Chronic ehrlichiosis treatment.

Dr. Marie replied:

Sorry to hear that Kahuna is struggling with Ehrlichiosis.

The questions you asked are really only able to be answered by your regular veterinarian. However, I'll give you a few of my thoughts.

There are three possible phases of ehrlichiosis:

Acute: A dog can show signs of ehrlichiosis within 1-3 weeks of being bitten by an infected tick. Symptoms are vague and include lethargy, enlarged lymph nodes, fever, and reduced appetite. Lab work will usually show reduced number of red blood cells, white blood cells and platelets. Some dogs will clear the disease and be clear of it, but then some dogs will go into a subclinical phase.

Subclinical: A dog with subclinical ehrlichiosis will often have no symptoms, but if bloodwork is done we will usually see a reduced number of platelets. Dogs with subclinical ehrlichiosis can go on to get chronic ehrlichiosis.

Chronic: A few months or years after the initiation of subclinical phase, a dog can start to go into the chronic phase of ehrlichiosis. When this happens there is damage done to the bone marrow cells that create red blood cells, white blood cells and platelets. This damage is usually severe and the symptoms include weight loss, lack of appetite, bleeding episodes and lethargy.

Unfortunately when a dog is in the chronic phase of ehrlichiosis it can be hard to treat. While some dogs can eventually be treated and recover, not all dogs do. The deciding factor on whether a dog recovers or not is how much damage has been done to the "precursor" cells in the bone marrow. These are the cells responsible for creating red and white blood cells and platelets.

It can take many months for a dog to recover from the chronic phase. Some vets report that the success rate for treatment of chronic phase ehrlichiosis is very poor. However, other vets have reported that most dogs make a recovery after 1-3 months of doxycycline treatment.

So, to answer your questions, it is likely not a good idea to reduce the dosage of doxycycline. The length of time that he will need to be treated will depend on how well he responds to treatment, and this will likely be gauged by bloodwork. We don't generally continue the doxy once a dog has gone into remission.

The idea of giving probiotics along with an antibiotic is in case there is disruption of the normal bacteria in the intestines. If your dog has diarrhea while on doxycycline then you can talk to your vet about adding a probiotic, but otherwise I wouldn't worry about it.

The idea of the vitamin K is to help reduce bleeding in animals that have ingested something (like warfarin) that affects certain clotting factors. I am not 100% sure but I don't believe vitamin K will help reduce bleeding that is caused by low platelet numbers (as is the case in ehrlichiosis).

The idea of vitamin B is to help with the anemia. It may have a marginal effect, but my gut instinct is that it will not really be that helpful.

I hope Kahuna makes a full recovery!

Dr. Marie

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