BRATTLEBORO — Spring is finally here. We can emerge from our houses, go for hikes, take walks, and stroll around in the woods.
But we should avoid getting bitten by a deer tick.
Deer ticks (Ixodes scapularis) live everywhere in the country, including here in Windham County. Many deer ticks now carry Lyme disease, as well as four other bacterial infections: Rocky Mountain spotted fever, babesiosis, anaplasmosis, and ehrlichiosis.
Lyme disease is caused by the spirochete (spiral-shaped bacteria) borrelia burgdorferi, which is similar to the syphilis organism.
This disease is becoming known as the “Great Imitator,” because its symptoms mimic those of many other illnesses, such as multiple sclerosis, amyotrophic lateral sclerosis, chronic fatigue, fibromyalgia, and other non-specific musculoskeletal and neurological diseases.
Half the people infected with Lyme disease get a characteristic bullseye rash (Erythema Migrans, or EM). Some of the other most common signs and symptoms of an acute infection with Lyme disease include headache, muscle aches and pain, heart palpitations, stiff neck, and joint pain (usually one-sided and in a large joint, like a knee of hip).
However, the list is much longer, and often overlaps with the symptoms that one might have with a cold or flu. This is where the tragic problem of chronic Lyme disease begins, when the infection is overlooked and dismissed.
The Politics
Lyme disease, and especially the notion of “chronic Lyme disease” is an area of contention among many doctors. This debate is driven by a number of factors, including science, politics, and the insurance industry.
The controversy becomes very heated and emotional for people, especially those who are struggling with their health and who suspect Lyme disease as the cause of their illness.
Over the past decade, two opposing camps have emerged in the battle. One camp is represented by the Infectious Diseases Society of America (IDSA), led by a group of academic researchers. This group maintains that Lyme disease is “hard to catch and easy to halt” (according to an oft-quoted New York Times story on the research) because the infection is “rare,” easily diagnosed, and treated with two to four weeks of antibiotics. This group also claims that chronic Lyme disease is rare or nonexistent.
This group of researchers has written the guidelines that most physicians refer to when treating Lyme disease. But here's the catch: The IDSA guidelines' authors have significant conflicts of interest that have biased their treatment and diagnostic recommendations, including:
1) Commercial interests in tick-borne disease tests and vaccines.
2) Supplemental streams of income from insurance companies that profit from a restrictive definition of Lyme disease.
The opposing camp is represented by the International Lyme and Associated Diseases Society (ILADS), led by a group of practicing physicians. Its members argue that tick bites often go unnoticed, and that a Lyme disease diagnosis is frequently missed, especially since commercial laboratory testing for Lyme disease is inaccurate.
Consequently, the disease is often not recognized and can persist in a large number of patients who require prolonged antibiotic therapy to eradicate the infection.
Diagnosis
While Lyme disease is increasing in every state, the Centers for Disease Control readily admits that under-reporting is a major issue, due to inaccurate testing and subsequent misdiagnosis, and failure to report positive diagnoses by physicians and laboratories.
The CDC emphasizes that you should not rely on blood testing to confirm or deny the diagnosis of Lyme disease. Lyme disease is a clinical diagnosis, based on patient history, signs, and symptoms.
An accurate diagnosis of Lyme is made from physician observation and patient history, “and a history of probable exposure to infected ticks,” according to the CDC.
Laboratory tests are neither suggested nor required to confirm diagnosis for patients with recent onset (2-3 weeks) of a bulls-eye rash. However, positive results of recommended two-tiered blood testing can confirm infection in patients with musculo-skeletal, neurologic, or cardiac symptoms, according to the CDC.
How long it takes a tick to transmit disease after it has attached is debatable. The CDC states that it must be attached for 24 to 48 hours before it can transmit Lyme disease. Other reputable sources, such as the International Lyme and Associated Disease Society, believe that it may only take four hours to transmit the disease.
If you have had a tick bite, with or without a rash, you should immediately seek the advice of a Lyme-literate physician.
What to do if you discover a tick on you
1. Pull the tick off swiftly and gently with tweezers or another tool, preferably a tick spoon (a notched spoon designed for the task). Do not light the bug on fire, and do not apply Vaseline or any other topical agents to the tick while it is attached to your skin.
2. Save it, especially if you have identified it as a female deer tick. After a tick is engorged with blood, it can be more difficult to identify by the unaided eye.
3. Place the tick in a zipper-lock bag and send it away to the UMass Extension Agriculture and Landscape Program for testing. The cost is $40, but this very reliable test will let you know whether the tick is carrying Lyme disease. (Tests for the other tickborne co-infections are now also available.) Visit www.umass.edu/tick/ for information and further instructions.
4. Consult your physician for preventative treatment while awaiting the results. I use antibiotics and herbs.
5. Consult a Lyme-literate physician for specialized treatment if the tick returns positive for Lyme disease or if you are experiencing symptoms of Lyme disease. Visit four to six weeks after the tick bite for testing (testing you, not the tick), as this is the window in which you have the greatest chance of getting accurate test results.
Treatment
The key to successfully treating Lyme disease is immediate treatment.
As a naturopathic physician who uses primarily natural medicines, I advocate highly for the use of antibiotics for a recent infection. Antibiotics are absolutely the most effective treatment for early Lyme disease.
For late-stage, chronic Lyme disease, many patients require a prolonged course (months to years) and high doses of antibiotics, sometimes intravenously. Though many people with chronic Lyme feel better when on antibiotics, some may relapse as soon as they discontinue the medication.
For this reason, I do not feel that the sole use of antibiotics is a sustainable treatment, as bacteria may become drug resistant, and the side effects of antibiotics can be harsh and, sometimes, intolerable.
Thankfully, there are many effective natural medicines emerging in the research - for example, the invasive species of Japanese knotweed (Polygonum cuspidatum) that has taken over parts of western Massachusetts and southern Vermont's roadsides. What a wonderful example of how nature provides humans with exactly what we need!
The Lyme disease epidemic might sound dismal, as many of us have been infected, but it might also serve as a catalyst for our community to become more aware of the human impact on the earth.
Remember, as a species, we have always battled infectious agents. Some bacterial species, such as those that caused cholera or the plague, have wiped out huge numbers of people. Other bacteria, viruses, and fungi remain more benign and live symbiotically with humans. (In a healthy human body, the number of viruses, bacteria, and fungi outnumber our own cells).
It's hard to say what impact this epidemic will have on our community, but I have faith that with a higher awareness, and a strong and vital immune system, we will continue to thrive as a species.
Even with the ticks.