PERSONAL HEALTH : New Fear in the Forest : As Tick-Borne Lyme Disease Spreads, the Best Defense May Be to Know the Symptoms
Dr. Leeber Cohen was the active sort when he lived back in Mt. Kisco, N.Y., always pedaling his bicycle, jogging down the streets, practicing the piano or puttering in his back-yard flower beds in the posh Westchester County suburb.
But about two years ago, the obstetrician, then 32, suddenly experienced a mysterious weakness in his right arm. First, medical colleagues said he must have suffered nerve damage while cycling. Then came terrible migraine headaches, which the experts blamed on stress. And when dizzy spells came on, an internist gave Cohen medication for vertigo.
Nothing helped.
After two months of feeling lousy, Cohen came up with his own theory--that he had Lyme disease, a sometimes hard-to-recognize, potentially crippling malady borne largely by deer ticks that he may have picked up in the garden.
‘Very Serious Complaints’
Several blood tests, spinal taps, CAT scans and intravenous antibiotic treatments later, Cohen thinks he has shaken the illness, though he still has a ringing in his ears that may never go away.
“I had never really been on the other side of the bed before,” said Cohen, who has since moved his practice to Chicago. “This was a very frustrating experience for me because I had very serious complaints that weren’t taken seriously for a long time.”
Unfortunately, Cohen’s experience is becoming increasingly common in some parts of the country as Americans head into another summer vacation season with something lurking in the trees and brush far more dangerous than poison ivy.
“Most of us grew up in a situation where you don’t have to worry much about walking in the woods and catching diseases,” said Phillip J. Pellitteri, an entomologist and Lyme expert at the University of Wisconsin. “That’s changed.”
First identified only 14 years ago in Old Lyme, Conn., Lyme disease has swept across much of the Northeast and Upper Midwest. Experts say it has hit epidemic levels in a few hot spots, most seriously in New York, where more than 2,500 cases were diagnosed last year alone.
The U.S. Centers for Disease Control have detected a nine-fold annual increase in cases since it first began systematic tracking of Lyme. A spokesman for the Atlanta-based centers said more than 14,000 cases had been reported nationwide since 1980, most of them on the East Coast or in Wisconsin and Minnesota. Because Lyme is so new and symptoms vary so widely, doctors can fail to recognize the disease and cases may go unreported.
At the same time, however, some experts warn that most outbreaks are localized and suggest that the Lyme threat has been overblown in the media, unnecessarily scaring many people at low risk and sending hypochondriacs scurrying to their doctors.
“In most of the states, only small numbers of cases have been reported,” Dr. Theodore Tsai of a federal disease control laboratory in Ft. Collins, Colo., told the Associated Press.
Though chances of contracting the disease are slight in much of the country, health officials say it is spreading and has been detected to varying
degrees in at least 43 states, including California where the bulk of incidents have been limited so far to coastal counties north of San Francisco.
Robert Murray, a Lyme specialist with the California Department of Health Services, said the outbreak is not as serious in the state as elsewhere. But, he said, the department has confirmed about 400 Lyme cases that appear to have been contracted in California between 1983 and 1987.
Ticks capable of carrying the Lyme bacteria have been found in most California counties, but Murray said that to date more than 70% of all cases of the disease in the state have been reported from Marin, Sonoma, Mendocino and Humboldt counties. He added that the number of reported incidents is expected to rise in the wake of regulations, which took effect March 30, requiring doctors in California to notify state health officials of all suspected Lyme cases.
Caught early, Lyme is relatively easy to cure with doses of tetracycline, penicillin or other antibiotics. The problem, however, is catching it early. Ticks are so tiny and their bites often so soft that many victims don’t even realize it.
Characteristically, a victim will come down with flulike symptoms and develop a circular rash around the bite area within three to 32 days after contact with an infected tick. But doctors say about half the children and one-third of the adults who get Lyme never develop the telltale rash.
Even if the disease progresses, later stages are also treatable. But the medical regimen is more complex and some symptoms, like the tinnitus in Cohen’s ears, may linger. Untreated, Lyme can mimic traits often associated with syphilis, entering into long periods of latency and then resurfacing with serious consequences such as rheumatoid arthritis, paralysis, heart block and even dementia.
Researchers in Minnesota are working on a vaccine, but it is believed to be at least five years away from commercial application.
Experts are not sure why the disease is mushrooming, though many believe a significant growth in deer herds in many parts of the country may be partly responsible. Infected ticks may also be hitching rides on migratory birds.
Though dozens of tick species can be found in this country, only a few so far have been identified as carriers of the spirochetes, or bacteria, that cause Lyme disease. The main culprit in the East and Midwest is Ixodes dammini , commonly known as a deer or bear tick. In the West, the primary carrier is Ixodes Pacificus , or the black-legged tick, which has slightly different feeding habits and doesn’t appear to spread Lyme quite as readily as its Eastern cousin.
Chain of Events
Ticks aren’t born with the bacteria, but rather are the common carriers that transmit it in a complex chain of events that relies on animals as a medium in much the same manner that certain mosquitoes spread malaria.
Typically, deer ticks feed and breed on the hides of deer, then females drop off to lay their eggs in brush. The larvae hatch and attach themselves to birds and small mammals, particularly mice. Many of the rodents already carry the Lyme bacteria, possibly having contracted it through previous tick bites, and pass it back to the new ticks who in turn can pass it on to whatever animal they hop on next.
The spread of the disease is by no means uniform. In some spots in even the hardest hit states, entomologists have found tick populations relatively free of infection. In other places, however, the infection rate is staggering.
Tests taken recently near Camp McCoy, a National Guard facility in western Wisconsin, found that 66% of the ticks, 90% of the mice and 16% of the deer in that area had traces of the Lyme spirochete in their systems.
“It’s mind-boggling that you could find that high a percentage of ticks that are carriers if you’re in the right area,” said Wisconsin’s Pellitteri.
Dogs Present Problem
Though they may be carriers of Lyme, mice and deer seem to be relatively unaffected by the disease, according to experts. However, veterinarians say the disease can produce arthritic and neurological symptoms in dogs, cattle and horses. And dogs pose a special problem for humans because they bring ticks into the house.
The situation would almost certainly be worse if not for a biological quirk that slows Lyme transmission. After a tick latches on to some flesh, it takes at least 18 hours and often longer before any of the Lyme bacteria squirt into the system of a victim. Someone bitten by an infected tick can take a pair of tweezers, quickly remove the pest, and probably avoid the illness.
Officials in New York and Wisconsin say they’ve fielded numerous inquiries from nervous tourists about Lyme, but so far see no evidence that vacationers are canceling reservations at resorts and parks. Still, health officials in several states have papered resorts, camps and schools with pamphlets warning of the dangers and giving tips on how to protect against ticks.
Jim Kazmierczak, a Lyme specialist with the Wisconsin health department, predicted that the threat will force a change in habits for campers and outdoorsmen as they learn to use more insect repellent, stick to the center of established forest trails and shun shorts when out in the woods.
Importance of Tick Checks
“And conducting tick checks on yourself and your kids after you’ve been out in an endemic area may become as much a part of the routine of camping as brushing your teeth before you go to bed at night,” Kazmierczak said.
Thomas Riddleberger, an official with the New York branch of the American Camping Assn., said he was “surprised” that members had not been deluged with calls from parents concerned over whether they should cancel plans for their kids to attend day or overnight camps this summer. Nevertheless, Riddleberger said most camps are training counselors to avoid ticks, as well as cautioning parents about the dangers.
And the dangers can be considerable. Just ask Richard Johnson, who finally closed his Eagle River, Wis., antique store in the North Woods last year when the pain from Lyme-related complications became unbearable.
Problems Remain
Johnson, 62, thinks he picked up Lyme about six years ago, even though doctors didn’t diagnose it until last year. Despite three series of antibiotic treatments, he still suffers from fatigue, achy joints and muscles, headaches, fevers and nausea.
“You always know it’s there,” he said. “You just keep thinking about it. . . . When you feel a muscle cramp or your bones ache or you move one way or the other or have trouble sleeping or nerve distractions, naturally you think about it.”
LYME DISEASE IN CALIFORNIA
The carrier: The Western black-legged tick is the only tick out of 49 occurring in California that is known to transmit Lyme disease to humans, primarily from mice and deer. The actual size of the tick pictured at right is about 1/8 of an inch long before feeding.
The range: A low percentage of the ticks tested so far are found to be carriers, but the ticks range in the state is wide. It can be found on grasses and brush in both urban and rural areas, and are most common in the humid coastal areas and on the western slope of the Sierra Nevada range.
Avoiding contact: When hiking, tuck pants into boots or socks and shirt into pants, and wear light-colored clothing so ticks can be easily seen. Use an insect repellent effective against ticks. Avoid contact with brush.
If bitten, pull out tick promptly with tweezers so that mouth parts are removed from skin.
Symptoms: Spreading rash accompanied by flu-like fever and aches. Long-term possible complications may include disorders of the heart or nervous system, as well as severe arthritis. A blood test is needed to make a diagnosis.
Treatment: Antibiotics during the early stages can cure the infection, but may not always be successful in the later stages.
SOURCE: California Department of Health Services
