One day last April, Craig Engwall noticed what looked like a dark freckle beneath his wrist watch. Putting on his reading glasses for a better look, he discovered it was a very tiny tick, which he removed. Engwall, who is the DNR's regional administrator in Grand Rapids, had been bitten by the miniscule nymph of a black-legged tick, also called a deer tick. Unfortunately for him, big problems can come in very small packages. Within days, Engwall says he felt awful, with pain in his joints, nausea and a rash encircling his wrist.
Recognizing the symptoms of tick-borne Lyme's disease and anaplasmosis, his doctor prescribed an antibiotic called Doxycline immediately and verified his diagnosis with blood tests. Because these illnesses are caused by viruses, they can be effectively treated with antibiotics. Engwall felt better and soon was back to his normal activities. But a couple of weeks later, the symptoms returned with a vengeance. Such a recurrence was strange, his doctor said. A blood sample was sent to the Mayo Clinic to test for a third tick-caused illness, babesiosis.
The test results were positive when they returned a week later. Babesesois, which is infrequent in Minnesota, is caused by a protozoan that attacks and destroys red blood cells. The symptoms are debilitating and for Engwall included severe vomiting and diarrhea, as well as a loss of appetite. Unable to eat, he drank Ensure for nourishment. In addition, he had neurological issues.
"What was scariest for me was if I slept for more than an hour, I'd wake up with no sense of time or place for 10 seconds or more," he said.
Babeseosis is similar to malaria and treated with antimicrobial drugs. As with malaria, it may or may not be eradicated through treatment. For Engwall, who is still having daily issues with fatigue, stiff joints and loss of appetite, an eventual full recovery is possible and even likely.
"I'm hoping my quick diagnosis makes a difference," he says. "I don't want to go through the long term stuff that has happened to other people."
Among those other people is his co-worker, DNR regional Wildlife supervisor Jeff Lightfoot, who has a condition called chronic Lyme's disease. Lightfoot never saw the tick that bit him and came down with symptoms in February, 2009. Feeling run down and fatigued, he went to the doctor's office thinking he had a seasonal virus. Instead, a blood test showed he was positive for Lyme's disease.
Like Engwall, Lightfoot was started on a 21-day course of doxycycline. The difference was Engwall was able to start treatment shortly after being, while months passed before Lightfoot showed symptoms and went to the doctor. When the doxycycline failed to address his symptoms, he received 10 days of intravenous medication via a permanent tic line in his arm. On day nine, he began feeling better. His health improved for several months, lasting through the summer, but the symptoms returned in the fall.
Lightfoot tried alternative and nontraditional treatments to restore the healthy bacteria in his body that were destroyed by antibiotics. Although he felt better for awhile, the symptoms came back again, including severe headaches, fatigue, general aches, difficulty keeping his eyes open and a condition called foggy brain, which he describes as feeling as though ]you’ve had a couple of glasses of wine when you haven’t had anything at all.
“Feeling lousy has sort of been my life for two years,” he says of the illness. “They call it chronic Lyme’s disease, but they’re not even sure what it is.”
Prior to the illness, Lightfoot ran and worked out daily. Now a workout is likely to lead to exhaustion and aggravate his symptoms. He goes to work, but sometimes is unable to put in a whole day. He has resumed activities such as hunting, but he doesn’t have the stamina to stay out all day. On a bright note, he has become more involved in youth soccer, which he enjoys. And he keeps hoping he’ll feel better someday.
“I keep waiting for the medical community to announce a cure,” he says.
Neither of the men has quit going outdoors when ticks are active. Engwall says he doesn’t intend to give up grouse hunting or other woodland activities, but he will take precautions to avoid ticks. He pulls his socks over his pant legs, applies DEET to his skin and sprays his clothing with tick-repelling Pyrethrum. When he is not using repellant, he avoids walking in places, such as tall grass, where ticks occur. In addition to practicing tick avoidance, Engwall thinks people should seek medical treatment if they have symptoms of a tick-related illness.
“Considering where we live and how many of us are active outdoors, if there is any chance you were bitten by a tick and don’t feel well, just go to the doctor,” Engwall says.
It’s good advice. As Engwall and Lightfoot have learned the hard way, a tiny tick can mean big trouble for your health.