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
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
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
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
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 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!
A Cocker Spaniel has tick
fever in 2011 or
animal activist's help of a tick fever rescue dog
The Rescue Group's vet had said that imizole
would not be effective against Babesia gibsoni
and advised a triple-drug combination costing
$1,000. The rescue group wanted this activist to
pay $600 to top up the $600 budget from the
rescue group. The activist sought my advice by
text and there was some delays as the Rescue
Group's vet said that Berenil would be available
as a cheap alternative in a few days' time. So
the activist waited. But no Berenil. The
activist was pro-active and posted online for
help. A donor responded and would pay for
treatment by the donor's vet. It seems that this
rescue dog will survive the tick fever and that
is good news for her and for anyone.
The following is her reply to my follow-up on
her rescue dog's status
E-MAIL TO DR SING DATED NOV 2, 2011
Its been a busy few days.
The Berenil is discontinued in Singapore
already, and the rescue people told me I have to
pay myself or let her die. We brought her home
on Saturday and on Sunday she was having
difficulty breathing and could not stand up. I
posted her pictures online and a very kind
stranger offered to pay for her treatment on the
condition that we go to her vet. ... is being
treated at (Name of vet practice given) as
requested by the donor.
Her red count had dropped even further, and her
platelets dropped to only 12. She stayed there
for 2 nights and they gave her lots of
supportive fluid therapy, erythropoietin and
used steroids to stop the hemolysis. She perked
up very well and is now resting at home. We will
repeat her blood count on Friday and give her
Imizole on Saturday if all goes well. For now
she is on pred, metronidazole, Doxycycline and
some other supplements. I was also force-feeding
her Hill's a/d several times a day. As of this
morning she was willingly eating herself! I
think things are looking up and Dr ... thinks
she will survive. I hope the Imizole works to
cure the infection.
I'm sorry we were not able to take her to you. I
have great faith in your clinic, but
unfortunately the money is not mine! :(
Thank you so much for your concern, you are very
Btw, she's not my dog! We are just fostering her
and hopefully will find her a home.
E-MAIL REPLY FROM DR SING DATED NOV 3, 2011
I thank you for being proactive in helping the
stray dog. The vet is doing a great job and I am
quite sure imizole will be effective. Best
ON JULY 18, 2012
I met the young undergraduate activist in
May 2012. The above-mentioned stray dog was
treated by the sponsored vet and is well. Based
on this anecdote, imizole was effective against
Babesia gibsoni infections in a stray dog.