Lyme Disease- by Dr.Richard Firshein

It seems that 2018 will be the worst year for Lyme disease in recent history. There are various theories as to why this is happening, but the most common is climate change.

As the weather is warming, the tick population which is normally reduced or regulated due to severe weather conditions- which includes normal winter temperatures- is no longer the case. This past winter was a mild one, and it gave the tick population ample time to replicate.

The CDC has estimated that 300,000 Americans are infected with Lyme disease each year. A massive increase from the 20,000 cases we believed were present in the early 1990’s. These estimates do not include the 60,000 cases contracted in Europe, where there are different forms of Lyme disease, but all in the same family. 

The problem with ticks is that they not only carry Lyme disease, they carry a significant number of pathogens as well. These include;

Ehrlichiosis– a bacterial disease also transmitted by the lone star tick. Symptoms may include fever, headache, fatigue and muscle aches. 

Babesiosisa malaria like disease typically spread by the deer tick in its nymph stage, which can cause severe fatigue and some cases may require hospitalization.

Anaplasmosis– a bacterial disease which is primarily transmitted from the black-legged tick and the western black-legged tick. Typical symptoms include fever, headache, chills and muscle aches.
Powassin a virus which can be transmitted within 15 minutes and can cause severe encephalitis that may lead to death. 
Rocky Mountain Spotted Fever a bacterial disease which usually causes fever, headache, a rash (as seen in the pic below) and can also be deadly if not treated early with the right antibiotic.

Meat Allergy?  

There is also a new condition associated with a specific compound called Alpha-gal, which creates a strange allergy to red meat induced by tick bites.

Alpha-gal is a sugar molecule carried by the Lone Star Tick. When it bites a human, it activates the immune system which starts producing this Alpha-gal antibody. The body then becomes wired to fight this specific molecule which is also present in red meat. Eating meat can then trigger an allergic reaction.

Lyme disease uncovered 

Lyme was first discovered by Doctor Allen Caruthers Steere. He found there to be a cluster of very significant symptoms among children visiting pediatricians in Old Lyme, Connecticut.

When the initial condition was diagnosed, it was thought to be a form of Rheumatoid Arthritis since most of the symptoms are related to joint pain.

That was later proved not to be the case, since Lyme also causes numerous other symptoms such as;

    Neurological problems
    Memory loss
    Fatigue
    Back pain
    Arrhythmia’s
    Radiculopathy

It was later determined that these symptoms were related to a spirochete that is attributed to the Deer Tick (pictured below).

The spirochete is a very tricky pathogen because once it is in the blood, it disguises itself by layering on a very specific coating (like a cloaking device), and releases specific fragments which confuse the immune system into attacking something other than itself.

Spirochetes have a corkscrew shape which allows them to literally drill through tissue and get to their target in a more direct fashion.

Typically, the Lyme spirochete is transmitted -through regurgitation- after the Deer Tick has been attached to your skin for 36-48 hours (but that can vary quite a bit). As the tick gets its fill, it regurgitates some of the victim’s blood. It is the actual mixture of blood with saliva, that passes the Lyme disease back to the patient.

Approximately 25-50% of those who have been exposed to Lyme, do not get the typical bullseye rash as seen in the pic below.

The bullseye rash identifies the area where the tick was most likely adhered to the skin. The ring that is moving outside of that tick bite is the bacteria spreading through the skin which ultimately finds its way into blood vessels and circulates through the body, where it begins it’s next pathogenic phase.

Usually Lyme is completely curable, if it is caught within the first few weeks. The problem occurs once the disease disseminates which can result in many disabling symptoms, including permanent impairment- particularly those associated with nerve pain-, radiculopathy and arthritis.

How ticks look

It is important to know the basic appearance of a tick during its different stages of life.

During the larvae stage the ticks generally have 6 legs. Their color is not as distinctive nor are their markings, and they have even been mistaken for a fleck of dust or dirt. Early in the spring/summer, the ticks mature from their larvae stage, into their nymph stage where they can easily fit into the head of a pin. Adult ticks have 8 legs and are more recognizable.

Deer ticks have a very interesting life cycle, which can last up to 3 years. At each stage of their lives, ticks feed on a particular host such as a mouse, then a deer or dog and lastly a human. Once a human develops Lyme, they are the last stage of infection in this particular lifecycle. After the female gets a blood meal, they can lay anywhere from a few thousand up to 18,000 eggs.

Ticks can crawl into any crevice of your body from your eyelids to your derriere. Therefore, it is critical to be aggressive in prevention. A few things you can do are

Avoid areas where ticks are present such as lawns, areas where tall grasses might grow and certainly wooded areas
Wear light colored clothing (which makes ticks more noticeable)
Use a tick repelling pesticide (such as Deet) on areas of exposed skin
Use Permethrin (a natural chrysanthemum derived tick repelling pesticide) on your clothes. There are clothing sold which have this pesticide embedded in it’s material. Tests have shown these do reduce mobility of ticks and therefore should reduce the chances of them finding a safe space to bite.

Ticks can swim and it is very difficult for them to drown, therefore submerging them in water won’t kill them. They can survive when it rains, in the shower or if you are swimming in a pool. They are able to do so by putting a protective bubble of air around their body, which keeps them alive under water for several days if necessary.

Ticks don’t just bite, they embed themselves into your skin.

As the tick starts getting its fill, it inserts a barbed like tube into the skin of its victim, which secures their bodies in place. Next, the tick secretes a small amount of glue to keep itself attached to the skin. Oftentimes tick bites go unnoticed not only due to the small size of the tick, but also because its saliva contains a painkiller which numbs the area.

Once a tick has been found, it is critical to carefully extract it- which includes the entire mouth -with it’s biting parts-, tube and legs. There is only one way to properly remove a tick. Methods such as alcohol, nail polish, ice or heat from a match, which will only force the tick to further burrow itself further into the skin.

A tick must be removed with a tweezer. This can be done by following the steps listed below.

To Prepare:

Remain Calm- The extraction process is very detailed, and you want to ensure that it is being performed properly.
Identify the angle at which the tick has entered the skin- This is important because you will need to pull in the opposite direction
Proper Tweezers and a Magnifying Glass- These are the tools needed for the extraction.

To Extract:

Place the tweezers as close to the skin and the head of the tick as possible
Apply a small amount of pressure on the tick- so there is a tethering of the skin- until the tick’s jaws release from the victim
Gently pull straight out. Do not twist or jerk the tick. Failure to do so could result in breaking a part of the tick’s body into the skin, and the resulted release of inadvertent Lyme spirochetes.

Once you remove a tick it should be carefully discarded, by being flushed down the toilet. If a part of the tick remains in the skin, apply alcohol to the area and attempt to remove the remnants with the tweezers. Usually if the tick is in less than 24-48 hours, the piece that is in the skin does not contain the Lyme spirochete.

Think you might have Lyme?

The diagnosis of Lyme disease is usually determined through physical signs and symptoms, as well as laboratory or blood testing. The first most important determinant is whether or not someone has been exposed to a tick bite. The second would be significant symptoms which are relatable to the tick bite, or signs including the typical bullseye.

The most commonly performed tests are the Western blot and the Elisa. Both are used to detect whether or not Borrelia Burgdorfi (through the actual antibody of the organism) is present. There are several tests which are available, although they do not generally turn positive until several weeks after the initial exposure. If your tests results come back negative, but you have symptoms consistent with Lyme, and have been in an area where Lyme is present, you should consult a specialist immediately who is familiar with Lyme.

Reports of actual transmission from human to human appear to be rare or non-existent. However, spirochete DNA has been found in semen and breast milk, but transmission has never been shown to take place through sexual contact.

Treatment

Once Lyme has been determined, the general rule is to treat for 2 weeks with an antibiotic of choice (generally doxycycline or amoxicillin). I have found the best results when consistently treating with a twice dose of doxycycline for a month. Missing doses of, or consuming alcohol with said antibiotics will result in an ineffective treatment.  

Antibiotics are only effective during the period of time when bacteria are replicated. About 10% -20 % of cases treated properly for the month require a repeat treatment.

We generally don’t treat children under the age of 8 with doxycycline, because it can interfere with tooth & bone formation. However, depending on the severity/degree of symptoms (ex: high risk of Lyme exposure or if a bullseye rash is present) doctors may decide to treat with the appropriate antibiotics. Treatments are determined on a case to case basis, so it is important to follow the guidelines set forth by your physician.

Symptoms of Lyme can remain dormant for many years. There are a significant number of people who develop long term chronic symptoms from Lyme. A couple of attributing factors are;

If the problem wasn’t completely treated
If exposure is unnoticed and left untreated.

 

In cases of Chronic Lyme, many patients have found relief with the use of supportive medications, supplements, vitamin infusions, hyperbaric oxygen and acupuncture to name a few. Each of these treatments need to be combined with careful testing, to ensure that the disease has been effectively eliminated.

In closing, there are a few things to remember which are to:

Avoid areas of high exposure

Watch for symptoms

Do not underestimate flu like symptoms-particularly in the summer

Treat consistently.

 

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