I’ve been posting short updates about Nemo’s health in the Friday Roundups, but I figured it was time to share a full post about what’s going on with him. So here’s the deal: He is extremely sick.
Sometime around last Thanksgiving, at the same time that Nemo got an infection that lead to his leg swelling up, Nemo also contracted a staph infection that we haven’t been able to get rid of. Amidst his other problems we didn’t catch it right away, but once we did we started treating it as diligently as we could. But I haven’t been 100% up front about what’s really going on. I think mostly I’ve been scared to admit that it’s really bad. Nemo hasn’t been fighting any ordinary staph infection, it’s MRSA. Evil, evil MRSA.
Unfortunately it’s the type of infection that’s highly resistant to antibiotics. That, coupled with Nemo’s barely-there immune system, means he hasn’t been able to fight it off. Over the past few months, we’ve tried a variety of antibiotics, including topical, oral, and injectible, and nothing has made a difference. Over time, the infection has actually gotten worse and spread. While it started off as a couple of spots on his belly, now it covers most of his abdomen, his underarms, and there are spots on his hind legs. It looks red, and crusty, and gross and hasn’t shown any improvement. This past week especially, the infection has worsened greatly.
We initially had the infected area cultured to identify exactly what strain of infection we were dealing with, to better identify which antibiotics would have the best chance of working. Since none of the antibiotics we’ve tried were working and it’s been a long time since the first culture was done, we had a second culture done. We haven’t gotten the full results back yet, but the initial results aren’t good. The strain that they’ve already identified is extremely resistant to antibiotic treatment. We’re still waiting to see the rest of the results (it looks like there’s at least one more strain they need to identify), but our vet was clear that just these initial indications aren’t good. Even if this other strain is identified, it’s possible that there is still even more infection occurring. Since the culture sample was taken from Nemo’s belly, he could have something different going on in his underarms and legs. Even worse, some cancers display similar symptoms so that is a possibility as well. Since Nemo’s insulinoma is a type of cancer, this is especially troubling.
For a long time, the singular upside during all of this was that, for the most part, Nemo seemed to still be acting like Nemo. While he was clearly more achy than he used to be, by most indications he was still a pretty happy dog. He loved mealtime, played with his ball, and was eager to be with his people. However, the last week has clearly been tougher on him. He’s less interested in food (although he still eats if you mix enough wet food in there) and he’s more lethargic. Clear signs that he’s not feeling good, and given his stoic disposition, it’s probably worse than he’s letting on.
To compound the problem, his infection is contagious. Not just to the other dogs, but humans could catch it too. And that means that Nemo’s had limited contact with people. He still gets some attention, but it’s not like he’s used to. We’ve also limited his interactions with the other dogs, so no more cuddling up on dog beds or licking peanut butter spoons together. We religiously wash our hands and the dogs beds frequently. When these were temporary measures that were only supposed to last for a couple weeks it was doable, but now months have passed and there doesn’t seem to be an end in sight. We are starting to have concerns about his quality of life going forward.
So now we’re at a real impasse. After a long conversation with our vet we’ve decided to try one last Hail Mary. While we wait for the final test results, we’re reducing his prednisone dosage again (prednisone inhibits the immune system, so we’re hoping it will give him a slight bump) and doubling up on some of the antibiotics that seemed to work least ineffectively the first go around (does that make sense? none of them really worked so we’re going with what seemed to help the most even if it was just to keep the infection from spreading) while we wait to get a more updated picture of what’s going on. We’re hoping that we’ll be able to manage his blood glucose levels despite the reduced prednisone, but of course there’s a chance we won’t be able to. Hopefully we’ll have the final test results from his second culture very soon and we’ll have a more solid idea of where we currently stand.
Beyond this though, we’re not sure what options we’ll have. Our vet has consulted with everyone in his practice and even more vets at another specialty practice nearby. None of them have given him good answers and most seem to be at just as much of a loss as what to do next. Nemo’s insulinoma complicates his case greatly and there is no treatment road map to follow. T and I are preparing ourselves to make some very difficult decisions, and it’s breaking my heart. Nemo is an amazing dog and he’s been through so much, I hate thinking his time is more and more limited. No matter what though, we’re keeping his best interests at heart.
Please send lots of good thoughts his way.
Sometimes it’s really easy for me to forget that Nemo is sick.
For a long time we’ve been managing his pancreatic insulinoma really well. He gets medication twice a day, feedings 6+ times a day, and his blood glucose is checked every morning. It sounds like a lot (and I suppose it is), but it’s become so routine that I don’t even think about it anymore. He’s happy. He’s cuddly. He acts like just the same Nemo as he always did. It’s worth it.
So it’s easy for me to think that it’ll just always be like this. Not ideal, but certainly not bad. And that Nemo will be here for a long time.
But that’s just not true. This weekend Nemo’s blood glucose levels were low. At one point scary low (actually lower than when he had the seizure that led to his diagnosis). We were testing him three or even four+ times a day to monitor him and try to get him back somewhere near the “normal†range.
I told Nemo that he’s such a sweet dog that I don’t understand how a lack of sugar could take him down. It seems poetically unfair.
Thankfully he didn’t have a seizure, but it was a horrible reminder that even though he’s been doing so well for almost a year, we don’t have the years ahead of us that we wished we would. We upped his prednisone dosage, gave him syrup for quick sugar boosts when necessary, and are feeding him around the clock (thanks to these automatic feeders while we’re at work during the day).
Even though I knew this would come eventually it’s still a blow. For now (knock on wood) we’re hoping that simply increasing his medication will help. A process that we’ll probably have to repeat again before it stops working all together (and hopefully that won’t happen for a long time).
We’re working with our vet to determine what the best next step will be. Continue with feedings and medication? Surgery? Something else? But this weekend was just an awful reminder that no matter how much I love him and care for him, that no matter what lengths we go to, Nemo’s life will be shorter than it should have been.
And that just plain sucks.
Related posts: Scared, Itty Bitty Pills for Nemo, Fat, but Happy: An Update on Nemo
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