Prakash Chandran
(Host): Although ticks might be tiny, their impact on public health has
been huge. When a tick bite's a sick animal, the pathogens in that animal's
body, stay in that tick saliva ready to be transferred to the new host with the
next bite. In humans, these tick-borne diseases can lead to severe health
complications if left untreated, and as tick populations continue to grow
across the globe, so does the number of people affected by them.

Here with us to discuss is Dr. Paul Sasso, Medical Site
Director of the Andrus Pavilion Emergency Department at St. John's Riverside
Hospital. This is Riverside Radio HealthCast, a podcast from St. John's
Riverside Hospital. I'm Prakash Chandran. So Dr. Sasso, thank you so much for
joining us today. I really appreciate your time.

You know I mentioned it at the top, but I'm curious, what
exactly are the key factors contributing to the recent increase in tick-borne
diseases?

Paul Sasso, MD, MBA, FACEP: Thank you so much for having
me, Prakash. It's interesting. We're definitely seeing a rise on the number of
tick populations. Predominantly in the Northern Hemisphere, we're seeing tick
populations expanding pretty much from the middle of the United States in the
Midwest, all the way up and down the Atlantic coast.

Predominantly, it's mostly saturated in the Northeast. That's
where we have the highest density of tick-borne diseases and illnesses. There's
a lot of factors that contribute to why we're seeing a increase in the tick
populations. And then because of that, the transmission of tick-borne diseases.
A lot of it has to do with climate change.

So ticks are exotherms, which means that they're dependent on
their environment to regulate their temperature. So as we see climate
temperatures increase, those warmer climates will speed up the tick's natural
lifecycle, which normally runs three years. So we're seeing them reproducing at
a faster rate and an earlier rate and at higher rates. So that's one of the
factors. The other thing that's contributing pretty significantly to the rise
in tick-borne illnesses is that we're noticing that as climate change and
climates increase, we're not getting those traditionally cold winters,
especially on the Northeast that we're used to. So we need those really cold
winters to kill off a percentage of tick populations.

And that's just like a normal regulatory process in nature that
helps to regulate tick populations. So the warmer that our winters are, not as
many ticks get killed off. So that's another factor. We're seeing more and more
humans inhabit areas where the animals that carry ticks live. So the animals
that carry the diseases that ticks then pick up are small rodents, such as the
white-footed mouse, chipmunks, squirrels, some raccoons. Those are the animals
that generally carry the disease. So as humans move more and more into these
more rural settings and outdoor settings, they're exposing themselves more to
the areas where we're finding the animals that ticks live.

The other thing that happens is we're seeing a decrease in the
predators, some of those small mammals. One of the predators that we've seen
the species kind of decline a little bit is the red fox. So, an animal that
would normally feed off animals such as the white-footed mouse. When we see the
predator population decrease,,that leads to an increase in these animal vectors
like the white-footed mouse. So as those go up, the amount of those small
rodents carrying disease goes up. And we talked about the factors leading to an
increase in the number of the tick populations going up. All those factors
together is what has caused an uptick, I guess pun intended, in the tick
populations and tick-borne diseases that we're seeing right now.

Host: Wow, there are so many factors that go into what
has caused this rise in tick-borne diseases. Let's get into the diseases
themselves. Can you talk a little bit more about what these tick-borne diseases
are?

Paul Sasso, MD, MBA, FACEP: Yeah, absolutely. So the
most common disease that we're probably mostly familiar with is going to be
Lyme disease, and that's caused by a bacterium, Borrelia burgdorferi. The other
diseases that we commonly see are Ehrlichiosis, which is another bacteria and
Babesiosis, which is a parasite. There's another very rare disease. It's a
virus actually. It's the Powassan virus. So ticks can carry a variety of
things. They can carry bacteria, they can carry parasites, and they can carry
viruses as well.

Host: Okay, so Lyme disease is the most common. What do
people experience, or what are the symptoms if people have contracted something
like Lyme disease?

Paul Sasso, MD, MBA, FACEP: Absolutely great question.
So Lyme disease is going to look like a summer flu, right? So very seasonal
illnesses. So the seasons, especially here in the northeast and Midwest that
we're going to see a lot of our tick exposures and tick-borne diseases is going
to be spring, summer, and fall. These are the times of years where we're
outside, we're hiking, we're biking, people are outside walking on trails, so
on and so forth.

So the symptoms of Lyme disease are going to present with
things like fever, chills, muscle, joint aches, headaches. And then about 70 to
80% of people are going to have a very classic rash around the bite. Uh, it's
been described as either a target lesion or a bullseye rash, but, just because
you don't get the rash doesn't mean you couldn't get Lyme disease.

Not everyone gets it, so 20 to 30% won't get that kind of like
classic rash. Babesia, very similar. Flu-like symptoms, fever, chills, sweats,
headaches, body aches, and sometimes you can get a little bit of nausea,
fatigue with these. And then Ehrlichia very similar as well. Fever, chills,
headaches, muscle aches, nausea, vomiting, sometimes diarrhea with this one,
loss of appetite.

And then sometimes in children, you'll see a rash, more of a
diffuse rash with a Ehrlichia. So the symptoms are kind of non-specific symptoms.
One of the ways that we teach these symptoms to residents and young doctors in
our program is that sometimes it could look like a flu, but it's not really flu
season, right? Flu season is traditionally in the winter, and we're seeing
these symptoms in the summer.

Host: Okay, so let's get into specifics. Can you talk to
us a little bit more about how you go about diagnosing and then treating some
of these tick-borne diseases?

Paul Sasso, MD, MBA, FACEP: Another great question. So,
depending on where you're practicing medicine in the United States and really
in the world, there's different diseases that you have to think about. Luckily
we don't have to think about every single disease all the time. Right? Some
diseases are very regionally specific, but where we're broadcasting from here
in the Northeast and here in Westchester, Lyme disease is prevalent. You know,
it's something that we don't see uncommonly. So it is part of the things that
we kind of think about, when we're diagnosing patients with these types of
symptoms during these specific seasons. There are very specific blood tests for
each of these. There are different blood tests for Lyme disease and Ehrlichia.
These have to be done via blood. There's blood smears for the parasitic
diseases.

And then that virus that I mentioned before, the Powassan
virus, that's a really tricky one to diagnose. Most labs actually don't even
have the capability to diagnose that one. Usually, it's a very tricky one to
diagnose. Usually those cases are pretty severe. But luckily they're still
pretty rare at this point, but we are seeing slightly more cases of those as we
talked about before, as we're seeing the numbers in the tick populations
increase.

Host: Okay, so because of this increase in the tick
population, I think it's important for people to know when they should be
concerned and when they should come in to get diagnosed. Like for example,
we're in the summer, there are summer allergies that are about, so do you have
a framework that people can use to basically tell themselves, Hey, this is
something more serious and I need to get looked at?

Paul Sasso, MD, MBA, FACEP: Another great question. The
big difference with these diseases and the more common things such as allergies
and seasonal allergies, allergic reactions, and so on and so forth, is really
going to be two things. It's going to be the presence of a fever. And it's
going to be the severity of the symptoms, right?

So, common allergies can present with runny nose and headache
and congestion, so on and so forth. But you're not going to get a fever with
those, right? Once you start to spike the fever there, there's something
infectious going on right? Now, not every fever necessarily means that there's
something terrible going on, right?

You can get a fever, a runny nose, a cough, sore throat, and
it's a mild upper respiratory infection, right? We get, usually we'll get a
couple of those during the winter. Some of us, especially with kids, we'll pick
up something from our kids and get one of those in the spring or summer as
well. Right? What's different about these tick-borne diseases is that you're
not getting that upper respiratory component. You're not getting that runny
nose. You're not getting that tickle in your throat. You're not getting the
cough. Really, the symptoms are going to be more fever, headache, body aches,
joint pains, nausea. So they're more systemic symptoms and you're not getting
that easy explanation.

So when we do see the runny nose, we do see the sore throat, we
do see the cough; those are pretty classic for common viruses, you know, your
common cold and so on and so forth. It's the absence of those and the presence
of the fever and the other symptoms we talked about, the joint pain, the muscle
pain, the headache, that kind of start to point us in the direction that this
could be something like a tick-borne illness.

Host: So as people come in for these tick-borne
illnesses, how exactly do they get treated? Are they given a regiment of
medication or is it something more involved?

Paul Sasso, MD, MBA, FACEP: It's a little bit of a two
part question, so it depends a little bit on when we're catching the disease.
Right? So there are stages to the disease. So I guess the first thing we could
talk about, and I'll touch upon this a little bit later too, is that it takes
about 36 hours for a tick to be attached to us in order to transmit a disease.
So, really the sooner that we can identify that a tick has attached to us and
remove it, the better chance that we have of avoiding any sort of serious
disease transmission. So there's treatment for tick exposure, right? So if a
tick has been attached for greater than 24 hours, there's a one pill antibiotic
that we traditionally give patients right? Now, after about seven to 10 days,
let's say we didn't catch the tick being attached to us after about seven to 10
days, we might experience some of these more severe symptoms. The fevers, the
chills, the body aches, the rash, so on and so forth. Once we get to that
stage, now we're talking about a longer duration of treatment. For Lyme
disease, it's 21 days. For Ehrlichia and Babesia, it's also a longer course of
treatment as well.

And then sometimes these disease, and that's why it's so
important to do things like this and educate our community and the patient
people in our community, is that some of these diseases can have really serious
consequences if left undiagnosed or untreated. And those sometimes can require
hospitalization, IV antibiotics, IV anti-parasitics, so on and so forth, and
longer kind of hospital stays.

But really our goal with this is to create some education and
awareness out there such that we're taking some preventative measures. We're
knowing what to look out for, and if we are exposed, we know what to do quickly
as opposed to waiting for things to progress.

Host: Okay, so let's dive into those preventative
measures. I imagine that one thing that you should do is if you are in one of
those areas that you were saying this uptick, in the Midwest and the Atlantic
Coast, that you should be checking yourself, especially after being outside for
a long time and even if you have an animal or a dog, checking them as well is
that fair? Is there anything else that you recommend?

Paul Sasso, MD, MBA, FACEP: Yeah, so I think a great
starting point when talking about prevention is where are we going to pick up
ticks, right? So there's the obvious stuff, right? So where do ticks live? So,
we talked a little bit before that their initial carrier is going to be the
small rodents, but then what happens is that the ticks leave them, get picked
up by deer, and the deer have like a wider range so they can drop it off on
like tall grass or tall brush.

So really what you want to avoid just to start off is like I
just said, avoid tall grass, avoid really brushy areas, right? Those are going
to be your highest risk areas for picking up a tick. Right? So if you're
outside and you're hiking, you're camping, you are hunting, whatever you're
doing outside, what you want to do is really stay to the marked trails. You
want to avoid going off onto those side areas where the higher grasses or the
brushes, brushy areas are.

And that's really the first Another thing that you can do.
Another thing that you could do is that when you are outside and you are in
areas that may have ticks, right? So you're hiking in the woods, you're
camping, so on and so forth. What you want to do is you want to wear proper
clothing, right? So what that means is you want to wear long clothing, right?

Long pants, long sleeved shirt, and even go as far as tucking
your pants into your socks, right? Maybe not the sexiest or most attractive
thing to be doing, but a great way to prevent kind of ticks from crawling up
your leg. And then the last thing that we could do is we can either spray our
clothing or ourselves with EPA approved sprays.

So there's permethrin, right? Which is a great chemical, which
is great at repelling ticks. There's clothing. You could buy these at your kind
of like outdoor clothing outlets that actually come embedded with this chemical
into the clothing. Or we can simply treat our own clothing with this.

So a combination of those three kind of mitigation techniques.
So avoiding high grass, avoiding brushy areas, wearing long clothing, and then
either having clothing that's pretreated or treating our clothing, is a great
way to prevent us from getting ticks in the first place. And then you touched
upon probably the most important thing out of everything.

After we're outside, you need to do a full body check, right?
So parents with kids, if your kids are at camp, if your kids are outside, you
got to look them over head to toe, right? And ticks like to move to the warmer
places of our bodies. So even though, let's say we're wearing shorts and a t-shirt,
maybe the tick got onto our leg.

That tick's going to move up, right? And we may not find it
until we look under our shirt, under our shorts, so on and so forth. Have
someone in your household, check your back. You know, you may not be able to
see every part of your body, but yet checking yourself over, definitely within
the first 24 hours. But I would recommend right away, as soon as you've been
outside, is really going to be a really helpful and effective method at
catching those ticks before they have a chance to latch on, bite and transmit
any disease.

Host: Yeah, really great advice. And I also mentioned
there if you have a pet, because sometimes you can't tell your pet, Hey, don't
run in the tall grass. They're going to do what they do. I imagine the ticks
also are able to latch onto them and then potentially latch onto you. Is that
something that you see and do you have any advice there?

Paul Sasso, MD, MBA, FACEP: Absolutely. And this is a
little bit harder, but the same way that we recommend for people to stay on the
low cut or hiking trails and avoiding the tall grass and the brushy areas, you
want to keep your pets out of those areas as well. Check your pets for ticks as
well.

Either brushing them or petting them, right? One of, one of the
most interesting and a little bit scariest ways that we can pick up a tick,
I've had patients where they're like, well, I don't hike. I don't go outside.
But it was actually their pet that brought the tick into the house, and then
the tick got onto them from their pet. So checking your pets and keeping your
pets out of those tall grass and brushy areas is super important as well.

Host: So you've already talked about the spray or
repellent that you can wear to prevent ticks from latching onto you, but is
there any other research or technology that people should be aware of that has
been developed to combat the rise of these tick-borne diseases?

Paul Sasso, MD, MBA, FACEP: Yeah, I think probably the
biggest take home point is that prevention is first and foremost, right?
Knowing good habits when we're going outside, especially in the spring, summer
and fall, that's really paramount. There really is some interesting research
going on. There's actually some gene modifying techniques that they're studying
to actually modify the genes of ticks such that they're not able to transmit
some of these diseases. A little bit away from things like that. But that's one
of the areas of kind of research that's being done right now. Also some areas
do employ local control measures, right? So we talked about some of the animals
that can spread ticks.

We talked about the white-footed mouse and chipmunks and
squirrels and deer populations, so on and so forth. So what some regions will
do is they will safely control those animal populations to try to help decrease
and mitigate the spread of disease. But those are things that aren't going to
be as effective as opposed to just good outdoor hygiene, right? Wearing proper
clothing, using properly treated clothing, and really just staying out of the
areas that are high risk to pick up a tick.

Host: So just before we close, I'm sure you've helped a
lot of patients that have contracted one of these tick-borne diseases. If
there's one thing that you know to be true that you want our audience to take
away from this conversation, what might that be?

Paul Sasso, MD, MBA, FACEP: I think a lot of the things
that we spoke about today can seem a little bit scary, right? We're talking
about like all these bacterial diseases and parasitic diseases and virus
diseases and tick populations are in, are increasing, but, I think with just
good common sense and a few pieces of information, we can really keep ourselves
safe.

I think that's one big take home point. The other one is stay
calm. If you do find a tick on yourself or on a family member or on a loved
one, don't worry about it. We can. We can treat it. You've already done a great
job in identifying it. Chances are if you're doing a good job checking in the
short term, after you've been outside, you're in that window to safely remove
it.

So removing ticks is pretty straightforward. You can look up
online how to do it, but pretty much a pair of tweezers and you grasp the tick
right at the head and gently pull it off, is more than adequate. If you don't
feel comfortable doing this, you can talk to your primary doctor or you can
check in with the local emergency department or urgent care.

If you do take the tick off. Put it in a plastic bag and bring
it to us for us to look at. We're pretty good at identifying what type of tick
it is. So not every tick carries diseases. So there are certain types of tick
that don't carry Lyme disease. And if we can identify the tick as one of those,
then you're in the clear.

Host: That's awesome to hear. Well, Dr. Sasso, this has
been a great conversation. Thank you so much for your time.

Paul Sasso, MD, MBA, FACEP: Hey, thank you for having
me. Really appreciate it.

Host: That was Dr. Paul Sasso, Medical Site Director for
the Andrus Pavilion Emergency Department at St. John's Riverside Hospital. For
more information, please call our physician referral service at 914-964-4DOC or
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listening to this episode of Riverside Radio HealthCast, a podcast from St.
John's Riverside Hospital. My name's Prakash Chandran. And until next time, be
well.