Hi SRM, I'm sorry to hear your news. Sure am glad that they included testing for TBD, that often isn't done. Do you by chance have a copy of the bloodwork? Your vet clearly saved your daughter's dog's life by catching this now. I can't remember the name of the dog?
I like this website for the description of the acute, subclinical and chronic stage: http://marvistavet.com/ehrlichia-infection-canine.pml
This is written by someone from our tick list: https://sites.google.com/site/tickbornediseaseindogs/ehrlichiosis
Some dogs will kick this with the first treatment, but some will not and it will become chronic. Because of this, on the tick list, we would always recommend a pretty aggressive dose of doxy, and most vets do not treat with this high dosage - our recommended dosage is about twice as high as a vet usually uses. We also treat twice as long. From the tickllist website: "The dosage we recommend on Tick List is an aggressive one: 5 mg. of doxy per pound of body weight given every 12 hours for 8 weeks. For those who prefer to figure body weight in kilograms, this is approximately the same as 10 mg per kg, the difference being not enough to mention." More is written here: https://sites.google.com/site/tickbornediseaseindogs/treatment
(We have had trouble with vets being willing to prescribe that high of a dose, and many of us used to purchase bird biotics and increase the dosage ourselves, but those are much more expensive nowadays, and harder to find. I haven't looked in awhile).
Using steroids at the same time, sometimes needed if the platelets get super low, will interfere with the treatment of the actual tick disease. We recommend to hold off the steroids unless there is a truly life-threatening circumstance, give time for the abx (antibiotics) to work.
So, if this were my dog? I will admit that I might do things that are a bit overkill, but here it is....
I would be aggressive with dosage and time of treatment.
About a week after starting doxy, I would have liver/kidney values checked. TBD will increase liver enzymes and these can go up during treatment. In a small percentage of dogs, doxy can actually increase liver enzymes. Indy and Max and no issues with their liver from doxy. Jazz cannot be on the aggressive dose because her enzymes skyrocket. (We use doxy for her lupus, IBD, and lymphangiectasia.)
A separate issue is how the dog tolerates doxy. Some have a really tough time with it, and there are some things that help, it should never be given on an empty stomach, even though it's more effective on an emtpy stomach.
My go-to liver support product by Country Life has changed dramatically and I no longer recommend it (though it still may work, it's a very different product now). That product also used to help kidney values for some reason, we were really sad when they changed it. I have no recommendation if liver support is needed, but I talked with the canine nutritionist awhile back and she has also switched and is recommending this product for now: https://www.luckyvitamin.com/p-1970...tox-repair-powder-tropical-twist-6-35-oz
The tricky part is testing. I think about testing in two ways. What is happening now, and many months from now. Regular blood testing is critical for monitoring current health, but I think you also need a measurement of infection in the body. Since treatment has already started, I'm guessing you don't have beginning titers, but sometimes the immune system is suppressed before treatment and those numbers are artificially low anyway. Titers can rise right after treatment is started.
I do all my tick testing through Protatek Labs. I like them because they specialize in tick disease, you can call and actually talk to the director about your dog, and you can have your vet draw the blood, and you can send the blood in, which can save a lot of money. I was really happy when I learned that Jazz's internal medicine vet also uses this lab. So, I would call the lab and explain what is going on, and ask what tests they recommend and the cost. Tick diseases often have coinfections, so there may be other things going on. When Jazz was young and had weird things with her bloodwork, the lab director (cynthia holland) made some recommendations for testing for her. Here is the website for protatek, the address listed on the tick list has been changed: http://www.protatek.com/ref_services.html
I would also ask the lab about the right schedule for follow-up testing - I have never been able to retain that information.
Okay, this is already too long! Sorry! Let me know how things are going, if you have any questions, etc.