Lyme Disease Is A Ticking Epidemic

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Lyme Disease Is A Ticking Epidemic

 

by Hank Pellissier, special to SF Gate

 

Monday, November 17, 2003

 

 

Dr. Rafael B. Stricker is a hematologist and immunotherapist who has

achieved acclaim for his diligent work with sufferers of Lyme disease,

the tick-borne malady that is often misdiagnosed and underestimated,

especially in Northern California. Stricker attends to about 600 Lyme

disease patients at his 450 Sutter St. practice, including luminaries

like best-selling author Amy Tan, and he's a member of the California

Lyme Disease Advisory Committee and the International Lyme and

Associated Diseases Society. I interviewed the busy physician last

week via cell phone.

Please tell us how people get infected with Lyme disease.

 

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 -Ð 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.