Saturday, August 25, 2018

3247. INTERN. A Miniature Schnauzer nearly died from tick fever


Intern to write a compelling story for the video


Aug 25, 2018
HOOK - appropriate video footage and narration

5 DAYS AGO, ON AUGUST 18, 2013, the old dog would eat only when spoon fed. 8 days ago, the dog had no appetite. This was a big worry for the owner. Not eating will lead to malnutrition and death.

The dog had a pale tongue and fever.




The vet did a blood test. It showed that the dog had  low red blood cell count, low haemoglobin and platelets. The owner wanted the dog home. She treated it with antibiotics and the dog ate when spoon-fed.

On Aug 25, 2018, the owner brought the dog in for dental scaling to improve the dog's appetite. I noticed the very pale tongue (video footage as HOOK -- White tongue on Day 1 compared to Day 3). A severe anaemia could be seen just by physical examination. This dog was not fit for anaesthesia. I asked the owner for consent for blood test and a tick-fever test as this would increase medical costs. The owner agreed.


BKTP




INTRODUCTION
Singapore is a city state with over 80% of the residents living in apartments. It is a developed country of around 6 million residents living in .......sq km. The cost of living and health care keep increasing yearly.

Apartments include condos and p
public housing HDB flats.



HDB apartments house around 80% of the residents. National Day on August 9 was celebrated recently.



Many dogs are kept at home as the owners lead hectic lives, working long hours in the offices, looking after families and young children. Many have little personal time left for the dogs as they have social activities, marketing and lead busy life-styles.






However, many younger pet owners treat their pets as family members and will research the internet for knowledge of their pet diseases like tick fever before consulting the vet. In some cases, they have done their homework and know more than the vet about a particular disease!




Some owners will bring their dogs downstairs or dog parks for exercises. These areas and some grooming shops may have infected ticks.






 A few dog will develop tick fever which is an uncommon disease in Singapore.  Presenting signs are pale tongue and gums, fever or no fever and loss of appetite.

   


EVIDENCE

1. Blood test on August 25, 2018.  The total red blood cell and haemoglobin levels had plummeted compared to 8 days ago. Platelets were very low. The owner said the dog drank but ate when spoon-fed. The dog was severely dehydrated and needed IV.  



2. Positive for Anaplasma antibody.



TREATMENT

Immediate anti-tick fever injection, iron, Vit Bs, Vit K1 in 2 bottles of IV drips. The pink colour of the tongue returned and looked almost normal on Day 3 ie. 2 days after the injection. (Image)



OUTCOME 
The dog ate the A/D canned food by herself the next 2 days after the injection and medication, indicating a happy outcome.

The owner was happy. The dog went home on August 25, 2018.
She phoned me later, "Doc, my neighbour's dog had tick fever and the vet had prescribed to her a bottle of prednisolone syrup! Do you think my dog needs it?"     
"No," I told her that each tick-fever case is different and her dog was recovering well. I reminded her that her dog needs another anti-tick fever injection one week later.

TIPS AND ADVICES FOR VETS

 1. All good vets should practise evidence-based medicine. However, some owners have a budget as laboratory tests increase medical costs.

2. Antibiotics do not cure tick fever cases. Doxycycline is used in some tick fever cases. Anti-tick fever injections are usually effective.





3. Physical examination of the dog's tongue in every case you see. It can tell you the dog had anaemia even without the blood test evidence.


3. Tick fever is a matter of life and death. As you can see in this case, the red blood cell count and haemoglobin had plunged much lower 5 days after the first consultation. The platelet count was at rock bottom. The dog was severely dehydrated when I saw him for "dental scaling". Any delay in a correct diagnosis and appropriate treatment  would be fatal.




4. When a dog has pale tongue and gums, has or does not havea fever and ticks or no tick exposure, I will give an anti-tick injection first based on a high probability of tick fever.

IMAGE OF BOTTLE OF IMIODOVER


A few dogs had been saved this way. Not every owner will consent to laboratory tests owing to financial reasons.


CONCLUSION




Sometimes, the reality of life is such that economics dictate that vets cannot practise evidence-based medicine which will add to the medical costs.









The owner is happy with a good outcome for correctly diagnosing and successfully treating tick fever as dogs are family members in Singapore.

 CREDITS

FOR MORE INFORMATION

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INTERNS NEED TO
DEFINE

Anaplasmosis
put up a written table of RBC and HB values for 3 blood test as the blood test image is too small. Also wait for the 3rd blood test by Mon or Tuesday.

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