Joey Wahler (Host): It's a condition many know very little about. So, we're discussing Lyme disease. Our guest is Dr. Anne Tarry. She's a primary care provider for St. Joseph Hospital. This is Wellness First, a St. Joseph Hospital podcast where we hear and learn directly from the experts on all things health and wellness. Thanks for joining us. I'm Joey Wahler. Hi, Dr. Tarry. Welcome.

Anne Tarry, MD: Hello. Thank you.

Host: Thanks for the time. We appreciate it. So first, for those that don't know, in a nutshell, what exactly is Lyme disease and how common is it in the United States?

Anne Tarry, MD: Lyme disease is common in the northeast. Up to 400,000 cases are diagnosed each year, and that is an increase from the past. So, it's a disease that's growing in prevalence, and it can be very important. It's one of the most feared illnesses in the world, partly because it's complicated. It's complicated to diagnose. People often don't know when they have it. The tick that gives it to us is very tiny and stealthy. Most people don't even know that they were bit by the tick that caused the Lyme to be transmitted to them.

Host: And so, what is it actually?

Anne Tarry, MD: It's a bacteria, it's a spirochete. It's Borrelia burgdorferi. It's a very stealthy bacteria that can bind to the cells directly so it's not in your bloodstream, and that's one of the reasons why it's so difficult to diagnose because it can hide within your cells. What usually happens is the tick that you might not even know that you had on you releases the bacteria into your skin. The bacteria takes four days to unwind and prepare itself to invade. And then it will grow as a round or oval red rash over a period of four to up to 30 days. Some people don't even have a symptom until day 21. So, that's what makes it so tricky to diagnose because a person doesn't know they ever had it. Then if they even notice the rash, they might think that it's something else. They might think it's ringworm or a cellulitis, and they might treat the wrong thing and then it goes away because that's what Lyme does. It goes away, but then it might come back. And when it comes back, it's more serious because it spreads to more parts of your body, including your knee, other joints.

So, the second kind of symptom that people have is to have a large red, swollen knee. And that's when it's critical to diagnose it. It's often the orthopedist that diagnoses it because the person thinks they've attributed this to something else, they think they've tripped or hurt their knee when it's really Lyme. And that's when you really need to make sure that you treat it properly.

Host: Gotcha. So, you mentioned it's very common in the Northeast. Any other parts of the country where it happens more than others?

Anne Tarry, MD: So, Northeast is the place where the conditions are right for it. It's because the bacteria normally lives in deer and mice. And the temperature when it's transferred from the tick to the deer or the mice, everything has to be just right for the bacteria to survive. So, there are definitely ticks that have this bacteria in other parts of the country, but they don't transmit it to humans as easily, but it can happen. It has something to do with the temperatures in the Northeast. So when it's drier in Georgia, you might not get it. But on days when they've had flooding or moist weather, it is possible that the transmission is higher in those cases.

Host: So, you mentioned one or two of the visible symptoms associated with this. How about. The way people feel, particularly perhaps after a few weeks of having gotten a tick bite. Is there a change in the way we would feel about ourselves?

Anne Tarry, MD: People definitely feel systemic effects like fever, myalgias. You can get a headache. You can get Bell's palsy. You can actually get changes to the electrical system of your heart. So, those are other symptoms, but they're symptoms that can be explained away by other illnesses. So, that's what makes it tricky. You have to be on the alert that you might have Lyme.

Host: And so, you mentioned a rash a moment ago as well, often called a bullseye rash. What makes it a bullseye rash? And is that always present with a tick bite? Not necessarily, right?

Anne Tarry, MD: No. Only 80% of people on average get the bullseye rash. You're lucky if you get the rash because then you know that you have Lyme if you're paying attention to it. The people, the 20% who don't get a rash at all, they're the ones who might get the stage II, the stage III Lyme, because they didn't get any warning.

Host: And so, when we say bullseye rash, for those that haven't seen it, what does that mean actually?

Anne Tarry, MD: It starts off as a red rash that grows. It's very important that it be a rash that grows. Because the Lyme bacteria are spreading within your skin and they're getting bigger, it can be up to four inches, five inches. And then, there's a time where there might be a central clearing where it still stays red at the center where the tick bit you, but then there's a clearing and then there's another red ring. So, that's why they call it the bullseye rash.

Host: Gotcha. It certainly makes sense there. So, what should we do if we find a tick on our body? Because it doesn't necessarily mean that the tick is carrying Lyme disease, correct?

Anne Tarry, MD: No. But it could also be carrying ehrlichiosis, anaplasmosis, Powassan disease. Some people are developing alpha-gal syndrome from tick bites. In general, Lyme, the tick has to be on you for two to three days, but people often don't notice when they have the small ticks, the nymphs, the male tick. They'll notice when they have the female tick, but that's the only tick that really tends to engorge and get large, and that's the one that you notice. In general, you have to act every day that you've been outside as if you were exposed to a tick. You should remove all your clothes, put 'em in the dryer for 10 minutes. You should take a shower. You should touch all the parts of your body that ticks like to go to, like behind the ears, behind the knees. Use the sweeping motion to wipe them off whether you see them or not. That actually works. And make sure you shower every day when you've been in the outdoors.

Host: So along with that doctor, how can we try preventing Lyme disease in the first place while spending time outdoors?

Anne Tarry, MD: I'm glad you asked because that's the most important. You should treat anytime you go out in the outdoors as a day that you need to take prevention. You can use DEET spray, which of course can have some chemicals that might be harmful to you. So, you want to use as little as possible and possibly only spray it on the clothes of your lower body, like your socks, your shoes, your pants.

Some people treat their clothes with something called permethrin. You spray it on the outside of the clothes, you let it dry. You wear those clothes when you go on a hike, when you're gardening, anytime you're with your pets in the outdoors. You want to be sure that you have on this chemical that can help repel the ticks and keep them from crawling on you. If the ticks get on you, washing them off is your best bet. You want to be sure and take a dose of doxycycline, if you tolerate it, 200 milligrams on a day when you know you've had tick bite, that may decrease transmission, there's no guarantee, but it might decrease transmission. And then, you have to watch the area for 30 days to see if you get the erythema migrans rash.

Host: And so, where would you obtain that?

Anne Tarry, MD: You can call your primary care doctor's office and ask for it. You have to give all the details when you thought you might've been exposed, and why you would want to take the medication to prevent it.

Host: And what is that called again?

Anne Tarry, MD: Doxycycline 200 milligrams, one dose, but for adults only. It's not a medicine that we generally give to children because they can stain their teeth. Same thing for pregnant women. They would have to take amoxicillin or cephalosporin because of the risk of doxycycline to the teeth.

Host: Gotcha. So if a doctor like yourself suspects Lyme disease could be present, how do you go about diagnosing it?

Anne Tarry, MD: Hopefully, they have the rash because then that means we're catching it early. We would give them 14 to 21 days of the doxycycline or amoxicillin. If they have the swollen knee, we would want togive them at least 28 days, and sometimes you have to repeat. The course of antibiotics an additional month if the symptoms do not resolve completely. And, unfortunately, some people get a chronic case. In that case, we really have to send you to a specialist, a rheumatologist, sometimes a special ID person at Mass General who can help us decide which symptoms are Lyme, which symptoms aren't Lyme, because chronic illness is very difficult to treat.

Host: Absolutely. A couple of other things here. What treatments are available for Lyme disease, presuming it's not chronic, and how effective are they?

Anne Tarry, MD: Well, the antibiotic, the doxycycline that we discussed is the most effective treatment, and we'll treat it completely if it's caught in time for most cases.

Host: But I meant perhaps it were not caught in time and the condition is a little bit further down the road, what happens then?

Anne Tarry, MD: If you have neurological Lyme, you may have to get ceftriaxone or even IV antibiotics. But usually, we have to get an infectious disease specialist involved at that point, mostly to make sure we're treating active bacterial infection. Lyme is extremely complicated. Some people have a reaction just to the residual bacteria proteins, in which case the bacteria isn't alive, but the proteins are around and your body's making an immune reaction to those proteins. In that case, trying to kill the bacteria doesn't help the situation. You have to try to decrease the inflammation.

Host: Now, this is a big one here in the question department, Doctor. You touched on it, but to follow up, what are the long-term effects of untreated Lyme disease? Because if it does go untreated and it is chronic, it can really become debilitating over time to say the least, right?

Anne Tarry, MD: Chronic Lyme disease is a terrible problem in this country. Hopefully, the numbers are not that large. But when people have it, it's hard to get answers on how to treat it and how to cope with it, and we often have to send them to a specialist at Mass General, such as Dr. Allen Steere, who was the person who first discovered that it was associated with the Arthritis in Lyme Connecticut 50 years ago.

Host: What are some of the things that can happen to someone over time if they're in a chronic condition of Lyme disease?

Anne Tarry, MD: They can feel extreme fatigue. They have recurrent arthritis. they. Can have carditis. They have changes to their heart. They can have changes to their brain. It's a terrible condition, which I wouldn't wish on anyone. But we would certainly try to help them through it.

Host: Doctor, in summary here, any common misconceptions you run into about Lyme disease that you can clear up here for our audience? Or along with that, any main message about Lyme that you want to give to those joining us, just to drive the message home here about the importance of prevention and early detection?

Anne Tarry, MD: Prevention is the most important because it's such a difficult disease to diagnose, to recognize. The tick that can give it to you is small and sneaky, and then the bacteria itself is small and sneaky and keeps coming back at you if you don't treat it properly.

Host: Great advice indeed. If you see a tick on you, certainly act quickly and check to make sure that you don't have any on you when you've been outdoors, especially in areas where it might be prone to tick presence. Well folks, we trust you are now more familiar with Lyme disease. Dr. Tarry, keep up all your great work and thanks so much again.

Anne Tarry, MD: Thank you.

Host: And for more information, please visit stjosephhospital.com/new-patients. If you found this podcast helpful, please do share it on your social media. Thanks so much again for being part of Wellness First, a St. Joseph Hospital podcast.