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.

Curing Beau's Anxiety

The other day I introduced you to Beau. He had lost his lifelong beagle companion and it sent him into an anxiety-ridden tailspin that led to destroying drapes, crying and whining incessantly. His fears were becoming more diverse, more frequent, and intensifying. He is the poster child for "separation anxiety" as we call it in veterinary medicine. I had met Beau not too long after his best friend had passed away and talked to his family about how to most adequately address Beau's stress and condition.

Beau's fight with the drapes. AKA "I want out!"

The family knew very early on after the death of their beagle that they needed to find another friend for Beau. They had jobs and lives outside of their love for Beau. He was a mess on his own and they couldn't fill the gap that their beagle had.

I saw Beau's family about a week and a half ago on my Sunday walk-in hours. Their chart was in the exam room box and I saw that they had a new pet. I was so excited to see their new addition and to hear about Beau's response to having a new friend that I forgot to actually read the chart's entry for "reason for visit."

When I walked in the room I saw looks of concern and a small Beagle recumbent on the exam table. Within a second my excitement dropped to despair.

The beagle on the table was small, about 12 pounds, and she was laying on her sternum with her head extended, nose pointed straight ahead, and breathing as if every tiny inhalation might be her last.

We didn't need words. We all knew she was terribly ill.

I then turned to read the chart. "New pet, sick."

Why hadn't I suppressed my excitement long enough  read the file? Why had I burst into the room excited when the room contained despair?

They introduced Brea to me and told me that they had just picked her up yesterday from the SPCA. (I quickly did the math in my head. They had only had her 20 hours).

They were told when they adopted her that she had kennel cough but was being treated for it. They then produced her antibiotic, doxycycline. They also told me that she had been given up, and then adopted, and then surrendered again.

When you see lots and lots of animals you get a good 6th sense about them. I could tell that there wasn't a mean aggressive tendency in this small scared and pitiful pup. She is a beagle. And although they are vocal and sometimes their nose forces them unconsciously to wander off for that elusive smelly bunny, they are sweet affectionate dogs. They told me that the second family had brought her back because she ran off and wouldn't come to them when they called. (Do people think that this is abnormal? Especially for a beagle? They are powerless to the nose-brain force that drives them to investigate the scent of any animal that has passed by). All pets need to be trained, and all new pets need to be intensively supervised and also trained. Poor Brea, she was a little beagle in a world that couldn't understand or appreciate her. That was until Beau's parents found her.

They explained that they loved beagle's and knew that another beagle would be perfect for Beau. They were so happy to find her, loved her instantly, and didn't care that she was a little sick, but on the mend.

I looked at Brea, gave her an exam and then notified them that she was "Very, very sick." I suspected that her kennel cough had turned into pneumonia and I was not sure she would live." How else could I tell them? She was less than a day theirs and I wasn't very hopeful that she would live past today.

This is what a dog that can't breathe looks like. Head extended, open mouth, reluctant to move.
Brea is in our oxygen cage. The sides are covered in yellow snot becasue she is so congested.
Pink tape covers her i.v. catheter.

Yellow crusted nose.

They said that they loved her already and they wanted to give her a chance. I told them they could call the SPCA tomorrow and see if maybe they would help with her treatment plan.They explained that they had signed paperwork that clearly stated that any medical conditions were their responsibility and that there was a medical facility they could send her to. But they felt confident that she wouldn't get immediate medical intervention and that the SPCA may elect to put her down. They didn't want to wait for her care and they didn't want to give her up.

We took a chest x-ray and ran some blood work. I reported back to them that the x-ray and the blood work didn't appear to look as badly as she clinically did. I discussed options for them. She could go to the ER until we opened again on Monday at 8 am. I told them that the "average ER overnight stay is about $500-$700." I also explained that they could take her home and monitor her very closely and go to the ER if she worsened. Because her blood work and x-ray weren't as severe as I had thought they decided to go home and bring her back first thing the next morning.

Brea's first three days in the quarantine area of our hospital were "touch-and-go."

Quiet, recumbent, and depressed. In quarantine.
A/d slurry (a high calorie prescription food) in with her, just in case she feels well enough to eat.
Because she hadn't eaten in so long with had to add potassium to her fluids.

She went to the ER every night at 8 pm for overnight oxygen cage therapy and came to us everyday for nebulization, i.v. fluids and antibiotics and prayer.

She had severe yellow thick mucous from her eyes, her nose and her throat. She was as sick as sick can be without dying. We all tried to convince each other each day that she had some slight glimmer of improvement. We were saying things back and forth to each other like, "she will get worse before she gets better," which is a difficult piece of advice to swallow when you look as sick as she did.
At day three her x-rays and blood work looked as bad as she did.

At day 4 we had a tiny interest in food. This was a HUGE milestone!

At day 6 we had a bark! A beagle eats and barks! She was finally classified as "recovering."

At day 8 her blood work worsened. Her white blood cell count had continued to climb every time we checked it. On  days 2 through 8 we had her on 3 different very strong antibiotics. On paper we were losing the war. In person we were beginning to see a real live beagle.

As the staff fretted about her stats I reminded everyone that "the pet tells you the most important information. The pet trumps any number." That first exam she was telling us that she was very sick, and now she was telling us that she felt better. We will treat her until both pet and blood work agree that we can stop.

At day 10 Brea remains with us for the day while her new family is at work. She has yet to meet Beau. It will have to wait until she isn't blowing disease droplets at every sneeze. But she is a bright, happy, wagging, nose to the ground, inquisitive girl who I think will be a perfect buddy for Beau.

Out for a walk in the sunshine! This is how you know a beagle feels better.
They are sniffing, digging, and watching other dogs.
And there is that "happy beagle wag!"

Her new family knows that they single handedly saved her life.

Please rescue, and please be patient if you do. These guys often come from broken homes, and many of them have been shuffled around. They in many cases also haven't been "trained." I know many people are hesitant to adopt because they are afraid of inheriting a pet with problems. I hear many people say to me "I think that Fluffy is this way because she was abused." I know a great number of pets who were adopted at 8 weeks old with behavioral issues that were never abused. Your pet Lives in the now and almost every single behavioral problem can be resolved with patience, kindness, determination and assistance from professionals. Please don't give up your pet without asking for help from your vet, your local rescue organizations, and behavioral advisers. Pets are a life-long responsibility.

It has been two weeks of hospitalization for Brea. I am soo happy to report that she is thriving and happy. I will post pictures of her and Beau soon. She is still being kept away from him for a few more days, while the antibiotics kill the last few bugs of her infection.

Update:
On September 13, 2012 Brea passed away due to a severe infection in her spinal cord. Her parents loved her immensely, fought countless battles with and for her, and in the end, although her time with them was very short, she found a place to call her own and a family that loved her every second of her time with them. We all should be so lucky.

Brea and Beau's family came into the clinic a few months later. At that time we were looking for a home for Pheobe. She was an overweight, under exercised mixed breed dog. She had been scheduled to be euthanized because her mom was entering long term hospice care. Her mom didn't believe that there was a possibility that Pheobe could find another home at her advanced age of 8. I spent 20 minutes pleading with her to let us find her a home. I had to say things that I was dumbfounded to answer. Like promising her "that we wouldn't experiment on her." Or, "that we wouldn't let her suffer in a tiny cage and never be able to go outside or see daylight." I was so disheartened that people could do such things, or even imagine doing such things.

Pheobe in the few months that we had her, blossomed into a happy, playful girl. Phoebe got a second chance at life because Brea's parents understood how important it was for Beau to have a buddy.