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| Discussion on Treatment for Very High Lyme Titer | |
| Author | Message |
| New Member: Tbluvr |
Posted on Thursday, Aug 17, 2006 - 2:13 pm: I just found out my 15 yr old gelding has a very high Elisa titer of 40,000 +. He also has a Western Blot of 1. His clinical symptoms are slight stiffness, easily bruised and sore feet, and lack of flexion in the hocks. All of these symptoms have arose in the last few months. Prior to this year he tested the past 4 years negative for lyme using both Elisa and Western blot. He has had a slight temp. lately as well. Other than that he is relatively sound and doing well.I live in a VERY endemic area for lymes (CT) so nearly all the vets up here treat for it. My vet is recommending 28 days of IV Oxytetracycline since the titer is so high. She says this is the most agressive treatment route. I am wondering if anyone has treated their horse using this method and if so what were the results and costs?? I am also wondering if such aggressive treatment is neccessary even if clinical signs are not significant?? Also, if anyone out there has treated a horse with a titer of 20,000 plus using another method please share as well!!! Dr. O I would like your opinion as well please. Thanks |
| Member: Caroltd |
Posted on Thursday, Aug 17, 2006 - 3:46 pm: My son's horse was just diagnosed with Lyme in May. We purchased him in CT. His levels were at 494...I'm thinking it was a different test or the reading is comparable to your 40,000. We chose to not do the IV...because his horse would have been stall bound for 28 days. We also considered the cost. Our vet told us it was 150.00 just to put in the IV catheter and if the horse brushed it out it would cost that to replace each time plus the cost of the oxytetracycline.We chose to go with the oral meds..we kept him on them for 6 weeks. The cost came to close to 1000.00...but he could continue to work and train and get outside into the pasture. We have seen real improvement in his attitude and movement and consider the money well spent. Our vet told us that the "gold standard" treatment was the IV and that there were fewer relapses after that treatment method, however the relapse rate didn't seem all that high with the oral meds either. It came down to what we could afford and how much confinement the horse was willing to stand for. Of course we will continue to have him tested on a 6 month basis to make sure there is no further flare up. |
| New Member: Tbluvr |
Posted on Thursday, Aug 17, 2006 - 4:34 pm: Thanks Carol- since lyme is such a mystery any feedback is appreciated. I dont' know if there is another test besides the Elisa titre, but 494 is not high and would only be a mild positive if indeed it was the Elisa titre. But symptoms vary from each horse regardless of the titer number. My other horse had lyme last year and a titre of 850. He was FAR more lame and symptomatic than this horse with the much higher titre. I am just curious of what other people have done in treatment for such high titres and costs. I imagine the IV oxytet for 28 days would cost a small fortune which I cannot afford either!!! I haven't got a price yet and was wondering if anyone had an idea as well. |
| Member: Ryle |
Posted on Thursday, Aug 17, 2006 - 9:48 pm: If you cannot afford the very aggressive treatment that your vet has recommended, ask her what your options are. Oral doxycycline may be a better option for your finances, but you need to talk to your vet about the differences in treatment plans. |
| Member: Paul303 |
Posted on Friday, Aug 18, 2006 - 2:07 am: We did the oral doxycycline treatment after our 11 yr. old QH mare showed a result of 410Elisa units last Feb. - March. The lab values were:0 to 129 kela units = negative 130 to 379 kela units= equivocal (need western blot) >380 kela units = positive The Western Blot just said - "High level of antibody to infection". Our big problem was that she had just spent 5 days in the clinic trying to get a diagnosis on a strange colic.....which turned out to be ulcers. The Lyme testing was just a shot in the dark. So, there she was, miserable, not eating, moderate temperature, and the Lyme test didn't come back until after she was home. There was a total of 5 vets on this case - each with their own opinions. The consensus was to treat with the Doxy course. Even though she had ulcers, she was still on her gastroguard course so they all agreed it was a good time for the doxy. They didn't mention the IV course. Possibly because she wasn't that bad. Anyway, she's fine now. My pocketbook is suffering from severe anemia, though. |
| Member: Kthorse |
Posted on Friday, Aug 18, 2006 - 6:55 am: My vet said IV has lots of problems on its own as mentioned above It can up the incidence of colic as well if the horse is not usually stall bound. My vet said she would have to come out every day to administer the antibiotic in the IV. It's very expensive she said the cheaper route and safer is the tablets. In the end my horses titer was not that bad so I opted to do nothing and watch him. He ended up fine.I am not a vet but having had lyme as well as my dog I would go the aggressive route. Although they say there is controversy as to whether horses are affected by lyme. I think Dr O is of that opinion. Forgive me if I am wrong and jump in. |
| Moderator: DrO |
Posted on Friday, Aug 18, 2006 - 7:48 am: Hello Sarah,The thoughts I express in Diseases of Horses » Fever of Unknown Origin » Lymes Disease » Lyme disease, though 6 years old, still apply. I have followed the research on this organism in horses and each experiment and survey done in the past 6 years and preceeding that supports the idea that though horses contract the Lyme spirochete it does not cause remarkable clinical signs in horses and is rapidly cleared. Your high titers suggest a strong immune response to me and not necessarily chronic disease. DrO |
| New Member: Tbluvr |
Posted on Friday, Aug 18, 2006 - 9:39 am: Dr. O- I have read your article on Lyme Disease. Can you explain what you mean by the high titer suggesting a strong immune response?? My horse definitely is showing some clinical symptons although none are terribly obvious or dramatic.In the studies/tests that have been performed by infecting horses with lyme and then looking for clinical symptoms etc...how long did they monitor the infected horses??? I believe in most cases, particularly in endemic areas it can take months and sometimes YEARS for clinical symptoms to arise from lyme. What are scientists doing to make these studies accurate??? Thank you everyone for the suggestions. KThorse- I would be particularly concerned with having my horse stall bound for 28 days. He is used to 24/7 turnout in a large field with a run in stall. He also is very attached to his pasture mate, myself and does not adjust well to change. I think sending him to the clinic for IV treatments for 28 days would do more harm than good. |
| Member: Kthorse |
Posted on Friday, Aug 18, 2006 - 10:09 am: I agree Sarah although my vet did say that the IV treatment was for I think 10 days verses 28 for tablets. I like Dr O's thoughts but don't understand why other vets treat it so aggressively. It makes life confusing these different ideas and thoughts especially when it comes to medical things. Dr O why do you think other vets are not of the same opinion as you?Katrina |
| Member: Amara |
Posted on Friday, Aug 18, 2006 - 1:30 pm: i lived in CT fir a long time before moving... have treated numerous cases of lyme in horses, dogs and humans.... generally was able to treat most cases with 28 day course of doxy.... there is conflicting info as to the dosage... i know of one horse that had to go to clinic for IV treatments... he was fine.. i dont know any of the details tho, but i did hear he was in very bad shape before he went in... i had to eventually treat my pony with injectable antibiotics, tho for the life of me i cant remember what it was.. it was 6-7 yrs ago... he'd had 3 cases of lyme.. he's been fine since.. i know of one horse that didnt get treated and he ended up being crippled... i myself didnt get treated for several months, and what a nightmare that was trying to get healthy..honestly i dont care what the research says... i've probably treated 50 or more cases of lyme (i'm NOT exagerating).... even the most minor of symptoms cleared up after a proper course of doxy... the most problem i've had with the doxy route is that the treatment dose was too low... i'd have to go to my notes at home to see what the dosages ended up being... all of these horses got better within 2 weeks, but stayed on the meds for at least 1 month.... it was only the horses with cases that were treated late that we had to go to diff. routes... good luck. i take lyme VERY seriously, whether people, horse or otherwise... |
| Member: Tbluvr |
Posted on Friday, Aug 18, 2006 - 2:56 pm: I have to agree with Melissa. Here in CT lyme is NO joking matter!!! People, horses and dogs get it all the time and have varying degrees of clinical symptoms. I just found out I have lyme a month or so ago. Fortunately I had the characteristic rash so I knew right away and was treated. I have had no symptoms so far.Like you Melissa, I too have seen countless horses with lyme disease, have OBVIOUS clinical symptoms and then respond phenomenally to various antibiotic treatments, doxy etc... There is no way that I can believe that horses DON'T get sick from lyme. I believe it takes awhile for symptoms to arise which is why I posed the above question to Dr.O. The range of symptoms and level of severity among each horse is so great as well which also needs to be considered when conducting a scientific study. Perhaps if more vets started believing that lyme exists in horses a vaccine would be created!!! It really is beginning to get way out of hand up here. Every horse owner in NE would get a lyme vaccine if it was available. |
| Moderator: DrO |
Posted on Friday, Aug 18, 2006 - 6:54 pm: Goodness this certainly has become passionate, but I like passion. Concerning your question about titers Sarah, titers are a measure of the antibody response to a disease. High titers mean there are a lot of circulating antibodies to the Lymes organism and associated with a strong immune response.I don't actually have an article on Lymes disease, just past discussions. However your posts certainly indicate there needs to be one. I have lived through several such epidemic episodes of poorly defined disease entities in the past only to find that in the end there was rampant misdiagnosis. Some of it has even been contrived by a company pushing a new medication or vaccine some of it, as I suspect is the case with Lymes, just a difficult diagnostic situation. There were hundreds of cases of PHF diagnosed in our area and treated, and yes most got better in spite of inappropriate therapy, and thousands more vaccinated. It took several years but with enough necropsies and improved diagnostic techniques it was found there was no PHF in our area nor had there ever been. This happens a lot more than folks realize. EPM is another good example that has been rampantly overdiagnosed with some areas having 20% of the horses diagnosed and treated when the actual rate appears to be closer to 0.5%. And yes many of those horses who were misdiagnosed for EPM were successfully mistreated. In fact it probably was the misdiagnosed that were most successfully mistreated! One things these past diagnostic miss-steps have in common with Lymes is the method of diagnosis: lab findings of uncertain significance. There have been more than a few well conducted studies of two types: In one they tried to make horses sick by exposure. They even went as far in one study as to cripple the immune system with steroids prior to exposure. In other studies retrospective surveys where hundreds and in one study nearly a thousand horses in Lymes endemic areas had the health histories carefully checked against comparing horses with and with no titers. There has not been any indication that Lymes causes significant disease in a horse in any of these studies. How do you put such findings along with Melissa's experiences? And Sarah, if your perspective is going to be one that no matter what the facts you are going to believe in something, how will you ever see the truth if it is different than what you believe? You cannot generalize disease findings from specie to specie. I am still open to the question of Lymes in horses but it is my job here to present the facts as they are. If you and your veterinarian believe that your horse has clinical signs due to Lymes infection I am not asking you not to treat, I am pointing out that this is not a well defined disease in horses. DrO |
| Member: Tbluvr |
Posted on Saturday, Aug 19, 2006 - 11:58 am: Dr.O- Thank you for the explanation of the titer. That makes sense and I will ask my vet about it on Monday. I feel that if my horse is not showing debilitating symptoms it would be causing undue stress to keep him at a clinic for 28 days of IV treatment.From what you have said so far about the studies it still is not factual to me that these studies were conducted in an accurate manner. Infecting horses with lyme is not going to cause symptoms initially, which is why I asked HOW LONG they monitored these infected horses. Not every horse that tests positive for lyme displays symptoms nor needs to be treated, that is already well known up here. Yes, many vets over diagnose lyme. But, the vets that REFUSE to diagnose and treat for lyme in a horse with obvious symptoms that have no other logical diagnosis and other treatments have failed I think are the real problem up here. I will believe that horses do not get sick from lyme when I SEE concrete, accurate evidence that proves otherwise, I have yet to see that. In the 1980's doctors told humans that there was no such thing as lyme, or humans can't get sick from lyme and here we are in 2006 and many people have lingering results of this untreated disease that has ruined their lives. In addition, when did you live up here in the NE?? Lyme has only become endemic in the last few years. It has been a problem in CT for quite some time but it has just recently become endemic in MA, RI etc... My horse that has the 40,000 titer lived in MA for 10 years. He was tested the last 4 years and it always came back negative. I have owned him for 1.5 years. He has never had a lame day, now the last several months he has had some random symptoms, stiffness in the back and hocks, soreness in the poll, tender feet and occasional grumpiness. Up until now he has always been 100%, never had a lame day. I have seen first hand how similar symptoms have affected my older horse, and then rapid improvement after treatment with doxycycline. I would be hard pressed to believe that lyme doesn't exist in horses because of my experiences. Why would oxytet, tetracycline and doxycycline get rid of all these symptoms in 1,000's of horses if there was nothing to treat??? Just like when horses ARE misdiagnosed with lyme, go through treatment..and there are no results, well of course symptoms that are NOT caused by lyme are not going to suddenly disappear with a course of antibiotics. I apologize if I am coming across as too passionate with this subject but I feel this is a major problem in the equine community that needs to be addressed. I would be more than happy to believe that lyme does not affect horses if concrete, accurate evidence from an experiment conducted over time proved otherwise rather than a survey ( which can have many statistical errors etc..) I think lyme disease in horses is a nightmare and if someone could really prove otherwise and come up with a logical solution I would be more than happy to change my opinion and beliefs. |
| Member: Amara |
Posted on Saturday, Aug 19, 2006 - 6:41 pm: we tested most of our horses before and after lyme treatment... if finances were tight our vet was willing to let us treat without testing.. HE believed lyme was a huge problem... many of the titres were high, tho i only remember a few being as high as sarah's.. we always treated if there were ANY symptoms, and if the titres didnt get down to next to nothing we kept treating (very few horses had this problem)...as far as not treating for lyme if no symptoms are present.. it is my personal belief-and experience, that a strong immune system can bolster the horse against the effects of lyme.. we do know from studies that the lyme organisms can bury themselves deep into the cellular level, coming out when the immune system becomes weak... in humans with long term exposure to lyme there is no cure.... if caught early-if you're lucky enough to get the bullseye rash (i wasnt), then lyme is very easily cleared.... in cases where there is no rash or no other symptoms, the immune system does appear to be doing a credible job clearing the bug, but those little guys are sneaky and just find a good hiding place and come out when you get stressed... once they find a good hiding place.. well... they dont leave easily! and they sneak around doing all sorts of fun things... there WAS lyme vaccine available for humans some years ago.... came off the market pretty quickly because of some problem i dont remember... there is also one available for dogs... the early one was known to cause problems in dogs with labrador breeding-my vet refused to give it.. i fought lyme with my dog half a dozen times until i was able to change her diet and bolster her immune system... since lyme is not pandemic in all areas i dont think we'll see much heavy research done in humans or horses as to its effects, or any good vaccine... pharmaceuticals put their money where people want it, and lyme disease just isnt "in" right now... good luck treating your mare... in my experience i think starting with a high dose of doxycyxline is a good starting place for treatment... |
| Moderator: DrO |
Posted on Saturday, Aug 19, 2006 - 6:56 pm: You have some misconceptions Sarah which I will try to correct:1) Science can not prove a negative. No can can ever prove that B burgdorferi does not cause infections. One can always hypothesize another set of conditions where it might happen. My concern is that there are many thousands diagnosed yet we still don't see an experimental case. This violates one of the basic tenets of Koch's postulates of determing whether an organism causes a particular disease. Prior to Koch's postulates there were many erroneous ideas of what causes disease. 2) There are many diseases known and most certainly unknown that cause generalized lameness, lord knows after a day of setting fence posts I will suffer many of them. 3) Just as none of your symptoms are pathognomonic for Lymes, horses get well for a number of reasons. In fact most diseases are self healing, statistically 70 to 80 percent. But lets say it is the doxycycline this may be another type of infection or perhaps it is the immune modulating properties that some of the tetracyclines exhibit. We have many examples of folks on this site whose horses got well with homeopathic preparations which are just simply water. But I am not exempt either. I and all of equine medicine misused prednisone for many decades believing there was a clinical response and causing side effects like founder when it is apparent that this is not likely. 4) These studies were conducted by folks who study diseases for a living. The published papers were accepted by well recognized refereed journals, which means they were reviewed by people who studied diseases for a living and found to have merit. Reviewing how the statistics was done is an important part of that review. 5) In the case of the surveys, the horses with titers had no history of how long these horses had their titers but you would assume that in many hundreds of horses picked because of their titer that more than a few had them for many years. In fact if you go in any barn in endemic areas you will find a portion of these horses have titers, in some areas a significant portion. A small percentage of the horses with titers will have had unexplained diseases and this study finds that that number will be equal to the percentage of the equine population who does not have a titer. 6) Where I live has no bearing on anything I have said. Even if I believed Lymes causes clinical disease and had treated dozens and thought I had made them all well, that does not change or even contradict anything presented here. This is the latest published review (just 8 months ago) where someone has reviewed all the scientific literature available on a subject, in this case the subject was does Lymes cause significant disease in horses:
Sarah you want to argue your beliefs and I am pointing out that there unanswered questions about Lymes disease in horses. I do hope your horse gets better and here is an interesting study comparing the various tetracyclines that seems well conducted and may change your mine about your choice of therapy:
DrO |
| Member: Kthorse |
Posted on Saturday, Aug 19, 2006 - 7:20 pm: The reason they took the Lyme Vaccine off the market was because one of the side effects was arthritic symptoms. which in a few cases was almost as bad as the Lyme itself> They still have it for dogs. My dog gets it every year as Lyme almost killed her and fortunately for her she did not get the side effect. |
| Member: ellab |
Posted on Tuesday, Sep 4, 2007 - 11:27 am: Anything new on the lyme front? My horses all have titers. I hate this disease!EllaB |
| Moderator: DrO |
Posted on Wednesday, Sep 5, 2007 - 12:07 pm: No Ellab, the information above remains current.DrO |
| Member: lsweeney |
Posted on Saturday, May 25, 2019 - 5:28 pm: Anything new on the Lymes disease topic in horses? |
| Moderator: DrO |
Posted on Tuesday, May 28, 2019 - 11:49 am: Hello Laurie,I am sad to say we still have a very poor handle on this disease. We can still say that antemortem testing can neither rule in or rule out this disease. Symptoms range widely across the central and peripheral nervous system further complicating diagnosis. While titers (and therefore infection) remain very common in endemic areas the incidence of disease is likely quite low. The best piece I have seen on Borreliosis in horses is: J Vet Intern Med. 2016 Jul-Aug; 30(4): 1305–1312. Published online 2016 Jun 21. doi: 10.1111/jvim.14369 PMCID: PMC5094551 PMID: 27327172 Retrospective Evaluation of Horses Diagnosed with Neuroborreliosis on Postmortem Examination: 16 Cases (2004–2015) L.K. Johnstone,corresponding author 1 J.B. Engiles, 1 H. Aceto, 1 V. Buechner-Maxwell, 2 T. Divers, 3 R. Gardner, 4 R. Levine, 5 N. Scherrer, 1 D. Tewari, 6 J. Tomlinson, 3 and A.L. Johnson 1 Background Equine neuroborreliosis (NB), Lyme disease, is difficult to diagnose and has limited description in the literature. Objective Provide a detailed description of clinical signs, diagnostic, and pathologic findings of horses with NB. Animals Sixteen horses with histologically confirmed NB. Methods Retrospective review of medical records at the University of Pennsylvania and via an ACVIM listserv query with inclusion criteria requiring possible exposure to Borrelia burgdorferi and histologic findings consistent with previous reports of NB without evidence of other disease. Results Sixteen horses were identified, 12 of which had additional evidence of NB. Clinical signs were variable including muscle atrophy or weight loss (12), cranial nerve deficits (11), ataxia (10), changes in behavior (9), dysphagia (7), fasciculations (6), neck stiffness (6), episodic respiratory distress (5), uveitis (5), fever (2), joint effusion (2), and cardiac arrhythmias (1). Serologic analysis was positive for B. burgdorferi infection in 6/13 cases tested. CSF abnormalities were present in 8/13 cases tested, including xanthochromia (4/13), increased total protein (5/13; median: 91 mg/dL, range: 25–219 mg/dL), and a neutrophilic (6/13) or lymphocytic (2/13) pleocytosis (median: 25 nucleated cells/µL, range: 0–922 nucleated cells/µL). PCR on CSF for B. burgdorferi was negative in the 7 cases that were tested. Conclusion and Clinical Importance Diagnosis of equine NB is challenging due to variable clinical presentation and lack of sensitive and specific diagnostic tests. Negative serology and normal CSF analysis do not exclude the diagnosis of NB. The abstract above does not give a good picture of the incidence and difficulty in diagnosis so I recommend you visit the article itself at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094551/ where these are handled in much greater detail. DrO |
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