Path: bloom-picayune.mit.edu!snorkelwacker.mit.edu!americast.com!americast.com!americast-post Newsgroups: americast.twt.news From: americast-post@AmeriCast.Com Organization: American Cybercasting Approved: americast-post@AmeriCast.com Subject: Devastating disease baffles doctors Date: Fri, 13 Nov 92 15:11:15 EST Message-ID: \SE A \HD Devastating disease baffles doctors \SH Tests, treatments lacking for Lyme \BY Janet Naylor \CR THE WASHINGTON TIMES The number of reported cases of tick-borne Lyme disease is down this year in the Washington area, but doctors and patient advocates aren't cheering the news. Lyme disease has spread from a few cases in two states to thousands of cases in 49 states, according to the federal Centers for Disease Control in Atlanta. More than 40,000 cases have been reported nationwide since 1982. The disease has no known cure, no reliable diagnostic test and, with very little data about effective treatments, no federally specified drug for treatment - making it perhaps the nation's most contentious disease after AIDS. Doctors commonly miss or misdiagnose Lyme disease. "We don't really know if physicians are underreporting or overreporting," said Dr. Elin Gursky, chief epidemiologist for Prince George's County. "We don't know if everyone's calling the same thing Lyme disease." The disease is common in the Northeast, especially in the moist climates that favor the deer tick, the most common transmitter of the disease to humans. The cool summer was favorable to the ticks, which despise dry, hot weather. The male deer tick is about the size of this "o"; the female is slightly larger. The ticks grow noticeably larger when gorged with blood. Juveniles are about the size of a period. Unlike the larger, more common dog tick, the deer tick remains active in the fall and winter when the temperature jumps above 60 degrees, experts said. The lack of a readily available lab test for the offending bacterium forces doctors to rely on a less effective test for blood antibodies that accumulate in infected people. A new urine test to detect the bacterium might be available next fall. The most effective diagnostic sign is the bull's-eye rash, also called erythema migrans. The sometimes painless rash is found in about 75 percent of Lyme cases but usually disappears after a few weeks. "We have to continue to educate our private physicians . . . about Lyme disease and hope that better diagnostic tools are available" in the near future, Dr. Gursky said. Because there is no known cure for Lyme disease, the best way to treat it is hotly disputed in the medical community. Researchers and clinicians can't agree on whether to use a short-term, intensive treatment of antibiotics or a longer-term regimen. They also disagree on which bugs carry the disease. "These doctors get into literal fistfights" at professional conferences, said Dr. Wendy Feaga, a veterinarian in Ellicott City who contracted the disease three years ago. Generally, research-oriented doctors at university medical centers favor shorter-term antibiotic treatments and question whether further drug therapy is needed. "There's no evidence that longer treatment is necessary," said Dr. Brian Schwartz of the Johns Hopkins University School of Public Health. "Doctors who are treating people for longer times may be treating for other diseases," he said. "There's a lot of unnecessary antibiotic therapy going on." But some doctors began preferring long-term treatment after catching the disease. "The doctors that got Lyme disease picked up very quickly that they felt better" when they stayed on antibiotics, Dr. Feaga said. "These patients are sick, they're hurting, and they find these private physicians are helping them," she said. Dr. Feaga said she recently found five deer ticks on a cat and four on a dog who came in for routine checkups. But none of the ticks that she sent for testing this year carried Lyme disease. About 5 percent of deer ticks in Maryland have been found to be infected. Although reported cases are down this year, the ticks are still out there, health professionals warn. "Clients in my practice have reported to me this fall . . . deer ticks like I've never seen before," Dr. Feaga said. While thousands of people may be suffering from the disease, it often goes unrecognized and untreated, leading to serious complications. Deaths are rare but have been recorded. Lyme disease takes its name from Lyme, Conn., where it was first reported in 1975. Scientists later realized that cases of a similar, less severe disease were seen as far back as 1899 in California. The culprit is the Borrelia burgdorferi, a bacterium from a class called spirochetes. It can produce symptoms ranging from a rash to flulike aches to arthritis. The symptoms often are mistaken for other maladies. Many patients who were later found to have Lyme disease say they were branded hypochondriacs by doctors unfamiliar with the condition. What doctors don't know about Lyme disease probably won't kill you, but the long-term effects can be painful, even devastating. "It's very difficult to handle chronic illness," said Lisa Nolf, 32, of Herndon, co-director of the Northern Virginia Lyme Disease Association. Mrs. Nolf believes she caught the disease two years ago just weeks after her marriage when she moved into a house infested with fleas and ticks. She was covered "head to toe" in bites and developed several bull's-eye rashes, she said. It took four months and a stroke of luck to get the correct diagnosis. "I was so scared. I didn't know. I thought I was dying," she said. Mrs. Nolf had to quit her secretarial job. She now does free-lance word processing and puts out a newsletter for the association's 45 members. "I'm hoping for a total cure," she said, "but I have to be a realist too." ****BOX FACTS ABOUT LYME DISEASE Symptoms * The most telltale symptom is a circular red "bull's-eye" rash that develops around the bite wound. The area inside the red circle is usually light. Other early symptoms often are mistaken for the flu: fever, chills, headache, stiff neck, sore throat and fatigue. * Later symptoms, appearing about four weeks to a few months after contracting the disease, include a skin rash, severe fatigue, dizziness, muscle and joint pain, blurred vision, facial paralysis (Bell's palsy), memory loss, chest pains, palpitations or other heart ailments. * Months or years after being bitten by an infected tick, patients can develop arthritis, speech and memory problems, psychiatric disorders, mood swings and other neurological problems. Protection measures * Stay away from grassy, marshy or wooded areas where ticks live. If you must go into tick territory, wear light clothing to make it easier to spot them. Wear long pants tucked into high socks, taping around ankles to prevent ticks access. * Use an insect repellant containing DEET. Follow package directions carefully and look for products that contain about 30 percent DEET. Stronger concentrations of the chemical can have serious side effects, including neurological damage, especially on children; 30 percent formulas have proven effective. * Check yourself, children and pets for ticks immediately after going outdoors in grassy or wooded areas. Ticks prefer dark, hidden places such as armpits, nape of the neck and the groin. If you find one, try to remove it intact by using tweezers and grasping the bug close to the entry point. If you think you have the disease * See your doctor immediately and ask about testing. Virtually all cases of Lyme disease can be cured if treated with antibiotics in the first few weeks while the bull's-eye rash is present. If possible, save the tick in a jar or envelope so that it can be identified and tested. * Call the Lyme Foundation hot line toll free at 800/886-5963. For information on patient support groups locally, call Lisa Nolf in Northern Virginia, 703/709-2205, or Joan McCallum, 703/620-0351. In Maryland, call Dr. Wendy Feaga in Ellicott City, 410/531-6330. This article is copyright 1992 The Washington Times. Redistribution to other sites is not permitted except by arrangement with American Cybercasting Corporation. For more information, send-email to usa@AmeriCast.COM