Fever of Unknown Origin - Update #2

[BG and Gavin]

So here I sit; I took the day off work.  Gavin started losing energy on Thursday night.  He went downhill to the point that we took him to the vet on an after hours call on Sunday.  He was totally lethargic, lying on his side, unresponsive.  He has a temp of 104.2 and his white blood cell count was elevated, but all other tests came back fine.  Urine test was fine.  Fever of unknown origin was the diagnosis.  The vet was troubled because the exact same thing happened last August with him. He is a bit stumped.  So treatment is Rimadyl (anti-inflammatory) and Clavaceptin (anti-biotic).  Gavin perked up right away on the meds, short bursts of acting normal (grabbing his ball, wanting to play, a short walk) followed by more than usual sleep. 

 

However, this morning I had to get his up and assist him outside again.  He would not do the stair steps or make eye contact or eat, just stood and stared at the floor, almost trance-like.  I called the vet again.  He said maybe the n-said was worn off and the fever was returning.  He wants to test for the white blood cells again when the meds are done. If they remain elevated, his next thought is an autoimmune disease, which is treated with a 2-3 month round of steroids when it flares up.  As we sit now, Gavin is bringing me his ball to throw and I just got him to eat some canned food with cut up chicken heated and mixed in.  Guess the n-said kicked in. 

 

Apologies for the long post but it’s been a stressful week. I am worried sick about Gavin, I have an important presentation to give at the College tomorrow, my 24 year job ends in a week and we are supposed to be looking after Mylie doodle for two weeks but have her farmed out while Gavin recovers.  Oh these doodles!

 

Any advice or similar experiences? Or a limerick for me??

 

UPDATE:  Gavin went to the vet today:  temperature perfect, negative on lymes, heartworm and two other things, auto-immune issue ruled out, white blood count still high (even a bit higher than when we were there 10 days ago).   He says he is a bit stumped.  The only thing he could think of is that the first blood test caught the count on the way up and it has not made its way all the way back down yet.  He is going to consult a pathologist about Gavin's case and get back to us next week.  He kept blood back from both visits for further analysis if necessary.  He gave us some Rymadyl to have on hand in case the fever returns so that we can begin to deal with it quickly.  I dunno?  He seems normal.  Any ideas?

 

UPDATE #2:  I just got the following email from my vet: 

I had a lengthy conversation with a pathologist at the animal health laboratory at the University of Guelph about Gavin.  She was saying that the effect of the WBC count going higher is not uncommon because the bone marrow is not shut off right away so  you can get a higher count before you get a decline.  She was very perplexed on why he was having these febrile episodes.  What she suggested to do is to do another CBC and urinanalyis in 60 days when he is apparently “normal”.  Immune disease does not fit here since he has recovered again in such a short period of time with NSAIDs and Antibiotics.   As well, we have ruled out Addison's disease via the normal Biochemistry profile and electrolytes.  We were thinking possibly a glomerulonephritis that is why we want to see urine again to monitor the protein level.  So if it is possible to get him back in probably the first part of June with a first morning urine sample and we can run a follow-up CBC that would be great. 

So the big word is a type of kidney disease.  I guess we will see.  He seems great now.

Update March 2013 Well this was two years ago.  We went on a session of 6 weeks of anti-biotics.  The only thing they could think of was a lingering kidney infection that was knocked down the first time in August, but never was really cured.  After the 6 weeks, white blood count was back to where it was supposed to be and urine was good.  That being said, about every 3-4 months Gavin has a mini-episode of lethargy reminiscent of the febrile episodes.  Usually he comes out of them on his own within a day.  If he does not come around right away, I give him a rymadol and it snaps him right out of it.  I have gotten pretty handy with the rectal thermometer though ;)

Update December 2013 - it has been almost a year since Gavin has any type of fever or period of lethargy.  Touching wood as I type, but I think we maybe out of the woods for good.

[AndySharon BoomerShaynaMariner]

Just a quick note -

 

Enteric coated aspirin is not recommended in dogs because about half the time the coating isn't digested and the aspirin is excreted whole in the stool.

 

That is why Karen says "buffered" aspirin.

[BG and Gavin]

Thanks for the information Andy and/or Sharon.

[BG and Gavin]

Point taken.  Thanks Karen.

[F, Calla & Luca]

I'm glad Gavin is feeling better. I am not sure the white count elevation after 10 days makes sense. I do hope the pathologist has some additional input but I think an infectious disease specialist still might be a good idea if not. There needs to be an explanation about these febrile, lethargic episodes.

[Jane, Guinness and Murphy]

I'm so glad to hear that Gavin is feeling better and acting more like himself.  I understand how frustrating it is when there is something "off" with their tests, without a clear explanation.  Murph still has elevated and reactive lymphocytes with no diagnosis.  We repeat the blood tests every couple of weeks waiting for this to change.  I'm so hopeful that when the Vet gets back to you next week, there is some good news and you can put this behind you.

[Debbie and Thomas]

Just catching up on posts!  I can only imagine how worried you have been!!!!  I am so happy that I read your update right away. I know that you must still be worrying about the elevated white count....but it sounds like he is getting much better.  Can I ask though...could you tell he had a fever or did you only find out when the vet took his temp?  Could you feel the heat of the fever on his belly, nose or anything?  In humans...104.2 is very high...is this also VERY high for dogs?

[Jane, Guinness and Murphy]

We keep a baseline temp for Guinness and Murph (which we revalidate at each wellness visit) so we know when we should be reacting to a fever.

[BG and Gavin]

I knew from our last experience what a fever "looked like."  Basically like he was going to die.  Lied on his side, not moving, eyes open, unresponsive, awful.  105 apparently can be fatal.  Thats why I really wanted to have the pills to take the fever down right away if this happens again.  I forgot to add that he gained .8 of a lb over the last 10 days which he really needed.  I think having Mylie in the house as competition made him eat with a bit more vigor.

[Phyllis & Duffy]

Thank goodness they ruled out the autoimmune!  Duffy goes again on Tuesday for more blood work to see how his counts are.  The shedding seems to have stopped since the prednisone was cut to 1/2 a pill once a day.  Thank goodness for that too. 

[BG and Gavin]

Another update including an email from my vet.  See original post.

[Jane, Guinness and Murphy]

I think this sounds like good news.  This whole episode seems to be confusing, but I'm thinking that if the Vet feels it's okay to wait 60 days for the next check, that's comforting.  We're continuing to keep fingers and paws crossed for Gavin.

[BG and Gavin]

Jane, I am not sure if any of this info would be helpful to you and Murph, but wanted you in particular to see my vet's response.