Diagnosing Lyme disease, and effectively treating it, gain some ground after two decades of integrative research
In 2007, integrative veterinarian Allen M. Schoen, DVM, MS, published evidence that acupuncture may be a beneficial tool in the diagnosis of equine Lyme disease (American Journal of Traditional Chinese Veterinary Medicine 2:1;75-78). Acupuncture, manual therapies, and nutritional and herbal immune support may increase the efficacy of antibiotic therapy when treating equine Lyme disease.
The evidence was 20 years in the making. At first, Dr. Schoen (whose services included acupuncture and chiropractic) thought his equine patients’ overall soreness and deterioration in behavior were the results of trauma or falls. Except that professional relief proved short-lived: “The horse would improve for two days then come up sore again.”
Schoen saw a recurrent pattern of good horses who, within days or weeks, went bad. Partnered with (or explained away by) bad behavior, was an unwillingness to be groomed or saddled, and joint soreness or lameness that alternated from limb to limb. What most shared, following diagnostic acupuncture point palpation examinations (DAPPE), were similar patterns of extreme sensitivity affecting them “from head to toe.”
Schoen began to describe such cases as generalized superficial hyperpathia. (Hyperpathia refers to a disagreeable or painful response to a normally innocuous stimulus, such as touch or sound.) But he could not shake the feeling that something deeper was going on. Like his patients, the problem -- and elusive solution -- got under his skin.
AN OLD NEMESIS
Most northeast horse owners connect “joint stiffness” and “Connecticut” with the possibility of Lyme disease, which earned its moniker from the Connecticut community where it was first detected in humans in 1975. It was another 20 years before the disease was acknowledged to afflict dogs or horses, but all the while, Schoen had his suspicions. By the early 1990s, he was annotating his charts accordingly: Suspicious of Lyme.
Then, as now, confirmation of the disease was via a Lyme titer blood test to detect antibodies. Horses with low titers were assumed Lyme-free. But Schoen’s DAPPE findings suggested otherwise. Something really could be under their skin: a bacterial culprit known as Borrelia burgdorferi.
Traditional Chinese Veterinary Medicine (TCVM) could relieve this new disease when modern methods could not because Dr. Schoen says there is probably nothing “new” about Lyme: “In ancient Chinese medical literature, a syndrome similar to Lyme disease was described thousands of years before Lyme, Connecticut, was named.”
CAN’T TOUCH THIS
Acupuncture seemed to need no introduction to an ancient rival. Dr. Schoen’s palpations showed “extreme reactivity of all association (Back shu) points, alarm (Front mu) points, acupoints in the cervical, shoulder, thoracolumbar and lumbosacral regions, as well as pelvic limb points along the Bladder and Gall Bladder channels.”
The DAPPE pattern suggested infectious disease, so he coined the immune response to the infection: Equine Immune-mediated Myofascial Syndrome (EIMS). “It made sense that acupuncture points were the most reactive, because that’s where the highest concentrations of nerve endings were located.” Compounding the association between superficial pain and Lyme was fascia, the tough, yet highly sensitive, web-like connective tissue that sheathes every muscle, bone, nerve, blood vessel and organ in the body.
“It was no wonder horses could not tolerate being touched. Patterns of sensitivity have been associated with infectious diseases such as equine borreliosis (Lyme disease).” If horses under his care behaved as though something was under their skin, indeed there was: an aggressive, painful bacteria.
OVER- AND UNDER-DIAGNOSES
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Horse being acupunctured on hind end
Schoen’s data demonstrated a correlation between DAPPE patterns suggesting EIMS and positive western blot Lyme titers. Yet other horses, with low titers, could also exhibit the pattern: “Low titer horses may suffer the most from superficial pain because their immune system may not be responding to the infection. Titers don’t give the whole picture.”
“I may do acupuncture initially, to alleviate the horse’s pain and discomfort, then treat the disease with antibiotics, and afterward, return to acupuncture to help rebalance the body.” How much post-treatment acupuncture is necessary depends on the individual horse and client, but Dr. Schoen generally suggests a one- to a two-month program of preventive evaluation. The goal is to treat the disease before it shows up as a chronic pattern.
“If you have Lyme in your area, and if your horse is showing clinical signs, and a titer confirms that, then you don’t need a DAPPE to confirm a diagnosis. But, if you have questions or doubts about what your horse is suffering from, acupressure palpation can bring an added level of confidence.”
“My feeling is that equine Lyme disease is both under- and over-diagnosed. It can mimic so many conditions that we risk both ascribing it too often as the fault (i.e, for lameness or hock problems), and not recognizing it often enough. If a horse is sore all over, my attitude is that it may be judicious to treat for Lyme first before choosing to go down the path of multiple joint injections.
“Lameness and Lyme disease are not mutually exclusive. You can have a horse with multiple joint lameness issues that are also aggravated by active Lyme disease. In cases like this, I recommend treating the Lyme disease first and seeing what level of inflammation in the joints that resolves. If the joints are still an issue, address them at that time. If you treated the joints first, you may not get as good results.”
STEP BY STEP
If your horse’s DAPPE pattern suggests the presence of the disease, start with “killing off the organism, by using antibiotic therapy for spirochaete or bacterial infections.” Schoen’s data reflected that 78% of diagnosed horses showed 50-100% improvement of clinical signs after therapy with doxycycline or other antibiotics. Acupuncture can reduce inflammation and boost the immune system once bacterial infection has been reined in.
“Acupuncture cannot ‘cure’ Lyme.” In jest, Schoen states, “The only way to accomplish that is to stick your needle in the deer tick (Lyme disease’s principal vector). Acupuncture and manipulative therapies may temporarily improve clinical signs of myofascial pain for a few days, but appropriate antimicrobial therapy is essential for long-term resolution of signs if caused by infectious agents. Addressing other issues such as lameness, shoeing, saddle fit, riding and training programs, is also imperative. Lyme disease is not mutually exclusive from any of these issues, and may indeed aggravate any or all of them.”
Chinese herbs and nutraceutical supplements can rebuild the immune system post-Lyme treatment. “I have seen a few barns, in known Lyme areas, reduce the number of incidences during spring and fall tick seasons through the use of colostrum supplements.”
“Clients who have had horses with a history of Lyme disease are aware that extreme superficial skin hypersensitivity may be the first sign that their horses have contracted Lyme. Immunoassays (or titers) may or may not confirm a diagnosis. An integrative approach is essential for both an accurate diagnosis and effective treatment of EIMS.”
STAYING ONE STEP AHEAD
Dr. Schoen suggests a thorough history of the equine patient, DAPPE, chiropractic evaluation, comprehensive conventional lameness exam (flexion tests, radiographs, ultrasound, MRI and diagnostic imaging), as well as tests for infectious disease. Equally important is an evaluation of saddle fit, shoeing and training programs, and its rider(s).
As for the tempting, but a controversial subject of using Lyme disease vaccines currently available for canines, Dr. Schoen has “serious reservations about using vaccines not approved for horses. The first canine vaccine that came out resulted in a lot of dog reactions. Today’s vaccine is more refined, and there are fewer reactions, but its efficacy in horses is questionable.”