Lyme disease is something you should know about, and Dr. Justine Lee is here to help. For more from Dr. Lee, find her on Facebook!
I've talked about what Lyme disease is and how to prevent it. Now, we’re going to focus on how to treat it and diagnose it accurately.
Is Lyme disease treatable?
If your dog tests positive for Lyme disease, or more importantly, is clinically sick from Lyme disease, then treatment includes an antibiotic called doxycycline (which often needs to be given for 4 weeks). While this is a relatively “safe” antibiotic, doxycycline can cause vomiting, esophagitis or reflux, sun-sensitivity, and permanent yellowing of puppy teeth – so make sure your dog really needs it before you give it!
As an FYI, you can help prevent side effects from doxycycline by doing the following:
- When administering the pill, give it in a small meatball, followed by your pet’s normal meal. This will help push the pill into the stomach, preventing the pill from sitting in the esophagus.
- Don’t give the pill right before your dog goes to bed – otherwise, if the pill is sitting in the esophagus (while your dog is lying down on his side), it can result in severe esophagitis.
- Keep your outdoor dog inside (so he’s out of the sun for long periods of time) while he’s on the medication, due to the rare risk of sun sensitivity (thankfully, dogs have fur, so are less likely to develop this side effect as compared to humans!).
- Don’t give this antibiotic with dairy products (e.g., in ice cream or yogurt), as it inactivates the antibiotic.
My general rule? If your dog has symptoms of Lyme, he should be treated. If he doesn’t have any symptoms and just happens to have a positive blood test for it, I don’t typically treat without doing more advanced tests (e.g., like a urine test measuring for protein or a specific quantitive C6 blood test…keep reading below to find out what these tests are!).
There are a lot of Lyme blood tests out there nowadays, and it’s important to know how these tests work. One of the most common, effective ways is via an Laboratories, Inc. SNAP® 4Dx® plus test, which your veterinarian can run immediately.
This test not only checks for heartworm, but it also tests for the following tick-born diseases: Borrelia burgdorferi (Lyme), Anaplasma phagocytophilum, Ehrlichia canis, Ehrlichia ewingii and Anaplasma platys. The test detects infection with the Lyme bacterium (via an antibody called C6), and this test isn’t affected by vaccine-induced antibodies. In other words, if your dog was vaccinated for Lyme disease, this test won’t falsely test positive just because of the vaccine, unlike the old tests out there.
Before the Laboratories, Inc. SNAP 4Dx test became available, an IFA antibody test was commonly used to test for Lyme. This disadvantage of this test is that it is unable to differentiate between antibodies from vaccination, infection, and just exposure to the Lyme organism. Dogs who test positive on this test should be confirmed with a more specific test such as a quantitative C6 or Western Blot, both of which can tell if a positive result is from true infection or Lyme vaccination.
If your dog tests positive on the initial screening test, you can request a quantitative C6 test to find out more about your dogs infection. The quantitative C6 provides a measure of how high the antibodies are, which can tell you if the infection is active or, in a dog who has had Lyme infection in the past, if the infection has responded to treatment.
Keep in mind that in some areas of the country, only approximately 5-10% of dogs infected with Bb will develop clinical signs of the disease. So, just because your dog tests positive doesn’t mean you necessarily need to treat. When in doubt, check with your veterinarian to see if a course of doxycycline is necessary.
If your dog tests positive...
Relax. If this was done on the Laboratories, Inc. SNAP 4Dx® Plus Test, it does mean that your dog was infected with the bacteria causing Lyme – but not that he has active, symptom-causing Lyme disease. Take the next step and get additional testing done (e.g., the quantitative C6 test) and a special urine test [urine protein creatinine (UPC)] to look for protein loss in the urine. If this is positive, your dog is showing symptoms of Lyme disease, or if your dog is a Goldie or Labrador, then yes – you should treat your dog. Otherwise, the positive test just means that at some point in his life, he’s been infected with the bacterium causing Lyme, and he may not need treatment.
If your dog is negative...
Chances are, your dog doesn’t have Lyme and doesn’t need to be treated. If your dog is still showing signs of shifting leg-lameness, fever, etc., your vet should hunt for something else going on, as it’s likely not due to Lyme – that is, unless it’s a very acute infection (and the body hasn’t had time to make antibodies to result in a positive test). Keep in mind that long-term treatment with doxycycline may eventually turn your dog’s test negative after a few months of treatment.
When in doubt, you want to have a healthy respect for this scary disease. Thankfully, it’s treatable! Check with your veterinarian on how and when to test for it. More importantly, focus on prevention, prevention, prevention! Tick-pick and use preventative care to avoid this potentially life-threatening infection to begin with.
If you have any questions or concerns, you should always visit or call your veterinarian – they are your best resource to ensure the health and well-being of your pets.
Thursday, September 3, 2015
FIRST, DO NO HARM: LYME DISEASE VACCINATION MAY PRESENT MORE RISKS THAN BENEFITS
Meryl P. Littman, VMD, Diplomate ACVIM
When veterinary clinicians decide whether to recommend a particular vaccine for a particular patient, risks and benefits are weighed. The “vaccinometer” tool, developed by Larry Glickman, was designed to help practitioners determine whether or not to recommend a vaccine. 1
As we investigate Lyme disease vaccination, the questions posed by the vaccinometer help highlight many unanswered questions and potential risks related to this vaccine. With these concerns in mind, I choose “first do no harm.” In other words, if we use proper tick control, vaccination is unnecessary.
Question: What is the prevalence and risk of exposure/infection in your area (eg, infectiousness)?
Answer: Risk of Lyme disease exposure/infection is high in my area, but proper tick control lowers the risk greatly.
The CDC website 2 shows that 95% of human Lyme disease is found in 12 endemic states in the Northeast, Mid-Atlantic, and Upper Midwest U.S. In some endemic areas, seroprevalence in healthy dogs is as high as 70% to 90%. 3 In high-risk areas, risk of exposure can be lowered dramatically with adequate tick control, which also decreases the risk for other tick-borne diseases, such as anaplasmosis, babesiosis, bartonellosis, ehrlichiosis, and Rocky Mountain spotted fever.
Question: How great is the risk of severe disease once the dog is infected (eg, pathogenicity and virulence)?
Answer: Risk of Lyme disease becoming severe is low, but possibly somewhat higher in retriever dogs.
Less than 5% of seropositive (and seronegative) dogs had signs attributed to Lyme arthritis, 3 which generally responds rapidly to antimicrobial therapy. Perhaps 10% to 15% of treated dogs remain non-clinical carriers. 3 One study showed that 40% of dogs diagnosed with Lyme disease were misdiagnosed and had another condition instead. 4 Adult beagles experimentally infected with Lyme disease via tick exposure became seropositive but remained nonclinical, and exposed puppies showed only self-limiting signs of arthritis, anorexia, and fever, which did not require treatment. 3
Perhaps less than 2% of exposed dogs develop the more serious Lyme nephritis, 5 an immune-mediated glomerulonephritis, with high Lyme disease-specific antigen–antibody circulating immune complexes (CICs) and deposition in glomeruli, causing protein-losing nephropathy (PLN). 6 This entity has not been duplicated in any experimental model, and is seen mostly in Labrador and golden retrievers.
However, even in seropositive retrievers, Lyme nephritis is uncommon, 7 and we do not understand why some dogs develop it while many do not, despite their high titers and high CICs. It appears that a genetic predisposition exists, and that inflammation from Lyme antigens, and possibly inflammation from other infectious and inflammatory conditions, may be an environmental trigger. A genetic podocytopathy identified in soft-coated wheaten terriers 8 may predispose them to further glomerular damage a similar condition may exist in affected retrievers.
In general, coinfections appear to result in more serious illness (eg, anaplasmosis/Lyme disease), which emphasizes the importance of tick control. 9
Question: How effective is the vaccine?
Answer: Not as effective as other vaccines we use.
Lyme vaccines appear to prevent seroconversion or illness in most (60%–86%) 3 vaccinates, but not consistently in all dogs, and not for a very long duration of immunity, thus annual (or even every 6 months 10 ) boostering has been recommended.
Question: How safe is the vaccine?
Answer: These vaccines are not as safe as other vaccines we use.
In the Banfield study of 1.2 million vaccinated dogs, the Lyme disease vaccine (monovalent bacterin), when used alone, produced more postvaccinal adverse events within 3 days than any other canine vaccine. 11 Adverse events associated with Lyme disease vaccine were described as “moderate” by an AVMA council in 2002. 12
All canine Lyme disease vaccines contain outer surface protein A (OspA), which attaches the spirochete to the tick’s midgut and is expressed on Borrelia burgdorferi while in the tick, and induces anti-OspA antibodies.
- OspA without adjuvant is a polyclonal B cell mitogen that induces pro-inflammatory cytokines, 5 causes arthritis in rats, 13 and causes a strong TH1 response in people with HLA-DR4 haplotype, immune-mediated arthritis, and high anti-OspA antibodies after natural infection. 14
- Lyme bacterin as well as OspA alone causes arthritis in hamsters 15 and sensitization 16 so that more severe arthritis is produced with boosters. 17
- Lyme bacterins were not developed for humans since various Lyme disease antigens appear to have a role in post Lyme disease immune-mediated diseases. 18
- In dogs with suspected Lyme nephritis, immunohistochemistry and elution studies have shown positive staining of glomerular immune complexes for a variety of Lyme antigens, including OspA and others, which are also found in Lyme disease vaccines. 5
Remember, inflammation or deposition may be delayed for months after vaccination and not seem temporally related nor recognized as a problem associated with vaccination.
Original reports of Lyme nephritis suspect cases 19 demonstrated that 30% had received Lyme disease vaccine, from 2 weeks to 15 months prior to illness. There is no experimental model for Lyme nephritis, which makes it impossible to study whether Lyme disease vaccine prevents, sensitizes, or aggravates it. However, since the most serious forms of Lyme disease are immune-mediated, I choose not to administer Lyme vaccine antigens that may elevate Lyme disease specific CICs (that increase after vaccination, as they should), which would circulate and need to be cleared (or deposited) for weeks to months after vaccination.
In addition, should we vaccinate retrievers (some of which are genetically predisposed dogs) that may develop Lyme nephritis or PLN? These patients are most likely the very ones we should NOT vaccinate lest we add more complexes or sensitize them for a more intense immune-mediated reaction when they are boostered or exposed naturally.
Question: What is the potential for zoonotic spread to human contacts, and zoonotic spread to other dogs?
Answer: Potential for zoonotic transmission of Lyme disease is minimal.
B burgdorferi is transmitted via tick bites, and is not contagious from dogs to humans or dogs to dogs via excretions or blood transfusion. The reservoir hosts are wildlife, such as mice, small mammals, and birds. Seropositive dogs are sentinels that their human companions are at risk for exposure—not from dogs, but from ticks in the environment.
Greencross In Australia
An Australian holistic veterinarian wrote to me about the Greencross chain of veterinary clinics in her country.
Greencross owns 132 veterinary clinics and 200 pet specialty retail stores across Australia and the company earns about 725 million Australian dollars (that’s over half a billion US dollars) a year.
Greencross is buying up independent veterinary clinics all over the country. In the last six months, they added 17 new vet clinics to their group.
My vet friend told me Greencross trains staff “to sell as much of anything as possible, including annual vaccination.”
Yet she was still disturbed to read an article they published recently called The Real Story on Vaccinating Pets.
The article starts out complaining that the media has been confusing dog owners by suggesting that dogs only need to be vaccinated every three years …
As the article continues, it’s clear that Greencross clinics encourage dog owners to have their pets vaccinated annually for core vaccines (parvo, distemper and hepatitis) as well as bordetella and parainfluenza, using scare tactics like “disease outbreaks of Canine Parvovirus occur on a regular basis throughout Australia.”
They also state their “philosophy” that pets should be examined twice each year.
Of course! This gives them more opportunities to sell you extra services.
Do you think this might be about the money?
It’s certainly not about the health of the animals, even though they try to tell you it’s to protect your pet from deadly disease.
In the UK, pet owners are also being pushed to over-vaccinate their animals, thanks to a devious scheme cooked up by a big pharmaceutical company.
(NOTE: Want to know exactly how many unnecessary vaccines your dog gets? Click here to find out if your dog is over-vaccinated)
Holistic Vets Disagree That Frontline Is Safe
Dr Chambreau, Dr Jennifer Ramelmeier and many other holistic veterinarians are critical of studies like the ones in the APVMA review. These studies only look at immediately visible symptoms and fail to account for long-term effects that are often harder to see.
These vets provide clients with recommendations on flea and tick prevention without Frontline Plus.
Here is some of the best advice:
- Maintain the health of your pet. This means a healthy diet and physical activity. Also minimize the use of unnecessary pharmaceuticals. Healthy animals have lower body temperatures and cooler animals attract fewer fleas.
- To actively repel fleas, she recommends products like neem oil.
- Use Shoo tags
- Feed garlic
- Apply geranium oil to the collar of your dog to prevent fleas and ticks
Want to know how you can keep the fleas and ticks away naturally? Check out this article for more information on safe flea and tick protection.