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In an endemic area-do you always treat for Lyme?

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  • In an endemic area-do you always treat for Lyme?

    Curious on views on this. My horse is an 18 year old OTTB. Started getting a bit ouchy in his hocks several years ago. Semi-retired. I ride and hunt, but no longer event him.

    He has no overt Lyme symptoms, but seemed to me to be stiff, not really lame, occasionally on different legs, but he is 18. Anyhow, when vet came for spring shots, I had him tested for Lyme. Eliza came back moderately positive at 1:5120.

    I am going to treat, but my vet said if it were his horse, he would not because the horse is well. I understand his feelings, because we are in an endemic area, but I figure, so long as the horse does not have an adverse reaction, I might as well treat.

    Lyme is a tough disease. If we tested all horses, almost all would have a titer. My guy is not overtly symptomatic, but we won't know if some of his stiffness is due to Lyme unless we treat.

    Just wondering what others thought.

  • #2
    If I were in your shoes I would probably treat the horse. I feel as though if you don't, you'll just keep wondering if his stiff/soreness can be attributed to the Lyme.

    Comment


    • #3
      I would go ahead and treat. Lyme is a really nasty disease if it gets out of control.

      Comment


      • #4
        Probably not without real evidence of a problem. If you are concerned, why don't you recheck the titer in a few weeks? If there is an active infection, the titer will have increased. Remember, even if you DO treat with doxycycline and he gets better, that does not mean that his stiffness was due to Lyme dz. Doxycycline has anti-inflammatory effects in joints, and you might have had the same effect by giving him a course of Adequan (with fewer potential side effects). Either way, it's a tough call, and I would go with what my vet said.
        The plural of anecdote is not data.
        Eventing Yahoo In Training

        Comment

        • Original Poster

          #5
          Originally posted by GatoGordo View Post
          Probably not without real evidence of a problem.
          That's the rub. His symptoms could be indicative of Lyme or aging. Given the lack of clarity, I feel better treating.

          The problem is (and I actually do health care research as a day job), if you look, then you need to act on your findings. He was getting stiffer in legs that usually did not have a problem, so that is why I decided to run the test.

          Comment


          • #6
            There's a very intersting article at:
            http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Abstract

            The abstract is below:
            Histopathological studies of experimental lyme disease in the dog.

            Summers BA, Straubinger AF, Jacobson RH, Chang YF, Appel MJ, Straubinger RK.

            Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853-6401, USA.
            Abstract

            Experimental borrelia infection was induced in 62 specific--pathogen-free beagle dogs by exposure to Ixodes scapularis ticks harbouring the spirochaete Borrelia burgdorferi. Clinical signs of Lyme disease occurred in 39/62 dogs, the remaining 23 being subclinically infected. Clinical signs consisted of one to six episodes of transitory lameness with joint swelling and pain, most commonly affecting the elbow or shoulder joints. The polymerase chain reaction and culture demonstrated that the dogs remained infected for up to 581 days. At necropsy, gross findings consisted of lymphadenopathy in the area of tick attachment. Microscopical changes consisted of effusive fibrinosuppurative inflammation or nonsuppurative inflammation, or both, affecting synovial membranes, joint capsules and associated tendon sheaths. Plasma cells dominated areas of chronic inflammation, with CD3(+) T cells being present in lesser numbers. Microscopical signs of arthritis were polyarticular and more widespread than indicated by clinical signs, and most of the subclinically affected animals also had synovitis. In areas of tick attachment to the skin, hyperkeratosis and a mixture of suppurative and nonsuppurative dermatitis were encountered. Lymphadenopathy in superficial lymph nodes resulted from follicular and parafollicular hyperplasia. In 14/62 dogs, lymphoplasmacytic periarteritis and perineuritis were noted, resembling lesions found in human Lyme disease and syphilis, in which an underlying microangiopathy has been proposed.

            PMID: 15904927 [PubMed - indexed for MEDLINE]


            Very scary indeed. I would treat all cases of Lyme very aggressively. There are many out here who can tell you what happens when you don't.

            There is another study, by Cornell, which found that treating with IV Oxytet first, and following up with oral Doxy was better at eradicating the Lyme (if that is indeed possible).

            Comment


            • #7
              I probably would not treat unless I was certain it was Lyme. I might have my vet do a lameness exam and see if it could be hocks.

              I had my gelding tested for Lyme before injecting his hocks since it is pointless to inject if the stiffness was caused by Lyme. His titer came back mildly elevated by consistent for a 16 year old horse that lives in New England. I injected his hocks and he was immediately more comfortable.

              There's a lot of controversy on treating Lyme. Some of the vets I've spoken to are adamant that just oral doxy won't do it. IV oxytet is the preferred treatment but that gets $$.

              So, I'd do a bit more to figure out the root cause myself.
              Equine Ink - My soapbox for equestrian writings & reviews.
              EquestrianHow2 - Operating instructions for your horse.

              Comment

              • Original Poster

                #8
                Originally posted by Bogie View Post
                His titer came back mildly elevated by consistent for a 16 year old horse that lives in New England.
                Hey Bogie,

                Do you remember what his titer was?

                I am on the fence to be honest. He has been a bit depressed lately,but the weather has not been conducive to being a happy horse. If the titer had been a low positive, I wouldn't treated. Since it was a moderate positive, I decided to. And yeah, I know the hocks are probably the next thing. I think that it might be a somewhat recent occurrence because a few shoeings ago, he was lame leaving the farrier in front after having his leg held up. It was really uncharacteristic. I don't think that there is a right answer. I am really interested to hear everyone's views, so thanks for posting.

                Comment


                • #9
                  Honestly, can't remember. It was more than 3 years ago. My vet wasn't concerned about the titer so I didn't spend a lot of time thinking about it. He told me it was completely within the realm of normal.

                  I guess it depends on the symptoms your horse is displaying and what your vet thinks. My horse was displaying classic arthritic signs and the hock injections did the trick.
                  Equine Ink - My soapbox for equestrian writings & reviews.
                  EquestrianHow2 - Operating instructions for your horse.

                  Comment


                  • #10
                    Originally posted by Bogie View Post
                    I probably would not treat unless I was certain it was Lyme. I might have my vet do a lameness exam and see if it could be hocks.

                    I had my gelding tested for Lyme before injecting his hocks since it is pointless to inject if the stiffness was caused by Lyme. His titer came back mildly elevated by consistent for a 16 year old horse that lives in New England. I injected his hocks and he was immediately more comfortable.

                    There's a lot of controversy on treating Lyme. Some of the vets I've spoken to are adamant that just oral doxy won't do it. IV oxytet is the preferred treatment but that gets $$.

                    So, I'd do a bit more to figure out the root cause myself.
                    But since Lyme DOES cause arthritis, perhaps the root cause is Lyme disease. I really don't understand why people are so resistant to treating it. Even with a positive test.

                    Comment


                    • #11
                      I would not be resistant to treating my horse if I knew that he for sure had Lyme and that giving him doxy would make a difference. Research, such as the study referenced below, suggests that oral doxy may not be enough. I haven't talked this over with my vet recently but I'm not sure if there is a standard protocol that specifies how long a horse would need to be treated for the doxy to be effective.

                      In a Cornell University study published in 2005 (Veterinary Microbiology), ponies were experimentally infected with Lyme organisms by infected adult ticks. Twelve weeks later four ponies were assigned to each of three treatment groups, tetracycline, doxycycline or Ceftiofur for 28 days. A fourth group was left untreated. ELISA antibody titers dropped in all the treatment groups, but began to rise again after three months in three of the four doxycycline-treated ponies and two of four Ceftiofur treated. The ponies were necropsied five months after treatment.
                      A horse that has a mildly elevated titer and no definitive symptoms? I don't know. It's really something to discuss with a vet not take advice on a bulletin board.

                      I've had long discussions with vets who do not support the oral doxy protocol because they don't think it works. Some vets also believe that it is a knee jerk reaction to prescribe doxy and that some of the benefits that people see are because the drug has anti-inflammatory effects.

                      Plus, keeping your horse on doxy for that amount of time can cause other problems, such as ulcers and digestive upset.

                      IV tet has it's own issues. It has to be administered by a vet, because it is highly toxic if it gets into the tissues. I've heard vets say that the only sure way to eliminate Lyme is a 21 day IV treatment.

                      The OP said that her VET did not recommend treatment. I responded because I was in a similar situation. My VET did not recommend treating my horse when I had him evaluated.




                      Originally posted by LauraKY View Post
                      But since Lyme DOES cause arthritis, perhaps the root cause is Lyme disease. I really don't understand why people are so resistant to treating it. Even with a positive test.
                      Equine Ink - My soapbox for equestrian writings & reviews.
                      EquestrianHow2 - Operating instructions for your horse.

                      Comment


                      • #12
                        My horse was treated for Lyme disease last year. He's an endurance horse and suddenly at an endurance ride his pulse wouldn't come down at a vet check. there was no good reason for this hanging pulse. then the next week he grunted when my farrier picked up his hind feet and pulled them away from the farrier. Again, not normal. I took him straight to the vet. he looked great to them, non-reactive to flexion tests but I insisted on testing. His Snap test was positive and hi titer level was a firm positive.

                        My vet wanted to start him in IV tetracycline then finish with doxycycline. I did some searching and found other people that has used oral Tetracycline with success and decided to try that rather than the expensive and frustrating IV for a month. I decided to use oral Tet powder and it cost me around $30 for 6 weeks of treatment. My horse recovered well and has been fine since last spring. Just something to consider.

                        chicamuxen

                        Comment


                        • #13
                          Could you try asking your vet to do a SNAP test on him? That would tell you whether or not he has an active infection vs. a titer which only tells you whether he has antibodies to the disease (which a lot of horses in the lyme regions have, even if they don't have an active infection). The SNAP tests for a certain chemical only found on the spirochete, which would be present in an active infection. My horses are tested with the SNAP tests now and in my experience, they have been spot on as far as accuracy. Just a thought!

                          Comment

                          • Original Poster

                            #14
                            Thanks all for your experiences. I should add that I am an epidemiologist, and my Masters is in infectious diseases so I understand the lack of clarity on the situation. To be honest, I could not find any good research to support one decision or the other. I have already made up my mind based on the scientific evidence that I could find, my horse's odd behavior, as well as discussions with my vet. My vet knows that I am a scientist, and although our opinions do sometimes differ, we have a mutual respect for one another (ok, I respect him and I think that he respects me ).

                            I posted here to get additional views on the topic because the area is so grey. There are no clear cut "right" answers.

                            Comment


                            • #15
                              Originally posted by LauraKY View Post
                              There is another study, by Cornell, which found that treating with IV Oxytet first, and following up with oral Doxy was better at eradicating the Lyme (if that is indeed possible).
                              Can you help me find that study? The one that I have is the same one referenced above that indicates doxy for 30 days did not eliminate the disease in the study animals. IV tetracycline did but they were treated for 30 days. When I read about the types and duration of treatment for humans with an established disease, it seems unlikely to me that the current 30 day treatments are really effective in horses.

                              I've heard of the study you refer to several times and I assume it's a later study but I can't find it.

                              OP, which test and where was it analyzed? I'm not familiar with that scale. I screen my horses and they're normally between 0 and 200. I'm not familiar with a scale nor the significance of a 5120 titer. But, I'm very interested in your qualified opinion on this disease and the treatments.

                              My concerns with treating are that I'm not convinced the treatment is effective and the horse will be exposed again and likely very soon (in an endemic area). I worry about a possible adverse effect to the horse's natural immune response with treating every time he comes back with a titer.

                              Comment


                              • #16
                                There are different tests. My vets send their's to Cornell, and we get the results back based on : Negative 0-129 (horse is not affected), Equivocal 130-379 (can't distinguish, do Western Blot if you want to further) and Positive >380 (infection). For the most part, if anything comes back higher than 380, my vets say treat. The gray area of 130-379, they'll either do a western blot or say decide based if there are symptoms.

                                I have one horse I just treated. His titer was 280, and doubled from last year's results, and he was VERY body sore, suddenly hating to be groomed and spooky, so we decided to treat. A couple years ago, another horse came back high, 390, so I opted to treat her even though she didn't have any symptoms, and the levels went down. I would differ to my vet in situations like this, but if there's a chance it's Lyme and not aging that is making him hock-sore...well, doxy is relatively cheap at $35/bottle, so worth buying 2 bottles, treat for 10 days and see if he is feeling better, if yes, continue treatment.

                                Comment


                                • #17
                                  Originally posted by Equino View Post
                                  There are different tests. My vets send their's to Cornell, and we get the results back based on : Negative 0-129 (horse is not affected), Equivocal 130-379 (can't distinguish, do Western Blot if you want to further) and Positive >380 (infection). For the most part, if anything comes back higher than 380, my vets say treat. The gray area of 130-379, they'll either do a western blot or say go based if there are symptoms.

                                  I think when the levels come back low, then you go based on whether there are symptoms. I have one horse I just treated. His titer was 280, and doubled from last year's results, and he was VERY body sore, so we decided to treat. A couple years ago, another horse came back high, 390, so I opted to treat her even though she didn't have any symptoms, and the levels went down. I would differ to my vet in situations like this, but if there's a chance it's Lyme and not aging that is making him hock-sore...well, doxy is relatively cheap at $35/bottle, so worth buying 2 bottles, treat for 10 days and see if he is feeling better, if yes, continue treatment.
                                  Exactly. And just like doctors, not all vets are up on the latest research and treatments.

                                  Comment

                                  • Original Poster

                                    #18
                                    My horse had the ELISA done at the CT lab at Storrs.

                                    I based my opinion on treatment on this book on Current Therapy in Equine Medicine:

                                    http://books.google.com/books?id=q-2...page&q&f=false

                                    Comment


                                    • #19
                                      From my experience with 5 horses, the faster you treat, the less chance of permanent damage and relapse.

                                      Granted, a horse may become reinfected at any time, but I'd rather deal with that than chronic relapses (latent problems) from the first bout due to delayed treatment.

                                      I've found this to be true with dogs as well as horses.

                                      Signs can be subtle, and typically, those are the ones that get treated late (I learned this lesson the hard way) and relapse, at least in my experience. That's what happened with one of my best horses who was destined for u/l dressage. Treated late and prone to relapse now and then.

                                      Purely anecdotal.
                                      www.littlebullrun@aol.com See Little Bull Run's stallions at:
                                      "Argosy" - YouTube and "Boleem" - YouTube
                                      Boleem @ 1993 National Dressage Symposium - YouTube

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                                      • #20
                                        Originally posted by sid View Post
                                        From my experience with 5 horses, the faster you treat, the less chance of permanent damage and relapse.

                                        Granted, a horse may become reinfected at any time, but I'd rather deal with that than chronic relapses (latent problems) from the first bout due to delayed treatment.

                                        I've found this to be true with dogs as well as horses.

                                        Signs can be subtle, and typically, those are the ones that get treated late (I learned this lesson the hard way) and relapse, at least in my experience. That's what happened with one of my best horses who was destined for u/l dressage. Treated late and prone to relapse now and then.

                                        Purely anecdotal.

                                        How do you differentiate relapse from reinfection?

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