Lyme disease advancing in Maine

By Meg Haskell, BDN Staff
Posted May 02, 2010, at 7:39 p.m.

Cases of Lyme disease are on the rise in Maine, spurred by climate change, development and the spread of tiny deer ticks throughout the state, according to public health officials. They expect to see more cases this spring, thanks to the mild winter, and say Mainers must become more diligent about avoiding tick bites.

Some people experience Lyme disease as a chronic condition, but this theory has not found broad support in the medical mainstream. Most physicians say that recognizing the early symptoms of Lyme disease and treating it promptly can make the difference between an uncomplicated recovery and longer-term sickness and disability.

Once confined to Maine’s southernmost counties, Lyme disease in humans now has been reported in every county in the state. The number of cases reported each year has risen from about 100 in 1990 to more than 900 in 2009. Deer ticks in the nymph stage emerge in the early spring and are responsible for most cases of Lyme disease in humans.

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“If you have a rash or flulike symptoms when it’s not flu season, you should call your doctor,” said Dr. Dora Anne Mills, director of the Maine Center for Disease Control and Prevention. “In the vast majority of cases that are detected early, people are treated with a course of antibiotics and recover fully.”

But when Lyme disease goes untreated, she said, or when treatment is delayed, it can be linked with lingering and sometimes disabling problems that include arthritis, nerve damage and heart conditions.

Lyme disease has been recognized since 1975, when the first cases were identified in the town of Lyme, Conn. In 1978, the source of the illness was traced to the bite of an infected deer tick, and in 1982, the tick-borne bacterium Borrelia burgdorferi was identified as causing the broad range of symptoms associated with the disease.

Sick and tired

As is typical in most cases, Amy Cray’s symptoms were vague at first. During a weekend trip in the spring of 2007, she felt tired. She developed some aches and pains. By Monday morning, the then-34-year-old Hampden resident, wife and a mother of two, was too sick and tired to go in to her job as a paralegal with a Bangor law firm. She stayed home and rested for a few days, but did not really recover.

A few weeks later, still feeling like she had the flu, Cray developed numbness in her face, a feeling of pressure inside her head, and an inability to think clearly. She found herself increasingly emotional, with episodes of depression that became more frequent.

“It starts out so small, and in stages,” Cray said in a recent interview at her home. “You just think it’s something else. But when my hair started falling out, I knew it was something real.”

Preliminary blood work ruled out Lyme disease and failed to identify any specific cause of her sickness, she said. But after several months, a friend referred her to a different physician. Comprehensive lab work through his office determined that the bacterium that causes Lyme disease was at work in her body.

Cray never found a deer tick on her body and never identified the trademark “bull’s-eye rash” often found in the early stages of Lyme disease. But she believes she probably picked up a tick on her daily walk with her yellow Lab, Kelley, through local woods and overgrown farm fields, and that the tiny insect made its way to her head before embedding in her scalp. Had the rash developed, it would have been obscured by her hair.

More ticks, more places

“There is good evidence that ticks are spreading in Maine,” said Chuck Lubelczyk, a scientist with the Vector-Borne Disease Laboratory at Maine Medical Center Research Institute in Scarborough. Since 1988, the lab has been collecting ticks removed from people, livestock and pets throughout the state, identifying the species of those ticks — there are 14 species in Maine — and determining if those identified as deer ticks are carrying the Borrelia burgdorferi bacterium.

Deer ticks, which 10 years ago were found almost exclusively in Cumberland and York counties, are now very common throughout the southern half of the state, Lubelczyk said, and are increasingly found as far north as Aroostook County. A growing number of those deer ticks, he said, are carrying the Lyme disease bacterium.

In addition to analyzing mailed-in ticks, Lubelczyk said, the laboratory has been working with veterinarians across the state to see if the dogs they care for have been exposed to the Lyme-causing bacteria. That can be determined at the same time and using the same test that most vets use to check dogs for heartworm.

“Quite a few dogs with no travel history are testing positive for Lyme [exposure] as far north as Aroostook,” Lubelczyk said. A Lyme disease vaccine is available for dogs but not for humans.

Perhaps more alarming is the personal experience of State Veterinarian Don Hoenig, who lives in Belfast.

“When I first moved to Maine 30 years ago, we didn’t have any ticks,” Hoenig said Thursday. But about 10 years ago, he started finding ticks on his own pets, on the animals he treats and examines professionally, and on his own body.

“In the last three to five years in midcoast Maine, the deer tick population has exploded,” he said.

In 2009, Hoenig found a deer tick on himself on Thanksgiving Day. On Dec. 1, he pulled one off his 11-year-old golden retriever, Mollie.

Adult ticks are most common in the fall, but hungry nymphs emerge in the early spring. As the climate warms, Hoenig said, Maine’s tick season is arriving earlier and lasting longer. In addition, expanding residential and commercial development in some areas has increased interaction between deer and human populations, he said.

Prevention is best medicine

For people such as Amy Cray, recovering from Lyme can be a long haul. She has returned to work and is able to participate more fully in the busy lives of her husband and children, but she is easily fatigued and feels her thought process is still foggy. She takes a lot of medication on a daily basis, including an antidepressant and several antibiotics.

Cray is among a number of people who experience Lyme disease as a chronic, even lifelong, condition, a controversial theory that has not found strong support among mainstream physicians.

The authors of an October 2007 article in the New England Journal of Medicine found that “Chronic Lyme Disease is the latest in a series of syndromes that have been postulated to attribute medically unexplained symptoms to particular infections.”

“There are a few physicians who believe very strongly in this diagnosis of chronic Lyme disease,” said Dr. David McDermott, president of the Maine Medical Association. “But there are many others who doubt it exists, including the vast majority of physicians who specialize in infectious diseases.”

McDermott said individuals should be wary of “pseudo-science” Lyme disease studies and practitioners who espouse protracted doses of oral or intravenous antibiotics and other drugs.

Mills at the Maine CDC said Mainers should focus on avoiding tick bites in the first place. There are concrete steps people can take, she said, including:

• Minimizing tick habitat by clearing outdoor areas of brush piles and leaf piles.

• Wearing long-sleeved shirts, long pants and an insect repellent that contains the chemical DEET when venturing into wooded areas or overgrown fields. Tuck pant legs into socks or boot tops.

• Checking adults, children and pets carefully for ticks after outdoor activities. Ticks often crawl to warm, moist areas of the body such as the groin, armpits, neck and scalp.

If an embedded tick is spotted, it should be removed by grasping it close to the skin with tweezers or fingernails and pulling steadily. Deer tick nymphs are tiny before they feed — only about the size of the period at the end of this sentence.

Cray said she tries to spread the word about Lyme disease. Most people know it exists and is transmitted by ticks, she said, “but no one has a clue it can make you so sick. … I want people to know it is real, that if you start to have symptoms you shouldn’t blow it off.”

But some habits linger.

“I still walk in the woods with my dog, and I still pick the ticks off us both,” she said. “You can’t let something like this stop your life.”

On the Web: www.mmcri.org/lyme;

www.maine.gov/dhhs/boh/ddc/epi/vector-borne/lyme;

www.mayoclinic.com/health/lyme-disease/DS00116.

Avoiding ticks in Maine

Dr. Dora Anne Mills, director of the Maine Center for Disease Control and Prevention, says there are concrete steps Mainers should take to prevent tick bites. These include:

• Minimizing tick habitat by clearing outdoor areas of brush piles and leaf piles.

• Wearing long-sleeved shirts, long pants and an insect repellent that contains the chemical DEET when venturing into wooded areas or overgrown fields. Tuck pant legs into socks or boot tops.

• Checking adults, children and pets carefully for ticks after outdoor activities. Ticks often crawl to warm, moist areas of the body such as the groin area, armpits, neck and scalp.

If an embedded tick is spotted, it should be removed by grasping it close to the skin with tweezers or fingernails and pulling steadily. Deer tick nymphs are tiny before they feed — only about the size of the period at the end of this sentence.

http://bangordailynews.com/2010/05/02/news/bangor/lyme-disease-advancing-in-maine/ printed on September 20, 2014