Lyme Disease In Placer County

For the last several years monitoring by the Placer Mosquito and Vector Control District has found increasing numbers of Lyme disease infected ticks at various locations around Placer County. Now, with all the recent rain and the weather warming up, the conditions are ripe for more of us humans to come into contact with those ticks.

As Spring progresses many of us will be heading out into the foothills to enjoy the beautiful weather and scenery. The recent abundant rain and the generally mild winter we’ve had suggests that this will probably also be a bumper year for ticks, the nasty little critters that can carry Lyme disease and a number of other infectious organisms.

Lyme disease was first identified in Lyme, Connecticut in 1975. Since that time it has spread to the Northern US and the West and is becoming endemic in many parts of the country including California. It is difficult to tell how many infections occur each year in our area. Annual statistics in Placer County are still in the single digits or low teens, however, it is almost certain that many cases are misdiagnosed or never receive a diagnosis at all.

Lyme disease is caused by a type of bacteria called a spirochete (Borrelia burgdorferi) and is transmitted to humans through the bite of certain types of ticks (deer ticks, Western black legged ticks). The first signs of infection often involve fever, headache, body aches and a characteristic rash that spreads from the site of the tick bite in a “bullseye” pattern. If the infection goes untreated, or is not treated successfully, it may progress to a chronic state that can involve long term neurological, cardiac and rheumatic symptoms. Chronic Lyme disease is difficult to treat and can wreak havoc in your life.

This is not meant to scare you or get you to stay inside. On the contrary, it is meant to help you understand a little more about how to avoid a tick bite in the first place and how to deal with it if you do get one, so that you can enjoy the natural beauty of the foothills safely and with confidence.

 

Avoiding a tick bite:

Ticks find their hosts by climbing as high as they can on grasses and other low lying vegetation and waiting for a large animal to rub against them. As the grasses and other vegetation get taller, and as we spend more time outside, there will be more opportunities for contact.

Common instructions for avoiding a tick bites include wearing light-colored clothing, long pants and long-sleeved shirts, tucking pant legs into your socks and staying on the middle of the trail to avoid contact with grasses and brush. While these recommendations certainly make sense, most people will probably not be able to adhere to them all the time. When the weather gets really hot are you still going to wear long pants and long-sleeved shirts on your hike or your run? Furthermore, if you are hiking, riding a horse or mountain biking, you will likely be venturing onto single track trails where the trail width is often 12 to 18 inches wide with tall grass or brush on one or both sides. If you are mowing a field or clearing brush, then you will almost certainly come into direct contact with grass and other low growing plants.

In our experience the most reliable way of preventing a tick bite is a regular full body examination. We call this the “tick check”. Once on the body, ticks will crawl on clothing and/or skin for several hours to a day before finding a site to feed. Even once they’ve attached themselves (i.e. bitten), the Lyme spirochete is virtually never transmitted within the first 24 hours.

 

How to do a “Tick Check”

If you are regularly venturing into areas of high grass and/or brush then once a day, at about the same time each day, do a full body examination without any clothes on. This is a lot easier with a partner, but you can do it alone as well. Stand naked before a full length mirror and examine every inch of your body both directly and in the mirror (This is not an opportunity for self judgement). Separate any folds of skin (such as under the breasts) and look very closely in hairy areas, such as the head, underarms and pubic area. The key is be take your time and be thorough. If you are doing this alone, a hand mirror may be necessary to visualize everything. A very thorough examination of the entire body can be done in about a minute.

While deer ticks and black legged ticks can be very small (the size of a sesame seed to the size of a small watermelon seed), they are always black or black and dark red and show up fairly well against the skin. Furthermore, if they haven’t latched on yet, they are generally moving which makes them easier to spot.

In addition to this, pay attention to the little sensations that you have throughout the day. Ticks keep moving until they find a place to latch on. As they do this they rub against body hairs which are very sensitive to movement. If you feel like something is crawling on you, check it out.

And now for a little war story. If you are squeamish about blood sucking insects (ticks aren’t actually insects, they are more related to spiders) then I suggest you jump to the next section. Most years, Greta and I visit a cabin in the woods of Minnesota. One year we went in May when it was still wet and cool. Between the two of us we picked thirteen ticks from our clothes and bodies in the space of about 5 days. Not a single one had latched on and neither one of us was bitten. We simply used the methods I’ve described above. (We now try to go to Minnesota later in the summer when there are far fewer ticks).

What to do if you get bitten by a tick

As mentioned above, even if you get bitten by a tick, you have about 24 hours before you are at risk of becoming infected with Lyme disease or another tick borne disease. So, if you do a thorough tick check daily, it is fairly unlikely that you will ever be bitten and very unlikely that you will ever contract Lyme disease.

If you do find a tick imbedded try to remove it without killing it. Using a pair of pointy tweezers, grab the tick on or as close to the head as possible, i.e as close to your skin as possible. Never put pressure directly on the belly of the tick. Apply firm but gentle pressure on the tweezers and pull directly away from the skin. Don’t twist or wiggle the tweezers. Don’t pull hard enough to tear the tick from the skin,  just hard enough to stress the tick. Continue to hold it in that position. After a few seconds to a minute the tick will let go on it’s own. In my experience older recommendations such as placing a hot match head on the body of the tick or smothering the tick with petroleum jelly don’t usually work. Doing these things also makes it impossible to get the tick tested.

Removing a tick from the skin

 

Getting the tick tested

If you have been bitten, getting the tick tested is a good idea, particularly if you’re not sure how long it’s been attached.

Testing requires a fresh, preferably living, intact specimen. Do not squash, twist, burn, or coat the tick with anything. Immediately after removing the tick place it in a hard, sealable container with a piece of moist paper towel or a moist cotton ball. Keep it in a cool place. Do not preserve it with alcohol, formalin or any other preservative. Deliver the specimen to the Placer County Public Health Laboratory as soon as possible.

 Placer County Public Health Laboratory

11475 C Avenue

Auburn, CA 95603

530-889-7205

 The Lab will ID the tick to determine if it is Ixodes pacificus, the West Coast species that carries Lyme disease. The fee for this is currently $12.00.

If it is determined to be Ixodes pacificus, the lab will do a test to see if that particular specimen is actually infected with the Lyme disease spirochete. The fee for this is currently $25.00.

Placer County Public Health Laboratory

How to know if you’ve been infected with Lyme disease

It is important to determine if you have been infected with Lyme disease as soon as possible because treating acute Lyme infection is fairly easy and straight forward. Treating chronic Lyme infection, on the other hand, is much more difficult and complex. Let’s look at various possible scenarios starting with the most clear cut and moving to those that are a little less certain:

Certain: 

• Developing a bull’s eye rash (erythema migrans) at the site of a recent tick bite

 Very Likely:

• Being bitten by a tick that was fully engorged at the time of removal and that later tested positive for Lyme disease at the county lab
• Developing a spreading, non-bulls eye rash at the site of a recent tick bite
• Developing fever and other flu-like symptoms within three weeks of a tick bite, even in the absence of a rash, particularly if the tick was identified as a deer or black legged tick

Possible:

• Any tick bite with uncertainty about the length of time the tick was attached or without a clear identification of the species of tick
• Developing flu like symptoms within three weeks of being in a tick habitat during high tick season (November through May in Placer county) even without finding a tick or evidence of a bite. Similarly, developing a spreading rash at the site of an apparent insect bite without the presence of a tick.

 

What to do if you think you may have been infected with Lyme disease

Contact your doctor. If your doctor is dismissive of your concerns, I recommend getting a second opinion. At this time, it seems that many physicians are still not well educated about Lyme disease and may be reluctant to pursue a Lyme disease diagnosis or implement treatment.

While there are several tests available for Lyme disease they generally don’t show positive results until three to six weeks after infection. In my opinion, that is simply too long to postpone treatment. Furthermore, even after three to six weeks, theses tests don’t always accurately identify a Lyme infection.

If you or your doctor have a strong suspicion of Lyme disease infection, then I strongly recommend treating “as if” you are infected.

 

Treating an acute Lyme disease infection

For those of you who know me, you are about to see me say something I almost never say: use antibiotics.

I have successfully treated high fevers, strep throat, whooping cough, respiratory syncytial virus and other serious infections with natural therapies for years. I truly believe that in most circumstances natural therapies work better and are both safer and restore health far better than antibiotics.

This is the rare exception!

Borrelia burgdorferi, the spirochete that causes Lyme disease is very susceptible to antibiotics in the early phases of infection. If, however, the organism is not effectively eradicated within the first month or two of infection it can find ways of evading detection and becomes very difficult to eradicate. This is why people with chronic Lyme disease infections are often on very aggressive therapies, including high doses of antibiotics, for years at a time, a situation that is far more destructive to health than the short course required to treat an acute infection.

furthermore, while there may be a natural substance out there that can eradicate Borrelia in the acute infective state, nothing has been confirmed to date and in my opinion, the small amount of adverse effects that may occur from a short course of antibiotics (two to three weeks) is well worth it to ensure elimination of the spirochete. Supportive measures can certainly be employed to support the body during the course of antibiotics.

 

In Summary

If you will be spending time in tick habitats (places w/ high grass, thick brush or wooded areas) then it is a good idea to be prepared for contact with ticks and to know how to protect yourself. Do a full body check daily so you can find ticks before they bite or so that if you find an embedded tick, you know the longest it may have been there. If you are bitten, keep the tick and have it tested. If you have any signs that suggest you may have been infected with Lyme disease, see a health care practitioner as soon as possible. If you do these things, there is almost no chance of developing any long term complications from a tick bite.

When I was in medical school I was bitten by a tick and did develop acute Lyme disease. Although I had a high fever and felt absolutely terrible, I was fascinated to see the classic “bull’s eye” rash developing on my leg and made a point of showing it to all my classmates (medical school does funny things to you). It was the only time in my adult life that I’ve taken antibiotics and I’m very happy that I did. I’ve had absolutely no long term consequences of that infection which sadly is not the case with many people who are infected with Lyme disease.