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June 30 - July 6, 2005 Edition
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Vet June 30, 2005 There is no new Visiting Vet column this week. Dogs and ticks an unhealthy mix June 23, 2005 By Michelle Gerhard Jasny, VMD Dolly was limping. The day before, she had been playing at the beach with a doggie friend. Perhaps she had just pulled a muscle — but today she felt warm and was acting mopey. Dolly was the fourth dog I saw that week with vague symptoms that raised concerns about Lyme or other tick-borne diseases. Lavender, the lab, had a fever and stiff hind legs and would only eat if hand-fed. Cedar Chips, the Corgi, wasn’t eating at all and had a fever. She was also stiff, but that wasn’t necessarily unusual, as old injuries from an earlier run-in with a car often caused her to be achy. Merlot, the standard poodle, was less active than usual, occasionally limping, and had a rash. It was the rash that primarily worried her owner, who is a human health care professional. “Does it look like ECM?” she asked. Hmmm. I’ve been in practice long enough to accept the futility of faking it. “What’s ECM?” I replied. Erythema chronicum migrans. In humans, ECM is defined as a skin lesion that begins as a red spot or bump and expands over a period of days or weeks to form a large, round lesion, often with partial central clearing. In other words, the classic Lyme “bull’s eye” rash. According to the CDC, a lesion must reach at least 5 cm in size to officially be called ECM and be used as criteria for reporting a case of human Lyme disease. For those of you who are metric-impaired like me, 5 cm is about 2 inches. In vet school we were told that women compare things to fruit, and men to sports equipment. Ok, that’s pretty sexist, but if you need a visual, we’re talking a big red splotch the diameter of a large plum or a racquetball ball. Once I realized what Merlot’s owner was talking about, I told her dogs do not get Lyme-related ECM lesions. People, dogs, cats, probably most animals, often develop a circular red swelling within several hours of a tick bite. These represent hypersensitivity reactions and do not qualify as ECM. Merlot’s rash was completely different, probably an allergy with a secondary bacterial infection. She was eating well. Her temperature was normal, and her lameness negligible. We tested her for Lyme, which we can do in the office in under 10 minutes, just to be sure. Negative. No Lyme. Her mom was moderately reassured but added that if word ever got out exactly how bad the tick-borne diseases are here on the Vineyard, all our property values would plummet, and the tourists would depart in droves. Pieces of the puzzle Maybe she was over-reacting. On the other hand, here came Lavender, the next sick dog. She would eat hand-fed treats, but her appetite was poor, she had trouble getting up, and she had a fever of 103.9 (normal being 101-102.5). Her Lyme test was negative. Her signs were suspicious enough that we sent out tests for Rocky Mountain Spotted Fever and Ehrlichiosis. Cedar Chips presented a similar scenario: appetite down, temperature up, Lyme negative. We started empirical treatment immediately on both dogs. Then along came Dolly. Unlike Lavender and Cedar, she was eating well. Good. Unlike Merlot, she had a pronounced limp in her left front leg and a low-grade fever. Bad. Now Dolly is a big, black dog and on a hot day, it’s not uncommon for a healthy animal to have an elevated temperature. We knew Dolly might have strained her leg playing. But it’s spring on the Vineyard. I was getting tired of this. I hate recommending expensive tests for every dog. I hate giving long-term antibiotics without a diagnosis. But I don’t want to miss a case of tick-borne disease. How do we know which cases to seriously consider tick-borne diseases and which dogs just have a sprained ankle, an allergic rash, an environmentally related “fever”? It is like doing a jigsaw puzzle. Take the various pieces of history, physical examination, lab tests, and put them together to solve the puzzle. All these dogs were vaccinated against Lyme disease, lowering my index of suspicion for Lyme a notch, but we know the vaccine does not provide 100 percent protection. Test them. Negative? Is there another explanation for a limp or stiffness? Dolly was playing. Cedar had old injuries. Lavender, however, had no history of trauma or excessive exercise and her stiffness came on suddenly. Lethargy and poor appetite? Lots of dogs are less active and eat less in hot weather. Lavender, however, usually loves to eat. Correlate the degree of inappetence with each individual’s usual demeanor to assess its significance. Same goes for activity. Many owners mistake the onset of maturity with lethargy. Merlot, who is four now, probably isn’t lethargic. She’s just growing up and acting less puppyish. If I am suspicious that a “fever” is just a response to a hot day, I ask owners to check their pets’ temperature at home when they are calm and cool. Tests and treatment Lab tests, when owners opt to have them, help immensely. Lavender tested positive for Ehrlichiosis. One puzzle solved. For Cedar, the final piece of the puzzle will be her response to treatment. If she gets better, we probably figured right. For Merlot, I didn’t see enough evidence to be concerned about tick-borne disease. Dolly was the most ambiguous of the lot. After discussion with her owner, we opted not to treat her empirically for tick-borne disease, at least not yet, but to monitor her temperature, appetite and attitude at home while, treating her leg as a sprain. Phew. I plopped down at my desk. It had been a long week. I went to my computer to read up on ECM and happened upon a list of articles about unusual Lyme manifestations in people: spontaneous brain hemorrhage, weakness of the tongue leading to trouble speaking, facial palsy, sciatic nerve disease, vertigo, low back pain, children who developed forgetfulness, declining school performance, behavioral changes, headaches and/or decreased vision, and one case of denervation of the muscles of the torso resulting in a primary complaint of “increasing abdominal girth.” It was enough to scare the most unflappable Islander. Maybe Merlot’s owner was right. Maybe it was time to move. Or maybe Spielberg could come back and make a new movie called “Ticks” so we could promote and market our annual Island Tickfest as a tourist event. |
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