Tags Posts tagged with "Lyme Disease"

Lyme Disease

Lyme disease starts with a circular rash where the ticks bite. Stock photo

By David Dunaief, M.D.

Dr. David Dunaief

Ah, summer is upon us. Unfortunately, this means that tick season is getting into full swing.Thus, it is good timing to talk about Borrelia burgdorferi, better known as the bacterium that causes Lyme disease. This bacterium is from the spirochete class and is typically found in the deer tick, also known as the blacklegged tick.

What do deer ticks look like? They are small and can be as tiny as a pencil tip or the size of a period at the end of a sentence. The CDC.gov site is a great resource for tick images and other information related to Lyme disease.

If you have been bitten by a tick, the first thing you should do is remove it with forceps, tweezers or protected fingers (paper) as close to the skin as possible and pull slow and steady straight up. Do not crush or squeeze the tick, for doing so may spread infectious disease (1). In a study, petroleum jelly, fingernail polish, a hot kitchen match and 70 percent isopropyl alcohol all failed to properly remove a tick. The National Institutes of Health recommend not removing a tick with oil (2).

When a tick is removed within 36 to 48 hours, the risk of infection is quite low (3). However, a patient can be given a prophylactic dose of the antibiotic doxycycline, one dose of 200 mg, if the erythema migrans, or bulls-eye rash — a red outer ring and red spot in the center — has not occurred, and it is within 72 hours of tick removal (4). Those who took doxycycline had significantly lower risk of developing the bulls-eye rash and thus Lyme disease; however, treatment with doxycycline did have higher incidence of nausea and vomiting than placebo.

What are the signs and symptoms of Lyme disease? There are three stages of Lyme disease: early stage, where the bacteria are localized; early disseminated disease, where the bacteria have spread throughout the body; and late stage disseminated disease. Symptoms for early localized stage and early disseminated disease include the bulls-eye rash, which occurs in about 80 percent of patients, with or without systemic symptoms of fatigue (54 percent), muscle pain and joint pain (44 percent), headache (42 percent), neck stiffness (35 percent), swollen glands (23 percent) and fever (16 percent) (5).

Early disseminated disease may cause neurological symptoms such as meningitis, cranial neuropathy (Bell’s palsy) and motor or sensory radiculoneuropathy (nerve roots of spinal cord). Late disseminated disease can cause Lyme arthritis (inflammation in the joints), heart problems, facial paralysis, impaired memory, numbness, pain and decreased concentration (2).

How do we prevent Lyme? According to the Centers for Disease Control and Prevention, we should wear protective clothing, spray ourselves with insect repellent that includes at least 20 percent DEET and treat our yards (3). Always check your skin and hair for ticks after walking through a woody or tall grassy area. Many of us on Long Island have ticks in the yard, so remember to check your pets; even if treated, they can carry ticks into the house.

Diagnosis of Lyme disease

Many times Lyme disease can be diagnosed within the clinical setting. When it comes to serologic or blood tests, the CDC recommends an ELISA test followed by a confirmatory Western blot test (3). However, testing immediately after being bitten by a tick is not useful, since the test will tend to be negative, regardless of infection or not (4). It takes about one to two weeks for IgM antibodies to appear and two to six weeks for IgG antibodies (5). These antibodies sometimes remain elevated even after successful treatment with antibiotics.

The cardiac impact

Lyme carditis is a rare complication affecting 1.1 percent of those with disseminated disease, but it can result in sudden cardiac death due to second- or third-degree atrioventricular (AV) node conduction (electrical) block. Among the 1.1 percent who had Lyme carditis, there were five sudden deaths (6). If there are symptoms of chest pain, palpitations, light-headedness, shortness of breath or fainting, then clinicians should suspect Lyme carditis.

Does chronic Lyme disease exist?

There has been a debate about whether there is something called “chronic Lyme” disease. The research, unfortunately, has not shown consistent results that indicate that it exists. In one analysis, the authors note that the definition of chronic Lyme disease is obfuscated and that extended durations of antibiotics do not prevent or alleviate post-Lyme syndromes, according to several prospective trials (7). The authors do admit that there are prolonged neurologic symptoms in a subset population that may be debilitating even after the treatment of Lyme disease. These authors also suggest that there may be post-Lyme disease syndromes with joint pain, muscle pain, neck and back pain, fatigue and cognitive impairment.

Ultimately, it comes down to the IDSA (Infectious Diseases Society of America) arguing against chronic Lyme but in favor of post-Lyme disease syndromes, while the ILADS (International Lyme and Associated Diseases Society) believes chronic Lyme exists.

Regardless, the lingering effects of Lyme can be debilitating. This may be as a result of systemic inflammation (8). Systemic inflammation and its symptoms can be improved significantly with dietary and other lifestyle modifications.

But to throw one more wrench in the mix, the CDC recommends that physicians look beyond Lyme for other possible diagnoses before diagnosing someone with chronic Lyme disease (9).

Prevention is key to helping stem Lyme disease. If this is not possible, treating prophylactically when pulling off a tick is an important step. Contact your physician as soon as you notice a tick. If you have a bulls-eye rash and it is early, then treatment for two to three weeks needs to be started right away. If it is prolonged and disseminated, then treatment should be for approximately three to four weeks with antibiotics. If it has affected the central nervous system, then IV antibiotics could be needed.

References:

(1) Pediatrics. 1985;75(6):997. (2) nlm.nih.gov. (3) cdc.gov. (4) Clin Infect Dis. 2008;47(2):188. (5) uptodate.com. (6) MMWR. 2014;63(43):982-983. (7) Expert Rev Anti Infect Ther. 2011;9(7):787-797. (8) J Infect Dis. 2009;199(9:1379-1388). (9) JAMA Intern Med. online Nov. 3, 2014.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.  

A deer tick is a common type of tick on Long Island. Stock photo

North Shore communities have found a partner in the battle against ticks and the diseases they carry.

“This new partnership is another example of local governments working together to save taxpayer dollars and protect the public health of our residents.” 

— Steve Bellone

On March 6, Suffolk County Executive Steve Bellone (D) announced the SuffolkSHARE Public Health Partnership. A part of the county’s shared services initiative, the new partnership will leverage the efforts of 10 local governments and the Suffolk County Department of Health Services to research and combat ticks and tick-borne illness, according to a press release from the county.

“This new partnership is another example of local governments working together to save taxpayer dollars and protect the public health of our residents,” Bellone said in the statement. “By taking collective action, we are expanding education, collection, and analysis to ensure that we have the information and resources at our disposal to deal with these illnesses head on.”

With the new partnership, towns and villages will be able to strengthen their efforts to combat ticks in ways that were previously prohibitive due to high cost and limited resources, according to the release.

The new partnership draws on efforts that include collecting data and procuring materials at lower costs while tracking progress over time. These processes are already underway by the Suffolk County Tick Control Advisory Committee, which researches and combats ticks and associated illnesses. According to the county, each year approximately 650 Suffolk residents contract a tick-borne illness, including Lyme disease.

Eight villages and two towns will work in conjunction with the county, including Asharoken, Northport, Head of the Harbor, Old Field and Belle Terre, according to the press release.

“Having the ability to work with other local governments and Suffolk County on this issue will give us the opportunity to address it effectively and affordably.”

— Bob Sandak

“Protecting public health is a priority for the Village of Belle Terre, and mitigating the risk of ticks and tick-borne illness is an important mission,” Bob Sandak, the Village of Belle Terre mayor, said in a statement. “Having the ability to work with other local governments and Suffolk County on this issue will give us the opportunity to address it effectively and affordably.”

Recently, Belle Terre moved to allow deer hunting within the village, citing that New York State is the only governing body that can restrict hunting. Sandak said at a Jan. 15 village meeting, where the possibility of deer culling in part with Port Jefferson Village was discussed, that in the near-mile radius of the village boundaries, there could be as many as 300 deer. It was expected that culling could bring the number of deer down to approximately 50.

The Department of Health Services will provide resources and guidance when it comes to ticks, while the county will facilitate testing of samples, collection of data and additional analysis. The cooperative procurement of corn, tickicide and other materials, as well as municipalities working together to collect samples to have them analyzed will happen at a cheaper rate due to consolidation, according to county officials.

The county health department and Suffolk County Department of Public Works Vector Control Unit will consult with villages launching their initial efforts at tick mitigation, tick-borne illness mitigation and deer mitigation, which may include municipalities sustaining a four-poster (also known as a deer feeder); using environmental controls, such as landscaping; and utilizing birth control. The participating local governments will assist the Department of Health Services with community education regarding the risk of ticks and how to avoid bites, tick collection for testing and health monitoring of residents.

According to the press release, North Haven, Saltaire and Shelter Island already operate four-posters. The deer feeders brush tickicide onto the animals to keep them free of ticks.

“While tick-borne illnesses remain a major concern amongst our community, we continue to look for new and innovative ways to protect the public’s health,” said Michael Levine, Village of Old Field mayor, in a statement. “Thanks to the work of County Executive Bellone and the creation of this new partnership, we will now be able to asses tick conditions, develop a comprehensive plan to combat this public health issues, and educate our residents on ways to stay safe.”

Stony Brook University Hospital. File photo

Most people only think about Lyme disease when taking a hike in a park, but for many doctors, the condition weighs heavily on their minds every day.

Dr. Benjamin Luft, director and principal investigator of Stony Brook WTC Wellness Program, is one of those doctors. He is currently working on two clinical studies examining the disease. One involves those who continue to present symptoms after being treated, and the other study involves Latinos on Long Island who work in the landscaping and agricultural fields.

In a recent phone interview, Luft said the clinical study involving Latinos is a straightforward one, where the aim is to help a population that has been underserved and understudied due to their work schedules. The other study is more involved.

After being bitten by a tick infected with a bacterium called Borrelia burgdorferi, many people with a bull’s eye rash or flulike symptoms may receive treatment and feel better; but there are those who will continue to suffer for a prolonged period, even years, with a variety of complaints like aches, pains and brain fogginess. Luft said at times there may be no clear signs of the disease in the body, but doctors may find evidence of it after thorough neuropsychological exams that can detect subtle abnormalities.

Dr. Benjamin Luft is one of the doctors at Stony Brook Medicine looking for answers when it comes to those who continue to suffer from Lyme disease after treatment. Photo from Stony Brook Medicine

“This study is really geared toward diagnosing and to find ways to be able to monitor the disease,” Luft said, adding in the future his hope is to conduct studies testing new ways to treat Lyme disease.

The doctor said it’s essential to receive a diagnosis because if Lyme disease is left untreated, it can lead to joint swelling, arthritis, neuropathies, meningitis or cardiac problems.

When Stony Brook University recently began making a more significant investment in its imagining facilities, Luft said he saw a chance to find an answer for those with chronic symptoms.

“I thought this is the opportunity to see what is going on in the brain of these patients with using X-ray techniques and radiological techniques which may give us some insight,” he said.

He said with cutting-edge neuroimaging studies researchers can look for evidence of inflammation in the brain which may be a reaction to the infection.

“That would be an important thing to do because it may give us another target for therapy,” Luft said. “A lot of the therapy that we now use is really just geared toward the organism itself, but it’s not really geared toward the body’s reaction to the organism which may also have to be treated in order to alleviate some of these symptoms.”

The doctor has studied Lyme disease for more than 30 years. When he arrived at SBU from Stanford University Hospital, he was involved in work with AIDs and age-related diseases, but he said at the university’s clinic in the 1980s many people complained of Lyme disease problems and there were no effective therapies at the time. Many of the first therapies and treatments used today were developed at SBU, he said, but there have always been people who haven’t responded well to those treatments.

“So that’s been something that’s been bothering me for many years as to why that is,” Luft said.

He said he will present initial data, which is promising, from the clinical imagining study at a conference in Barcelona, Spain, later this month and hopes to get more patients for the clinical study. Those who are interested can call 631-601-5615. Subjects must meet stringent criteria including not having any other disease, having serological evidence of Lyme disease and a clear history that they had the rash.

In addition to Luft’s studies, Dr. Christy Beneri, assistant professor of pediatrics at SBU, and her team are working on a pilot study to look at newer diagnostic tools to establish a better way to diagnose early Lyme disease.

“We also will be doing work on understanding tick epidemiology in our area and working with the local health department to understand potential new tick-borne pathogens,” Beneri said.

Stony Brook Lyme Disease Laboratory has been performing Lyme disease testing on clinical specimens since 1984. Both inpatients and outpatients can have a Lyme ELISA screening test and Western blots confirmatory test at Stony Brook Medicine. Almost 10,000 screenings were done in 2017 at the hospital, which has been actively working with state senators for funding for Lyme disease outreach and research, according to Beneri.

Students learn about life cycles while helping to curb Long Island’s growing tick population

Fifty bobwhite quails are being raised at Mount Sinai Elementary School to be released at a park in Ridge. Photo by Kyle Barr

Mount Sinai Elementary School fourth-graders are raising quails to help curb the tick population.

As part of a seven-year program, teacher Kevin Walsh works with students to raise a group of 50 bobwhite quails from eggs in a classroom incubator, then transfers them to a large pen located in the corner of the courtyard under heat lamps. The young students watch their project grow before their eyes and learn about the natural process of life.

“We teach the kids about food chains, about ecosystems, predator-prey relationships and the needs that all our creatures have to survive,” Walsh said. “We teach kids how to properly carefor living animals. It carries with them later in life.”

Mount Sinai Elementary School fourth-graders are in the process of raising 50 bobwhite quails. Photo by Kyle Barr

As similar as the quails are to one another, the fourth-graders who raised them said they could be distinguished by their look and personality.

One is named Michael Jackson, another Brittany, Roadrunner, Scooter and Beyoncé. The kids curled their fingers through links in the mesh fence and called the quails by name to see if they would touch their hands.

“They claim they can tell them apart,” said Walsh as he watched them, laughing. “I’m like, ‘Are you sure?’ They all look the same to me.”

The school received the quail eggs in April and watched the quails hatch inside their classroom incubator. By the end of this month, the quails will have reached the size of a grown man’s fist. By the time they are released in July at Brookhaven State Park in Wading River, the teacher said he expects them to double in size.

“Back when I first started last July, one of the first things I saw out here was [Walsh] standing in the courtyard tending to the quails,” said principal Rob Catlin, who is finishing his first year at the helm of the elementary school. “He’s out there seven days a week. In summers and on Memorial Day weekend — he’s coming in to check on them.”

Quails, as birds who stay close the ground, are a natural predator for ticks, whose population has swelled in recent years. If the problem wasn’t already as front and center as it was for Walsh, two years ago he was infected with Lyme disease, and for days was cooped up in his home suffering pains and a fever.

“We teach the kids about food chains, about ecosystems, predator-prey relationships and the needs that all our creatures have to survive.”

— Kevin Walsh

The disease can be debilitating and infectious, and causes severe headaches, joint aches and tiredness, especially if not treated immediately. Left untreated the disease can potentially cause paralysis in the face, heart palpitations and memory issues.

“Luckily I got the meds really quickly, but I haven’t been that sick in a long time,” Walsh said. “I had aches, pains, a high fever and was sweating like crazy. This project has taken on a more personal meaning since then.”

Superintendent Gordon Brosdal said without Walsh there would be no quails.

“It’s near impossible to find a guy as dedicated as Kevin,” Brosdal said.

Walsh recalled moving to the suburbs of Long Island from the city, and how his mother called his father at work, excited to learn their new home came with a flock of chickens. She later learned they were a flock of brown speckled bobwhite quails.

With changing times, Long Island’s quail population has changed, too, seeing a severe decline due to loss of habitat and excess predation.

“The quail like open landscapes – really sunlit areas,” Walsh said. “And a lot of the places left on Long Island are wooded, heavily forested or turned into developed land.”

Local biologist Eric Powers said household cats have also made a huge dent in population.

“It’s pretty simple math — one plus one,” Powers said. “You add cats to an environment and they just decimate the local ground dwelling animal population, particularly the birds.” 

Mount Sinai Elementary School teacher Kevin Walsh shows off one of the 50 bobwhite quails his class is raising. Photo by Kyle Barr

Walsh receives his quails every year through a program developed by Powers back in 2002 for the dual purpose of rejuvenating the local quail population while curbing the rising tick problem, which gets worse every year with a lack of natural predators.

The Centers for Disease Control and Prevention reported the number of illnesses related to ticks, mosquitos and fleas have tripled from 2004 to 2016, with 69,313 diseases reported from ticks in New York state in that time. In 2013, the CDC estimated that nationally there were 300,000 cases of Lyme disease annually, which is carried by deer tick.

Brosdal’s daughter Erika suffered through the pains of Lyme disease when she was 13 years old. As a father, watching his daughter lay in pain on the couch was heartbreaking.

“She couldn’t breathe,” Brosdal said. “It affected her so terribly – she was an A-grade student until that happened, and then she had to read everything twice. I give her a lot of credit — she’s 44 now and has two master’s degrees and she’s a high school psychologist.”

Brosdal said the quails have an important job to do and “can do a lot of good.” 

Powers said multiple schools participate in his program and will release the quails in parks all over Long Island. If any school or group is interested in raising quails, Powers can be contacted through www.yc2n.com.
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Tips and tricks when handling ticks
By Desirée Keegan

According to Stony Brook Southampton Hospital, over 900 calls were received from people seeking advice from its tick helpline in 2017.

A free tick kit provided by Stony Brook Southampton Hospital includes tweezers, a magnifying glass and sanitizing wipes. Photo by Desirée Keegan

If a tick is found on your body, there are ways to safely remove it:

• Tweezers are the best tool and should be placed as close to the skin as possible — grabbing the tick’s head.

• Pull upward with a slow and steady motion and try to avoid breaking the tick in half. If the head snaps off, know disease transmission is not possible without the entire body.

• Disinfect the bit area with rubbing alcohol or soap and water and contact a physician. Consider placing the tick in a baggie or pill vial.

• Pay attention to your health in the weeks following.

There are also ways to reduce your exposure, like checking for ticks daily, especially under the arms, in and around the ears, inside the belly button, behind the knees or between legs and on the hairline and scalp.
Remove and dry clothing on high heat as soon as possible to kill ticks. They can’t be drowned by washing. You can create a tick-safe yard by mowing frequently and keeping leaves raked. Also be sure to treat dogs and cats.

One tick can carry multiple pathogens. Deer ticks or blacklegged ones have no white markings, are brown or black in color and are very, very small. Both nymph and adult stages can transmit diseases like Lyme and babesiosis.

For more information on handling and treating ticks or for a free removal kit visit www.eastendtickresource.org or call the helpline at 631-726-TICK (8425).

Early treatment is crucial

By David Dunaief, M.D.

Dr. David Dunaief

Ah, summer is upon us. Unfortunately, this means that tick season is getting into full swing. Projections for this year’s tick population are ominous, because of seemingly unrelated issues like an increase in last year’s acorn population, which feeds mice that are carriers, and a relatively mild winter (1).

Thus, it is good timing to talk about Borrelia burgdorferi, better known as the bacteria that causes Lyme disease. This bacteria is from the spirochete class and is typically found in the deer tick, also known as the blacklegged tick.

What do deer ticks look like? They are small and can be as tiny as a pencil tip or the size of a period at the end of a sentence. The CDC.gov site is a great resource for tick images and other information related to Lyme disease.

What if you have been bitten by a tick? The first thing you should do is remove it with forceps, tweezers or protected fingers (paper) as close to the skin as possible and pull slow and steady straight up. Do not crush or squeeze the tick, for doing so may spread infectious disease (2). In the study, petroleum jelly, fingernail polish, a hot kitchen match and 70 percent isopropyl alcohol all failed to properly remove a tick. The National Institutes of Health recommend not removing a tick with oil (3).

The deer tick on the right is about half the size of a dog tick,
as seen on the left.

When a tick is removed within 36 to 48 hours, the risk of infection is quite low, according to the Centers for Disease Control and Prevention (4). However, a patient can be given a prophylactic dose of the antibiotic doxycycline, one dose of 200 mg, if the erythema migrans, or bulls-eye rash — a red outer ring and red spot in the center — has not occurred, and it is within 72 hours of tick removal (5). Those who took doxycycline had significantly lower risk of developing the bulls-eye rash and thus Lyme disease; however, treatment with doxycycline did have higher incidence of nausea and vomiting than placebo.

What are the signs and symptoms of Lyme disease? There are three stages of Lyme disease: early stage, where the bacteria are localized; early disseminated disease, where the bacteria have spread throughout the body; and late-stage disseminated disease. Symptoms for early localized stage and early disseminated disease include the bulls-eye rash, which occurs in about 80 percent of patients, with or without systemic symptoms of fatigue (54 percent), muscle pain and joint pain (44 percent), headache (42 percent), neck stiffness (35 percent), swollen glands (23 percent) and fever (16 percent) (6).

Early disseminated disease may cause neurological symptoms such as meningitis, cranial neuropathy (Bell’s palsy) and motor or sensory radiculoneuropathy (nerve roots of spinal cord). Late disseminated disease can cause Lyme arthritis (inflammation in the joints), heart problems, facial paralysis, impaired memory, numbness, pain and decreased concentration (3).

How do we prevent this disease? According to the CDC, we should wear protective clothing, spray ourselves with insect repellent that includes at least 20 percent DEET and treat our yards (4). Always check your skin and hair for ticks after walking through a woody or tall grassy area. Many of us on Long Island have ticks in the yard, so remember to check your pets; even if treated, they can carry ticks into the house. My Golden Retriever, Buddy, whom I loved dearly, died of Lyme complications.

Diagnosis of Lyme disease

Many times Lyme disease can be diagnosed within the clinical setting. When it comes to serologic or blood tests, the CDC recommends an ELISA test followed by a confirmatory Western blot test (4). However, testing immediately after being bitten by a tick is not useful, since the test will tend to be negative, regardless of infection or not (7). It takes about one to two weeks for IgM antibodies to appear and two to six weeks for IgG antibodies (8). These antibodies sometimes remain elevated even after successful treatment with antibiotics.

The cardiac impact

What are some of the complications of Lyme disease? Lyme carditis is a rare complication affecting 1.1 percent of those with disseminated disease, but it can result in sudden cardiac death due to second- or third-degree atrioventricular (AV) node conduction (electrical) block. Among the 1.1 percent who had Lyme carditis, there were five sudden deaths (9). If there are symptoms of chest pain, palpitations, light-headedness, shortness of breath or fainting, then clinicians should suspect Lyme carditis.

Does chronic Lyme disease exist?

There has been a debate about whether there is something called “chronic Lyme” disease. The research, unfortunately, has not shown consistent results that indicate that it exists. In the most recent report, chronic Lyme is refuted (10). In the analysis, the authors comment that the definition of chronic Lyme disease is obfuscated and that extended durations of antibiotics do not prevent or alleviate post-Lyme syndromes, according to several prospective trials. The authors do admit that there are prolonged neurologic symptoms in a subset population that may be debilitating even after the treatment of Lyme disease. These authors also suggest that there may be post-Lyme disease syndromes with joint pain, muscle pain, neck and back pain, fatigue and cognitive impairment.

A previous analysis suggested that chronic Lyme may indeed exist and that post-Lyme disease syndrome is a nebulous term (11). The authors point to several randomized controlled trials (RCT) to help validate their point (12). They believe that the bacteria may be able to evade shorter courses of antibiotics.

Ultimately, it comes down to the IDSA (Infectious Diseases Society of America) arguing against chronic Lyme but in favor of post-Lyme disease syndromes, while the ILADS (International Lyme and Associated Diseases Society) believes chronic Lyme exists.

Regardless, the lingering effects of Lyme can be debilitating. This may be as a result of systemic inflammation (13). Systemic inflammation and its symptoms can be improved significantly with dietary and other lifestyle modifications.

But to throw one more wrench in the mix, the CDC recommends that physicians look beyond Lyme for other possible diagnoses before diagnosing someone with chronic Lyme disease (14).

So what have we learned? Prevention is key to helping stem Lyme disease. If this is not possible, treating prophylactically when pulling off a tick is an important step. Contact your physician as soon as you notice a tick. If you have a bulls-eye rash and it is early, then treatment for two to three weeks needs to be started right away. If it is prolonged and disseminated, then treatment should be for approximately three to four weeks with antibiotics. If it has affected the central nervous system, then IV antibiotics could be needed. Post-Lyme syndrome vs. chronic Lyme disease needs to be discussed with your physician. Symptoms attributed to chronic Lyme could have another cause.

References: (1) npr.org online March 6, 2017. (2) Pediatrics. 1985;75(6):997. (3) nlm.nih.gov. (4) cdc.gov. (5) N Engl J Med. 2001;345(2):79. (6) N Engl J Med. 2003;348(24):2472. (7) Clin Infect Dis. 2008;47(2):188. (8) uptodate.com. (9) MMWR. 2014;63(43):982-983. (10) Expert Rev Anti Infect Ther. 2011;9(7):787-797. (11) Future Microbiol. 2008;3(6):621-624. (12) Neurology 70,992-1003 (2008). (13) J Infect Dis. 2009;199(9:1379-1388). (14) JAMA Intern Med. online Nov. 3, 2014.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

Mice are very efficient transmitters of Lyme disease, infecting about 95 percent of ticks that feed on them.

By Matthew Kearns, DVM

I was listening to the radio and a segment was introduced as “How a Mouse Plague Is a Forbidding Forecast for Lyme Disease in the Northeast,” predicting 2017 as a particularly risky year for Lyme disease. I had always focused on how close deer came to a dog owner’s property when discussing the risk of Lyme disease. I realize now that I must also ask about mice.

I decided I need to do some more investigating myself. I started with a little coffee, a doughnut, and started pounding the streets (I pictured myself as a regular “Magnum PI”). OK, back to reality. Coffee yes. Anyone whose seen my waistline would say, “doughnut NO!” Lastly, I only pounded the streets of Bing, Google and the Veterinary Information Network.

The first stage of my investigation was to refamiliarize myself with the life cycle of the deer tick. I learned that there are four stages: egg, larvae, nymph (young adult) and adult. The larval stage is the first stage to feed, so they do not have Borrelia burgdorferi (the bacteria that causes Lyme disease) but can acquire it during their first feeding. The adult stage of the tick prefers deer; however, the larval and nymph stages prefer smaller mammals such as dogs, cats, possums and, most importantly, mice.

Another fun fact I learned is that although other mammals, such as possums, will regularly groom off or kill the ticks on them, mice tolerate these ticks on their bodies. It is estimated that a white-footed mouse can have anywhere from 10 to 50 ticks on its face and ears at a time, and mice are very efficient transmitters of Lyme disease (they infect about 95 percent of ticks that feed on them).

Once the larval and nymph stages have fed (and possibly ingested Lyme disease at the same time), it is off to another host. The next stage of my investigation was to find out why there is an upsurge in the mouse population. Was it weather related? Other environmental factors? Actually it had most to do with a downtick in the population of the natural predators of mice. Many call it “Suburban Sprawl.”

Hawks, foxes and owls are the natural predators of the white-footed mouse and these predators need large forests to survive. Today we have more of a fragmented landscape — plenty of smaller forests that are broken up by small farms, housing developments and roads. Mice are prolific at making babies and actually thrive in these environments. Unlike deer, mice will come right up to (and sometimes into) our homes with all these ticks.

The Centers for Disease Control and Prevention report about 30,000 cases of human Lyme disease annually, but many experts feel that number is not accurate and that there could be as many as 10 times that amount. I would say it is safe to assume that the risk is just as high, if not higher, for dogs. There is no Lyme vaccine currently available for humans, but there has been a safe and effective vaccine for dogs on the market for decades. Please be aware that the canine Lyme vaccine has to be a series of two vaccines three weeks apart, and then once annually to be effective.

So, if you didn’t finish the initial series, or there has been more than a year gap since your dog received the vaccine, please make an appointment with your veterinarian ASAP. I would recommend a discussion about flea and tick preventatives at that same visit.

Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine.

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Here we are, in a new year, and I am going to start off with a cautionary tale. I was just about to take a shower when I felt a small bump on my left thigh. I thought that was strange since I hadn’t before felt anything there but it was just beyond my view as I fingered the spot and craned my neck to try and see. Then, to my amazement, the bump came off in my hand, revealing itself to be a tick. Ugh!

The legs were moving so it was clearly alive and rather large, so I guessed it was a dog tick. With wonderful coincidence, I happened to have an appointment with the dermatologist that afternoon, so I put the tick into a little plastic baggie and brought him this present. Although I half expected him to just throw it away, he in fact filled out the paperwork and sent it to a lab.

Now I am sharing this with you because I suspect that, like me, you thought tick season had ended with the start of winter. I even stopped putting Frontline on my golden retriever, figuring any ticks would have gone into hibernation or been killed off by the colder weather. But I should have realized that the calendar and the weather aren’t always in sync. We have been enjoying fairly mild temperatures for this time of year and, as it turned out, so have the ticks.

Now I don’t know if the tick fancied me rather than my dog, or if he just found me as I was walking across the lawn or brushing against a bush while putting out the garbage. However it happened, I was, so to speak, stuck with him until that lucky moment when my fingers brushed against his body. Anyway, I got a call from the doctor four days later with the surprising news that despite its large size, the critter was an engorged deer tick.

Not good. We all know that deer ticks can carry Lyme disease and transmit it to humans when they suck up to you. We have had several deer sightings in the neighborhood, especially around a wooded piece of property nearby. To me they are beautiful, graceful animals, and I watch them with admiration as they run. But I certainly don’t appreciate the bugs they can bring and leave behind as a souvenir of their visits.

The doctor asked me if I preferred waiting for the blood test, six weeks away, to determine if in fact I had been infected or if I wanted to go on the antibiotic regime immediately. I chose the latter and began taking 100 mg of doxycycline, with lots of water but no food as seriously instructed, every 12 hours. But the story doesn’t end there.

After only two pills, I developed a headache that just wouldn’t quit. This is apparently a not uncommon side effect with this medicine. So I was then transferred to 500 mg of amoxicillin three times a day for at least 20 days and advised also to take a daily probiotic, though not within two to three hours of each other, and to eat lots of yogurt. As we know, that only partially works to offset the distress to the gastrointestinal tract that accompanies regular doses of antibiotics. Plus I have broken out in splotches of itchy rashes, another unhappy side effect.

Bottom line: A tick bite can be a nasty thing, bringing along all sorts of minor and even major miseries. So from my experience, I hope you will check your skin regularly, even hard to see places, and not assume that a tick is just another summer pest.

Oh, by the way, Happy New Year!

Residents vet plan for Eaton’s Neck deer

Some Three Village residents became concerned when they received an advertisement for a deer management program offering its services. File photo

Dozens of residents weighed in at a public hearing on Tuesday on a Huntington Town Board plan that would allow seasonal longbow hunting of deer on Eaton’s Neck.

The proposal would amend the town code to allow longbow hunting during hunting season on private properties on Eaton’s Neck and in unincorporated areas of Asharoken to anyone who has a hunting license issued by the New York State Department of Environmental Conservation. Nearly 30 people took to the podium at town hall to voice their concerns on the plan.

Those who supported the proposal, which would only apply to private properties, said they wanted the measure in place to regulate what’s become an overpopulation of deer in the neighborhood. The great numbers of deer have given rise to public health, safety and quality of life issues, supporters said.

Opponents called the plan an “inhumane” solution and suggested the town explores other deer management routes and raised questions about whether the hunting method would even be effective in curbing the population.

Among the residents who spoke against longbow hunting included some who have been impacted by tick-borne illnesses, like Lyme disease, an infectious bacterial disease that if left untreated can spread to the joints, heart and nervous system; and babesiosis, a disease caused by microscopic parasites that infect red blood cells.

Dr. Gary Stone, Huntington Hospital’s chairman of pathology and director of the laboratory, said in an interview on Wednesday that the hospital has treated about 10 to 15 cases of babesiosis in total this year. Those cases are of individuals from the Huntington Town area, he said. The hospital announced in a statement “more are expected,” and said the disease is “prevalent in our area but sometimes goes unnoticed.”

“This has happened before but it doesn’t happen to do this degree this summer,” Stone said. “This summer is definitely worse than the last few summers.”

He said in research he’s carried out on cases at other area hospitals, it seems as though medical centers on the North Shore are experiencing greater numbers of cases of babesiosis.

“I’m thinking there’s a higher percent of ticks here on the North Shore actually have the disease than on the South Shore,” he said.

Doug Whitcomb told Town Board members that the population has exploded to the point where “everybody encounters deer on a daily basis.” He and others pleaded with board members to consider the elevated health risks associated with a large deer population and to allow longbow hunting.

“I am here to represent that the residents of Eaton’s Neck deserve the same opportunity to quality of life as all of the other residents of Huntington have, and deer are causing us unimaginable problems,” Whitcomb said.

Animal advocates, however, took aim at longbow hunting.

“Animals feel pain and experience a full range of emotions — happiness, contentment, fear and dread,” Jeannie Gedeon said. “They are intelligent. …  If you vote to allow deer hunting in the Town of Huntington we might as well go home and shoot our pet dogs and cats with an arrow and go watch them die.”

The uptick in the deer population has led to a rise in car accidents, residents said. They also claim the animals eat their plants.

Residents of the Eaton Harbors Corporation have been working on the issue. The group posted on its website a January meeting with DEC deer biologist Josh Stiller, who provided an overview of the deer population growth issue.

“The problem is going farther and farther west it seems like every year,” he told residents then. … “Deer can multiply really quickly under ideal situations and in a lot of these suburban areas you have an ideal situation for deer.”

In prior interviews, Councilwoman Susan Berland (D) and Councilman Gene Cook (I) spoke about wanting to see a more humane approach to managing the deer population. In separate interviews after the public hearing, they said they hadn’t decided whether they’d support the measure or not.

Councilman Mark Cuthbertson (D) echoed similar sentiments. Supervisor Frank Petrone (D) told reporters that he felt something needed to be done and that he’d look into the issue further.

“It is getting out of hand. We have to do something. Are we happy about this alternative with bows and deer running and they’re shot? No. There’s no immediate quick fix,” the supervisor said.

Deer rutting season means more of the animals running out on local roads. Photo by Rohma Abbas

The Huntington Town Board is taking a shot at regulating what some say is an uptick in deer by hosting a public hearing on a plan to allow seasonal bow hunting on Eaton’s Neck.

Residents who are interested in weighing in on the plan can get a better understanding of what changes would be made to hunting laws at the hearing on Aug. 11 at 2 p.m.

The proposal would amend the town code to allow long bow hunting during hunting season on private properties to anyone who has a hunting license issued by the New York State Department of Environmental Conservation.

A survey of the area’s residents shows support for the proposal, according to town spokesman A.J. Carter,

“Our major concern is safety, traveling our roads at night is hazardous and using our property has become impossible,” Ken Kraska, a resident of Eaton’s Neck said at the July 14 Town Board meeting.

Kraska said himself and many other residents own several acres of “virgin, wooded, undeveloped land,” and the deer population is starting to overrun it. He also described the deer as aggressive, especially during mating season.

The issue of Lyme disease also has residents worried.

“The number of deer has doubled and then tripled, people have had to hire companies to spray for ticks, and you have to do it constantly to stay on top of it,” Joe DeRosa, another Eaton’s Neck resident said at the meeting.

DeRosa has several grandchildren, and says he’s constantly on alert with them as well.

Mel Ettinger, trustee and police commissioner of Asharoken Village, said that an increased deer population has been a problem for years there, too.

“Every year there are more accidents involving deer and automobiles,” Ettinger said.

Animal activists don’t support this method of dealing with the issue and believe that there are more humane ways to reduce the number of deer.

“Bow hunting is one of the cruelest forms of hunting,” Kristin DeJournett, cruelty casework manager for PETA said.

DeJournett described alternative methods to keep deer away, including targeting food supply by cutting back on edible plants.

An increase in native plants, or plants that grow naturally in a particular region, without direct or indirect human intervention, will help reduce interest from deer, since native plants have grown over time and have a natural resistance to local deer, she said.

DeJournett said that scarecrows could work against deer, as well as placing soap or pepper spray on your property, because the smell deters the animals.

“Lethal methods don’t work to control animal populations in the long-term,” she said. “When animals are killed, more animals move in to replace them, and it creates a temporary increased food supply, which causes the remaining does to breed at an accelerated rate.”

Wendy Chamberlin, president of the Wildlife Preservation Coalition of Eastern Long Island, also shares the belief that bow hunting is a cruel and ineffective option.

“For sentience animals, that have thoughts and feelings, it is particularly cruel…it is a long, drawn out, agonizing death,” she said.

Members of the Town Board offered mixed thoughts on the proposal in interviews this week.

“I do think it’s a complicated and sensitive issue,” Councilwoman Tracey Edwards (D) said. “Any time lives of wildlife are taken we have to be very clear on what we’re doing and why.”

Councilwoman Susan Berland (D) seemed a bit more decided against the proposal.

“I know that there is a problem with the deer population, but I believe there is a probably a more humane way to deal with it.”

Councilman Gene Cook (I) indicated that he would be voting against the measure.

“I don’t like it, I think it is a cruel way to handle this, and it’s dangerous. It is bad for the residents and bad for the deer.”