Tuesday, June 19, 2007
Monday June 18, 2007
Imagine an illness that is difficult to diagnose, last for months to years, and brings with it symptoms like crushing fatigue, neuralgias and crippling pain. Now imagine that medical doctors can't agree on who has it, how long to treat it, and if in fact the disease really is a problem in Ontario.
Lyme disease brings not only those challenges, but a whole lot more. The Canadian Lyme Disease Foundation lists over 70 different signs and symptoms of the disease. It has purportedly been misdiagnosed as Juvenile Arthritis, Rheumatoid Arthritis, Reactive Arthritis, Infectious Arthritis, Osteoarthritis, Fibromyalgia, Raynaud's Syndrome, Chronic Fatigue Syndrome, Multiple Sclerosis, Scleroderma, Lupus, early ALS, early Alzheimers Disease, Crohn's disease, Ménières syndrome, and Reynaud's syndrome amongst others.
To further complicate matters, detection and testing is challenging at best. According to Health Canada, about 70% of individuals bitten by a tick carrying the bacteria will develop the characteristic "bull's-eye" rash - erythema migrans or EM. However, other sources peg this number much lower - at only 30% of those bitten. The offending organism, the Ixodes scapularis (Deer Tick), is the main vector for the bacteria, but Borrelia burgdorferi (Lyme Disease) has been found in Ixodes pacificus (Western Black Legged Tick), Amblyomma americanum (Lone Star Tick), and Ixodes Angustus. These ticks are easily transported by songbirds and have grown from a small area in Lyme Connecticut (hence the name) to far flung locations all across North America. Lyme has been detected in ticks all over the province of Ontario.
Just across the border in New York State, reported cases of Lyme disease are at 28.9 cases per 100,000 people in 2005, according to the Centers for Disease Control. Pennsylvania tracks at a whopping 34.5 cases per 100,000. And here in Ontario? According to the Ministry of Heath, between January 1, 2006 and April 2007, there were only 38 reported cases, meaning we're at 0.3125 cases per 100,000. So what's responsible for the disparity? In a word, testing. Ontario's ELISA test for Lyme isn't foolproof and can miss early and late disseminated cases.
Lyme Disease is a clinical diagnosis, according to Richard Sadovsky, M.D., American Academy of Family Physicians, "The diagnosis of Lyme disease is clinical. Early infection is often accompanied by false-negative serologic tests, although this can occur late in the disease. The positive predictive value of serologic testing is low in patients with vague symptoms unaccompanied by any objective signs."
According to Public Health, other than the "bull's-eye rash" there are other symptoms of Lyme Disease:
muscle and joint pain
swollen lymph nodes.
If the infection goes untreated, the second stage of the disease can last up to several months with possible symptoms including:
central and peripheral nervous system disorders
multiple skin rashes
arthritis and arthritic symptoms
Extreme fatigue and general weakness
If the infection continues to go untreated, the third stage of the disease can last months to years with possible symptoms including, chronic arthritis and neurological symptoms. If contracted during pregnancy, adverse effects on the fetus, including stillbirth, can occur.
Treatment for Lyme disease is dependent on the stage at which it is diagnosed. If caught early, treatment can be as short as 3-4 weeks with an antibiotic like Amoxicillin or Doxycycline. If the diagnosis is delayed, as is so often the case, treatment can take months to resolve the disease and requires high doses of a combination of antibiotic therapies. A knowledgeable practitioner is crucial in the successful treatment of Lyme disease.
Prevention is definitely the best medicine with Lyme disease. In early summer, ticks can be as small as a poppy seed and their bite can go undetected for days. If you do find a tick on your body, remove it immediately.
From Health Canada:
Carefully remove attached ticks using tweezers. Grasp the tick's head and mouth parts as close to the skin as possible and pull slowly until the tick is removed. Do not twist or rotate the tick and try not to damage the tick (i.e., squash or crush it) during removal.
Testing on the tick itself is possible, so take the tick with you when you see your doctor (suggested preservation of the sample is to put it in a plastic baggie with a moist paper towel). Prompt treatment for Lyme disease is crucial, so if you know you were bitten and have the characteristic rash, get to your doctor quickly and don't take no for an answer.
Lyme disease is most prevalent in the late summer and early fall.
For other tips from the CDC on avoiding tick bites, click here.
Follow these links for more information on Lyme Disease, its symptoms and diagnosis from Health Canada, and Public Health.
To visit the Mayo Clinic's site on Lyme Disease click here.
For more information, including support groups and discussion boards, visit the Canadian Lyme Disease Foundation.
Photo courtesy of Canlyme.com.