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Lyme Disease

Deer ticks are widely known as the sole carrier of the bacteria that causes Lyme disease in humans. Stock photo
The lingering effects of Lyme can be debilitating

By David Dunaief, M.D.

Dr. David Dunaief

After a spring where we’ve spent more than our fair share of time indoors, summer’s heat is finally here. Many of us are taking advantage of the weather to enjoy day hikes and picnics along the shoreline or bike rides through wooded areas.

The summer’s heat also means that tick season is in full swing. This means we need to be aware of Borrelia burgdorferi, better known as the bacterium that causes Lyme disease. This bacterium 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, you should 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; 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 a 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 sometimes cause nausea.

Lyme Symptoms

Stock photo

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).

Lyme carditis is a rare complication affecting 1.1 percent of those with disseminated disease, but it can result in sudden cardiac death (6). If there are symptoms of chest pain, palpitations, light-headedness, shortness of breath or fainting, clinicians should suspect Lyme carditis.

Preventing 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 (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.

Diagnosing Lyme

Lyme disease often can be diagnosed within the clinical setting or with a blood test. 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.

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 recognize 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, the IDSA (Infectious Diseases Society of America) argues in favor of recognizing 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.

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 of antibiotics 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. David 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.

A buck spotted on a lawn in Port Jefferson. Photo by Phil Shiavone

Drivers are regularly reminded that deer populations along the North Shore of Long Island are increasing as many of the animals graze alongside or dart across roadways. Some of these encounters unfortunately end in collisions. With deer and people on the move during the busy holiday season, TBR News Media is taking a look at issues to hopefully curb the impact.

Deer are spotted all over the North Shore. The one above is seen near Old Homestead Road in Belle Terre, Port Jefferson. Photo by Phil Schiavone

Destruction of vegetation

Christina Maffia, who has lived in Old Field South for 18 years, said she sees deer on her property every day, sometimes a lone buck and other times two or three animals. She described her property as “once lush, green, temperate forest that has been reduced to bare limbs below 5 feet.” She said her perennials don’t grow back due to being continuously eaten.

The appearance of depleted vegetation coincided with the arrival of the deer a few years ago. She said her neighborhood had been planted back when Frank Melville established the neighborhood in 1929. The grounds in Old Field South were designed by the landscape architecture firm of Frederick Law Olmsted, which also designed Central Park.

“These plantings are considered historical,” she said. “It’s such a shame that the historical part of this area that made it so beautiful is now being compromised.”

Maffia has sprayed her plants with a product called Deer Off, which incorporates rotten eggs in the ingredients. It deters deer, she said, but her experience has been that whenever it rains or she runs the sprinklers, she needs to reapply the product which she uses around the perimeter of her property.

The Village of Old Field recently sent an email to residents encouraging them to use deer repellent on their properties. Village officials reminded homeowners that a new generation of deer will establish their own feeding trails this time of the year. Because of these new trails, “it is a good time of year to use repellents to redirect these trails before they become solidly developed,” the village said.

According to the village email, deer repellent means less plant damage during fall and winter, and fewer deer in the village.

Kathy Schiavone, of Port Jefferson, said she and her husband also have problems with their landscaping due to the deer.

“We had tried the various remedies that have been suggested and have come to the conclusion that we will no longer buy and plant flowers to ornament our yard,” she said. “We did replace a number of yews with Japanese plum yews, which the deer do not bother. We had done this about five years ago. So far, so good.”

According to the DEC’s website, among the food deer prefer are cedar, sassafras, wintergreen, yew, mountain maple, flowering dogwood and more. A list of other vegetation they feed on can be found at www.dec.ny.gov/animals/7195.html.

There is evidence that deer are also altering forests across New York, according to the DEC. This can reduce diversity in the forest understory, enable invasive species to outcompete natives and prevent seedlings of many species from growing into the next generation of trees.

A couple of deer spotted on a lawn in Belle Terre, below. Photo by Jean Thomas

Lyme disease

Maffia and Schiavone said they are concerned about deer ticks and contracting Lyme disease due to the increased population of deer. Both have friends and neighbors who have suffered from the tick-borne disease. Schiavone said she also knows four people who have contracted babesiosis, three of whom had to be hospitalized. Maffia said she had one neighbor with Lyme disease who later got Rocky Mountain spotted fever. Another was hospitalized with a severe inflammation around his heart caused by Lyme disease.

“It’s not just aesthetics anymore,” Maffia said. “It’s people being impacted by the deer.”

Nancy Irvolino has lived near Brooksite Drive in Smithtown for more than 40 years and has noticed an increase of the animals in the area.

“Sometimes they are on the side [of Brooksite], but a lot of times they run out at night in front of my car and I slam the brakes,” she said.

While Blydenburgh County Park abuts the lane she lives on, she said it wasn’t until a couple of years ago that she started seeing deer walking down her street and eating plants. Recently, she has seen them every night near her house.

Irvolino said she worries about herself and her dogs contracting Lyme disease and doesn’t even walk in the park due to it.

According to the DEC website, deer are the primary food source for adult female ticks and reduction of deer populations to very low levels may reduce tick densities and infection rates.

The Village of Old Field email to residents claimed that deer over time can carry thousands of ticks.

Solutions

Villages across the North Shore are debating the best way to cull the herds.

“My hope is that our elected officials will realize the overabundance of deer is an important enough public issue to take action against,” Schiavone said.

Brookhaven Town Councilwoman Valerie Cartright (D-Port Jefferson Station) is currently working to present a townwide forum on deer with the DEC in the near future, according to her office.

Belle Terre allows bow hunting, and Head of the Harbor last year joined Avalon Park & Preserve in Stony Brook with a contraceptive vaccine experiment to help with deer management. The DEC supports the use of sharpshooters, who aim for an instant kill, so the animal doesn’t suffer and also advocates donating the meat to food banks.

“I am not a fan of hunting just for the sake of demonstrating one’s prowess in killing any animal,” Schiavone said. “I have been convinced by information I have gotten that culling is the answer.”

Maffia, who has been a vegetarian for 30 years, agreed.

“At this point, because there are no natural predators, they’re attacking so many things people wouldn’t think of.”

— Christina Maffia

“At this point, because there are no natural predators, they’re attacking so many things people wouldn’t think of,” she said.

Maffia said she and her wife, Donna Crinnian, have been able to decrease the amount of bird seed they buy in the winter as nesting birds have disappeared since the deer have eaten the ground covering where the birds would nest.

“They’re impacting the ecosystem,” she said.

In the Village of Port Jefferson, where hunting is prohibited, residents are asked to call 631-774-0066 if they see a deceased deer on the road and 631-744-2507 if they see a wounded deer on their property. Those who spot hunter tree stands on private property can call Kathy Grady, DEC officer, at 631-744-2507 so the location can be checked to see if it qualifies as legal hunting ground.

Brookhaven residents can call the Animal Shelter at 631-451-6950 to report deceased deer on the road. In Smithtown, people can call the Animal Shelter at 631-360-7575 about dead or injured wildlife.

When it comes to roadways, the Department of Motor Vehicles advises drivers to be extra cautious during both dawn and dusk when deer are most active, especially in the autumn months.

Insurance company State Farm recently released its animal collision study from claims data from July 1, 2018, to June 30, 2019, which estimated 1.9 million animal collision claims industrywide nationally, the large majority being with deer. During the same period, it was estimated there were 1.5 million deer claims.

“Remember, animals are unpredictable, especially when faced with glaring headlights, blowing horns and fast-moving vehicles,” said Billy Williams, Setauket State Farm agent. “They often dart into traffic.”

He added that drivers should remember that deer move in herds, so if one is seen on a roadway there may be more following.

Researchers regularly gather at the Banbury Center at Cold Spring Harbor to share ideas about to counteract Lyme Disease.

Lyme disease, the increasingly common tick-borne disease, may soon be preventable. 

Experts from academia, government and industry have been discussing at Cold Spring Harbor Laboratory’s Banbury Center the benefits and scientific feasibility of developing a vaccine that would essentially stop the infection in humans. 

The highlights of those discussions are summarized in a new study published Oct. 17 in Clinical Infectious Disease. Its conclusion: 

“We are now positioned at a crossroad where advanced technologies allow for application of new genetic strategies for immunizations, possible identification of new immunogens, and repurpose of proven vaccine candidates not only for humans but also for domestic animals and environmental reservoirs.” 

In laymen’s terms: New techniques are there, it’s creating a lot of excitement and there’s hope. 

The study is the culmination of more than 3 years of meetings held at the lab, where the most promising strategies for counteracting the infection were discussed. 

Lyme disease is caused by a bacterium transmitted through the bite of an infected tick. Traditionally, vaccines have been used to treat infectious diseases and rely on human antibodies to attack the germ. One of the new vaccines, which might be used in combination with traditional techniques, actually impacts the tick.

“What was discovered several years ago, to everyone’s surprise, a Lyme vaccine worked inside the tick itself and inactivated the Lyme bacteria. Newer vaccines are being designed to disrupt the mechanism for transmission of the Lyme bacteria from tick to human,” said Dr. Steven Schutzer, one of the study’s lead authors. 

Researchers cannot speculate when the vaccines will become publicly available, but they said they feel encouraged that they are in the pipeline with some trials underway.

Lyme disease can be treated with antibiotics, such as doxycycline, and is most successfully eradicated with early diagnosis. The only preventative measure to date, the researchers note, is to simply avoid tick bites. That strategy, though, has been ineffective at stopping the disease’s prevalence. Each year, more than 300,000 people are diagnosed with the disease. In Suffolk County, 600 people are diagnosed with Lyme disease, the highest rate in New York State. 

Lyme disease symptoms include fever, fatigue and headache, symptoms that often mimic other illnesses. It is often diagnosed by its characteristic bullseye skin rash, but not all cases present with a rash. Left untreated, the disease can infect the joints, heart and nervous system. Some people suffer from a post-treatment Lyme disease syndrome and have trouble thinking six months after they finish treatment, according to the Centers for Disease Control and Prevention. 

Former Suffolk County Legislator Vivian Viloria-Fisher was recently diagnosed with meningitis, induced she said, by a severe case of Lyme disease. After hearing other people’s stories about how Lyme disease can cause major illnesses, even a heart attack, she said a vaccine would be welcomed. 

During the Cold Spring Harbor meetings, a recognition emerged among participants that an effective vaccine was an important public health tool and the best path to follow to counteract the disease. 

Schutzer emphasized, though, that getting vaccinated for Lyme disease, a noncontagious disease, would be a personal choice, rather than a public health mandate. 

“When the pathogen is highly contagious, vaccines are most effective when a large population is vaccinated, creating herd immunity, and leading to the protection of the individual and of the community,” the researchers state in the study. “A vaccine directed against the causative agent B. burgdorferi, or against the tick vector that transmits this bacterium, will only protect the vaccinated person; thus, in this case, herd immunity does not apply toward protection of the community.” 

Stony Brook University researcher Jorge Benach participated in the meetings and noted Lyme vaccines are currently available for dogs but not appropriate for humans. 

“There’s clearly a need,” he said. “A lot of things need to be considered before an approval of a vaccine.”

One of those factors: 25 percent of ticks carrying the Lyme bacterium also carry other infectious organisms. 

Both researchers said they valued the rare opportunity to commingle, discuss and share expertise about a certain aspect of science under one roof during the Banbury Center’s meetings on Lyme disease.  

Dr. Rebecca Leshan, executive director of the Banbury Center at Cold Spring Harbor Lab, is proud that the meetings can impact the wider community. 

“I can’t overemphasize the importance of the small meetings convened at the Banbury Center of Cold Spring Harbor Laboratory,” she said. “They provide a truly unique opportunity for experts to engage with counterparts they may never otherwise meet and stimulate new ideas and strategies. And the beautiful Lloyd Harbor setting may provide a bit of extra inspiration for all those who participate.”

The first meetings of the group resulted in improved diagnostics that has already had major effects, with FDA approval of a number of tests. Outcomes from the most recent meetings, she said, continue to set the right course of action. 

Vivian-Viloria-Fisher. File photo by Kyle Barr

By Vivian Viloria-Fisher

I thought I had taken all the right steps to protect myself against tick borne diseases; avoided going onto tall grassy areas without gloves, long white pants and white socks, and I sprayed legs — and shoes — and arms with repellents. All that notwithstanding, I did find more than one tick on me this summer. Again, I followed the prescribed steps and collected the vermin, saved it and saw my doctor, who prescribed a prophylactic dose of doxycycline. After the requisite weeks, I had blood work done which showed no sign of disease.

So, when I was flying home from a visit with our two sons in California and was not able to eat my salad at my layover stop, I was surprised but not concerned. I’d had a very busy week enjoying time with my kids and grandson. I felt very achy but chalked that up to the long drive from Marc’s home in Sebastopol to Dan and Megan’s home in Thousand Oaks. That’s more than 400 miles.

I was very tired the next morning but pushed myself to get up and get ready for the funeral that caused me to shorten my trip. During the Mass, I swung from hot to shivering cold and began to feel lightheaded. I turned to my husband, Stu, and told him that I felt as if my head was exploding in a white flash before my eyes. He helped me to my feet, and we made our way out of the church, quickly hugging my cousins as we passed. We bought a thermometer at a drugstore across the street from the church. It read 103 degrees.

This was Friday, the beginning of a week of fevers rising and falling, no ability to eat, muscle aches, headaches, earache and fatigue. My search for answers included three visits to doctors’ offices and finally, on Thursday, Mather Hospital Emergency Department in Port Jefferson where Dr. Hirsch did not dismiss it as just a virus. I told him I thought I had meningitis. He shook his head and said, “I suspect Lyme.”

My father had meningitis when I was 5 years old. He had continued to work although he was sick with mumps, and the infection spread. I remember the grown ups’ conversations about the tube driven into his head to relieve pressure. That left me with a very vivid but equally inaccurate image of what he endured. I wished something could relieve what I knew was going on in my head.

Stu and I had just watched “Jeopardy!” on Friday evening, and my right eye hurt so much that I decided to go to bed, since I couldn’t read or watch TV. I looked in the mirror as I brought the toothbrush to my mouth and saw that only half my mouth was opening. Off we went to Mather ED.

Within a day it was determined from the spinal fluid that the Lyme disease did cause the meningitis — and the palsy that froze the right side of my face.

I refer to tick borne diseases as the Black Plague of our county. These diseases are not to be taken lightly either by the public who don’t believe it will happen to them or by health providers who don’t consider the possibility of Lyme as often as they should. One can be bitten and walk away free of any infection or one can be bitten, feel safe because blood work shows no infection and find oneself close to death. I was very lucky to have had excellent medical care, both in the hospital and at home. I was discharged with a midline for a 28-day course of intravenous antibiotics and a service that provided a nurse who came to our home once a week and instructed my devoted husband on how to administer the medication when she wasn’t there.

Nobody drilled a hole in my head. Instead, my family, my friends and my community surrounded me with love, care and prayers. I am so grateful.

Vivian Viloria-Fisher and her husband live in East Setauket. She is a former county legislator in the 5th District, and is now chair of the Jefferson’s Ferry board of directors.

Stock photo

By Matthew Kearns, DVM

Dr. Matthew Kearns

We recently had a dog present to our clinic for weight loss and decreased appetite. Initially, the owners were suspicious that a change in diet was the culprit. However, as the situation progressed in a negative direction, the owners consented to blood work and it was discovered that the dog’s kidneys were functioning very poorly. Even after referring this patient to a specialty hospital, her condition worsened. She was dead within less than two weeks of a diagnosis of Lyme nephritis.  

Nephritis is defined as inflammation of the kidneys. Lyme nephritis is an uncommon manifestation of the infection with the bacteria that causes Lyme disease, Borrelia burgdorferi (Lyme arthritis, or swelling of the joints, is the most common manifestation of disease). What makes Lyme nephritis so dangerous is that it is not only the infection that triggers this condition but also the immune system’s response to the infection. It is the development of an antigen-antibody complex that triggers inflammation in the kidneys and, ultimately, the destruction of the organ.

Antigens are foreign proteins that trigger a response by the body’s immune system. Most antigens are viruses, bacteria, abnormal cells, etc. Antibodies are proteins produced by the immune system in response to antigens. Antibodies identify and tag antigens which signal white blood cells to destroy these foreign invaders. Usually this process just clears the infection or destroys abnormal cells before they can become tumors or cancers. Sometimes the antigen and antibody combine to form a single unit called an antigen-antibody complex. These complexes circulate throughout the bloodstream until they lodge in the body’s tissue (in this case the kidney). Once the antigen-antibody complex deposits in tissues it triggers an inflammatory response that damages the tissue itself. 

Lyme nephritis is especially dangerous because the inflammation secondary to these complexes continues even after the infection is cleared and leads to a condition called a protein losing nephropathy. A protein losing nephropathy leads to protein loss, as well as progressive destruction of the kidneys until they shut down completely (as with what happened to our patient). There is no such thing as kidney transplants in dogs at this time and dialysis is both expensive and limited as to which clinics can provide this service. 

The best defense to this condition is to vaccinate against Lyme disease before an infection occurs. It is usually a series of two vaccines and then once annually. Remember that this vaccine is only effective if given annually so don’t skip.  

In summary, if you live in an area where tick exposure is at higher risk, or you have found ticks on your dog (even if they’ve tested negative in the past), I would recommend a serious conversation about vaccinating your dog against Lyme disease.

Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine. Have a question for the vet? Email it to [email protected] to see his answer in an upcoming column.

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.