Off North Road
Our tick gatherer
I returned home one mid-afternoon last week. Mary Ann was sitting in the living room where I could see her as I passed through the kitchen. She sat in an arm chair. Ticker, our springer spaniel, sat at her knees with her head cradled in Mary Ann's lap, a picture of tranquil home life at the onset of the warm season on Martha's Vineyard. Sunshine sent rays of light across the room and my lady sitting there seemed consumed with knitting or sewing or something I couldn't see from my vantage point.
"I've got another," she said. "It makes six this afternoon, not so many as I used to count in past summers." Ticker yipped quietly and backed away for a nano-second and resumed the suppliant posture. MaryAnn continued, "Got another but it won't come, darn things dig in and she doesn't like it." (meaning the dog didn't like it.) I had looked Ticker all over the evening before and hadn't found a thing. Mary Ann is the master tick gatherer in our household. Even the tiniest nymph does not elude her nimble fingers and my job escalates down to retrieving a jar of soap concentrate at the side of the sink. The turbid fluid of this glass gaol is now loaded with ticks, most floating near the bottom; one moves visibly as she tries to reach surface, the one I've just plunked in on my way to the kitchen. When the mess becomes revolting enough, one of us flushes it down the toilet and refreshes the liquid for the newcomers, a deadly business far better than torching them when they may burst and spread their guts of poisonous bacteria or squashing them with finger nails (they resist for a while) or just adding them to the neighborhood's rising population in the months of May, June, and July by tossing them out a window. Leave them around the house and pets inevitably land them in our bed where they will have hours to find you.
We remember earlier times when Mary Ann clocked 30 or 40 removals in a single mid-summer day. We lay the decreasing numbers on our pets to fewer animals in the house (one less dog). However, we continue vigilance in wearing light clothes on walks in woods and marshy areas so that we will see the dark ticks and remove before they attach to us. We try to remember daily inspection of ourselves and Mocha the cat and Ticker. The greatest improvement has been in anti-tick repellents such as Frontline applied to pets monthly. Other important repellents contain DEET and Permethrin, the later to apply to outside clothing. We use caution in children, avoid use in young babies and spraying on or near the face. However, we don't trust these strategies entirely because some ticks get through and illness may not be heralded by the tick's presence or her legacy of a bull's eye rash at the site of her bite. All of these strategies fall short of total protection against tick-borne disease.
In the 1960s, we planted our first garden on a shared lot on Lambert's Cove and trucked a dozen or so bales of old hay to mulch the rows of vegetables. We remembered carrying loose hay from the bails to garden gathered against our chests. We thought we would have enough veggies for the season. A couple of days later, as we rested up our aching muscles from unaccustomed work, Mary Ann showed me a sore spot on her shoulder. More than a spot, an angry round blistered area the diameter of a coffee cup with surrounding redness, glared out at me. She wouldn't let me touch it for the pain. She felt shaky and achy in the joints and her temperature was around 100 degrees. Later that night it rose to 105. Whatever this was, it was unexpected and totally unexplainable. Our doctor friend examined Mary Ann and looked at her shoulder solemnly.
"I think it must be a brown recluse spider bite," he said finally. "You told me the hay had been stored in someone's barn for the last year and you never felt the bite." The history seemed typical in other cases he'd seen. I had only read a few accounts of such bites that were usually quite serious and difficult to treat. In some cases, doctors were excising (removing by surgery) the whole area to hasten healing. We treated the spider bite with tetracycline, pain relievers and warm compresses. Weeks went by before the area returned to anything like normal. Mary Ann felt poorly the whole summer. Daily temperatures to 99 and 100 were steady for weeks and a series of strange rounded pink outbreaks on her whole body occurred, some enlarged to the size of a dinner plate, then disappeared and recurred again until fall when they and the fever left and she began to regain her normal health. Another patient in the same town had a similar but milder illness the same summer although had no history of an initial skin outbreak like a spider's bite.
By 1984 I had developed a small emergency medical clinic in Chilmark. In June or July I saw a woman who had almost the exact replica of Mary Ann's 1960 skin lesion, fever and aches and pains but by this time we had been encountering and treating cases since the late 1970s of the newly described Lyme Disease which fit this same description of a mystery illness which had been prevalent in summer for several years on the Vineyard. A series of articles in the American Journal Of Medicine by rheumatologist Allan Steere, MD, at the Yale-New Haven Medical Center and others had described an epidemic of childhood arthritis in the town of Old Lyme, Conn., and the eastern bank of the Connecticut River valley; those communities had been alarmed and a group of astute mothers would not accept the diagnosis of rheumatoid arthritis. Soon the doctors were persuaded to look harder and proved those mothers' suspicions of an infectious source correct. My second patient with "spider bight" turned a fourfold increase in antibodies against the bacteria then recognized as the culprit causing Lyme disease, which was acquired by the bite of a tick, which had been infected in turn by feeding on an infected mouse. It seemed likely that both Mary Ann in the 60s and my more recent patient had had Lyme disease, not a spider bite. Fortunately the new discoveries enabled the recent patient to recover completely within several days after treatment with Ampicillin and remain well
At least in this season of 2007 we should be able to diagnose and treat this no-longer so mysterious illness, Lyme disease, but every home will continue to need a good tick gatherer and jar of liquid soap.