Parvovirus

Yes, I know, yet again, for multiple days, I’ve disappeared.  For good reason.

So you know about the little puppy, and have eagerly awaited more pictures of her.

But for the past few days, she has been horribly, horribly sick.

She’s had diarrhea for a while.  We’ve tried various remedies–at one point when she was on an antibiotic, and her symptoms went away completely for several days, but they returned as soon as the antibiotic course was completed.  We spent multiple days trying to find a specific worm-curing medicine recommended to us, but we couldn’t find it, and we worried over her continued stomach upset.  And on Tuesday night, she again woke several times in the night, crying to go out.

On Wednesday night she woke having soiled herself.  After throwing up earlier in the day.  And on Thursday morning, even as I started making our Kathmandu-Thanksgiving desserts to chill before I started to cook the main meal… she threw up again, what looked like every fragment of her breakfast.

So we took her to a different vet, one of the most well-known amongst the expatriates here.  And he promptly ran a few actual tests on her.  And administered intravenous antibiotics, and fluids.  And we learned the puppy had a mild case of fleas, a stronger case of worms, a bacterial infection called giardia… and parvovirus.

The last scared me from the very name–I knew it only as one of those scary dog diseases that all puppies are vaccinated against in the United States.  And when I started searching for information about it online, I found that it seemed most people had the same impression of it:  even on veterinary pages, I found rehashes of the same basic information that looked like it had been pulled from a common textbook on pet care.  A basic overview of the structure of the virus itself, its mode of infection, a few sentences about its symptoms, diagnosis, prognosis, followed by multiple sentences underlining the importance of vaccination… and nothing else.  It looked like nearly all of it had been written by people who had never actually seen a dog with the disease.

Not quite all–a few sites spoke with the voice of experience, though they, too, tended to be brief, and never included actual case studies.  Parvovirus does occasionally still rear its head in the U.S., in the same group as our puppy:  very young dogs just on the edge of their vaccinations, who haven’t yet gotten them.

Here… well, it’s Nepal.  All sorts of scary diseases lurk everywhere–ground, air, and water combined.   For Pete’s sake, WE had to be vaccinated against rabies before coming here.  Yes, it’s that common, with the leagues of street dogs, not to mention the occasional wandering monkeys.  Go read Water, Water Everywhere for info about our distiller–we forbid even the pets to drink the tapwater here, or, even worse, from the occasional standing puddle in the yard.

It’s a wonder the puppy didn’t have something worse.  Basically, in my reading, and from the vet, I learned several things about parvovirus:

• Yes, it’s a virus, untreatable–but the danger is in secondary problems, which can be treated.
• Untreated, the virus causes death in 80% of dogs
• Treated, the statistics reverse, and 80% survive–good we had her diagnosed!
• The virus tends to run its course in 3-5 days (we’re on 4, thank God)
• If a dog doesn’t show improvement by day 4, it normally doesn’t survive (she is improving)
• The disease symptoms include foul-smelling, bloody diarhea and frequent vomiting
• The virus attacks the intestinal lining, causing both problems above
• The virus can also shut down white blood cells and weaken immune response
• The biggest danger is how the virus weakens the dog–most die from dehydration, or because a secondary infection takes advantage of the dog’s weakened immune system to do its nasty work
• Even if a dog is improving, sometimes they abruptly die, and no one really knows why.
• Even if a dog recovers, it’s possible for the virus to have first hidden itself in the heart, where it can reactivate months or years later, triggering a heart attack and sudden death.
• Even if a dog does completely fight off the disease, they often tend to be mildly weak and sickly for the rest of their life.

So our puppy’s situation looked fairly bad–but not not awful.  Some scary things could happen; her risk of dying peacefully from old age just went down.  On the other hand, her chance of dying immediately wasn’t impossibly, terrifyingly high.  At least she didn’t have rabies.

Yesterday I caught her foaming at the mouth.  Twice.

And in the evening, in my husband’s lap, she went into convulsions–a full-blown grand mal seizure, jerking and drooling and losing control of her bowels and urination.

We were horrified.  As she came out of the seizure–after a minute or two, that, like the expected Kathmandu earthquake, seemed to last hours longer–I raced upstairs, found the card from the vet, and called his cell phone, even though it was nearly 9 PM.

And he answered promptly, calming me down.  “Yes, sometimes we see this in parvo puppies… her body is very weak… her liver may not be working well, and sometimes they have seizures… keep her warm and still–she may want to run around, but don’t let her–don’t give her any more food or water tonight, but the antibiotic is okay, if it’s due… call me in an hour and let me know how she is.”

I sat on the floor of our bedroom with our puppy wrapped in a towel in my lap, singing her Christmas songs like “Silent Night” and “What Child is This?”  When I was a child myself, I’d learned from several pet cats that having a human hold them and sing lullabies could be just as comforting to a pet as a it was to a baby.  It worked on the puppy, too, helping her calm down–she was tense, her eyes terrified, with good reason… she’s barely 11 weeks old!

A few years ago, I thought I’d been frightened holding a sick kitten on the way to the vet, with him oddly rigid in my arms, drooling and unresponsive although undoubtedly alive and softly crying out… My own heart had stopped when the vet told us he had a congenital heart disorder called cardiomyopathy… Even when he was treated and allowed to come home with us, when he lay around listlessly and with a bloodclot in one leg causing it to literally rot, the fur falling out and the skin decomposing… oh, when I held him in my arms while my dad unwound the bandage on his leg, applied an ointment, and applied a fresh bandage, every day for too many days… my ears rang with the horrible sentence of “even if he recovers, we’ll probably have to amputate the leg… but then he could maybe live anywhere from 6 months to 2 years…”

That cat tried to shorten the time even more, lying in his bed and refusing to move, looking at me with pained, empty eyes when I tried to interest him in food.  He couldn’t have said any plainer, in English, “Don’t you see?  It’s just not worth it.”

Until, finally, the day that I enticed him with a strip of beef (yes, Nepalis, I’m sorry you’re horrified, but it’s true) from an Arby’s roast beef sandwich.  And he finally looked at me like he was cross, the message in his eyes changing to, “Oh, all right, if you insist.  But it won’t make any difference.”

He ate after that day.  Miraculously, his leg healed.  And, though my horror at all this had been increased by watching it happen in a kitten barely 10 months old… that cat is now going on 8 years, and–while he has needed daily medication–he’s been robust and healthy ever since.

I had all this running through my head as I sat on the floor holding our puppy.  And her age was even worse, barely 2 months.  She’s so tiny–she shouldn’t have to suffer.

After less than an hour, our vet called US.  And we reported that the puppy was sleeping in my lap, having passed from scared to slightly more relaxed.  He repeated to not give her food or water overnight, and call him again in the morning.

At midnight, I gave the puppy her antibiotic and took her outside.  She’d slept until then, and again until about 1:30… when she abruptly suffered a seizure again.

We found a fresh towel to wrap her in, surface-cleaned the other one, then ducked it in the washing machine with a healthy dose of bleach… and she cuddled against us and slept again.  Until 3 am.

Again.  But even worse–this one seemed stronger, and after it seemed to have finished, she abruptly stood rigid and began to bark and bark and bark and growl, her eyes still glazed as they’d been during the main part of the seizure.  But then the noises stopped–or rather, changed to low whines of fear and pain.  And she lay down and curled up again, returning to herself with her eyes more terrified than ever–and almost guilty, like she thought we’d be mad at her, as if she’d just been hollering horrible swear words about us like a child with Terrettes.

We again changed the towel and again cuddled her, but she didn’t relax as easily–she whined softly to herself, even bursting into the occasional miserable howl, until she finally couldn’t resist falling asleep again.

And… yes, again.  At 5 am.  But not as bad as before, shorter and without the uncontrolled barking.  Still, she again softly cried to herself for a while before she could sleep.

At 7:30 I wakened with the vet again calling us to inquire how she was.  We reported, and–following on some more online reading I’d done during the night–I mentioned that I was afraid she might have distemper, too.  He told us he had a testing kit, and to bring her in to be looked at… but he also reiterated that “because their liver is affected” parvo puppies could sometimes have seizures during the worst day of the infection, and he suspected she was in it.

Our puppy heard me talking on the phone, but she stayed exhausted enough to sleep until 8:30, and I wasn’t about to move her before then.  When she got up, I took her out, gave her the antibiotic, and we rushed her to the vet.

But, strangely, she seemed to be feeling pretty well.  She stood and wandered around on her own, wagging her tail and looking for food and toys and petting.  The vet found she now no longer had any fever.  She was still dehydrated, but not as badly.  And we’d reported that her diarrhea had been subsiding yesterday–so he again affirmed that she seemed to be recovering well, and–aside from the seizures, which could have another cause–showed no clear sign of distempter.  So we should continue her antibiotic, finally give her the worming medicine, and keep increasing the amount of food she was eating, as the seizures could be brought on by “hypoglycemia,” or low blood sugar, brought on by the stomach upset robbing her of nutrients and us restricting her to small meals as we let her digestive tract recover.

So we fed her a larger meal at home, and she seemed playful and happy again, though sleepy…

…until 11:30, when, just before she was due to eat again, she yet again suffered a seizure.  But, again, it was relatively mild, maybe not as bad as any that had come before.  When it ended, for the first time, she kept wiggling and refused to sit still–finally, after 15 minutes, we set her down in the kitchen with all the doors closed and, vaguely unnerved, we watched her pace through circles at a fast walk.  I’d read that some dogs did that after seizures; I’d also read it was better to prevent them from doing it, but I wasn’t sure how, and as I resumed my reading, she finally settled and let Sean hold her again, and was asleep the next time I saw her.

And then the afternoon began–and, at first every half-hour, then every hour, I offered her food.  She’s eating the strangest recipe.  Initially, the workers at the KAT Centre where we adopted her had recommended a diet of minced chicken, rice, and warm water for her until she got bigger (remember, she was just 5 weeks old when we took her home, and already separated from her mother for 2 weeks–they warned us then that her immune system would surely be weak).  Her latest vet, when we took her in on Thanksgiving, recommended a diet of 1/2 teaspoon of a medicine containing yeast, 2 teaspoons of plain yoghurt, and 2 more teaspoons of water, to help increase her hydration and the amount of good bacteria in her system to fight off the bad.  When she’d returned on Friday for her final administration of the intravenuous antibiotics, he’d recommended continuing the same diet in larger doses, with increasing levels of normal puppy food mixed in… and, too, somewhere along the way a vet visiting from England had recommended an electrolyte drink for the puppy composed of a half-teaspoon of sugar and half-teaspoon of salt added to water.

So I’m now combining all of those–the yeast, the yoghurt, the water, a spoonful of rice, 2 or 3 spoonfuls of minced and boiled chicken and chicken liver, a pinch of sugar, an pinch of salt, and a sprinkling of puppy food that increases slowly with each mini-meal.

And our puppy is feeling much better.  It’s after 8 pm; she’s had no more seizures.  Instead, she’s eaten up every morsel of food… until around 4 o’clock, when she decided hourly meals were too frequent, and she was fine to wait and eat again around 5:30.  She has enough energy to run off from us outside and try to lap up up the dirty puddle we try to keep her from.  She has grudgingly accepted a bowl of plain distilled water instead.  And her sides have more of a healthy bulge–not as sunken and skeletal as she has been–and while she still has diarrhea, it’s firming and she’s excreting the icky-inch-long worms that the worming medicine she took this morning has killed off.  As the afternoon went on, she began to curl up with us to nap more comfortably; until then, early in the afternoon, she tended to cry between one meal and another, trying to go into the kitchen, though I kept her meals small to keep from overwhelming her system and making her throw up again, which she hasn’t done since Thursday.  Now she’s again napping on my husband’s lap, after another mini-meal.  And I know from the last time I checked her that the too bad signs that vets have pointed out to me have instead now improved–when I lift the loose skin behind her neck, it snaps back down before I can say “One Mississippi,” so she’s no longer dehydrated.  Her gums are steadily becoming more of a rosy pink, so her anemia and hypoglycemia should be fading, her liver functioning better.

She’s not well yet.  We’re keeping a close eye on her.  But she’s doing much better.

I hope she’s even better tomorrow!