There are a lot of benefits to living in the country. I love the fresh air, the lack of traffic and congestion, the beautiful scenery, and earthy smells. City life seems cramped and pale compared to rural living, but there are also some inherent dangers. Some are obvious, like the improper use of chainsaws and guns, or farm equipment. Others are more subtle, like lead poisoning and exposure to certain diseases.
Lyme disease is one of those hidden dangers. And while a lot of information has recently been presented in the news, I have seen some misconceptions and erroneous facts presented. So I would like to set forth a more detailed and concise description of the signs, symptoms, treatment, and prevention of Lyme disease. I hope that this article will serve as an educational tool, helping to keep you safe as you continue to enjoy rural life.
But before we begin, here is the usual disclaimer. This is for educational purposes only. The information in this article is not intended for self-diagnosis or treatment. If you feel that you are suffering from any of these symptoms, you need to be seen by a healthcare professional for proper medications and follow-up. As will be discussed below, Lyme disease is a serious infectious disease, and it can have a lot of long-lasting health effects if not treated promptly.
Now let’s get to the matter at hand. Lyme disease is an infectious disease caused by the bacterium Borrelia burgdorferi. The illness derived its name from the town of Lyme, Connecticut, where the first cluster of cases were discovered and described in the 1970s. It is carried in the wild by animal vectors, such as deer, mice, and squirrels. The major source of transmission from wild animals to humans and pets is ticks. In the northeastern United States, the hard deer tick (Ixodes) is the main species responsible for infection. The infected tick, carrying the bacteria in its salivary glands, bites the victim and, during the course of its blood meal, regurgitates some of the bacteria into the wound and infects the victim. The Borrelia bacteria cannot be transmitted from person to person by casual contact, or sneezing, or shaking hands. Infections occur most often during the warm spring and summer months, but can happen throughout the year.
One of the major ways of avoiding the chance of developing Lyme disease is to avoid being bitten by an infected tick. Ticks lie in wait on the ends of blades of grass, and can sense the body heat and movement of warm-blooded animals nearby. Female ticks need blood meals from mammals in order to have enough protein for egg production. By reducing the number of ticks present around your house, as well as their preferred habitat, you can go a long way in preventing infection. Keep grass trimmed to avoid overgrowth and long stems, which can reach the level of unprotected skin on your legs, especially if you like to wear shorts during the summer (which I do). One technique that I am looking forward to putting into practice is having chickens patrol the yard, searching for ticks, as well as other nuisance invertebrates, to attack and devour. If you are looking for poultry that is even more selective for ticks, based on reputation, guinea hens, and Muscovy ducks are your fowl. The logic behind these organic means of control is that, if there are no ticks in your yard to bite you or your pet, then there is no chance for either one of you to develop Lyme disease. (And you get delicious eggs and meat as a bonus!)
Outside of your yard, a major risk factor for being bitten is walking in tick-infested areas with bare skin. Therefore, when walking through tall grass or wooded/brushy areas, we should all wear loose-fitting, long-sleeved shirts and pants, preferably tucked into our socks. (I know, it isn’t the most attractive fashion, but it does help detract ticks too, and is a lot better than the alternative.) After that walk in the woods, we need to check ourselves and our loved ones for ticks from head to toe also, in order to remove them before they bite and start taking their blood meal.
In addition to ourselves, we need to check our pets for ticks also when they come in the house because they could be harboring stowaways that may drop off and latch on to you at a later date. And we want to remove any attached ticks from our pets too since they can also be infected by Borrelia. There are many effective chemical tick deterrents for dogs and cats that help protect against flea infestation also, which are applied to the skin and mix with the body oils. These can be discussed with, and obtained from, your veterinarian, and are a good way to help protect your pet from unnecessary suffering. Another way to help protect against suffering from Lyme infection is to have your pet vaccinated against Borrelia. Since they are more likely to carry ticks into the house, vaccination will help prevent infected ticks from passing the disease on to your pet, and will in turn help protect you.
But for the unfortunate victim who is bitten, the tick will feed until it is engorged, growing several times its original size. If you are able to identify and remove it before a day or so, there is a much lower chance of being infected with the bacteria. Whether it is on you, a family member, or a pet, here is a quick, simple way to remove a tick. It isn’t pretty, but it saves you a trip to the doctor or vet, and most of us have probably already done it.
Simply take a nice, well-articulated set of tweezers, and grasp the tick as close to the skin as you can. As you have probably read in several locations, don’t use a match or something else to “help encourage” the tick to disengage itself. It doesn’t work, because the tick is actively inserted into your skin at the point of feeding, and its instinct is to burrow down further in response to stress or injury. Instead, grasp the tick firmly as close to the skin as possible (below the legs, which are probably squirming at this point), take a deep breath, and pull in a sharp, clean motion. Try not to squeeze the back of the tick, which is full of digested blood, because it’s a pain to clean up. If you have done everything correctly, you’ll be the proud owner of a live, disgusting, squirming tick. Dispose of it at your leisure, and according to your comfort level. (I prefer either flushing it down the toilet or placing it inside a napkin and squishing it outside. Eventually, I’ll feed it to the chickens.)
After you have removed the tick, however, you need to watch the bite site for a couple of days to make sure that it does not appear infected. I like to put some triple antibiotic ointment and a bandage over the bite to try to prevent an infection from coming into the wound. If the area becomes infected, though, it will turn red, warm, and usually painful, and there might be pus coming out of the bite itself. At this point, it is best to have the area checked out by a doctor to see if medicines are needed.
For the first several days to two weeks after the tick removal, if the tick did transmit the bacteria, the infection will be localized at the site of the tick bite. The classic finding everyone looks for in Lyme disease is the “bull’s-eye” or “target” rash. The immediate bite site is red, surrounded by an area of clearing, and then a red border. But don’t be surprised if you do not see it. In almost one-third of diagnosed Lyme disease infections, patients do not have this rash or even notice a tick or bite. Once in the bloodstream, the Borrelia bacteria travel throughout the body and attack numerous tissues. Other symptoms of early Lyme disease are nonspecific and include fever, malaise, headache, and muscle aches – very similar to having the flu. So, if you or a loved one has some of these symptoms, but did not notice the rash or tick, you still might be infected, especially if you are in tick-infested areas and are susceptible (which is pretty much anyone who spends a significant time outdoors).
These early cases of Lyme disease should be diagnosed and treated quickly because this will help prevent future complications and suffering. The best test for diagnosing Borrelia infection is to check for blood antibodies against the bacteria. Interestingly, this same test is done for both people and animals, such as dogs, that are suspected to be infected. The doctor or veterinarian will also ask about the history of the disease – when the symptoms started and what they were, where you were when you noticed them, was a tick ever seen, was there a rash, and was there any time outside? The treatment for Lyme disease in the initial phase is oral antibiotics like doxycycline or azithromycin.
Another classic symptom of early untreated Lyme disease is facial paralysis. It is not as common as the rash or flu-like symptoms, but seeing it should prompt investigation for Lyme disease. This finding happens because the Borrelia bacteria interrupt the nerve signals from the brain to the facial muscles. The facial palsy, or weakness, presents as a drooping lip edge, sagging cheek, and the inability to close the eyelid or furrow the forehead on the affected side. It can be confused with stroke-like symptoms (which also can have a sagging lip, but does not usually include the eyelid or forehead). Rarely, it can affect both sides of the face simultaneously. It is also treated with the same antibiotics, but the facial palsy takes several months to get better.
Hopefully, the infection will be diagnosed and treated at these stages. However, some people are not as fortunate. For these poor patients, the bacteria will continue to attack body tissues. In the next several months after infection, most of the symptoms result from nervous system derangement. This includes inflammation around the brain, known as meningitis, which presents with neck stiffness, sensitivity to light, and headaches. It can also cause mild inflammation of the brain itself, or encephalitis, with memory loss and depressed mood. Diagnosis of Lyme meningoencephalitis requires a lumbar puncture, where cerebrospinal fluid is collected by a needle from the spinal canal (with a technique similar to an epidural for pregnant women) and tested for the presence of Borrelia. At this point, the treatment is still with antibiotics; however, since it is now infecting brain tissue, the medicine must be of an intravenous form.
For those who suffer for years from prolonged infection without treatment, the Borrelia bacteria can ravage the body, and will result in more extensive and severe neurological disorders, like encephalitis – sometimes to the point where people develop cognitive problems and psychological disorders. Untreated sufferers can even act like they have psychosis and can be misdiagnosed as being schizophrenic! The bacteria attack numerous nerves throughout the body, known as polyneuropathy, and can lead to muscle weakness, difficulty walking, dizziness and vertigo, continued facial palsy, and problems controlling bladder function. Lyme arthritis can devastate the knee joints as a result of the Borrelia bacteria causing inflammation and damage to the cells lining the joint capsule, leading to decreased lubrication and severe joint pain. Antibiotics are again the mainstay of therapy but are usually less effective in reversing the damage done by long-standing infection.
Another illness associated with Lyme infection is a long-standing disease that persists even after antibiotic therapy. The prevailing theory behind “chronic Lyme syndrome” is that the bacteria use molecular markers on their cell surface to “blend in” with normal host tissue. This is known as molecular mimicry. The problem arises when the immune system – the body’s defense network – starts to recognize the bacterial molecules as foreign, as well as the similar host proteins. At that point, the immune system starts to attack the host proteins and tissues, resulting in inflammation and cellular damage in the absence of the Borrelia infection. While there is currently a lot of controversy behind this theory, several observations seem to suggest that some form of molecular mimicry is at work, producing these chronic symptoms. Evidence includes the persistence and progression of arthritic changes, even after rapid diagnosis and prompt treatment. This autoimmune reaction may also play a role in progressive neurological symptoms reported by some patients, such as memory difficulties and changes in mood. However, at the time of this writing, these are all theories, and the established medical and scientific communities do not formally recognize “chronic Lyme syndrome” as a separate diagnostic entity. From the perspective of the medical establishment, especially the infectious disease sector, once antibiotic therapy is completed, Lyme disease is effectively treated and eradicated. However, based on my personal experience and anecdotal evidence, I feel that there is more to the story, but only time, and further research, will tell who is right, what is happening, and what the effective treatments will entail.
Whew! So there you have it – an introduction to Lyme disease. I know – that was a lot of information! But here are some final points I would like to summarize and emphasize for you. First of all, Lyme disease is a bacterial infection transmitted to people and animals by a tick bite. It is classically associated with rash and flu-like symptoms, and less often with facial weakness and other neurological symptoms. Prompt treatment with antibiotics will cure the majority of cases. Preventing tick bites, both for you and your pets, is very important in reducing your overall risk of becoming infected. And learning how to properly remove a tick in a safe and expedient manner will also reduce the chance of suffering from this disease. I hope now, with this information in hand, we can continue to enjoy our rural lifestyle and outdoor pursuits, but with a better respect and understanding of the potential dangers, and how to avoid them.