Ticks Bite!

Have you been laid low – yet – by this bloodsucker the size of a pinhead?

Australia, where I come from, is home to a startling array of exotic dangers.

Ten out of ten of the world’s most poisonous snakes live there. So do several species of deadly spiders. Other things that can kill you include several types of jellyfish, the pretty little blue-ringed octopus, and beautifully patterned cone shells. Also sharks, crocodiles, stonefish, stingrays, and a bird (yes, a bird): the giant flightless cassowary, which is quite capable of kicking you to death. There are stinging trees in the rainforest, scorpions and centipedes in the desert. Why, even the cute little platypus is not so cuddly; the males are armed with a poisonous spur that can cause excruciating pain for days or even months, a pain resistant to morphine and other pain relievers. This list is by no means comprehensive.

In almost fifty years of life there, I had encountered quite a few of these – snakes in the bush, redback spiders in the backyard, huge saltwater crocodiles in Kakadu National Park, octopuses and sharks while fishing, a stingray once while snorkeling on the Great Barrier Reef – but I had never been harmed by any of them.

How ironic, then, that within a few months of my move last year to what I thought a far more benign environment on Martha’s Vineyard, I should be laid low by a piece of local wildlife about the size of a pinhead. I was undressing for a shower one night and noticed a tiny black dot high on my rib cage on my left side. A deer tick. I removed it promptly.

About two weeks later, I started to get flu-like symptoms. It began one evening with a mild fever and a headache. Within twenty-four hours, I was as sick as I can ever recall. Bed-soaking night sweats, tremors, aches and pains all over.

I took myself to the doctor. I already thought I knew the problem, and after she listened to my story, so did she. The clincher was when she found the telltale bull’s-eye rash radiating out from the bite site. It was so classically symptomatic of Lyme disease that she summoned a trainee, who closely inspected the area adjacent to my embarrassingly sweaty and pungent left armpit. She was excited. “Can I get pictures?” she asked. I agreed on the proviso that my face would not be in the shot. I had become a case study.

I had also taken a big step on the road to becoming a Vineyarder. If there is an upside to contracting this mysterious, nasty disease, it is that it gives the new chum a point of connection with the locals. Just as you can always get a conversation happening with farmers by mentioning the weather, you can always bond with Vineyarders by mentioning Lyme.    

There is certainly plenty to talk about. The Health Conditions and Health Status Report of Martha’s Vineyard, produced last year, contained results from a 2003 survey in which 12.24 percent of people reported having been told by a doctor at some point in their lives that they had Lyme – and some multiple times. So, if you get two Vineyarders talking, there is a one-in-four chance one of them will have suffered it at least once. And there is virtually a 100 percent chance someone near and dear to them will have. That last figure is based on self-reporting, of course, which some might find statistically suspect. But the Vineyard health report also included statistics from the Massachusetts Department of Public Health on the incidence of actual, medically documented Lyme cases. They showed an inexorable rise virtually everywhere across the state over the five years from 2000 to 2004. The standout figures, though, came from Dukes County and Nantucket, which in 2004 stood at 340.3 and 525.2 new cases per 100,000 population, respectively. The next highest was Barnstable county, at 86.4.

It gets worse. State health figures for 2005, which were not available when the health report was produced, show the Vineyard overtaking Nantucket as the Lyme hot spot of America and probably the world, with 577.2 cases per 100,000. The stats are not in yet for last year, but there is no reason to believe they will be significantly different. Bear in mind, too, that many cases of suspected Lyme are treated but are not counted, because of the absence of positive test results or a rash. What we have here is an epidemic; some experts go so far as to call it a plague. And while the Vineyard is the worst-affected place, Lyme is now the most frequently reported vector-borne disease (meaning it’s spread by a host or agent) in the United States.

And the figures are all the more startling because only a decade ago, the disease was all but unknown here. In 1995, the public health department recorded just six cases; in 1996, it was five cases, and in 1997, eleven.

The evolution of Lyme

Indeed, there was no such thing, terminologically speaking, as Lyme disease before 1975, when several children in Connecticut developed symptoms that resembled those of juvenile rheumatoid arthritis. It was only then that the medical profession identified a “new” illness and named it after the place the kids lived. Later it was realized the vector that spread the disease was the deer tick, and later still, in 1982, the germ itself was identified and named – Borrelia burgdorferi. Scientists are still working to understand the whole Lyme puzzle, but the key pieces are the ticks and the animals on which they feed, which are primarily deer and white-footed mice.

So where did this disease come from? Dr. Sam Telford, an infectious diseases specialist and professor at Tufts University, has spent twenty-odd years trying to find out.

“We’ve searched the colonial literature pretty thoroughly,” he says. “There’s no indication that people in this part of the world were afflicted with this thing – which is fairly easy to recognize – whereas in Europe some elements of this disease were recognized as early as the 1880s. The rash itself was recognized there, and some of the symptoms, although the cause was not known.”

The science suggests, however, that Lyme and a couple of other nasty diseases with which it co-evolved (babesiosis and anaplasmosis, formerly called HGE or human granulocytic ehrlichiosis) have been hanging around in a sort of microbial gang (Dr. Telford calls them a “guild”) in this part of the world since before the Ice Age.

There are a variety of theories about why Lyme disease suddenly started infecting people in large numbers. Some blame global warming – incorrectly, because the bug actually needs cold in its life cycle. There is also a wonderfully detailed conspiracy theory relating to germ warfare experiments allegedly conducted by the military after World War II, involving ticks on Plum Island, which lies close to the town of Lyme. It is based on credible evidence that the Borrelia genus of bacteria – to which Lyme belongs – has been of interest to biological warfare researchers for many decades. Maybe it was a custom-made germ agent that got away.

The problem with that theory, though, is that Dr. Telford has shown that Borrelia burgdorferi was around in the environment in these parts long before the alleged bio-warfare experiments supposedly took place. And, more importantly, long before the Lyme epidemic began. One of the things he did for his doctoral thesis was trawl around museums, conducting analyses of the germs in their old specimens.

“I found mice from Cape Cod in the 1890s and ticks from Long Island in the 1940s that were carrying the [Lyme] bacteria,” he says. “So it was around in nature. It’s just that people weren’t meeting it very frequently.”

There were good reasons why people might not have had much contact with Lyme during the century or so before the disease was recognized. Most of the forests were cut down and most of the deer were gone. In the 1880s, around three-quarters of the land in New England was farmland; deer were virtually exterminated in much of the eastern United States by the 1930s. Then the new-fangled idea of wildlife protection began to spread, and farms in this part of the country were abandoned. Now about three-quarters of New England is again covered in trees. This pattern holds true for the Vineyard, which was formerly substantially deforested.

“It was when the forests grew back up again and we started protecting deer that the ticks came to numbers we’d never ever seen before. It reached some sort of threshold in the late 1960s, and we started seeing cases,” says Dr. Telford.

But the forests that exist now are not like the mature, old-growth ones that existed before. Old-growth forest is not actually the best deer, or tick, habitat. Deer thrive on forest margins: where there are trees enough to hide and open land enough to feed. And ticks like the dense scrub that thrives where there is no forest canopy to screen out the light. They like it moist – a humidity of about 85 percent is ideal – down among the leaf litter and thickets that
no longer get periodically cleaned up by fire.

“I sometimes think about the most useful thing that could be done on the Vineyard or Nantucket would be for someone to go up one of the big hills in April and drop a match,” says Dr. Telford.

He’s certainly not suggesting arson. But he believes controlled burns would be about the most effective single measure that could be taken. Fire was always a big part of the Island’s ecology, which used to burn regularly; many Island species, like the pitch pine, are adapted to it.

“But I fear that’s just never going to happen,” says Dr. Telford. “That’s a big social education problem we have in America. Sometime in the 1930s or ’40s, someone got it in their heads that forest fires were a bad thing. Kids grow up learning about Smokey the Bear. And we’ve never really questioned this, but it turns out that it’s dead wrong.”

The irony is exquisite: In creating a semi-rural idyll for people, by banishing natural fires, by providing new food sources for rodents in our fields, gardens, and compost bins, by curtailing hunting, and by maintaining a picturesque patchwork of fields and forest, we have also inadvertently created an idyll for ticks, their host animals, and the disease.

Treating Lyme

Borrelia burgdorferi, the bug that causes Lyme, is a particularly nasty and resilient kind of bacteria, although if detected early, it’s readily treated with antibiotics, or so the prevailing medical wisdom goes. I got a thirty-day course, and was feeling as good as new within forty-eight hours of taking the first pill. But some people claim that various manifestations of illness can persist years afterward: arthritic symptoms, memory problems, lassitude, et cetera. Dr. Telford, for one, cautions that it can be hard to make a firm link between current non-specific symptoms and a long-ago tick bite. People can feel the natural aging process and blame a long-ago tick bite. Medical opinion is divided though; about the best that can be said is that if treatment is prompt, it is usually effective.

The real problems start when it is not treated promptly, and it is not always easy to diagnose Lyme. Not everyone gets a rash, and the initial symptoms are flu-like. If there is one good thing about the prevalence of Lyme on the Vineyard, it is that medical authorities here are always on the lookout for it and are not reluctant to begin treatment on suspicion. Because if the disease goes untreated for any length of time, it can become a health nightmare.

Lyme is caused by a spiral-shaped organism called a spirochete (the best-known spirochete causes syphilis), which can disseminate widely throughout the body. It reproduces relatively slowly, which sounds like a good thing until you realize that antibiotics are most effective in destroying bacteria in the process of reproducing. That is why Lyme sufferers are prescribed long courses of antibiotics.

Wherever the blood goes, Lyme goes, and it can penetrate deeply into places where antibiotics and the immune system may not be able to effectively combat it. It affects a wide variety of organs and systems – the nerves, the heart, the brain. About 60 percent of people with untreated Lyme get arthritis, usually in the elbows, knees, or wrists. Ten to 20 percent get nervous system problems, including meningitis (an inflammation of the membranes covering the brain and spinal cord); facial paralysis (Bell’s palsy) or other problems with the nerves of the head; and weakness, pain, or both in the hands, arms, feet, and legs.

About 8 percent have heart problems, often a slowing of the pulse, which can cause fainting. A small number of sufferers have eye problems like photophobia. The spirochetes can cross the placenta, possibly resulting in stillbirth. The bug also has been detected in both breast milk and semen, but there is no evidence that it has been transmitted by these routes. A wide variety of mental conditions also are associated with chronic Lyme:

depression, anxiety, schizophrenic-like psychosis, bipolar disorder, memory deficit, disorientation, and obsessive behavior. The Vineyard, interestingly, has high levels of depression, and many people believe this could be related to the prevalence of Lyme.

For a case study of what happens with untreated Lyme, consider the story of longtime Vineyard resident Kib Bramhall, who came down with Lyme in 1978, before the disease had been documented on the Island.

“The initial symptoms were lassitude, fever, pain in the neck, various neurological symptoms,” he recalls. “I went to the hospital and they didn’t know what it was, and I went home. A couple of days later, the fever was so bad and it was just so awful that my wife took me back. By that stage, I had the classic bull’s-eye rash on my leg. The entire medical staff gathered round and looked at this doughnut thing on my leg. They thought maybe it was the bite of a recluse spider. They didn’t know how to treat it, so I left again.”

About ten days later, Kib saw an article in The New York Times, describing this new disease. He says, “The symptoms matched me absolutely.”

Kib contacted Dr. Allen Steere at Yale – the man who first identified the disease in those Connecticut children.

“He diagnosed me by phone, but of course they had no idea then that it was a bacteria,” Kib says. “A couple of months later, arthritis set in my joints, particularly my knees, one at a time, which blew up in size. It made it difficult to walk and even sleep, the pain was so bad.”

Kib promptly went to Massachusetts General Hospital in Boston, but the doctors didn’t know how to treat him. “I was advised to take up to twenty-eight aspirin a day, or until my ears started ringing, and to take it easy, not to stress my joints,” he says. “I did that for a while, and then they discovered that by aspirating my knees, they could drain the fluid out. They did that, and with steroid shots they made me mobile with crutches. For a couple of years, I spent about 40 percent of my time on crutches. I never was given any antibiotics. My heart stopped twice. At MGH, the doctor there said, well, you know, the heart bone’s connected to the knee bone. Basically, my immune system battled this disease for about fifteen years before it won” – meaning the arthritic episodes became occasional, maybe once a year.

“That sort of thing went on until last year,” Kib says, “when my present doctor heard late-term Lyme could be cured by a thirty-day regimen of antibiotics – Doxycycline. I haven’t had any problems since.”

Like many doctors, Kib did not really believe antibiotics could do him any good so late in the progression of the disease. With some understatement, Kib describes the treatment for chronic Lyme as “pretty controversial.” In fact, there continues to be raging disagreement within the health community about whether long-term antibiotic treatment of chronic Lyme does any good.

Avoiding ticks, preventing Lyme

If the prospects of a cure for Lyme are uncertain, so are those for inoculation. There was a vaccine, called LYMErix, approved by the U.S. Food and Drug Administration in 1998, but it was withdrawn from the market in 2002, allegedly because of poor sales.

For the foreseeable future, prevention seems the only answer. And the standard advice is obvious, really. When you’re in woody or grassy areas, cover up. Tuck your pants into your socks; wear long sleeves and a hat. Apply repellent. Wear pale colors on which the tiny black dots of ticks will be visible. Check yourself, your kids, and pets regularly. If you find and properly remove a tick within the first day or so, the chances of getting Lyme are much reduced.
This is because the bacteria do not immediately pass from the tick to its host; they remain dormant until after it starts to feed. It takes around 24 to 48 hours before the bacteria become active and pass up through the tick’s digestive system and into your bloodstream. That’s why it is also important to remove the tick as gently as possible. It’s actually less dangerous to leave the tick’s mouthparts in you than to squeeze its body and possibly “inject” the contents of its gut into you. Swab the bite site with antiseptic.

Other measures? As already mentioned, ticks like damp places. They dry out quickly if exposed to the sun, so a well-manicured lawn is a good defense. Guinea fowl eat ticks, so some people keep flocks of them. One Island artist, Bill McLane, says he has protected himself while out painting a landscape by winding gaffer tape, sticky side out, around his legs.

You can take steps to ensure your home has no inviting hiding places or food sources around to attract mice. You can also buy “tick tubes” and leave them around in the undergrowth. These contain cotton balls that have been soaked in permethrin, an insecticide that is of low toxicity to people, pets, and mice. The mice then use the cotton for nesting material, which kills the ticks. Damminix tubes can be found on the Internet; they cost about $80 for 24 tubes, enough to treat a half-acre.

Other measures which could help control the plague include applying the tick-tube principle on a grander scale – setting up feeding stations, where deer are attracted to food baits placed in such a way that the animals are brushed with pesticide as they eat. They have been experimented with at several dozen sites on the Cape and Islands over the past few years, with some success. But they don’t come cheap – certainly not cheap enough for household use. In 2005, 19 sites on Martha’s Vineyard used 12,700 pounds of corn bait and 359 pounds of permethrin. Last year the deer hunting season was extended a week in the hope of more sharply reducing the deer population. It was a limited success. There have also been several attempts, so far unsuccessful, at biological control of ticks through the introduction of a parasitic wasp.

And the idea of inoculation – not against Lyme itself but against ticks – still has prospects, says Dr. Telford, who has never had Lyme, despite innumerable tick bites over the years from “crawling around in the bushes” on the Vineyard, Nantucket, and elsewhere.

“I consider myself vaccinated, in that I’ve been bitten so many times that I know immediately when they’re on me, because I start to itch,” he says. “I’ve developed an allergic reaction, so I know they are there, and I pull them right out. One of the hot new areas of research is to find an anti-tick vaccine.”
Yet these partial solutions and prospective solutions really don’t go very far toward addressing the basic cause of the problem, which is that a natural
balance has been upset here, resulting in too many deer, too many mice, and too many ticks.

There are two obvious answers to the problem; let’s put them bluntly. We’ve got to cull Bambi, and light a fire under Smokey the Bear. Now, I know those suggestions will make some people uncomfortable, but not nearly as uncomfortable as a dose of Lyme.