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Hi Sarah, I'm Dr. Deb. I will do my best to assist you today. I'm so sorry that you lost Romeo. This must have been absolutely heart breaking for you. My condolences to you and your family for your loss. As to your question about Powassan Disease, this is not likely to have been the cause of his symptoms and ultimate death. Significant disease associated with infection with this virus would be extremely rare. Lyme disease is not commonly associated with neurologic signs in dogs but other tick diseases could be: Rocky Mountain Spotted Fever and other tick borne diseases such as Ehrlichia and Babesia, We do have tests for many of these diseases, but we are testing for antibodies, not the organism itself, in most cases. If antibodies are not being produced (for whatever reason) then the tests could be negative and yet this is still the underlying problem. I've also come to believe (as have many veterinary infectious disease specialists) that there are tick diseases that we haven't even been able to identify yet and thus would not have tests for all of them. Other possible explanations might include Cryptococcus (a fungal infection), or Toxoplasma (a protozoal infection) I know this must have been very difficult for you and your family but I hope you take comfort in the knowledge that Romeo spent many months with a family who loved and cared for him. I hope this helps provide additional possible explanations for his condition.Deb