DEAR DR. GOTT:
I went walking in the woods recently. I took precautions such as wearing long sleeves and pants. When I got back home I did the customary “tick check” and (much to my chagrin) found one on my leg. Because I live in New England, I am always fearful of Lyme disease. Can you give me any guidelines on this dreaded disease?
DEAR READER:
Lyme disease was first recognized in the United States more than 30 years ago, and has been diagnosed from coast to coast. In the east, the black legged deer tick known as the Ixodes scapularis spreads the disease, while a different species of the black-legged tick known as the Ixodes pacificus is the culprit on the west coast. Ticks are usually found in wooded areas; however, it is common to have one crawl up a pant leg while walking across your own back yard. Dogs, cats, deer and mice are common carriers.
Most humans are infected through the bites of immature ticks known as nymphs. They are tiny, feed during the spring and summer months and are extremely difficult to see. Adult ticks tend to feed during the summer and fall. They, too, can easily transmit Lyme bacteria, but are substantially larger and are often picked off the skin faster because they are easier to see.
Contrary to popular belief, ticks cannot jump or fly. They crawl onto people or animals as the recipients brush against them. They feed on blood by inserting their mouth parts only into the skin and because they are slow feeders, a complete meal can take several days. During that time, the body of the tick swells.
Early stage Lyme disease can be marked by a characteristic skin rash or multiple rashes, bulls-eye ring, chills, fever, headache, muscle and joint pain, and swollen lymph nodes. The rash is a red circular patch that ordinarily appears within three to thirty days after the bite of an infected tick. The rash can be warm, but ordinarily isn’t painful. Other symptoms of Lyme disease may also develop during this time frame. However, some unfortunate individuals may not develop symptoms for weeks, months or even years after the initial tick bite. Additional symptoms include arthritis, numbness, pain, nerve paralysis, meningitis, abnormal heart rhythm, fatigue, headache, sleep disturbances and/or memory and cognition difficulties. Fortunately, today most doctors recognize the symptoms of Lyme (regardless of what part of the country they are in), test and successfully treat it.
When feeding, an allergy to the tick’s saliva often occurs. This results in the initial bite area that is surrounded by a dark pink or red ring, surrounded by the normal color of the flesh. This is not a bulls-eye ring, but a common reaction to the saliva itself. A true bulls-eye is exactly that — ring surrounded by ring, surrounded by ring.
The fever, fatigue and muscle aches and pains of Lyme are often mistaken for infections such as influenza, arthritis and other conditions. Diagnosis is relatively simple when the typical rash is present and an individual gives a history of tick bite. When no known tick bite has occurred and a physician is uncertain, he or she might order laboratory blood testing. Herein a problem could surface. Take, for example, an individual who presents in a physician’s office because of flu-like symptoms present for three days. In an endemic area, the physician might be suspicious enough to obtain blood work for Lyme disease. However, blood tests do not detect infection until the body starts to produce measurable levels of antibodies to the Lyme bacterium which often occurs from two to four weeks after a bite. The tests will be negative, the patient will feel miserable, and the doctor is back to square one. Timing is extremely important in this case.
When a patient presents to his or her physician with a history of removing a tick within the prior three days, the physician might choose to prescribe two doxycycline to be taken as a means of boosting the immune system. When a patient presents with flu-like symptoms, aches and pains, and more but doesn’t remember when the tick bite occurred, then a full course of antibiotics might be more appropriate.
In summary, before walking in the woods, use an insect repellent with a 20-30% concentration of DEET. Spray it on shoes, pant legs, and exposed skin. Wear protective clothing such as long pants and long sleeves. Tuck pant legs into socks while in wooded areas. Perform tick checks regularly. They ordinarily must be attached for at least 24 hours before bacteria can be transmitted. Simply remove them before then and you will substantially reduce the risks of acquiring Lyme disease.
