WHAT SHOULD I KNOW ABOUT LYME DISEASE?
Here’s what the CDC says:
Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of infected blacklegged ticks. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system. Lyme disease is diagnosed based on symptoms, physical findings (e.g., rash), and the possibility of exposure to infected ticks; laboratory testing is helpful if used correctly and performed with validated methods. Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics.
Borrelia miyamotoi infection has recently been described as a cause of illness in the U.S. It is transmitted by the blacklegged tick (Ixodesscapularis) and has a range similar to that of Lyme disease. This is the bacteria which primarily causes Lyme in Europe, and our Western Blot does not test for it. It can be an aggressive illness.
Most humans are infected through the bites of immature ticks called nymphs. Nymphs are tiny (less than 2 mm) and difficult to see; they feed mostly during the spring and summer months. But with the warming of the climate, nymphs are being found active during a longer season. Adult ticks can also transmit Lyme disease bacteria, but they are much larger so, luckily, you are more likely to discover and remove them. Adult Ixodes ticks are most active during the cooler months of the year.
American dog ticks can carry the bacterium that causes Rocky Mountain spotted fever. Dog ticks are reddish-brown and larger than deer ticks. Deer and dog ticks are most active during the spring, early summer and fall.
The Lone Star tick is a tick which is primarily in the South and Southwest, but is being seen with greater and greater frequency in the Northeast. It is said to not carry Lyme, but instead to carry STARI (Southern tick-associated rash illness) which is transmitted via bites from the lone star found in the southeastern and eastern U.S. The Lone Star is a particularly aggressive biter, and STARI is thought to be caused by the bacterium Borrelia lonestari. Its symptoms are similar to Lyme, caused by Borrelia Burgdorfia.
There are other tick-borne diseases — taken from the CDC site for information purpose:
Where are infected ticks found in the United States?
|Tick-Borne Disease||Common US Regions|
|Lyme disease||Northeast, North Central, Pacific Coast|
|Babesiosis||Northeast, Midwest, Northwest|
|Ehrlichiosis||East, Southeast, Central|
|Rocky Mountain Spotted Fever||Southeast, Atlantic Coast|
|Southern Tick-Associated Rash Illness||Southeast, Atlantic Coast|
|Tick-Borne Relapsing Fever||Rocky Mountains, Pacific Coast|
|Tularemia||All States except Hawaii|
|Anaplasmosis||Northeast, North Central, Pacific Coast|
|Colorado Tick Fever||Northwest, Rocky Mountains|
|Q fever||Throughout the United States|
Untreated or Chronic Lyme disease
If a tick bite is not treated, which is very common, because it is not seen or felt, and only sometimes causes a rash, some people go on to develop either neurological Lyme disease (neuroborreliosis) or arthritic Lyme disease. Symptoms can be widely diverse and debilitating. People with Lyme complain they have a mental fog, and are more forgetful and less focused than they were. In fact, studies show that IQ goes down significantly with Lyme disease. The list of symptoms is so diverse and all-encompassing that like syphilis, another illness caused by a spirochete, it has been called the Great Imitator. Lyme causes headache, muscle and joint aches, dizziness, problems with conduction of impulses in the heart, problems maintaining blood pressure, and great fatigue. Many people are disabled by chronic Lyme, and some die.
How does Chronic Lyme get established?
The Lyme spirochete has the most complex DNA of any bacteria known to mankind. When it is under threat, it curls up into a ball, secretes a waxy substance that is protective, and hides deep in joints, tendons, and organs. This is not unlike the chicken pox virus, which hides out until it causes shingles late in life. Many bacteria have stealth, hiding forms. But the Lyme bacteria is hard to reach because it burrows down so deeply. It also lives inside cells, which is another way it causes damage, while being difficult to reach. It hampers immune response so, while humans can develop antibodies to it, they are generally ineffective in killing the bacteria off. Chronic Lyme is debilitating, and it is sometimes misdiagnosed as Multiple Sclerosis or ALS, Lou Gehrig’s disease. Both of these groups of patients have extremely high rates of the presence of antibodies to Lyme.
What is wrong with the Lyme Test?
The current standard, is a “two-tiered” test: First, an Elisa, and then, if it is positive, a Western Blot. The Western Blot tests for ONE species of borrelia, but there are many, just as there are many flu types. Each year we take a new flu vaccine, because there are so many ways the organism mutates and changes form. Borrelia is similar. There are over 35 species of bacteria that cause Lyme disease, but the current Lyme two-tier testing process tests for only one type. This type of Lyme was born in a lab decades ago, and isn’t the most common form infecting ticks or people. We are missing the borrelia species which are most common, and we are missing borrelia miyamotoi, the cause of most Lyme in Europe, which is increasingly common in the US. We cannot rely on the current test.
For you: If you have been bitten by a tick in an endemic area, you need treatment with antibiotics even before you show any symptoms, and should be followed so if you develop a co-infection, so you can be treated for it promptly.
Do your city children play in a park? Be careful and do tick checks and inspect them closely when they come in. Treat their clothes. Even if you are city apartment-dweller, you can be at risk.
EARLY TREATMENT IS YOUR BEST DEFENSE
There are two kinds of prevention:
- Primary Prevention: Clear your living area of ticks; wear tick-protective clothes, and DO NOT GET BITTEN.
- Secondary Prevention: After a tick or an associated bite has been found on you, take appropriate antibiotics immediately to prevent disease from establishing itself.
My goal is to help with Secondary Prevention. I will see you as quickly as possible so that you have a better chance that Lyme or other tick borne disease do not establish themselves.
There is a proper way to remove a tick
With a pair of fine point tweezers, grasp the tick as close to the skin as possible and pull outward with a slow, even force, pulling in the opposite direction to how the tick entered the skin.
- DO NOT JERK OR TWIST THE TICK. This might tear the head and mouth parts from the tick’s body and will encourage the tick’s fluid to enter your blood stream or skin.
- DO NOT USE THE FINGERS TO REMOVE THE TICK. Squeezing the tick could cause it to disgorge the contents of its body into the wound.
- DO NOT ATTEMPT TO REMOVE THE TICK WITH CHEMICALS OR BY HEATING THE TICKS WITH A MATCH. This can kill it before it disengages its mouthparts. It can cause it to disgorge contents immediately, and thus cause infection.
- WASH THE ATTACHMENT SITE. Use warm soapy water and rubbing alcohol. You can apply an ointment like Neosporin to help protect the open site from contamination.
- SAVE THE TICK. Place it in a small sealed Ziploc bag with a very slightly damp cotton ball (not wet). Send to the appropriate lab as soon as possible but keep it in the refrigerator until you are ready to ship it. I work with Igenix Labs for testing of ticks. Negative results from study of the tick, however, does not mean it could not have transmitted disease to you. Positive results just mean that disease transmission is more likely.
- TAKE TICK WITH YOU TO YOUR APPOINTMENT: While it is not necessary for treatment to be begun, it can help; we may be able to identify co-infections more easily in the tick than in your blood.
Do Not Wait!
Less than 50% of people bitten report a rash and less than 10% of children nationwide have a rash. Do NOT wait for the disease to spread and cause symptoms. Treat the bite as soon as possible. The one dose treatment of the antibiotic Doxycycline – which some health care professionals may try to pass off as curative – has not shown to be effective. Use common sense- one dose of antibiotics will not kill an infectious disease that can spread throughout your body in a manner of hours.
Experience in treating Lyme disease matters
You deserve Lyme literate physicians. My membership in The International Lyme and Associated Diseases Society (ILADS) and attendance at their conferences and meetings allow me to stay at the forefront of knowledge about how to best diagnose and treat Lyme disease.
My experience working with patients suffering from Lyme disease has become a mission to help tease apart the emotional suffering from the disease itself. Patients with this complex disease deserve and need solid support dealing with their illness in as many non-pharmacological ways as possible. If you have Lyme, you deserve excellent treatment, no matter how briefly or how long you have been ill.