|Mercy Animal Hospital
Dr. Thomas B. McMillen
1395 New London Avenue
Cranston, Rhode Island 02920
A Practical Veterinary Controversy
One problem we sometimes run into in veterinary medicine is that one practice may choose to handle a particular procedure differently from another. For example, one practice may choose to vaccinate more frequently, or recommend additional routine vaccinations. This can leave clients in a quandary - is one veterinarian not doing all they should be doing for the client's pet, or is the other recommending unnecessary extra services?
There was an interesting article about a year ago dealing with one of the more common of these controversies, so we felt we would offer it as food for thought, with a little commentary. While this was written for the professional, I believe that our typical client, (being an intelligent and pet-educated owner ) will be able to understand the arguments, if not all of the jargon.
So... A healthy dog, with no symptoms, tests positive for Lyme disease- do we put it on antibiotics?
Many veterinarians do, we generally do not. The question was covered in depth in an article from roughly one year ago in Clinician's Brief- the Journal of The NAVC.
Click HERE to read the original article.
First off, to 'demistify' that intimidating title to the article - forget the 'Nonproteinuric' part for now (addressed below.) Seropositive simply means positive on a blood test. So we are left with 'Should we treat dogs with no symptoms who test positive for Lyme with antibiotics?'
Two experts disagree (slightly). Dr. Littman, a board certified Internal medicine specialist from U Penn, says 'No.'. Dr. Goldstein, a board certified Internal Medicine specailist from Cornell and the AMC, says 'It depends.' Note that neither says 'Yes.' Dr. Littman goes on to say that the American College of Veterinary Internal Medicine, after carefully reviewing the literature and canvassing expert opinion, did not recommend treatment, noting 'there is no evidence that treatment prevents further illness.'
What of the 'quantitative ' tests? (Qualitative tests say positive or negative, quantitative tests measure (of course) the quantity - that is not yes or no but how much.) Many veterinarians routinely test, then if they get a positive test do a quantitative test and treat pateints with large or increasing antibody titers . Again, according to Dr. Littman , 'there is minimal evidence that the magnitude of quantitative C6 titers will predict illness or that treatment decisions should be based on these titers.' That seems pretty clear cut.
The article goes on to discuss Lyme nephropathy (kidney disease) - a tragic though rare (except in labs, apparently) late effect of Lyme, but this syndrome is so poorly understood that it is hard to make any recommendations beyond guesswork. Finally there is the problem of risk to the patient of unneccessary antibiotic use (especially doxycycline) as well as the threat of creating antibiotic resistant strains of bacteria by oversusing antibiotics, as happened with MRSA.
Our experiences agree with Dr. Littman, and we agree with his recommendations. However we urge our clients to also read Dr. Goldstein's 'other side of the story', which is well presented and measured as well. Be aware, though, that his conclusion is not 'Yes', but 'Perhaps'.
Incidentally, for the sake of clarity we did not address the 'nonproteinuric' part of the study, so as not to involve a confusing complicating element. 'Should we Treat Lyme Positive Dogs with no Symptoms' is simply clearer. Proteinuria means protein in the urine, which should not occur with a healthy kidney. If an otherwise healthy dog should test positive for Lyme it would not be unreasonable to test the urine for protein, and maybe - maybe, for reasons discussed above- treat it with antibiotics. Lyme nephropathy is, at this stage, very uinclear. Some experts say it does not exist, and there is no question that many dogs who have succumbed to renal failure, (which, sadly,very common in the dog) and also tested positive for Lyme, (also very common), have convinced the owner that there was a connection, when probably there was none. We did not ignore that part of the story because it weakens our argument, but rather because neither we, nor either of the experts consulted for the article, can offer a lot of advice on preventing, or dealing with, Lyme related kidney disease.