Lyme Disease in Dogs: Does Positive Mean Curable?

Lyme disease in dogs is a common tickborne disease in the U.S. Where you live determines how at-risk you and your pet are for this disease. Carried by the black-legged tick (deer tick), Ixodes species, it is transmitted to mammals. The life cycle involves deer, but you do not have to have deer anywhere near you to have this tick or Lyme disease in your area. If your pet is exposed to ticks (and any diseases they carry), so are you, and all family members should take precautions against bites. Recognizing signs of tickborne diseases, like Lyme, early and seeking care for your pet is vital, though prevention is supreme.

Lyme disease can be challenging to treat and doesn’t provide lifetime immunity, so repeat infections happen. However, understanding the disease, how it is transmitted, and being able to recognize symptoms in dogs can help lessen your dog’s chances of illness.

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Understanding Lyme disease in dogs

Canine Lyme disease is a considerable contributor to dog illness in the U.S. However, the disease is easily preventable with newer flea and tick products, vaccination, and careful attention to lawn care and environmental awareness. Understanding the disease, its transmission, and what to look for in your dog may help your pet prevent complications and get care quickly.

Transmission of Lyme disease

Can Lyme disease in dogs be completely cured? The simple answer is yes, with a few caveats if treated early enough and before complications arise. But first, let's understand a bit more about Lyme to understand why this is the case.

The majority of cases of Lyme disease in dogs are in the Northeastern United States, from Maine to Virginia. However, the disease is nationwide. Tickborne illness is happening all year round and is no longer restricted to specific months or seasons as climate changes impact the expansion of tick ranges. Any area that has ticks is at risk, though some are more at risk for Lyme, while others are at risk for other tickborne diseases. Still, the risk of disease exposure occurs all year round in most places. Unless your ground is frozen for two weeks or more at a time in winter, you can have ticks at any time of the year.

Considering that the disease is nationwide and any area may be at risk, where do ticks live specifically? This depends on the tick, but they can be on your pet, other animals, or in the grass, wooded areas/trees, shrub/wooded areas, and brush. Outdoor activities increase exposure, especially if hunting, hiking, camping, or gardening, but you can simply be walking in your backyard and be bitten by a tick.

Further, dogs can be infected by any stage of the tick (larva, nymph, adult), and the deer tick is minuscule. You won't see it likely with the naked eye until it has taken a meal (engorged). By then, the disease could already have been transmitted.

Some diseases in ticks can be transmitted as soon as 4–6 hours after the tick bites, while Lyme can take 24–48 hours. Still, the sooner a tick is removed, the better. But all it takes is for a tick carrying the Lyme bacteria, Borrelia burgdorferi, to bite your dog, take a blood meal, and take a little time for transmission.

Symptoms of Lyme disease in dogs

What symptoms of Lyme disease do veterinarians see in dogs? It's rare to get the bullseye tick bite on dogs, so a bright red circle isn't likely. Though this commonly indicates the presence of a tick bite and Lyme disease in people, it isn’t recognized as common or even used for diagnosis in dogs. With the fur, it would be missed even if it were present.

Most dogs with Lyme disease are asymptomatic, showing no signs at all, with only 5–10% of those infected ever developing symptoms. In most dogs, the body clears the infection on its own. However, dogs that do show clinical signs can develop them six weeks to five or six months after a tick bite.

For the 5-10% of dogs who do get sick, general symptoms of tick bites in dogs with Lyme disease include:

• Shifting leg lameness. One minute, the dog may seem lame on one leg, then another, or the dog may just be very stiff and hesitant to walk.
• Waxing and waning lameness (e.g., okay today, but lame tomorrow)
• Fever
• Lethargy/weakness/not wanting to walk/exercise
• Swollen joints (uncommon)
• Painful joints (more common than swollen)
• Decreased or no appetite
• Uveitis (inflammation within the eye)

A minimal subset of dogs with Lyme disease develop kidney symptoms. These may include increased drinking and urination, vomiting, diarrhea, weakness, and not eating, in addition to the symptoms listed above. Lyme disease causes an immune-mediated destruction (the body’s immune system) of a portion of the kidney(s) called the glomerulus, leading to glomerulonephritis. This causes damage and protein loss from the kidneys into the urine. Animals who do not receive treatment, and even those who do, can die from this complication of Lyme disease in dogs.

In people, Lyme disease can commonly cause neurologic, heart, or skin issues (bullseye). Neurological signs are uncommon in dogs with Lyme disease, and only rarely are there heart problems associated with Lyme (endocarditis).

Diagnosing Lyme disease in dogs

Lyme disease is relatively hard to diagnose in people. Lyme infection is more easily diagnosed in dogs, and most veterinarians can test for it right in their clinic. However, the in-clinic test and several laboratory tests will only be positive once the body’s immune system has had time to react (produces antibodies). This can take six weeks or more after the bite of a tick and disease transmission. In symptomatic dogs, a PCR test can be performed a bit earlier, which looks for active organisms.

You may hear your vet call the in-house test a snap test or 4Dx. If your dog is positive for Lyme disease, additional testing is recommended. This includes:

• CBC (complete blood count). This evaluates the red and white blood cells and checks for anemia and related factors.
• Chemistry. This will examine many things, including liver, kidney, and electrolyte values. This is critical because Lyme disease can (uncommonly) negatively impact the kidneys.
• Urinalysis. Your vet will ask you to, ideally, provide the first urine sample of the morning. Dogs don’t usually drink overnight; if their kidneys work well, their urine should be very concentrated. The concentration will be examined to determine if protein has spilled into the urine. If so, this could suggest kidney damage, and additional testing may be recommended.

Most dogs with Lyme have normal bloodwork and urine results. Many ask if it is necessary to run those tests. It is the owner's decision. Still, it's often unknown when the dog was bitten, so there is no way to know how much damage has been done. Therefore, it's best to ask your veterinarian to explain the necessity and benefits of the testing.

There are a few newer ways to evaluate antibody levels and differentiate between active infection (meaning symptoms are caused by disease) and chronic exposure, but these vary with each laboratory, and your veterinarian can discuss this more with you if needed.

Diagnostic costs can add up. If you have pet insurance and major medical or emergency coverage, Lyme disease should be covered. Accident and illness coverage plans may cover Lyme disease, assuming it is not a pre-existing condition and doesn't develop while in the waiting period. Some preventative insurance plans cover the Lyme vaccination and flea and tick preventatives, but not all plans do.

Further, routine screening for healthy pets for tickborne disease may not be covered by insurance plans, but testing in the case of pets with symptoms may be covered. Regardless, read your policy carefully, as each plan is different.

Treating Lyme disease in dogs

Lyme disease is readily treatable when caught early. Usually, treated dogs with symptoms do well and never relapse. However, if untreated or if renal or heart issues occur, it can be fatal. Bacteria may hide in tissues and cause disease later in life (recrudescence). Most dogs recover without incident. However, despite successful Lyme therapy, tests may stay positive indefinitely. Further, new infections are common and challenging to diagnose due to the lack of lifetime immunity.

Deciding to treat a positive dog

Treatment for Lyme disease in dogs depends on whether the dog is positive and has symptoms of disease, whether the kidney values are elevated, and whether protein is present in the urine.

There are two things to consider when deciding about treating Lyme disease.

1. Did your dog test positive? Yes or no, and on what test?
2. Is your dog clinical, meaning lame, sore, weak, not eating well, or has a fever?

If the answer is yes to both questions, then treatment is warranted. However, whether to treat a positive, non-clinical animal is less cut and dry. Based on consensus statements by the American College of Veterinary Internal Medicine and infectious disease specialists, many vets now recommend against treating every dog with no signs of disease. Treatment consists of an antibiotic. The primary antibiotic used to treat Lyme disease in dogs, doxycycline, and as with all medications, does have the risk of side effects.

Exposure vs. infection

It is valuable to understand the test for Lyme disease in dogs done in the vet clinic; if positive, it only means your dog was exposed. It doesn’t tell if the pet has an active disease. In the face of symptoms consistent with Lyme and a positive test, it must be assumed it's from Borrelia burgdorferi. If the dog responds to treatment, then it was likely the positive test and clinical signs supported that the dog had Lyme disease.

However, if a dog is positive, has no clinical signs, has normal liver and kidney values, and has no protein loss in the urine, the current evidence and proper antibiotic stewardship suggest the dog not be treated as 95% can clear the infection on their own without intervention.

Ultimately, it is up to the owner and the veterinarian to discuss whether to treat dogs who have no symptoms but are positive. The positive here means that better prevention strategies are needed.

How vets treat those who are positive and clinical

For dogs that test positive and have symptoms of Lyme disease, treatment might include:

• Antibiotics. Doxycycline is the most commonly used medication. Typically, a 30-day treatment is advised.
• Pain management. Dogs with Lyme can experience pain. The antibiotics usually start to work within 24–72 hours, but in the meantime, vets want pets to be comfortable. The most commonly used medication is a non-steroidal anti-inflammatory pain medication (NSAID) like Rimadyl®, Deramaxx®, or related medicines. Gabapentin, a different type of pain medication with some anti-anxiety properties, may be used as well, depending on your pet's level of pain.
• Exercise restrictions. While your dog is recovering from Lyme, minimize activity. They may start feeling better within 1–3 days, but they should remain calm and quiet for a few weeks to ensure a full recovery. Leash walk only to the bathroom and back (five minutes), minimize play, running, and jumping, and don’t permit running/playing with other dogs.
• Supportive care. For dogs with kidney complications, this is a potentially life-threatening illness, and these dogs need IV fluids, hospitalization, 24-hour care, and medications to protect the kidneys, in addition to pain meds (opioids often) and antibiotics.
• Sedation. If your dog is too hyper, wants to run, jump, and play, and won’t take it easy, talk to your veterinarian about sedative options to help keep the pet calm while recovering from Lyme disease.

Long-term effects and prognosis

The good news is that Lyme disease has a good prognosis for most dogs when caught early and treated correctly. Overall, the prognosis for dogs with clinical signs of Lyme disease, having no evidence of kidney damage, and receiving treatment early on for the disease is good. They usually make a full recovery. However, infection with this disease does not offer lifelong protection. This means that if your dog isn’t on a well-researched, good quality, effective flea/tick preventative every month, your dog can get sick with Lyme disease repeatedly.

Some evidence in people and animals suggests that some organisms may escape antimicrobial therapy, hide in tissues, and become reactivated in the future. So, recrudescence or recurrence of clinical signs may occur. However, it is next to impossible to prove this happens compared to another tick bite and exposure. Thus, most dogs are cured, and prevention is paramount.

Preventing Lyme disease in dogs

No one wants their pets or family members to be sick. Protect the human-animal bond and the health and well-being of two-legged and four-legged family members by taking steps to prevent tick exposure and bites. Two key ways we can protect dogs from Lyme disease include:

1. Vaccination. If you live in endemic areas, talk with your veterinarian to discuss whether this is right for your dog and lifestyle. The vaccine is very effective at preventing symptoms, but not 100%. Still, it is rare for vaccinated dogs to develop symptoms of Lyme disease.
2. All-year-round tick preventatives. These include topicals, the newer oral options, and the Seresto® collar. Talk with your vet about what works for you. All have drawbacks, side effects, risks, and benefits. Dogs with allergies or gastrointestinal (GI) disease may not be able to take the orals, and topicals aren’t great for dogs who are bathed/groomed regularly or swim.

Additional steps you can take to minimize tick exposure for you and your dog include:

• Perform regular tick checks on your dog after being outside, especially after walks and time near woods and shrubs.
• Remove any ticks promptly and cleanly by following tick removal instructions. Treat ticks in people and dogs the same way — always remove them completely and carefully.
• Limit exposure to tick-infested areas.
• Ensure that grass is trimmed regularly and kept short.
• Ensure that humans and pets are protected.
• Walk on trails and paths wherever possible.
• Avoid leaf piles and other debris areas.

Year-round protection and vigilance

Check your dogs frequently for ticks, especially in Lyme-endemic areas. Keep your dogs on all-year-round prevention. The deer tick, especially the juvenile stages, are almost invisible to the naked eye, let alone trying to find them in a dog’s fur coat.

Keep in mind that your pet's exposure means you are potentially exposed as well. Therefore, take precautions to protect the two-legged critters in your life, and use Deet® and related products on clothes and shoes to protect yourself from tick bites.

When using topical flea/tick products on you, your clothing, or your dogs and cats, make sure that you check the ingredients. Cats are extremely sensitive to certain chemicals, such as pyrethrins and permethrin-containing products. Never put a dog product on a cat, and if you use topical products, prevent your cat from grooming the dog overnight to permit the product to dry fully.

If your pet is showing signs of Lyme disease, seek veterinary care earlier rather than later. Early diagnosis and treatment can prevent complications to the kidneys, heart, or nervous system.