Lyme Disease: Separating the Myths From the Medicine

Lyme disease is here again and stirring controversy

From the pesky black flies in the spring to the disease-carrying mosquitoes of summer, New Hampshire certainly has its fair share of bugs. We know it’s bad when a neighbor accompanies his Labrador Retriever on its daily constitutional with a fine-meshed racket in hand. For hitting balls to the dog, we ask? “No, it’s for the bugs. I’ve nailed three of them so far,” he says proudly.

Every creature plays its role, and it’s comforting to know that much of the ecosystem appears to be alive and well in the Granite State — aside from our neighbor’s victims, of course — but it’s tough to appreciate anything about the ticks that carry Lyme disease. Not to be confused with other parasitic ticks, such as brown ticks, which are also called dog ticks and are the freeloaders that often come home with our pets, deer ticks cause Lyme disease by spreading bacteria as they feed on the blood of their meal-time hosts (animals and us). Young deer ticks are very small, about the size of a poppy seed, and many people don’t realize when they’ve been bitten, says Jeffrey T. Reisert, DO, an internal medicine specialist at Littleton Regional Healthcare’s North Country Primary Care.

Awareness of Lyme disease is high, but many uncertainties surround the illness, and medical experts disagree about various aspects of the disease. For sure, Lyme disease can be serious if left untreated, spreading in some instances to the heart, joints, brain — just about anywhere in the body, says Leon Hecht III, ND, a naturopathic doctor at North Coast Family Health in Portsmouth. “It can be devastating,” he says.

But symptoms vary, making diagnosis of some cases a challenge. In some patients, the effects of Lyme disease are minimal. “A friend of mine had one swollen knee” from Lyme disease, Hecht says. “That was it. His energy was fine, his brain was fine.” In other instances, patients are “leveled” by the disease, unable to work and miserable with aches throughout their body. “Everyone is so different,” Hecht says.

That’s at least partly due to the fact that a tick is like “nature’s dirty needle,” Hecht says. Think “tick” and you might think “Lyme disease,” and rightfully so. But ticks can deliver other nasty surprises in addition to Lyme disease. “They have a whole bunch of stuff in them that can make you sick,” and create a tangle of symptoms and infections that extend beyond Lyme disease, Hecht says.

In addition, Lyme disease symptoms can mimic those found in a lot of other ailments. Typical signs of Lyme disease include a bull’s-eye rash, fever, headache and fatigue. But “it can look like dementia, it can look like heart disease, it can look like a flu, it can look like arthritis, it can look like gastrointestinal issues, and on and on,” Hecht says.

The good news? “The majority of tick bites we see are not deer tick bites,” says Reisert. A tick needs to be attached for at least 24 hours in order to transmit Lyme disease. “So just because people have had a tick on them or had a recent tick bite doesn’t mean they’re going to get Lyme disease,” Reisert says.

A rash in a bite area also does not necessarily indicate Lyme disease. “A lot of people bitten by a brown tick or dog tick — the kind that doesn’t [carry] Lyme disease — get a red spot at the bite site,” Reisert says.

But don’t think you’re off the hook if you don’t have the bull’s-eye rash that is a telltale sign of Lyme disease. Not everyone who develops Lyme disease will have a bull’s-eye rash, Hecht says. Instead, many people get no rash or have a solid rash that isn’t necessarily round. “It can be oblong — it really depends on the part of the body, the blood flow to the area, what the skin is like,” he says. “Commonly, I see solid red, two to three inches oblong, and then spreading and fading.”

Similarly, don’t jump to conclusions if you have joint pain, which by itself is not a clear indication of Lyme disease. “I see people with joint pain probably every hour in my office,” says Reisert, including many who are worried that the pain signals Lyme disease. “A lot of people get joint pain, but Lyme disease causes swelling, not just joint pain,” he says. “The majority of people that have Lyme disease typically get a single joint that’s very much inflamed or swollen, and a swollen joint associated with a bull’s-eye type rash is highly suggestive of Lyme disease.” But make no mistake: Even if you do not have any swollen joints, if you have been bitten by a tick, have a rash or have other typical Lyme disease symptoms, you should be seen by a doctor, Reisert says.

Commonly, diagnosis will include a blood test to check for the presence of antibodies. But some physicians find that interpreting test results can be difficult, Reisert says. And testing is an area in which physicians begin to have strongly divergent opinions about Lyme disease.

For example, some experts disagree about the usefulness of the blood test and which type of test to use. Test reliability can vary with the timing of the test — give it too early or too late in the course of the disease, Hecht says, and the antibodies will not be present.

Likewise, the staying power of Lyme disease is a topic of fierce debate. Some experts stand firm in their belief that antibiotics can almost always clear up the disease, while others say that Lyme disease symptoms can linger even after 30 days of treatment. More research is needed to uncover the cause of persistent symptoms.

Regardless, “if people think they have Lyme disease, they should get checked,” and receive treatment as early as possible, Reisert says. If symptoms persist, he says, follow up with your doctor and continue to seek treatment.