A Veterinarian’s Humility Is Just As Important As His/Her Competence

photocredit: http://www.ct.gov/dph/cwp/view.asp?a=3143&q=388948

My main area of expertise in my career has been dogs and cats with a smattering of rabbits and small mammals.  Thus, when my trusted associate joined my practice in 2012, an excellent veterinarian who in addition to dogs and cats brought with him a strong background in exotics medicine – most notably ferrets – the dynamic of my practice suddenly changed.  We went from dogs and cats admixed with the occasional rabbit, guinea pig, gerbil, or hamster, to now having every manner of critter in our waiting room; including a lot of ferrets.

One of our most important ferret clients is a lady named Jenny, a person with a passion for these delightful creatures and runs a ferret rescue from her own home.  Although we get along very well, with many years of experience treating ferrets, Jenny almost always sees my associate; as she should.  However, with the number of ferrets she cares for, medical crises sometimes occur where I am her only option, as my associate is not in the hospital all of the time.  Holding Jenny and her efforts in high regard, I gladly will step in and do what I can during these circumstances, utilizing the best of my ability to interpret physical examination and diagnostics (many of which share strong similarities to dogs and cats), while having the HUMILITY to rely on invaluable feedback from Jenny, a person who in addition to being very intelligent, has life long experience caring for ferrets.  Together, Jenny and I work through these cases with mutual respect and humility, and as a result, my comfort level and expertise with ferrets continues to increase as the result of our combined effort.

Humility is not just important for species or branches of medicine a veterinarian may not have extensive experience with, but extends to all facets of a veterinarian’s dynamic, including a willingness to consider feedback from owners, technicians, and fellow veterinarians.  I cannot tell you how often I have amended a diagnostic or treatment course based on feedback I have gotten from a particularly knowledgeable clients, technicians, or from feedback I have gotten from veterinary colleagues.

All too often, veterinarians and physicians alike take questioning of their recommendations or feedback from owners and co-workers as insulting, or a questioning of their competence.  This kind of attitude and stance not only upsets the doctor-patient-client relationship, but also may serve to alienate co-workers that are invaluable contributors to patient care.  Most importantly, it may cause a veterinarian to dismiss valuable feedback that may lead to a reduced standard of care.

Let us not confuse humility with lack of confidence.  In fact, it is quite the opposite.  In my experience, veterinarians that exhibit the most humility are the ones that tend to have the most confidence and competence.  They know that they are good at their craft, but also recognize that they are human and therefore not perfect, and may benefit from feedback from others, including non-medically trained clients.

Clients are commonly way off base with their assumptions or preconceived notions they have about a case, these days most commonly emanating from erroneous information gathered from the internet.  But that is okay; as paying customers of my practice and people who must advocate for their furry friends who have no voice, it is their prerogative to be heard respectfully.  If their sentiments are not something I agree with, I politely explain why I opine differently from a physiological, medical, or research based perspective.  My clients are always assured that they may feel free to ask questions, have an opinion, and know that they will never be dismissed.

However, humility must be a two way street.  Many an owner, who may have a human medical background or experience as breeder, groomer, etc., has been guilty of at least giving the impression that they may know more than their attending veterinarian.  Situations such as these not only lead to frustration on the part of the veterinarian, but also may adversely affect patient care.  Clients that close themselves off to the recommendations of a veterinarian because of their own lack of humility, often decline important diagnostics or treatment that the patient would likely be benefitted from.

Thus, be selective in choosing your veterinarian who toes the line of having optimal competence, while exhibiting humility.  However, always remember that respect is a two way street and that your own humility must be returned in kind for you and your pet to enjoy optimal results and patient care.

Dr. Roger Welton is the President of Maybeck Animal Hospital in West Melbourne, FL, Chief Editor of the Veterinary Advice and Information Website, Web-DVM, and founder/CEO of Dr. Roger’s Holistic Veterinary Care.

The Anti-Vaccine Movement Is Spreading To Pet Owners

photocredit: http://novapetsboarding.com/boarding/whynova.html

I have written about this topic before, but the recent outbreak of measles in children as the result of anti-vaccine movement for children recently making headlines has brought the issue front and center once again.  What unfortunately did not make headlines, was the deadly canine distemper outbreak that infected 200 plus dogs in Texas in late 2014; one that many veterinarians in Texas feel resulted from the same mindset that is now spreading to pet owners.  To be sure, I most certainly have seen an increase in pet owners choosing to opt out of important immunizations for their pets, so it is not surprising that it is occurring in other areas of the country.

Like measles in people, canine distemper was once a very rare disease that is making a resurgence in the United States because of the same anti-vaccine sentiments that are now permeating the pet world.  Although there is no scientific evidence to back the claims of an increase in allergies, cancer, and other diseases as the result of immunizations, a number of people are choosing to believe unsubstantiated rhetoric over sound medical and scientific evidence…and putting not only their own pets, but community pets at risk as well.  Some even go so far as to state that veterinarians willfully unnecessarily vaccinate pets to pad our bottom lines.

In my veterinary clinic, if an owner pays for a yearly examination and stool analysis for their cat, or exam, stool analysis, and heartworm screening for their dog; all immunizations are complementary.  Thus, whether a pet receives 0, 1, or 4 immunizations in a given well visit, it makes no difference financially to the pet owner or to my clinic’s revenue.  Yet just last week, the owner of a dachshund declined a leptospirosis vaccine for her dog on the grounds that the leptospirosis vaccine kills dachshunds.

I have just recently written about leptospirosis being a deadly disease that is on the rise in my area, which I shared with the aforementioned owner.  I also informed her that there is neither evidence in the veterinary scientific literature or among the hundreds of dachshunds that I immunize for leptospirosis per year with no adverse reaction to the vaccine, which even suggests any increase in reactions to the vaccine in the breed, let alone the vaccine being deadly.  What is deadly are the liver and kidney failure and 50 percent mortality rate that results when a dog becomes infected with leptospirosis, not to mention the risk it poses to people and other animals; as any mammalian species is capable of contracting leptospirosis.

Nonetheless, the dachshund owner was un-phased by my assertions, convinced by non-medically trained internet friends of hers in a dachshund forum that the leptospirosis vaccine kills dachshunds.  From the perspective of a veterinary practitioner with 13 years’ experience and knows better, visits like this are frustrating beyond comprehension, especially when I have diagnosed 2 cases of leptospirosis in the past month, one of which died from the disease despite aggressive therapy!

Both veterinarians and pediatricians are not in the business of knowingly harming our patients, but instead make our immunization recommendations based on risk and well established protocols that have resulted from years of epidemiological data and research.  The anti-vaccine movement is as misguided as it is irresponsible and based on nonsensical assumptions that carry no scientific proof.  It is as inappropriate and dangerous in veterinary medicine as it is human medicine.

Dr. Roger Welton is the President of Maybeck Animal Hospital in West Melbourne, FL, Chief Editor of the Veterinary Advice and Information Website, Web-DVM, and founder/CEO of Dr. Roger’s Holistic Veterinary Care.

Urban Sprawl Is Making Preventative Pet Well Care Increasingly Important

photocredit: http://www.statesymbolsusa.org/North_Carolina/mammal_graysquirrel.html

I started my veterinary career in a very densely populated suburb on the North Shore of Long Island, NY, called Huntington.  In that environment, the hospital I worked in saw several canine cases of a bacterial disease called Leptospirosis, which is transmitted primarily via the urine of its most common carrier, the squirrel.  The bacteria are excreted through the urine of infected squirrels, and then have a knack for persisting in the environment in fresh, standing water (lakes, ponds, puddles, etc.).  Thus at the practice I worked at in Huntington, we administered the Leptospirosis immunization to dogs with few exceptions, as a core immunization.

As I was preparing to move to Florida in 2004, a state known for its fresh water marshy landscape and prevalence of large puddles, drainage ditches and retention ponds, I thought that I was going to be seeing a much greater number of Leptospirosis cases.  As I took over the practice I purchased, to my virtual disbelief, I learned that my predecessor was not regularly immunizing for Leptospirosis.  She informed me that she never saw any cases of it.

This made no sense to me, as the environment here in Florida would seem much more conducive to persistence of Leptospirosis bacteria in the environment than it would in Long Island where I saw cases all the time.  However, as I engaged in the local veterinary community, I learned that many other veterinarians had not observed Leptospirosis with any significance either.  Thus, for many years, I did not administer Leptospirosis regularly to dogs as a core vaccine.

Around 2011, my area started seeing a spike in Leptospirosis cases in dogs.  This is a particularly troubling development given its high mortality rate in dogs, as well as its potential to infect people.  That trend has continued with the disease remaining steadily on the rise as evidenced by the fact that I have personally seen 2 cases just in the past month.  Thus, most area veterinarians, me included, are now recommending Leptospirosis as a core immunization, now recognized as a disease significantly endemic to this region.

So what changed?  Why the sudden rise of disease?  Consider this: during the same time period that I have observed more cases of Leptospirosis in dogs, I have also observed a sharp increase in cases of intestinal parasites diagnosed on routine stool analysis.  It is a simple deduction to reflect on what parasites and Leptospirosis have in common: wild animal reservoirs.

There has been a construction boom in the Florida Space Coast where I live and practice, that started in late 1990s, slowed down temporarily by the Great Recession in 2008, and then resumed full steam around 2011.  As the urban sprawl continues to encroach into former conversation areas, marshlands, and cattle ranch lands that were home to countless wildlife species; the wild animals are transitioning into a suburban existence.  Just yesterday evening, I saw a Bobcat on the edge of the school field where my son had just finished up lacrosse practice.

Bobcats and other wildlife carry diseases and parasites that our pets can catch, making preventative pet health care increasingly important for the safety of not only family pets, but the human family members that can catch disease like Leptospirosis from household pets.

While urban sprawl and its aftermath happened in Long Island a long time ago, it is happening here and in many other areas of the country.  With wildlife increasingly living among us, preventative well care for household pets has never been more essential.

Dr. Roger Welton is the President of Maybeck Animal Hospital in West Melbourne, FL, Chief Editor of the Veterinary Advice and Information Website, Web-DVM, and founder/CEO of Dr. Roger’s Holistic Veterinary Care.

Puppy Mills And Pet Store Puppies Will Continue to Thrive…As Long As A Market For Them Remains

photocredit: http://lonestarshihtzurescue.com/

A very kind retirement age client of my veterinary clinic of many years brought her new puppy in to see me a few months ago.  She was beaming with pride with her new little Shih Tzu, as he was the cutest little fur ball and had the personality to match.  When I asked where she obtained the puppy, she replied with a bit of awkwardness that she had purchased the puppy from the pet store in the mall just down the road, a notorious puppy mill client, and peddler of expensive, sick dogs.

She could not help herself, she told me, as she had seen the puppy in a cage as she looked in while walking past the pet store, while at the mall shopping for things other than a new family pet.  The little puppy reminded her of a past beloved dog who had long since passed.  She knew the source of these dogs and the reputation of the store, but proceeded to pay an inordinate sum for the puppy nonetheless.   From her point of view, she was rescuing the puppy from its caged existence or from possibly being bought impulsively by people who may lose interest and neglect or give up the dog at a later time.

I could certainly understand this lady’s perspective, as I am heartbroken when I see puppies segregated in cages, creatures that crave and long for their mother and litter mates, who by their nature are social animals needing social interaction for their mental health and development.  They have been taken from their mother and litter, shipped, and put in cages until such a time that a person may choose to buy them.  One would have to be cold hearted to not be affected by that.  That is why I do not even look when I pass pet stores that sell puppies and kittens.

Knowing what a good person my client was, I did not want to make her feel horrible in the midst of her joy with her new friend, but I did have to let her know that the purchase of these puppies keeps pet stores and the puppy mills that supply them in business.  As long as they are in demand, the cycle will never end.  And while the puppy may have gotten a great home, its little mates may not have, and the mother is left to continue churning out litter after litter with no regard or compassion for her; rotting in a cage likely in filth and in abysmal conditions until the day comes that she no longer is able to bear puppies.

I also reminded her of the poorly ethical breeding practices of puppy mills, commonly leading to congenital defects and predisposition to any number of chronic congenital diseases.  I told her that I would not lay on any more guilt, let her enjoy her puppy from here on out, and cross fingers that he would turn out to be healthy.

Right out of the gate, I found an umbilical hernia on the puppy and also found that he was infected with two worm parasites and two protozoal parasites.  We successfully treated the puppy for the parasites, but by puppy visit number 2, I discovered a grade 2 out of 6 heart murmur (heart murmurs are graded on a scale of 1-6 with 1 being the least intense, 6 being the most…intensity of murmur often correlates with the degree of heart defect).  By the fourth and final visit, the murmur had progressed to grade 4.  The rapid progression concerned me, as did the owner’s observation that the puppy was getting fatigued by what was before, a very tolerable level of exercise.

Given this, as well as the fact that we needed to repair his hernia as well as neuter him if he remained stable enough under anesthesia, we performed a cardiac work-up on him (chest  x-rays, cardiac ultrasound, and EKG) and discovered that he actually had two congenital heart defects: pulmonic valve stenosis and aortic valve stenosis.  These defects would most certainly shorten his life, and necessitated that he begin cardiac medication at only 6 months of age.

Luckily, able to take necessary precautions knowing the exact condition of the heart, the hernia repair and neuter proceeded without incident.  My client still does not regret her decision; however, she better understands the nature of pet stores, puppy mills, and the industry she supported, as her experience really hit home.  She feels that she was meant to adopt this puppy, as many an impulse buyer may not have had the puppy worked up properly, nor have been willing to commit to what will be lifelong medical care for his heart disease.  Many an impulse buyer may have even returned the puppy under the Florida puppy lemon law, after which the pet store most assuredly would have had the puppy destroyed.

She also plans to share her story with anyone who will listen, to shout from the roof tops and spread the word about pet stores that sell puppies, and what results when people choose to purchase from them.  Who knows, perhaps in the grand scheme of the things, my client was meant to have this puppy.

At any rate I shared her and her puppy’s story so that I can make clear that puppy mills and the societal ills and cruelty they peddle, exist because there is clearly a market that supports them.  Until that market diminishes, they will continue to exist.  We can complain, feel sadness, express outrage all we want; but when it comes to puppy mills and pet stores that sell puppies, the blame for their persistence is all ours.

Dr. Roger Welton is the President of Maybeck Animal Hospital in West Melbourne, FL, Chief Editor of the Veterinary Advice and Information Website, Web-DVM, and founder/CEO of Dr. Roger’s Holistic Veterinary Care.

Sterilization of Large/Giant Breed Dogs Before Adulthood And Its Effect On Bone/Joint Development

photocredit: http://www.gopetplan.com/

Although veterinarians and the orthopedic foundation for pets have not observed developmental orthopedic (bone, muscle, and joint) abnormalities, the notion that neutering large to giant breed males or spaying females before they reach sexual maturity leads to increased ligament injuries and the development of hip dysplasia, has been prevalent in breed forums, among breeders, groomers, etc.  Despite there being no evidence to support this claim outside of innuendo and assumptions, the rhetoric has nonetheless persisted and now commonly ends up in my examination room.

To make matters worse, a study conducted by the veterinary college of UC Davis in 2013, kind of lent some credence to the large breed pre-adult anti-sterilization movement.  I state “kind of,” because the study only concluded a very small, virtually nominal increase in the incidence of orthopedic problems in dogs sterilized less than 6 months of age.  For dogs sterilized over 6 months of age, no appreciable increase in orthopedic disease was observed.   For even dogs that were sterilized prior to 6 months of age, no deficiencies in if reaching full growth potential were noted in the UC Davis or any other study that has preceded it.

Consequently, while many in the large breed pre-adult anti-sterilization movement may see the UC Davis study as vindication of their sentiments, veterinarians view it as proof that it may not be a good idea to spay/neuter a large breed dog before 6 months of age; something that the majority of us were not recommending anyway.  It also proves that waiting until adulthood and/or sexual maturity to sterilize a large/giant breed dog does absolutely nothing to decrease the incidence of orthopedic deformities or injuries if done at or about 6 months of age.   On other hand, waiting until sexual maturity to sterilize may accomplish the following in male and female dogs, respectively:

–          Males

• Development of aggression, marking, and other unwanted “male” behavior that may not resolve with neuter after sexual maturity
• Development of a thickening of the tail base tissue called stud tail, which commonly leads to ski infections.
• Growth of benign but unsightly and/or unhygienic tumors around anal region, called perianal adenomas.
• Increased incidence of infection of the penis and skin sheath that covers it (called balanoposthitis).
• Increased incidence of prostate infections and prostate enlargement.

–          Females

• Increased incidence of mammary cancer.
• Predisposition to life threatening infection of the uterus called pyometra.
• Increased tendency for nervous or aggressive demeanor.
• Predisposition to infections of the mammary gland (called mastitis).

In conclusion, there is absolutely no increased risk of orthopedic disease in large to giant breed dogs before adulthood if done after 6 months of age.  On the other hand, waiting until adulthood to have these pets sterilized can lead to number of problems, not to mention making the procedures at that time a greater risk and recovery slower (reproductive organs after sexual maturity of great blood supply and are larger, predisposing to more bleeding, while necessitating larger incisions).

Dr. Roger Welton is a practicing veterinarian and well regarded media personality throughout a number of subjects and platforms.  In addition to being passionate about integrative veterinary medicine for which he is a nationally renowned expert, Dr. Welton was also an accomplished college lacrosse player and remains to this day very involved in the sport.  He is president of Maybeck Animal Hospital , runs the successful veterinary/animal health  blogs Web-DVM and Dr. Roger’s Holistic Veterinary Care, and fulfills his passion for lacrosse through his lacrosse and sport blog, The Creator’s Game.

A Key Strategy To Prevent Kidney Failure In Dogs And Cats

(photocredit: http://isabellasnow.hubpages.com/hub/Chronic-Kidney-Failure-Cats)

Degenerative chronic kidney failure is the number one cause of death in cats and the number two cause of death in dogs.  Given these statistics, we should really be looking to best practices to help reduce the incidence of this disease in both species.  While there are clearly genetic links to the development of canine and feline kidney failure that cannot be helped outside of ethical and responsible breeding, there is one very important trigger that statistically increases its occurrence, and speeds its progression: dental disease.

While the mechanism is not really understood, there is no debate that the incidence of kidney failure from degenerative disease is significantly higher in dogs and cats that live with a moderate to severe level of periodontal disease and gingivitis.  According to UC San Francisco College of Medicine, the same phenomenon is seen in people, prompting researchers there to look closely at the link of kidney failure and dental disease in people.  Although the mechanism of the higher incidence of kidney failure in patients with chronic periodontal disease is not yet directly established from a pathophysiological standpoint, the link of periodontal disease and the incidence of heart disease in dogs and cats long has been.

This cardiac disease link may shed some light on the periodontal disease and how it affects other organ systems.  With regard to heart disease, increased levels of disease causing bacteria in the blood stream from the mouth of patients with chronic dental disease lead to inflammation of the blood vessels, heart valves, and heart chambers.  This causes degenerative changes at the cellular and tissue level that lead to physical damage over time.

It is currently theorized by many researchers and veterinarians that a similar cellular affect from blood born bacteria as the result of chronic periodontal disease and gingivitis occurs in kidney tissues.  Specifically, microscopic filtration units in the kidneys called nephrons, responsible for detoxification of the blood and selective elimination of nutrients and waste may be uniquely affected.  It is the gradual loss of these units that lead to kidney failure, so it would seem that bacteria in the blood stream as the result of a diseased mouth adversely affecting nephrons as it does the tissue of the tissues of the circulatory system, would be the likely mechanism.

While much research stills needs to be done to establish the direct link of periodontal disease and gingivitis to the incidence of kidney failure in dogs and cats, the increased incidence is indisputable.  The data is clear that bad teeth and infected gums significantly increase the incidence of the number one killer of cats and the number two killer of dogs.   This is yet another important reason to take your pet’s dental health very seriously.

Dr. Roger Welton is the President of Maybeck Animal Hospital in West Melbourne, FL, Chief Editor of the Veterinary Advice and Information Website, Web-DVM, and founder/CEO of Dr. Roger’s Holistic Veterinary Care.

Preventative Pet Health Care Series: The Stool Analysis, Protecting Your Pets and Your Families!

I conclude my preventative pet health care series with one of the most important topics, the stool analysis.  One in four dogs lives with a preventable parasite.  One in three cats lives with a preventable parasite.  These parasites not only adversely affect your pet’s health, reduce quality and length of life, but also pose a serious threat to your human family.

Perhaps the most common worm parasite seen in dogs and cats (round worm) can reach a larval stage of development in young children that can migrate into the eyes and cause irreversible blindness, through a phenomenon known as ocular larval migrans.   Hookworm, a common canine parasite, has larval stages that can migrate into human skin, most commonly through the bottom of bare feet, and cause rashes as they leave track through the deep layers of skin of infected people.

These are just a couple examples of parasites that not only have the potential to harm your pets, but also the human members of your family, yet the stool analysis is one of the most commonly owner declined aspects of the yearly wellness visit.  Also, when pet owners think of parasites that we see in dogs and cats, they often just think of worm parasites, but many parasites are not worms.  Giardia and coccidia, for example, are protozoal parasites.

I cannot stress the importance of regular stool analysis enough.  My recommendation is to administer general deworming medication to all puppies at 3 and 5 weeks of age, then run stool analysis for the first and last puppy/kitten well visits (6 and 16 weeks, or 8 and 16 weeks; depending on which protocol a veterinarian may follow).  Thereafter, a stool analysis should be run at least yearly for each pet in the home.  Given the risk for young children, I advise a stool analysis done twice yearly for each pet in the home, for households that have children 5 years of age or younger.

Dr. Roger Welton is the President of Maybeck Animal Hospital in West Melbourne, FL, Chief Editor of the Veterinary Advice and Information Website, Web-DVM, and founder/CEO of Dr. Roger’s Holistic Veterinary Care.

Preventative Pet Health Care Series: Feline Leukemia – Core or Non-Core Vaccine?

photocredit: http://bestfriends.org/

Feline leukemia is caused by a retrovirus for which there is no cure once a cat is infected.  Many cats may contract the virus and be latent carriers that do not show outward signs of disease for months to years, potentially spreading the disease to other cats during this time, while themselves not showing any signs of disease.   Most feline leukemia positive cats die within 3 years of infection.

Feline leukemia virus can be transmitted in three ways.

1.)    Saliva of an infected cat coming in contact with eye, mouth, nose, and genital membranes of non-infected cats via licking or biting.

2.)    Passing of blood into non-infected cats as commonly occurs during coitus or fights.

3.)    Mother to fetus during pregnancy.

Feline leukemia primarily infects the bone marrow of cats, leading to deficiencies in blood cells that the bone marrow is responsible for synthesizing.  This commonly leads to anemia and low white blood cells.  The latter is the feline immune system’s first line of defense, thus feline leukemia commonly leads to opportunistic infections and cancers (much like HIV does in people).   Direct degenerative disease can occur in any tissue or organ system that the virus subsequently invades.

There is no cure for feline leukemia, with treatment generally aimed at management of disease.  Once in full blown disease, management commonly becomes expensive and of limited benefit.  Management may include chemotherapy, interferon, Protein A, steroids, and supportive measures.

Prevention

All new cats with an unknown medical history or who have never been retroviral tested before should for feline leukemia prior to introduction to an environment with non-infected cats.   Any household with at least one cat that has access to outside should be immunized yearly with the feline leukemia vaccine.  This would make feline leukemia a core vaccine for cats that have access to outdoors (and therefore access to other cats that kmay be feline leukemia positive).

 Some veterinarians do not consider feline leukemia a core vaccine for indoor cats, since they feel that strictly indoor cats with no access to other cats are not candidates for the vaccine, carrying very little risk.  Other veterinarians consider feline leukemia a core vaccine for all cats given lack of compliance of many feline owners to engage in proper testing prior to adding new cats to a household; and many cats having a tendency to try to escape outdoors.

I can understand both stances.  My position is a bit of a hybrid of the two.  With kittens being the most susceptible to disease, as well as taking into consideration feline escape tendencies and feline leukemia screening compliance issues; even for kittens slated to be indoor cats with relatively low risk of disease, it is advisable to administer the feline leukemia vaccine at 9 weeks, 12 weeks, then boostered one time one year later.  From my view, this middle ground imparts some immunity to account for possible accidental/incidental exposure to feline leukemia virus, while avoiding over-vaccination for generally low risk feline patients.

Dr. Roger Welton is the President of Maybeck Animal Hospital in West Melbourne, FL, Chief Editor of the Veterinary Advice and Information Website, Web-DVM, and founder/CEO of Dr. Roger’s Holistic Veterinary Care.

Preventative Pet Health Care Series: Non-Core Vaccine – Lyme Disease in Dogs

In our last stop for canine non-core vaccines (and canine vaccines period for that matter) in my preventative pet health care series, today I discuss Lyme Disease in dogs.  Lyme disease’s causative agent is a bacteria called Borrelia Burgdorferi.  Borrelia is one of a classification of bacteria called rickettsial bacteria; that are unique in that they utilize ticks as their vector to complete their lifecycle and inoculated into their definitive host.  This type of transmission is known as vector transmission.

Specifically, Borrelia is picked up following feeding on an infected dog by a tick species known as Ixodes, commonly known as the “deer tick.”  Once inside the tick, the bacteria remain in its gut and are then able to infect other dogs that the tick feeds on.  Dogs may begin to show signs of disease within weeks to months of the initial tick transmission, signs which include: high fever, anorexia, listlessness, weakness, and muscle/joint pain sometimes in one or more limbs.

Easily recognized, diagnosed, and successfully treated most of the time in areas endemic for Lyme Disease, with veterinarians frequently encountering the disease and able to effectively recognize and treat it, mortality rate for Lyme Disease is generally low.  A rare complication where kidney disease may occur due to the formation of antibody complexes against Lyme that damage the filtration units of the kidneys; may greatly reduce short and long term survival rates, but luckily this is not common.

Treatment generally begins with supportive care with IV fluids and anti-inflammatory medication to reduce fever and prevent dehydration, while giving the time for the patient to respond to the drug of choice, doxycycline.  Dogs will typically respond profoundly to doxycycline within 1-2 days, often requiring just a short hospital stay, with the remainder of ongoing treatment being completed on an outpatient basis.  Most confirmed canine Lyme Disease cases will be treated with doxycycline for 3-4 weeks.

To Vaccinate or Not to Vaccinate?

Lyme Disease has several effective and safe immunization options against Lyme Disease.  Advocates against vaccinating think that routine vaccination is unnecessary for a disease that the majority of dogs will recover from.  Patients vaccinated against Lyme also requires a special type  of (and more expensive) blood test called PCR for suspect Lyme cases, as standard Lyme antibody tests are not accurate in Lyme vaccinated dogs (a vaccinated dog will come up positive for Lyme antibody for at least one year).

On the other hand, since illness can be severe and debilitating for the dog, expensive and stressful for the owner, many would state that it makes no sense to opt against vaccination to prevent disease in the first place.  In many Lyme Disease hot beds where deer tick populations are very high, it seems that it is less a question of if one’s dog will be exposed to Lyme Disease, but when.

I fall somewhere in the middle, having started my career in the Lyme hotbed of the North Shore of Long Island, NY, where I diagnosed 5-7 cases a month; but for the past 11 years, have practiced on the Florida Space Coast, where Lyme Disease is quite rare (2 confirmed cases in 11 years).  In Long Island, I was a strong proponent of immunization against Lyme Disease, whereas here in Central Florida where disease rates are very low, I do not.   For dogs of “snow birds” that spend winters in my area, but return to a Lyme hotbed for the spring and summer months, I still recommend yearly immunization against the disease.

There is little debate that tick prevention is a good idea when it comes to canine Lyme Disease prevention.  With 48 hours of feeding on a dog required for a tick to successfully transmit Lyme Disease to a canine host, picking the tick off or killing the tick with a veterinary grade tick preventive within this time period will effectively prevent disease.  Thus, regular administration of a veterinary grade tick preventative and vigilant physical inspection for ticks are common sense measures against Lyme Disease infection in dogs.

Dr. Roger Welton is the President of Maybeck Animal Hospital in West Melbourne, FL, Chief Editor of the Veterinary Advice and Information Website, Web-DVM, and founder/CEO of Dr. Roger’s Holistic Veterinary Care.

Preventative Pet Health Care Series – Non-Core Vaccine: Leptospirosis

photo credit: http://galleryhip.com/dog-drinking-from-puddle.html

Leptospirosis is a bacterial disease that attacks the canine liver and kidneys.  While it has an affinity for canines that are considered among the highest risk with regard to both morbidity and mortality in companion animal species, it is a zoonotic disease; that is, it has the ability to infect any mammalian species, including people.  Leptospirosis is unique in that it is primarily transmitted via the urine of infected squirrels (which are the primary reservoir for disease), and, it has the ability to survive for extended periods of time in fresh, standing water (lakes, ponds, puddles).  Thus, anywhere there is a local squirrel population and a dog may have access to contact with fresh, standing water; that dog is at risk for leptospirosis.

Clinically, leptospirosis invades the liver and kidneys of infected dogs and leads to liver and kidney failure.  Even with aggressive hospitalization that includes treatment with intravenous fluids, antibiotics, anti-nausea medication and GI protectants, and fresh, frozen plasma, leptospirosis carries very high mortality rates approaching 50%.  Given its potential to infect other animals and people, leptospirosis is especially concerning.

Leptospirosis is still considered a non-core vaccine, but realistically, there are few places in the US that are devoid of squirrels and/or fresh, standing water.  Even in arid climates, puddles created by a sprinkler system, garden hose, or washing a car, etc., still constitute fresh, standing water.  Few areas have zero wild squirrel populations.

Leptospirosis has an effective vaccine commercially available.  The vaccine still carries some negative press in certain canine enthusiast circles lingering from a leptospirosis vaccine put out by Fort Dodge Animal Health in the early 2000’s that carried a higher rate of adverse reaction in comparison to other canine immunizations.   Since then, the vaccine has been perfected and made quite safe by several animal pharmaceuticals for over a decade, and Fort Dodge Animal Health no longer exists.  Still, some pet owners are gun shy about the vaccine, and for some, no amount of convincing that the risk of disease far outweighs the risk of immunization against it will change their minds.

For the majority of dog owners that comply with leptospirosis immunization when there is a clear and present risk of disease based on geography/landscape, the vaccine is administered at 9 weeks, boostered at 12 weeks; then administered once yearly thereafter.

Dr. Roger Welton is the President of Maybeck Animal Hospital in West Melbourne, FL, Chief Editor of the Veterinary Advice and Information Website, Web-DVM, and founder/CEO of Dr. Roger’s Holistic Veterinary Care.