Great Dane. Sleepy, not interested in his curry chicken rice for past 2 days. "He had a few ticks," caregiver said.

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 in my encounters with her. 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.

Complete blood count needed.  I/V antibiotics and amino acids given. Sent home with the i/v catheter in his vein.

Put catheter IV 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.

Vet needs to do a house call. The busy caregiver did not update the vet.

Caregiver cooked liver. She gave a few bags of fluid and lots of multivitamins to the Great Dane for the past 2 days.

"Dog lookes normal," his gentleman owner said. "No pallor of tick fever."

The Great Dane remembered the injections and drips at the vet and ran into the safety of his home.

The Great Dane reluctantly said goodbye to the vet since his caregiver asked him to do it. Given anti-babesia injection on Aug 21, 2008 before I left the Great Dane's residence. He had not  recovered fully as at Aug 25, 2008. Jenny was advised to monitor his rectal temperature.  She needed to buy a thermometer.

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 food."

"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 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.

Conclusion
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.  

UPDATES

This case is probably an acute tick fever. Although the blood parasites were not isolated, the blood test of low blood cells and platelets is suggestive of an acute tick fever. Aggressive treatment is necessary to prevent recurrence of fever. As at Sep 10, 2008, the Great Dane is normal.   

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 (ricketssia) and Babesia canis (protozoa) destroy the blood cells. 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.

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 available.