Transcription:

Scott Webb: Lyme disease is caused by ticks, but there are different types of ticks and differing degrees of Lyme disease. To help clear up any confusion and perhaps help us to avoid tick bites and Lyme disease, Dr. Jignesh Modi is here again today. He's an infectious disease specialist with Genesis. This is Sounds of Good Health with Genesis, brought to you by Genesis Healthcare System. I'm Scott Webb. Dr. Modi. It's so great to speak with you again, we've spoken before today, we're talking about Lyme disease and I think Lyme disease is one of those things that many of us may feel like we know what it is exactly. Or maybe some of the ways that you can contract it, but great to have an expert on. And you definitely are that. So let's start here. What is Lyme disease?

Dr. Jignesh Modi: Lyme disease is a bacterial illness that can present in a variety of ways. And it's a tick associated disease. There's a long list of tick associated diseases and the various tick associated diseases are seen with the different ticks and also the different parts of the country. And they present in a variety of ways.

Scott Webb: Yeah, so it does definitely seem for most of us, like it's a summer thing, right. It seems like people,, talk about it more in the summer, contract it more in the summer. So let's talk through this just a little bit more, we're talking about ticks, right. But how exactly does it spread? Do they bite us? What happens?

Dr. Jignesh Modi: Lyme disease is transmitted by a tick on the east coast that's called Azos scapularis, it's much more common. On the east coast in the upper Midwest. Lyme disease is much less common on the west coast and is transmitted by a different tick that's called Azos Pacificus it's transmitted by the bite of the tick.

And, typically it requires tick attachment for at least 48 to 72 hours to transmit. If you were to get a tick bite, and notice the tick within 15 minutes, that definitely would not be enough time to transmit, , the bacteria that causes Lyme disease. It is transmitted by the, by itself, and requires, like I said, attachment for 48 to 72 hours.

Scott Webb: All right. So let's talk about prevention, right? I know there's lots of,, sprays and things that people can wear and just maybe generally avoiding wooded areas, perhaps, but, from your perspective, what are the best ways to avoid getting Lyme disease and can we really prevent it?

Dr. Jignesh Modi: Lyme disease is to some degree, a seasonal disease, especially the acute forms of it that are associated with the rash, because the rash occurs early during the illness. There are some late versions of Lyme disease that obviously are not necessarily seasonal. But in terms of preventing Lyme disease, the first step would be to avoid the tick bite itself. That would include avoiding grassy or bushy or wooded areas as much as possible. You can also acquire the tick from animals, pets. If you go into the woods, it's best to stay on the trails. In terms of clothing, light colored clothing..

If you tuck your pant legs into your socks, that might prevent, a ticket attaching. There are clothings that you can buy that are infused with permethrans, but more readily available, are just permethrans over the counter. You can get them at any local large box retailer. They come in a variety of forms, but sprays would be a common form, that's a good way to avoid, , tick bites. When you do come inside, you should check for ticks the ticks that transmit Lyes are quite small. There's an early young form of the tick. That's actually quite small.

That's poppy seed sized and there's a larger adult form that sesame seed sized. Once they attach and consume a meal of blood, they do become slightly larger. And it's important to check for the ticks, they like to attach to places that you might not ordinarily look, in the hair, the armpits behind the knees, , warm moist areas. Specifically looking for them in the mirror is a good way to define them. It's also helpful to shower within two hours after coming indoors, that's actually been proven to reduce the likelihood of t cki attachment and lime transmission.

Scott Webb: What are some of the early symptoms other than maybe, seeing the tick or feeling a bump, something like that? So let's talk about the early symptoms and then the later symptoms. And then how exactly do you diagnose?

Dr. Jignesh Modi: So there are at least three versions of Lyme disease, and it depends upo n how long after the tick bite we're talking. There is an early version which is associated with a rash that we call erythema migraines. It's typically identified as a circular or oval rash. At times it can be target like with a central area of clearing, but more frequently it's just a solid, pink to red rash with a well demarcated border not painful, associated with minimal symptoms. And in the early version, it actually presents at the site of the tick attachment.

If you have a circular or oval lesion like that's Five centimeters or more in diameter. That's pretty classic. There are early disseminated forms of the disease. The early form usually occurs within to 30 days. There's an early disseminated form where you can get a similar rash, but you can get up to dozens of these circular areas on your body at other areas, besides where the tick attached. Also with early disseminated disease, you can get very rarely heart involve.

It's actually quite uncommon. We're talking maybe 1% of all cases of Lyme disease. There also is a neurologic form of early seminated Lyme disease, which most commonly presents as a Bell's palsy. You can get a meningitis with it, but it's uncommon and it's not the type of meningitis that most people think of. The later form of Lyme disease typically involve Lyme arthritis and that can occur in up to 25% of people. It's a redness and swelling and discomfort that, usually starts with one joint. It can come and go a little bit over time.

It does usually improve with antibiotic therapy, but there can be a persistent, long term arthritis, that results. And it's not the type of arthritis where you just have pain. You will have swelling of the joint. And typically you're talking about the larger joints, not necessarily for example, fingers, but usually a knee would be the most common site for that. With regards to testing for Lyme disease, the options are actually fairly limited. If you test for Lyme disease within a couple of days of a tick bite, the test would be expected to be negative.

Testing for Lyme disease for the rash, the aery Theo migraines itself is actually not recommended the test. If you were to do it four to eight weeks out should be positive. If you have the later versions of Lyme disease, whether it's the arthritis or the Bell's palsy, I would expect the testing to be positive. The other important thing to remember about the testing for Lyme disease is there is no test of cure. The test that we do actually stays positive, whether you're treated or not, and would be expected to stay positive, actually for many years.

Scott Webb: So a lot of good reasons obviously then to see a provider and maybe we should talk about that. Right? What should folks do? So they realize they've been bitten by a tick or they have a tick on them. Should they try to remove it themselves? And if so, what would you recommend? And basically when is it time to visit a doctor?

Dr. Jignesh Modi: So, if you notice a tick that you think has been there 48 to 72 hours. One of the things that we do sometimes do in places that are endemic for Lyme disease, , we would do this to some degree in Ohio, but for example, if you lived in New England, the MidAtlantic states, Wisconsin, Minnesota, if you had a tick that had been attached for 48 to 72 hours, then it's actually recommended that you give a single dose of doxycycline. If you give it within 72 hours of the tick attachment. Giving the doxycycline two weeks later as a single dose, isn't shown to be a benefit, but given early can be a benefit.

Other things that you might, see your primary care provider for would include unexplained fever, rash, fatigue, headache muscle ache, joint ache, that last for a couple of weeks and are unexplained. Now you may not necessarily know that you had a tick that was attached. But we do sometimes diagnose Lyme disease in that setting.

Scott Webb: Yeah, so let's talk through the treatments and really the long term complications of untreated tick bites or Lyme disease.

Dr. Jignesh Modi: In addition to what I mentioned previously with regards to a single dose of doxycycline, given within three days of a tick that had been attached for two to three days, treatment would include doxycycline for 10 days for the rash that I mentioned previously known as erythema migraines. There are, as I mentioned, other forms of Lyme disease can be associated with fever, rash, fatigue. You can have Bell's palsy. Those are also treated with oral medication, which can include typically doxycycline, but also amoxicillin or sine given by mouth for 10 up to 28 days are used.

There are longer term complications of Lyme. If you have Lyme arthritis, or for example, if you had Ben Jain, we would frequently treat you with intravenous medication. Long term people do occasionally have fatigue, , muscle lakes, joint aches, , and those can persist even after the infection itself is treated. It has not been proven to be of any benefit to retreat after you've treated one time for those symptoms, they are considered long term complications of Lyme disease.

Scott Webb: Yeah. So it sounds to me like maybe Lyme disease is preventable. You gave us some good suggestions here, definitely doesn't sound like we wanna let, Lyme disease go undiagnosed and untreated. So Doctor, always great to have your expertise as we wrap up here. What are your takeaways when it comes to Lyme disease?

Dr. Jignesh Modi: I would say Lyme disease can be a challenge in terms of, diagnosis and treatment in the less common version. The most common version of Lyme disease is the rash known as athe migraines. It's pretty classic and generally spawns very well to treatment. Longer term people do have some sequelae that are sometimes difficult to manage and difficult to live with. But they don't respond to additional antibiotics and those are usually managed symptomaticly.

Scott Webb: Well, that's perfect. You and I have had a chance to speak before, and unfortunately, Dr. There's lots of diseases and lots of viruses in the world. You and I were joking that, that's kind of your thing. That's your lane at Genesis, so great to have your time and expertise. Thanks so much. You stay well.

Dr. Jignesh Modi: Thank you.

Scott Webb: And for more information, visit genesishcs.org. And thanks for listening to Sounds of Good Health with Genesis, brought to you by Genesis Healthcare System. If you found this podcast to be helpful, please be sure to tell a friend and subscribe, rate and review this podcast and check out the entire podcast library for additional topics of interest. I'm Scott Webb. Stay well.