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Articles and Publications:
Medically Speaking
On Lyme Disease
by Margaret T. Hessen, MD and from the physician members of the Delaware County Medical Society
Several recent columns in this space have dealt with various infectious hazards of summer and precautions that can be taken to prevent them. One more deserves our attention, and then I will stop focusing on the infectious diseases of the season and leave you to enjoy the summer in good health!
Lyme Disease was first recognized in the late 1970’s in Connecticut, but shortly after was found to be present in other areas, including Pennsylvania, and it has been a part of the local scene since. As most people know, the disease is spread by deer ticks, so it can be acquired anytime from spring through late fall when the ticks are active. When an infected tick attaches itself to a susceptible animal or human, it can transmit infection over a 24-36 hour period. After an incubation period of several days to several weeks, generalized symptoms such as chills, achiness, and headache may occur. Those infected often have a fever and many (not all) develop a characteristic bull’s-eye rash. This rash is the most diagnostic feature of Lyme Disease, and an experienced physician can make the diagnosis based on its appearance without bloodwork or other tests (most of which are negative at this early stage of infection, anyway). A rash fitting the description of a “bull’s-eye” or “target” should prompt a call to a doctor.
If the infection is not recognized and treated at this point, some patients go on to develop more advanced disease (“Stage 2”) characterized by severe headaches and inflammation of the spinal fluid or, in some cases, a slow heart rhythm which can result in light-headedness, fainting, or palpitations. Some patients experience none of these symptoms and progress to Stage 3 of the disease, most commonly manifested as arthritis with one (most common) or several swollen joints. In some patients with Stage 3 disease, the nervous system is the area in which symptoms are most severe and most commonly include paralysis of one or both sides of the face (Bell’s palsy) or visual disturbances. Again, any of these symptoms should be evaluated by a physician.
When diagnosed, Lyme Disease can be treated by a variety of antibiotics. The treatment period varies with the stage of the disease. Most patients can be treated with oral antibiotics, but some patients with advanced disease require intravenous antibiotics. Contrary to popular opinion, Lyme Disease is curable in the vast majority of patients, even those with Stage 3 disease. A small minority sustain permanent complications such as persistent joint pain or fatigue, but scientific studies are reassuring in repeatedly demonstrating that this is a relatively rare occurrence.
As usual in medicine, the most important and effective attack on this disease is prevention. Since the disease is transmitted by ticks, that means avoiding tick bites and eliminating ticks to the extent possible. When walking or working in areas likely to be tick-infested (woods, brush), wear long sleeves, long pants, and socks or boots that cover the lower part of the pant leg, preventing ticks from crawling up inside the pant leg. Wear tick repellant, preferably containing DEET. If exposure to these areas is frequent, consider using permethrin treatment of your clothing for added protection. Permethrin products come in several forms (spray, laundry additives) and can be purchased from camping goods stores.
Various environmental measures have been studied in the hope of decreasing the tick population. Many of these are not practical or feasible for individual home-owners, but keeping the yard free of brush and establishing a ground cover of wood chips separating grass from wooded areas may help reduce the chance of a tick bite in your immediate area.
As mentioned above, the deer tick must be attached for more than 24 hours to cause disease, so a daily “tick check” is also an effective way of preventing disease even should other preventive measures fail. Every 24 hours, at the time of a bath or shower, check all body surfaces for ticks and remove any found. Removal is best done by grasping the body of the tick with a tweezers and pulling it from the skin. Remember that deer ticks are very tiny (the size of a pinhead), and can easily be missed, for example in the hair. They prefer to attach in warm moist areas such as the groin and underarms, but can attach anywhere. If you repeat this every 24 hours, you can feel fairly certain that any deer tick found has not been present for long enough to cause Lyme Disease. Note that there are other tick-borne diseases (usually transmitted by dog-ticks and wood-ticks) that can be very serious, even life-threatening. If the tick is not a deer tick, or if the type of tick or duration of attachment cannot be established with certainty, you should consult a physician. Likewise, any illness characterized by fever and a rash, particularly in the setting of a recent tick bite, should trigger a prompt call to a doctor.
Lyme Disease is very common in our area; almost everyone at least knows someone who has had it! But it is often preventable, and almost invariably responds well to treatment when it does occur. Take precautions, and enjoy the summer!
-end-Note: this article is presented through the efforts of the Delaware County Medical Society and is intended for informational purposes only, the contents should not be intended as medical advice. “You and Your Doctor – Preserve the Relationship”.
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