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.

"Many cases require some degree of sleuthing," says Dr. Edlow, who is 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.

“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 ED these days, and 2014 has seemed to be a banner year for ticks. In part, he says it’s because people are more aware that ticks can transmit disease and know the importance of prompt treatment. Over time, Lyme disease is becoming more common in New England.

“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.

The most common symptom is a large, flat uniformly red rash — a round rash, sometimes with a darker red center, sometimes with a lighter center suggesting 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 [fevers, chills, headaches and sore muscles], you really need to do a careful tick check after you have been in the woods or field,” recommends Dr. Edlow.

That’s what Cheryl Crawford does. She goes over her six-year-old 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.

“It often takes 24 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.”

While early-stage Lyme disease is treatable with a course of antibiotics, later-stage disease can be harder to treat, says Dr. Edlow. If not caught early, symptoms can include facial paralysis and severe headaches to debilitating arthritis. 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 avoiding ticks altogether is important. That includes clearing brush out of the back yard, wearing white or light colors when you’re outside so it’s easier to spot a tick, 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. You can also use your cell phone to take a picture of the tick or of any rash that develops and e-mail 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.”

Posted October 2014