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Rocky Mountain Spotted Fever? But We Live in NJ!

Posted on April 13, 2016February 3, 2023 by Eileen Anderson

Guest post by Kate LaSala, CTC

It’s the start of tick season here in the Northeast and I’ve been reflecting on last year’s tick season and how we almost lost our sweet BooBoo. So in the interest of raising awareness and saving lives, I share with you our story.

It was a beautiful Sunday in April 2015, one of the first nice days of the spring. My husband and I decided to take our two rescues, Mr. Barbo and BooBoo, for a hike and before we headed to bed that night, we did our standard post-hiking tick check and everyone checked out clean.

The next day we let the dogs out and as they chased the squirrels, BooBoo’s rear legs slipped and she fell. Did she trip on the pool cover? Maybe her hip dysplasia was acting up after our hike? I wasn’t really sure but she wiped out and then just kept going.

By dinnertime she was non-weight bearing on her right rear leg and I immediately worried she had an ACL injury from her earlier slip. I knew that non-weight bearing was a classic symptom so I put an afterhours call into our vet and immediately started her on some Rimadyl.

Over the next five days she improved and regressed. We brought her to the vet to rule out an ACL injury and our vet suggested we could re-run a Lyme test, even though she had just had one two months ago and even though we use Vectra 3D monthly. We declined the test and suspected it was an injury from the slip that was causing her limp.

Our first red flag that we were dealing with something else came Saturday evening when she was curled up on the couch and whimpered as she adjusted herself. We left a message for the vet saying we would need an appointment first thing after the weekend because the Rimadyl wasn’t working.

But, that plan changed Sunday morning when we woke up and she wasn’t in bed with us. We found her on the floor, lethargic and reluctant to move. She wouldn’t eat, not even her favorite treat and her temperature was well over 105. We rushed her to our local emergency facility, calling ahead so they were prepared to receive her. When temperatures are that high, the chance of a seizure is a real risk.

We arrived at the ER and they immediately started cooling her. We explained the weeklong history since our hike and they suggested a Lyme test, as our vet originally did. So we did the in office “snap test” but it came back negative. Despite the negative results, she was symptomatic of a tick disease and they suggested a full antibodies panel and PCR test for all the tick illnesses. We started Doxycycline right away and ran bloodwork and everything came back normal. The tick panel would take several business days for results but if it were a tick disease, the Doxy should start to knock it out. They admitted her for IV antibiotics and fluids to stabilize her and then said we could take her home. After midnight, they called, said her temperature had been stable since 10PM and we could take her home with oral Doxy and Tramadol for pain.

We followed-up with our regular vet on Monday and she agreed with the ER’s diagnosis. BooBoo was on the meds, still lethargic and not eating well but her temperature seemed to be controlled.

But then Tuesday evening her temperature spiked back over 104 again and we rushed back to the ER where they admitted her again, this time for several days. We consulted with the internal medicine specialist to discuss the all possibilities from cancer to autoimmune issues to tumors and other super scary things since the Doxy didn’t seem to be working. We ran additional diagnostics including ultrasound and x-rays and she got the all clear. No cancer. No tumors. All of her organs were the right size and everything looked perfect. A glimmer of good news in a sea of uncertainty. But her fever was still fluctuating and they were struggling to keep her stable. The 5 doctors now on her team were all brainstorming to figure out what was causing our sweet Boo to be so sick.

Later in the week, the antibodies results returned a “high positive” for Rocky Mountain Spotted Fever. I was thrilled to know what we were dealing with but I was baffled. We hadn’t been in that area of the country, so how did she get it? But then I learned that despite its name, only 5% of the cases were actually from that region¹. As I researched, she fit much of the epidemiology. RMSF is called “the great imitator” because clinical signs are often vague and symptoms are often confused with other infections but high fever, joint and muscle pains are usually observed within 3 days of exposure. And with delayed diagnosis and treatment, within days the effect on the central nervous and vascular systems can be devastating including death within a very short period of time. I was beginning to realize how close we were to losing her.

So with the RMSF on the radar, the vets changed the drug regimen within 24 hours she stabilized and we were able to bring her home Friday. The bad news was the PCR test came back negative, which meant either she had been a carrier of RMSF for a long time and it was a red herring that was throwing off what we should actually be treating or that the DNA wasn’t in her bloodstream because it had attached to things like cell or artery walls. Since RMSF typically attacks the vascular system the latter option was a possibility, but we had no way to be sure.

We stayed the course and remained vigilant for any additional symptoms and completed the prescribed 3 weeks of medication. She progressed little by little but never got to 100% by the time the drugs ran out. She was still reluctant to jump up and was still very tentative on the stairs.

So what now? Retesting the tick panel at this point wouldn’t give us any new information. We could do additional diagnostics like joint taps to rule out things like autoimmune polyarthropathy but doing invasive procedures like that brings its own risks. Would she now be lame forever?

We opted to started her on Prednisone to see if her mobility improved. After 2 days of Prednisone, she had mobility improvement but also was experiencing the known side-effects of steroids – increase appetite (not really bad for her at this point) and increased thirst/urination. We continued the Prednisone for months, dropping the dose as advised but noticed that even though we were dropping her dosage, her need to urinate very frequently wasn’t subsiding. This caused our vet to begin to worry about liver, kidney and diabetes risks. We ran additional bloodwork and now her liver values were dangerously high. We continued to step down the Prednisone as quickly as we safely could and added in Denamarin, to help support her liver.

It would take over six months after her diagnosis to completely step her down off the medications before her liver values returned to normal and she got a clean bill of health.

Black dog BooBoo, survivor of Rocky Mountain Spotted Fever, joyfully running on a bridge — BooBoo feeling good again

So here we are, a year later at the beginning of a new tick season. She’s healthy and happy but is a changed dog and we’ve made changes as a result of this experience. We still hike – our dogs love it and even through almost life ending experience, I wouldn’t want to keep them from that joy. After all my research on RMSF and the recent Powassan virus, I discovered that some of these tick-borne diseases only take a few hours to be transmitted and that is truly frightening to me. Unlike Lyme, where the tick needs to be attached for 24-48 hours to transmit the disease, RMSF can be transmitted in as little as 5 hours. This means hiking a full day and not checking for ticks until before bed will no longer do. We now do a mid-hike tick check every 2 hours if we’re out for a long day in the woods.

As I reflect back on this ordeal, I’ve got several important takeaways that I’d like to share.

Know your dog inside and out. Know how to take your dog’s temperature and pulse. Just like people, dog temperatures vary and knowing what is normal for your dog could help you spot an early warning sign. Know your dog’s normal vitals (body temperature, average resting pulse), appetite pattern, coat texture and sleeping habits.
Be your dog’s advocate. Don’t just wait it out to see if it gets better on its own, as tempting as it might be. Time is of the essence. Seek out care right away and be your dog’s advocate. Don’t wait for organ failure or hemorrhaging – it very well might be too late to treat at that point. Be proactive in the care your dog gets.
Pet insurance. We purchased insurance soon after adoption so there would be no excluded pre-existing conditions. Having the peace of mind knowing that everything would be covered allowed us to focus on BooBoo and do whatever the doctors recommended and not have the financial strain as a deciding factor in her medical care. Yes, the monthly premium is a lot but insurance is exactly for cases like this. We received 100% reimbursement of over $6500 in vet bills (minus our $100 deductible.)
Topical treatments. Although we are generally holistic, we do apply a monthly topical tick preventative. When I approached the manufacturer about how she could be infected with being on preventative every month, even through the winter, they stated it’s only 97% effective in repelling. So some ticks will get through. I suspect we never found the tick that infected Boo because it bit her and then the Vectra killed it, and the tick fell off before we did our evening check. We still use the topical but now also supplement with an essential oil spray. Also, having proof of purchase of tick preventative was necessary for our insurance claims to be paid 100%.
Have a regular vet. As tempting as it is to bounce around to low cost clinics for vaccines, this reinforced how it’s far more important to have a solid relationship with a regular vet, who sees your pet at least once annually, whether they are sick or not. We have an amazing vet and we trust her implicitly. When ER vets were throwing out all sorts of tests and things they could do, we relied on our regular vet’s advice and knowledge of the history of our dog to help us decide a course of treatment. Our regular vet worked in tandem with the ER staff and the specialists, reviewing all the lab reports and treatment plans. They sent her daily updates and reports. It’s easy to be overwhelmed when your pet is in medical crisis and having a regular vet as an ally helps you make decisions and not feel like the ER vets might be taking advantage of your compromised state.
Have an ER vet. You never want to need to use it, but in an emergency you don’t want to lose precious minutes looking up who your closest ER facility is. Know where they are, know how to get there and have the phone number programmed in your phone so you can call them on your way so they’re ready to take you in for a real emergency. In our case, getting Boo’s temperature down was critical to saving her life and preventing a seizure. The hospital knowing we were on our way gave them advance warning to prepare a room for her so there was no delay when we arrived.

I am forever grateful to the medical team that saved our girl but I know our quick action also played a part. Many dogs do not get diagnosed with RMSF until it is too late to save them – until they are hemorrhaging or some other equally awful symptom appears. It wasn’t her time but it easily could have been if I hadn’t taken her temperature or if the ER vets hadn’t started her on drugs at that moment. There are so many things that could have altered our outcome. Our sweet Boo came to us as a feral dog from Kentucky and is now a certified therapy dog and I like to think the world needed her around for a while longer. I hope that others hearing our RMSF story will bring awareness to tick-borne illnesses and help people notice the symptoms early on to help save lives.

For now, we will keep hiking but checking for nasty ticks often and cuddling as much as possible to enjoy every moment that we have left together.

For more information, please check these RMSF resources

JAVMA, Vol 221, No. 10, November 15, 2002
Companion Animal Parasite Council
Merck Veterinary Manual
Medscape
US CDC

Kate LaSala, CTC is an honors graduate of The Academy for Dog Trainers and owns Rescued By Training in Central NJ. She is also a certified AKC Canine Good Citizen (CGC) Evaluator and trainer for the NJ Chapter of Pets for Vets. She shares her home with her husband John and their two rescue dogs, Mr. Barbo and BooBoo. Kate and BooBoo are a certified therapy dog team, visiting nursing and rehabilitation homes locally. Follow her on Facebook for training tips and helpful information.

Diagnosis

In September 2014, I started to notice that Clara was getting increasingly stiff and weak in her hind end. This worsened, and by early November when she was finally diagnosed, she had also gotten prone to trembling, not only when she was cold or excited, but sometimes for no apparent reason, even while asleep.

Thinking back, for as long as several months before this, she had run and jumped less when playing with Zani and had less stamina for playing ball. I didn’t mention it in the post, but you can see in the video in “How My Dogs Play” that Clara typically waits in the corner while Zani runs around the yard (previously, she would have run after her every time). Clara also lies down a lot in the play session, which is very polite and self-handicapping of her, but also could have been because she was tired.

She also had a rash on her chest, abdomen and legs in October 2014, which may or may not have been connected.

I made the movie below to chronicle her symptoms, but held back for some time on publishing it. I wanted to be as sure as possible that her diagnosis was correct and that there wasn’t an additional problem or other reason for her symptoms.

The symptoms of tick-borne diseases vary greatly and also can be confused with many other diseases and conditions. (There are quite a few of these diseases, the most well known of which is probably Lyme disease. I included some links in the Resources section at the bottom of this post that list all the types, for humans and dogs.)

So before the blood work to test for tick-borne and parasitic diseases was done, the following tests were performed:

extensive range of motion testing on hips and back legs (excellent!)
hip, pelvis, and back leg X-rays (clear!)
complete blood count including to test for muscle enzymes related to soft tissue damage. The muscle enzymes were fine, but the CBC showed a lowered platelet count, which is a typical symptom of tick-borne diseases.

The lack of other diagnoses plus the low platelet count made tick-borne diseases the next most likely candidate for Clara’s symptoms. She was put on antibiotics and more blood was drawn so she could be tested for tick-borne and parasitic diseases.

The subsequent blood work returned a Rocky Mountain Spotted Fever titer of greater than or equal to 1:1024, the highest result possible at that lab. This high reading indicated that Clara had a large number of antibodies to the Rickettsia rickettsii bacteria and had been fighting the Rocky Mountain Spotted Fever infection for a while, probably weeks or months.

This movie is a bit hard to watch.

Link to the video for email subscribers.

Mechanism of the Disease

The Rickettsia rickettsii bacteria are introduced into the dog or other animal from the bite of a tick that has been attached for 5-20 hours.^[1]Comer, K. M. “Rocky Mountain spotted fever.” The Veterinary clinics of North America. Small animal practice 21.1 (1991): 27-44. (This is a very good reason to perform daily tick checks if your dog has been in areas where ticks are present.) The bacteria have been found to be transmitted by at least four tick species, but the most common are the American dog tick (what probably bit Clara) and the Rocky Mountain wood tick.

**Tick hemolymph cells infected with Rickettsia rickettsii. Public domain image from the US Centers for Disease Control.**

The bacteria are nasty. They immediately spread throughout the body via the blood and lymphatic systems and invade the cells of the endothelium, the cells in the lining of the blood and lymphatic vessels. They multiply there and move into the smooth muscle tissue. ^[2]Harrus, S., et al. “Rickettsiales.” Pathogenesis of Bacterial Infections in Animals, Third Edition (2004): 425-444. Since this is happening all over the body, the presenting symptoms can vary. Many different organs can be damaged or fail. The dog often bleeds from the nose or other locations. There are joint and muscle problems. There can be gangrene in the extremities as the tissue dies. Dogs can have inflammation of the eyes, shortness of breath if the lungs are affected, have seizures or other nervous system symptoms, or can die suddenly of a heart attack. The kidneys can fail.

It most often affects dogs under four years old (Clara is 3 1/2). The response can range from no apparent problems at all, where the dog is infected but remains asymptomatic and lives a normal life, to death in a matter of days.

One dog study reported a mortality rate of 4%^[3]Comer, K. M. “Rocky Mountain spotted fever.” The Veterinary clinics of North America. Small animal practice 21.1 (1991): 27-44., but there doesn’t seem to be much information in general on that topic. The rate is probably higher. In studies where dogs were injected with large quantity of the bacteria (sorry to even mention this), mortality was 100% when the disease was untreated.^[4]Keenan, K. P., et al. “Studies on the pathogenesis of Rickettsia rickettsii in the dog: clinical and clinicopathologic changes of experimental infection.” American journal of veterinary … Continue reading In humans, RMSF is fatal in 20-25% of untreated cases and for 5-10% of treated ones.^[5]Bakken, Johan S., et al. “Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis—United States.” MMWR Morb Mortal Wkly … Continue reading

Treatment

Clara is now on her second three-week round of Doxycycline, which luckily does not appear to upset her stomach. She obviously felt better in a metabolic sense after two days on the antibiotic; she was perkier and had more energy, and has stayed that way. But the stiffness has been much slower to change. I’ve been keeping a video record and I think she is finally improving, though. I have to remind myself that progress won’t necessarily be linear.

The Future

I feel a little weird for publishing this movie and blog, like I’m exaggerating the seriousness of Clara’s illness. But I’m not. Although the trembling has lessened, she still has periods of weakness and/or stiffness and is clearly fatigued after she exerts herself. I’m still trying to get my head around it all. I go from thinking she will be tragically affected for the rest of her life, to thinking there isn’t much to it and I’m overreacting. There’s still a flavor of “this can’t be happening…” But I’m also counting our blessings.

I’m almost afraid to ask for others’ experiences, because I’m sure there are some sad ones out there. But I think education about RMSF and the other tick-borne diseases is valuable and important. So please share if you are willing.

Kate and BooBoo’s Story: Rocky Mountain Spotted Fever? But We Live in NJ!

Resources

Lists of tick-borne diseases.

Tick-Borne Diseases of the U.S. (list for humans)
Tick-Borne Diseases (list for dogs)

Rocky Mountain Spotted Fever in Humans

Rocky Mountain Spotted Fever
Rocky Mountain Spotted Fever: State of the Art Clinical Article (includes an incidence map)
Diagnosis and Management of Rickettsial Tick-Borne Diseases–CDC

Rocky Mountain Spotted Fever in Dogs

Tick Safety

Do whatever you can to prevent tick exposure in the first place.
Check your dog thoroughly after possible exposures.
Remove any attached ticks quickly. Some tick-borne diseases are transferred quickly.
Get your dog to the vet if she has a fever or any of the symptoms listed here: Symptoms of Tick-Borne Diseases.
Oh yes, and be careful for yourself and human loved ones as well. There are cases of dog and humans simultaneously getting the disease because of concentrations of infected ticks in the same area.^[6]Paddock, Christopher D., et al. “Short report: concurrent Rocky Mountain spotted fever in a dog and its owner.” The American journal of tropical medicine and hygiene 66.2 (2002): 197-199. ^[7]Elchos, Brigid N., and Jerome Goddard. “Implications of presumptive fatal Rocky Mountain spotted fever in two dogs and their owner.” Journal of the American Veterinary Medical Association … Continue reading If you are in the U.S., check the incidence map in this article to see how prevalent it is in your state. RMSF is not found outside the Americas, but there are other related spotted fevers found in most parts of the globe.

Notes[+]

Notes
↑1	Comer, K. M. “Rocky Mountain spotted fever.” The Veterinary clinics of North America. Small animal practice 21.1 (1991): 27-44.
↑2	Harrus, S., et al. “Rickettsiales.” Pathogenesis of Bacterial Infections in Animals, Third Edition (2004): 425-444.
↑3	Comer, K. M. “Rocky Mountain spotted fever.” The Veterinary clinics of North America. Small animal practice 21.1 (1991): 27-44.
↑4	Keenan, K. P., et al. “Studies on the pathogenesis of Rickettsia rickettsii in the dog: clinical and clinicopathologic changes of experimental infection.” American journal of veterinary research 38.6 (1977): 851-856.
↑5	Bakken, Johan S., et al. “Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis—United States.” MMWR Morb Mortal Wkly Rep 55 (2006): 1.
↑6	Paddock, Christopher D., et al. “Short report: concurrent Rocky Mountain spotted fever in a dog and its owner.” The American journal of tropical medicine and hygiene 66.2 (2002): 197-199.
↑7	Elchos, Brigid N., and Jerome Goddard. “Implications of presumptive fatal Rocky Mountain spotted fever in two dogs and their owner.” Journal of the American Veterinary Medical Association 223.10 (2003): 1450-1452.