diagnosis, infection, my story, treatment

It had to happen one day…

I love being outdoors, and I love being outdoors with my children and teaching them how beautiful and special nature can be. So I knew that a day would probably come eventually when one of us would be bitten by a tick. My daughter has a morning of wood time every friday and we take hikes and walks in the woods fairly frequently. As a result, I am very very careful to do tick checks at the end of any day where there might be a risk.

Since I’ve been feeling much better (and in fact finished the unique treatment I began this spring), I had a hike planned with my family in the swiss mountains. I let my guard down and didn’t insist on socks around pants until I realized we were heading off trail (and found my missing tick spray); we didn’t wear light colors, and I generally relaxed more than usual. I should know better.

Then on the train ride home, we discovered an adult deer tick crawling down my husband’s arm. So when I got home I insisted on doing a very very thorough tick check on each child, and gave them a hot bath to boot (on the theory that if I missed one maybe it would drown :). I also checked my husband and he checked me.

As you’ve probably guessed by now, we found a tick. A nymph tick, attached to my hip. Interestingly, I had experienced some discomfort in the area near the tick during the train ride home (and attributed it to the fact that my back went out last week on that side). After finding the tick, I can’t help wondering if perhaps it was something else (I’ve had no back pain for a week and when I had it it was quite a different sort of pain). In any case, once the tick was discovered I did the following:

1) I went to the website of a reputable lyme organization (lymedisease.org) and looked up how to remove a tick  

2) I followed the instructions carefully, with my husband’s help, and put the tick in a ziplock bag

3) I emailed my doctor, a tick expert, and asked what he knew about the standard of care in this situation. He pointed me at a very interesting paper titled “Accelerated transmission of Lyme disease spirochetes by partially fed vector ticks” [1]. The article shows that a nymph tick attached for as few as 8 hours can transmit Lyme disease spirochetes (to mice)  if it was previously attached to an infected host and partially fed.

4) The normal treatment if you catch infection immediately is 3-4 weeks of antibiotics (usually doxy), according to the ILADS guidelines (the standard I choose to use when considering treatment options).

I considered the situation. My tick was was attached for 8 hours or less (I don’t know when I got it, only when my hike started), and was a nymph tick. I don’t know whether it had a previous feeding or not, but I do know that if it did, there’s a significant chance that I could have acquired an infection.

As a result, I decided to treat prophylactically, and simultaneously to get the tick tested for Lyme disease (the test available here only tests for that, but co-infections are apparently less common in Switzerland). If it comes back negative, I can reconsider whether to continue the antibiotics.

This leaves me with one important question: Have I made the right larger choice. Is the risk of Lyme disease, and the concern over getting it, worth being out and about in nature? So far, my answer has been yes. But the outcome of today’s events may affect how I think about all this. I am most thankful, though, that it was myself and not a family member that was bitten. I at least know what needs to be done and am willing and able to do it.

[1] C. M. Shih & A. Spielman, Accelerated transmission of Lyme disease spirochetes by partially fed vector ticks” J. Clin. Microbiol. November 1993 vol. 31 no. 11 2878-2881

infection, research

Sexual transmission of Lyme Disease

— EDIT —

There is an excellent and very thorough new analysis of this issue, in two parts, at

http://campother.blogspot.com/2014/03/part-1-sexual-transmission-of-lyme.html

and

http://campother.blogspot.com/2014/04/part-2-sexual-transmission-of-lyme.html

and

http://campother.blogspot.com/2014/04/part-3-sexual-transmission-of-lyme.html

While it is a blog post, it is more recent than mine and at least as thorough if not more. I encourage those interested in the topic to read it.

— END EDIT —

 

I’ve been wondering on and off for some time whether I need to worry about sexual transmission of Lyme disease. Now I’ll be honest, although I love my spouse very much, it hasn’t been that much of an issue in the last year or two. But I’m starting to feel a little better, and the last thing I want to do is create a husband who can’t get off the couch just when I’m able to enjoy him.

Humor aside, I decided to do a literature review for myself on the issue. Not being an expert in this field, I am trying very hard to avoid much interpretation of these results, but here’s a raw dump of what I found (note: Bb, and Borrelia Burgdorferi both refer to the causative agent of Lyme disease, the spirochete Borrelia Burgdorferi and (in some cases) related strains that also cause Lyme disease). Continue reading “Sexual transmission of Lyme Disease”

infection, my story

When it probably started: Demi’s got lyme disease, again

For those of you who don’t know me, Demi is my wonderful wonderful dog. She spends some of her time with my parents in NY, and the first time she had lyme disease, we think she got it there (in Spring 2006). We only found out she had it because she had a positive ELISA when we checked her for heart burn in August 2006. We treated her with about 1 month of oral antibiotics. She never had any symptoms.

About two months later, late on Wednesday night of 10/4/06, Demi suddenly lost the use of all four of her limbs around 11pm. I was asleep at the time (I have two young children who don’t sleep well, one who was still nursing, and was catching up), but I happened to wake up an hour or so later and my husband told me what had happened, I immediately headed out to the emergency vet.

They had no idea what might have caused it, and lyme was never mentioned, but several other probably deadly hypotheses were discussed. In any case, they put her on IV antibiotics, and sent me home around 3am. The next day, she was already able to move a little. I asked them if lyme was a possibility, and they thought it was unlikely. However, her improvement was so rapid that they began to agree it was a possibility that her summer lyme disease had not been successfully cured. I was able to bring her home not long after that, though she required support under her belly to help her walk. We put her on oral antibiotics again, in consultation with her regular vet, for 6 weeks. By 10/8/06 she was outwardly completely better, and no symptoms have recurred since then.

At the time, I believed that her infection had occurred the previous Spring when she was visiting my parents, that treatment had been unsuccessful, and that her October symptoms were likely from the original infection. I also thought, at the time, that lyme was not something one would get in inner-city Pittsburgh. With my current (12/2007) knowledge, I now believe that she was probably cured in August and was re-infected by a tick in Frick Park sometime in late September or October. For those of you who understand the lyme wars (see other posts on the topic by clicking on the tag “lyme-ware”), you’ll see that I essentially switched camps. Actually, my opinions on this are more subtle than that, I believe that both are possibilities, I just think in this case one explanation is more likely. If it’s true that she was reinfected, it seems plausible that I may have been infected at the same time. The timing certainly makes sense.