FUO and MYSTERIES

Life can throw some nasty curve balls. Our turn was on Thursday, November 7. I noticed sixteen month old Cinnamon Teal was different. She wasn’t her lively, spirited self. Young dogs can change daily, and it was my thinking she was growing up. More reserved, less energetic, she was content to stay close at heel on our walk. By early Friday afternoon, she still was not herself. My first instinct was then to take her temperature. It’s a darn good way to measure if a body is mounting a defence. 105 F. I was struck by sheer terror. Normal dog temperature is 101-102.5 F. Everyone was packed into the car and off we went to our veterinarian.

Teal received a comprehensive, thorough physical exam and blood was drawn for testing. Metacam (an NSAID) was administered to control her fever, which was down to a more comfortable 103 F a few hours later. Now we wait and see.

Saturday at 1 am I awake to find Teal sleeping soundly beside me, breathing heavily. Up we get to take her temperature. 105.4. While making arrangements to visit to a 24 hour emergency clinic, her temperature rose to 105.6 in 45 minutes. I put a cold soaker coat on her to bring her fever down. She began to shiver. Again we get in the car, arriving at emerg in Barrie at 4am . More blood was drawn, and Xrays taken.

Blood profile by this time indicated there was “inflammation “ occurring, some anemia and dehydration. Her left cervical lymph nodes were enlarged. X-rays were unremarkable. We left with a diagnosis of ”FUO” - Fever of unknown origin. Antibiotics are not dispensed until an accurate pathogen is found, for which I’m thankful. However, I was hoping for some answers or solutions.

We spent the better part of Sunday napping and taking Teal’s temperature. We received a call from our concerned, compassionate veterinarian on Sunday evening. The decision was made to take her in again the next morning and she would be seen before the doctors’ regular appointments began.

The fever was staying high and now Teal was reluctantly eating small amounts only when fed by hand. She was experiencing increasing generalized body pain and was very lethargic. There was no vomiting or diarrhea. I syringed water under her lip trying to keep her hydrated. Monday morning Metacam was administered and she began a course of antibiotics. Her blood work from that day showed more deterioration. Teal’s blood was again tested for Lyme disease. Twice it had been negative for Lyme, so a more comprehensive test for “tick borne diseases” was performed. Again, negative. As each test came back “normal”, with the exception of the blood profile, Teal’s condition became more and more worrisome. Her symptom profile sort of matched some things, but not enough of one thing for a clear diagnosis. As soon as the Metacam wore off, her fever would spike. Her body was fighting a hard battle. The decision was made to send her to a specialty clinic.

Tuesday evening we went to Toronto, to the VEC…an emergency veterinarian referral clinic and hospital. It’s the place you go to when the condition becomes complicated. Magpie and I headed into the blizzard’s jaw with Teal bundled up and sleeping in the back. I have been living in “fight or flight” for several days now, my sympathetic nervous system in overdrive. Constantly alert, needing little sleep and forgetting to eat were some symptoms of that. I was unprepared for the irritation the
”Spa” radio station created. While I usually enjoy the ambient playlist, it jarred my senses like fingernails on a chalkboard. Our bodies are designed to block out all but important sound when on high alert. Clearly the Spa station wasn’t meeting the criteria for important. The humming of snow tires was the only tolerable sound. I took comfort from Magpie’s contented snoring as she slept on the seat beside me.

Upon arrival, we join many stressed, sad and worried pet guardians. A somber, heavy mood prevailed in reception. Weary, tear streaked faces glance frequently at the clock. I was surprised by the number of people sitting, waiting for news so late in the evening. Admitting staff were patient, gentle and caring for each individual they encountered….be they either two or four legged. The shuffling of feet, soft spoken words between people and the distant meowing of a cat were the only sounds to be heard. We were lead to a triage room.

A thorough case history is taken by a veterinary nurse. A brief physical exam, including blood pressure was done. As we waited for the doctor, another veterinary nurse ran past in the hallway carrying an small white fluffy bundle of a dog, appearing to be having a grand mal seizure. This place is busy, and everyone here is in need of attention. For a moment, our troubles seemed minor. The doctor arrives and another case history taken. Teal was then escorted to the back for yet another physical exam. Another kind veterinarian came to talk to us. The next step in the plan is an abdominal ultrasound to hopefully find the cause of the fever. She would be unable to see the internist and have the test until the next morning. This meant we could go home (it’s now 11 pm) and return for 9 am, or she can stay the night in hospital. I opted for her to stay….she’d be monitored carefully, and was in a good place if her fever spiked again. They admitted her, and began IV antibiotics and fluids. They allowed me to say ”Goodbye” to Teal before I left, giving me as much time as I wanted with her. Their compassion was exemplary.

As I left, my heart ached for little Teal. A rather suspicious personality, she will be so frightened. We are both so frightened. She is in unfamiliar surroundings, and I am in unfamiliar circumstances……watching my once active, energetic puppy struggle to be well and the cause of her condition still unknown. I think we are accustomed to having answers for physical problems when sometimes there are none. It’s precisely the reason there’s a diagnosis “FUO”. To even have a diagnosis is somewhat comforting…. “Dia” means discern between, “-gnosis” means knowledge. If we know what it is and what it isn’t, then we can plan a course of treatment. The unknown and the helplessness create such anxiety.

Through the years in practice, I have witnessed many times when all we can do is support a body and wait for the body to heal itself. And many times that does happen. One of the great mysteries yet to be solved….how do bodies do that? We don’t yet have all the answers. And it does seem with increasing knowledge through advancing diagnostic imaging and equipment, the mystery deepens. We understand more about pathology and process, but we still know little about the how bodies heal.

Teal’s fever had dropped to normal after her first night in the hospital. The Internist called the next afternoon saying an abdominal ultrasound would be of little use as her condition had improved. He called again in the evening, suggesting she stay another night to make sure her fever stays down. If she’s well, she can come home after a second night in their care.

The call we’d been hoping for came on Thursday morning…Teal was stable and ready to come home. I arrived at reception around noon that day to find it filled with people and “designer” dogs. Some small fluffy dogs, small hairless ones, tall slim dogs, some breeds I’ve never seen. A nurse brought Teal to the front for me to pick up. Little Teal looked so bewildered and out of place. The sporting dog, country bumpkin didn’t fit amongst these city cousins. She didn’t recognize me at first, but when she did, we were both ecstatic. We spoke to her kind internist who instructed in home care, offering that we call any time if there’s a concern. He too, this very experienced internist, was confused by Teal’s condition.

Sometimes there are no answers, just mysteries. And I’m Ok with that. Sometimes healing occurs, sometimes it does not. And I have to be Ok with that too. This time, we were lucky.