Sunday, October 30, 2011

716. Sunday's interesting case. Oct 30, 2011. $600 for a rescue dog with tick fever


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. According to her, Vet 1 said that the imizole commonly used for treatment of tick fever will be ineffective as this dog had Babesia gibsoni. Imizole is "ineffective" against Babesia gibsoni. The "effective" drugs will be the atovaquone, clindamycine and azithromycin but it will cost $1,000.

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.

Below are some of my replies to her.

It is kind of you to do dog rescue work. There are many financial considerations.

Combination of oral atovaquone, clindamycine and azithromycin by (Vet 1) as said by you, is effective against Babesia gibsoni infections in this dog.

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, 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.

Name given

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.

She came today for her 2nd imizole injection (0.6 ml SC today, Sunday) 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 this matter of the stray dog to the cocker spaniel and she was worried that I had not given the correct treatment.

"Will you dog be active and rushing out and have pink gums 10 days after the first injection if imizole was ineffective?" I asked her as I gave the 2nd injection today.

My thoughts are for that stray dog. I had offered to give the imizole injection and help out with supportive therapy but the lady activist was a caregiver only and could not decide as she was not the paymaster.


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