A veterinary-client relationship of trust and respect benefits this Great
"My Great Dane does not eat even his favourite curry chicken rice. He is
tired and has pale eyelids for at least 2 days. Is it possible he has tick
fever?" Jenny phoned me. "I removed some ticks from him recently."
She was my ex-veterinary nurse some 20
years ago and has at least 20 years of handling dogs and cats in various
employment in boarding, veterinary practice, breeding and retail. She
started work with animals since she was 18 years old and has hands-on
experiences in dog diseases in Singapore.
Jenny continued: "The Great Dane has no appetite and sleeps a lot for the
past 2 days. He looks pale in his gums. Can it be tick fever? Can you make a
house-call?" the caregiver asked me.
"Jenny, if you think it is tick fever, bring the dog to the Surgery. There
is no point making a house-call as it is much easier to treat him in the
Surgery." I advised this busy manager of a large pet accessory warehouse
retail shop in Pasir Ris.
"Can I come tonight?" the caregiver wanted to clear her administrative and
paper work first.
"If you think he has tick fever, do
not delay treatment," I needed no explanation that every delay permitted the
blood parasites to multiply and destroy the blood cells.
"I will get a pet transport man to bring the dog down to the surgery. If it
is the starting of tick fever, come down now to get the dog treated before
the blood parasites multiplying in his red blood cells overwhelms and kills
him," I advised.
Jenny arrived at 3 pm with an assistant. She is a gentle soft-voiced lady in
her forties. I was surprised that her hair was disheveled while multiple
frown lines creased her face. The 2.5-year-old male giant canine came
down from Jenny's car and sauntered into the Surgery. He had never been sick
and therefore had not been to the veterinary surgery for the past 2 years.
He was as tall as a 12-year-old child.
Fever of 40.2C was confirmed by taking the rectal temperature. There was
moderate pallor of gums and conjunctiva.
Two men carried the giant onto the table. He weighed around 80 kg.
An IV catheter
was inserted. 3 blood
samples to be sent to the laboratory. IV dextrose saline, duphalyte and
baytril IV given. Sent home with bottle of 5% dextrose saline and duphalyte
on slow IV drip. Dog could still walk home. He looked normal.
Wednesday Aug 20, 2008
Not eating much. Lethargy. No news from caregiver.
Pancytopenia in blood test result - Low red, white blood cells and
platelets. Based on laboratory tests, the Great Dane should not be standing
and should be bleeding to death. But he could be at the start of the acute
stage of Tick Fever and the parasites were just destroying his blood cells.
Was there any hope for him?
Thursday Aug 21, 2008 house-call by vet
Phoned caregiver. Not really improved. Still not eating much. I told
caregiver I would need to make a house-call to check and give anti-babesiosis
injection. What I said was all Greek to the caregiver.
The caregiver was cooking liver. Dog
ate when caregiver hand-fed bits of liver. Caregiver showed me that she had
bought 0.9% Sodium Chloride from a general practitioner and 5% dextrose bag
from somewhere. She would give the solutions by SC. I gave 2.6 ml Imizole
SC. Duphalyte x 1 bottle to caregiver. Advised caregiver to come for more
vibravet medication on completion of 7 days' course and buy a thermometer.
Friday Aug 22, 2008
Great Dane not really interested in food.
"No time to buy the thermometer," caregiver said.
"Did you check on how much water the Great Dane drink and what is the colour
of his urine?" I asked.
"You know, I have been very busy updating price list of goods nowadays," she
said. "I also cooked for the dog. I do not have time to monitor how much
water he drinks or the colour of his pee!" The cost of goods must increase
as there was a surge in food, petrol and other prices in the past week and
the caregiver was responsible to get the updates done before the weekend
sales. The Great Dane had to fall sick and took up a lot of her time.
"Blood tests for Babesia and Ehrlichia at the AVA would cost $200. Do you
want them?" I asked the caregiver. She was hesitant about the costs
involved. As I have had given the Great Dane the important treatment for the
two types of parasites causing tick fever, I said, "Wait and see".
Tuesday Aug 26, 2008
"Great Dane asked to be bathed today," Jenny phoned me. "I need to
come down to your surgery to get the vibravet tablets". Surprisingly the
caregiver remembered as she had a lot of paperwork to do and I did expect
her to forget about the medication as most owners will do. After all, the
Great Dane is now eating and medication had been given for 7 days.
"When did the Great Dane recover?" I asked as I did not pester Jenny since
the last call. She said she had some much paper work to do the last time I
phoned her. Nowadays, a capable and intelligent hardworking employee does
the work of 3 people and work never ends for the good employee.
Jenny said, "On Sunday, the Great Dane was so hungry and wolfed down his
"It must be due to Imizole and medication," I forgot to acknowledge
caregiver's important role.
"It is due to my extra vitamins and cooking of liver for him." Jenny
replied. Sometimes veterinarians look at the cause and effect of drugs
rather than the acknowledgement of the care, time spent and love of the
caregiver when the case is closed successfully.
Her boss came to the surgery to get vibravet for 10 more days as Jenny was
busy updating the pricing of pet products. "Go and buy two thermometers," I
said to the boss. "Jenny has been too busy to buy one. The thermometers can
help to monitor the fever of your sick dogs." Jenny monitored the fever by
feeling whether the belly of the Great Dane was hot to the hand or not. That
was not a good way to do it.
It is important for the vet to follow up on suspicious tick fever cases. As
there was a relationship of trust and respect, I made a house-call to give
the Great Dane the anti-Babesia injection after reviewing his blood panel
tests. There was no time to wait for the specific blood tests to confirm the
presence of the blood parasites which may or may not be present.
This caregiver was extremely good in the nursing care of the Great Dane and
a great asset to her boss. A relationship of trust and respect between the
caregiver and the veterinarian is always beneficial to the pet. If there was
no such relationship, I doubt I would dare to do the house-call as a follow
up on the first treatment.
TICK FEVER IN DOGS
Acute Tick Fever in dogs is hard to diagnose as there are no specific
signs. Lethargy, fever and loss of appetite may be the only signs. As these
are non-specific symptoms, diagnosis of tick fever is often missed.
Blood parasites such as Ehrlichia canis and Babesia canis (protozoa) destroy
the white and red blood cells respectively.
Haematolgy. Blood tests can be very useful in aiding the diagnosis of
tick fever. In this case, the Great Dane had very low white cell, red cell
and platelets. Test for Ehrlichia titres and babesia are available at the
AVA (Agri-Food and Veterinary Authority) laboratory. The cost for both is
around S$200.00. 5 ml blood in plain tubes is needed. However, the client
did not want the blood tests done.
Subclinical Tick Fever (no
signs) can exist in the dog for years. Then it becomes Chronic Tick
Fever (severe anaemia, bleeding from nose, kidneys and intestines to death).
Most cases of tick fever are diagnosed at the chronic stage.
Doxycycline oral tablets and Imizole (imidocarb) injection are drugs of
choice for the treatment of tick fever. Avoidance of ticks by using
fipronil, permethrin and amitraz are best as there is no known vaccine
In this case, financial considerations prevent me from following up to check
the elimination of the parasites or any carrier status.