lyme disease: it’s here…it’s us…

A Lifetime of Quality Care That’s Convenient & CompleteA Lifetime of Quality Care That’s Convenient & Complete

Lyme Disease: It’s here…it’s us…Robert Grimshaw MD FACP

A Lifetime of Quality Care That’s Convenient & Complete


As you can see from the map, Lyme disease is found primarily in the Northeast. In fact, the 6 northern towns of Westchester County are a major hot-bed of Lyme. Lyme was first described in the town of Old Lyme Connecticut after Dr. Allan Steere was put on the trail by a local artist, Polly Murray, who had found that many area residents, including a large number of children had been diagnosed with "juvenile rheumatoid arthritis." Steere and his Yale group were able to trace the disease to the "deer" tick Ixodes scapularis, and a germ in it, Borrelia burgdorferi. There have been over 161,000 cases reported in the US; 2,580 this year so far.


Tick Life:

No deer, no Lyme is the bottom line. Although other animals, specifically white-footed mice, are important in the tick life cycle, the disease is where the deer are. On Grand Island, a peninsula off Cape Cod, all the deer were "harvested" – and no more Lyme occurred!


Symptoms:

Early Disease: flu-like headache, fever, muscle aches, fatigue and the famous "bulls-eye rash." Disseminated Disease: nerve problems, such as facial droop (Bell’s palsy), arthritis (usually a few red, hot joints) and slow heart beat (heart block). Memory issues and trouble working with numbers have also been reported. According to the Centers for Disease Control, "Lyme disease is rarely, if ever, fatal."


Diagnosis:

Early Lyme is diagnosed from the rash. Blood tests are not helpful at this stage. In disseminated Lyme, the diagnosis is made by history and physical exam, supported by lab tests. The main blood tests are a screening ELISA and a more specific "Western Blot". Unless antibiotics have been given, the tests, in my experience, are very good, especially for Lyme arthritis.


Treatment:

Early Lyme is treated with 10 to 21 days of antibiotics. Doxycycline (Doryx, Vibratabs) is preferred, because it penetrates the joints, the central nervous system and covers for a frequent co-infection, Ehrlichiosis (see below). Stay out of the sun (due to rash)!


Disseminated Lyme

Treatment has become controversial. First therapy is 30 days of oral antibiotics, doxycycline again preferred. Studies have shown that this works as well as intravenous (IV) drugs, such as Rocephin (ceftriaxone). It’s good to remember that improvement can continue for up to 6 months, "coasting" after therapy is finished. IV meds are used if oral treatment fails. Unfortunately, there is a subset of patients who don’t get better, no matter what. A recent study showed no improvement with long-term antibiotics. But it’s been faulted for only using 1 month of IV meds and 2 months of oral therapy.

More data is needed!


Prevention:

Stopping ticks from biting is the best way – no bite, no Lyme. Long sleeves and long pants help. Picking the ticks off also helps: they have to feed for at least 36 hrs to infect you.


Antibiotics for Tick Bite?

A report from NY Medical College shows Lyme can often be aborted by giving one dose of 200 mg doxycycline, if you’ve got a blood-engorged deer tick.


LYMERix Vaccine

Generated some controversy, but was deemed effective and safe by the FDA. In March 2002, it was voluntarily withdrawn from the market by the manufacturer, GlaxoSmithKline.


Lyme FAQs:

• You can get Lyme again.• Ticks walking on you haven't infected you.• Testing ticks is NOT helpful.• DON'T LIVE IN "TICK FEAR!!"


Here's how to remove ticks:


Don’t Forget Ehrlichiosis:

In our area, ½ adult deer ticks carry Lyme; ½ also carry the germ that causes Ehrlichiosis; 1/4 carry both! Of the young nymphs, the figures are 1/4 for each and 1/8 for both.

Symptoms: a flu-like complex of headache, fever, fatigue and muscle aches comes 5-10 days after the bite. If you get these, get in right away! Ehrlichiosis can cause serious pneumonia and can be fatal.

Diagnosis is made from history and exam, supported by a blood count and liver tests. The best test is response to treatment; a specific blood test is expensive and slow.

Treatment is with doxycycline for a week; other drugs are available.


COUGH HISTORY QUESTIONNAIRE

Babesiosis can also be carried by the deer tick, but hasn’t been reported in our area - yet. Patients with both Babesiosis and Lyme have been seen in Nantucket and treatment is complex and difficult.

A New Lyme-like Germ was reported in May by Dr. Durland Fish at Yale. They don’t know yet if it causes human disease.

Could it be the reason some patients do poorly?

lyme disease: it’s here…it’s us…

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