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Discussion on Lyme Disease - Treatment
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New Member:
Annc
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Posted on Monday, Aug 29, 2005 - 12:31 pm:
One of our horses has been diagnosed with Lyme Disease (Elisa Units: 216; Western Blot: Low level of Antibody to infection - staining pattern consistent with an infection of Borrelia burgdorferi). Symptoms: Rapid onset of sore muscles and joints.
We have been given 3 different suggested treatment protocols by 3 different veterinarians: 1.Doxycycline for 30 days at 10mg/kg body weight; 2.Tetracycline IV every 24 hours for 4 weeks; 3.Tetracycline IV for one week followed by 3 weeks Doxycycline. We understand that the IV Tetracycline treatment poses possible risks in itself.
This horse is very valuable both emotionally and monetarily. Any updated information as to the treatment of Lyme in horses would be most appreciated!
Thank you!
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Member:
Ejar
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Posted on Monday, Aug 29, 2005 - 12:57 pm:
I would check the CDC website. Whatever they're doing in humans, you know they tested on animals. It might give you a point of reference for reviewing your options.
Antibiotics is the right thing to do. You might ask your vet why the options - what do we gain by the IV if there are known risks? Is this because we don't know the exact time of onset of the disease? Timing is crucial in Lyme, perhaps your vet wants to hit the germ hard because he/she isn't sure about when the disease was contracted.
Good luck.
Erin
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New Member:
Annc
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Posted on Monday, Aug 29, 2005 - 2:18 pm:
Erin,
Thank you for your response. I will definitely check CDC information.
In order to keep my first post fairly short I did not include all the information, as it has been explained to me, of which I am currently aware. As explained by one vet, the latest research indicates that at least some horses do not absorb Doxycycline very well, tissue samples of some horses treated with oral Doxycycline have shown very little Doxy. However, Tetracycline is definitely absorbed. The problem with Tetracycline is that it must be given IV; a new catheter must be setup every 4 days. Risks include everything normal for this procedure (infection, blood vessel irritation and collapse, thrombosis, etc.).
According to this vet, some horses do respond to the oral Doxycycline treatment, both in titers and symptoms. Since our horse's symptoms are not worsening and we have already started him on the Doxycycline, we have (at this point) decided to keep him on Doxy for 2 weeks and retest. If this test indicates that the titers have improved it would suggest that the horse is absorbing the Doxy and responding. If the titers have gone up we would immediately switch to the IV Tetracycline. (Obviously, if at any time during these first weeks his symptoms increase we would immediately switch to Tetracycline).
Also, all three of these vets feel that horses tend to recover very well with treatment, and, unlike humans, are not prone to long-term problems.
We have very little Lyme in this area (we are less than an hour from the Canadian border). In the past three years we have seen an increase in Lyme in dogs, but I do not even know of a case in horses here. This horse was in Virginia from April to early August, which is where he contracted the disease. First signs of soreness appeared the first week in August. For a week 2 different vets in Virginia focused on his hocks (x-rayed clean as they had at pre-purchase vetting). Finally my daughter (horse's owner and rider) convinced them that she thought his whole back was sore and that he was moving gingerly in all 4 legs. The Lyme test was then taken (as well as full blood work). The results came last Thursday.
If anyone has information that would add to, substantiate, or disagree with the above we would certainly appreciate it!
Thanks again for responding!
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Member:
Ejar
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Posted on Monday, Aug 29, 2005 - 5:36 pm:
Sounds to me like you are doing exactly the right thing - minimizing risks while attacking the problem head on. It also sounds like you identified it right at onset, which means a less risky method makes sense. Certainly what I would do if I were in your shoes!
My daughter has done a little research on Lyme disease - there's an entymologist at UC Berkeley who's been studying the relationship between lizards (blue bellies and alligator lizards) and Lyme disease. Something about their blood neutralizes the bacteria in the tick, and the tick is Lyme-free for life! I think that's why California has relatively few cases despite our population; our lizard population is equally abundant.
Please post how your horse responds to the treatment.
Erin
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New Member:
Annc
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Posted on Monday, Aug 29, 2005 - 9:15 pm:
Erin,
Thank you for all of your information and support. We really appreciate it! We will keep you posted of our guy's progress.
Ann
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Moderator:
DrO
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Posted on Tuesday, Aug 30, 2005 - 6:18 am:
Hello Ann,
We don't have treatments for Lymes Disease because I am not convinced it causes overt disease in horses. Though we know they become infected and develop titers, experimentally any significant symptomology has not been observed.
Here is a edited reprint of an earlier reply to a member and there is nothing new in the current research that suggests differently:
quote:There have been attempts to induce disease experimentally in horses with this organism and so far none have developed the symptoms attributed to this disease. Just last year this experiment was attempted in immune suppressed ponies with these results:
"Except for skin lesions (These were from the tick infestations, DrO), we failed to induce any significant histopathologic changes in this study."
Experimental infection of ponies with Borrelia burgdorferi by exposure to Ixodid ticks. Vet Pathol. 2000 Jan;37(1):68-76.
I believe this is critical step in developing a disease's characteristics particularly when so many healthy horses in endemic areas display titers too. It becomes very easy to blame diseases of unknown origin on the titer. There are a set of rules, called Koch's postulates, that were formulated in the last century that still are valid today. Borrelia burgdorferi (Bb) continues to fail one of the most important steps.
The most interesting new development in Bb infections in horses is a very large survey done on this disease that is just out: Prev Vet Med 2001 May 1;49(3-4):191-208 Cross-sectional study of the seroprevalence to Borrelia burgdorferi sensu lato and granulocytic Ehrlichia spp. and demographic, clinical and tick-exposure factors in Swedish horses.
This survey looked at 2018 horses of which 16% were seropositive for Bb. In this survey they attempted to find correlations between the incidence of diseases that were present or had been diagnosed in the past and the presence of a positive serologically. Their conclusion is: Except for the positive association between coffin-joint arthritis and serologic reactions to B. burgdorferi s. l., there were no significant associations in the multivariable models between non-specific or specific clinical sign or disease with seropositivity to either of these agents.
When you look at the correlation to coffin joint arthritis it is not strong and since it was not correlated to any other form of arthritis, unless you believe this organism has a special predilection for this joint this appears to be a coincidence as it seems unlikely.
I know there are many very bright people who believe that Bb is a source of significant disease in horses but so far the research does not support this.
DrO
I continue to look for better evidence of disease in horses caused by this organism. However we do have information on the use of tetracycline and doxycycline. See Equine Medications and Nutriceuticals » Antibiotics and Antimicrobials » Tetracycline, Oxytetracycline, & Doxycycline. If you or your veterinarian feel strongly this is a possibility you should continue treatment.
DrO
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Member:
Annc
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Posted on Tuesday, Aug 30, 2005 - 9:59 am:
Dr Oglesby,
Thank you very much for the updated information and for taking the time to respond. We sincerely appreciate it. We will discuss your information with our veterinarians. I admit that IF they feel strongly that we continue the Doxycycline, we will probably not fight their recommendation (especially since we have already purchased the medication). If we do continue treatment, it will be interesting to see what happens to his titer at the two week test (we will let you know).
We definitely feel much better about our decision not to do the more aggressive IV Tetracycline treatment.
We will also continue to look for other causes of his muscle and joint soreness (which is getting better each day). At the onset he was put on MSM and Cosequin. He showed a positive response within a week of the addition of these two supplements.
Again, thank you very much!
Ann
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Member:
Miamoo
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Posted on Tuesday, Aug 30, 2005 - 12:41 pm:
I have read Dr. O's findings on Lyme and I know what is said here is the latest research but my mare absolutely had Lyme. The first thing I noticed was that she was uncomfortable to the curry. This was not her normal behavior. Her coat was poor, she ne ver shed out correctly and she was moving "just not right" you know how we know our own horses. Well my vet came for some other reason to my farm and I had him look at her. He said that there was no reason to worry, that she was just a poor mover. I fr eaked - I bought her in the first place for her excellent movement. He said "OK, we'll check for Lyme" (there is lyme in my area). It came back positive in the upper 300's. We treated her for a month on a high dose of Doxycycline. Her coat grew in sh iny, her movement became fluid again and she stopped being sensitive to grooming utensils. I am paranoid because I love this mare so I have retested her every 6 months. Her levels have consistently DrOpped every test. Her last one was 26. A big difference from upper 300's.
Good luck, Because the research is not out there yet I have had such a hard time finding anything out. I am still wondering if I am going to get future problems from any damage from this infection. I hope all goes well for you. If you get information please post it here. I would be really interested!
Ella  Ã
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Member:
Annc
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Posted on Tuesday, Aug 30, 2005 - 2:44 pm:
Ella,
Thank you for writing. I spoke with our vets this morning, and they all feel that what we know about Lyme is far less than what we do not know about this disease. Considering this void in knowledge, they strongly recommend that we continue the Doxycycline treatment. In addition, the horse has significantly improved since he was started on Doxy. Although we realize this may simply be coincidental, it is another reason supporting continuation of this treatment. Providing he has no negative responses, we will continue the Doxycycline until receipt of the results of the titer test (taken in two weeks).
I will post any changes and results as they occur.
Thank you again!
Ann
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Member:
Miamoo
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Posted on Wednesday, Aug 31, 2005 - 8:22 am:
The one reaction my mare had was diarrhea (sp?). It continued for about 3 weeks after we stopped treatment.
Ella
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Member:
Annc
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Posted on Wednesday, Aug 31, 2005 - 9:23 am:
Ella,
Thank you for letting me know. Following is a quote from Dr. O's article:
Doxycycline's elimination from the body is relatively unique. The drug is primarily excreted into the feces via non-biliary routes in an inactive form.
I suspect this method of excretion might be the cause of your mare's diarrhea. Our guy's manure has become less formed and very odorous. Luckily, so far, he has had no other adverse reactions.
Thanks again!
Ann
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