Know the status of your dog’s health, and whether he has any health or behavioral issues that your veterinarian should be aware of. Bring a list of your dog’s current medications and supplements, including dose, strength, and frequency.
Have an idea of what the visit will cost, including any tests, to avoid sticker shock or making hasty (bad) decisions based solely on price. Call ahead.
Be prepared to take your dog and go home if you are uncomfortable with your veterinarian’s recommendations. There’s no need to get nasty or defensive. We suggest something along the lines of, “I’m not sure I’m comfortable with those recommendations. I’d like to go home and think about them.”
If you are going to see a veterinarian who is new to you and your dog, consider making an appointment with the veterinarian, without your dog, to discuss her philosophy toward vaccinations and antibody titer tests.
Even a little education goes a long way
Michelle Kitzrow, of Sugar Hill, Georgia, had a change in thinking regarding vaccine protocols after hearing immunology expert Dr. Schultz speak on the topic (see “Vaccinations 101,” WDJ August 2008). Armed with a new understanding of vaccine protocols, Kitzrow took her then-four-year-old Bouvier, Casey, in to see her longtime veterinarian for Casey’s annual exam.
She admits that it “wasn’t very easy” to convince her veterinarian that, in lieu of vaccinations, Casey should receive an antibody titer test to determine whether she had what vaccination experts regard as a “protective level” of circulating antibodies from past vaccinations. But in the end, Kitzrow’s veterinarian relented, and agreed to take and send a blood sample off to a lab for the titer test.
Kitzrow believes that it was the relationship she already had established with Casey’s veterinarian, along with a new and accurate understanding of vaccines, that helped her veterinarian to support her decision. “He knows that I bring in my dogs regularly for veterinary care, and he trusts me to do the right thing. He also appreciated that I had taken the time to educate myself about vaccine protocols and titers.”
An acquaintance of mine, Diane (name changed at her request), had a bit harder time at the annual exam convincing her veterinarian to check her dog’s antibody titers instead of reflexively vaccinating – despite an 18-year relationship with her dogs’ veterinary clinic and the fact that she takes in her dogs twice a year for checkups. Diane’s 16-month-old Bouvier had received a puppy vaccine series, with the final boosters given after she was 16 weeks of age. The series included distemper, hepatitis (adenovirus), parvovirus, parainfluenza (shorthand for this combination of four vaccinations is DHPP), rabies, Leptospirosis, and Bordetella.
"Yeah, hmm, I don't think so." The fact that you receive a postcard from your veterinarian suggesting that your dog is "due" for certain vaccines does NOT mean your dog must have those vaccines!
“At my dog’s most recent vet checkup, I requested that only the rabies vaccine be given. I asked that titers be checked for distemper and parvovirus, and I requested a SNAP® 4Dx® test, which checks for heartworm disease, as well as the most prevalent tick-borne diseases: ehrlichiosis, Lyme disease, and anaplasmosis.
“I declined the combo, ‘all-in-one’ vaccine for distemper, hepatitis, parvovirus, and parainfluenza, as well as the Leptospirosis and Bordetella vaccines. I did not want all of those vaccines given at the same time and hoped that the titer results would show adequate immunity. I was adamant that my dog receive only the rabies vaccine at that time. The vet marked ‘refused’ on my dog’s chart next to the other vaccines she wanted my dog to receive that day.”
Diane understands that Lepto and Bordetella need to be given at least yearly to be effective, but has made the decision not to re-vaccinate her dog for those diseases at this time and understands the risk. Dr. Wynn notes that while we as clients might consider a notation of “refused” on our dog’s chart to be judgmental on the veterinarian’s part, the reason that the vet must note in the file that the client declined vaccination is to limit liability in case the animal is infected with that disease and subsequently blames the vet. (Dr. Wynn assures me that this has happened.)
“In this particular situation, it turns out that my decision to decline all of the ‘recommended’ vaccines, except for the rabies booster, was a good choice as the SNAP 4Dx (checked in-house afterward) indicated that my dog has Lyme disease. A follow-up Lyme Quantitative C6 Antibody Test confirmed an active Lyme disease infection, which means that her immune system was already compromised at the time of the exam. The distemper and parvo vaccine titers showed adequate immunologic response, indicating that my dog was still protected against these diseases, most likely from her previous round of vaccinations.”
In fact, vaccinating a dog who has an active Lyme infection might have been harmful. “It is never wise to vaccinate a dog whose immune system is preoccupied with something else,” asserts internal medicine specialist Nancy Kay, DVM, DACVIM, author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life. “The vaccine might ‘distract’ the immune system from the more important task at hand. Also, in theory and for the same reason, the vaccine might not be as likely to create protective immunity.”
Similar to Kitzrow, Diane finds that “Although my dogs’ veterinarian gets exasperated by the decisions I make that are counter to her recommendations, she knows that I appreciate and respect her knowledge and experience. I always ask for her advice regarding my pets’ well-being and do not hesitate to bring my pets to the hospital whenever I have concerns about their health, above and beyond checkups twice a year. She is also aware that I obtain information from a variety of other sources and that I become concerned and wary when there is a real discrepancy or controversy.
“Although she stresses the importance of following her recommendations, she has come to understand that I feel a strong sense of personal responsibility in the decisions made and their effect on the long-term well-being of my pets. If I have serious doubts about a stand that she takes, I will seek a second opinion, elsewhere. On this day, I guess you could say that we agreed to disagree.”
Antibody titer test results showing that no, Otto does NOT need to be vaccinated yet!
Diane is a little saddened that she and the veterinarian were unable to reach common ground, or at least have a more comfortable dialogue, noting, “It’s important for me to have a good rapport with the vets who care for my beloved pets. It’s important to me that they consider themselves an essential part of a team working for the well-being of the animals. Open communication and teamwork between pet owners and their veterinarians is essential.”
How antibody titer tests may affect your decisions
Antigens are any substance that the immune system identifies as an invader and responds to by producing a chemical defense: antibodies. When everything is working as it should, your dog’s immune system will recognize disease antigens that were introduced to his system via a vaccine (weakened or killed) or by natural exposure to the antigen that causes the disease (viral or bacterial).
A “titer” is a measurement of how much antibody to a certain antigen is circulating in the blood at that moment. The result is usually expressed in a ratio. A positive titer test result is strongly correlated with a good antibody response to either a recent infection or vaccination. A dog who has received “core” vaccines and who displays a positive antibody titer test result should be considered protected from the diseases for which he was vaccinated (meaning, he doesn’t need vaccines at that time).
Your dog must undergo a blood draw in order to have an antibody titer test. Labs such as Antech, IDEXX, and most veterinary college laboratories offer these tests. Antibody titer testing is typically run for parvovirus and distemper, since the dog’s antibody response to these two antigens is highly predictive as to the dog’s immunologic competence in dealing with any other antigen to which he has been exposed.
Rarely, there are exceptions. When an antibody titer test is negative, the owner and veterinarian should consider revaccinating and then testing the titers again. It may turn out that the animal simply needed another exposure to the antigen in order to stimulate a stronger immune response. Or, it may develop that the dog lacks the ability to respond normally to vaccines, that is, by mounting a proper immune response. In this case, the owner and veterinarian have gained very valuable information about the dog’s compromised immune status – information they never would have gained by simply vaccinating and assuming the dog was “protected,” as is usually the case with healthy dogs.
Dr. Kay comments, “There are several reasons I can think of why a vet might be loathe to run titers, but of these, I consider only a couple of them to be ‘honorable.’” Two examples she gives are:
Some veterinarians question the accuracy of titers in terms of accurately assessing immunity.
If a dog is truly at a high risk of infectious disease, revaccination might be a safer bet than relying on the results of an antibody titer test. She adds, “Very few dogs are truly in this situation, such as those who live in the midst of lots of completely unvaccinated dogs and in a lower socioeconomic setting.”
When I pressed Dr. Kay on the first point, asking what information “Dr. Doe” would have that trumps information provided by someone such as Dr. Schultz, she replied, “You will get no argument from me on this. I suppose that if Dr. Doe professes that titer tests are not accurate, one could ask to see the data that leads him (or her) to this conclusion.”
Although Dr. Wynn adds, “If a distemper or parvo titer is positive, we know that the dog is protected. If it is negative, the dog might be protected, but we have no practical further test to know whether or not it is. Hence, some veterinarians have said the titer isn’t accurate to point out that we don’t know what a negative titer means.” In the case of negative titers, Dr. Schultz recommends revaccination, even though the dog could already be protected.
If you choose to vaccinateIf you determine that your dog is in need of vaccination, consider the following:
Ask the veterinarian to perform the health exam and other tests first; you might even wait to vaccinate until those results are in, and schedule a follow-up vaccine visit once you know your dog is in the clear, health-wise.
