Lyme Disease...where is it?

I have left this blog mostly vacant for the last few years, since leaving the health department,
but lately I have had some stirrings and this one happened at the ground breaking for the new carousel at the Mill River Park.
I was not aware of this event, but saw a steam shovel for a few days and today a crowd of people...
I walked over to find out what was happening.  I believe i only saw one person i knew, but he was engaged with a number of other people.
I sent over to a table with a bunch of goodies on it and notice the grass was tall...
I could only think of ticks.
I asked what was going on and was told it was the ground breaking for the Carousel and i replied that it was a good place
and then i did what i always do, spoke what was on my mind...."except that the grass is tall and invites ticks and i should know cause this was what i worked with at the health department for 33 years.:
The first person i spoke to, walked away with an annoyed look on her face.
The others looked questioningly at me and i repeated myself and another said; "certainly not here".
I realized i was dealing with ignorance with the unwillingness to learn anything, i walked away.
I learned much about these awful insects for many years while i worked and shared my knowledge daily.
I learned from people who knew about predators and their impact on the population of small mammals, like the white footed mouse and chipmunks, who are the primary host of Lyme disease.
I learned that as suburbia moved the predators away, those small mammals increased.
The animal most people think of when they think of mammals and Lyme disease is the deer, yet the deer does not carry, nor transmit Lyme, but it does help the tick over winter.
So do those other small mammals, which will carry and transmit Lyme.
Deer have been seen near down town on summer street, mice are every where.
I would simply say there is no grassy area that is immune from this scourge and precautions must be kept in mind.

The ticks are coming after us!

It has been a very bad fall as far as the numbers of ticks biting people in Stamford, the worst one we have had since i started keping tabs in 1989, but next year could be worse.
Why?
This NY Time Article, link from a "Time for Lyme" newsletter tells it all.
There are 2 sides to this though.
The lack of small mammals will have the ticks looking for other prey, but the main source of Lyme disease is the White footed mouse and other small creatures.
Deer do not get, do not carry and do not transmit Lyme.  This might mean more tick bites, but fewer cases of Lyme disease or it may take a season or 2 to show up as a decrease, but i will be looking.
Average infection rate varies according to the life stage:
Adult female - Ioxides damminies (the black legged tick we have in CT) is 35% infected.
THe adult male only 25% infected.
The nymph - 18% infected and the larva not infected at all (it has not fed on any one to get the disease).
This has remained very consistent snce 1989 in this area of Stamford-New Canaan.  We will see if it changes...

What has happen, we have done to ourselves!

This is not about the dump, even though the Advocate wrongly says the underground water for North Stamford is bad.
No, this is about a whole host of things that have happened as we push "suburbia" further into undeveloped land.
The first portion of this is Lyme disease, it was discovered relatively recently, but in all actuality, it has existed for a long time.
As we pushed housing developments further into the woods, we eliminated the various predators of deer and the white footed mouse. The change in species allowed a proliferation of both and Lyme and the tick became more prevalent. This is not my study, this was a study done in Westchester county and clearly categorized the changes in species, but anyone could easily tell that the deer population has increased.
The second portion is Long Island Sound - this year there were fewer fish than ever before and everyone who has concerns is worried because all the things they have done to "clean up" the Sound have failed miserably.
How we changed the Sound and made it dependent on our "organic" pollution (Read treatment plant waste) and then fed into it all the things we put on ur lawns to make it prety has killed the Sound. Although I am involved, the biggerstudies have been done by the Marine fisheries division of NOAA and some graduate students in New York.
The third portion has to do with our drinking water - This is more complex, but still our fault.
Small farms , which prospered after World War II, did so using the new and amazing chemicals we made to control pests. Soon it was not profitable to have a farm of only a 100 acres or so and the land became more valuable as real estate. Small farms were subdivided into lots where houses were built and who would ever think that they were time bombs? They were away from public water and wells were drilled.
So for 30 to 50 years, these homes have been pulling down the clean out products of the farmer. the land was not pristine, it was hazardus, for after every spray with these "wonder" chemicals, the farmer had to clean out his canisters and those become hot spots.
Others of us dumped still more chemicals into land fills and backyards and into septic systems never dreaming that there would ever be a problem.
This has been found by epidemiologist studing developed farm land and cancer clusters.
We did it to our selves in our precieved needs and our lack of understanding.
All of these occur because

Ticks and Disease

It is time again that the main ticks that are active are the little larva, the ones who never fed on any thing yet and have never tested positive for any disease organism. Besides that, they are so tiny (the size of the dot in my "i") that I am always surprised when some one brings one in.
The good news is that for the next 3 months, there will be very little transmission of Lyme disease into the human population (the other ticks mostly are not feeding) until mid October!
We are still getting back reports from all the submission we have had ( it can take 6 weeks, but mostly 4 weeks) for us to get a report back from the CT Agricultural Station .
Why so long? Because they are testing all of Connecticut! That is a lot of ticks for a limited staff doing the work for free (these are really good people,trust me).
In the mean time, I put some thing on my plate that I probably should not have (see my post on overwhelmed). I was looking at tick data, data that no one else has because I will call every positive from the CT Ag Station to make sure people understand and go to their doctors. I also ask a few questions.
One thing we keep stressing is that if you find one tick, there is a chance there are more.
So when people report having symptoms and the tick is not positive or is unengorged, we make a very rational assumption that there was another tick.
While the Ag Station will put a disclaimer on all their tests, it is a very, very good test. It tests for the spirochetes in the tick by PCR. It has found the disease in ticks with no body, so it is very good!
So symptoms are the big thing. Why?
Besides the one issue I just raised, there are other issues, there are other diseases. While Lyme is spread by the white footed mouse, who remains infected for life (3 years) once it is infected. Deer do not get Lyme and can not transmit it, but they are know to carry babesia and Ehrlichia organisms. I have only had 5 posts on Lyme, so it gets to be more interesting to me than a lot of things.
Why all of this? Because one of the things I found in the survey was people having real symptoms when the tick they submitted was either not infected or unengorged.
Many doctor do treat quickly. There many cases of single dose Doxycycline being given, with no reports of symptoms afterward.
There were also cases where the doctor would not treat with out a positive blood test even though there were classic symptoms and a positive ticks.
The variance on the treatment was amazing, different drugs, different time periods, very little would even be considered standard.
That is the medical profession.
Should the Health Department take the lead on education? I think so, but it is not going to happen, the interest in being a front runner in anything is minimal.
There are many doctors who are very proactive in this area and this is a good thing.
This was just the begining of me taking apart my little survey. It does make life interesting.

Combating Hysteria

All who have met me in my 30 something years of working with the city, know that I am a fairly no nonsense kind of guy when it comes to m work (I won't go to out of work or non-work areas with that attitude though).
When the data has been against the city, I stand against the city, when the data does not support what the public thinks, I am sorry, I will not make things up for anyone's convenience.
StamfordNotes has a quick review of the new "documentary" about Lyme and I also heard some discussion on NPR concerning the info on the movie.
I have a rather strange stand when it comes to Lyme disease, there is a lot of unnecessary hysteria over the disease and a lot of mind boggling complacency also.
The complacency comes in the form of doctors not being proactive when it comes to treating when symptoms are present, preferring to rely on blood tests.
I take my cue in this from the state health department lab, which a number of years ago (10?), stopped offering a blood test for Lyme, even tho it is on the significant illness list of reportable diseases. Their Reasoning? The test was inaccurate! That was more than enough for me. After years of working on it, the tests still relies on an antibody response from humans to be effective. We do not all get the rash, we do not all or can identify that lousy feeling that comes form the infection. Those are immune responses, without them, the test will not work.
Now for the hysterical part. Lyme is every where, it is spreading, it will get us all.
Partly true, mostly because of man. An environmental organization in Westchester presented that the rapid spread of Lyme has been mostly because of our own push into the suburbs and the decline of predators of the white footed mouse.
Well we know that the deer population explosion is due to us and our desire to protect "Bambi", but what woth the mouse?
The mouse is the primary vector of Lyme disease, not deer. They get infected and stay so for their entire 3 year life. The deer do not get and can not pass on Lyme.
We have given them great hiding spots in loose stone walls and have pushed creatures like owls out of the area. Even the raccoon population has decreased by over 95% since 1`990 (this is due to rabies, not specifically man) and they did feast on the mice as well.
But Lyme disease has remained at a constant infection level since 1989 (when we did the first testing), It has not increased in prevalence and the reality is that we were very late is discovering something that has been in this country for long before we were.
So whay is not every one crippled with Lyme?
Thjat is the next point of hysteria - when doctors prescribed antibiotic for just about everything, a person with sudden aches would go on a quick course and weather theree were other things involved or not any possibility of Lyme disease was stopped in its tracks.
The organism is very susepible to antibiotics. Its effects may linger for years, but that is not the disease anymore, it is not dissimilar to syphilus in that way, if you do not treat it early, you will always have a "marker" showing you have been exposed.
Quick treatment works!
The studies on the single dose have been performed and by several orginizations, the New England Journal of Medicine and the Chicago Journal of Medicine are a couple.
It works, convincing doctors of that is a different sstory, the CDC refers to those orginizations in regards to the single dose of doxycycline within 72 hours of a tick bite, other wise it is 4 weeks.
Convincing people who have not discovered a problem until months after and having doctors who now are reluctant to treat gives great rise to hysteria.
It is actually understandable, but it is not the end of the world and we are not all going to be horribly crippled by untreatable Lyme.
And yes I have had Lyme, twice and do understand it well.

Ticks

I promise to finish my "treatment series" in the next post. There is only one or two more things to discuss, but my "adventure" and all the consequences of recovering have left me a bit slow in posting here. However as the temperatures warm up here in Connecticut, the ticks are becoming active. Usually the first batch of ticks waking up from their winter nap are almost 50% infected. Either people are not bringing in those ticks or things changed this winter because we have not had a positive test result out of a number submitted.
We have some complications with testing - the reliable CT agricultural station is still that, reliable, but sending tick there will take several weeks for results. The good news is that they only test ticks which have fed and therefore can transmit Lyme disease. They will not test unengorged ticks.
The Ct Vet Lab has upped prices and required prepayment, so we can't handle them except for special request. They have also added tests for Babesia and Ehrlichiosis. They do have rates that discount if you want all 3 and they will take 5 business days, once they receive the tick.
I do NOT recommending testing ticks as a diagnostic tool, symptoms are a much better indicator, but I recognize that not all doctors follow the CDC guidelines for tick bites and Lyme symptoms.
The following is a general recommendation based on what people who have symptoms have told me.
I want everyone to know I am not an expert on Lyme disease, I can only pass on what others have experienced or discovered.
For those having symptoms and doctors unwilling to treat with out positive tick results, I would refer them to the CDC website with disease and treatment recommendations.
For those who have had the misfortune of having Lyme disease without the benefit of finding a tick bite or a doctor (usually in the past) who would not diagnose or treat, the CDC website will not help. There is lots of information out there, some of it correct, some hype, some confusing.
My own interpretation my not be completely correct, but it fits most of the issues and the people who have followed this (not from my recommendation, I created it from what worked for them) seem to have come out of the long term Lyme syndrome.
Sadly. even the best tests have a time window in which they work. Blood tests do not always tell the story.
1) 3 weeks of antibiotics is enough to kill the organism, but if it has been in your system for more than 3 months untreated, you will still have an immune response and symptoms.
- why i say this is that the organism is similar to syphilis, treating it stops the organism, but you are going to have positive markers for life.
2) Stress, other illnesses, weight loss will make you go through it all over again.
- this releases the markers into your system and no Lyme test in the world will show it.
3) Homeopathic persons and nutritionists can help.
- Some maybe quacks, just like there are good MDs and not so good MDs, find someone who works with you.
4) You are not going to die.
-too many people have been told so much nonsense, they believe they are going to die because of it. You will get better.
5) Make sure you do not get re-infected!
-the ticks are out there, hungry.

My final statement refers to a New England Journal of Health Article on long term Lyme disease and suggests that there maybe another cause. Check my previous post.