Ask Dr. Bob: What is Lyme Disease...

This is summer time and the biggest concern we have here in Saddle River is about the huge numbers of deer.  They seem to be everywhere, causing accidents, offering themselves up as food for the new crop of coyotes, and causing disease.  All deer are carriers of ticks and ticks cause several diseases, the most important one being Lyme disease.  I informally took questions from our residents and those of some neighboring towns that also have deer problems.

What is Lyme Disease and why the big deal? (CDP, Saddle River)

Lyme disease is a tick born bacterial infection that can cause major health problems, especially if it goes undetected early.  Its an organism called Borrelia burgdorferi and its carried by ticks that live on deer.  It’s a big deal because it can cause serious infection and, in some instances, even death. 

There are three phases of Lyme.   First, is the early phase which is a bulls-eye rash seen in 75% of those bitten.  The rash at the site of the tick bite spreads outward.  You might have muscle aches and stiffness, swollen glands, headache and joint pains which resolve in a about one month. The second phase is the disseminated phase where organs can be affected like the heart, brain, and nerve palsies. The second phase happens about a month after the initial red rash and can pose some serious problems. The third phase is the late phase which usually affects motor and sensory nerves with damage to them.  The covering of the brain called the meninges can be infected, confusion, nerve damage with the most common finding being Bell’s palsy, and there is bad arthritis with joints affected in asymmetric fashion. The bad news is that the arthritis can last long after the bacteria are gone.

What do I do if I find a tick on me? (VB Hohokus)

Take the tick off of your person and place it in a small bottle so hat you can take it to your doctor who can have it identified as a deer tick or some other kind of tick.  The ticks that cause the disease are small and have official names: the most common is called Ixodes scapularis and the next most common is the Ixodes pacificus. You guessed it, one of them is found predominantly in the western US. The tick is not always seen, and doctors rely on the appearance of a rash that looks like a target and gets bigger and bigger by the hour.  The most important thing to do is look for a rash.  Some doctors prefer to treat with antibiotics prophylactically, but the rash will appear and should prompt therapy, so you don’t get treatment for a non-existent infection.

Is there a way to prevent the infection, because my yard is full of deer at dawn and dusk? (MZ Saddle River)

Yes, keep a bottle of spray bug repellant around the house and spray yourself and your guests (especially children) before you venture through the woods or even on your lawn. Wear long sleeved shirts and long pants.  Spray yourself with repellant containing DEET before marching into the woods. Examine your pets for ticks and if you are concerned, take the tick off the body and give it to your health professional for identification.  If you like to wear a bikini or are in your yard “au natural”, spray yourself with bug repellant before you exit the house.  Ticks like a big target.

If I find a tick on me, should I look for some antibiotics I have around the house and treat myself? (AT Saddle River)

No, you should never treat yourself.  You might be using old expired antibiotics, the wrong dose, and the wrong drug.  See your doctor who will prescribe the right drug.

Isn’t there a vaccine for Lyme? (TP Clifton)

There used to be a vaccine, but there were problems with it and it was taken off the market in 2002. The problems with the old vaccine was that people felt terrible after getting the vaccine which caused a condition that some said was worse than the Lyme disease.  Since then the deer population has increased drastically, Lyme has become epidemic, and people and pets are being infected and there is no way to prevent human infection except using bug sprays and common sense.  There is vaccine for dogs and it is available through your veterinarian.

Does my doctor know what to do and what to look for? (RS Saddle River)

One can only hope that your physician is able to notice and treat a case of Lyme disease.  It is not rocket science and the antibiotics are readily available. The blood tests for Lyme do not become readily positive until one to two weeks, so we rely on the presence of the typical rash. It’s a target like rash that looks like a bulls-eye.  Blood tests should be taken or scheduled by your doctor. The positive tests are always confirmed with something called a western blot, because some of the bacteria in your mouth or other parts of your body may cause a false positive Lyme test. The western blot allows the doctor to confirm the real presence of the Lyme bug in your blood.

The treatment for the infection is Amoxicillin (Amoxil), or Cefuroxime axetil (Ceftin), or Doxycycline
(Vibramycin).  With treatment the rash goes away in about two weeks, otherwise it could take a month or so.  In the later stages of the disease you might need to take an antibiotic like Rocephin intravenously.

There are other diseases spread by ticks and these are found in the summer months.  They are Ehrlichiosis and Babesiosis.  Ehrlichia are found on the tip of long island, like the Hamptons or Shelter Island and Babesia are found in many places like Fire Island.  Both of these conditions can be crippling and require immediate treatment.  They are diagnosed through blood tests.

I hope that this has bee helpful.  Please send your questions to Ask Dr. Bob via the SR Magazine and I will do my best to answer them.