Friday, June 7, 2013

Puppy Strangles, Beau's Story

A very good client of ours came in three weeks ago with one of her 5 week old Havanese pups. She had noticed that he felt very warm, was not as playful, nor was he eating as well as he had the day before.

Sure enough he had a very high fever. He was 104 degrees, (normal for dogs is about 100-102). He certainly looked subdued, but with a fever like that I wasn't surprised that he didn't feel well. Otherwise everything looked and sounded very normal with him. We started him on antibiotics, gave him some subq fluids (to keep him hydrated and help bring down his fever) and sent him home to be back with his litter mates. I gave very explicit directions to keep a very close eye on him.

A few days later he returned not much better. His fever was not as severe but he was now more lifeless and depressed. He was switched to a stronger antibiotic and told to return in a few days if he wasn't better, or comeback immediately if he worsened.

He came back to see me a few days later looking like this;

He had a very swollen nose and muzzle, swollen eyelids, lots of discharge from the eyelids, painful all over, enlarged lymph nodes around the face, and he was very, very, cranky.

It was at this point that we decided we were going to add a steroid and start treating for what we call "puppy strangles."

Puppy strangles is our layman's term for juvenile sterile granulomatous dermatitis and lymphadenitis, juvenile cellulitis, or juvenile pyoderma. 

Juvenile cellulitis is described as an idiopathic (nice scientific way of saying we don't know why this happens), skin disease of puppies that occurs between 3 and 16 weeks of age.

The disease can vary in severity from mild, with very few clinical signs other than fever or swelling, to severe and can even cause death.

It can affect one or more in the litter. The primary clinical signs of this disease are found in the head and face, and most commonly affect the mucocutaneous areas of the eyes and mouth. 

Diagnosis is by exclusion of other causes that cause similar clinical signs, like demodicosis (mange or demodex), and blood work, skin biopsy, and lymph node aspirates. This disease is also poorly responsive to antibiotic therapy alone.



In almost all cases the initial clinical sing that is observed is facial swelling and enlarged lymph nodes around the face and neck. The swelling (edema) can be profound and is centered around the face to include eyes, mouth, and ears.



The breeder also brought in another littermate as a companion, but she serves well to show the big difference in appearance between the two puppies.



The following pictures are one week after starting a steroid. The swelling has diminished significantly around the eyes, nose, and the lymph nodes are smaller. Most notably this puppy is back to eating, playing and feeling much more comfortable.






These pictures are from the two week re-check. We have started to taper the steroid, but clearly he still has some facial swelling, so he is still on prednisone. But he is happy, eating, playing, and sick of us looking at him. An ornery impatient puppy is a puppy that feels better!

Treatment should be instituted quickly because the lesions can cause scarring and the facial swelling open tissue and abundant exudative fluid allows for secondary infections.


Treatment for this puppy included;
  1. Oral steroid at a high initial dose that was tapered based on response. This puppy required two months of steroid. Published doses are oral prednisilone at 2 mg/kg every 12 hours. We try to taper at 14 days, and keep retrying as the condition improves. Do not taper fast unless the puppy has an adverse drug reaction. Most cases require 4-8 weeks of treatment. Vigilant monitoring and rechecks with the vet determine the most successful cases.
  2. Antibiotic to help keep the oozing skin from becoming infected. This was done as a short course  and stopped once the steroid began to reduce the swelling of the face and skin. Recommended antibiotics include cephalexin at 22 mg/kg every 12 hours, or, amoxicillin-clavulanic acid 15 mg/kg every 12 hours.
  3. Baths in an antiseptic surgical prep solution. This also helps relieve the discomfort and also acts as a topical antibiotic. We used our surgical scrub 2% chlorhexidine.





The breeder was concerned that the eyes and nose didn't look that improved because there was crusting and flaking skin around them, but I reminded her that the underlying skin was much calmer, i.e. not red, not swollen, and not painful. The skin that had been so swollen and red and the fever had literally burnt the skin and it needed to peel and flake off before the healthy skin below was apparent. In these cases the puppies will tell you before your eyes can that they are either sick, or getting well.

When it comes to puppies (I call them 'puppies' until they are a year old), the younger the more fragile they are, the more diligent, hyper-vigilant that you need to be in monitoring and seeking help if they even look sick.

Puppies with strangles should be showing significant improvement within 3 to 5 days of starting the steroid. The prognosis is much poorer if it takes them longer to respond (although my advice is TO NEVER GIVE UP ON A PUPPY OR KITTEN! They will surprise you often). It is also important to have a long term treatment plan with breeders/owners. Weekly, or more often if needed, re-checks are incredibly important because the disease can return if the steroids are stopped pre-maturely, and remember steroids have their own set of potentially damaging side effects if they are used for too long.

Update:
Four weeks after the start of treatment and this little puppy has a new home, has started his puppy shots and is looking like a full recovery is eminent. We are all so happy to see this little love bug playing, kissing, snuggling and acting like the bubbly bundle of joy he is.




Photo from Tuesday, 17 June, 2013. At first puppy visit .

These pictures are from his third puppy visit. Now almost 6 months old. He looks so amazing!!







His name is now Beau. He has been adopted by a wonderful woman who has another Havanese.
She tells me that they play constantly. I watched two videos of them scurrying around the house to prove it.

There are few things more inspiring and satisfying in the world than the joy of a healthy growing baby!



This was just taken on 8/19/13. Beau had his first official grooming!
How handsome is he??
Dashing!! (He knows it too!)
Beau is scheduled to be neutered in late August (2013). I expect he will have a completely normal long healthy life! He is a true testament to perseverance, dedication, and the glory of medicine!

XOXO Beau, from all of us at Jarrettsville Vet!

I am asked often about the long term affects and success of treating this disease. I will continue to say that if treated early and aggressively these puppies have an excellent chance at a complete recovery. I also have not seen any long term affects to their health and longevity. Scarring is possible but puppies are incredibly resilient and heal quickly. I would never discourage someone from adopting or treating these puppies.

Update: November 18, 2013. Beau was neutered today! He also had his upper deciduous canine (cuspids) teeth removed. He did wonderfully, even though I know his mom was petrified about putting him under anesthesia.






Update; Beau was at the clinic on 7/3/14 for his first year puppy visit!
He is perfect!! And soo handsome!



If you have any questions about this disease, or any pet related question that you would like answered, you can find a whole community of pet friends at Pawbly.com. Pawbly is free to use and dedicated to helping people take better care of their pets.

You can also find me at the clinic trying to save the world one wet nose at a time. Call or visit Jarrettsville Vet in beautiful Harford County Maryland, or chirp me on Twitter @FreePetAdvice.


And, my last note, believe in miracles, they do happen, but only if you try and you believe, just ask Beau.

13 comments:

  1. Is it normal for lymph nodes to swell after decreasing steriod?

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    1. Hello Ash,
      If you have a pet care related question please ask it on Pawbly.com. I can answer it faster there.
      No, the lymph nodes should not get bigger as you decrease the dose. Please call your vet for assistance.
      Best of luck

      Delete
  2. I was simply touched by Beau's story. We just bought 2 Pomeranians & it's looking like we are heading in the same path with our little 9week old girl, Mia. It is absolutely devastating to say the least, seeing her go through this skin disease. She is only 1LB & 11oz, She does complain about her eyes & I hate to see her trying to scratch them with her paws but other than that she still has an appetite. On the day of her 1st check up with us, I realized her eyes were looking a bit gloomy, I mentioned it to the vet but what alarmed her immediately was the swollen lymph nodes on each side of her neck which one was a size of a marble & the other a gumball. She put Mia on antibiotics(Amoxicillin) & was hoping it was just a minor virus but also mentioned 'Puppy Strangles', Told me to not hesitated if there are any changes. Next day, Mia's Lymph nodes were a lot more swollen, eyes were like Beau's; Swollen shut, mouth swollen with scratches around & later on I noticed her private was getting affected too. She was put on steroids & here I am on Day#2, She still going strong on her perky pup ways but as Beau's owner was saying, I cant help but worry about the scrappy look around her lids, I am trying my best to pat her eyes every so often with a damp,cotton rag so I can eliminate some of the gunk & to put her eyedrops in but my heart aches for her especially when I have to give her the medicine because to her i'm being such a 'bad guy' but i'm truly hoping we are taking the right measures to aide her recovery. I will continue to keep an eye on her. I did give her body a light soak but was too scared to wash her face. Can you please give me tips on how to clean her face or should I just leave it alone til she recovers? Very worried since she's so delicate but Beau's story truly touched me, gave me more hope plus answered many of my concerns especially the part of how they act is more of an indication on how they feel rather than how their appearance is. Once again, Thank you for sharing such an amazing story & Please any tips would be greatly appreciated. ~The Marshalls

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  3. To the Marshalls, Am hoping your little pup is all healed up and recovered from Puppy Strangles, Beau is wonderful, no,lasting effects.. Dr. Magnifico did a wonderful job and we are so glad she diagnosed him so quickly...

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    Replies
    1. Thank You!! Hugs and kisses to Beau! happy new year to all!

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  4. Hi. I was wanting to know why if a pup has stangles you can't give them a vaccination? A friend of mine has a 9 week old lab pup and got her her shot and didn't know she had stragles. What is going to happen to their puppy?

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    Replies
    1. Hello,
      We don't usually vaccinate while they have the disease as the disease is caused by the immune system and vaccines challenge the same immune system which might be more than the pup can handle. Therefore minimize exposure to other pets and discuss when it is time to resume vaccines after the disease is under control.
      If she is on prednisone I would just talk to the vet about whether or not she will need additional vaccinations after the condition is under control.

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  5. I know someone with a 9 week old lab pup and got her her shot and didn't know she had stangles. What is going to happen to their puppy?

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    Replies
    1. The immune system might be challenged more than it should. This should be discussed with your vet.

      Delete
  6. My wife and I got a Brittany pup that came down with strangles. The vet put him on prednisone and amoxicillin two times a day for two weeks and then we slowly tapered off after that to just prednisone once a day. After two days of once a day he started to get the swollen bumps in his lips again. Took him back to the vet and we are continuing two prednisone with stronger dose of antibiotics. He's really playful still and wouldn't think anything is wrong with him. He's eating well and has gained two pounds in two weeks. Will this disease ever go away. Just want him to get better

    ReplyDelete
    Replies
    1. Hello Mitch,
      Yes it will go away,, (EVER, is a strong word). I think that it sounds like things are going well. The pred treats the bumps, and the puppies attitude is the most important indicator of over all health. Keep seeking the helpful advice of your vet and watch your pup closely for any signs of a change in his condition. BTW 'getting better" = happy and gaining weight.. you're doing great!! good luck!

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  7. Hi everyone, I have an almost 12 week yellow lab that was diagnosed at 11 weeks with puppy strangles. However it took almost a week to diagnose. His ears are pus filled mush even with me cleaning them 2x daily. His muzzle is completely covered and now scabs. His eyes are my most concern because they ooze green eye boogers then the scabs fall off and bleed. He can barely open his eyes. I am stationed overseas in Germany with us military so it's slightly different practices here. My german vet is giving injections once a day of antibiotics and prednisone. Not 2. Is this something I should ask him to do? We are on day 6. He vet did take biopsy from his muzzle. and the first report came back today, it said staph infection on top. 2nd report is scheduled to come back tomorrow and 3rd report Friday. Also as of today he has a blood blister on his back. I asked the vet he said it was interesting? Should i be concerned? They took him off his wellness Brand puppy chow and have me feeding him Vetinary prescription wet food horse meat. Is that ok? He is eating it but not drinking water at all. So I add water each of his 3meals a day. However he is loosing weight. He went from 6 kg last Tuesday to 5.75 last Friday and today he was 5.45kg. I apologize for all of the questions I am so concerned with my little für baby. Especially because he has no interest in anything he has not once even attempted to play like a puppy. Also the vet said to not allow him outside. Basically he goes to the bathroom inside only on puddle pads and when we leave for the vet I carry him everywhere. Is this right?

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    Replies
    1. Hello,
      I think that this disease is very labor intensive and absolutely requires a very aggressive and proactive plan. I think that if you are ever concerned about any part of the treatment plan that you should absolutely keep pestering and advocating for your pet. The first few weeks are the worst, hardest and most critical.. keep speaking up and if you have to visit them twice day for help do it! Losing weight is extremely concerning. I cannot advise on the diet, but a veterinary nutritionist is available through your vets lab services provider or VIN.com, or a colleague. Best of luck to you both!

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