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Thursday, August 11, 2005 The Halifax Herald Limited

Doctor: Testing for Lyme in N.S. positive

By EVA HOARE / Investigative Reporter

One of Nova Scotia's top medical health officers is sending out more information on Lyme disease to other provincial health authorities in light of this newspaper's series on the illness.

Dr. Richard Gould, in charge of Nova Scotia's western region, said an article about the illness will serve as a "good followup" to material previously sent to them.

He also defended the type of testing used to detect human cases of the illness here, saying it is very "sensitive."

Nova Scotians also don't have to travel outside the region to get definitive tests, Dr. Gould said Wednesday from his Wolfville office. "I don't think there's any need really."

Nova Scotia resident Kelly Burke told this newspaper that doctors here initially refused to have her tested for Lyme after she was bitten by a tick in May 1999. Then when she was tested, the results were negative.

After travelling to Connecticut, where she was examined by Dr. Amiram Katz, she was positive on four tests for the illness.

To date, Ms. Burke's case has not been recorded among Lyme-positive cases in Nova Scotia. There are three cases of Lyme on record in the province, two in 2002 and one in 2004.

Recently, a three-year-old boy from Aylesford tested positive for the ailment, using the province's tests, but his file has yet to be added to the list.

Ms. Burke and her husband Larry are angry they had to travel outside Nova Scotia to get medical help for her condition and are suing one of the specialists she visited in the years after 1999.

Some doctors here discredited the U.S. lab that did Mrs. Burke's testing and questioned the credentials of her Connecticut doctor.

"You've got to be very careful about what the test is," said Dr. Gould, referring to those done outside the province.

He couldn't comment directly on the Burke case or any other, citing confidentiality rules.

"There are some unreliable labs out there, so you might get a false positive. There are a number of tests out there that have not been properly validated."

Dr. Gould said false positives are potentially dangerous because a person could get sick from being treated with antibiotics if they really don't have the disease.

"There's a lot of contentiousness about what is Lyme disease or what it is not. I'm not saying they're making up the symptoms," he said of those who test negative here.

"They're settling on Lyme disease as a diagnosis when it may not be. You need to be very cautious . . . about these things."

Dr. Gould said doctors should clinically check a potential Lyme patient and not disregard the illness if they have typical Lyme symptoms, such as the bull's-eye rash and/or flu-like complaints.

The South Shore remains the major area for Lyme, he said, but health authorities are on the "lookout" for it elsewhere.

"As far as we're able to determine from the surveillance . . . there is Lyme disease present in the province but the risk is limited."

Antigonish County, where previous scientific sampling noted 17 per cent of 141 deer ticks tested carried Lyme, doesn't seem to be a troublesome area right now, Dr. Gould said.

He said there's no way of knowing whether Lyme will become more widespread, although Lyme advocacy groups and many U.S. physicians fear it already has. It's the provincial Health Department's job to ensure information gets out, but the risk of Lyme disease must be put "into context," he said.

"If you have a bunch of positive ticks, what does that mean? I'd be very surprised there would be any kind of watering down (of information.) We don't want to come out inappropriately and make a huge human cry about something that is low risk, because that is a disservice too."

In the U.S., about 24,000 Lyme cases were reported to the Centers for Disease Control in 2004, but the CDC admits the numbers could be up to 10 times higher.

In Canada, there have been a total of 310 cases reported since 1995.

Sunday, August 14, 2005 The Halifax Herald Limited

Lyme disease: time to invest needed millions in research

By JIM WILSON

Thank you to Eva Hoare for the articles in The Chronicle Herald outlining the problems with getting a Lyme disease diagnosis and then treatment in Nova Scotia. The doctors are not given the true picture. Lyme disease-carrying ticks didn't just show up on a bird in 1999; that is simply when they actually looked.

In the Aug. 8 article titled "More than a little ticked off," Dr. Kevin Forward made some very seemingly scripted comments about laboratory testing. The reason I say scripted is because these comments are being made coast to coast almost verbatim by various medical representatives.

He implies that the labs in the U.S. that did the testing on Kelly Burke were somehow using pseudo-science and lack credibility. He further states that the tests used in Nova Scotia are very "sensitive," implying, of course, that they are good tests.

The tests Nova Scotia uses for screening boast both high specificity and high sensitivity, yet these tests have failed multi-lab studies, whether in North America, Europe or Asia. None of the specificity or sensitivity numbers claimed were achieved in these studies. Sensitivity and specificity do not translate into accuracy.

If Nova Scotia is so comfortable with its tests, then we at the Canadian Lyme Disease Foundation would be more than willing to participate in a competency study in which Nova Scotia tests will be measured for accuracy. I do not expect this offer to be accepted.

The taxpayers of Nova Scotia, and Canada, should demand it be done, as this same scenario is being played out Canada wide. If, every time we claim they missed a case of Lyme, those in control of "health care" exercise "health control" by simply making blanket statements, and are allowed to do this without backing it up with good science, then our system has failed us miserably. What we are asking for is not unreasonable and is simple common sense. We have good science and, more important, good scientists to back up what we state.

There have been many studies linking Lyme disease to other illnesses such as multiple sclerosis, Alzheimer's, chronic fatigue syndrome, fibromyalgia, arthritis, etc., and virtually nothing is being done to connect the dots. If only one per cent of these turn out to be treatable Lyme disease (spirochetosis), we will save billions in Canada alone.

It's time we let real science have a look at this; too many lives are being destroyed. We have huge revenue surpluses in government; perhaps now is the time to invest the many millions in research so dearly needed.

Jim Wilson, AIIC, is president, Canadian Lyme Disease Foundation: www.canlyme.com.

Tuesday, August 16, 2005 The Halifax Herald Limited
Risk of contracting Lyme in N.S. remote: health official

By DR. RICHARD GOULD

THE RECENT articles in The Chronicle Herald serve as a timely reminder that a limited risk of infection for Lyme Disease exists in Nova Scotia. Testing for the organism that causes Lyme Disease in deer ticks and other animals involved in the natural cycle of Lyme Disease as well as the reporting of human cases shows that the risk in our province is not widespread or commonplace.

The organism that causes Lyme Disease, Borrelia burgdorferi, can be present in the natural environment in deer ticks, birds, deer and small animals such as mice. People can become infected through bites from infected deer ticks. The bites of other species of ticks, like the more common dog tick, cannot cause Lyme Disease. Infected deer ticks are occasionally imported into Nova Scotia on migrating birds. However, in most cases, populations of infected deer ticks do not become established here because of the environment. Consequently, the risk of human infection from such importations is small.

The Nova Scotia Department of Health has been monitoring the tick population for almost five years. Testing for infected deer ticks and small animals has to date shown that the only area where Lyme Disease has become established is in a small area near Lunenburg. Only three human cases of Lyme Disease have been confirmed in Nova Scotia through reporting to the Health Department (two cases in 2002 and one in 2004). All three people lived near Lunenburg.

Lyme Disease is almost always a mild disease and can be effectively treated. Left untreated, it can occasionally cause heart, nervous system or joint symptoms. However, these can also be treated with antibiotics. It is seldom, if ever, fatal.

The diagnosis of Lyme Disease in areas where infected deer ticks are present should not be difficult to make. The most obvious characteristic is a rash seen in most cases along with general flu-like symptoms (fever, achiness, and headache).

The Lyme Disease testing method used in Nova Scotia is very sensitive and reliable. It follows the recommendations provided by the Public Health Agency of Canada and the Centers for Disease Control and Prevention in the United States. Other invalidated tests have been used in the U.S., but last spring, the Centers for Disease Control warned they are regarded as being unreliable.

There are ways to reduce the risk of being exposed to Lyme Disease. Keep grass and shrubs near residences neatly trimmed. When you are outdoors in a wooded area, use insect repellants containing DEET, wear light-coloured clothing and wear long sleeves and pants with your socks tucked in. You may also want to check for ticks after being in the woods, as deer ticks must remain attached to the skin for about 24 hours to cause an infection.

While the risk for Lyme Disease is low in Nova Scotia, the Department of Health takes it very seriously. The department supports ongoing surveillance for infected deer ticks in the province. Information is also provided directly to physicians and to the general public through information sheets sent to homes in Lunenburg on the Health Department website. Please visit

www.gov.ns.ca/health/ocmoh.

Dr. Richard Gould is a Medical Officer of Health in Nova Scotia and chairman of the provincial tick-borne disease committee.