By Dr. Mark R. Windt
Summer is nearly here and with it comes lots of outdoor activities. Being outdoors is great fun for the entire family and there is no reason not to enjoy hiking, picnicking, camping or other activities. The great outdoors can bring some health risks, but being prepared can help ensure a safe summer for everyone.
Ticks and Lyme disease
A brief history:Lyme disease is in the news a lot today, but it was first diagnosed in 1976. Research into the disease started in the fall of 1975 when two mothers, desperate for medical help, reached out to the Connecticut State Department of Health and the Yale School of Medicine. Previous doctor visits had yielded no diagnosis of the mysterious symptoms plaguing them and their families.
The ensuing studies were carried out by Dr. Allan C. Steere and Dr. Stephen E. Malawista from Yale, and Dr. David Snydman and Dr. Francis Steele from the Department of Health. They examined and interviewed families in Lyme, Connecticut, and surrounding towns. Fifty-one cases of what appeared to be juvenile and rheumatoid arthritis had been documented out of a total population of 12,000.
The initial medical tests revealed no new information, but the interviews did. Roughly 25 percent of the patients reported a bulls-eye lesion four to six weeks before the arthritis symptoms appeared. Most of the patients lived in rural or wooded areas, and most symptoms had onset during the months of June through September. Rheumatoid arthritis would not cluster this way. The bulls-eye lesion piqued the doctors interest because it matched the description of a lesion that had appeared in Europe and was the result of an infectious agent.
First documented in 1909 by a Swedish researcher, the lesion was sometimes associated with a tick bite and could lead to meningitis, paralysis and nerve pain. Treatment with penicillin sometimes helped. However, arthritis was not a symptom of that illness. Still, the doctors wondered if a tick could be to blame here in Connecticut.
Further research showed that the disease was most concentrated where the number of deer and deer ticks were highest, which happened to be the town of Lyme. Within a few years, Drs. Steere and Malawista had determined that Lyme disease was transmitted by deer ticks, and that it could lead to complications of the nervous system, heart and joints. In 1984, the Yale School of Medicine held the first international conference on Lyme disease, and in 1985, Drs. Steere and Malawista received the prestigious Ciba-Geigy International League Against Rheumatism Prize for their efforts in the discovery of and education about Lyme disease.
How Lyme disease is transmitted
First, it is important to note that not all ticks cause Lyme disease, so a tick bite does not mean you are infected. However, a conversation with your health care provider is important if you are bitten because determining a Lyme disease diagnosis and appropriate treatment can be complex. In addition, if you are bitten by an infected tick, the sooner you get treatment, the greater your chances of complete recovery.
As previously noted, the bacteria that causes Lyme is found only in deer ticks, which are present all over New England and also in the Midwest. New Hampshire and Maine are especially fertile ground for ticks because of our abundant deer populations, largely rural character, and the frequent presence of stone walls, which provide excellent homes for chipmunks and other rodents, which can also carry the tick.
Deer ticks are quite small and are rust and black in color; the immature ticks, called nymphs, are only about the size of a sesame seed. Because they are so small, you may not see these ticks at all. Other ticks can carry other diseases, but not Lyme disease.
Symptoms and diagnosis
There are different stages of Lyme disease, and the more worrisome symptoms occur when the bacteria has been present in the body for a longer period of time. Erythema Migrans is the bulls-eye-like rash that occurs days to weeks after Lyme transmission from a tick bite. The rash can occur with joint pain, fever or malaise and is part of Stage 1, but all of these symptoms are not always present. Similarly, it is possible to have Lyme disease without the bulls-eye rash. Stage 2 can have all the symptoms of Stage 1, but can also affect the nerves. A Bell's palsy can also be a symptom of Lyme disease. The final stage, Stage 3, can affect the brain and heart.
Diagnosis for Stage 1 can sometimes be done without lab work. If lab work is done, there is a two-step lab process, which is the only one approved by the Centers for Disease Control. The first blood test looks for antibodies. If these antibodies are present, a more detailed protein analysis is performed to confirm the diagnosis. Please keep in mind, your body tries to make long-term antibodies in order to fight any infection, and Lyme disease is no exception. Even short-term antibodies can stay in the blood for five years after an infection. This is why the antibody test alone is not enough to verify the presence of active Lyme disease. You may also want to bring the tick to your provider's office to confirm it is a deer tick.
Interestingly, Lyme disease is in the same bacterial family as syphilis, which was once known as the great masquerader because its multiple symptoms made it hard to diagnose. It seems that some of these same characteristics are true of Lyme, which can be equally hard to diagnose.
The most cases of Lyme disease are diagnosed in June and July.
Prevention of Lyme disease
Preventing tick bites is very important. Lyme disease now affects more than 30,000 people each year. Maine ranks third in number of cases of the disease and New Hampshire ranks seventh, according to the CDC. The best protection against Lyme Disease is preventing tick bites in the first place. Using a bug spray with DEET of a 20 percent to 30 percent concentration is recommended. There are also sprays that are safe for children. Be sure to wash off all sprays once you are indoors.
Check yourself for ticks whenever you are done with outdoor activities. Taking a shower after doing yardwork, hiking or being active outside is a good idea, as is running your outdoor clothes through the dryer with it set on high heat; this will kill any ticks. When walking or working in the woods or in areas of long grass or leaves, wear pants tucked into boots, long sleeves, and a hat. Light colored clothing makes it easier to see ticks. Some people also put Premethrin on their clothing.
Avoid having piles of leaves and long grass in your yard. These are great homes for ticks. Move recreation areas, such as picnic tables or childrens swingsets, away from wooded areas, brush piles and stonewalls. Its also wise to keep your lawn mowed. The CDC website is a great source of information for how to minimize ticks in your yard (www.cdc.gov).
Ticks are most active May through August, so it is important to follow tick prevention methods during this time.
If you are bitten
If you need to remove a tick, make sure to grab the tick by the head, not the body. If you grab the body, it could inject its contents into you. Use tweezers to remove the tick and be careful to pull it straight out, then disinfect the area. An old-fashioned method that works well for tick removal is to douse the tick with peppermint oil; this will cause the tick to release intact.
While not as potentially harmful as a tick, an encounter with poison-ivy can make you pretty miserable! Poison-ivy is not a true ivy, hence the hyphen in its name. It can appear as a climbing vine, freestanding shrub or single plant. All parts of the plant are poisonous and contain a heavy oil called urushiol, which can cause itching, redness and blisters within a few hours of contact. Never touch the leaves, stems, berries or flowers of this plant. (Eating the berries would be fatal. Old wives tales used to say that you would not get poison-ivy if you ate it, which is not only not true, but a potentially deadly myth.)
If you do touch poison-ivy, wash thoroughly with a thick lather of old-fashioned yellow laundry soap and you may remove enough of the oil to prevent symptoms from occurring. Water alone will not do the job and may simply spread the oil. Treatment for poison-ivy rash is usually topical lotions such as Calamine, but if the rash is on the face, eyes, genitals, or is widespread, then a physician should be seen. (Anyone can get poison-ivy those who say they dont get it have either never crushed the plant enough to release the oil, or were not in contact with poison-ivy.) If you want to have a bonfire, check your firewood for the poison-ivy vine, as even the smoke from burning it can give you a rash and lung complications. Climate change has made the potency of poison-ivys urushiol stronger, and be aware that you can get poison-ivy year-round even from the woody stems poking up through the snow.
Learn what poison-ivy looks like and where it is found and you can avoid an itchy summer. First, poison-ivy is a very resourceful plant and likes to grow where something has disturbed the soil, thus making it easier to take root. Its found in vacant lots and sand pits, along roadsides and trail edges, near beaches where waves disturb the sand, in orchards, and along stone walls. It likes full sun, so once trees start to fill in, poison-ivy begins to die back. Folklore says that it only grows where man has disturbed the ground, but it will grow in wild areas as well.
Poison-ivy has three leaves, which may be shiny or dull, smooth-edged or wavy, stiff or thin, have hairy undersides or not. In short, the leaves vary greatly. The best identifier, other than where its growing, is the bud which is naked and hairy, looking like a small golden mitten. The flowers, which are yellow and white appear May to July; poison-ivy berries, which appear in fall, are white. Poison-ivy leaves turn yellow in fall, although dying leaves can be reddish.
Surprisingly, animals are not affected by the plant. Deer and goats browse the leaves, rabbits eat the bark, bees flock to the flowers, and more than 60 species of birds benefit from the berries, which have a high-fat content and help provide fuel for migration.
First, if you are allergic to bee stings, make sure you always have your Epi-pen with you, as it could save your life. For those of us not allergic, bee stings are still painful. To lessen the reaction, and the pain, I suggest carrying some Afrin nasal spray with you when hiking. Squeeze some Afrin onto the sting site and it will cause the blood vessels around the sting to constrict. This prevents the spread of venom and lessens the reaction. Later, apply some cold water or, if on the trail, some cold mud, to continue to reduce swelling. Various first aid cremes and sprays, which are tailored to bee, wasp or hornet stings can also help.
There are steps you can take to help avoid bee, hornet and wasp stings.
1. Avoid wearing perfumes, lotions, hairsprays or other scents, which attract bees.
2. Avoid wearing floral patterns and bright colors, which make you look like a flower patch.
3. Be careful with food. Sugary drinks such as colas, lemonade and juices attract bees. If outside, always check the inside of your soda can before drinking outdoors. Wasps are carnivores and drawn to meats and salads. Keep food covered as much as possible and clean up quickly after an outdoor party. Be sure to rinse any food items and soda cans thoroughly before throwing them in the trash.
4. Do not burn scented candles or incense at an outdoor party.
5. Do not swat at bees. If bees are buzzing around, be still. Swatting just makes them angry.
6. Avoid wearing flip flops or going barefoot as yellow jackets and certain other wasp and hornet species are ground nesters.
7. Look for bees nests around your home in unexpected places. Under eaves and shingles are fairly common, but yellow jackets may also nest in abandoned holes, such as where a water spigot used to be. Wasps can also nest in clothesline poles, behind light fixtures and near rock walls. Bees and wasps can also gain access to attics and nest there, which may call for a professional exterminator.
8. Do not crush yellow jackets and certain other wasps as killing one releases a pheromone that will attract the rest of the swarm.
9. Bees, hornets and wasps are most aggressive in the fall, when they are hungry and desperate for food, so you are more likely to get stung then.
If you vacation in the Southwest or South, be aware of fire ants, which have a painful sting. There is no personal repellent that works against fire ants, so wearing socks is a must. Be sure you know what a fire ant mound looks like and stay away, as ants are easily angered.
With a few precautions, you can enjoy a safe and active summer outdoors.
Dr. Mark R. Windt is an allergist, immunologist and pulmonologist who has been treating allergies, including food allergies, and respiratory illnesses, for more than 30 years. He is the medical director for the Center for Asthma, Allergy and Respiratory Disease in North Hampton, a facility he started in 1985. Dr. Windt is also an adjunct professor at the University of New Hampshire's School of Nutrition and founder of the Probiotic Cheese Company (www.theprobioticcheesecompany.com). For information, visit http://www.caard.com or call 964-3392.
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