Fighting Lyme disease with education
Dr. Ryan Harden
Lyme disease is "an acute inflammatory disease caused by a spirochete (Borrelia burgdorferi), transmitted by ticks, usually characterized initially by a spreading red annular erythematous skin lesion and by fatigue, fever, and chills, and that, if left untreated may later manifest itself in joint pain, arthritis, and cardiac and neurological disorders." Merriam-Webster
Following is an interview with Gateway Family Health Clinic's Ryan Harden, M.D., M.S. regarding Lyme disease and its treatment.
Dr. Harden is a Family Medicine practitioner who also teaches biochemistry and molecular biology to medical students preparing for the United States Medical Licensing Exam.
He has been a guest lecturer at the University of Minnesota School of Medicine, Duluth, and the Montana State University WWAMI program (a cooperative between Washington, Wyoming, Alaska, Montana and Idaho).
While springtime is often termed "Tick Season," Dr. Ryan Harden of Gateway Family Health Clinic states that tick-borne Lyme disease is not confined to spring.
"It can happen all times of the year," said Dr. Harden, "but is more common in the spring, summer and fall, when people are outside in tick habitat."
Geographic location is another indicator.
"When you look at the number of cases of Lyme disease diagnosed in the nation," said Dr. Harden, "Pine County, Carlton County, and north central Wisconsin are a hotbed."
Public awareness is key in fighting Lyme disease.
"If people in the community know what the rash looks like, they know they need to be treated," said Dr. Harden. "The rash is characteristic. It has been called the 'Bulls Eye Rash.' It has a red outer ring with a central clearing.
"That being said, not everyone who gets bit presents with a rash. However, there are some situations where people get the rash but it's on a part of their body where they don't see it.
"Typically, we see tick bites in the groin, armpits, behind the knee, or at the nape of the neck, but that doesn't have to be the case. A tick can bite anywhere."
Though Lyme disease can be detected with a blood test, timing of the test affects its accuracy.
"When somebody has the characteristic rash, oftentimes their blood test will actually be negative because it's too early in the illness to have a positive blood test even if they do have Lyme," said Dr. Harden.
"Generally I will do the blood test if somebody presents in the later stages of the illness, where they have involvement of joints or possibly the heart or central nervous system."
Under some circumstances, treatment may be recommended without a blood test.
"Oftentimes a person will actually give a history of having had a tick attached," said Dr. Harden. "As they develop a rash about that area, it is reasonable, in fact recommended, to treat them without the blood test because the rash is so characteristic."
Another important fact to know is that not every tick bite develops into Lyme disease.
"There are a lot of factors that come into play," said Dr. Harden, "such as how long the tick has been attached, what type of tick it is, and whether the tick has the Lyme spirochete.
"People who spend time in tick infested areas, like the woods or grassy fields, are certainly at risk, so it's important to know how to respond to a tick bite and how to prevent tick bites. Education and awareness are key when it comes to dealing with Lyme disease."
If Lyme disease is present, the doctor recommends treatment with antibiotics.
"The most common treatment for Lyme disease is antibiotic therapy with doxycycline or amoxicillin," said Dr. Harden. "I usually treat Lyme disease with three weeks of antibiotics. That should essentially rid the body of the bacteria."
Do antibiotics kill the good bacteria in one's body?
"No," said Dr. Harden. "Antibiotics interfere with the life cycle of the microorganism so the immune system can clear the body of infection. They work in concert with the immune system."
However, maintaining a healthy balance is key.
"Antibiotics actually can kill bacteria that are a normal part of a healthy individual's body, specifically in the gastrointestinal tract," said Dr. Harden. "This is why judicious use of antibiotics is important."
Can a person become re-infected with Lyme disease?
"It is certainly possible for people to get re-infected," said Dr. Harden. "However, for people who have presented in the later stages of illness, it's less likely for them to become re-infected because of the immune response.
"People who just have the rash, if they are treated promptly, are more susceptible to repeat infection if they are re-exposed to ticks, than somebody who was treated in the later stage of the illness."
As always, prevention is the better alternative than the cure.
"One way to avoid getting Lyme disease is to avoid wooded areas or grassy fields where ticks are found," said Dr. Harden, "but a lot of people don't want to do that, myself included.
"Other preventive measures include wearing long sleeve shirts and long pants, tucking pant legs into socks, or using tick repellants with DEET.
"People who spend a lot of time outside should check their body for ticks," said Dr. Harden. "The longer a tick is embedded in the skin, the higher the chance of developing Lyme. The disease is not transmitted immediately upon being bitten."
The size of ticks can be a challenge.
"Some of them are barely visible," said Dr. Harden. "That is one of the hard parts about tick checks.
"Absolutely there are people out there who get bit by a tick, then the tick releases from their body and they don't even know they've been bitten. However, if somebody does an appropriate tick check, that's rare."
Dr. Harden maintains education is the best form of prevention.
"If a person ever has questions about a reaction they get from a tick bite, they can go to the clinic, get that confirmed, and get treated appropriately," said Dr. Harden.