Tis the season for Ticks:
Well, spring is on the horizon. Temperatures are up. And rain and sun have replaced wind and snow. But with the welcome relief of warmer times ahead, there comes a new concern, especially for those of us who intend to be enjoying the great outdoors for the next several months.
.......The ticks are out!!!
Over the last 5-6 years or so, tick numbers have been on the rise, possibly with climate change being a major factor. With an increase in the incidence of ticks and tick bites, comes an increased risk of infection with the bacteria that can cause Lyme disease. While the risk is not overly high, it exists, and is something to be aware of as our summer plans draw close.
While the larger brown dog ticks are more noticeable (Rhipicephalus sanguineus) these are not as significant a vector for disease as the black-legged deer ticks (Ixodes scapularis). These are the ones that carry Lyme disease bacteria, and they are still considered somewhat rare in Saskatchewan. Nevertheless, we should be prepared to recognize them. The black-legged deer tick is only about half the size of the brown dog tick, and it is mostly found in wooded areas, as opposed to areas of tall grass or near riverbanks, where the brown dog tick is more usually found.
LYME DISEASE - Overview
Lyme disease is an infection caused by the spirochete bacteria calledBorrelia burgdorferi. This bacteria is typically contracted through the bite of a black-legged deer tick (Ixodes scapularis). While the bacteria have been detected within other kinds of ticks, such as the American Dog tick (Rhipicephalus sanguineus), and other insects, actual transmission through these other vectors has not been proven to date. In addition, although the DNA of Borrelia bacteria have also been detected in semen and cervical tissue, it has still not been proven so far that Lyme can be sexually transmitted. However, because
Borrelia burgdorferi is a spirochete bacteria, similar to syphilis, some physicians suspect that sexual transmission is a serious possibility.
Contraction of the Lyme infection through a tick bite typically presents initially with a distinctive rash, greater than 5cm in diameter, which slowly increases in size, and is usually painless and non-itchy. The lesion also presents with central clearing, creating the characteristic "bull's eye" look.
This rash will present on most patients within 7 days of the tick bite. Because the rash can take this long to appear, and because the black-legged tick is so small in size, many people may not have realized, or may not remember being bitten, and will not associate the rash with a bite. To make matters even murkier, a Lyme infection may not present itself with that distinctive rash at all. So the absence of such a rash does not rule out the possibility of Lyme. Other early symptoms include fever, headache, muscle pain, and feeling tired.
If left untreated, symptoms of Lyme may include paralysis of one or both sides of the face, joint pains, severe headaches, neck stiffness, or heart palpitations. Over the long term, months or years later, there may be recurring episodes of joint pain and swelling, and perhaps shooting pains or tingling in the extremities.
Unfortunately, because of the general "flu-like" nature of the initial presenting symptoms, and because only a handful of blood tests effectively detect Lyme bacteria, the infection is often missed. All too often, patients receive several false negatives before being correctly diagnosed. Many experienced doctors will recommend that the diagnosis be made clinically, based on the presenting symptoms, and the patient's history. (i.e. was there recent travel or activity in a woodsy area, where a tick bite may have occurred)
There are two common antibody tests to consider if you suspect a case of Lyme. There is the ELISA test (Enzyme-linked immunosorbent assay), and there is the Western blot test. Laboratories who commonly test Canadians are Igenex Inc in California, as well as
Stony Brook University in New York. The ELISA test is often not sensitive enough for screening, and will frequently miss an infection.
The Western blot is more accurate, so when speaking with your doctor, request this test specifically.
Lyme disease, ideally detected or suspected as early as possible, is usually treated with multiple rounds of antibiotics in order to kill the tenacious bacteria. Depending on your medical history, your doctor may prescribe Doxycycline, Cefuroxime axetil, or Amoxicillin.
There is currently a bit of a controversy around Lyme disease, which boils down to a disagreement over "persistent infection" vs "autoimmunity", where some patients continue to experience symptoms such as recurrent joint pain and swelling, even after having undergone the antibiotic treatments. In the supposition of a "persistent infection", the idea is that short-term antibiotic treatment is not sufficient, and patients will seek additional courses of treatment.
However, institutions such as the Infectious Disease Society of America, and insurance companies, as well as many doctors here in Canada, hold the viewpoint that these persistent symptoms are due to "autoimmunity", perhaps as a residual effect of the infection, but is NOT indicative of "persistent infection". Thus, they will often take steps to withhold further antibiotic treatments, as excessive antibiotic use can promote antibiotic
resistance in bacteria. Rather, they recommend anti-inflammatory drugs to control what they consider to be autoimmune symptoms. Settling this controversy is a conundrum, and speaks to the need for more reliable and accessible testing for confirming Lyme infection. Beyond that, early treatment and/or prevention are your best protection.
There is currently no vaccine for Lyme disease. The best way to avoid this disease is to protect against tick bites. Recommended precautions include:
- If you live in a tick zone, remove leaf litter and tall grass around your house to reduce their numbers.
- Cover up with light-coloured clothing to spot ticks more easily.
- When hiking, walk in the center of designated trails
- Wear closed-toed shoes.
- While not exactly "fashionable", tuck your pant legs into your socks to prevent ticks from crawling up your legs.
- Tuck your shirt in to prevent ticks from getting onto your skin.
- Use insect repellents that contain N,N-Diethyl-meta-toluamide (DEET) and/or Icaridin.
- Have a friend/travel buddy give a quick scan at regular intervals to check if a tick is crawling on you.
- Shower or bathe within two hours of being outdoors to wash away any loose ticks.
- When returning home, change your clothes and hang them outside so ticks don't get in the house.
- Running clothes through the dryer will kill ticks more effectively than in the washer.
If preventative measures fail, and you find you have been bitten by a tick, do not panic. A tick usually needs to be attached for between 36 to 48 hours in order for the bacteria to be successfully transmitted. This can be determined by the level of engorgement of the tick, or by your knowledge of your recent outside activities. So if you have reason to believe that the tick has been attached for less than a day and a half, then proper removal is likely all you need. Improper removal of ticks increases the risk of contracting tick-borne infections.
DO NOT squeeze the tick, and DO NOT burn it or put aggravating substances on it. This is important to remember, as many people may instinctively want to pinch or squish a tick, upon discovering it. Instead, use a pair of forceps (tweezers) to firmly grasp the tick as close to the skin as possible. You are trying to grab it around its head or mouth parts, which are less compressible than the abdomen. DO NOT twist the tick. Just pull it straight out. Use antiseptic on the skin. Disinfect your forceps. Wash your hands thoroughly. See your healthcare provider about possible diagnosis, testing, and treatment. You may also want to save the tick itself, preferably alive, in a zippered plastic bag or closed container with a moist cotton ball, in order to have it tested for the presence of Lyme bacteria.
DO YOU HAVE ANY QUESTIONS OR CONCERNS?
The Naturopathic Doctors at Choice Nutrition would be happy to discuss any questions, symptoms, diagnostic techniques and treatment options regarding Lyme Disease and associated infections.
CONTACT US to book your appointment today!
Our services qualify for insurance coverage under most extended health care plans.
HAVE A HAPPY TICK FREE SUMMER!
With that in mind, enjoy the warmer weather to come. As long as we cultivate awareness, and take realistic precautions, we needn't let fear of ticks or Lyme disease get in the way of enjoying our all too brief summer months. Have fun out there!
Yours in health,
Dr. Evan McCarvill, ND