May is National Lyme Disease Awareness Month – and it’s also the month when people are venturing outdoors again, walking their dogs, golfing, picnicking, or raking up the leaves out back. But May is also when the deer ticks are out, looking for a warm-blooded host like you, your kids, or your dog to latch onto. They’re no bigger than a poppy seed, but if a Lyme-infected tick bites, you could be in for a whole world of hurt.
Ticks are very strange critters. They don’t fly or make noise or hop or slither. They pretty much live in suspended animation, clinging to wherever they were born, waiting patiently for a warm-blooded mammal to come near – then they let go, latch on, and bite you. Or that deer. Or that cat.
Tick bites are most common in the late spring and summer, and everyone needs to take steps to avoid getting bitten [see sidebar]. But more importantly, Lyme sufferers need to be aware of the behind-the-scenes tug-of-war going on about the proper prevention, diagnosis, and treatment of Lyme disease.
An Ounce of Prevention?
Insect-borne diseases like Lyme disease, malaria, scabies, bubonic plague, cooties/crabs, or
West Nile Virus are certainly not new human afflictions. But what is new is that modern public health authorities are fully capable of killing off the offending pests.
Yet that has not happened with the eradication of Lyme-infected ticks. Public health tick-control prevention programs have taken a far backseat to mosquito-control sprayings programs. More than $10,000,000 is spent annually in the Bay State to eradicate mosquitoes, but only $60,000 is funded to kill ticks. Go figure.
Lyme disease is the second-most commonly reported infectious disease in New England, second only to chlamydia, a sexually-transmitted disease. Meanwhile, far fewer cases of EEE (eastern equine encephalitis) and West Nile virus are reported here in New England than are cases of Lyme disease. In 2012, Massachusetts physician reports tallied over 3,300 confirmed and 1,700 probable cases of Lyme disease – an almost 20 percent increase over the year before. At the same time, there were only seven reported cases of EEE and 33 cases of West Nile Virus, both of which are transmitted by disease-carrying mosquitoes.
But Lyme disease is not just a New England issue. New CDC research indicates that there are more than 300,000 cases of Lyme disease diagnosed nationwide each year – ten times higher than previous estimates. The epicenter of the Lyme disease outbreak may well be in New England, but it has already spread to the upper Midwest, the Carolinas, the Dakotas, and the upper West Coast. And if we don’t all figure out how to get rid of the infected ticks, Lyme disease will continue to spread.
With alarming statistics like these, you’d think there’d be a huge outcry for more research and funding into the prevention, early diagnosis and rational medical treatment of Lyme disease – but there’s a ridiculous controversy going on that’s preventing that from happening. And we all need to do something about that.
No Litmus for Lyme?
Lyme disease was first identified in a cluster of children stricken with strange arthritic symptoms in Lyme, Connecticut, back in the 1970s. Poppy-seed sized deer ticks, common to areas of dense, brushy growth and high grasses, were quickly found to be the carrier-culprits of the infectious bacteria Borrelia Burgdorferi.
But Lyme disease has proved to be very difficult to diagnose using standard blood tests. Antibodies may not appear in the blood until long after the initial infection (way too late), and yet very little research or funding has been devoted to creating more rapid and accurate diagnostic tests for Lyme.
Even a Lyme patient’s vague symptoms can make an accurate diagnosis difficult. After being bitten, many people exhibit flu-like symptoms of fatigue, fever, joint-aches, and a telltale “bulls-eye”-shaped rash near the bite. But at least 25% of people bitten by an infected deer tick don’t develop the signature rash, and so the infection often goes untreated.
Too often, Lyme sufferers are misdiagnosed with fibromyalgia, chronic fatigue syndrome, depression, or just treated as hypochondriacs, referred to by some doctors as “Lyme loonies.”
If diagnosed early enough, the Lyme-bacteria infection can be knocked out with an intensive course of antibiotics. But if left misdiagnosed, untreated, and allowed to spread through the lymph nodes, Lyme disease can lead to crippling and chronic disorders.
Even after a few months of aggressive antibiotic treatment, almost one in four Lyme patients still don’t feel better. Others feel better initially, but then they feel sick again when the intensive antibiotic treatments are stopped. Many go on to suffer progressive arthritic symptoms, cardiac problems, neurological disorders, and constant headaches for months or even years.
“Above All, Do No Harm”
The most significant obstacle to treating Lyme disease is the ongoing controversy within the medical establishment itself: should chronic-Lyme cases (the ones that don’t respond to aggressive short-term antibiotic regimens) be treated with antibiotics over longer periods of time? The potential dangers of over-prescribing antibiotics is indeed a serious scientific issue, but that’s largely been caused by indiscriminate and unnecessary use of antibiotics for non-bacterial ailments, like the common cold or the flu.
As a result, many doctors who advocate for longer-term antibiotic treatment (referred to as “Lyme-literate doctors”) have been criticized by their peers and even sanctioned by state medical boards, to the point where they do not publicize that they favor this course of treatment for chronic Lyme symptoms. Without clear-cut diagnostic tools, and with increasing pressure to limit antibiotic treatments, many doctors hesitate to take on new patients with Lyme symptoms. This, in turn, makes it extremely difficult for patients to find a local doctor who is “Lyme-literate” and willing to treat their lingering or worsening chronic Lyme symptoms.
To make matters worse, many health insurance companies refuse to pay for long-term antibiotic treatments, which puts additional pressure on doctors not to prescribe them. Chronic-Lyme patients are left suffering and frustrated.
Many patients and their families have taken an activist role, demanding that those who suffer debilitating chronic Lyme symptoms long after the initial tick bite should continue to be treated with antibiotics.
There is some grassroots hope on the horizon for Lyme sufferers: both Rhode Island and Massachusetts have recently passed laws to protect doctors from professional discipline for long-term use of antibiotics to treat chronic Lyme disease, and the Massachusetts legislature has considered a bill that would require insurers to cover the cost of those long-term treatments.
But more needs to be done – like spraying and public education – to prevent Lyme disease. More needs to be done to develop accurate diagnostic tests. More needs to be done to allow for flexible medical treatments for chronic Lyme disease.
May is National Lyme Disease Awareness Month. If global public health agencies can almost eradicate malaria, polio and smallpox, why haven’t we eradicated Lyme disease?
Tiptoe Through the Deer Ticks
Even if your town isn’t spraying to kill the Lyme-infected deer ticks, you can at least take some measures to minimize your exposure to them. First of all, avoid walking through places where deer ticks like to hang out – low-hanging trees, bushes, tall grasses, and leaf piles that could brush up against you. If you wouldn’t stroll through a mosquito-infested swamp, then don’t go strolling through places like that unprotected.
If you’re going to spend time in the great outdoors, cover as much of your skin and hair as possible (just as you would to prevent skin cancer) – no matter the temperature, wear long-sleeved turtle-neck shirts, long pants, and a wide-brimmed hat. Never go barefoot and bare-chested, sock-less, or wear shorts, T-shirts, and sandals if you’re going to be in deer tick territory.
Most tick bites occur from the knee down, so always stuff your pant legs into socks or boots. If you’re a hands-on gardener or doing backyard cleanup, always wear gloves and stuff your shirt cuffs into them so that the ticks can’t get onto your hands and arms. Baseball caps don’t protect your neck, hair or shoulders – wear a wide-brimmed hat to prevent ticks from dropping onto you.
You can prevent bringing deer ticks into your house by taking a few more common sense steps. If you’re going to go tromping through the outdoors, wear light-colored clothing so that you can see those tiny dark specks on your clothing when you undress (preferably before you enter the house). And don’t leave your discarded outdoor clothing on the bathroom floor or toss it onto your couch.
Tumble-dry your bed linens, towels, and blankets in the dryer, rather than hanging them on the clothes-line outdoors. And don’t bring that picnic blanket into the house!
Man’s best friend may be harboring man’s worst enemy. Always check your dog or cat’s fur for ticks before they come inside and take a nap on your bed. Change their tick-repellant collars regularly. Indoor pet beds and favorite sleeping spots need to be vacuumed/sprayed religiously.
By the same token, wash your own hair thoroughly after you’ve picnicked in the meadow or walked in the woods – especially if you forgot to wear that hat. After you shower, have someone look you over for tiny black dots on your skin (i.e. deer-ticks), bite marks, or sudden rashes, especially on your neck or back (where you can’t see for yourself). If your kids have been playing sports near grassy fields, been off to summer camp or playing in the woods, this is especially important.
How to Off! the Ticks
Remember when spray-bottles of Avon’s “Skin-So-Soft” were suddenly the rage in deer tick repellants?
You can buy commercial spray-products that contain DEET, an EPA-approved pesticide, to ward off deer-ticks. But DEET is also a pretty harsh chemical, so it’s better to apply it to your shoes and clothing, rather than directly onto your skin. Products containing more than 30% DEET are not recommended for children, and any DEET product mixed with a sunscreen is a total waste of money.
Another tick-repellant chemical is permethrin, which is often used to pre-treat outdoor clothing, camping gear, and pet collars (it also kills mites and lice). A more natural solution is to use a spray of water mixed with rose-geranium oil, peppermint oil, or lemon oil on your clothing, hat, fabric, or dog collars.