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Monty's Story — Part 2
What came after the sting.
A year in blood test results.
The first part of this story ended with a diagnosis. This part begins there—and explains what a tick bite medically set in motion: a chain from infection to an autoimmune reaction to a therapy that itself became a challenge. And it tells how Monty is doing today.
By Pia von Ramin · Reading time approx. 8 minutes.
Monty today — one year after the sting
Some illnesses give warning signs. This one didn't. Between the bite and the moment it became clear how serious the situation was, there were weeks in which nothing outwardly happened.
What followed was a year of blood tests, medication, and a slow recovery. We're telling the story here in as much detail as we ourselves would have liked to read about it somewhere.
Chapter 1 — The Cause
The pathogen has a name
Rickettsia. That's the name of the pathogen the tick left in Monty's blood—a group of bacteria transmitted through saliva during blood feeding. An antibody test confirmed the infection with a pathogen from the tick-borne fever group at the end of May.
What makes rickettsiae special is their hiding place: they don't live freely in the blood, but rather penetrate the cells that line our blood vessels from the inside—the so-called endothelium. There they multiply, and there they also cause the first damage by irritating the delicate vessel walls and making them more permeable. An antibiotic can reach these cells and fight the pathogen. But by then, the real battle has already been fought: the immune system has begun to turn against the body's own tissues.
Figure 01 — How the pathogen enters the vessel wall
1 The tick sucks blood. A small blood vessel runs under the skin; its inner wall is intact.
2 Rickettsiae enter the tissue via saliva. Some of them reach the wall of the blood vessel.
3 The pathogen penetrates a cell in the inner wall of the blood vessel and multiplies there — inside the cell it is protected from the immune system of the blood.
Why the body attacks itself
An autoimmune disease initially sounds paradoxical: Why would an immune system attack the body's own tissues? In Monty's case, the most likely mechanism is quite understandable. Experts call it molecular mimicry.
The immune system learns to recognize the pathogen by specific surface structures and produces precisely matching antibodies against it. Now, some of these pathogen structures happen to resemble the body's own characteristics—in Monty's case, those on the surface of platelets. As a result, the antibodies match both: the invader and the body's own platelets.
From then on, the marked platelets are recognized as foreign by the spleen and broken down. Doctors refer to this as a process. immune-mediated thrombocytopenia Thrombocytopenia means a deficiency of blood platelets. The insidious thing about it is that the pathogen may have long since been eradicated, while the once-learned abnormal imprinting persists. The trigger is gone, but the reaction continues.
Figure 02 — Molecular mimicry, the confusion
1 The rickettsiae have nested in the cells of the inner wall of the blood vessels.The platelets are intact.
2 The immune system produces antibodies against the pathogen. Because a characteristic of the body on the blood platelets closely resembles the structure of the pathogen, the same antibody matches both — and also marks the body's own platelets.
3 In the spleen, the marked platelets are recognized as foreign and broken down, even after the pathogen has long since been defeated.
Chapter 2 — The Consequences
When platelets are lacking
Platelets are the cells that close a wound. In a healthy dog, their count is between approximately 150 and 480 G/l (billions per liter). In Monty's case, it dropped to a single-digit number during the acute phase—practically no effective protection against bleeding.
The first visible sign was Petechiae: Pinhead-sized hemorrhages under the skin, particularly noticeable on Monty's almost hairless belly, along with larger, more widespread bruises. At such low levels, even a minor injury can cause internal bleeding. This is precisely what makes the condition serious—and requiring treatment.
The bleeding under the skin — the first visible sign
"The pathogen may have long since been defeated, while the once-learned incorrect reaction persists."
Chapter 3 — The Treatment
The therapy itself became a task
The treatment proceeded on two fronts. An antibiotic, doxycycline, was administered against the pathogen for several weeks, supplemented by injections of imidocarb. Prednisolone—a cortisone preparation that suppresses the immune system and thus stops the breakdown of blood platelets—was used to combat the misguided immune response.
It worked. The platelets recovered. But when the first attempt was made to reduce the prednisolone, they collapsed again. That's the insidious thing about immune-mediated thrombocytopenia: the drug that suppresses the reaction can't simply be discontinued as long as the immune system hasn't unlearned its mistake.
Blood test, check-up, dressing — the rhythm of an entire year
What cortisone does in the body
Cortisone is an effective medication—and a costly one. Administered over months at an effective dose, in Monty's case around 1.2 milligrams per kilogram daily, it noticeably alters the metabolism. Typical side effects include central obesity, primarily affecting the torso, hair loss, increased appetite, and lethargy. These side effects are well-known and must be considered when weighing the risks and benefits of any long-term therapy.
Monty is a Whippet, naturally slender and light. At this stage, he weighed 9.2 kilograms—clearly too much for his delicate build. At this point, his weight itself became an issue, affecting his mobility and well-being.
The silent side stories
Such an illness doesn't just affect one area. The persistent inflammation also disrupts iron metabolism—doctors refer to this as iron overload. functional iron deficiency: Iron is present in the body, but under inflammatory pressure, it is released less efficiently for blood cell production. This was evident in the hemoglobin levels of his young red blood cells, which were temporarily below the normal range. With recovery, these values normalized again—one of several side effects that illustrate how far-reaching the consequences of a tick bite can be.
The search for a way out
Because the side effects were increasing, we sought a second opinion from an internist. Two options were available: reducing the prednisolone very slowly, in steps of about 25 percent every four weeks — or additionally using a steroid-sparing immunosuppressant such as cyclosporine, which suppresses the immune response in a different way and allows for a faster reduction of the cortisone.
The decision was made to proceed slowly, with the second medication as a backup in case the levels dropped again during the reduction. Platelet counts were checked at each follow-up appointment—they remained stable.
Chapter 4 — The Way Back
What helped
The documents contain a sentence that sticks in your mind: He feels better since he lost weight.
Weight was not a trivial matter. Every kilogram less gave Monty back a bit of mobility and lightness. From this experience, we gained a great deal—the conviction that nutrition for a chronically ill dog is not an add-on, but an integral part of the treatment.
Chapter 5 — Today
Where Monty stands today
The cortisone has now been almost completely discontinued, and the platelet count has remained within the normal range. This is the real turning point in this story. Because if the values remain stable even without medication, it means that the immune system has unlearned its misguided reaction. It no longer marks the body's own platelets as an enemy.
Should this be successful in the long term, one can certainly speak of a cure—with one important caveat: there are no guarantees. A new trigger, an infection, another tick bite, could theoretically reawaken the learned pattern. This possibility of relapse remains throughout life. Dealing with it doesn't mean living in constant worry, but rather being vigilant.
Figure 03 — The course of the platelets
Simplified representation based on laboratory results
What remains
What we've learned from this year: A tick bite is no small matter. The crucial weeks often come afterward. And: Such a diagnosis isn't the end of a good life. For a while, it's a different way of caring for a dog—with the realistic goal of returning to a completely normal dog's life.
What you should pay attention to after a tick bite
- Pinpoint red hemorrhages under the skin, especially on the abdomen
- Bruises without any apparent cause
- Bleeding from the nose or gums
- Unusual tiredness or weakness
- Fever, loss of appetite, weight loss
- Lameness or stiff gait
- The weeks after the bite are crucial — not the day after.
"Such a diagnosis is not the end of a good life. It is, for a while, a different way of caring."
How to properly remove ticks and what kind of protection is right for your dog is best discussed with your veterinarian. The first part of Monty's story tells how it all began: One sting. A lifetime.
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Pia von Ramin is founder of 4legs.de and lives in Hamburg. She regularly travels through Europe with her dogs — and knows the pitfalls of every transport route from her own experience. |