Health Care and Lyme Disease

Summertime is when many Americans go camping. It is a great time to be outdoors--enjoying wildlife, crisp, clean air, and the majestic scenery usually found in many campgrounds--especially in various state and national parks. However, it can also be a time when your guard should be up concerning Lyme Disease. Lyme disease is sometimes misdiagnosed, usually because people misidentify Lyme disease symptoms and because it can sometimes be difficult to confirm that a child has Lyme disease, according to About.com and pediatrician Dr. Vince Ianelli. Children can get Lyme disease after they get bitten by a tick, usually a deer tick, that is infected with the Borrelia burgdorferi bacteria, especially if the tick isn't removed before 48 to 72 hours. This makes it important to do daily tick checks if your child has been in an area where he might be bitten by a tick, such as while camping.

According to the Center for Disease Control (CDC), typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system. Lyme disease is diagnosed based on symptoms, physical findings (e.g., rash), and the possibility of exposure to infected ticks; laboratory testing is helpful in the later stages of disease. Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics. Steps to prevent Lyme disease include using insect repellent, removing ticks promptly, landscaping, and integrated pest management. The ticks that transmit Lyme disease can occasionally transmit other tick-borne diseases as well.

Within 1 to 2 weeks of being infected, according to the CDC, people may have a "bull's-eye" rash with fever, headache, and muscle or joint pain. Some people have Lyme disease and do not have any early symptoms. Other people have a fever and other "flu-like" symptoms without a rash. After several days or weeks, the bacteria may spread throughout the body of an infected person. These people can get symptoms such as rashes in other parts of the body, pain that seems to move from joint to joint, and signs of inflammation of the heart or nerves. If the disease is not treated, a few patients can get additional symptoms, such as swelling and pain in major joints or mental changes, months after getting infected.

According to About.com, this circular rash occurs at the site of the tick bite, about 7 to 14 days after the tick bite, although it may begin as early as 3 days or as late as 32 days after the tick bite. This erythema migrans rash is usually described as:
--Looking like a target or bull's eye, with a central red spot, an area of clear skin, and a red border.
--Being itchy, warm, and sometimes painful.
--Gradually expanding to a size of 7 to 14 inches.
--Lingering for about 2 weeks.

In addition to the rash, according to About.com, other Lyme disease symptoms that some children have resemble flu-like symptoms and can include fever, myalgia (muscle aches), chills, headache, fatigue, and joint pain (arthralgia). More serious symptoms can occur in those children who aren't treated and develop early-disseminated Lyme disease. These symptoms can include having multiple erythema migrans lesions, fever, myalgia (muscle aches), headaches, fatigue, pink eye (conjunctivitis), swollen lymph glands (lymphadenopathy), aseptic meningitis, facial nerve palsy (Bell's palsy), and more rarely, carditis (inflammation of the heart) with heart block. Symptoms of late Lyme disease, which may begin several months after the initial tick bite, include arthritis, that most often affects large joints, like a child's knees. These joints may stay swollen and tender for 1 to 2 weeks at a time. Some children rarely develop chronic neurological symptoms, including numbness and tingling in their hands and feet, shooting pains (radiculoneuritis), and concentration problems. Fortunately, the late symptoms of Lyme disease can usually be prevented with early treatment with antibiotics. Keep in mind that not all children have all of the classic Lyme disease symptoms, which makes it important to see your pediatrician if your child develops a rash or fever following a tick bite, especially if you live in an area where there are a lot of Lyme disease cases.

You're more likely to get Lyme disease if you live or spend time in the grassy and heavily wooded areas where ticks carrying the disease breed, according to the Mayo Clinic. It's important to take common-sense precautions in areas where Lyme disease is prevalent. If treated with appropriate antibiotics in the early stages of the disease, you'll most likely recover completely. However, some people have recurring or lingering symptoms long after the infection has cleared. Left untreated, Lyme disease can cause:
--Chronic joint inflammation (Lyme arthritis), particularly of the knee.
--Neurological symptoms, such as facial palsy and neuropathy.
--Cognitive defects, such as impaired memory.
--Heart rhythm irregularities.
--Memory loss.
--Difficulty concentrating.
--Changes in mood or sleep habits.

You may ask. "How can I protect myself from Lyme disease?" Here are tips from the CDC:
--Whenever possible, you should avoid entering areas that are likely to be infested with ticks, particularly in spring and summer when nymphal ticks feed.
--If you are in an area with ticks, you should wear light-colored clothing so that ticks can be spotted more easily and removed before becoming attached.
--If you are in an area with ticks, wear long-sleeved shirts, and tuck your pants into socks. You may also want to wear high rubber boots (since ticks are usually located close to the ground).
--Application of insect repellents containing DEET (n,n-diethyl-m-toluamide) to clothes and exposed skin, and permethrin (which kills ticks on contact) to clothes, should also help reduce the risk of tick attachment. DEET can be used safely on children and adults but should be applied according to Environmental Protection Agency guidelines to reduce the possibility of toxicity.
--Since transmission of B. burgdorferi from an infected tick is unlikely to occur before 36 hours of tick attachment, check for ticks daily and remove them promptly. Embedded ticks should be removed by using fine-tipped tweezers. Cleanse the area with an antiseptic.
--You can reduce the number of ticks around your home by removing leaf litter, and brush- and wood-piles around your house and at the edge of your yard. By clearing trees and brush in your yard, you can reduce the likelihood that deer, rodents, and ticks will live there.

About.com makes these facts about Lyme disease available:
--Even in hyperendemic areas, places where there are a lot of Lyme disease cases, the the risk of developing Lyme disease is usually estimated to only be about 1% to 3%. It is so low because not all deer ticks are even infected with the bacteria that causes Lyme disease and most people remove ticks before they have been attached for 48 to 72 hour period, which doesn't give the bacteria time to infect them.
--In the United States, most cases of Lyme disease (hyperendemic areas) occur in southern New England, New York, New Jersey, Pennsylvania, Minnesota, Wisconsin, and the northern Pacific coast.
--Lyme disease is usually diagnosed based on the history of a tick bite and finding signs and symptoms that suggest that the child has Lyme disease. Laboratory testing is available, but is not always necessary. Testing ticks for the Lyme disease bacteria is not usually recommended.
--Most cases of Lyme disease occur during the summer.

You can decrease your risk of getting Lyme disease, according to the Mayo Clinic, with some simple precautions:
1.) Wear long pants and sleeves. When walking in wooded or grassy areas, wear shoes, long pants tucked into your socks, a long-sleeved shirt, a hat and gloves. Try to stick to trails and avoid walking through low bushes and long grass. Keep your dog on a leash.
2.) Use insect repellents. Apply an insect repellent with a 10% to 30% concentration of DEET to your skin and clothing. Choose the concentration based on the hours of protection you need — the higher the concentration of DEET, the longer you are protected. A 10% concentration protects you for about two hours. Keep in mind that chemical repellents can be toxic, and use only the amount needed for the time you'll be outdoors. Don't use DEET on the hands of young children or on infants younger than age 2 months. According to the Centers for Disease Control and Prevention, oil of lemon eucalyptus, a more natural product, offers the same protection as DEET when used in similar concentrations. Don't use this product on children younger than 3 years.
3.) Do your best to tick-proof your yard. Clear brush and leaves where ticks live. Keep woodpiles in sunny areas.
4.) Check yourself, your children and your pets for ticks. Be especially vigilant after spending time in wooded or grassy areas. Deer ticks are often no bigger than the head of a pin, so you may not discover them unless you search carefully. It's helpful to shower as soon as you come indoors. Ticks often remain on your skin for hours before attaching themselves. Showering and using a washcloth may be enough to remove any unattached ticks.
5.) Don't assume you're immune. Even if you've had Lyme disease before, you can get it again.
6.) Remove a tick with tweezers. Gently grasp the tick near its head or mouth. Don't squeeze or crush the tick, but pull carefully and steadily. Once you've removed the entire tick, dispose of it and apply antiseptic to the bite area.

Lyme disease can affect your health not only short term, but also with long term detrimental results. Use common sense when camping or visiting areas known to be high in possible deer tick population. Preventive measures can help decrease the risk of getting Lyme disease.

Until next time. Let me know what you think.