Diagnosing is a process. Sometimes the obvious answer is the correct one and sometimes it is not.
Be relentless and don’t settle for a diagnosis that provides neither relief nor a proper explanation.
BooBoo’s Story
It’s the start of tick season here in the Northeast. I’ve been reflecting on last year’s tick season and how we almost lost our sweet BooBoo. So in the interest of raising awareness and saving lives, I share with you our story.
It was a beautiful Sunday in April 2015, one of the first nice days of the spring.
My husband and I decided to take our two rescues, Mr. Barbo and BooBoo, for a hike. Before we headed to bed that night, we did our standard post-hiking tick check and everyone checked out clean.
The first symptom
The next day we let the dogs ou.t As they chased the squirrels, BooBoo’s rear legs slipped and she fell.
Did she trip on the pool cover? Maybe her hip dysplasia was acting up after our hike? I wasn’t really sure but she wiped out and then just kept going.
By dinnertime, she was non-weight bearing on her right rear leg. I immediately worried she had an ACL injury from her earlier slip. I knew that non-weight bearing was a classic symptom. So I put an after-hours call into our vet and immediately started her on some Rimadyl.
BooBoo is getting worse
Over the next five days, she improved and regressed.
We brought her to the vet to rule out an ACL injury. Our vet suggested we could re-run a Lyme test, even though she had just had one two months ago and even though we use Vectra 3D monthly. We declined the test and suspected it was an injury from the slip that was causing her limp.
The first red flag that we were dealing with something else came Saturday evening when she was curled up on the couch and whimpered as she adjusted herself.
We left a message for the vet saying we would need an appointment first thing after the weekend because the Rimadyl wasn’t working.
Veterinary ER
But, that plan changed Sunday morning when we woke up and she wasn’t in bed with us. We found her on the floor, lethargic and reluctant to move. She wouldn’t eat, not even her favorite treat and her temperature was well over 105. We rushed her to our local emergency facility, calling ahead so they were prepared to receive her.
When temperatures are that high, the chance of a seizure is a real risk.
We arrived at the ER and they immediately started cooling her. We explained the week-long history since our hike and they suggested a Lyme test, as our vet originally did. So we did the in-office “snap test” but it came back negative. Despite the negative results, she was symptomatic of tick disease. They suggested a full antibodies panel and PCR test for all the tick illnesses.
The treatment
We started Doxycycline right away and ran bloodwork and everything came back normal.
The tick panel would take several business days for results. However, if it were a tick disease, the Doxy should start to knock it out. They admitted her for IV antibiotics and fluids to stabilize her and then said we could take her home. After midnight, they called, said her temperature had been stable since 10 PM and we could take her home with oral Doxy and Tramadol for pain.
We followed up with our regular vet on Monday and she agreed with the ER’s diagnosis.
BooBoo was on the meds, still lethargic and not eating well but her temperature seemed to be controlled.
But Tuesday evening her temperature spiked back over 104 again. We rushed back to the ER where they admitted her again, this time for several days.
With the internal medicine specialist, we discussed all possibilities from cancer to autoimmune issues to tumors and other super scary things since the Doxy didn’t seem to be working. We ran additional diagnostics including ultrasound and x-rays and she got the all-clear. No cancer. No tumors. All of her organs were the right size and everything looked perfect. A glimmer of good news in a sea of uncertainty. But her fever was still fluctuating and they were struggling to keep her stable.
The diagnosis
The 5 doctors now on her team were all brainstorming to figure out what was causing our sweet Boo to be so sick.
Later in the week, the antibodies results returned a “high positive” for Rocky Mountain Spotted Fever. I was thrilled to know what we were dealing with but I was baffled.
We hadn’t been to that area of the country, so how did she get it? But then I learned that despite its name, only 5% of the cases were actually from that region1. As I researched, she fits much of the epidemiology.
Rocky Mountain spotted fever
Rocky Mountain spotted fever (RMSF) is called “the great imitator. ” That is because clinical signs are often vague and symptoms are often confused with other infections.
High fever, joint, and muscle pains are usually observed within 3 days of exposure.
And with delayed diagnosis and treatment, within days the effect on the central nervous and vascular systems can be devastating including death within a very short period of time. I was beginning to realize how close we were to losing her.
With the Rocky Mountain spotted fever (RMSF) on the radar, the vets changed the drug regimen. Within 24 hours, BooBoo stabilized.
The bad news was the PCR test came back negative. Which meant either that
- she was a carrier of RMSF for a long time and it was a red herring that was throwing off what we should actually be treating
- or that the DNA wasn’t in her bloodstream because it had attached to things like cell or artery walls
RMSF typically attacks the vascular system the latter option was a possibility, but we had no way to be sure.
Little progress
We stayed the course and remained vigilant for any additional symptoms and completed the prescribed 3 weeks of medication. She progressed little by little but never got to 100% by the time the drugs ran out. She was still reluctant to jump up and was still very tentative on the stairs.
So what now?
Retesting the tick panel at this point wouldn’t give us any new information. We could do additional diagnostics like joint taps. That would rule out things like autoimmune polyarthropathy. However, doing invasive procedures like that brings its own risks. Would she now be lame forever?
Prednisone
We opted to start her on Prednisone to see if her mobility improved. After 2 days of Prednisone, she BooBoo mobility improvement but also was experiencing the known side-effects of steroids
- an increased appetite (not really bad for her at this point)
- and increased thirst/urination
We continued the Prednisone for months, dropping the dose as advised but noticed that even though we were dropping her dosage, BooBoo’s need to urinate very frequently wasn’t subsiding.
Prednisone side effects
This caused our vet to begin to worry about liver, kidney and diabetes risks.
We ran additional bloodwork and now her liver values were dangerously high. We continued to step down the Prednisone as quickly as we safely could and added in Denamarin, to support her liver.
It took over six months off the medications before her liver values returned to normal and she got a clean bill of health.
A year later
So here we are, a year later at the beginning of a new tick season.
She’s healthy and happy but is a changed dog and we’ve made changes as a result of this experience.
We still hike. Our dogs love it and in spite of the almost life-ending experience, I wouldn’t deny them the joy. After all my research on Rocky Mountain spotted fever and the recent Powassan virus, I discovered that some of these tick-borne diseases only take a few hours to be transmitted. That is truly frightening to me.
Rocky Mountain spotted fever transmission
Unlike Lyme, where the tick needs to be attached for 24-48 hours to transmit the disease, RMSF can be transmitted in as little as 5 hours.
This means hiking a full day and not checking for ticks until before bed will no longer do. We now do a mid-hike tick check every 2 hours if we’re out for a long day in the woods.
As I reflect back on this ordeal, I’ve got several important takeaways that I’d like to share.
Know your dog inside and out.
Know how to take your dog’s temperature and pulse. Just like people, dog temperatures vary. Knowing what is normal for your dog could help you spot an early warning sign. Know your dog’s normal vitals (body temperature, average resting pulse), appetite pattern, coat texture, and sleeping habits.
Be your dog’s advocate.
Don’t just wait it out to see if it gets better on its own, as tempting as it might be. Time is of the essence. Seek out care right away and be your dog’s advocate. Don’t wait for organ failure or hemorrhaging – it very well might be too late to treat at that point. Be proactive in the care your dog gets.
Pet insurance.
We purchased insurance soon after adoption so there would be no excluded pre-existing conditions. Having the peace of mind that everything would be covered allowed us to focus on BooBoo and follow recommendations instead of the finances beings a deciding factor in her medical care. Yes, the monthly premium is a lot but insurance is exactly for cases like this. We received 100% reimbursement of over $6500 in vet bills (minus our $100 deductible.)
Topical treatments.
Although we are generally holistic, we do apply a monthly topical tick preventative. When I approached the manufacturer about how she could be infected, they stated it’s only 97% effective in repelling. So some ticks will get through. I suspect we never found the tick that infected Boo because it bit her and then the Vectra killed it, and the tick fell off. We still use the topical but now also supplement with an essential oil spray. Also, having proof of purchase of tick preventative was necessary for our insurance claims to be paid 100%.
Have a regular vet.
As tempting as it is to bounce around to low-cost clinics for vaccines, this reinforced how it’s far more important to have a solid relationship with a regular vet, who sees your pet at least once annually, whether they are sick or not.
We have an amazing vet and we trust her implicitly. When ER vets were throwing out all sorts of tests and things they could do, we relied on our regular vet’s advice.
Our regular vet worked in tandem with the ER staff and the specialists, reviewing all the lab reports and treatment plans. They sent her daily updates and reports. It’s easy to be overwhelmed when your pet is in a medical crisis. Having a regular vet as an ally helps you make decisions and not feel like the ER vets might be taking advantage of your compromised state.
Have an ER vet.
You never want to need to use it, but in an emergency, you don’t want to lose precious minutes looking up an ER facility. Know where they are and how to get there. Have the phone number programmed in your phone so you can call them on your way so they’re ready to take you in. In our case, getting Boo’s temperature down was critical to saving her life and preventing a seizure. Knowing we were on our way allowed the ER to prepare a room to avoid delay.
In closing
I am forever grateful to the medical team that saved our girl. But I know our quick action also played a part.
Many dogs do not get diagnosed with RMSF until it is too late to save them; not until they are hemorrhaging or some other equally awful symptom appears.
It wasn’t BooBoo’s time but it easily could have been.
There are so many things that could have altered our outcome.
Our sweet Boo came to us as a feral dog from Kentucky and is now a certified therapy dog. I like to think the world needed her around for a while longer.
I hope that our story will bring awareness to tick-borne illnesses and help people notice the symptoms early on to help save lives.
For now, we will keep hiking but checking for nasty ticks often and cuddling as much as possible to enjoy every moment that we have left together.
For more information, please check these RMSF resources
JAVMA, Vol 221, No. 10, November 15, 2002
Companion Animal Parasite Council
Merck Veterinary Manual
Medscape
US CDC
The Story of BooBoo’s Rocky mountain spotted fever was originally posted on eileenanddogs, by Kate LaSala, CTC