Melanie Cole, MS (Host): Welcome to Back To Health, your source for the latest in health, wellness and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back To Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole. And today, we're talking about Lyme disease. And joining me is Dr. Maryellen Benito. She's an assistant attending physician at New York Presbyterian Hospital, Weill Cornell Medical Center, and a Clinical Assistant Professor of Pediatrics at Weill Cornell Medical College, Cornell University. Dr. Benito, thank you so much for joining us today. I'd like you to start by telling us really what is Lyme disease and how do we get it.

Dr Maryellen Benito: Lyme disease is caused by the bacterium Borrelia burgdorferi. It is transmitted to humans through the bite of an infected black-legged tick, deer ticks. The ticks must remain attached for at least 36 to 48 hours before they can transmit the bacterial pathogen. It's definitely very common out where I practice. So, I practice out at South Hampton. So, anyone that comes and visits in the Hamptons, you'll definitely hear a lot about ticks and Lyme disease and a lot of other tick-borne diseases. But I guess for this podcast, we'll just focus on Lyme disease.

Melanie Cole, MS: Well, it certainly is pretty prevalent all around. And I know that animals get ticks too. So, can animals get Lyme disease, like my dog?

Dr Maryellen Benito: Yes. We've had several of those. And actually, those pets can definitely, if they go out and they come back at the home, they could go on the bed, on the couch. And then, when you sit in the couch or sleep on the bed, that's where you can get bitten by the ticks. So, you definitely want to check your pets for any ticks and also treat them too, if they actually act out, you know, bring them to the vet and tell them you've seen ticks on them and if they're not feeling well, so that they could also treat them.

Melanie Cole, MS: So, how do we get the ticks on us? You just mentioned the couches and if our pets, you know, come into the house with a tick on them, but do ticks live on surfaces in our house? People think, you know, when we think of it, we think of fleas or lice or any of these things, but they don't jump. Do they jump?

Dr Maryellen Benito: So, what usually happens and how people get them is that they're mostly commonly found in wooded areas, so leafy litter, tall grass, beach grass, bushy areas. They can also be found in the stone walls and the perimeters where the lawn meets the woods. But I've had patients that would walk in the village or walking down the sidewalk and they would still get a tick. I have kids that would go in the playground in the area or in the park and they would still get ticks.

So, usually, if you're walking through the dunes in the beach or in a wooded area, the ticks usually, they wait out towards the end of the grass and then they jump on you in a way or like when you walk by them they'll just clasp onto your clothing and that's where they attach to you. As for the dog or the pets or rabbits or whatever, if people have farms out here, they come into the house, they could stay in the couch or the bed, and if you're sitting down, they'll just wait for another host and then they'll just climb on and latch onto you.

Melanie Cole, MS: Uck! That's disgusting. Those things are so gross. And if you've ever had to pull one out of your pet, I can tell you that ain't fun. So, Dr. Benito, tell us about symptoms because Lyme disease is notoriously difficult to diagnose. And so, I'm hoping you'll tell us why that is and what symptoms that we're looking for if we're somebody who knows maybe that had a tick on us or we found one or something like that.

Dr Maryellen Benito: So, the most common symptom is the bullseye rash. It looks like a target lesion. It's red and then there's a clearing around it and another red kind of like the Target shopping bags and how you look at it. But that's only 70-80% of people actually have that symptom. Sometimes what happens is that you get bitten by the tick. And you will not know that the tick's on you because they don't really like have a head so they inject some numbing, like an anesthetic so that you don't feel them biting you, and they have to feed on you for at least that 36 to 48 hours. So, some people feel it, some people don't. But what happens is if the tick does fall out, you might not even see that bull rash, the target lesion, for up to three to 30 days. But the average is around seven days after you get bit, you'll see it. And it's not always where the actual bite is. Sometimes it can be found somewhere else on the other body where the tick didn't even bite you.

When you get the lesion, it expands. The reason why it's called the target lesion is because it's something called erythema migrans, where the rash expands, and it can reach up to about 12 inches or more, so about like 30 centimeters across. It can feel warm to touch, but it's rarely itchy or painful. So, a lot of my patients that come in and they're afraid, "Oh, I think I have a tick bite." But, well, if it's painful, it's most likely a spider bite. If it's itchy, it's most likely a mosquito bite. But if they said they just woke up with this rash and "I don't know what this is," and they don't know if they've gotten bitten by a tick or not, but it has that red-white-red look to it, it's more likely Lyme.

So, the Lyme disease occurs in three stages. There's the early localized, early disseminated and late disseminated. However, the stages can overlap and not all patients go on all three. So, I'm going to go over each stage.

On early localized, it can begin in hours, a few days, or even weeks after the deer tick bite. At this point, the initial infection has not yet spread throughout the body. Lyme is the easiest to cure at this stage with help from your healthcare provider, a blood test and an antibiotic treatment. The early stage of symptoms may include early localized disease like the erythema migrans, the skin rash, which may or may not look like the bullseye I told you; flu-like illness including chills and fever, fatigue, headache and stiff neck, muscle soreness and joint pain, swollen lymph nodes or sore throat. That's the first stage.

On the second stage, the early disseminated Lyme, it may occur several weeks or months after the tick bite. And that begins to spread throughout the body. So, with that, you're going to have chills, fever, headache, fatigue, pain, weakness or numbness in the arms and legs, vision changes, Lyme carditis, heart problems such as palpitations, chest pain; rash may appear on the body, may not; and you also get something that's called Bell's palsy, which is facial paralysis, where some patients think that they're having a stroke, but it's a second stage of Lyme.

The third stage is called the late disseminated Lyme disease. And if that's not treated on the first stage, and bypasses the first and second stage, then you're going to get the post-treatment chronic and neurologic Lyme. And that can occur weeks, months or even years after the bite. And it spreads throughout the body and the nervous system. Many patients develop chronic Lyme arthritis, as well as increase in neurological and cardiac symptoms. The more severe symptoms may include arthritis in large joints or near the point of infection, severe headaches or migraines, vertigo, dizziness; migrating pains that come and go in joints, tendons; stiff aching neck, chronic fatigue syndrome, sleep disturbances, insomnia and disturbance in heart rhythm, mental fogginess, concentration issues; numbness in the arms, legs, hands or feet; and problems following conversations and processing information.

Melanie Cole, MS: Wow. This is really a complex disease, isn't it? Tell us a little bit about how it's diagnosed. If somebody has all of these symptoms or a few of them, they could be many other things. And I know that, doctor, sometimes this could be something that's overlooked. So first of all, tell the listeners if they have any of these symptoms, if they know they've been bit, what kind of doctor? Do they go to their primary care physician? Who do they go see?

Dr Maryellen Benito: Yes. Your first step would be your primary care doctor. You tell them where you were when you started having these symptoms. If you had pets or no pets, if you were going through the beach or walking around an area that's wooded, and if they have any of these symptoms, definitely explain to them that, "This is where you were." And then, tell them, "You don't know if you've been bitten by a tick or not, but you have all these symptoms and you just want to be tested for Lyme disease or any other tick-borne illnesses because they also have some similar symptoms." But if they definitely have a rash, that bullseye rash, they definitely have Lyme. So, that would be automatically diagnosed as Lyme.

Melanie Cole, MS: So, what treatments are available? Are there treatments that are available? Because I've heard stories about people that have this for years going on. Tell us what do we do for people that are diagnosed with Lyme disease.

Dr Maryellen Benito: So if you definitely have the target lesion, for adults, there's several antibiotics you can use. The first line treatment though definitely is an antibiotic called doxycycline. With doxycycline, when you take it, you definitely want to take it with food. You definitely do not want to take it with any calcium or magnesium, either supplements or calcium-rich foods or magnesium-rich foods, because it can make it ineffective. If you have to take calcium or magnesium supplements, you have to take it at least two hours before taking the antibiotics or four hours after taking the antibiotic. Doxycycline also is definitely photosensitive on your skin. So when you go out in the sun, you can definitely get third degree burns. I've had patients where they would go on a sailboat and the doctor never told them that they can get the photosensitivity with the doxycycline, which is a problem. And they would come in with, you know, second to the third degree burns. So, the safest time to go out in the sun after taking doxycycline is about six hours after taking the first pill because you have to take it one in the morning and one at night. So, I would tell my patients to definitely wear sunscreen and cover themselves if they start feeling some tingling on their skin, stay away from the sun, cover up, especially when they're on the medication. So, usually, you take that for about 10 to 14 days for it.

And for children younger than eight, you can't do the doxycycline, you have to use amoxicillin. But they said that now they can take doxycycline for up to 21 days without the teeth staining. But usually for pregnant individuals or nursing individuals, they usually do the amoxicillin as a safer antibiotic.

Melanie Cole, MS: And what can we do for the symptoms that we're feeling from this? The fatigue and there's a lot of concern if you have Lyme disease, you get worried about things, but mostly that fatigue, the feeling of just not being well. As we get ready to wrap this up, Dr. Benito, give us your best advice about taking care of ourselves, checking ourselves, including under our socks, which is a place that I've found them and what we can do with those symptoms to help make ourselves feel just a little bit better.

Dr Maryellen Benito: So, you want to avoid tick-infested areas like the ones I described earlier. You want to wear light-colored clothing to spot the ticks more easily. Long-sleeved shirts tucked in at the waist, long pants tucked into the high socks, closed toe shoes, a hat with your hair tucked in if possible. You do not want to walk in the grass barefoot or in open sandals even if it's cut short, especially when there's definitely a lot of ticks around the area. You want to apply tick repellent such as DEET or picaridin insect repellent, insecticides such as permethrin on the clothing. What I tell my patients is to get the big bottle of permethrin, spray as much as you can, soak pretty much the clothing if they're planning to go hiking. Soak it, let it dry for about a couple of hours. It's actually good and could be in the garment for about a couple of washings. So, a lot of my hikers, that's what I tell them to do.

Definitely when you're done hiking, remove the clothing. Once you get home, put all the clothes into the dryer in high temperature for about 10 to 15 minutes to kill any other ticks. Don't put it in the wash and then put it in the dryer. That's not going to kill them. It's going to kill them when you put them in the dryer, so just put them straight into the dryer and that will definitely really kill them.

You want to examine yourself and your pets daily. If you feel any bumps, look at them. Don't just scratch it and think it's just a scab or like a crumb is on you. Really inspect that area. Look at it. You want to look in the back of the knees, the groins, the armpits, in and behind the ears, the belly button, the scalp. What I tell my patients that ticks love dark moist areas. So, think about all those parts on your body and check them. Definitely shower and bathe as soon as possible. And once you see that tick, you want to remove it quickly. Because the longer it stays in there, the more likely you're going to get the disease.

Melanie Cole, MS: How do you remove a tick, Dr. Benito? Because I know that people are worried that the head stays in. How do you remove a tick?

Dr Maryellen Benito: You need a fine-tipped tweezer. I know not everybody carries tweezers around, but it would be good to have it somewhere either in your car or in your bag to have, especially if you're planning to hike in areas that have a lot of ticks. You want to grasp the mouth parts as close to the skin, so where the tick's actually biting the skin, you want to take that forceps and pinch where the mouth parts are. And then, you pull up with a steady and even pressure. Don't twist it, don't jerk it, because the mouth parts can break off. But if you squeeze on the belly, not where the teeth is, you're injecting, if that tick's definitely infected with Lyme, into you. So, just remove it.

If the mouthparts stay inside, don't worry, your body will try to get rid of it because it's foreign. But as long as you get most of the tick out, that's what you really want to do. After that, you wash that area with warm water, liquid soap, you could put some rubbing alcohol if you want that. And then, put some ointment on it just to prevent any infection if you started digging even deeper to get some of the mouth parts in.

Melanie Cole, MS: Yeah. It's pretty intense too if you have to do that. I've had to do it quite a few times. So, you've given us a lot to think about and great advice, Dr. Benito. Thank you so much for joining us. And Weill Cornell Medicine continues to see our patients in person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Back To Health. We'd like to invite our audience to download, subscribe, rate and review Back To Health on Apple Podcasts, Spotify and Google Podcasts. And for more health tips, please visit weillcornell.org and search podcasts. And parents, don't forget to check out our Kids Health Cast. I'm Melanie Cole.

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