Lyme Disease

Jul 16, 2015

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
I just spilled leech water all over the fridge! That is sooooo gross! Dad you are never, ever, ever, ever allowed to put leeches in the fridge ever again! Despite Emily's horror, those leeches I bought from Sticky's worked well when Pat, Murray and I fished in front of Pat's lot in the Bayduza development. We ate Murray's famous peanut butter and onion sandwichs, drank cold beverages and caught some pickerel. I won't say I love leeches now, but I'll handle them enough to jam a hook through one. I was terrified of leeches as a kid. I hated getting them stuck to me when I went swimming. I also hated getting wood ticks. Honestly, I'm not sure which terrified me more, ticks or leeches. However, I find it interesting that the terror they inspired in me as a kid has faded over time.

Today, if you mention ticks, someone says Lyme disease. Lyme disease has been a popular topic in the pharmacy lately. One of our staff had a tick bite recently, which caused some excitement. Would the tick bite give her Lyme disease? Lyme disease is a bacterial infection caused by the bacterium Borrelia burgdorferi. The bacterial infection is spread to humans through the bite of a tick. It is believed that a few different species of ticks can spread Lyme disease, but the most likely culprit is the blacklegged or deer tick. The blacklegged tick bites a mouse or deer and picks up the Lyme disease bacteria. Then the blacklegged ticks can bite a human, spread the bacteria and give the human Lyme disease.

What are the symptoms of Lyme disease? Up to 80% of people will develop a rash three to 30 days after a bite from an infected tick. This rash, known as Erythema migrans (EM), is a red expanding skin rash usually more than five cm in diameter. It is not tender or itchy and usually occurs at the site of the tick bite. Often the centre clears and it looks like a bulls eye. Other symptoms of Lyme disease are tiredness, fever, headache, stiffness, muscle aches, and joint pain. People who do not get treated for Lyme disease may go on to have symptoms such as joint pain and swelling weeks to months later. Lyme disease can also affect the heart or nervous system.

Although Lyme disease may have been around for a long time, it has only been described scientifically fairly recently. In the early 20th century, erythema migrans and Bannwarths syndrome, which are now known to be the skin and nerve problems of Lyme disease, were written about in Europe. Lyme disease was first written about in North America in 1977 and it was called "Lyme arthritis". Apparently it was named after Lyme, Connecticut, the town where the first cases were noticed. It wasnt until 1982 when the bacteria that causes Lyme disease was discovered. In the early 1980s Lyme disease cases started to be reported in Point Pelee, ON which is the farthest south you can go in Canada. Now Lyme disease has been reported from Nova Scotia through Saskatchewan.

It is important to remember that not all ticks in Manitoba carry Lyme disease. Most ticks you run into will be wood ticks which are otherwise known as dog ticks. The blacklegged tick which can spread Lyme disease is quite a bit smaller that the wood tick that most of us are familiar with. Before feeding, adult females are approximately 3-5 mm in length and red and dark brown in colour. Ticks feed on blood by attaching to animals or people with their mouth parts. Females are a little larger than males. Blacklegged ticks really arent that common in Manitoba yet. They seem to be slowly spreading in from the South East corner of the province. We believe they are spread by migrating birds. The Manitoba Government has a Blacklegged Tick Surveillance Program. Blacklegged ticks have been submitted from many locations in southern Manitoba and occasionally from more northern areas. Tick submissions range from about 150 to 300 blacklegged ticks per year. Adult blacklegged ticks are most active in the spring and fall. They remain active until the first permanent snowfall or when air temperatures are consistently below 4C. Not all blacklegged ticks have the Lyme disease bacteria on them. So, just because a blacklegged tick bites you, doesnt mean you will get Lyme disease. Finally tests on lab animals have shown that an infected blacklegged tick must be attached to a lab animal for 24 to 36 hours to pass on the Lyme disease bacteria. We assume that a blacklegged tick must be attached to a human for 24 to 36 hours to pass on Lyme disease as well.

So how do you avoid getting Lyme disease? First avoid getting bitten by ticks. If you go for a walk in the bush wear long pants and long-sleeved shirts so most of your skin is covered. Tuck your shirt into your pants and your pants into your socks, and use bug spray with DEET in it that says for use against ticks on the product label. Once you come inside, take a shower within two hours. Put your clothes in a hot dryer for one hour to kill any ticks you may have picked up. Check your skin for ticks each day. Remember, Lyme disease isnt likely to develop if a tick is removed within 24 hours, and possibly up to 36 hours, after it attaches. If a tick is attached to you, remove it carefully with sharp, pointy tweezers. Grab the tick by the head a slowly and firmly pull straight out. Grasp the tick firmly and as close to the skin as you can. Slowly pull the tick away from the skin without twisting. Clean the area with an antiseptic. Do not use petroleum jelly, a hot match, or nail polish to remove a tick. CanLyme has some nice tick removal videos on their site. Clean the skin around the tick bite with soap and water. Mark the date and location on the body of the tick bite on the calendar for future reference. If a tick is attached to you for more than 24 hours or you get the bulls eye rash, see your doctor. Lyme disease is treated by common antibiotics like doxycycline.

Leeches and ticks may only inspire annoyance and mild disgust in me instead of terror now, but I've found I've developed new phobias over time. I really don't like enclosed spaces. From igloos in the yard to the crawl space under our newly lifted cottage, I don't want to be in them. Recently, I did force myself to crawl under the cottage to look at the new sump pit the nice people at Steiner's set up for us. However, I didn't have the nerve to go look for the second hole the plumber found. My claustrophobia doesn't appear to be contagious, as Eric and our dog Sheldon have no problems with small spaces. Eric is harassing me as we speak to take his dog and flashlite to explore the second hole. I hope he doesn't get stuck. I'll miss him, but someone else will have to go in and get him.

I am Trevor Shewfelt from the Dauphin Clinic Pharmacy. The Pharmacy Feature is heard here every Tuesday on 730 CKDM

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

Manitoba Health Lyme disease info: www.gov.mb.ca/health/lyme/

Where black legged ticks are in Manitoba: www.gov.mb.ca/health/lyme/surveillance.html

How to identify black legged ticks: www.gov.mb.ca/health/lyme/blacklegged.html

Canadian Lyme Disease Foundation: www.canlyme.com/

CDC tick borne diseases: www.cdc.gov/lyme/resources/TickborneDiseases.pdf

Tick identification: www.tickencounter.org/tick_identification/deer_tick

The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis,and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America (including how long has tick been attached by size of tick estimator) : http://cid.oxfordjournals.org/content/43/9/1089.full.pdf+html

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