Meet Orville, the adorable four-year-old Pointer mix! Orville was adopted at two years old from a family who loved him very much but could no longer afford to care for him. Orville fit right into his new family, and over the past couple of years, they’ve realized just how special he is. Not only is he quick to learn tricks, but he will also easily learn his fur-dads ringtone and start spinning and jumping at the door when he hears it. Even when the ringtone changes, he figures out the new tone quickly!

We first met Orville when he came to see our Internal Medicine service in May of 2021 after bloodwork performed at his primary veterinarian tested positive for nasal sinus aspergillosis, an invasive fungal infection in the nasal cavity. This infection can cause destruction to the bones inside of the nose called turbinates and can form lesions called fungal plaques. We performed a head CT scan which was able to confirm the presence of aspergillosis fungal plaques and disintegration in the frontal sinus bones. This indicated that there was direct communication with the brain. Traditional therapy for aspergillosis involves trephination into the frontal sinus, flushing out/removal of the fungal plaques, and application of a topical antifungal, as well as a long-term course of oral antifungal medication. However, when there is the involvement of the brain, it has been traditionally thought that trephination and topical medication application is contraindicated due to the concern of causing chemical meningitis. There is also the complication of oral antifungals generally taking a long time to start being effective due to the difficulty of drugs crossing the blood-brain barrier.

We decided to start Orville on Hyperbaric Oxygen Therapy (HBOT) based on studies done regarding its effects on aspergillosis. Evidence shows that HBOT helps inhibit the rate at which aspergillosis grows as well as increases the availability of oral medications. HBOT treatments were done concurrently with oral medications in hopes that these two things combined would allow the bone to heal enough for traditional aspergillosis treatment.

We repeated the CT scan after two months of treatment, and unfortunately, there was still the destruction of the bone. Orville was referred to our Neurology department to see Dr. Beryl Swanson for an MRI to gain more detail of how much invasion there was.

Based on a published and peer-reviewed study on a small sample size of dogs with the same diagnostic results as Orville, we elected to still go forward with the traditional therapy, despite the previous school of thought that this would be contraindicated. Orville was prepped for surgery with the neurology service, where his frontal sinus was flushed extensively to remove as much of the plaques as possible and topical medication was applied. Despite the severity of his disease and the seriousness of the procedure he went through, he recovered beautifully and was happy, tail wagging and begging for treats by the next morning.

We are still waiting to see how Orville responds to the treatment long-term, but his family is grateful for the care he received from our amazing team at a time when they didn’t think he had much longer to survive. His friends at the Animal Medical Center of Seattle are all rooting for his recovery!

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