Summer is always a good time to talk about Lyme disease, but the soggy start we had helped the breeding ground for ticks.
This month’s expert for my Healthy Actions column, which takes a look at a different medical topic, is Summa infectious disease physician Dr. Shanu Agarwal.
Q: What is Lyme disease?
A: It’s an infection caused by bacteria and transmitted through the bite of a tick.
Q: Where are the ticks?
A: In grassy areas and wooded areas, so landscapers, gardeners, homeowners and kids are at risk of getting a bite from a tick, which likes to be on deer.
Q: Are there preventative measures?
A: Wear long sleeves and jeans and an insect repellent that is 20 to 30% DEET or clothes treated with permethrin.
After, remove those clothes, wash and dry with heat and check your body for ticks.
Q: Can I see a tick on me?
A: The ones we see are the baby form of the ticks. They look like a poppy seed. They can often be in areas that are harder to see, such as underarms, groin or scalp.
Q: Can animals bring a tick in?
A: Yes, check them and talk with your vet about tick-control measures.
Q: What are symptoms of a tick bite?
A: Anywhere from three days to within three to four weeks, 70 percent of people will get a rash that looks like a bull's-eye, or the Target sign. You can have flulike symptoms, like fever, chills, fatigue and headache. Sometimes, people may not notice the rash or symptoms may be nonspecific.
Q: What do I do if I see one on my skin?
A: Don’t pull it or flick it off. Get fine-tipped tweezers, place it down and pull it up straight. Put soap and hot water and rubbing alcohol on the site and call your doctor. Watch for symptoms in the next 30 days.
Q: Should you save it?
A: It’s not necessary. Flush it down the toilet. But if you save it, put it in alcohol in a container to take to your doctor.
Q: Will I see symptoms right away?
A: There are no early symptoms. It can be within three days to 30 days.
Q: What ages are most at risk for Lyme disease?
A: It tends to be children 4 to 14 and adults 45 to 55. Children are outside a lot and the middle-age group are likely homeowners doing a lot of yardwork. Landscapers and those working outdoors are at higher risk.
Q: If I see a tick or have a bite, does that mean I will get Lyme disease?
A: You may see something red and it doesn’t turn into anything. The majority of people who get Lyme disease don’t find a tick and not all ticks transmit Lyme disease; a majority do not. If a tick is not engorged then it likely has not started feeding. An engorged tick has started feeding and should be removed; call your doctor.
Q: What will my doctor do?
A: Doctors may prescribe one dose of antibiotics as a preventative measure.
Q: What if I see the rash, feel fatigued and have other symptoms?
A: Your doctor would most likely treat you for 10 to 21 days with an oral antibiotic.
Q: Then is it done or can there be longer-term problems?
A: The treatment is very effective. If you weren’t treated within those 30 days, you can develop things like arthritis or single-joint swelling. Sometimes you can get neurological manifestations of Lyme disease like paralysis or palsy. It can also lead to heart complications.
Q: Is there a test to check for Lyme disease?
A: The blood work test is good in the right setting. In the early week or two, if you’ve got the rash, or history of being out in the woods, do not do the blood test. It’s too early to see anything. We would treat that patient with oral antibiotics.
The gray zone is beyond those couple of weeks and you’re having some symptoms, then the CDC recommends a two-step test. One test is to see if you’ve got antibodies against Lyme disease. If you do, then you move on to the second test to look for specific antibodies on that bacteria. That would be treated with a longer course of antibiotics, either oral or IV depending on the doctor’s evaluation. If the first test shows no antibodies, you don’t get treated and other things may be the cause.
Q: There is some controversy related to Lyme disease, diagnosis and treatment. Is it often misdiagnosed?
A: The testing is good. If you have a history of having some sort of complaints within the 30 days of being out in the woods like arthritis or an abnormal heart rhythm and testing shows you do not have Lyme disease, then clinicians should look at other possibilities.
The other gray zone is sometimes people are treated appropriately, still have symptoms and think they should still be on antibiotics. Doctors do not recommend prolonged antibiotic treatments as that could have side effects and promote antibiotic resistance. You may need to treat the symptoms and it’s no longer the Lyme disease.
Blood testing is not always helpful. The blood test can be positive for years, even if we’ve treated you, or it could be a false positive.
There are symptoms to other diagnoses that can cause the same symptoms as Lyme disease. Patients may come in for fatigue and want to get tested for Lyme disease. When we ask if they’ve been out in the woods and they say no, then it’s not appropriate to test for Lyme disease.
Some patients may say they have chronic Lyme disease, but the CDC says Lyme disease is not a chronic disease. Lyme disease can trigger your autoimmune system to attack your joints or trigger other chronic diseases. You might need to go see another specialist.
Q: Do I need to see a specialist first to treat Lyme disease?
A: A lot of times family practitioners see more of the early stages and can treat for it. It’s very appropriate to see an infectious disease specialist if after 30 days you still have the vague symptoms and never had the target rash. In that case, the doctor may look at other diagnoses.
Betty Lin-Fisher can be reached at 330-996-3724 or firstname.lastname@example.org. Follow her @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ and see all her stories at www.ohio.com/topics/linfisher