Tbds

[feemandvm]

OK... clearly there are some very different opinions on TBDs here on GT... so just thought I'd list some common comments I've seen and give an opinion on them.

 

1. "If you suspect a TBD, put them on Doxycycline just in case".

 

Not all TBDs respond to doxycycline so a trial of doxycycline does not rule out a TBD. If there is a strong suspicion of a TBD then Doxy can be started pending titer results... but it should not be used instead of titers.

 

2. "My dog has a TBD because the titer was positive"

 

The only thing a titer can tell you is exposure. Certain titers are more suggestive of infection... but techincally they really only can tell you that your pet was exposed to a TBD and not that they are actively infected with one. As an aside... did you know that 95% of dog's with a positive Lyme titer will never have a single clinical sign or be ill a day in their life (compared to only about 10% of people)? Also... 40% of the dog's referred to the University of Pennsylvania for Lyme disease, actually had another diagnosis and were not actually sick with Lyme disease despite a positive titer.

If I have a healthy dog and they have a positive titer to a TBD... I may look into general labwork but I am very rarely going to be convinced to treat a titer w/o bloodwork or clinical signs to support it. If nothing else is wrong... how will you ever know if the treatment worked? Titers can remain elevated for years even if the infection is gone. Also, be careful not just to assume the problem is a TBD with a positive titer, work up the dog and make sure the diagnosis "makes sense".

 

3. "I'm just going to PCR test for TBDs b/c that identifies the actual TBD and not just the body's response to exposure."

 

Great idea in theory, bad in practice. PCRs can have false negative results so I would generally only pursue them if a dog had a positive titer and I wanted to confirm that the titer = infection.

 

4. "The RIGHT dose of Doxycycline is 5 mg/lbs twice a day."

 

This dose is completely arbitrary and based on zero scientific fact. Just to show it wasn't only my opinion that this statement is incorrect, I contacted The Ohio State University, University of Florida, North Carolina State University and Texas A&M and none of those veterinary teaching hospitals believed that 5 mg/lbs was the "right dose". In fact, not one of them said they would use that dose. An argument for this protocol is that some strains of Ehrlichia COULD need a dose almost this high. While this is possible, it is like saying we should treat every urinary tract infection with 8 weeks of Baytril b/c some infections could require this. THe "right dose" of Doxycycline is 5-10 mg/kg orally once to twice daily. If your vet isn't using 5 mg/lbs of Doxycycline 2x/day it doesn't mean that they are "out of the loop"... it means they are actually doing what is recommended by every tick borne disease expert at the major teaching universities.

 

5. "It is safer just to treat my dog for Babesia or Ehrlichia based on a high titer than not."

 

The treatment for babesia is far from a benign medication and can potentially have some serious side effects. I would feel terrible if my dog had a serious side effect from a drug that they never actually needed. If bloodwork was normal and the dog had no signs, I would definitely pursue a PCR test before commiting to treatment.

While doxycycline may have fewer side effects, do I really want to put a dog on 8 weeks of an antibiotic that doesn't need it? How do you think we ended up with such nasty resistant bacteria in the environment? It has been due ot the use (or misuse) of antibiotics. Could we be setting these dogs up for resisitant infections in the future by giving them 8 weeks of antibiotcs that they don't need? Hard to say for certain but 8 weeks of doxy isn't risk free.

 

 

 

[GreyAcresMom]

Thank you. I always am inpressed with you and the personal touch you give!

[Batmom]

Thank you -- answered a question or two of mine.

[Guest vahoundlover]

Thank you!

[gazehund]

Thank you -- answered a question or two of mine.

 

Me too, thanks Dr. Bill.

Especially since all four of my dogs allegedy tested positive for Lyme disease. They fall in to the 95% you mentioned who have 0 symptoms and have never been sick (with classic symptoms of Lyme disease) a day in their lives.

 

[macoduck]

Thank you!

[Guest anneh]

Following up a positive lyme with a C6 test is what my holistic vet recommends. The result should be <30 but in our case my non grey was 38 but she still elected not to treat as he has no symptoms and the result was so close to 30. We will retest this Spring and if results are in same parameter we won't treat.

anneh

[Trudy]

Thanks Bill. This is exactly the thoughts of my vet (almost word for word ) and why Ryan was not treated for a TBD when he first started having issues.

 

After ruling out lots of other stuff, only a few things remained on the list as possible suspects for Ryan's issues and one was Lyme, so he's being treated as such again when the last round of issues came up and tests didn't give us any other info.

 

I think there is a lot of push for "just treat it if you suspect it" without proof and lots of people push their vets to treat for something their dog likely doesn't have.

[feemandvm]

Following up a positive lyme with a C6 test is what my holistic vet recommends. The result should be <30 but in our case my non grey was 38 but she still elected not to treat as he has no symptoms and the result was so close to 30. We will retest this Spring and if results are in same parameter we won't treat.

anneh

There was a lot of discussion on this at The North American Veterinary Conference. The question was why is a level of 30 considered a level high enough to treat? Severity of signs or liklihood to develop signs has NOT been associated with higher levels... it just seems to be random dogs (dogs may be sick with a level of 10 and healthy at 110). The level of 30 picked by IDEXX is arbitrary and not really based in science. The recommendation of the ACVIM is not to treat an asymptomatic dog no matter what the C6 is. Now if you treat, you should pursue a C6 titer as a response to treatment has been associated with a signficant drop in c6 levels so they do recommend a baseline c6 and retesting 6 months later to see if response was "adequate".

 

Here is a link to the ACVIM position paper:

 

http://www.acvim.org/uploadedFiles/Consens...20in%20Dogs.pdf

 

 

[ShantisMom]

You answered a few questions for me. Oh how I wish you posted this a few months ago when we started our TBD path. Yesterday we opted out of retesting Shanti's titer level as we did not think it would change that quickly (she was treated in December). You just confirmed that, and I am thankful I did not waste $225. I wish the treatment for Babesia made a bigger difference on her, but what we are dealing with is more than a TBD.

 

Thank you!!!

[Guest anneh]

Thanks for that info, very informative. I guess I was worried when he tested low positive because my beloved Aussie had tested positive when he was alive and we decided with no symptoms not to treat but then he suddenly developed kidney disease and I felt awful for not having treated him If my dog has a higher result this year (he is still asymptomatic) should we treat him?

anneh

There was a lot of discussion on this at The North American Veterinary Conference. The question was why is a level of 30 considered a level high enough to treat? Severity of signs or liklihood to develop signs has NOT been associated with higher levels... it just seems to be random dogs (dogs may be sick with a level of 10 and healthy at 110). The level of 30 picked by IDEXX is arbitrary and not really based in science. The recommendation of the ACVIM is not to treat an asymptomatic dog no matter what the C6 is. Now if you treat, you should pursue a C6 titer as a response to treatment has been associated with a signficant drop in c6 levels so they do recommend a baseline c6 and retesting 6 months later to see if response was "adequate".

 

Here is a link to the ACVIM position paper:

 

http://www.acvim.org/uploadedFiles/Consens...20in%20Dogs.pdf