This is how small the tick that causes lyme disease can be.

Notice how tiny the tick that causes Lyme disease can be.

by James Hubbard, MD, MPH

When someone comes in my office for a tick bite, their main concern is usually, what’s their risk for Lyme disease.

And I can’t blame them. Lyme disease from tick bite warnings are all over the media (one reason probably is New York is a high-risk state), and since the disease has only been recognized in the U.S. since 1975 (first suspected by a physician in Lyme, Connecticut, who was seeing kids with unusual symptoms) we’re still learning about it. This, and its rather general initial symptoms, make it rife for myth and speculation.

One thing’s for certain, Lyme disease is serious business. And it’s at full force in the summer because that’s when the ticks that spread it are most prevalent. So, in this post, I’ll try to answer some of the most common questions I’m asked.

How is Lyme disease spread?

Ticks. Ever had one on you? Yeah, it’s pretty creepy.

Ticks are one of nature’s true vampires. The tiny specks sit silently on leaves of bushes and trees, patiently waiting for whatever warm-blooded creature (they’re attracted to the carbon dioxide we emit) might pass by. Then they pounce. No roar, rattle, or sting. You don’t even know they’re on you.

Immediately they start searching for a piece of flesh to attach to and eventually begin to painlessly suck our blood. To make it worse, many ticks carry viruses and bacteria they’ve picked up from other animals. So, while they’re dining on us, they share the disease. Not exactly the kind of dinner gift I cherish.

Right now I think there are 12 diseases ticks can give us and more will likely be discovered.

But it’s not just any tick bite that gives us Lyme disease. It’s the bite of the the blacklegged tick, also known as the deer tick. Insects (ticks are arachnids), such as mosquitoes, have been known to carry the Lyme disease bacteria, but none have ever been shown to transmit it to humans. And yes, animals can have Lyme disease, but the only way they’re known to transmit it to us is via a tick. The tick feeds on the infected animal, then feeds on us. Oh, and there’s no proof you can get it from sexual contact, contrary to what’s going around in some circles. As a matter of fact, there’s no proof you can get it from another person period. Just ticks.

And here’s the thing. The deer tick and Lyme disease are fairly regional. True, it’s seen throughout the United States, but 95 percent of reported cases come from 13 Northeastern and north Midwestern states.

How can you prevent it?

Keep the ticks off, duh. However, that’s sometimes easier said than done. But, even if they bite, you can prevent getting Lyme disease by removing the tick promptly, and properly. Tips on keeping ticks off and removing them properly can be found in another post I’ve written by clicking here.

The chances of getting Lyme disease from an infected tick are 0 percent if you remove it within 24 hours of it biting you, 12 percent at 48 hours, 79 percent at 72 hours and 94 percent at 96 hours.

But, there’s a big problem. Many people are bitten by the tick; it feeds, leaves, and the victim never knows of the assault. No clue. I mean, did you see in the photo how tiny those things can be? They could get imbedded in a little skin fold or in some hair and you might never know.

How do you know if you’ve got it?

That’s another problem.

  • The signs and symptoms of Lyme disease can be as vague as some aches and pains and a little fever. Of course if you have the typical target lesion rash you’ll know. Otherwise, all you may think is you have a summer cold.
  • Current Lyme disease tests may not become positive for a couple of weeks after the symptoms.

If untreated, these symptoms will usually subside, but sometimes, debilitating heart, joint, or nerve problems can crop up, even years later.

So, how do you know when to treat it?

Play the odds? At least, that’s what I’d do.

Fortunately, some facts we do know about Lyme disease can help you decide about treatment. Such as:

  • We know some regions are much more likely to have the Lyme disease bacteria in ticks. Probably your local news will clue you in. But if you’re traveling, you can check here.
  • So, if you live in a high-risk region and come down with flu-like symptoms in the summer, when no one around you seems to have the same symptoms, you probably need treatment. Get to a doctor.
  • Also, if you live in a high-risk area and find a tick on you, and it could have been on you for more than 36 hours, get treatment. Actually, the current thinking is one dose of doxycycline given within 72 hours of finding the tick will prevent you from getting the disease. Doxycycline is not recommend if you’re under 8 years old, pregnant, or breastfeeding, and there’s not a great substitute so you’ll either need to watch for symptoms or go ahead a take a full two-week course of other antibiotics. But that’s something to go over with your doctor.
  • Even without symptoms, tick or no tick, low-risk or high, a diagnostic target lesion, such as the one seen here, warrants treatment.

Other than the fever; aching; headache; sore neck; and swollen, tender lymph nodes, other signs and symptoms of Lyme disease may include:

  • Painful swelling of large joints, such as the knees
  • Bell’s palsy (a paralysis or drooping of one side of the face)
  • Heart palpitations and dizziness
  • Severe weakness
  • Unusual body and extremity pains
  • Decreased concentration

And that’s just the acute phase.

If you get antibiotic treatment at this point, you’ll likely recover within a few weeks; however, about 20 percent can take a few months. These people have what is called post-treatment Lyme disease syndrome. Some call it chronic Lyme disease, but as you’ll see further in the post, that name has different meanings to different people.

What is the treatment?

Details can be found here.

As usual, for any medicine you’re taking, know the side effects, interactions, etc. The following are the antibiotics of choice. I’ve provided the usual adult dosage. You’ll have to look it up for children.

  • Doxycycline 100 mg twice a day. Don’t give to children or pregnant or breastfeeding women.
  • Amoxicillin 500 mg three times a day.
  • Cefuroxime (brand name Ceftin) 500 mg twice a day.

If you can’t take these, azithromycin 500 mg daily for 14 days is an option but it may not be as effective. So keep a particularly close eye on persistent symptoms.

Usually treatment is two weeks. Sometimes you’ll have treatment recommended four weeks. For the 20 percent of people whose symptoms linger, all of the best-quality studies have so far surprisingly shown that continued antibiotic treatment doesn’t help. It’s thought the persistent symptoms are from some sort of antibody reaction and inflammation in your body. And that continued antibiotics will only increase your risk for all sorts of ill effects, like diarrhea, and creating antibiotic resistant bacteria.

Now some will dispute that. They think the problem is that all the bacteria haven’t been completely killed and point to people with prolonged symptoms reporting they feel much better while taking more antibiotics. Of course, they might be right and the studies, so far, be wrong. Or this might be explained by the placebo effect. Remember placebos are sham treatments. An example is “sugar pills.” Placebos are inert, but have been shown to sometimes have powerful effects on the body–and not just mentally. The effects can become quite physical and provable by tests. Another possibility, other than placebo effect, could be the benefit coming from the anti-inflammatory quality that antibiotics can have.

What is chronic Lyme disease?

Some details are controversial. There is no doubt that people can have persistent symptoms. The CDC calls this post-treatment Lyme disease syndrome since chronic Lyme disease can mean different things to different people. And there’s also no doubt that Lyme disease, if untreated, can often lead to arthritis, serious heart problems, memory problems, etc. Any of these problems can be very hard to treat and should definitely be addressed. One of the main controversies is which other long-term symptoms can actually be attributed to Lyme disease, and what’s the most effective way to treat these symptoms.

But, like other illnesses, just because many are exposed to Lyme disease doesn’t mean all are infected. True, it can be a hard disease to diagnose and can be often missed, and may (but nearly always) cause serious complications and long-term problems if untreated. And many people suffer chronically from the symptoms similar to some of the symptoms attributed to Lyme disease. But many, many diseases can cause these symptoms. And there are many causes we just haven’t figured out, yet.

All I’m trying to get at is caveat emptor: Buyer beware. Or maybe, it’s more, patient be aware. It’s going to take excruciating time to completely sort this disease out, to make an always proper diagnosis, and to determine who can be helped by what treatment. Meantime, be careful spending your money and time on unproven diagnostic tests and treatments that could actually harm you. Be especially wary of those who speak the loudest and tout they know things that the regular scientists and doctors who study this disease full-time and have their findings peer-reviewed don’t know. Or for some reason, just won’t tell you. Yes, it could be true. It does happen (the part about the majority being wrong. The part about a bunch of doctors conspiring to keep you from knowing the truth, I extremely doubt.) In my over my 35 years of practice, I’ve seen groundbreaking cures for many diseases. But I’ve also seen a boatload of patients duped by questionable claims.

What’s the bottom line?

You can prevent Lyme disease in times when expert help is impossible by doing some of the same things you should do when it is. If you’re outside in the summer, always check for ticks before you go to bed. Know how to remove them properly. Know if you’re in a high-risk region, and, if you are, you’re over 8 years old, not pregnant or lactating, take a 100mg doxycycline within 72 hours of removing a tick. This last step should be with the advice of your health care expert, during the 72-hour window, if possible.

If no expert is going to be available soon and you have symptoms, consider playing the odds for treatment with antibiotics as I’ve suggested in the post. Of course that assumes you have enough of the right antibiotics. Otherwise, all you can do is treat the symptoms and hope for the best. The acute phase usually goes away in a few weeks. Although, never take the chance if help is available. If it’s not and Lyme disease is not treated, not everyone gets long-term serious complications by any means. But the risk is too high and the consequences too dire not to get treatment if available.

As for what to do for chronic Lyme disease or whatever’s causing similar symptoms when no medical help is available, about all I know is treat those symptoms the best you can (whatever you use for other pains, use for this pain, etc.).

Have you had acute Lyme disease? What were the symptoms? How long did it take to go away? And if you live in a high-risk area, have you been advised in other ways not covered in my post?


Photo: Flickr/FairfaxCounty, shared under CC BY-NC 2.0