He Dodged Another Bullet

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.

JabberWhere 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!

Jabber and MerlinWhere 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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