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Ticks

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.”

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).

Long Island is an ideal environment for many species of ticks, specifically the deer tick.

By Matthew Kearns, DVM

I commonly get the question, “What month can I stop using tick preventatives?” My answer is always, “That depends.” It used to be that somewhere around late October/November until late March/early April one could stop using flea and tick preventatives. However, with changing climate conditions and parasite adaptation this is no longer true.

The tick life cycle contains four stages: egg, larval, nymph (young adult) and adult. After the larval stage hatches out from the egg, it must feed and go through a molt between each successive stage. Ticks are sensitive to environmental changes throughout their life cycle but, ironically, are most resistant to temperature changes. It has to be below 35°F for ticks to even “overwinter.”

Overwinter is a term that refers to a process many species use to pass through the period of the year when “winter” conditions (cold or sub-zero temperatures, ice, snow, limited food supplies) make normal activity or even survival difficult or near impossible. During the overwinter period all activity nearly completely ceases until conditions become more favorable. If conditions become more favorable (above 45°F) ticks will set out in search of a host.

To kill a tick temperatures must be consistently below 10°F for many days in a row. If the tick is able to bury itself in the vegetation below a layer of snow, even below 10 degrees may not kill them. It is pretty routine even in January to have one or two days that are in the 20s during the day, dropping to the teens or single digits at night followed by a few days in the 50s.

Ironically, as resistant as ticks are to colder temperatures, they are much more sensitive to higher temperatures and humidity (or lack thereof). Eggs will desiccate, or dry out, and die during hot dry periods. The other life stages are at risk for dehydration due to increased respiratory rate in an effort to thermoregulate (control body temperature) and questing (looking for hosts).

Hotter, drier temperatures mean less vegetation. Less vegetation causes multiple problems for ticks: less protection from the elements and less vegetation for hosts.

The white-footed mouse is the primary host for the larval stage of the deer tick. This mouse survives on vegetation, and less vegetation and less resources for the mouse means a subsequent decrease in the mouse population. A decrease in population means less hosts. Less hosts, less ticks survive from the larval stage to adulthood. Fortunately, and unfortunately for us, the northeast United States rarely sees prolonged droughts. Even if we have hot, dry periods during the summer, we usually make up for it in the fall. It is an ideal environment for many species of ticks, specifically the deer tick.

In summary, it is my feeling that the tick season is 9 to 10 months out of the year. You may be able to stop applying preventative during the months of January, February, and March (this depends on temperature), but the rest of the year ticks are active.

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!

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

As Long Islanders are warned about an uptick in Lyme disease, another tick-borne virus has emerged in Connecticut across the Long Island Sound.

Nearly 12 years ago, Eric Powers, a biologist and wildlife educator, noticed an increase in the tick population at Caleb Smith park in Smithtown, after pulling nearly 40 ticks off a group of his students.

Powers conducted a survey of the park and discovered the population of tick predators had decreased, as feral and outdoor house cats either chased them off or killed them.

“It’s becoming a huge nationwide issue with our wildlife,” Powers said during a phone interview. “Wherever people are letting their cats out, we’re seeing this disruption in ecosystem where these tick predators are gone.”

But what Powers did not find was the prevalence of a tick-borne virus, the Powassan virus, which recently appeared in Bridgeport and Branford in Connecticut.

Between 1971 and 2014, 20 cases of POW virus were reported in New York, according to the Cornell Cooperative Extension in Suffolk County. The Centers for Disease Control and Prevention reports the virus has been found in Maine, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Virginia and Wisconsin.

Like Lyme disease, the virus can cause long-term neurological problems if left untreated. But Long Island POW virus incidences remain low despite the increase in tick population, according to Daniel Gilrein, an entomologist at Cornell Cooperative Extension.

POW virus, which is related to the West Nile virus, was first identified in Powassan in Ontario, Canada, in 1958 after a young boy was bitten by an infected tick.

Little is known about how much the tick population has exactly increased on Long Island, but Tamson Yeh, pest management and turf specialist for the Cornell Cooperative Extension, said it is unlikely cats are contributing to the increase by eating tick predators like birds.

“Birds will eat ticks, but not all birds are insect eaters,” Yeh said in a phone interview.

She said the snow cover during the winter months served as insulation for the ticks hiding in the ground, which helped them survive during the colder weather.

Richard Kuri, president of R.J.K. Gardens, a St. James-based landscaping company, has not noticed an increase in tick population recently. Regardless, he and his men continue to wear long sleeves and use a variety of sprays to ward off bugs while on the job. Kuri also said people may use more natural remedies to deter ticks.

“There are people who apply peppermint oil and rosemary mix that will help,” Kuri said. “But none of them are cure-alls.”

He added that granular insecticides, like Dylox, help kill a variety of unwanted bugs including ticks carrying viruses like Powassan.

There are two strains of the virus, which are carried by woodchuck and deer ticks. Since only about 60 cases of POW virus were reported in the United States in the past 10 years, Yeh said the chance of encountering POW virus is unlikely since the virus is rare.

Symptoms of the virus include fever, headaches, vomiting, weakness, confusion, drowsiness, lethargy, partial paralysis, disorientation, loss of coordination, speech impairment, seizures, and memory loss. Other complications in infected hosts may possibly arise, such as encephalitis, inflammation of the brain and meningitis.

Powers said he hopes to reduce tick population on Long Island through his quail program. He encourages local teachers, who use chicks or ducklings to educate their students about the circle of life, to raise bobwhite quails. He said releasing these quails annually will not only help them adjust to the presence of cats, but also control the tick population.