he would
call me with the results when they came in. We waited expectantly. To
make a long story short, the report was returned to VSS on Friday as
scheduled, but Dr. Shealy never got back with me. I phoned the clinic
on Friday, Monday, Tuesday and Wednesday. Dr. Shealy did not return
any of my calls. Late Wednesday afternoon – almost a week after
Jabber's ultrasound exam – I was finally passed off to Dr.
Kaufman who explained to me that Jabber's blood chemistry was "unremarkable."
There was absolutely nothing in the report to suggest he has cancer.
Whew!
 Where
do we go from here?
Dr. Kaufman said that Jabber's ultrasound exam can be used as a baseline
for future comparisons should the need arise. The irregularities she
observed may or may not indicate problems. It is too early to tell,
especially since Jabber's blood chemistry is okay. The next step is
to decide whether or not to start Jabber on Amikacin. On Wednesday my
local vet, Dr. Nori Warren, sent a urine sample off to AnTech for culture
and sensitivity testing. Prior to shipping, she tested the specimen
for blood. Though the urine appeared clear on visual inspection, it
did contain some blood. Friday Dr. Warren phoned me to say that the
preliminary report indicates bacteria is still present. We expect a
full report to come back in a day or two. The report will identify the
bacteria (no doubt E. coli), quantify it, and tell us how it responded
to various antibiotics. Dr. Kaufman asked me to send her a copy of the
report and she will help us decide what to do next. If we decide to
start Jabber on Amikacin, he will have to undergo daily injections for
4 to 6 weeks. The way I understand it, his urine would have to be evaluated
under the microscope every two or three days. At the first sign of kidney
breakdown, treatment would be immediately suspended.
What's the deal on these super-bugs?
I once asked Dr. Shealy if he has ever had a patient with an E. coli
infection as resistant as Jabber's. He has not. It's a different story
at Shandonwood Clinic in Columbia, SC, where Dr. Warren works. Right
now she has two patients undergoing Amikacin treatment for drug-resistant
bacteria. One of them, a Rottweiler, has exactly what Jabber has. I
think the other dog has drug-resistant Enterococcus. Amikacin is generally
considered a "last resort" treatment because of the potential
side effects, but so far both dogs are doing all right. It is very unsettling
to know that these deadly antibiotic-resistant bacteria exist. They
are often referred to as super-bugs. I suspect we will be hearing more
about them in years to come.
Culture and Sensitivity Report
Both Jabber and Merlin had a nice weekend. We hiked around the pond
again and the two dogs went wading. Jabber is finally beginning to handle
stairs without assistance. He is still awkward, but he can go up and
down three steps without falling – anything more than three steps
requires support from a belly sling. We see no indication that Jabber's
E. coli infection is bothering him. I will post the results of Jabber's
urine culture as soon as we hear something.
Do you believe in miracles? This ought to qualify...
August 1, 2001 – Jabber's urinalysis and culture came back this
morning. He has been off antibiotics since July 4. At that time, high
levels of E. coli were still present – 1,000,000 cfu/ml. Yet now
there is no sign of E. coli !!! Not only that, but Jabber's urinalysis
was completely normal, indicating that Jabber's kidneys are doing fine.
Non-hemolytic Gamma Streptococcus was isolated (100,000 cfu/ml) but
the Strep infection is sensitive to all the usual antibiotics. Even
better, Jabber may not have any infection at all. Dr. Kaufman reviewed
the lab report and told me she feels the Strep is possibly just a contaminant.
Evidently finding a Strep-based urinary tract infection is pretty unusual,
plus no bacteria were observed in the urinalysis. Dr. Kaufman suggested
Jabber undergo cystocentesis for a new culture and sensitivity profile.
This should confirm or rule out the Strep infection. Cystocentesis involves
inserting a large hollow needle directly into the bladder and extracting
the urine. This method bypasses possible contamination from other sources
such as the prostate or urethra. Jabber has experienced "cysto"
before and I am sure after everything else he has endured for the past
five months, cystocentesis should be a cake-walk. I can't begin to describe
how shocked and pleased I was when I learned Jabber's E. coli infection
has disappeared. It really does seem like a miracle!
Next
Installment
(See last week for more details about
Jabber's case.)
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