Lyme Disease Is A Ticking Epidemic

Lyme disease is transmitted by several species of ticks. People get infected when they're bitten by these ticks, generally when they're hiking or camping. Many very healthy and active people contract Lyme disease. They're often outside exercising vigorously, and then, all of a sudden, the next day, they can't get out of bed.

The ticks hang out on the top of blades of rough grass -- by trails, riverbeds, even at the edge of golf courses. This is called questing: The ticks are waiting for an animal -Ğ usually a deer -- to come by so they can latch onto it and feed. The tick transmits Lyme disease as it engorges itself with blood.

What are the initial symptoms of Lyme disease?

Victims frequently are not aware that they have been bitten, partly because the ticks carrying Lyme disease are so tiny. A larval tick is the size of a poppy seed, and an adult tick is only as big as the head of a pin. There is, however, a classic symptom: a bull's-eye rash of concentric red circles at the site of the bite. The bite is usually on the arms or legs of an adult, but it could be anywhere on he body, and with children it can often be on the hairline or scalp, where it is difficult to see. I frequently hear from people, "I had a tiny mole on my arm that left a rash, and then the mole went away." Initial infection also has flulike symptoms such as muscle aches, fever and joint pain.

Many people don't know that they have been bitten, and they don't see the rash. But if Lyme disease is not treated in its early stages, serious heart, muscular, skeletal and neurological problems can arise. There can be facial paralysis and seizures. One of my patients, Amy Tan, has had hallucinations and memory loss due to Lyme disease. In advanced stage it is extremely debilitating, and the problems that can arise can eventually be fatal.

The ticks are actually carrying a bacterium that causes Lyme disease -- is that correct?

Yes. A bacterium called Borrelia burgdorferi. It is a corkscrew-shaped bacterium of the spirochete group, in the same family as syphilis.

Are human beings the only animals that can get Lyme disease?

No. If dogs are bitten by the ticks, they can get sick symptoms like lameness, joint pain and neurological and heart problems. Cats can also get sick, but ticks don't like to feed on cats -- no one knows why! Deer get bitten by the ticks, but they don't seem to get sick. Birds get infected, but they don't get sick, either. Ticks actually get the bacteria from rodents -- rats, gophers, moles and especially field mice -- but rodents also have no symptoms when they're infected.

Is Lyme disease often misdiagnosed?

Yes. Lyme disease is often called "the Great Imitator" because it imitates other diseases. One of its very prominent symptoms is fatigue, so it is sometimes confused with chronic-fatigue syndrome. It is also frequently misinterpreted as severe depression, as fibromyalgia [a condition that causes muscular and joint pain] or as lupus, multiple sclerosis, Lou Gehrig's disease, rheumatoid arthritis, Alzheimer's, a brain tumor and other diseases.

I interviewed a parasitologist from Kaiser Permanente, and he said that "local residents are at very low risk for contracting Lyme disease. Only about 1 percent of local ticks carry Lyme disease." Do you disagree with this statement?

Yes. And Kaiser Permanente has been a big problem. They don't want to diagnose or treat Lyme disease, because it is very costly to diagnose and treat. Kaiser has a system where you can't sue them if you are misdiagnosed, so it just doesn't care. I have a lot of patients that came to me after being totally ignored at Kaiser. Blue Cross and Blue Shield also often won't pay for long-term treatment.

How are people with Lyme disease cured?

Lyme disease is easy to cure if it is diagnosed early and treated with oral antibiotics. But when Lyme disease is in a more advanced stage, the patient needs intravenous feeding of the antibiotics. Amy Tan, for instance, needs intravenous feeding, but she has such a hectic travel schedule that it is hard to administer this consistently. She's going to the Galapagos Islands soon, and there aren't health facilities there that can provide her with the intravenous feeding she needs.

A lot of people believe erroneously that Lyme disease is not a problem on the West Coast.

That's correct. There's a misperception that Lyme disease doesn't exist in California. This belief is absolutely wrong. A recent tick study conducted by Robert Lane of the UC Berkeley Microbiology Department revealed that parts of Mendocino have a tick-infection rate of 41 percent, which is equivalent to the East Coast infection rate. Another survey showed up to a 30 percent infection rate in Santa Cruz-area state parks.

I just read a Public Health Service report that said that Lyme disease is underestimated by a factor of 1:25. This means there are 25 times more cases than are diagnosed. In California, we rely on doctors to file a report if they have a patient with it, and that is a very inefficient method. Basically, anywhere there are deer there is the possibility of Lyme disease. People who have deer running in their backyard are the most at risk.

In what parts of the world does Lyme disease exist?

Lyme disease is now worldwide in distribution. It exists in many parts of Europe, particularly France, Switzerland and Russia. There's another strain of the bacteria -- B. orientalis -- in China and Vietnam. But the highest rate of infection is probably in the East Coast states, like New Jersey, New York, Connecticut and Massachusetts.

Amy Tan has a house in New York state, in Dutchess County, which has the highest infection rate in the United States -- 70 percent. She also saw ticks on her dogs when she was at her house in Mendocino, which has the 41 percent infection rate. She could have contracted the disease at either or both places. She developed all these neurological problems, but doctors didn't know what she had until she came to me.

How long has Lyme disease been infecting people?

Something that sounds just like Lyme disease was described by European doctors in the mid-19th century, so it's probably safe to say it has existed in Europe since 1850. It didn't get to the United States until the 1950s, and how it got here remains a mystery. Lyme disease was not recognized as an infectious disease until the 1970s.

There are also a few conspiracy theories about Lyme disease. We know that the bacterium was developed as a biowarfare weapon by the Soviet Union, and one theory claims that it was also developed in the United States and that it got loose here.

"We follow clinical guidelines for diagnosing and treating Lyme Disease that were published jointly by The Infectious Diseases Society of America and American Rheumatologic Association. Our world-class clinical laboratories diagnose complex diseases Ğ- including Lyme disease. If there is any question, we send specimens to the laboratory run by Allen Stere, MD of Massachusetts General Hospital," he said.