Transcription:
Guard Against Lyme Disease This Summer

Prakash Chandran (Host): Lyme Disease is an infection caused by bacteria that is carried by little deer ticks and these ticks are most active between May and July. So, around summertime. It’s really important that we protect ourselves from getting Lyme Disease and today, we’ll talk to Dr. Azfar Chak, in Infectious Disease Specialist and Chief of Infectious Diseases at Montefiore Nyack Hospital. This is Health Track, the podcast from Montefiore Nyack Hospital. I’m Prakash Chandran. So, Dr. Chak, let’s talk about what Lyme Disease is and how exactly it’s contracted.

Azfar Chak, MD (Guest): In brief, as you mentioned, Lyme Disease is a bacterial infection caused – transmitted by a tick, typically seen in summer months and the predominant area that we see Lyme Disease in is typically in the northeast part of America. It is in infection that typically results into fever, fatigue, headaches, chills, body aches and muscle aches along with some swollen glands. And as you stated, it’s usually seen predominantly in the summer months, but it could be seen outside of those months as well.

Host: And why is that? Are the ticks just more active then? Tell us a little bit about why it’s between May and July.

Dr. Chak: That is correct. So, the ticks are typically more active during those months. They have a tendency of hiding underneath the bushes or some leaves and they just become a little bit more active because the bushes and leaves are a little bit more pronounced during those months and they’ve become a little bit more active and they come out in those months.

Host: Okay, I got it. So, I want to shift a little bit to what are some of the symptoms that you experience when you have Lyme Disease and then let’s talk about how it’s diagnosed.

Dr. Chak: Certainly. So, typically, the symptoms can occur anywhere from three to thirty days after a tick bite or an exposure. And the most common symptoms, one of the way I was taught about it was they are very similar to the flu, except you will not have a runny nose. So, the flu symptoms as you know, most of the time can consist of fever, chills, fatigue, muscle aches, headaches, joint aches, swollen lymph glands. But typically those are the common symptoms that we see with Lyme, like I said, very similar to the flu except you will typically not have a runny nose, that’s very commonly associated with the flu.

And another aspect is typically you will not see the flu during the summer months. So, flu during summer months should be considered as having Lyme until proven otherwise.

Host: Got it. So, you are experiencing all those symptoms like achy bones, you might have a headache, but there is no runny nose at all. Is that correct?

Dr. Chak: That’s correct. In addition, I should mention one more symptom. Very commonly you see a rash, a so-called bull’s eye rash which has a prominent area in the center then a hollow ring around it and then another red circle around it. so, it resembles a bull’s eye. That’s a very common symptom. Typically anywhere from 70-80% of the Lyme Disease people will experience that symptom as well. But the other symptoms that you mentioned.

Host: Is that rash located directly where the bit took place?

Dr. Chak: Usually, yes, that is the case. But it could be in other parts as well, but typically, it’s where the bite occurred.

Host: Okay, so let’s say someone is experiencing those symptoms, they see that rash and then they come in to see you. Talk a little bit about how you go about diagnosing it and then initially treating it.

Dr. Chak: So, good question because there is a test that we do for Lyme, but we will come to that in a second. So, the first and foremost thing as clinicians, it is important that we go over the history of the individual. Was this individual outdoors? Was he or she on a hiking trip? Where they in the bushes? Where they participating in some marathon that involved being in the outdoors exposed to the bushes? Does this individual have pets that go outdoors and then they take the pets outdoors?

So, first and foremost, getting a good history from the patient is crucial and then the second thing will be to go over the symptoms as we discussed. As far as the test goes, there is a laboratory test that we do but the catch on that is it typically does not become positive until about anywhere from three to four weeks after the exposure. So, if there’s a high suspicion, we need to obtain a good history from the patient and start the treatment rather than waiting for the test because the test will not be positive for three to four weeks after the exposure.

Host: Got it. Okay and so you’re saying that you have to wait a couple of weeks, so you start treatment early and what does that treatment exactly look like?

Dr. Chak: So, the treatment typically and universally which the most effective treatment, is an antibiotic called doxycycline and that’s what we give typically for anywhere from two to three weeks of duration. And it is very effective if it’s caught early in the disease stages. It has a very high success rate as long as the patient tolerates doxycycline; it’s considered a mainstay in treatment for Lyme.

Host: Got it. You know I just think that there is so little education that we get around Lyme Disease that I worry that sometimes people that are even experiencing these symptoms like you said, they think it’s the flu and then they wait, and they wait for it to get better. So, maybe talk a little bit about the risks of waiting and how bad Lyme Disease can actually get.

Dr. Chak: That’s a very good question. Now typically, if one waits for the treatment, there are certain parts of the body that Lyme gets very attracted to, if you will, such as the joints. We see very frequently, people coming in with debilitating joint pain if they wait and Lyme starts attacking certain joints.

In fact, if I can backtrack, that’s how initially Lyme was discovered. It’s named after Lyme which is a town in Connecticut. There was an outbreak of some young individuals probably in their teens who presented with swollen joints and there was a cluster of them. Then when they investigated that’s how basically Lyme was discovered. It was Lyme that had attacked their joints and there was a cluster of cases and people especially the parents were quite worried that their kids were coming down with severe arthritis. So, there’s actually so-called Lyme arthritis and that’s how Lyme got it’s name. It was a cluster of cases in Lyme, Connecticut.

Host: I see.

Dr. Chak: Right, so that’s one thing that we have to wary about. It does have a tendency of attacking the joints. Another very serious risk factor with Lyme is attacking the heart muscle, so you can get this so-called entity called Lyme carditis where the heart can go into palpitations or it can stop beating all together. So, that could be a very serious condition and typically we see that in later stages of Lyme. So, if it’s caught early enough, if it’s treated early enough; we can prevent Lyme to progress into these stages. And one more place is the nervous system. So, you can get so-called neural Lyme, you know neurological Lyme. So, those are the three main organs that I has a tendency of attacking.

Host: Yeah, so, what I’m hearing from you is that it’s better to be safe than sorry. If you live in the northeast region, and you are experiencing these flu-like symptoms, it’s better to just go in and get checked just to be sure. Wouldn’t you say, Dr. Chak?

Dr. Chak: Absolutely. Absolutely. Please contact your physician as soon as you get these symptoms and yes, let them evaluate.

Host: Okay, a couple more practical questions. So, I know that the cases of Lyme Diseases has been high and increasing in Rockland Counties. So, what should people that live in that area do when they head outdoors to avoid these tick bites?

Dr. Chak: So, again, a great question. There’s a so-called ABCs of Lyme. So, A would stand for avoidance. Now again, I’m not advocating living in a bubble or just locking yourself inside the house and not going outdoors at all. But there are somethings that are recommended in avoidance such as the CDC, Center for Disease Control has a recommendation to keep your bushes and your shrubs and your grasses at a very low level, i.e. lawn moving on a regular basis, so these ticks don’t have a place to hide, if you will. So, that would be one of the avoidance.

B stands for bug spray. So, one of the most effective bug sprays is DEET which is readily available, so you can apply that on your body, and it works as an excellent repellent. In addition, there is another liquid form called permethrin which is used for lice treatment but what we recommend is applying that on your clothes and that’s another very effective way of preventing Lyme from attacking your body. Another natural again, I’m not sure if it’s very effective but some people have recommended eucalyptus with lemon and that could be helpful as well.

And the C is clothing. So, I strongly recommend to all my patients again, it’s a little bit difficult during summer months but do cover yourself up especially when you are going in the bushes, so the less your body is exposed, the less probability you have in attracting these ticks to different parts of your body. So, as I said, ABCs, avoidance, B for bug spray, C for clothing, cover yourself.

Host: Okay, that’s really great advice and my final question is around our four legged friends that don’t necessarily know the ABC fundamentals. How do we best keep these ticks or protect our pets away from these ticks?

Dr. Chak: So, typically, what we recommend is checking your pets on a regular basis, if possible, on a daily basis. The areas to check for would be around the ear, around the collar bone, in front and in between the legs and in between the toes and the tails. Those will be the areas where you should look for ticks and just remove them and that should be quite effective as well.

Host: Okay, that sounds fantastic. All really good advice today and I think the main takeaway is if you are experiencing these symptoms, please go in to get it checked and if you aren’t experiencing these symptoms, then remember the ABCs, avoidance, bug spray and clothing. Thank you so much Dr. Chak for your time. That’s Dr. Azfar Chak, an Infectious Disease Specialist and Chief of Infectious Diseases at Montefiore Nyack Hospital.

Thanks for checking out this episode of Health Track. And head to www.montefiorenyack.org to get connected with Dr. Azfar Chak or another provider. If you found this podcast helpful, please share it on your social channels and be sure to check the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.