Lyme Disease

I live in Connecticut, 15 miles from Old Lyme, CT, where Lyme disease was first identified, and which provided its namesake. My vet was involved in the original clinical trials of the canine Lyme vaccine for a number of years before it was released to the public in 1992, and has continued to be very heavily involved in ongoing veterinary research into canine Lyme Disease (LD) and its prevention and treatment. Also, I have personal experience with Lyme: one of my two dogs has had Lyme disease and so have I (I was diagnosed after I asked my doctor for a Lyme test BECAUSE my dog has tested positive -- otherwise I might never have found out that I had it too. I had been to the doctor already because of not feeling well, and the doctor had originally told me that I had (ahem) arthritis and advancing age, and that I just needed to get more exercise and maybe lose a few pounds and learn to live with the fact that I wasn't getting any younger. So thank heavens my dog's positive Lyme test alerted me to ask to have myself tested for it).

A few points here which I know from my closer-than-desired contact with Lyme disease and its ongoing research:

1. There are more strains of the Lyme spirochete than what the canine vaccine covers. That is a known fact. What they DON'T know yet, is whether vaccination with the canine Lyme vaccine induces cross-immunity against the strains of Lyme which are similar to, but not the same as, the ones covered by the vaccine.
2. It is also known that some dogs can and do get Lyme Disease even though they were vaccinated against it. The percentage is small, but not zero.
3. Until recently, every dog who had ever been vaccinated ALWAYS tested positive for Lyme after receiving the vaccination, for the rest of its life. That was one of the effects of the vaccine. That meant that it was impossible to tell whether a vaccinated dog had become ill with LD or not. Just within the VERY recent past few months, a new test has come out which can be used to test dogs who HAVE been vaccinated against Lyme, to see if they have contracted the disease despite having been vaccinated. That is a very new capability, which was not available until VERY recently.
4. Some number of dogs, nobody knows how many, seem to seroconvert to a positive Lyme test, apparently indicating that they have contracted the Lyme spirochete -- WITHOUT ever having any symptoms. The current speculation is that SOME dogs (nobody knows how many) may develop immunity to Lyme through natural exposure (i.e., tick bites) without ever becoming ill. This phenomenon is still being studied; nobody knows what it means yet.
5. Signs of Lyme in dogs can be very subtle, i.e., slight stiffness or lameness upon first rising. One might not suspect Lyme, especially in older or already arthritic dogs. Dogs do not get a characteristic rash, like many humans do.
6. A dog who has HAD and been successfully treated for Lyme Disease, should STILL receive a Lyme vaccination after the dog has been treated. The vaccine DOES provide additional immunity, and yes, humans and dogs CAN get Lyme more than once.
7. Whether or not to vaccinate depends on the dog's risk of exposure. Whatever you decide is a calculated risk, of course. If your dog travels a lot or is in contact with other dogs from other parts of the country, it probably should be vaccinated. It is known that Lyme Disease can be transmitted between cows and horses via being splashed with an infected animal's urine. This has not been proven DEFINITIVELY yet in dogs, but it is suspected to be likely that it is possible. So show dogs and dogs who travel or come in contact with large numbers of other dogs from outside their immediate areas should be vaccinated, regardless of whether their individual risk is low.
8. No inter-species transmission between mammals (i.e., from dog to human, or from horse to human, etc.) has been documented yet. However, there is a very high correlation between the incidence of Lyme among animals and the incidence of Lyme in people living in the same area. So if you have any animals who have ever had Lyme Disease, you should be tested for it yourself if you feel at all ill or otherwise off-peak, health-wise.

   The following are questions/answers between Laurie and Ms. Ginzberg

   What is the test for Lyme?

   The "old" test, the Lyme antibody titer, is ineffective, and does have so many inaccurate results that it truly is worthless. Slightly better is the combination of the Western Blot combined with the ELISA (yes, these are the same tests which test for the AIDS virus -- they "also" give fairly good results when testing for the Lyme-causing spirochete, even though the two diseases are unrelated). These two tests together may well run over $100, so cost is a problem. Even better is the new Polymarase Chain Reaction (PCR) test, which tests directly for strands of DNA from the Lyme spirochete. Alas, this is also expensive. To be absolutely thorough, you should have not only blood, but also some other fluids and tissues tested -- especially if you are having CNS (central nervous system) symptoms (memory problems, etc.) you should have a PCR test run on cerebrospinal fluid (which UNFORTUNATELY means having a spinal tap). Or -- you need to find a physician who is willing to treat based on "clinical" diagnosis alone (i.e., based on symptoms and history of exposure -- which you DO have).

   What about treatments?

   I hate to say this, but the cost of "treatment" may also be a problem. The average cost of treatment of Late-Stage Disseminated Lyme is over $37,000. (I am currently taking an antibiotic that costs $5/day -- which is a last effort at "cheap" treatment before going to the $200/day intravenous antibiotics, which I "HOPE" I won't need, but which my doctor is afraid I might have to have. This is because I went for several years between exposure and treatment, without knowing that I had Lyme). EARLY treatment of Lyme is easy and cheap. The longer you have UNTREATED Lyme, the more expensive and difficult it becomes to treat. There are some doctors who believe that there is a chronic form of it which cannot be cured, which patients can get after years of going untreated.

   This is why it is ABSOLUTELY CRITICAL that physicians be convinced to offer patients with simple exposure and "early possible" symptoms of Lyme, a $10, 2-week course of cheap antibiotics,which WILL cure it at that point. Later on, that is too little, too late.

   My dentist diagnosed herself and treated herself without testing, and seems fine now. I have had these symptoms about three years, since I was in an area in the Northeast where I had to be outdoors a lot for a few days for a National. Did find some tiny ticks in my clothes after spending a day at St. Hubert's Giralda in New Jersey.

   You DO have a definite history of exposure and symptoms which should indicate that you should be treated just on clinical diagnosis alone. Perhaps your dentist would be willing to prescribe Doxycycline or Amoxicillin for you (the first drugs which you would try -- probably for no less than one month to start, given the length of your history of symptoms and the possible time of exposure). Neither Doxycycline nor Amoxicillin will break your bank account - - not just a one month supply anyway.

   I really urge you to be aggressive about acquiring proper treatment for yourself. Untreated Lyme can cripple and debilitate otherwise healthy children and adults (1/2 of all Lyme patients are children under 12). Of those who testified before Congress earlier this year, many untreated Lyme patients testified that they are now unable to hold jobs, unable to walk, unable to read or write (due to one common symptom of advanced stage Lyme: dyslexia), some were unable to feed themselves, some had suffered severe brain damage giving them Alzheimer-like symptoms, and heart and kidney damage is common. It MUST be treated -- it does NOT "just go away" if you "wait long enough." It is progressive and debilitating. Given the history you have told me, you really MUST seek and find effective treatment, OR definitive proof that you do not have it. Don't let your doctor be lazy. My doctor told me that my symptoms were "menopause" (when I was 39 years old!!!), while at the same time refusing to test me for Lyme because she thought I was being "hysterical." I had to switch doctors just to get tested (which test came out with an almost-off-the-scale high positive).

   What breed(s) do you have?

   I have a Cocker Spaniel who competes in Obedience and is training for AKC Hunting Tests, and a mixed breed (Siberian/GSD) who does Agility. And, I am the list owner for the Flushing Spaniel list, spanie-l. :-) I also assist in teaching Beginning Obedience classes at a local Training Center. It was the cocker who had Lyme Disease -- I think she and I both got it while doing field training (TONS of ticks).

   Thank you both for the information. We will be featuring other articles on Lyme in future issues. Anyone who has come in contact with this disease (human or dog) is welcome to write The Reporter about their experiences. Note that it is suggested by Dr. Stockner that if you do vaccinate for Lyme that you perform the test several weeks after vaccination to get a "baseline" level of the titer for future reference when the actual disease may be suspected.