SUNDAY'S INTERESTING CASES
Oct 30, 2011
On Friday, Oct 28, 2011, I got a text message from a young lady caring for a Singapore Rescue Group's stray dog with tick fever diagnosed by Vet 1 consulted by the Group. According to her, Vet 1 said that the imizole commonly used for treatment of tick fever would be ineffective as this dog had Babesia gibsoni.
As imizole is "ineffective" against Babesia gibsoni, Vet 1 wanted to use the "3 effective" drugs atovaquone, clindamycine and azithromycin. However, it would cost the Rescue Group $1,000. Berenil was cheaper but might cause anaphylaxic shock and in any case there was no stock at that time.
The Rescue Group asked her to top up the bill but she did not have the means to do so. So, she texted me for advice and alternative options.
Below are my replies to her.
It is kind of you to do dog rescue work. There are many financial considerations.
Combination of atovaquone, clindamycine and azithromycin by (required by Vet 1) as said by you, is claimed by Vet 1 to be effective against Babesia gibsoni infections in this dog. Vet 1 had said that imizole is ineffective against Babesia gibsoni.
I will not comment further as I don't use these expensive drugs. Success rate depends on follow up, not just one injection. Blood transfusion 1.5 bags at $500/bag and hospitalisation will be more than $600 budget from the Rescue group.
Berenil is cheap but anaphylaxis according to your text. Hb at 5 is low for your affected dog, but you also need to know total RBC.
In conclusion, anti-tick fever treatment is not cheap due to prolonged treatment and follow ups.
E-MAIL TO DR SING DATED Oct 29 (2 days ago)
Thank you very much Dr Sing. I am heading out to check on the dog this morning. If the rescue doesn't want to pay for treatment, I think I will bring the dog home to die as she doesn't like the cage...
Thanks again. Will email u soon.
The dog was sent home without the expensive treatment or imizole. The lady activist thought that the dog was "alone" at the vet clinic and she would take the dog home to die. Berenil would be available possibly 2 days later.
Coincidentally, I was following up on an English cocker spaniel, 11.5 kg with Babesia gibsoni and Ehrlichia tick fever 10 days ago. A Cocker Spaniel has tick fever in 2011 is the case report.
Day 1 to Day 5 of tick fever
She came today (Sunday Oct 30, 2011) for her 2nd imizole injection (0.6 ml SC today) 10 days after the first injection (0.5 ml SC). Based on her active normal behaviour and much pinker gums, the first imizole injection had worked. Otherwise she should be dead by now.
So, should Vet 1 have given imizole to that stray dog rather than wait for the cheaper Berenil to be available later? Is imizole totally ineffective against Babesia gibsoni? I related the story of the stray dog with tick fever to the cocker spaniel and she was worried that I had not given the correct treatment.
Day 1 --->
Day 4 & 5 --->
Day 4 & 5 --->
Day 4 & 5 --->
Day 10 --->
"Will you dog be active and rushing out to play and have pink gums 10 days after the first injection if imizole was ineffective?" I asked her as I gave the 2nd injection today. As the dog still had ticks attached to her head and spinal area, I asked: "Does your dog go under the bed?". She said "Yes, my dog likes to sleep under the bed." I said: "Ticks may be present on the under part of the bed and attaches to the dog. Advantix should work as this spot-on was given 10 days ago when the dog came in. Give another dose in 4 days." I wanted to prescribe the anti-tick wash but did not as I asked her to use the Advantix and the dog had not many ticks.
My thoughts on this fine Sunday morning were for that stray dog and the caregiver who was a student. The young Singaporeans prefer to text and on Saturday, Oct 29, 2011, 2.53 pm, I got the following:
"Dr Sing, I brought the dog home as they could not do anything for her. Rescue opted to try Berenil but can't get for a few days so we are waiting. She is very weak. I think she may be dying. How much is one shot of imizole? Do u think it is worth a try? If not too expensive, I don't mind trying myself. What else can we do for her in the meantime?
I phoned her on Saturday and told her to bring the dog for the imizole injection on Saturday at 9.30 am. But she said that the transport was not available. In any case, the Berenil may be available on Monday and the dog was still alive. So I hope that this dog had the Berenil treatment soon.
As for the English Cocker Spaniel, as at Nov 3, 2011, the dog is normal. "Except that she tires easily," the owner said to me. She submitted a urine sample for testing. The values were normal. The urine SG was high, at 1.041 (range should be 1.005 -1.030), pH was 7.0 and struvite crystals were present. "Could it be the high liver I am feeding?" the lady asked me. "Should I stop feeding the liver?" She was also feeding iron supplements and all the good home-cooked food. "Since your dog tires easily, she has not fully recovered her normal red cell amount," I said. "The high urine SG is unusual. It shows that the kidneys can concentrate the urine well but what causes it is hard to say." I may need to have another urine test 2 weeks later.
Nov 3, 2011, as I update this report, I had been thinking about the high urine SG. My hypothesis is that the destruction of so many red and white blood cells damaged by the Babesia and Ehrlichia organisms during the past 14 days would have contributed to a large amount of protein damage for the past few days. The kidneys are normal and have to work hard to excrete the urea. This resulted in a high urine SG. There may be a high blood urea but I did not take a blood sample when the urine sample was sent.
Since the kidneys and bladder were normal, there was no proteinuria during urinalysis. Is this hypothesis sound? These are the types of questions the professor may ask in a case study during the final exam of the 5th year vet student. I remembered my "viva" or "oral exam" on a case study during my final year by my Professor of Vet Medicine and an external examiner and I presume Murdoch vet students still get this oral test.
A reply or hypothesis may not be possible for a vet student so much burdened with 5 years of vet knowledge memorised to pass the Final examination in November 2011 if the Professor of Vet Medicine asked about the high SG during the oral test!
Earlier report: A Cocker Spaniel has tick fever in 2011 or
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