North Adams Regional Hospital Director of Emergency Nursing Services Joyce Mickanin [Photo by Sue Bush]
It has become a medical scourge for several reasons, among them, it's insidious ability to mimic other diseases.
And that is why patients are a very important link in a quest for an accurate, timely diagnosis of Lyme Disease.
Patient Communication Imperative
"This is one of those things where we look to the patient to tell us the things we need to know," said North Adams Regional Hospital Director of Emergency Nursing Services Joyce Mickanin. "You want public awareness, you don't want public panic."
Lyme Disease is caused by a specific bacteria and is spread by tics that are infected. Black-legged [deer] tics are responsible for the spread of the illness; the tics live on white mice in their infancy, then migrate to deer, and finally, during the spring and fall seasons, seek warm-bodied hosts such as people and dogs as a feeding ground.
Infected tics that burrow into a body spread the bacteria.
First stage symptoms include a rash that resembles a "bull's eye" with a white or clear center surrounded by a red ring. But the rash is not present in all cases of the disease and other first stage symptoms, such as low-grade fever, muscle aches, headaches, chills and fatigue are also symptoms of the flu and other common ailments.
And that is doctor/patient communication is so important, said Mickanin.
"The patient has to tell the doctor if they are experiencing these symptoms and they've been out in the woods, in grassy areas, if they believe they were bitten by a tic or if they recently removed a tic," she said. "These symptoms mimic so many other conditions and often the symptoms go away."
First stage Lyme Disease diagnosis is treated with antibiotics and most people who are treated early do recover, she said.
But as each stage progresses, the chances of chronic symptoms and conditions increase.
Weeks or even months later, stage II symptoms may appear, and often impact the joints, the heart, and the nervous system, according to Mickanin and information provided by the Massachusetts Department of Public Health.
Stage III symptoms may appear years after exposure to the disease and may be even more difficult to link with Lyme Disease.
"It becomes harder to remember something like a tic bite as time goes on," Mickanin said."[During stage III] you're probably into the chronic, lifelong symptoms, lifelong conditions."
The "conditions" may be frightening and serious; according to the state DPH information, "About 60 percent of people with untreated Lyme Disease get arthritis in their large joints, usually knee, elbows, and wrists. The arthritis can move from joint to joint and become chronic. About 20 percent of people who don't get treatment develop nervous system problems, The most common problems include meningitis [an inflammation of the membranes covering the brain and spinal cord], facial weakness, or other problems with the nerves of the head and weakness or pain in the hands, arms, feet and/or legs."
The DPH information also advises "The heart beat can also be affected with Lyme Disease. with slowing down of the heart rate and fainting. The effect on the heart can be early or late."
Northeast A Target Area
Numerous statistics point to increasing diagnosis of the disease.
According to the U.S. Center for Disease Control, during 2005, there were about 5,565 Lyme Disease diagnosis in New York, 2,336 in Massachusetts, 54 in Vermont, and 265 in New Hampshire.
Vermont's numbers took a hike upward during 2006 to 105 reported cases.
And that could be partially due to past undetected or unreported Lyme Disease cases; although there are tests for the disease, tests may deliver a "negative" result when the patient is, in fact, infected, said Mickanin. If there is good reason to suspect the disease, additional tests may be administered and if those tests provide evidence of Lyme Disease, a doctor may prescribe antibiotic treatment as a precaution, she said.
Part of a diagnosis challenge is that until 1975, there was little mainstream medical knowledge about the condition, Mickanin said.
"This was recognized as something in 1975, when the people at the Connecticut Department of Health and some of the people at Yale University began getting reports from mothers in the Old Lyme [CT] area of kids with increased incidents of rheumatoid arthritis," she said. "There was investigation into what was going on and somehow, someone had a suspect tic that ended up being tested and Lyme Disease became known."
The bacteria that caused the disease, a corkscrew shaped organism named Borrelia bacteria, was identified in 1983.
Mickanin said that body searches are a must when children or adults come in from time spent outdoors. She reiterated that if a tic is found, there is no need to panic.
But do not be a welcoming host, either.
The appropriate method of tic removal is to use a pair of tweezers to grasp the head and gently pull the tic away from the skin. Take a few moments to properly identify the head.
"These tics are very tiny and what is easily visible is the swelled belly they get from feeding," she said. "Grab the head and pull slowly and gently straight out. You will see a small hole if you removed the entire tic, if you didn't get it all, the head will be covering the hole."
People have brought tics to the hospital for testing and identification but Mickanin said that the hospital isn't the best place for that type of testing. If a person did not get the head during tic removal, they may visit their primary care physician or the hospital to have the tic removed.
And should symptoms develop after an outdoor trek, a doctor should be contacted, she said.
"Tics are world-wide but they are more prevalent in certain locations," she said. "We are in the target area between Massachusetts and Maryland. There are other tic-borne diseases, for instance Rocky Mountain Spotted Fever, which is more prevalent in the Central South and the South. So here, we have to be aware if someone who is visiting from the South or just returned from the South comes in with certain symptoms."
"The important thing is for people to be aware and to tell their doctor what the doctor needs to know," she said. "It's nothing to panic about, tics are looking for a host, a warm body, so the tic searches are important. If you find one, remove it."
"The advice is to wear long pants tucked into boots, long-sleeved shirts, but that just isn't practical and we know that, for example, the hikers on the trails aren't wearing turtlenecks and long sleeves as they hike in the summer," she said.
"The important things are to be aware, to check for tics, remove any tics that are found and if you start showing symptoms after being outdoors in a wooded or dense foliage area, even if you did not find a tic, see your doctor, and be sure to let them know if you were in these tic-prone areas."
Susan Bush may be reached via e-mail at firstname.lastname@example.org or at 1-413-663-3384 ext. 29.
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