Clean Run - June 2018 - 37

patients displayed their joint swelling during winter. This shows the lag
phase of Lyme disease. A joint tap of
each patient was positive for Borrelia
burgdorferi. Both patients responded well to antibiotics and physical
therapy. This stresses the importance
of testing throughout the year.2
*	 The final example was a 19-year old
male who had an ACL reconstruction. Three months post-surgery he
had severe joint swelling in his operated knee. He did not have a fever on
presentation, but joint fluid was again
positive for Lyme disease. Surgery
showed that the repair was intact,
and he returned to full function and
limb use after a course of antibiotics
and physical therapy.3

The same laboratory did show very promising results for one of the Lyme vaccines.
In dogs that were negative for Lyme, vaccinated, and then exposed to Lyme disease,
they did not develop the lesions seen in the joint capsule (synovium). All dogs in the
study that were not vaccinated did develop the changes in their joint capsule.5

So What Do We Do?
The age-old adage that "an ounce of prevention is better than a pound of cure" holds
true for tick-borne diseases. Vaccinating months before exposure and using year
round flea and tick prevention (as recommended by your veterinarian) is crucial.
For our canine athletes, our practice recommends serial blood titers. This utilizes an
outside laboratory to look for changes in the immune response of your dog to the different tick-borne diseases and tests for RMSF. The in-house tests can be challenging
for achieving a diagnosis in these chronic cases, as they do not test for all the diseases,
or show the dog's immune response.
A full physical examination, gait analysis, and advanced diagnostic techniques (musculoskeletal ultrasound, MRI, arthroscopy) and tick titers will allow us to further understand and treat your canine athlete and have them back at peak performance.
To learn more about tick-borne diseases we recommend the following:

Those are just a few examples from the
human literature. To date, we do not have
any published research on this occurring
in dogs. However, we do have anecdotal
and case reports in veterinary medicine.

*	 An interactive map of prevalence of tick-borne diseases: http://www.dogsandticks.
com/diseases_in_your_area.php

More importantly, we do have published
research showing that Lyme disease can
cause changes in the joint capsule similar to that seen in people. This method
of testing was 88.2% sensitive and 100%
specific. Unfortunately, it does require
biopsy of the joint capsule, and at this
time is only applicable to research. It
does give us a baseline to understand
changes in the joint, but cannot be used
in clinical practice. Currently, we do not
fully understand the clinical implications
of these lesions. However, based off
of the human research to date, we can
hypothesize that similar events occur
in dogs, as shown in the case of Flash.
The study also looked at the method of
determining Lyme disease in the three
human studies mentioned above (Polymerase Chain Reaction for the DNA of
Borrelia), but that test is not effective for
detection of Lyme disease in dogs.4

Research References

*	 A current list of tick preventatives for your dog: https://www.vin.com/apputil/image/handler.ashx?docid=8400436
1) Coulon CL, Landin D. Lyme disease as an underlying cause of supraspinatus tendinopathy in an overhead athlete. Phys Ther. 2012;92:740 -747.
2) Baima, Jennifer and Woo, Lauren, "Two Cases of Lyme Arthritis in Winter In New England: A Case Series" (2017). Orthopedics and Physical Rehabilitation Publications and
Presentations. 181.
3) Matthew R. M, Vishnu C. P, Omkar B, Robin G. Septic Lyme Arthritis after Recent Anterior
Cruciate Ligament Reconstruction. Ortho & Rheum Open Access J. 2016; 2(3): 555587.
DOI: 10.19080/OROAJ.2016.02.555587
4) Susta L, Uhl, EW, Grosenbaugh DA, Krimer PM, Synovial Lesions in Experimental Canine
Lyme Borreliosis, Veterinary Pathology 49(3) 453-461.
5) Grosenbaugh DA, Rissi DR, Krimer PM, Demonstration of the ability of a canine Lyme
vaccine to reduce the incidence of histological synovial lesions following experimentally-induced canine Lyme borreliosis, Veterinary Immunology and Immunopathology,
2016 Nov 1;180:29-33.

Online References
1) https://www.cdc.gov/lyme/index.html
2) https://www.avma.org/public/Health/Pages/Outdoor-Enthusiasts-Precautions.
aspx#ehrlichiosis
3) http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=1588

D

Dr. Matt Brunke, a native New Yorker, received his B.S. in Animal Science from Cornell in 2000, and his DVM from Ross University in 2004. he has been
certified in rehabilitation since 2008, and recently completed his career path candidacy and passed boards to be a Diplomate of the American College of
Veterinary Sports Medicine and Rehabilitation. He is a fellow at VOSM in Annapolis Junction, Maryland. Visit vosm.com for more information on Dr. Brunke.
Dr. Nicole Chun was born and raised in Hawaii. She received her Bachelor of Science in Animal Sciences from Oregon State University in 2011 before graduating from
veterinary school in 2015 from the University of California, Davis. She then completed a rotating internship in medicine and surgery at BluePearl Veterinary Partners in
Tampa, Florida, and is now pursuing a residency at Veterinary Orthopedic and Sports Medicine Group (VOSM) with the American College of Veterinary Sports Medicine
and Rehabilitation. Dr. Chun passed her certification in canine rehabilitation (CCRP) in December 2017 with the University of Tennessee, and is currently performing
research on platelet-rich plasma in cats while at VOSM. Visit vosm.com for more information on Dr. Chun.
June 18 | Clean Run

37


http://www.dogsandticks.com/diseases_in_your_area.php http://www.dogsandticks.com/diseases_in_your_area.php https://www.vin.com/apputil/image/handler.ashx?docid=8400436 https://www.vin.com/apputil/image/handler.ashx?docid=8400436 https://www.cdc.gov/lyme/index.html https://www.avma.org/public/Health/Pages/Outdoor-Enthusiasts-Precautions.aspx#ehrlichiosis https://www.avma.org/public/Health/Pages/Outdoor-Enthusiasts-Precautions.aspx#ehrlichiosis http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=1588 http://vosm.com http://vosm.com

Table of Contents for the Digital Edition of Clean Run - June 2018

Contents
Clean Run - June 2018 - Cover1
Clean Run - June 2018 - Cover2
Clean Run - June 2018 - Contents
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Clean Run - June 2018 - Cover3
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