Tick alert - Hampton Union
News Desk
the board, and they have often been diagnosed with other illnesses such
as chronic fatigue syndrome, fibromyalgia, lupus ...
Tick alert
By Liz Chretien
hampto...@seacoastonline.com
Complete Living Index
For most New Englanders, summer represents a fleeting period of time
after a long, cold winter that must be enjoyed to the fullest. This
means camping, hiking, trips to the lake and many other outdoor
activities that most of us don't think twice about. So what could put a
damper on all this fun?
The answer is becoming all too common: Lyme disease, inflicted by the
bite of a deer tick.
"People need to be aware of the risks of this disease," said Dr. Don
McNeel, M.D., PLLC of Seacoast Lyme Center in Epping. "I've seen people
who are very sick. It's a very devastating disease."
McNeel decided to focus primarily on Lyme Disease care and treatment
after seeing a rise in the numbers of patients at his primary care
practice who presented with the disease. He said there are two types:
acute and chronic.
"Most acute cases have taken place within six months and doctors are in
agreement on how to treat the patient," he said. "Chronic patients have
been sick longer than a year, their symptoms are all over the board,
and they have often been diagnosed with other illnesses such as chronic
fatigue syndrome, fibromyalgia, lupus, multiple sclerosis, or even
stress. These patients are still sick and fighting infections, but it's
a disease that can improve with treatment."
So who is at risk for Lyme disease? According to the CDC's Web site,
"Individuals who live or work in residential areas surrounded by
tick-infested woods or overgrown brush are at risk. ... Persons who
work or play in their yard, participate in recreational activities away
from home such as hiking, camping, fishing, and hunting, or engage in
outdoor occupations, such as landscaping, brush clearing, forestry, and
wildlife and parks management in endemic areas may also be at risk."
"We see a wide range of both children and adults who have Lyme
disease," McNeel said. "Kids who are outside a lot or adults who live
near the woods or who have pets are obviously at risk."
According to CDC final reported numbers for 2004, New Hampshire was
12th in the nation for the number of reported Lyme cases, but McNeel
said that cases are underreported "by tenfold."
"New Hampshire was reported to have 226 cases in 2004," he said. "That
means the accurate number is around 2,000."
Maine was 13th in the nation, with 225 reported cases.
McNeel said a common misconception is that a tick has to be attached
for 48 hours before Lyme disease can be contracted.
"A tick infection can spread in six hours," he said. "Of course, the
longer the attachment the greater the exposure."
There are two common kinds of ticks: the dog or wood tick, which can be
identified by a brown stripe on the back and does not transmit Lyme
disease; and the deer tick, which is a smaller, black-legged tick that
does carry Lyme disease. A red crescent on the back can identify the
adult female deer tick. The nymph stage of a deer tick is also
dangerous; being so tiny it is difficult to identify the tick and it's
easier for the tick to hide in skin, according to McNeel.
"Not every tick carries Lyme, and not every deer tick carries Lyme
either. But it is very prevalent in the area," he said. "In the nymphal
stage especially, where the ticks are so small you can barely see them,
it is very easy to get exposed."
Symptoms
Diagnosing Lyme disease can be a problem, McNeel said, because symptoms
can be similar to classic infections or symptoms of other diseases. The
classic symptoms in the early stages of Lyme disease include fever,
headache, fatigue, rash, swollen or tender joints, or flu-like
symptoms.
"But you don't have to have all these symptoms to have Lyme," he said.
An unmistakable sign of Lyme is a bull's eye rash developing around the
site of a tick bite, but "40 percent of people don't get the rash,"
according to McNeel.
Chronic sufferers can present with a host of problems, including
migrating joint pain (when the pain moves around the body into
different joints), swelling or stiffness, burning pains in the hands,
feet, or chest wall, bells palsy, light-headedness, poor balance or
difficulty in walking, brain fog, and mood swings.
"Not every patient has every symptom," McNeel said. "The key is a
cycling of events -- there are periods when the symptoms are pronounced
and periods when they aren't as bad."
Treating the disease
McNeel said that when it comes to treating Lyme disease, there are two
completely different camps of opinions.
"Some doctors treat all Lyme disease patients as acute and give them a
course of antibiotics, a belief supported by the Infectious Diseases
Society of America (IDSA). But the International Lyme and Associated
Disease Society sees patients developing other symptoms that don't
improve without higher doses and longer durations, so now they are
approaching the disease by trying to boost the immune system overall."
Supplements, physical therapy and sleep therapy are used to improve the
patient's overall well being, McNeel said, and these would be used in
conjunction with antibiotics to kill the bacteria.
McNeel said that the testing surrounding Lyme disease is not always
accurate, which presents additional problems.
"In my practice I see 40 percent of tests being false negatives, where
the patients are told they don't have Lyme but their past histories,
location, pets, and other modalities indicate otherwise."
Several blood tests are available, but they are not always accurate,
McNeel said, adding that doctors should not rely solely on tests, but
on symptoms, history, and exposure to ticks. The ELISA test is
"unreliable," and while the Western blot test may show infection where
ELISA does not, guidelines that the CDC set were intended to be used
only as surveillance criteria to analyze the spread of the disease and
were not intended to treat patients; therefore many infected people are
left without treatment.
"Some patients go through a series of evaluations but aren't diagnosed
with Lyme. These patients tend to be a challenge, but after treatment
we often see improvement," McNeel said. "We can't guarantee every
patient can be cured."
Often, it is a question between being the disease being cured or
maintained. "We aren't sure if it's ever really cured. Some people seem
cured and I don't see them again. Others never see complete relief and
struggle with many symptoms."
Lowering your risk
Precautions against tick bites should be a priority.
"Parents need to do a complete tick check on their children and pets
every night," McNeel said. "Wearing long sleeves and tucking pants into
socks is a good precaution."
Wearing light colored clothing will make it easier to spot ticks, and
windbreakers or nylon materials make it harder for a tick to grab onto.
McNeel also suggested treating clothes with repellents that contain
permethrin.
"People should also be vigilant about tick habitats. Ticks live in
moist areas, tall grasses, and wood piles," he said. "Ticks don't jump
from trees. Adult ticks travel with deer herds, so watch for deer in
your backyard. The nymphal stage of ticks is associated with
white-footed mice also, so reduce habitats that attract both deer and
mice, including stone walls."
McNeel said that while it's important to be aware of the dangers of
Lyme disease, people should still be able to enjoy the outdoors.
"My caution level is higher than most, but I've seen what can happen,"
he said. "The minority of people are exposed, but I'm not willing for
people to be at risk. Take proper precautions, but don't be afraid to
enjoy the time outside."
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