Feeling Ticked Off?

by Dr. Cory Tichauer

If you’ve been paying attention, you have plenty of reason to feel this way!  The beauty of springtime in the Rogue Valley, majestic though it may be, is not without its harsh reminders.  In my practice, this means dealing with the seasonal surge in patients with recent tick bites.  An increasing awareness around the risk of Lyme disease has led many more people to seek assistance following a bite.  Unfortunately, amongst medical professionals, there is still a great deal of denialism, improper treatment and lack of understanding around Lyme testing.  I’ll do my best to clarify all this ambiguity in 650(ish) words or less!

First off, let’s clear up the obvious.  YES, LYME DISEASE EXISTS IN SOUTHERN OREGON.  I am just utterly shocked and outraged by how many physicians still tell their patients that Lyme only exists on the East coast.  As far back as 1997, a published study demonstrated Borrelia infection rates of 4-6% in the adult Ixodes pacificus ticks, 20-30% in the nymphs and 18-19% in the rodent population in Jackson and Josephine Counties.  This statistic was reinforced by a 2010 Jackson County tick study headed by Southern Oregon Lyme Disease (SOLD) that showed approximately 5% of the adult ticks harbored Borrelia burgdorferi, the bacteria responsible for Lyme.  If you are wondering why the nymphs are so much more dangerous, read about the relationship of ticks and Lyme to the Western Fence Lizard.  Ultimately, however, a bite from a nymph, which is about the size of a poppy seed, can easily go unnoticed or scratched off thinking it was nothing more than a random irritation or a small scab.  To complicate things further, the more recent appearing Relapsing Fever Borrelia species is capable of vertical transmission from adult tick to egg, leading to an exponential increase in prevalence as it continues to rapidly spread up the West Coast.   

As a general rule, any flu-like illness that suddenly appears between now and fall must have Lyme disease as part of the differential diagnosis.  Assuming you didn’t previously have a Lyme infection and the associated antibodies, it typically takes 7-21 days to develop symptoms following a bite.  The appearance of fever, fatigue, muscle and/or joint pain, swollen lymph nodes, headaches and altered mental status following a trip outdoors should prompt a visit to a physician familiar with the diagnosis and treatment of Lyme.  If your doctor comments that you don’t have the characteristic bulls-eye rash, you can remind him/her that only 15-30% of Lyme disease cases start with the this rash and fewer than 50% of patients recall the presence of any rash at all!  And, unless your doctor is familiar with T-Cell based Elispot testing, which is sensitive within 10 days of a bite, they should also be reminded that the traditional antibody test, known as a Western Blot, is not sensitive until at least 30 days following a bite from an infected tick.  If you are able to SAFELY remove the tick (https://lymediseaseassociation.org/about-lyme/tick-removal-a-testing/tick-removal/), I recommend immediately sending it to be tested through the University of Massachusetts Amherst at tickreport.com which is affordable and a more sensitive lab analysis than standard blood testing in people. 

Should you end up with a confirmed or suspected Lyme infection, getting treatment within the first 14-60 days is key to ensuring that the bacteria is eradicated and unlikely to progress to a more advanced state.  The appropriate treatment is 4-6 weeks of Doxycycline, Cefuroxime or Amoxicillin or 3-4 weeks of Azithromycin (https://www.ilads.org/research-literature/lyme-disease-basics-for-providers/).  Herbal and complementary medicine can help to improve overall outcomes while minimizing side effects.  Treating for shorter durations has been shown to be inadequate and also associated with a high incidence of false negative results for future Lyme testing, since it can impede the development of an adaptive immune response.  Since the potential for co-infection with other tick-borne diseases exists (Babesia, Bartonella, Rickettsia, Ehrlichia, Anaplasma, etc), persistence of symptoms or the appearance of new symptoms following treatment should be reported to a Lyme-literate physician for additional testing as soon as possible.