Lyme disease

I do not care for Lyme disease. Because the veterinary community does not yet fully understand how it affects dogs, diagnosis and treatment can be challenging. Plus, it’s a confusing disease, which can be tough for pet owners to understand. The best way to protect your dog from Lyme disease is through a combination of prevention and monitoring.

The tiny deer tick that transmits Lyme

Prevention is your first essential step. Because Lyme disease is caused by a bacteria transmitted through a bite from the tiny deer tick, the best way to ward it off is with topical flea and tick preventatives like Frontline. In a temperate climate like ours, these should be applied once a month, every month.  These also protect your dog against other tick borne infections such as Erlichia and Rocky Mountain Spotted Fever.

Monitoring is equally important. Here at Friendship, we include a screening for Lyme disease in our canine patients’ yearly heartworm tests. This shows us whether or not a dog has been bitten by a tick carrying the bacteria. When a dog tests positive for Lyme disease, it does NOT indicate active infection only exposure. In Lyme endemic areas like DC, there are reports that up to 70%-90% of dogs will test positive. The good news is that the vast majority of the Lyme-positive dogs we see never develop clinical signs of the disease.

If the Lyme disease test is positive, your next step is to bring in a urine sample so we can test for Lyme nephritis, a serious and fatal complication involving the kidneys. This test, known as a urine protein creatinine ratio, looks for protein loss through the kidneys. If your dog’s urine has increased protein in it we will recommend treatment with oral antibiotics. In addition, we will also ask you to keep a sharp lookout for clinical signs such as lethargy, decreased appetite, fever and a lameness that shifts from leg to leg. If your dog displays any of these symptoms, we will ask you to schedule an appointment so we can discuss treatment. Based on the recommendations of the American College of Veterinary Internal Medicine, Friendship treats only those dogs that have abnormal urine tests and/or display one or more of the clinical signs of Lyme disease.

Now onto the big question - what about the vaccine?

Last fall I attended DC Academy; a continuing education meeting held monthly for local veterinarians. The speaker was Dr. Goldstein, an Internist from Cornell Veterinary School, who discussed his latest findings and recommendations related to Lyme disease.  What he said about Lyme disease completely challenged what I had previously thought about vaccinating.  After much consideration I have changed my view of the vaccine and now recommend it for specific at risk dogs. 

I have always recommended against vaccinating for Lyme, concerned that the vaccine is not effective and reportedly causes more vaccine reactions than the other vaccines we give.  Besides, we have so many dogs test positive for Lyme that never develop any clinical signs, it doesn’t seem like a disease that causes many problems – until you consider Lyme nephritis which terrifies me.

Lyme nephritis is a syndrome characterized by acute kidney failure that almost always results in death.  It occurs most frequently in younger adult dogs and there may be a higher incidence in Labrador and golden retrievers.  Clinical signs come on suddenly and include increased thirst, increased urination, lethargy, decreased appetite and vomiting.  Despite aggressive treatment dogs that develop Lyme nephritis rarely survive.

The topic of vaccination for Lyme is such a hotly debated issue in veterinary medicine that even the members of the American College of Veterinary Internal Medicine (ACVIM) Lyme Disease Task Force could not come to a consensus.  Dr. Littman of the University of Pennsylvania College of Veterinary Medicine does not believe in vaccinating for Lyme.  She argues that the vaccine has not been proven to prevent Lyme nephritis and in fact may predispose dogs that have already been infected with Lyme disease to developing Lyme nephritis. 

I am not advocating that we vaccinate all dogs against Lyme disease, only those that are at increased risk.  This group includes dogs that frequent dogs parks, Rock Creek Park and any other wooded area that they would be likely to come into contact with ticks.  I would also strongly consider vaccinating all Labs and goldens given their tendency to contract Lyme nephritis.  The final caveat with vaccination is I would think very hard about vaccinating a dog that is already positive for the disease given that we really don’t know if the vaccine contributes to Lyme nephritis.

To sum up – when it comes to Lyme disease, the best medicine is a combination of prevention and monitoring. Keep on track with your dog’s monthly flea and tick preventative. Whether or not to vaccinate is a personal decision that you need to make for your dog based on the risk of disease and the risks associated with the vaccine.  Bring your dog in for a yearly heartworm screening, so we can test for Lyme disease. If your dog does test positive, don’t panic! Most dogs that test positive never display clinical signs of Lyme disease. Whatever happens, you can rest assured that we will work with you to keep your dog healthy and comfortable.