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April 2, 2013

The good news? A total of 7 weeks of antibiotics (2 different kinds) wiped out Lilly’s e coli bladder infection. The bad news? Now she has an antibiotic-resistant bacterial infection called staph pseudointermedius. People get MRSA infections. Dogs sometimes get MRSP infections, like this one. All of this stems from her treatment for rabies vaccine-induced meningoencephalomyelitis (and the resulting incontinence). The drug chosen for this next canine bladder war is a doozy.

Canine Bladder Wars Backstory

For those catching up, Lilly first got sick with brain and spinal cord inflammation after receiving a routine rabies vaccine in January 2012. We’ve been in a life / death battle ever since.

Her treatment includes, among other drugs and supplements, 3 different immune squashing medications:

  • Steroids (dexamethasone)
  • An immune mediator drug, given to people after organ transplants, (cyclosporine)
  • Cytarabine, a chemo drug used to combat the specific kind of white cells they found in Lilly’s spinal cord fluid

Some 50% of dogs on long-term steroids will get bladder infections. Cytarabine is also pretty doggone hard on the bladder.

Lilly become totally incontinent (both ways) in June 2012, and it has been unrelenting since then … though, the recent addition of veterinary acupuncture has helped some.

In January 2013, Lilly suffered her first seizure in a year and began peeing blood. That’s when we found the e coli bladder infection was causing emphysematous cystitis (air in the bladder and bladder wall from the off-gassing bacteria).

We fought and won that battle, even though the infection was probably in there since at least September 2012.

But, then a few days after getting the news that Lilly’s latest bladder ultrasound showed all clear, we got the urine culture news telling she now battles staph pseudointermedius.

Canine Bladder Wars Theory

The best guess is that this is NOT a “new” infection. Our veterinary team hypothesizes that this bacterial infection has been going on for a while, but oddly enough, they think the e coli won the battle for resources inside Lilly’s bladder and kept the staph pseudointermedius at bay.

Now that the e coli infection is gone? The staph pseudointermedius is going wild.

On a Scale of 1 to Scary

On the How-Much-to-Worry Scale, we’re at a 7. This is a bad, bad antibiotic-resistant infection. On the plus side, according to our veterinary neurologist who joked last night about being “pathologically optimistic”:

  • At least there is a drug we can use
  • At least this drug isn’t prohibitively expensive (about $75 for 3 weeks’ worth)
  • Maybe Lilly’s incontinence and overall status will improve once we beat this staph pseudointermedius

The Dog Gods Must Be Crazy

Now, the CRAZY-@$$ news. The chosen antibiotic (chloramphenicol) is great for dogs — NOT so great for people. Chloramphenicol can cause irreversible bone marrow damage in some people (even if they merely touch the drug).

It’s a slim chance (1 in 10,000), but considering how Lilly’s Medical Miracle Tour started with an adverse vaccine reaction probably rarer than that, I’m being BEYOND careful. This crap CAN happen, and unfortunately … it seems to happen to ME.

Alas, I have to treat our sweet canine heroine like she is a HAZMAT hazard. I’m supposed to wear medical gloves anytime I:

  • Give Lilly her chloramphenicol (twice a day for 3 weeks, to start)
  • Change her diapers
  • Help her potty
  • Clean her up
  • Do her laundry

There isn’t much of a zoonosis risk (catching her infection), but between the bacteria she sheds via elimination and the concentrated chloramphenicol potentially in her mouth and eliminations, we’re being VERY careful.

Let’s just hope she doesn’t suffer the common chloramphenicol side-effects of vomiting and diarrhea since those, too, would require containment / safety protocols.

Why this particular drug? Chloramphenicol hasn’t been used much in the last 20 years, so bacteria hasn’t had the chance to become resistant to it. We’re lucky that our neurologist had some in stock — apparently, it’s hard to find.

For some reason, though, he has seen 3 cases needing chloramphenicol recently. All of them border collies. Wild!

Canine Bladder Wars Re-checks

We’ll do another urine culture at 10 days and again at a week after she finishes taking 3 weeks of chloramphenicol.

Other Adverse Vaccine Reaction Treatment News

You may recall that I ditched her cytarabine treatments for 7 weeks while Lilly battled the e coli infection. That withdrawal of treatment brought us near the brink, where Lilly easily could have suffered a major brain and spinal cord inflammation relapse — and, we probably would have ended the fight there.

We will postpone her next set of cytarabine injections by 1 week as we test to see if a 4-week cycle works OK. If so, then she’ll get 4 cytarabine injections over 2 days, every 4 weeks — instead of every 3 weeks. Our veterinary neurologist feels that Lilly is stable enough to give a longer treatment timeline a try.

 How Does Lilly Feel?

  • Lilly is tanking up on water more than she had been.
  • She is a little subdued and tired.
  • After nearly a week, where Lilly nearly peed on her own at least once a day … that has stopped.
  • We’re seeing more standing potty accidents, which had stopped when we began treating the first bladder infection.
  • Today (Tuesday 4/2) she is in pain — crying when I try to help her pee. So, I’m just letting what happens happen, rather than risk hurting her.

best dog blog, champion of my heart, border collie on dog sofa

And, Me?

I’m worried and discouraged, but hopeful. I knew we’d face more immune-suppression troubles. I just hoped we would get a little springtime reprieve first.

I had a good talk last night with our veterinary neurologist. Even though he’d just gotten back from vacation, even though he’d just worked probably 14 hours, even though he has a terrible cold, he called to give me context on both Lilly’s antibiotic-resistant staph staph pseudointermedius infection and the relative danger to me of using chloramphenicol.

He talked me down off the ledge, as it were.

It’s snowing hard on the mountain (again) tonight, so I’ll end with a photo of yesterday’s sunrise.

Tomorrow is Lilly’s survival day # 435. She is a bundle of love in a tough, miraculous package.

best dog blog, champion of my heart, sunrise in the Colorado Rocky Mountains

Thanks, as always, for your interest and concern.

About the Author Roxanne Hawn

Trained as a traditional journalist and based in the Rocky Mountains of Colorado, USA, I'm a full-time freelance writer for magazines, websites, and private clients. My areas of specialty include everything in the lifestyles arena, including health and home, personal finance and other consumer interests, relationships and trends, people and business profiles ... and, of course, all things pet related.

I don't just love dogs. I need them in my life. Seriously.

  1. So sorry to hear of this recent development. The horrible aspect of any kind of steroid is, it lowers the immunity. I have been lifting Lilly and you up in prayer. Have you ever heard of Manuka honey? There have been studies using it against MRSA. I wonder if this might be beneficial? I guess this would be a question to ask a holistic veterinarian.

    1. Interesting idea, Dillon. Thanks. I took a quick look online, and it seems better suited to topical uses to fight infection, but I’ll keep it on my list of ideas. It can interact badly with certain chemo drugs, but so far, I haven’t found a list of those drugs. Let’s hope Lilly’s cytarabine isn’t on the list.

  2. One day at a time. And I know lovely Lilly has good days, too. Anyone who has loved and cared for a pet with such serious issues knows every decision is made on an individual basis. You’ve shown us this over and over.

  3. My thoughts and prayers are with you. I can relate, my dog died due to MRSA, STREP GROUP A, PSEUDOMONAS, ESCHERICHIA COLI, and KLEBSIELLA PNEUMONIAE. Yes, dogs can get MRSA, MRSP, MRSS…

    In my case I did not have a good vet and by the time it was all diagnosed, it was too late.

    Superbugs are here to stay and more and more dogs and cats are getting them.

    I put together a website in hopes that pet owners can become more aware of these horrible diseases.

    Your baby seems so very strong and your vet sound like he really knows what he is doing.

    Again, my thoughts are with you and I do believe she will pull through.

    1. Thanks for dropping by, Jen. I’m so sorry to hear your story about Cashew’s deadly infection. We are hopeful for Lilly, but the fact that we’re deliberately suppressing her immune system to protect her brain … makes our case strange, at best.

  4. So sorry to hear Lilly is in pain from this infection. I hope she responds quickly to the chloramphenicol so she starts to feel better soon! It sounds like it’s going to be quite challenging to maintain the necessary “hazmat” precautions. Your neurologist is one in a million! Glad he gave you a pep talk. Sending hugs for you and a gentle pat for Lilly.

  5. Thinking of you and sending you hugs of comfort and calm. You are absolutely amazing. And Lilly’s neurologist sounds fantastic and so dedicated! And thanks for the beautiful picture of the sunrise.

  6. This is such an incredible story. I only know one other person who is as devoted to her pet. I know you wouldn’t subject Lily to this new treatment unless you had weighed the pros and cons, as you describe here. I hope it will work.

  7. 3 Border Collies needing the same thing recently? That is wild.

    Glad to have an update. That medication does sound super scary 🙁

  8. Hugs! I know how hard this is. Hang in there, you are doing the best you can!

    1. Jo, it’s not your place to judge Roxanne on the medical decisions she makes for Lilly. She is receiving guidance from more than one doctor and makes responsible, informed decisions based on that and knowing her dog. Judging Roxanne is unfair and out of line. This community is here to support and encourage Roxanne and Lilly. Consider that before you post more negative comments here.

      1. I agree with Amanda. It’s really bad news to judge someone. What would you think if someone decided what was best for you and your sick dog without knowing you?

  9. God has blessed you in helping him care for what is obviously a very special bundle of love and courage. I hope you have come to know this deeply. A year into a very similar story with our beloved Molly (german pointer), down on my knees cleaning up after another horrific grand mal seizure, tears in my eyes asking “why us?”…. I got this and it changed the constant terror of waiting for the other shoe to drop… to God put me here to help him with her because he knows what I am capable of giving. Hang in there and remember to tell her now how to get to the Rainbow Bridge and who to look for when her time comes. I even tell my young pups about the bridge in case something ever happens to me. It wouldn’t be heaven with out them!

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