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Lyme Disease: What You Need to Know

Dr. Jonathan Edlow enjoys a good medical mystery. And it’s a good thing because in the ER where he works, at least a couple walk through the door each day.

“Most cases require some degree of sleuthing,” says Dr. Edlow, Vice Chairman of the Department of Emergency Medicine at Beth Israel Deaconess Medical Center. “Each symptom is like a clue and from there we piece together a diagnosis.”

Many now-known medical disorders, in fact, started as mysteries. Take, for instance, Lyme disease.

“Back in the mid-1970s, two housewives in Lyme, Connecticut noticed children in the neighborhood were becoming ill,” says Dr. Edlow, author of the book Bull’s-Eye: Unraveling the Medical Mystery of Lyme Disease and The Deadly Dinner Party and Other Medical Detective Stories. “But it took nearly 10 years to actually track down the full range of symptoms and the causative bacterium.”

Dr. Edlow says he’s seeing more tick bite cases in the emergency department these days. In part, he says it’s because people are more aware that ticks can transmit disease and know the importance of prompt treatment.

About 4,000 cases of Lyme disease are reported to state agencies in Massachusetts each year, but Dr. Edlow says there’s pretty good data to indicate that actual cases are about tenfold higher.

“Anywhere you see a deer, there are ticks that transmit Lyme disease, and in New England, that means just about anywhere,” notes Dr. Edlow.

Deer ticks are about the size of a sesame seed and are tough to see, which often means people need to be particularly aware of the symptoms.

Dr. Edlow emphasizes that not all deer ticks carry the bacteria that causes Lyme disease, and that most people who get bitten by a tick do not get Lyme disease.

“Your own defense mechanism, antibodies and white blood cells, may stop the infection at the site of the tick bite,” he says.

But, if you are infected, the most common symptom is a large red rash that can be of any shape, often with a darker red center; sometimes, but not necessarily, appearing in the shape of a bull’s eye. According to the Centers for Disease Control, the rash occurs in 80 percent of cases, usually two to 30 days after a tick bite. Other symptoms of early Lyme disease include fatigue, chills, low-grade fever and headache.

“Because the symptoms can be a little like the flu, it’s possible to initially overlook them,” says Dr. Edlow. “You really need to do a careful tick check after each time you have been in the woods, a field or anywhere ticks might be.”

That’s what Cheryl Crawford does. She goes over her young daughter Amanda from head to toe every evening.

“I found a tick on her stomach a couple of weeks ago. She had no idea it was there,” says Crawford, who lives on a New Hampshire farm. She pulled the tick out and watched over the next few days for any signs of trouble. “Fortunately, there were no marks or other symptoms.”

Dr. Edlow emphasizes that the tick check should include the hairline, under arms and behind the knees, and that if an attached tick is discovered, early removal is important. He recommends using fine tweezers to gently and slowly pull the tick out.

“It takes 24 to 48 hours for bacteria to spread to the glands,” he says. “So if you remove the tick right away, you markedly decrease your chance of getting disease.”

The good news is that while Lyme disease is becoming increasingly more common, when it’s caught early, it’s very treatable using antibiotics. If not caught early, symptoms can include facial paralysis and severe headaches to debilitating arthritis. But, even these later stages are almost always treatable with antibiotics.

Ticks can transmit more than Lyme disease. Dr. Edlow says some ticks could carry two to three different diseases, so the best thing is to do is to try to avoid ticks altogether, which these days can be nearly impossible.

He recommends clearing brush out of the back yard; sticking to the middle of the trail when hiking, away from low bushes and tall grass; wearing white or light colors when you’re outside so it’s easier to spot a tick; doing a daily tick check, especially for children; and using repellents that contain Permethrin or DEET.

If you do pull a tick off of yourself or a loved one, Dr. Edlow says you can do some sleuthing of your own.

“Google ‘deer tick’ and you’ll find lots of great photos so you know what to look out for. You can also use your cell phone to take a picture of the tick or of any rash that develops and send it to your doctor for clarification,” suggests Dr. Edlow.

“Just be vigilant,” he adds. “If caught early, Lyme disease can easily be treated with excellent results.”

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.