Tuesday, March 1
I think I can speak for both the Emmerich family and myself when I say that today is so incredibly different than how we had envisioned it.
Today, we were supposed to be rechecking Indie’s right eye. And since it was still bulbous and inflamed and uncomfortable and non-visual, we were most likely sitting together in the specialist’s office, holding back tears, while Dr. Wasserman reiterated that in the absence of significant improvement, it was time to look at a second enucleation.
We knew it was possible, we even began dreading and anticipating this scenario, because – after a little bit of an initial positive response to the addition of oral steroids last week, Indie’s eye seemed to return to its previous state. And he has certainly been acting blind still. Better, not so painful, at least. And adjusting more and more, by tiny increments, to his new, non-visual state. But nowhere near where we would expect him to be if he was on the path towards a cure, at long last.
Instead, we are in completely unexpected territory today. Like Indie, we are suddenly reaching out and feeling our way through a fog, hoping to find something of substance, hoping for concrete answers. But patience is the name of the game, and will be for the next few weeks.
So we ask you all to join us in our patient, but cautiously hopeful (though oh! how dangerous hope can be, as we all know) as we wait and pray for Indie to respond to his new therapy.
But I get ahead of myself – again, and as usual, because Indie’s eye condition has been nothing if somewhat mystifying, filled with twists and turns. So let me back it up a few days to the end of last week, when last we updated…
Indie had begun oral steroids (10 mg tablets of prednisone twice a day) last Tuesday. I suppose you could say it was a bit of a last ditch effort to save his eye but adding in yet more anti-inflammatories, which we were finally clear to do since his blastomycosis (a fungal disease) test had come back negative.
At first, Indie appeared to be responding a bit. The blue cast over his eye disappeared somewhat, and his eye looked clearer. It even looked a little less bulgy and swollen. Indie appeared to be feeling perkier as well, getting a bit of pep and attitude back (yay!) and acting less depressed and more willing to explore his world without vision. But by late Sunday, his eye was returning to its former poor state again.
Lorri and her family were devastated, and as we talked by phone yesterday, we began to try to prepare ourselves mentally for the worst. We had promised to update the eye specialist yesterday – Monday – with Indie’s response to the prednisone, and we knew if the response was not solidly positive, we were essentially out of options. We would schedule a recheck of course, for this morning presumably – but exam results were almost predictable, given the state of Indie’s eye.
We never ever never anticipated what happened instead. My phone rang yesterday afternoon as I was getting my son from school.
Dr. Wasserman’s name came up on my caller ID and I assumed he was returning my phone call – I had left him a message regarding Indie and the promised update.
Instead, he sounded somewhat excited, slightly shell-shocked, and definitely advocating any optimism to come with caution, but…Indie’s toxoplasmosis results were finally in and surprise, surprise…he had tested positive for both types of toxoplasmosis antibodies, IgM and IgG, one indicating more of a chronic infection and one indicating more of an acute infection.
!!!
We had wondered why we were waiting so long on this last piece of bloodwork, but across the board we all assumed it was going to be negative, which the odds are so very strongly in favor of. This was a shock, truly…
And quickly, for those who are thinking about cats and pregnant women: it is important to note that most mammals are subjected to this disorder, but only the cat family is zoonotic, meaning posing a threat of infection to humans and other species, because they shed toxoplasmosis oocysts in their feces. This is why pregnant women wear gloves when handling litter boxes, which is the limit of what most of us think about it when we hear the word toxoplasmosis. It is important to note that Indie may have contracted this is the womb from his mother, or he may have ingested soil at some point which was infected, or he may have even cat poop somewhere along the way…but his dog and human family are completely safe, and he poses no threat of infecting others. But I digress…
So. Indie testing positive for toxoplasmosis, for both antibodies…
Well, this was pretty crazy because who ever wants to receive positive findings on lab work, right?? Yet as weird as this would be, I guess you could say that the news is not unwelcome.
To explain, we had been treating symptoms as they came before but losing hope, since Indie was having very little response in his right eye. He had also responded poorly or not at all to treatments of his left eye over time, and we all know how that ended.
Testing had also ruled out almost all clues as to a cause. We had begun starting to think it was just some sort of primary uveitis/glaucoma issue, from some previous trauma of known origin. Or perhaps, as can rarely happen, a response to having had ehrlichia in the past. But he had been completely cleared of ehrlichia through intensive treatment long before, and even now, his tests are negative. Yes, he had it or was exposed to it before, but there is virtually no trace of it left in his bloodwork. So that made no sense either as a cause.
Toxoplasmosis is very rare in dogs, and was included in his bloodwork only because it was part of a large infectious disease panel we had sent in. In all honesty, neither the doctor nor we ever anticipated one, let alone two, positive results for it.
So suddenly, we have this crazy new information to process. We also have this possible little glimmer of hope. And yet, we are trying very hard not to hope too high, because there are many scenarios possible, given this new information.
So to explain better – toxoplasmosis is a systemic issue and Indie has a couple of the symptoms (though its symptoms are simply so wide-ranging that just about anything could be considered a symptom, honestly). He is occasionally short of breath, and he has had this chronic persistent uveitis (inflammation of his middle eye and iris) – those are two of the symptoms.
Now don’t get me wrong, having toxoplasmosis is certainly no party. BUT – since Indie is stable and hopefully it has not affected him much, PLUS it has a treatment (and we would have wanted to know about it anyway ultimately, so of course he could be treated for it) – I guess you could say, yes, we are “happy” to hear this news. To be honest, if he has to have a systemic illness, we would definitely take this over many other possibilities.
Also, and I am not making any promises here, so let’s be clear about that – but the other piece of this diagnosis is, we can have a tiny glimmer of hope that this might not only be something Indie has, but that it might actually be the CAUSE of the eye issues.
So – and I apologize for jumping around here, but I am thinking out loud and want to spell this out for everyone as we see it now, since there ARE just so many ways this could go at this point. We see two (at least) ways this could go, moving forward:
FIRST SCENARIO (and the best). Toxoplasmosis may be the actual, only cause of Indie’s eye disorder. Wow…if that is so, now that he has started treatment (which is an oral antibiotic called clindamycin, twice a day, for four weeks)…if it is true, which seems too much to hope for…
Well, ocular toxoplasmosis has a bit of a guarded prognosis, so even if it is the cause, we don’t know how much damage he has already sustained in the remaining eye, and if what he has sustained is irreversible or not. There are other factors to remember: the ocular form takes longer to respond to treatment, so we should not expect immediate changes, which makes patience even more important. So, if this is really what we are looking at – and we are crossing everything that this is so – if any damage is revers, it should at least start to happen by the end of three weeks’ time. To that end, we have scheduled a recheck with Dr. Wasserman for Monday, March 21 unless we see any unexpected changes between now and then, such as a worsening of current symptoms. So barring the unexpected, we just have to cool our jets for the next three weeks – argh. Excruciating, but this respite is also so very very welcome, as we can hang on to a shred of hope now.
SECOND SCENARIO. Indie is treated for toxoplasmosis, he is hopefully cured according to recheck bloodwork, which we may repeat at his recheck appointment. But his eye issues may turn out to be simply a concurrent issue, coincidentally occurring at the same time as the toxoplasmosis, but unrelated. This is a sad thought, but must be considered as a possibility, since we weren’t even really looking for toxoplasmosis, and found it mostly by chance thanks to the big blood panel that was run. In which case, we are in the same place as we were before today’s diagnosis, in terms of the eye…giving it a little more time on steroids, and praying.
So now you are standing right here where we are, right beside us. We don’t have any concrete answers, and we probably won’t for some days now, possibly not for a few weeks. But we have a little flutter of hope in our hearts. And we are hoping, wishing, and praying with everything we’ve got!
Moving forward.
Indie has only been on clindamycin since last night, which is way too short of a time to see any true response, one that we can set any store by. However, we are working hard on tamping down on our hopes because his eye is looking slightly better, especially when compared to this past Sunday – perhaps coincidentally, perhaps thanks to the prednisone or other reasons, and in fact, most likely so. But we are human, so of course, our hearts jump with hopeful flutters.
The clindamycin will be given for four weeks, to clear Indie of toxplasmosis. Whatever else happens, we will know at least that he was cared for in terms of this systemic bug.
Indie will stay on his steroidal eye drops and anti-glaucoma eye drops, which were strengthened to include timolol a week ago.
He will stop the cephalexin antibiotic, to be replaced by the clindamycin.
He will stay on doxycycline for a couple more weeks, although if he has any GI upset, we will stop it, as it was only to help in case ehrlichia was a contributing factor to the eye issues. His blood results don’t corroborate that anymore. However, doxycycline has some properties that can help reduce his eye inflammation, so as long as his tummy can tolerate both antibiotics simultaneously, he will stay on doxy in conjunction with the clindamycin.
In a few days, Indie’s family will begin the slow process of decreasing his oral prednisone. He will go down to a 10 mg tablet once a day for a week starting this weekend; then he will decrease to a tablet every other day, and he will stay at that low dose until our recheck appointment with Dr. Wasserman.
We do still await our last piece of lab results, which are the second opinion we sought from an ocular pathologist, the only specialist around. Dr. Wasserman has contacted him to tell him about Indie’s extraordinary toxoplasmosis results, and I am sure this is being taken into account as he carefully accounts for any findings on the slides prepared from Indie’s left eye. We do not know when to anticipate his results, so we are again, practicing the art of patience.’
So other than these therapies and the final test results, we have no marching orders for the moment except to wait…and wait…and watch…and wait… (and pray) – and it is no small comfort to know that our ISDF family will be doing the same alongside us. We thank you for that, yet again!
Please keep Indie in your thoughts this week, and if you pray, please join us in sending our most fervent wishes and hopes that he recover as much ocular ability and health as possible!
We really have no idea how much damage has already occurred in his right eye. We also don’t know how much damage incurred is permanent. We know any response to treatment is going to take time.
So we stand here, in a field of question marks, and don’t expect to find our way out anytime soon – but if we have to be lost out here, at least we are not alone. We know you are all around us, hoping, praying, and daring to (cautiously, very cautiously) dream alongside us. THANK YOU, from the bottom of our hearts!
To our donors to date: we are so incredibly grateful.
Thanks again for walking this path with the Emmerich family and with all of us in the ISDF family.
Additions to this list as of our last update are in caps with asterisks:
Anonymous
Anonymous
The Bartuch family, in honor of Babe
Shirley Belz, in memory of Winnie and Werner
Dr. Vinay Bhardwaj
Dianne Bozzy
Jill Bozzy
Tami Cabrera
Barbara Charlton
Christine D’Ambrosia
Elizabeth Garnish, in honor of Isobel Grant (Indie’s rescuer in New Delhi)
Isobel Grant
Sonia Heller, in honor of Indie (Indie’s foster mom in New Delhi)
Ashley Johnson, in honor of Frodo and Gilli
Diane Kreuger
Andrea Lewis, in honor of Daisy
Irene Low
Tina-Marie Marshall
Malaysian Dogs Deserve Better
Regina Matschi
Tom & Margaret Moureau
Wani Muthiah
Michelle Orcutt, in honor of Wiley and Diya
Tricia, Matt, and Lily Puetzer, in honor of Jake
Samantha Quintero, in honor of Shelby
Brad Reed
Gina Scott
Lise Siegel
Tina Smothers, in honor of Mandy
The Twerpyman family, in memory of Sammie and in honor of Jimmy
* CAROLINE, NICK & ANNELIESE ZAWILINSKI, IN HONOR OF RONALDO
Toni Ziemer, in honor of Lulu