This article is a transcribed edited summary of a video Bob and Brad recorded in August of 2021. For the original video go to https://www.youtube.com/watch?v=N0HWZlN57hM
Brad: Today we have a special guest, Chris, and we're going to cover in detail, the latest research and information on Lyme's disease. And the title of this video is, "Lyme's Disease is a Growing Problem. Where, symptoms, treatment, and prevention,” we're going to cover all those sections. You're going to find out some very interesting, updated information I'm completely unaware of, but I'm glad I know now. We're covering all the bases.
Chris: All the bases.
Brad: So Lyme's disease, something that people, I think across the United States for sure, everyone's heard of it.
Chris: Yep. I think it's a growing, a spreading problem. And a lot of that comes down to climate change, there's a lot of it, they like warm and moist. And let's face it, things have kind of changed over the last 20 years. When you look at some of the maps that are available, it shows the spread pretty dramatically over the last 20 years. Midwest, out east. Out east is particularly bad, but the Minnesota, Wisconsin area is a pretty big hot zone, too.
Brad: And we do have a really nice map showing statistically where the cases are and where they're intensified. You know, if you want to go to the end you'll see what those look like.
Chris: We'll place those maps for you.
Brad: That's right. Another thing, I don't think Chris minds me mentioning this, is one of the reasons we did this topic is because someone here actually has Lyme's disease. (It’s Chris)
Chris: No longer. I'm cured.
Brad: So you're really motivated to get, or extra motivated, to get more updated information on how to treat it and how to get better.
Chris: Yeah. You know, as a pharmacist, I deal with customers and patients that come in all the time, and I've always just kind of counseled them on their meds, but I really never took much. You take it for granted what people feel like until you actually perceive it yourself.
Chris: And frankly, I think I was in denial. I thought it was a spider bite or something at first because I had these two small bites kind of in the hip region, and it was just kind of started spreading to a rash. And my wife's like, "You need to go in. "I'm like, "Nah, it'll be fine." She's like, "No, you really need to go in."
Brad: And so it's from a tick.
Chris: Yep. It's from a tick. When I went in, and this is one of the problems with Lyme disease, Lyme disease mimics, they call it the great pretender. So it looks like a lot of other diseases. So arthritis, flu, you can have headaches, so migraines, Bell's palsy where it actually can cause facial paralysis. Yeah.
Brad: So it's not actual Bell's palsy. It's kind of symptoms.
Chris: No, yeah because it can actually go into your cranial nerves. You have the 12 cranial nerves, and so what can happen is the spirochete, which is what the bacteria is, it can affect those nerves and actually requires pretty intensive IV antibiotic therapy to get the patient out of it. So, and there's three stages of Lyme disease itself. So it's the variety, the severity and when you catch it, are all critical in its treatment. And so the key is early detection, and that's the problem. If you can get it in the first stage, that’s great. And usually when does that happen for people? The stage one is going to be, you probably see the rash, it could feel a little achy, weak, tired, fatigue, even kind of confused, your thought process isn't that great.
Brad: Is rash location always associated with the location of the bite?
Chris: Generally, but not always. And actually, only 70% of the cases have the rash. So there's another full on 30% that don't even show this rash.
Chris: And that's why Lyme disease can be so devastating, even to the point where it's fatal. So that's the scary part because it can progress to things like Lyme carditis where it affects people's hearts. And that can cause arrhythmias and ultimately fatality. So, that's the worst case scenario.
Brad: I have a good friend. She was in her sixties, lived on our farm all her life, and all of a sudden, very healthy person, very aware of her health, and she got Lyme disease and it did affect her heart, and she actually got a pacemaker as a result of it.
Chris: Yup. Yeah, and they do talk about that quite a bit in most of the research. It's some scary stuff, and the key is early intervention to get it treated as quickly as possible. Hopefully your doctor is knowledgeable about it. And that's one of the problems is, we're a pretty travel prone society. So let's say you're up from Kentucky, camping in Minnesota where there's a lot of tick problems, or in Pennsylvania where there's probably more ticks than any other state. All of a sudden you get bit, you go back home, and you have a rash, you don't really think about it, or let's say you don't get the rash, and you're just kind of achy and feverish, and like, “oh, I must've picked up a virus.”
Chris: You know; you can't really discern what it is because it does so many different things in your body.
Chris: So if you go and you see your doctor. “Oh, it's just a virus, it'll pass.” And all of a sudden, you're two months into this thing and all of a sudden, your face is not working right, you can't sleep well, you're crabby, you're moody, your muscles ache, you have an arthritic joint that just blows up on you for no reason when you didn't have any history of arthritis.
Chris: When they say it's the great pretender, it picks up just about everything head to toe.
Chris: It can cause brain and thinking issues. It can cause, essentially, the burning and tingling like a neuropathy, which we've talked about in the past.
Chris: So, you know, these are things that, you know, when you talk to your doctor, you want to be, super-duper careful with that and make sure that they're knowledgeable about the symptoms.
Brad: Now typically, when people get bit by one of these little baby deer ticks, you can hardly see them. Because they're most infectious when they're in their baby phase?
Chris: The nymph stage.
Brad: So that's like a baby deer tick.
Chris: Yeah. So that's the third stage. So mom lays eggs in the fall. They're actually disease free, which is what I found pretty interesting. They hatch. They emerged, become a larva. They attach onto a mouse or a bird. That's where they pick it up. They take their blood meal, then basically they molt and they grow into the nymph stage, which is about the size of a poppy seed. So if you've ever had a lemon poppy seed muffin, that's the size you're dealing with. And most people don't see those, and that's why they're more dangerous at that stage than anything else. Because the contact time for a tick bite, the CDC actually says that, and most of the entomologists and disease specialists and the bug specialists say it has to be in place for about 24 to 36 hours for the disease to transmit into your body.
Brad: Yup, I've heard that.
Chris: So you can't see a nymph. And the other goofy thing these little buggers do, although they're arachnids, is that when they bite you, they contain a little bit of an anesthetic, so you can't even feel the bite. It's completely numb to you. So most people don't have a clue that they even were bit by a tick.
Brad: So that leads me into the previous question I was wondering. So after they bite you and you cannot feel it, but like, I was bit by one, and I did have the red ring. Nothing happened as a result, but do you always get the red ring around the bite, or typically?
Chris: We'll touch on that. Most times you do, but not always. And then also just because you got a red ring around the bite does not necessarily mean you're going to get Lyme disease either.
Brad: Which is what happened to me. That was clear.
Chris: Yup. And probably in more cases than not, that's going to be the case.
Brad: Oh really?
Chris: Because, it’s interesting, they think there's about 300,000 cases per year, but they only have definitive diagnosis for about 30,000. So when you go in and get lab testing, most doctors, and that's why that number is skewed by we're talking, you know, 10%. I mean, it’s a big number, 300,000 down to 30,000. But I think most of the cases, doctors will basically empirically treat based on your symptomology. And we have a lot of very experienced clinicians out there that recognize, at least if you're in the Minnesota, Wisconsin, out east, New York, Massachusetts, New Hampshire, Pennsylvania. All those states are just huge with tick populations and Lyme bearing ticks.
Brad: Sure. Now the other thing I wanted to mention, this is our talk about virus, bacteria. This is not a virus, right?
Chris: No, it's a bacteria. Although, ticks are filthy. So they carry, I mean, everything. I mean, they got viruses, parasites, but in this particular case, the bacteria, it's a spirochete.
Brad: You're not making me feel good about going hunting again, or hiking.
Chris: No, I know. Well, but we'll talk about how to make sure you don't get bit too.
Brad: Okay, good. There's light at the end of the tunnel. We can continue to be active in the outdoors.
Chris: Yeah, no, we want you outside. We want you to be doing those things, but we just have to be smart about what we're doing and when we're doing it.
Brad: Sure. So you get the bite from the little, nasty creature. You get the red ring. You go into the doctor. Is there a blood test or something to get a positive diagnosis?
Chris: That's what's interesting, yes. The tests are tricky, you see online advertising saying, "Get tested for Lyme disease now." These tests are great, but they're not great early on. It takes about six or so weeks to develop antibodies. So you have to have the disease for a while. And that's the problem is sometimes you just don't remember having a tick on you. It's one thing when you see a wood tick. We've all seen those. Those are the big flatter ones that you recognized right away. Deer ticks, particularly if it's a nymph, are so dang small. I don't know how you're going to see it. So it'll just sit there, drop off you when it's had its fill, and move on. I mean, that's literally what happens. Little bastards.
Brad: It's a family show!
Chris: I'm sorry, I'm sorry. Nonetheless, I have an intense dislike for ticks. I'm sorry.
Brad: Yeah, well, that's understandable, because you've been diagnosed with the antibody, so you've had it for a while.
Chris: They didn't do the lab. I foregoed having the lab test done, because it was pretty obvious with the rash and some of the other symptoms, the cardiac symptoms I was experiencing. And so the doctor felt like, no, we're just going to throw you on an antibiotic for a month. And that's what happened. And I'm good to go.
Brad: Yeah, because I remember we were biking. We were doing some sprints, and Chris is typically faster than I am. And I was like keeping up with him almost passing him like, “yeah, I'm getting in better shape.” And then, Chris says that, "Something's going on with my heart." It's like was it a heart attack or what? We found out it was from the Lyme disease.
Chris: Yeah, but it still took another, what, five, six weeks for me to get better from that with antibiotic therapy too. I mean, I didn't really come around until about last week.
Brad: Yeah. What about the rash? Is that clear?
Chris: The rash is gone. Rash went away last week. It went away last Saturday to be honest. So I had the rash for five weeks, and that's about normal. And it spreads too. So it's not always just located where you get the bite. It can go all over. I ended up with it on my shoulders, wrist, arms, legs. So I had it all over, and that's more common than what people believe.
Brad: You got bit where?
Chris: Right in the groin area.
Brad: That's very interesting, because that's exactly where I got bit.
Chris: Yep, and it is. They're sneaky little buggers. They like to go where they're not going to be seen, because it takes them a while to feed. And they'll hang out and feed for a long, long time to engage themselves, like days. So it's one of those things. And so if you do get a tick on you, the best way to remove it is thin nose tweezers where basically you want to grab right by the head at the base where the tick is actually inside you, and you want to pull straight out. You don't want to twist, because if you twist, you can leave the mouthpieces in there. And the mouthpieces pieces are barbed, so they can get a good attachment, so they can just suck away. They're, I'll call it, one of nature's impressive beasts, because they know what they're doing. I mean, they inject you with an anesthetic, so you can't feel them. Like I said, they're sneaky little buggers. So they feed, they drop off, and they move on. But what most disease specialists suggest is that it has to be in place for 24 to 36 hours for you to actually even pick up Lyme disease. So it's not common. Not every tick bite's going to infect you. And that's why the nymphs are so dangerous, because we can't even see those things. Whereas, an adult you're like, "Oh, I got a tick on me." And so we take care of business.
Brad: Right. The only other thing before we get into some treatment and how to avoid getting these bites, this started, this was discovered in the United States 1970s?
Chris: Yeah, 1975, Lyme, Connecticut.
Brad: So that's how it got its name.
Chris: Yep, that's how it's named, Lyme, Connecticut. And basically a woman had just recognized, there were 51 cases that this woman observed, and 39 of them were kids, that all had basically arthritis. So that's unusual, kids under the age of 14 having big swollen joints, pain, and as the progression went on, I mean, there was more and more studies. Yale kind of started to pioneer most of the studies with it. And then there was also a very special person, Willy Burgdorfer, he was the guy that basically isolated the disease. And in '82 it was named Lyme disease officially. By 1987, it was a named disease state.
Brad: But then by that time it had been spreading. And it seems like in the last five or 10 years the spreading increased?
Chris: In the last 20 years it's been pretty dramatic. And then we'll see if we can attach that to the end of this too. You can just kind of see the spread. It's actually a scatter map where they use little tiny dots to just show cases. And you can see out east and through Minnesota and Wisconsin in particular.
Brad: So we're in that area.
Chris: Right, basically if you look at the United States map, I90, they call it the tick highway.
Brad: That's that interstate section going right by La Crosse.
Chris: So it's kind of interesting. Like I said, it's the number one vector-borne illness around. So, ticks, as I said, there's an egg. They're disease-free. They attach to a mouse. They get bigger. They go to the nymph, and they find a bigger blood meal, and then they become their adults.
Brad: And evidently, they do go to deer, and I don't know how that name is.
Chris: Deer, people. It's just mammals, but I mean actually it's a black-legged tick, but we call them deer ticks specifically.
Brad: How do we prevent it? That's a big topic.
Chris: Yeah, prevention is kind of interesting. This is where I kind of look at both natural and chemical treatments. There's a lot of repellents out there. They hate the smell of lemons. They hate the smell of eucalyptus. So those are more natural treatments that do repel, as well as DEET, and you want something like 20% DEET, but a lot of people are not crazy about DEET, because some people can get some nervous system problems with excessive DEET exposure. And when you compare it to permethrin, which is an extract from chrysanthemum, the flower, mums would be another name, so when you look at that one, the half percent permethrin seems to be more effective. In a lot of cases, when you treat your clothing with it and let it dry, a tick will curl up and fall right off. They cannot deal with permethrin but DEET is not quite as effective.
Brad: Permethrin, where do you get that?
Chris: You can get it online. You can go to like a Cabela's. You can go to just any kind of outdoorsy store.
Brad: And just look at the active ingredient?
Chris: Yeah, and if you just go and you go to their bug repellent area like probably the camping section would be a god spot in most sporting goods stores or online, you want a good permethrin based, and it's 0.5%. And you can treat you clothes with it. It's not generally recommended to put directly on your skin, but you can put it on your shoes. Prevention is the key to avoiding tick bites. So when you're outside, we want to make sure we're wearing pants. We want to tuck our socks into our pants. You don't look too cool, but it definitely works to keep them out.
Brad: Just cover up. The longer the sock, probably the better depending on if you're going to layer like you said. Keep them, so they have to work to get to your skin.
Chris: Exactly. And then, it's like when they're out there when ticks are on the hunt, so to speak, they detect our CO2 and our perspiration and smells. So they're really sensitive, little critters.
Brad: They can sense that?
Chris: Like a mosquito does. They sense your breathing, your CO2.
Brad: How do they? Do they ask them or what?
Chris: I don't know. Well, I would take a room of 1,000 ticks, and I would actually start to individually question each one, because that's how I roll.
Brad: Sometimes you wonder how they know, but anyways.
Chris: They've figured it out, some smarter people than you or I, for sure.
Chris: Yeah, there you go, etymologists. But, what they do when they're hunting, they call them a quest. So I don't know if they're into like "Lords of the Ring" or something, but they call it questing. So they kind of hang out on leaves and blades of grass, and they kind of extend their legs. And you walk by, they'll just kind of sneak right on aboard, and then they're going to start looking for a place to eat.
Brad: Kind of like Velcro, or it just catches.
Chris: Yeah, kind of. They're sneaky, and they're opportunistic, but they sense you coming, and they're ready. They just know that there's going to be a meal on the way. They just see meal tickets. So they don't care if you're a person, a deer, a mouse, a bird, lizards. They found it on all sorts of different things. So usually your bites are going to be the hairline and the groin area in particular, because those are not areas that people readily check. So if you've been hiking... Oh, the other thing, while we're talking about prevention before I digress too far, when you're walking on trails, try and walk more in the middle away from brush. And in your yards, keep everything kind of pruned. So if you're on a wooded lot, you want to make sure everything's kind of trimmed back. Mow your lawn regularly.
Brad: Walking through tall grass, brush, are things you want to avoid.
Chris: Those are prime targets. So those are the things that you want to do to avoid. And then when you get back, either use a mirror, so you can check your body, backside, all the weird cracks and crevices you normally don't look at, because that's where they're going to be, or just a trusted loved one that can kind of look you over really quick.
Brad: What time of year is it most prevalent? Temperature wise I'm assuming.
Chris: Temperature wise is kind of interesting. They like the hot and humid is what's ideal, but like you said, you were talking about deer hunting. Deer hunting is a prime opportunity. Even though it's colder, the adults are out looking for a meal. But it's more prevalent in spring and summer. But you can get bit in the winter. You used to think that it had to be like a 70 or 80-degree day for a tick to be active. Well, they found ticks are active in the 40s like in December in Wisconsin and Minnesota. So you get that nice day, and you're out there, they'll hide in the underbrush and leaves, so it's not really snow packed. So you just have to be mindful that it's kind of a year round problem. And because we're such a mobile society, if you end up with symptoms, just make sure you say, "Hey, I was in a tick area. "Can I be checked for Lyme?" Especially if you're like in a stage two where it's been like four weeks or a couple of months, and you got weird symptoms, you don't know what the heck's going on, and they can't figure it out, just, "Oh, I was in Wisconsin, Minnesota, Pennsylvania, "New York, New Hampshire, wherever." But those are all high tick bearing areas. And let's not forget about our friends over across the pond. There are very similar tick-borne diseases in Europe and UK and those areas as well. So it's good to be mindful of these types of infections. And the treatments are going to be the same no matter where you go.
Brad: Okay, so they're going to work with the antibiotic for that bacteria.
Chris: Exactly, and so the primary one is doxycycline, which is a tetracycline antibiotic.
Brad: Lots of words.
Chris: Lots of words, but it's the drug of choice. You want to be on it from 14 to 28 days depending. The studies vary. I would tell you three weeks to four weeks is probably most ideal, because it's a tricky thing to test. There's some studies that say seven to 10 days is enough. I flatly disagree with those. I think that I've seen enough people in my profession come back, "Man, I'm back for more." And it just didn't treat it. So, I mean, if we treat it long enough and strong enough right out of the gates, that's great. But what do you do if you're allergic to tetracycline type drugs like doxycycline? Well, then you can use amoxicillin, which is a penicillin based or Ceftriaxone, which is a cephalosporin based drug.
Brad: And that's all your doctor will refer?
Chris: Your doctor's going to take care of business. Your doctor's going to know what’s best, but those are the big three drugs. Basically, it's doxycycline to amoxicillin. If you're allergic to penicillin, then you go to Ceftriaxone. So that's kind of the progression.
Brad: All right, well, everything I wanted to know and more and sometimes less, but very interesting, very informative. I learned a ton that I didn't know about these little creatures.
Chris: Yeah, I learned more than I wanted to, but I felt like I was forced to.
Brad: And you're feeling much better.
Chris: I feel much better 100%.
Chris: So it's treatable, guys, and the sooner the better. If you do recognize just weird stuff, think about where you've been and let your doctor know that you were in a tick area, because oftentimes Lyme's is missed. Let's say you live in Florida, there's cases where people had heart transplants, because they missed the Lyme diagnosis. So that's how bad it can get. So it's one of those things that it goes long. You can have basically chronic Lyme disease, so it's just we got to pay attention. Just be knowledgeable about it. Just remember, could I have been somewhere outside where I got bit by a tick? You've got one of the most active audiences I know, so that means you guys are out there doing, which is the best thing for you. We just have to be smart about it.
Chris: Sure. All right, very good. Thank you, Chris. We appreciate the wonderful information. And be careful and tick-free.
Chris: Thanks, guys.
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