Family physician addresses concerns over tick-borne illness infecting more people

More than a decade ago, people weren’t talking much about Lyme disease — certainly not in upstate New York where, if you got sick from a bite of an infected tick, that bite happened somewhere else.

Up until a few years ago, family physician Dr. Robert Ostrander at Valley View Family Practice in Rushville hadn’t seen more than one or two cases of Lyme.

“It was really rare,” said Ostrander, who has been in practice 31 years and co-founded Valley View with offices in Rushville, Gorham and Canandaigua. And those patients had been bitten outside the area, in downstate, Pennsylvania or other areas where Lyme was a known problem. In all, Ostrander said he’s had about 10 cases of Lyme, and it wasn’t until the past few years that cases stemmed from bites close to home.

Tick numbers are on the rise across the Northeast, and so are cases of Lyme — along with prospects of other diseases associated with the blood suckers. Last year, the drought took a toll on ticks, whose numbers drop as the humidity falls below 85 percent. But with this year’s wet spring, ticks are taking advantage. On top of that, ticks have taken advantage of a proliferation in their favorite hosts, especially mice, chipmunks and other small rodents. But it isn’t so much the number of rodents this year that is critical.

Researchers from the Cary Institute of Ecosystem Studies, a private, not-for-profit environmental research organization in Dutchess County, N.Y., have studied ticks for the past decade. They found that a bevy of acorns one year can lead to a spike in Lyme-infected ticks two years later. They documented a bumper acorn crop in 2015 that resulted in an increase in small-rodent numbers a year later. As a result, they projected that 2017 would be especially bad for Lyme-disease ticks.

“When those mice have a big boom in their population in the summer, that is when new baby ticks are just hatching out of their eggs,” said Richard S. Ostfeld, a disease ecologist with the Cary Institute. “If there are a ton of mice, many of those baby ticks feed on a mouse. They are likely to survive and come out as nymphs the next year, and those mice are the place those baby ticks get infected with Lyme disease bacteria.”

With the explosion in tick numbers in the past decade, there has been a dramatic increase in tick-related diseases. The Centers for Disease Control and Prevention estimates 300,000 people are diagnosed with Lyme disease every year in the U.S. — that’s 1.5 times the number of women diagnosed with breast cancer and six times the number of people diagnosed in the U.S. annually with HIV/AIDS.

 

'A complicated problem'

Many experts believe the true number of cases is much higher because diagnosing Lyme can be difficult. As with tests for other infectious diseases, the accuracy of the test depends upon the stage of disease, according to the CDC. During the first few weeks of infection, such as when a patient has a rash often associated with Lyme, the test is expected to be negative. Several weeks after infection, several different tests are good at picking up the disease.

It’s possible for someone infected with Lyme to test negative for a couple main reasons: Some people who receive antibiotics (such as doxycycline) early in the disease (within the first few weeks after tick bite) may not develop antibodies or may only develop them at levels too low to be detected by the test. Antibodies against Lyme disease bacteria usually take a few weeks to develop, so tests performed before this time may be negative even if the person is infected. In this case, if the person is retested a few weeks later, they should have a positive test if they have Lyme disease. It is not until four to six weeks have passed that the test is likely to be positive.

“The test will eventually turn positive if you have Lyme,” said Ostrander, adding it’s also possible to get a positive test result and not have Lyme.

“It’s a complicated problem,” added Ostrander, a member of the New York State Academy of Family Physicians and its past president.

It’s a problem the Academy is wrestling with as Lyme disease has spread across the state. Nationally, New York now has the highest number of people reporting Lyme infection. It is also an emotional issue that comes with a lot of misinformation, Ostrander said. “We at the Academy of Family Physicians have been trying to dispel some of the myths.”

 

‘This is like warfare’

The first sign of Lyme disease is often a certain kind of circular skin rash (called erythema migrans) and common flu-like symptoms: Fever, malaise, fatigue, and muscle and joint pains. However, the rash doesn’t always appear, which can make diagnosis more difficult — especially when the person isn’t aware of being bitten by a tick.

Other early signs may cover a slew of symptoms that can vary greatly from person to person. Those may include small skin lesions, facial nerve paralysis, lymphocytic meningitis, and heart-rhythm disturbances. Early infections usually are cured by two to four weeks of orally-administered antibiotics (amoxicillin or doxycycline). However, if untreated or inadequately treated, a person may suffer from neurologic, cardiac or joint problems.

Lauren Coe, 53, who lives in the Monroe County town of Webster, thinks she was bitten by a tick about 13 years ago when she became mysteriously ill. Doctors couldn’t figure out what was wrong. Normally a fit, active person used to hiking outdoors and other rigorous activities, she became nearly unable to walk. For four months she was confined to a chair and relied on a cane or walker to get around.

“I had paralysis, pain in all my muscles that felt like I'd been beaten from the inside, and stress would bring it on even worse,” Coe said.

Doctors couldn’t figure out what was wrong, Coe said. She eventually found relief from homeopathic remedies, which are based on the philosophy the body has the ability to heal itself. She made lifestyle changes that involved stretching exercise and changes to her diet.

Then, this past February, the pain returned along some new symptoms.

“Everything just hurt,” said Coe, an independent sales director with Mary Kay cosmetics and founder of the charity One Soldier at a Time. “My muscles ached, I had sharp shooting pain, headaches I wouldn’t wish on anybody.”

In addition, the right side of her face drooped like a sign of Bell’s palsy, a paralysis or weakness in the muscles on one side of her face. “This is like warfare,” she remembers thinking.

That’s when a doctor had Coe tested for Lyme. It came back positive.

Coe was treated with 30 days with the antibiotic doxycycline. It was by no means instant relief, she said. She still has aches and pains and her dog, a boxer named Joc, also was diagnosed with Lyme this spring. He was treated by a veterinarian and they are both doing much better, she said.

 

Lyme’s aftermath?

Can a person be persistently infected with Lyme after treatment?

“The answer to that is almost certainly no,” said Ostrander. “There is no evidence that once you have been treated with standard course of two to four weeks of treatment that you still have the germ in your system.”

Yet, people can suffer symptoms after treatment. Fatigue, pain or joint and muscle aches can last for more than six months after treatment. Sometimes it’s called “chronic Lyme disease,” according to the CDC, which identifies the condition as “Post-treatment Lyme Disease Syndrome” (PTLDS).

Ostrander said the damage Lyme can do to tissue is not to be taken lightly. After your body is free of the infection, you can “still hurt, still have an irregular heartbeat, you may still have some numbness and tingling and joint pain” and other ailments, he said. He gave the example of a sprained ankle that still feels out of whack after it is supposed to be healed.

“Because you got scar tissue, things don’t heal as good as new,” Ostrander said. “So part of it is you have tissue injury — you kill the germ but it doesn’t feel as good as new.”

He added that another issue probably at play is the way the body attacks the Lyme germ. “The antibodies that attack Lyme can also attack your own tissues, and if that’s not associated with infection it is an autoimmune disease,” he said, citing rheumatoid arthritis as an example. Ostrander said that after certain infections, the antibodies that your body made to fight that infection linger and that can cause an autoimmune disease.

“We don’t have great treatments for autoimmune disease, but more antibiotics is not the answer,” Ostrander said. He added there’s no cure for the damage from autoimmune disease: “We don’t understand that enough yet so we have to manage it.”

The Associated Press contributed to this report 

 

Senate task force tackling Lyme

State Sen. Pam Helming, R-Canandaigua, is a member of the Senate Task Force on Lyme and Tick-Borne Diseases. She responded to questions about the Task Force

What can be accomplished through the Task Force?

There is a constant stream of information on Lyme disease, which makes it difficult for people to know what information to trust. As a Task Force, we are committed to disseminating verified, fact-based information on Lyme disease to at-risk communities throughout New York State. To do this, the Task Force works closely with Lyme disease experts around the state.

As a Task Force, we can advocate for more funding and research on Lyme disease since New York rests in the epicenter of this nationwide epidemic. To do this, we will continue to seek further engagement from Governor Cuomo and commitments from the Department of Health, as there is much more that can be done.

What is happening now with the Task Force?

We are continuing to make sure that accurate information is disseminated through informational pamphlets mailed out to our communities as well as holding educational forums that are open to the public. Many such forums are held in partnership with other organizations that are engaged with their communities, including universities.

We achieved $400,000 in funding in this year's state budget. Cornell University and its cooperative extensions around the state will receive $200,000 for prevention and outreach work. Another $200,000 will support continued research on Lyme and other tick-borne diseases.

The Task Force also carries Senate Bill 2168 to study the cost of coverage for treatment of chronic Lyme disease, Senate Bill 2621 to increase awareness of Lyme and other tick-borne diseases in the medical community, and Senate Bill 6084 to direct the DEC to develop best practices in treating residential properties for integrated pest management. I have co-sponsored these three bills.

What is being discussed?

We meet as a body once per legislative session, with our most recent meeting in May 2017.

This year's Task Force meeting included educational presentations by two Cornell researchers, specifically on identifying ticks versus other insects, proper removal of ticks, tips on how to protect both people and pets from tick exposure when outside, and the latest information from the CDC on common symptoms after infection, as well as time frames for such symptoms to emerge. There was also a Faces of Lyme video presentation featuring individuals who have suffered from Lyme disease and discussed their experience with the disease.

The members of the Task Force also hold educational forums throughout the state, in partnership with several other organizations, and work hard to maintain consistent communication with experts on Lyme disease to ensure that information that is shared is accurate and up to date.

What is the plan going forward?

The priority for the next year, in addition to continuing the dissemination of accurate information about Lyme and other tick-borne diseases, is to seek better engagement on the issue from the Governor and the Department of Health to significantly increase funding for outreach and research.

Lyme disease is the second-highest contracted infection in the nation, and New Yorkers face a high risk of infection. In addition to what has already been achieved by the Task Force, we need to allocate greater statewide resources to this issue, and that requires the full commitment of the Governor and state agencies.

On the upcoming forum in September:

When I was recently appointed to the Task Force, I began planning for a public educational forum in the 54th District, which is targeted for September. State and local experts will speak at the event, as will individuals who have been affected by Lyme disease.

The forum will educate residents and community leaders about prevention and awareness, more specifically how to prevent tick bites, how to identify ticks, what to do in the event of a tick bite, and what someone may experience after a tick bite. Additional information on the event, including a confirmed speakers list, will be disseminated by the end of July.

We also recently mailed out a brochure about Lyme and tick-borne diseases to residents of the 54th District as well as school districts. Many organizations, such as the Boy Scouts, have reached out to us for additional copies to distribute. An updated version will soon be available in the district office in Geneva.

 

What you can do to prevent Lyme disease

Michelle Vignari, Thompson Health director of infection prevention, offered tips for tick and Lyme protection:

— Ticks are most active during warmer months (April-September)

— Ticks love moist/humid environments, usually wooded or grassy areas. This includes your own back yards.

— Avoid direct, high-risk contact areas, such as high grass, brush and leaf litter areas. When hiking, walk in center of trails.

— Cover as much exposed skin as possible. and wear lighter-colored clothing.

— Treat clothing and gear with a product containing Permethrin. Use on boots, shoes, clothing and camping gear. Permethrin remains on clothing/gear to repel ticks even after several washings.

— As for skin, while there are many natural “recipes” out there for tick prevention the Centers for Disease Control and Prevention (CDC) recommends using an Environmental Protection Agency (EPA)-registered insect repellent. Most common are DEET (greater than or equal to 20 percent), Picaridin and Oil of Lemon Eucalyptus. There is a link on the CDC website to help you choose the best repellent for you: https://www.epa.gov/insect-repellents/find-repellent-right-you Always follow product instructions. For babies less than 2 months, consult with physician before using insect repellents.

— Conduct a full body check upon return from potentially tick-infested areas, which even includes your back yard. Use a hand-held or full-length mirror to view all parts of your body. Check these parts of your body and your child’s body for ticks: under the arms, in and around the ears, inside belly button, the back of the knees, in and around the hair, between the legs and around the waist.

— Check your clothing for ticks. Any ticks that are found should be removed. Tumble dry clothes in a dryer on high heat for 10 minutes to kill ticks on dry clothing after you come indoors. If the clothes are damp, additional time may be needed. If the clothes require washing first, hot water is recommended. Cold and medium temperature water will not kill ticks effectively.

— Shower soon (within two hours) after being outdoors. Showering may help wash off unattached ticks, and it is a good opportunity to do a tick check. 

— If you find a tick attached to your skin, use fine-tipped tweezers to grasp the tick as close to the skin's surface as possible. Pull upward with steady, even pressure. Don't twist or jerk the tick; this can cause the mouthparts to break off and remain in the skin. If this happens, remove the mouthparts with tweezers. If you are unable to remove the mouth easily with clean tweezers, leave it alone and let the skin heal. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water.

— Dispose of a live tick by submerging it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the toilet. Never crush a tick with your fingers.

— Contact your medical provider. Depending on several risk factors your provider will decide on if antimicrobial prophylaxis for prevention of tick-borne illnesses is warranted.

— Use tick control products to prevent family pets from bringing ticks into the home. Tick collars, sprays, shampoos, or “top spot” medications should be used regularly to protect your animals and your family from ticks.