Or, The Devil You Know………..
Our beautiful Harlem Valley countryside has many wondrous attributes, but, alas, an abundance of Lyme-carrying ticks as well. Lyme is a fascinating disease model, and understanding it may help you recognize symptoms earlier and receive treatment more promptly.
Lyme Disease is caused by bacteria termed a “spirochete,” so named for its spiral shape (think fusilli). Like its infamous cousin syphilis, the Lyme spirochete is able to constantly alter the unique proteins on its outer shell. This is why you don’t develop immunity after an infection — your antibodies are constructed to recognize and
destroy protein particles that are no longer there! So there is no limit to the number of times you can contract Lyme. Prevention, therefore, is crucial. After any day that you’ve been in fields or on grass, spend several minutes searching for ticks on your skin. Deer ticks are very small, and seek out warm creases where the skin is thin, such as behind the knees. If you find one, simply hold a cotton ball doused in rubbing alcohol against it for sixty seconds. This causes the tick to release its grip, and also cleanses the wound.
Most scientists agree that Lyme Disease can only be contracted by having a deer tick feed on you for a minimum of 24 hours. So don’t panic if you find a tick; the majority of instances do not confer risk of disease. But it is always a good idea to mark down on your calendar the date you noted the tick bite and to monitor yourself for the next 2-3 weeks. Ideally, you should observe your naked self in a full length mirror, looking for the tell-tale “bull’s-eye” lesion. Often described like a “target,” this rash usually is oval, not round, and can be quite subtle. But it is unequivocally diagnostic — if an experienced doctor recognizes a Lyme rash, then the diagnosis is clinched — no blood test needed. And in areas where the rate of Lyme Disease is very high, there is a role for preventative antibiotics. We sometimes prescribe one day of antibiotic to reduce the risk of disease if we’re sure a deer tick was attached more than a day. This reduces the likelihood Lyme Disease will develop.
Lyme Disease has multiple stages. Primary Lyme Disease, usually occurring several days to several weeks after a bite, typically is comprised of flu-like symptoms (fatigue, headache, chills, aches) and /or the classic rash. Only 50% of sufferers develop the rash.
Treatment with an extended course of an antibiotic, such as amoxicillin or doxycycline, has an extremely high rate of cure when the disease is caught at this stage. But as the blood testing is often “false negative” early on, empiric treatment or close follow-up with repeat labs may be necessary. And even when appropriately treated, sometimes a patient will feel intensely worse, not better, early in the course of the antibiotic. This severe flu-like illness is the “Jarisch-Herxheimer reaction,” and is caused by the simultaneous death and destruction of the many organisms in the blood stream, and the resultant release of their irritating proteins into your system. As unpleasant as it is, it is brief and requires no special treatment — and it actually indicates an excellent prognosis!
Later stages of Lyme Disease usually cause single, intense joint pain and swelling — the knee being the most common site–or, much less frequently, heart involvement. Lyme bacteria can invade the heart muscle and disrupt electrical conduction, resulting in “heart block” (a dangerously slow heart rate) or an uncontrolled fast and irregular heart rhythm called atrial fibrillation. While special heart medicine or even a temporary pacemaker-may be required, this problem is ultimately cured just like primary Lyme Disease — with antibiotics. The rarest but serious sequela of Lyme Disease is tertiary Lyme meningitis, which is when the spirochete invades the brain. This can result in profound neurological dysfunction, including frank psychosis. That is why, in Lyme endemic areas, Lyme screening is performed on patients being admitted to a psychiatric facility. Though curable with antibiotics, this deep-seated infection frequently requires a period of IV medication. Scary, yes, but easily treatable.
The same ticks that carry Lyme Disease may harbor other “tick-borne illnesses” such as Ehrliciosis, Babesiosis, Bartonella and Rocky Mountain Spotted Fever. Many of these are killed by the same antibiotics that kill Lyme, so they are usually not tested for initially. But more specialized testing and additional treatment always needs to be considered in cases of Lyme that do not respond as expected. Another reason someone may not respond as quickly to antibiotics as expected is termed “post-Lyme syndrome” and is felt to be due to residual inflammation and damage left behind by the longstanding spirochete invasion. In decades past this was felt to be a major cause of lingering disability, but newer, more comprehensive and aggressive treatment protocols make this “chronic Lyme” quite rare. It is common, though, to be mildly “achy” and fatigued for up to three months after infection; extra rest and cautious use of anti-inflammatories, such as ibuprofen, help symptoms resolve.
Information is power, so you now are armed against our local scourge — Lyme Disease.
Re-posted from 2011