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Saturday, July 16, 2016

A Conversation About Vaccine Responses And Reactions

Recently I had a reader, Bill, email me with concerns about his recently vaccinated puppy.  We began a brief email conversation which I think is valuable to share with everyone as it addresses some of the worries that clients can have, and how important communication is.

Bill:  My wife and I are freaking out.  We took our fun loving 3 year old Golden to the vet to get 4 vaccines: Bordatello, distemper, rabies, and the new lymes.
Anyway, my usually happy puppy barks and runs around every morning.
However, within an hour after the shots he became lethargic.  He stands in one place and acts like his hind legs hurt.
We took him to the ER and they said he was fine.  Breathing was fine.  Heart was fine.
Now today, 24 hours later, he walks very, very gingerly and he will stand in one spot for 20 minutes or more if you let him.
What did these people do to my happy puppy?  I was such an idiot for allowing all these shots at one time.
1. we got him to pee 3x today.
2. he pooed twice yesterday and NO poo today.
He went into the vet's a happy, active dog and now it looks like the life and fun was drained out of him.
Is any of this normal?
The ER prescribed tramadol for pain.
Thank you for any help you can provide.   We just never saw such a dramatic and downward attenuation of our puppy’s soul.

Dr. Bern:  Bill, I'm very sorry that your puppy doesn't feel good, but you're probably worrying too much.  It's actually perfectly normal for a puppy to be sore and slightly lethargic for 24-48 hours after vaccines.  What you're describing doesn't sound like anything that would worry me or keep me from vaccinating him again in the future.  If the ER vet said he's fine, I would trust that.  But talk to your vet about it and see if they may be willing to send him home with pain medication for a day or two after his next vaccines.

Bill:  As it turns out, your DX is amazingly spot on.  
Miraculously, after 21 hours, Charlie snapped out of it---three (3) hours after giving him pain medicine.
It's like the vaccines attenuated my puppies soul.
I think some puppy parents (like us) fail to realize that these are animals and not people.  
However, I get a general sense that doctors, vets, and interested corporations don't like to address vaccine related complications.
Maybe it's because there is a fear that any talk in this area may prevent people from vaccinating their pets.  
Had I been told, your dog might act like he is in a stupor for 2 days, then I might have been prepared.  Instead, the vet and all techs said it was "no problem" to hit my puppy with 4 separate vaccines in one day. 
Even our visit to the ER does not mention anything about a reaction to the vaccines.  Instead, it mentions only pain.  
Finally, I have to tell you, I was really upset when I wrote this email to you.  I can't thank you enough for your email.  Your response was incredibly intuitive. I think half your training as a vet must go to dealing with over the top puppy parents like me---please forgive me!

Dr. Bern: First of all, don't worry about being freaked out and "over-reacting".  You were concerned about your puppy and that always makes people emotional.  I completely understand that and deal with those situations regularly.  It typically isn't because a client is being irrational, but instead because they are worried about their pet.  That's understandable and even expected when something like this happens.
I can't speak to other vets, but my clinic always tries to caution people that there can be soreness and lethargy for 24-48 hours.  It doesn't happen in most dogs or cats, but can happen sometimes and we want people to be aware.  If a client is aware of the possibility they can prepare themselves and also watch for anything more serious.  We also try to let people know what more serious symptoms are (facial swelling, hives, profuse vomiting, sudden weakness or collapse).  I will sometimes compare it to a human getting a flu or tetanus shot.  Sometimes you don't feel anything at all, sometimes there is local inflammation and soreness, and sometimes you can have flu-like symptoms for a day or two.  All of these things are highly variable based on an individual patient's immune response, and are completely normal.  These symptoms are a "response" and not a "reaction".
Why does this kind of thing happen?  When we give a vaccination we are stimulating the immune system with a killed version of the infectious organism, or a part of that organism.  Doing so causes the body to develop antibodies against that organism so if they are exposed to it in the future the body can quickly attack and destroy the invader before illness is caused.  But think about what happens when the body responds to a natural infection, such as a cold or influenza.  The immune system responds to the organism by releasing various biochemical that have effects on the body such as raising the temperature, causing inflammation, making them lethargic, and so on.  When we stimulate the immune system with vaccines, we can potentially cause similar responses because they naturally occur as a result of certain immune cells responding in the way that they are designed.  This is normal and not a concern.  Think of it like a set of dominos that you have stood up.  When you knock the first one over the whole string will start to fall down in a cascade.  It doesn't matter if you knocked down the first one with your finger or a pencil, the response is the same.  That's how your immune system works.
True reactions happen when the immune system over-reacts.  Compare this to a toddler that wants a toy and doesn't get it.  Some may be sad but go on with the day.  Some may cry a little but quickly get over it.  Those are like a "normal" immune response.  But some toddlers throw themselves on the ground kicking and screaming, having a true fit.  This is a complete over-reaction, and is what can happen to the immune system at times.  Instead of a certain mild response, more biochemical are triggered which leads to a more serious effect on the body.
Various responses and reactions can occur no matter how many vaccines are given.  I will routinely give multiple vaccines at the same time to my patients and my own personal pets.  In general this is considered safe, but you might have a slightly more intense response since the body is working with multiple antigens at the same time.  I currently have a three month old puppy and have no hesitation giving him multiple vaccines on the same visit.
To me the main focus is proper communication and setting realistic expectations.  If your vet had explained even part of this to you it would have kept you from worrying and you could have just observed him.  You would also have been aware of when to start worrying and rush back to your vet or the ER. 
I hope this helps explain things a bit better, and I hope your puppy is continuing to do well!

There are a few lessons here. 

First and most importantly, communication from the vet to the client is extremely important.  With just a few seconds and a few sentences, the vet could have prepared Bill for what might happen and prevented a lot of worry.  Most people understand mild side effects from medical treatment, and don't worry if they see them.  However, they need to be prepared for it.  Clear communication is the key, and it's the responsibility of a veterinarian and their staff to make sure that clients are prepared.

Second, soreness and lethargy after vaccines are considered normal and not a true reaction.  When this happens it is absolutely appropriate to call the vet and describe the symptoms so the vet can determine if the pet needs to be seen.  Or, if you're really worried, take the pet in.  While we don't become concerned about these situations and consider it a routine variation, a good vet will understand a client's fears and help to assure them.