Summer brings risk of bug-borne illnesses such as Lyme disease
FARGO – Stacey Nice knew something was wrong when she woke up with a migraine one morning in 2006.
She hadn’t previously suffered from anything like this, and the headache wouldn’t go away.
That one symptom started Nice, 48, down a long path of medical testing, several diagnoses and appointments with specialists across the country until she found out last fall what was causing her escalating problems, ranging from shooting arm and leg pain to dementia-like forgetfulness and confusion – Lyme disease, the most common tick-borne illness in North America.
The news was a relief in some ways, she said, because at least she knew what ailment had changed her life.
“I just was kind of waiting for my time to come up, and I just didn’t want to give up, and so I kept pursuing it,” she said.
Lyme disease is a concern for people in this region during the summer and early fall, when eastern black-legged deer ticks are active. They can carry the disease, or other infections, that can be transmitted to humans through a bite, said Augusto Alonto, chair of Sanford Health’s infectious disease department in Fargo.
Treating the bite
Lyme disease, caused by bacteria that ticks can get from infected rodents, used to be less common in North Dakota, according to state Department of Health epidemiologist Alicia Lepp. From 2000 to 2005, the state reported a total of six cases.
But she said North Dakota has seen a slow increase in Lyme disease since 2007, recording 29 cases in 2013 and 14 in 2012, and said it could be related to the deer tick spreading into the eastern part of the state.
Deer ticks – and Lyme disease – are more common in Minnesota, she said. Nearly 13,000 cases were reported in the state from 1996 to 2012, including 912 in 2012. Another 604 probable cases were reported that year.
Many of the North Dakotans who were infected in recent years reported traveling to Minnesota or owning a lake cabin there, Lepp said.
Across the country, more than 20,000 cases were reported in 2012, according to the Centers for Disease Control and Prevention.
Not all ticks are infected with Lyme disease or other bacterial infections that humans can get if bitten, Alonto said, and a part of the increasing case numbers could be related to more awareness of the disease and more medical testing to confirm it.
The illness does have some common early symptoms, he said, including fatigue, chills, fevers, headaches and a possible red, expanding rash, and anyone who may have been exposed should see their medical provider.
Doctors can use diagnostic tests to confirm the presence of the bacteria that causes Lyme disease, he said, and the vast majority of patients – 85 to 90 percent – will improve within a few weeks of starting a short-term round of antibiotics.
Two other tick-borne illnesses that can be spread in this region, anaplasmosis and babesiosis, also usually respond well to antibiotics, Alonto said.
Still, 10 to 15 percent of Lyme disease patients continue to have lingering symptoms, including fatigue, pain and muscle aches that can last six months or longer, even after completing treatment.
The reason for those chronic symptoms remains unclear, Alonto said. One theory suggests it could be caused by residual damage to nerves and the immune system, though that hasn’t been proven, and these patients usually don’t see improvement even if they continue treating with antibiotics.
‘I’m very fortunate’
After she woke up with a migraine that day in 2006, Nice went through several diagnoses that could have explained some of her symptoms. She was diagnosed with lupus, amyotrophic lateral sclerosis and multiple sclerosis, though none could explain her specific problems, and eventually was told she had autoimmune autonomic neuropathy.
She was tested a few times for Lyme disease, though those tests came back negative, and a series of aggressive treatments, including a round of antibiotics, made her feel better for about a year.
“Then, it all came back,” she said.
After consulting with specialists, Nice tested positive for Lyme disease last fall and was told levels of the bacteria had built up in her brain – causing the dementia-like “brain fog” symptoms that had stumped her family and friends.
“I’d go to appointments and couldn’t remember where I was going, and I couldn’t remember conversations I had,” she said.
Since getting the diagnosis, she’s been active with a Lyme disease support group in Alexandria, Minn., and has learned tips from other longtime sufferers on how to start feeling better.
Later this year, she’ll begin one year or more of intravenous antibiotic treatment that will require a home visit from a medical professional to administer the drugs five days a week. Once complete, she said the goal is to knock down the levels of infection in her body and make her feel better, though her current doctors don’t expect she will be cured.
But first, she’s undergoing several treatments at home, spending $2,000 to $3,000 out of pocket each month to take supplements, painkillers and other remedies to get her body ready for IV antibiotics.
Nice is grateful to have support – her sister and fiancé helped her make ends meet, her daughter has been a big help at home, and her friends and family recently raised $50,000 at a benefit to cover her medical expenses for now.
Still, she said more awareness about Lyme disease is needed to make sure others won’t have to go through what she’s experienced.
“I’m very fortunate,” she said. “I count myself among the blessed ones, believe it or not. At least I know.”
Tips to minimize chances of getting sick from ticks, mosquitoes
The season of cookouts and summer vacations has a less pleasant side – the return of ticks and mosquitoes that can infect us with West Nile virus, Lyme disease and other illnesses.
But Alicia Lepp, an epidemiologist with the North Dakota Department of Health, said we can minimize the risk of exposure.
If possible, avoid the prime tick habitat in heavily wooded areas or tall grass or brush.
Lepp said it’s best to use a bug repellant that contains DEET on clothes and exposed skin. Repellants containing permethrin are safe to use on clothing, tents and equipment, but not bare skin.
Wear long-sleeved shirts and pants, and tuck in the shirt and pant legs to give ticks less skin to bite, she said.
After spending time outdoors, Lepp recommends taking a shower or bath and washing the clothes immediately to kill any ticks.
It’s also recommended to have another person look for ticks, especially because the young nymphs can be small and hard to find on the body, said Augusto Alonto, chair of Sanford Health’s infectious disease department in Fargo.
If a tick is found, use tweezers to grasp the tick close to the skin and gently pull upward. Don’t squeeze or burn it, Lepp said, because it could cause the tick to release fluid that could be infected.
Check pets for ticks, too, and talk to a veterinarian about tick repellant options.
Light-colored clothing can make it easier to spot small ticks, Lepp said, and lighter attire has the added benefit of not being as attractive to mosquitoes.
Insect repellants containing DEET, permethrin and other ingredients are effective against mosquitoes, she said, though it’s recommended to avoid going outdoors during dusk and dawn when they’re most active.
Eliminate any possible breeding grounds, including containers or low spots where water can accumulate, she said. Empty out bird baths every few days to prevent mosquito breeding there.
Anyone with symptoms that could be caused by a mosquito or tick bite – fatigue, chills, headaches or a red, expanding rash for Lyme disease, and fever, headaches, fatigue, mental confusion or tremors for West Nile virus – should consult a doctor.