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To Your Health: Lyme disease really ticks me off!

By Dr. Rick Donahue/rickdonahue@personalhealthmd.com

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Brookline — Lyme disease can be challenging for doctors to diagnose and treat, as well as frustrating and sometimes devastating to the people who have it. In 2009, there were 4,028 cases of reported Lyme disease in Massachusetts, with 456 cases registered in our Norfolk County alone!

Interestingly, the young and not-so-young are the two age groups most affected: Lyme disease has two peaks, at ages 5 to 14 and 60 to 69, perhaps reflecting the age groups that have more time to get close to nature.

Lyme disease is caused by the nasty spirochete bacterium called Borrelia burgdorferi, and transmitted to humans by the deer tick called Ixodes scapularis, a much smaller tick than the more common brown speckled dog tick. (Find good pictures at www.cdc.gov/ticks.)

With Lyme disease, an ounce of prevention is well worth it! If you are hiking, playing or gardening at the edge of woods or meadows — even in Brookline — you are at risk. Many Lyme tick bites occur from the tick crawling up your leg (eek)! Wearing light-colored clothes, non-open shoes, and tucking your pants into your socks gives maximum protection. You can decide if it’s worth looking like Pee Wee Herman to keep a tick from reaching your skin.

You can wash off or locate a biting tick by hopping into the shower within two hours of outdoor exposure. DEET tick repellant is partially effective, but don’t use DEET on infants, and use less than a 30 percent concentration with children.

The tick bite: We are now approaching the peak season for deer tick bites and Lyme disease. Two weeks ago, a 37-year-old woman jogger came to see me with a small 2- to 3-millimeter deer tick that she properly removed from her leg using tweezers to gently pull on its head, not body, until it released. She learned on the Centers for Disease Control website (www.cdc.gov/lyme) that squeezing the body of a tick might push more of its contents into her.

The young nymph tick we identified is known to be at higher risk of transmitting Lyme disease. Her risk was also increased because this tick had been attached to her for at least 36 hours after jogging through a grassy Brookline meadow, long enough for the tick to inject the Lyme spirochete under her skin. After discussing these risks, she was relieved that a single dose of the antibiotic called doxycycline taken within two to three days of her tick bite could prevent Lyme disease from occurring. This tick bite treatment can be given to a person over 8 years old, and to adults who are not pregnant or breastfeeding.

Symptoms and treatment: It’s been a busy season for the little deer tick. A 32-year-old non-pregnant woman presented with a gradually worsening “bug bite” behind her left knee two weeks after vacationing on Cape Cod.  She is now concerned that her low-grade fever, headache, fatigue and muscle aches without any respiratory or gastrointestinal symptoms could be signs of early Lyme disease. She was right. On exam, behind her knee was a 4-centimeter oval faint red rash with a faint outer red ring. It was the classic Lyme disease rash called erythema migrans — so unique to Lyme disease that no blood tests were required to diagnosis her. I explained that because there is also a chance of other nasty tag-a-long tick-borne diseases such as babesiosis and ehrlichiosis (now called “HGA”), we would use doxycycline for two to three weeks to treat all three. She was cured.

Here’s the bad news: Up to 25 percent of people who get Lyme disease never get the EM rash. As a result, the diagnosis is often delayed for weeks or months while the Lyme spirochete travels in their blood stream to distant organs causing late-stage disease. The organs most commonly attacked are the joints, causing arthritis; the heart, causing muscle or rhythm problems; the peripheral nerves, causing facial weakness; and, most insidiously, the brain, resulting in stiff neck, headaches and a more late-stage encephalopathy with brain fog, confusion and depression-like symptoms that can last for more than a year.

Unfortunately, the indirect antibody tests for diagnosing late-stage Lyme disease are not always accurate and can lead to frustration between suffering patients and their doctors. There is some early progress towards new diagnostic tests that can more directly detect the Lyme spirochete. Such tests are sorely needed to help people know if they have late-stage Lyme disease. Proper treatment for late stage disease can require months of intravenous antibiotics, but can lead to a cure.

In summary:

– Protect yourself and loved ones from tick exposure. See the CDC website www.cdc.gov/lyme/

– If you think you have been bitten by a deer tick, save it, and see your doctor.

– If you have been in known tick areas, and you have some of the symptoms of Lyme disease discussed above, even without a known tick bite or EM rash, please see your doctor.

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