Ehrlichia
Background
Canine Ehrlichiosis or Ehrlichia is the "up-an-coming" tick disease of the Midwest. Unfortunately, most information is learned about Erhlichiosis post mortem—that is, after one of your dogs has been affected by (often lost to) this terrible disease.
The disease has two phases, acute and chronic. The acute phase occurs 1-3 weeks following tick exposure. Clinical signs of illness are pretty generic, and may include listlessness, swollen lymph nodes, anorexia, achiness, and fever. Since exposure often occurs during the end of summer, this symptoms are often missed or written off as heat sensitivity. The symptoms go away…and untreated, the dog progresses into the chronic stage a few months later.
Because the acute stage of Ehrlichiosis often does respond well to treatment, it is now recommended that any Lymes-like symptoms in endemic regions be treated as possible ehrlichia. Doxycycline is the drug of choice, since it is effective against both Lymes and Ehrlichia. If there is any doubt, forego the conventional amoxicillin or tetracycline and head straight to the doxy.
The signs of the chronic phase can be identical to the acute, with the additional possibility of nosebleeds or other abnormal bleeding and weight loss. The chronic phase usually occurs several months following the acute phase.
In both phases, the damage done to the body relates to destruction and decreased production of all blood cells (red blood cells, white blood cells, and platelets). This leads to anemia, decreased resistance to disease, infection and abnormal bleeding.
Once a human or animal is stricken with ehrlichiosis, white cells die off faster than the bone marrow can replace them. These dead cells migrate primarily to the spleen which enlarges as a result. The bone marrow goes into overtime, trying to form new, healthy cells. In its haste, it sends out immature cells which do not work efficiently. These cells are nearly indistinguishable from those seen in leukemic patients, and ehrlichiosis is often misdiagnosed as leukemia or lymphosarcoma for this reason.
Adding to the complications, research suggests that chronic ehrlichiosis may lead to various cancers, especially leukemia and lymphosarcoma, and may predispose animals to other forms of cancer as well. Ehrlichiosis can affect dogs neurologically, causing seizures, lack of coordination, temperament changes, or obsessive-compulsive behaviors.
Once the chronic stage is reached, the rickettsial organism has taken up residence within the bone marrow. At this point the damage done is considered irreversible. It is not unusual for dogs in this final stage to suffer massive internal hemorrhage, or succumb to sudden stroke, heart attack, renal failure, splenic rupture or liver failure, resulting in death. An ironic peculiarity about the disease is that these dogs often do not look or act as though they are in a terminal stage of disease until their final hour.
Why?
Like most personal web resources on Ehrlichiosis, I have been affected by the disease. In 1998 I started hearing stories about dogs in the Northern Midwest dying suddenly with little warning…usually with massive hemorrhaging. Most of these dogs were sporting breeds, and because of the sudden and horrid end, many were necropsied. The answer that came back sounded impossible: ehrlichia. The disease I, along with many others, associated with tropical jungles (I’d heard of the MWDs in Viet Nam being preventatively euthanized to avoid bringing home the disease). If tick control had been important to avoiding Lymes, it was now doubly important.
In July, 2000, I had an unusual experience with one of my dogs during a Saturday training session. It was hot, of course, and she seemed off, sore perhaps…and her eyes looked very red after working. I treated it as heat exhaustion and made sure she was hydrated, watching her carefully.
On Monday she did not get off the bed when I got up to let her out. When I encouraged her, she complied…but slowly, with stiffness. I offered food, which she refused. At this point I knew things were serious. This was a dog who had never in her life refused food. I took her temperature, which was 105! I called the vet and brought her in. We sent tick panels off and did a full CBC/Chem Panel. The only thing off was her white cells, which were sky high. We started her on tetracycline thinking either Lymes or Pyo, and the fever came down.
On Tuesday the tick panels came back negative. My vet felt strongly that Alix had Pyo and should be spayed immediately. I gave the OK, and she was spayed that morning. Curiously, the ovaries were cystic but there were no other classic signs of pyo. Alix came home with antibiotics and seemed to make a full recovery.
In late November, I started seeing periodic stiffness, and what I considered depression. I had a foster dog at the time, and assumed this might be playing a part. By Christmas I was concerned. The foster was gone, and the stiffness was now periodic lameness. I took her in for another tick panel, started her on tetracycline again, and sent another sample to Colorado to have an IFA done for Ehrlichia. She came back highly positive for Lymes and Ehrlichia. We switched from tet to doxy at this time.
It was almost immediately apparent that the Doxy was working. At the end of six weeks (the recommended course then) when she came off, though, the symptoms were back within 48 hours. Back on, for another six weeks. Off, symptoms returned. She ended up on Doxy for 18 weeks. By that point, I was afraid to ever take her off. But this time she seemed OK.
For almost 18 months, Alix did pretty well. She had another couple of Lymes flares we treated with doxycycline.
At about the time I noticed Alix becoming subdued and sore, the bleeding started. I’d hear a funny noise from Alix, who would be doing a "high nose" move. That would be followed by a sneeze and then a trickle of a nosebleed. My friend who’d lost a Malinois to Ehrlichia told me to watch for a real nosebleed. Her dog, she remembered, made it six weeks once the nosebleeds started. Soon after, if only to confirm my paranoia, Alix had her first real nosebleed. My vet counseled me to be ready and to watch carefully for signs of renal failure.
I decided to talk to a homeopathic vet about other approaches. She put Alix on a cocktail of elderberry syrup and capsules with exotic mushrooms and herbs plus vitamins B & K. After eight weeks, waiting for the "big one" Alix was nosebleed free…which she remained for a little over a year.
Another big nosebleed Summer ’03, and a couple of tricklers through Summer ’04. When Alix started acting painful and subdued in late ’04, not her normal "nanny" self with the youngster in the house, we were off to the vet’s again. This time the bloodwork and UA showed the beginnings of renal failure.
A change in diet actually yielded improved values…not perfect but better than when first diagnosed. We’ve really battled weight over the course of this disease, with Alix three to four pounds underweight at a minimum. The change in diet actually helped round some of those edges, in addition to improving her kidney function. While people may disagree with my choice to experiment with raw foods and higher levels of protein with an immuno-compromised dog in early kidney failure, the results (and the very fact that she is still alive) speak well to that decision. She is now maintained on Innova’s EVO product although we will probably vary between some of the Timberwolf Organics products now that they are available in my area again.
Each winter brings more problems and this winter is no different from previous ones. We’re probably reaching the end game—I’ve certainly believed that before—but only time will tell.
