Off North Road
Tick survival - yours, not theirs
By this time in spring, most Vineyarders have encountered one or more ticks. Not to say you do not find them at other times, because they are ever-present, but in fewer numbers from November to March. They appear on any part of your body, either crawling about looking for something or bitten-in to varying degrees. You find them after walking in wooded or scrubby areas, near sand dunes and high beach grass, marshy grassy areas, even over trimly cut lawns. If you have a pet, ticks may sneak in for an indoor safari and if, by any stretch of the imagination, Ticker or Tabby sleep on your bed, either on the covers or, for Heaven's sake, beneath the sheets, you are more than likely to awake with one in your head or crawling up your arm hoping to drop anchor in the first luscious spot found.
All ticks should be disposed of in a closed jar or container of concentrated soap solution, probably the safest. Avoid flammable liquids or poisons for children's safety. If a tick is attached, grasp the back of the tick with tweezers or covered fingers and pull directly upward without twisting. Do not pop with a lighted match, which will explode tick contents into the air. Tearing the tick releases body fluids that may be infective. Wash hands thoroughly when finished.
Dr. Michelle Jasny wrote an enjoyable account of the life cycles of our favorite Ixodes, the deer tick, in the Times of April 13. It makes good reading and describes a complicated sex life discretely and well. Off North Road's subject this issue will describe some highlights and personal experience with more of the Vineyard's tick-borne diseases continued from the Times, April 6.
Was it Lyme?
Sometime in the 1960s I treated an elderly man from up-Island with a mysterious illness: prolonged low-grade fever, weakness, and fatigue without localizing symptoms except for a strange round but faint skin rash which came and went all through July and August. I never could prevail upon him to go to the hospital for more testing, although in retrospect I probably would have found nothing else remarkable had he done what I asked. "I'm too old," I remember he said to me," I usually get better with time." And he did. However years later in the '80s he began to have crippling arthritis. Could it have been late Lyme disease? We will never know.
Lyme disease, now the most publicly discussed illness on Martha's Vineyard and certainly the most controversial, continues to be the bane of existence here on-Island. In the '60s, I would see 35 cases of Lyme in a summer. One year the whole state of Massachusetts reported only 35 cases, more a measure of poor reporting than actual incidence. Nevertheless, Lyme (as many people say) is a big problem.
Initiated by the bite of a deer tick that has previously fed on an infected mouse, vole, or white-tailed deer, the victim first feels logy, headachy and strangely disconnected, perhaps with low-grade fever, aches, and pains especially around the head and neck. Within days he may or may not note a rash, which contrary to popular folk-lore, is not always a bright bull's-eye in pattern but may take on almost any iteration, from a simple round expanding area of pink, red or purple to the random variegated shape and hue of the mark of a hand slap. Late in the course a bluish dull color may spread uniformly over the entire trunk. In time, areas of redness similar to the original rash may occur at a distance from the tick bite (chronic erythema migrans), disappear and then reappear in another location. It eventually disappears for good in weeks or months.
That may be the end of illness or the beginning of more. The course varies enormously and may be mild or totally debilitating; even a rare death has been documented. Most commonly after a week or more, large joints may be involved with arthritis (swelling and pain). A month or two later, the heart may be infected and bring about heart block (slowing of the pulse) which often reverts to normal after an interval; or more serious conditions prevail. The central nervous system may be invaded, leaving little or no trace for the laboratory or x-ray. The symptoms of "chronic" Lyme disease have been described in almost any way imaginable. Patients often live with a sense of hopelessness and anger. Laboratory testing is often so confusing as to be misleading or worthless. Perhaps the hardest experience to live through in the long view is a newly discovered disease before all its machinations are worked out.
During and after the '70s, when Lyme became recognized as a unique medical disease, I was amazed that I began to treat patients appearing regularly with signs of this "new" illness. Where had they been the previous 20 years? The answer may never be known. I remember only the up-Island man with the summer-long circular rashes from that early period. The rash, in my thinking, remains the most reliable marker for a definitive diagnosis of acute Lyme. It is unique. When it is never seen in the patient, confusion begins. Doctors who practiced outside of a particular endemic region like the Vineyard or seashore Connecticut were slow to accept the diagnostic worth of that often faint rash. Doctors who had never recognized Lyme disease before would tell a patient, "No, that rash is certainly not Lyme!" The longer a condition is suspected but not proved as Lyme disease, the more confusing the problem becomes.
Unfortunately, unanswered questions about Lyme disease persist and the question of the cause of long-standing arthritis, numerous syndromes of myalgias, nerve damage, mental depression and memory loss, chronic pain syndromes and much else have been attributed to "chronic Lyme." Long-suffering patients with life-distorting effects feel abandoned in many instances by us in the medical profession, as much for appearing not to honor patients' symptomatology as for denying that Lyme disease may be the cause. Proof to the satisfaction of our profession has been so far inadequate for many areas in this national debate. As a young man I was guilty once in a while, perhaps even now, for thinking something did not exist if I did not know it of my own experience. How many patients I turned away with this mindset I do not know; I hope only a few. With time we will probably chart the entire devious route the Lyme disease organism has taken. When that is finally done, management and treatment of Lyme disease will become more rational and satisfying to patient and doctor alike.
A future article will be devoted to more on tick diseases found on the Vineyard as the season for higher incidence opens up.
This is Part II of a three-part series. Look for Part III in the May 18 edition of the Times. For Part I click here.