Several times this summer, people calling for help have told me that doctors in Ohio have told them �You can�t get Lyme disease in Ohio.� When patients tried to correct these physicians, the doctors didn�t want to hear that they were mistaken, and insisted they were correct.
Here are some data from the Centers for Disease Control (CDC), based on reported cases since 1990. .
You will see that Ohio ranks 16th in the country for total cases, and ranked 18th for 1999. The CDC also says that because Lyme disease is so underdiagnosed and underreported, the numbers should be multiplied by 10 to estimate the real numbers. The final numbers for 2000 have not been reported.
The Vector-borne Disease Unit (VBDU)of the Ohio State Department of health is careful to follow up on every reported case. Not all of them fit the strict epidemiological definition set by the CDC, or are rejected for other reasons. As of last summer, 620 Ohio cases were accepted by the CDC since Ohio began reporting in 1984.
If you have been diagnosed with Lyme disease, you should check to see if your doctor has reported your case to the VBDU.
| - | - | (since 1990) |
| U.S.Total | 16,273 | 122,651 |
| 1. New York | 4,402 | 40,762 |
| 2. Connecticut | 3,215 | 20,634 |
| 3. Pennsylvania | 2,781 | 17,072 |
| 4. New Jersey | 1,719 | 14,560 |
| 5. Wisconsin | 490 | 4,488 |
| 6. North Carolina | 74 | 4,711 |
| 7. Maryland | 899 | 4,177 |
| 8. Rhode Island | 546 | 3,917 |
| 9. Massachusetts | 787 | 3,287 |
| 10. Minnesota | 283 | 1,959 |
| 11. California | 139 | 1,619 |
| 12. Delaware | 167 | 1,177 |
| 13. Virginia | 122 | 1,003 |
| 14. Missouri | 72 | 989 |
| 15. Texas | 72 | 656 |
| 15. Florida | 59 | - |
| 15. Tennessee | 59 | - |
| 16. Ohio | 47 | 451 |
When your doctor says �You can�t have Lyme disease in Ohio,� show her or him this article.
This issue features three cases of guys from the midwest, all deserving our thoughts and best wishes and thanks for their willingness to share their experiences with us.
My Battle with Lyme Disease
By Indiana Conservation Officer, Tom Williams
I was the normal Indiana Conservation Officer that loved the outdoors and liked to keep the bad guys guessing, hunt, fish, find and eat wild mushrooms, and I love the game of golf. I am 55 years old and have been a Conservation Officer for more than 26 years. In the fall of 1998 I was playing the best golf of my life and got my handicap down to a 10. I was looking forward to retirement in a few years and pursuing my hobbies and playing with my grandchildren. In the spring of 1999 the Division advised us that they were offering us free
Lyme disease shots to protect us from the disease. This was a vaccine called LYMErix, marketed by the company, SmithKline Beecham Pharmaceuticals. We were told the shots were safe and would protect us
from getting the disease the rest of our lives. We were to get three shots of vaccine. The second shot one month after the first shot and the third shot 12 months after the first. If I had known then just a couple of simple honest truths about the risks involved, I would have never agreed to take the vaccine. If I had known the partial protection would only last 1 to 2 years, or that the vaccine had caused severe arthritis in hamsters, or if you had a gene called HLA-DR4, it could theoretically give you an untreatable auto immune form of arthritis, or that law suits had been filed from trial participants, I would have passed. I had never known any Officer with Lyme disease.
I got my first shot the end June and got along fine with just a little soreness in my arm. I got my second shot on 8-3-99. My arm became very sore and about a week later I noticed a very sore spot under my left armpit. I thought that I must have bruised it, but I could not remember how. After about 10 days without any decrease in the soreness, I became concerned and made a doctors appointment. I had a chest x-ray that came back normal and the sore spot finally went away.
In September I was checking fishermen and stepped up on a 3-foot seawall and had a severe shooting pain in my left hip joint and my left leg nearly collapsed. �What was that�, I remember thinking. This pain in my hip was a sharp, almost nauseating pain and only occurred when I made unusal twists or turns or tried to put my full weight on it. I learned real quick not to make sharp turns going through door ways.
On September 7 and 8 I went to see my chiropractor because my lower back and left hip felt out of place. He commented that the muscles around my hips seemed weak.
About this same time I developed a case of tennis elbow in my left elbow. In late September I was shaving and my neck cracked so violently it concerned me. The cracking and crunching in my neck became worse in the following weeks. My right knee would pop or jump, and felt like it was trying to dislocate sometimes when I would push back from the table. I noticed almost constant ringing in my ears and commented to a friend and my wife about it. Strange little white mouth ulcers began to appear for no apparent reason. They would last a few days and then heal up. I had become increasingly absent minded and was having trouble concentrating.
By October 5 both hips hurt and my legs were starting to feel weak with some muscle aches. On two occasions in September and October I was outside and bent over for some reason I saw colored bands of bright light in the peripheral vision of my left eye. Migraine headaches and a nauseous feeling followed both episodes. In November as cold weather arrived I noticed that I got chilled very easily and it was hard to get warm. When I went hunting I noticed that I tired easily, got cold, and was somewhat short of breath.
In early December my hamstrings started to ache, usually of an evening. I commented to my wife that I thought something was really wrong with me. I had started to notice a strange click in my throat when I swallowed that had never been there before. On December 14th, I went to my family doctor for a physical and x-rays of both hips and my lower back. They were normal. I was started on an anti-inflammatory drug but by January 2000 I was not any better and was starting to feel run down and flu like. My doctor referred me to an orthopedic doctor and on January 11, a MRI was done of my left hip. The results were normal and I was referred for physical therapy and I had my first session on January 26, 2000. I felt really run down in the P.M. after this work out.
On January 29 I took a sick day as I felt weak, flu like, my legs ached, my hips hurt and I had chills but no fever. I did not feel much better the following day, super bowl Sunday, January 30,2000. My thighs and hamstrings had been hurting and aching all evening and just as the super bowl ended the muscles in the top of my thighs began jumping up and down. I had on sweat pants and you could see them jumping from the muscle twitches. I told my wife to come and look and I told her I thought something was wrong with my nervous system. I had my wife run a hot tub of water and I sat in the hot water. Some of the muscle twitches had moved into my chest and upper arms. The twitches or spasms subsided and I went to bed after we agreed to call the doctor the first thing in the morning. I did not sleep well as had been the case lately.
January 31, 2000 began the parade of doctors and tests to try and figure out what was wrong with me. In the weeks and months to come I would literally endure a nightmare. The aching in my legs would not only get worse but they started burning and tingling as well. I would chill and huddle under the covers and felt like I had the worst case of flu ever, only I had no fever. I had no appetite and my throat felt tight and I began to have difficulty swallowing. I felt so bad that it was all I could muster to get up to go to see the doctor. My wife said I had a wild look in my eyes and I could not sleep without medication. I was started on calcium, sleeping pills, an anti-inflammatory, and an anti depressant.
I had an MRI of the head to test for MS and another of the lower back. I had blood and urine tests for Lupus and other possibilities.
Around the third week of February my stomach started bloating and I belched and burped whenever I sat up or stood up. My family doctor told me it was anxiety. I found out later that I had candida, or a severe yeast infection in my digestive tract. I had almost constant diarrhea and had to take Immodium often. The ringing in my ears became more of a grain auger or locusts in the trees noise. Loud noises would bother me, especially the telephone and doorbell.
On February 29, 2000 I became photophobic. I could not stand to look at bright lights and I had started to question my sanity. Was I going insane? I still had no clue as to what was wrong with me except I knew something was very wrong. I considered Lyme Disease but dismissed the idea, as I thought it was strictly an arthritis disease. I became hyper sensitive in all of my senses. I was now using earplugs and only used about 25 percent of the normal volume on the TV. Loud voices, dishes clinking, the dog barking and other similar noises would make me cringe. I could smell odors I never smelled before. The one bright spot I had was that food tasted wonderful, due to a heightened sense of taste. The eyes were getting worse daily and we covered all the windows and changed all the light bulbs to 25 watt. I still had trouble with 25-watt bulbs being too bright and had to shield my eyes with my hand or a strip of dark cloth. Shoes hurt my feet and my wrist watch hurt my wrist, and I wore loose fitting clothes. I had neuropathy. Neuropathy is weakness or pain in the hands or feet as a result of nerve interruption between the nerve endings and the brain or spinal cord. I could not turn on a lamp or open a can of soda without pain in my fingers.
March 6, 2000, was the worst day of my life. It was a bright sunny day and I had to go to Indianapolis to see a specialist at the I. U. medical center. By now I could not stand any light. I put on a pair of tanning booth goggles, then a pair of wrap around sunglasses, and then draped a dark towel over my head. When I was outside the sunlight coming in around the edge of the glasses was like someone shinning a bright spotlight in my eyes. I also had earplugs in my ears. I was led around by the arm like a blind man when I was outside. I saw 2 doctors and they interviewed and examined me. They approached me with great care as if I might be a psychopath. They told me they were sure that I didn�t have ALS. (Lou Gerrigs Disease) They told me to get my eyes checked ASAP. Phone calls were made and I was off to another city to see the eye doctor.
This doctor was very understanding and professional. After the exam he asked me if I had checked into Lyme disease. I told him no, but I had 2 Lyme vaccine shots the summer before. He thought this was very interesting and suggested I see a doctor about getting tested for Lyme disease. He prescribed steroid eye drops and I went home exhausted but somewhat relieved that I didn�t have Lou Gehrigs disease.
Two days later I received two books on Lyme Disease by Fed X from a relative. When I came to the list of Lyme symptoms I am sure that my mouth dropped open. After counting them up I had 28 symptoms of Lyme disease. On March 9, I had blood drawn by my family doctor for a western blot Lyme test. I began reading up on Lyme and contacted a relative about doing some Internet searches, since we didn�t have a computer. Reading was difficult because of the floaters, the little germ looking things that sometimes float around in your vision. They were so bad that that the words sometimes looked like they were swimming.
He called on March 12 and asked me if I knew that SmithKline Beecham was being sued for causing untreatable autoimmune arthritis and other adverse reactions to LYMErix. On March 13, I had a lumbar puncture or spinal tap by my neurologist. I was now sure after thinking back, that my problems stemmed from the LYMErix vaccine.
This was a very trying time as I felt so cold that night like all the blood had been drained from my body. I lay in bed with 5 covers on me as well as heating pads on my legs and thought I would never get warm. I had to be in almost totally dark conditions and I used a penlight to brush my teeth. It took all of my will power to get up and take a shower and the water hurt my skin like hailstones. I had muscle twitches in my buttocks, legs, arms, and face. I developed pounding headaches whenever I got up.
The depression was terrible. I spent 3 days and nights in bed feeling like I was going to die. I felt like I always thought it would feel like to have AIDS. I had lost considerable weight, about 20 pounds, and none of my clothes fit. My wristwatch didn�t fit and hurt my wrist anyway. My wedding ring was loose and I was afraid it would fall off my finger, but I refused to take it off. It was like my whole body was shriveling up.
I feared that I might have some untreatable autoimmune disease. I had a speckled rash under the skin of the palms of both hands that had never been there before. and purplish nail beds. I told my wife that I never knew it was possible to feel this terrible and I could not have dreamed of a worse nightmare. I was shocked when both Lyme tests came back negative.
Not much changed in the next 2 weeks. I had HLA gene testing done and learned that I had the HLA-DR4 gene. I saw an infectious disease doctor who reviewed my reports and said he didn�t think I had Lyme disease. Everything I had read so far said �Lyme disease must be a clinical diagnoses�. How can a person have almost every symptom in the book of Lyme disease and a highly reputable doctor says no, I don�t think you have Lyme disease.
And so began my education of the unfair, uneducated, political, and shameful treatment of Lyme patients in the United States and the world. It is now the first of April and my throat is red and has ugly white spots and my gums are swollen. I am started on Amoxicillin for a sinus infection and get an appointment made to see a Lyme literate medical doctor on the East Coast. It had been agreed that this was the best move by my family doctor and my neurologist. The trip was miserable to say the least, especially going through the mountains of Pennsylvania, as I would have stabbing pains in my ears from the pressure changes. I could not drive, as my eyes were still far too light sensitive. My wife drove the whole way.
The doctor was very professional and took more blood and urine for more tests. This doctor explained that false negatives for Lyme Disease are very common and their lab was very accurate. I was advised that it was possible that I could have a Lyme like illness caused by the LYMErix vaccine and it might not be treatable. We would have to wait and see the results of the tests. The prospect of having a terrible untreatable illness was pretty terrifying and the wait would be agonizing.
I learned of a highly regarded Lyme doctor much closer to me and decided to make an appointment. This doctor made a clinical diagnoses of Lyme disease and ordered more tests including a gall bladder ultra sound and a brain scan.
I bought a welders mask and used it whenever I went outside in the sun. I had a mouth ulcer nearly the size of an almond at the base of my tongue that hurt so badly I could not talk or eat for several days. A new ulcer would pop up every 10 days or so and they made my life even more miserable. The disease causes severe depression and mine was bad. The hours and days dragged on and sometimes it became my goal to just get through the day.
The second western blot tests finally came back with 7 positive bands, an unquestionable active Lyme infection, undoubtedly exacerbated by the vaccine. I was elated because at least I had a disease that I could fight. I had probably been previously infected with the Lyme disease bacteria and it was apparently dormant at the time of my vaccination. The next year of my life has been devoted almost solely to the combat of severe Lyme disease.
I have a lot of pain and stiffness in my hands. A lot of the neurological symptoms have gradually subsided and my eye and ear sensitivity is nearly normal as I write this more than a year later. I still have a lot of burning and tingling in my knees and lower legs and a spot in my neck. At times my knees would burn like there was liquid fire in them. My jaw would ache and I developed TMJ but it is better now. My hips still hurt and the muscles in the hips and legs are weak and I have difficulty rising from a chair without using my hands. My muscles have atrophied pretty badly and my stamina is at best 50 % of what I could do before. I had a MRI of the throat, which showed a small mass at the base of my tongue. I had a biopsy done and held my breath to see if the results were cancerous. It was benign and likely the Lyme caused the swollen tissue.
I bought a computer and have learned much about Lyme disease and of the hundreds of other people whose lives have been turned upside down by Lyme disease and a vaccine that was said to be safe. Many Doctors and researchers are calling the vaccine �too reactive�, and are asking for a recall, or for the FDA to withdraw their approval. I have learned that for every known case of Lyme disease, there is someone walking around infected and doesn�t know it. Many people on the East coast had battled Lyme Disease and won, and jumped at the chance to be vaccinated, only to have the disease come back worse than before. I have learned that big money drug companies don�t really care if they wreck lives, just if they make money. I would not recommend that anyone In Indiana take LYMErix vaccine unless you are tested for Lyme and the HLA gene first!
I have learned that people don�t understand how a person can look good and feel terrible. I have learned that doctors across this nation are divided in the way they view and treat Lyme Disease. My doctor has had Lyme disease and understands how it makes me feel and the long-term fight to try and eradicate it, or at least control it. Medical licensing boards are actually persecuting some East Coast doctors over treatment of chronic Lyme Disease with antibiotics. This is an outrage, as these doctors are honestly following their Hippocratic Oath.
The Lyme bacteria, or spirochetes, have a knack of getting into cartilage and tendons and camouflaging themselves to avoid antibiotics. I get windows of several days where I feel better and then I start feeling bad again. I have lost large amounts of energy, enthusiasm, and athletic ability to do the things that I enjoy to this disease. I only have memories of days without pain. I have also lost peace of mind, confidence, and the opportunity to enjoy a day or a meal without pills. I currently don�t have the strength or stamina to do my former job and I have lost large amounts of money, because of it.
In conclusion, I have to say I am a victim of American corporate greed. There was a race to get the first Lyme vaccine on the market. Warning signs were overlooked and I believe figures were manipulated to make the performance of LYMErix look much better than it really was. The protests of many researchers and doctors went unheard and these concerns were legion. When the head study doctor refuses to take his own vaccine, that speaks volumes, and yet he had no concerns about giving it to the general public? I feel that my immune system was good and had fought off Lyme until I took LYMErix.
I know that Lymerix has diminished the quality of my life tremendously for the last two years and I am afraid it is permanent. I have pain as a constant companion now. My hands are so stiff I can barely close my fingers when I get up in the morning. My energy level is so poor I am sometimes amazed when I think of all the things I did just two years ago. All I can do is hope and pray that I will get better as time passes.
RANTOUL � Danne Buchanan of Rantoul walks with a noticeable limp, suffers from constant fatigue, his eyes are highly sensitive to sunlight and his body twitches.
That is a far cry from the man who five years ago could run 20 miles with 60 pounds of military gear on his back. Buchanan is showing the effects of osteoporosis and Lyme disease he says he contracted in the Marine Corps in 1994.
The disease, which claims muscle and joint pain, energy loss and fevers as some of its symptoms, is spread by bites from deer ticks.
The day he was infected with Lyme started out normally.
He was out patrolling on a training mission at Fort Bragg, N.C., and Buchanan, 34, didn�t notice it until he got home the next day. He saw the bite and removed the tick from his arm with tweezers. Several days later, he felt sick.
�I didn�t think anything of the bite at first, but I started coming down with flu-like symptoms and something didn�t feel right,� Buchanan said.
The bite started as a small red circle, then spread outward, becoming white in the center and spanning five inches. He was admitted to a naval hospital and stayed for 20 days while doctors gave him antibiotics. The upper east coast is known for bouts of Lyme, but North Carolina displays only moderate cases, according to the Centers for Disease Control.
After the pain remained, Buchanan asked for further treatment.
Instead of getting support from the military he always wanted to join, he said, the Marines turned their back on him.
�They said life could be made very difficult on me if I kept asking for any more medication,� he said. �I felt like I was betrayed.� Military officials did not return calls seeking comment.
Buchanan took his case to the Department of Veterans Affairs last November, seeking a chance for full disability for Lyme and degenerative arthritis to his knees, an ailment also caused from military action, according to Buchanan. The response fell well short of his expectations.
In May, the VA Ratings Board sent a letter to Buchanan assigning him a 10 percent service-connected disability rate or $101 a month.
But intravenous medicine alone for six weeks cost double that amount.
Ten percent means the board agreed there was painful or limited motion of a major or group of minor joints, according to VA reports. It�s the most common level of disability for veterans, with more than 853,000 people. VA reports state a 20 percent evaluation was not warranted because Buchanan didn�t have two or more major or minor incapacitating joints.
The percentage given for each case is set by law depending on the injury, not the extent of the person�s disability. Nationally, Lyme accounts for 114 out of 2.3 million veterans� cases, according to the VA public affairs office. Any adjustments to the rates are based on whether there are loss of limbs, veterans who need constant assistance eating and bathing or service-related injuries that render employment impossible.
Buchanan said the amount the VA gave him hardly covers the $15,000 in medical costs for more than five different medications he has taken since leaving the military. He tries to take care of the bills a little at a time, but some remain unpaid.
Carl Henderson, spokesmen for the VA in Chicago, said two steps are involved in determining the disability payment. First, the organization examines the individual�s service records to determine if the injury was a result of active duty. Then the ex-soldier undergoes examination by VA doctors on the extent of the injury. Though Henderson wouldn�t talk directly about Buchanan�s case, he said the system is as objective as possible. Henderson said the evaluation never takes liability � whether the soldier caused the illness � into account and only focuses on giving veterans benefits for service-related injuries.
Through outpatient treatment reports, his service medical records from May 20, 1994, to Feb. 2, 1999, and VA examinations, Buchanan received the 10 percent compensation for Lyme, but the department rejected his arguments of adjustment disorder and arthritis. The military claims the knee injury is not service-related, according to the ratings board.
�How many 34-year-old people complain about having osteoporosis?� Buchanan said. �How can you not see the daily weight I carried on my back in the Marines and not connect it to my bad knees?�
The department allows every veteran to request an appeal within a year of receiving the original decision by writing a letter to the appellate board. The board takes up to 205 days to reassess the appeal, according to the VA public affairs office in Washington, D.C.
Buchanan didn�t appeal because he said he didn�t want to go through the same process that took more than six months and possibly be disappointed again.
After he received an honorable discharge on Feb. 5, 1999, Buchanan set his sights on being a cop as another way to serve his country. However, the Las Vegas police department saw his military records and he was denied a job, Buchanan said.
A sudden halt for a man who thought he would be in the military for 30 years.
Hungry to live out his life�s dream of defending his country after reading books about soldiers� bravery in war, he began his military career in the Marine Corps on April 9, 1991. Two years later, he joined reconnaissance school.
Like the Army Rangers or the Navy Seals, Recon is voluntary and each cadet can drop out at any time. Buchanan successfully completed the nine-week course, which included a �hell week� of running six miles a day and not sleeping until �they break you,� he said. Buchanan said he used his strong wide-framed body on training missions to his advantage over smaller but quicker soldiers.
�For a guy my size it was great to make it through the program because the next biggest guy to me was 190 pounds,� said Buchanan, who weighed 260 pounds after graduating.
He received Good Conduct Medals and awards as a sergeant for his technical work as a leader for the Marines. But now, there are obvious signs that his ailments have taken a toll on the former commanding officer.
The 6-foot 5-inch, 300-pound man, who used to carry those 190-pound soldiers on his back during Recon missions, struggles to pick up his 5-year-old daughter Danielle, and on some days walks with a cane. More severe cases of chronic neurologic problems have placed those afflicted with Lyme into wheelchairs, according to Dr. Joyce Beitel of Carle Clinic.
The summer months have become more of a painful annoyance than restful pleasure. He wears protective sunglasses to shield his eyes.
Buchanan tried not to let these obstacles stop him.
He drove trucks for Creek Carrier in Lincoln, Neb., for a couple of years, a job made more difficult because he had to drive hours without taking medication that might make him drowsy. Buchanan missed numerous days of work due to doctor appointments and sickness. He went from earning $1,000 a week to $250 because he worked so few hours.
Buchanan�s next step was looking to the government for help. He went to U.S. Rep. Tim Johnson, R-Urbana, with his hopes hinging on at least getting 20 percent of disability, which would qualify him for educational funding to receive training for a new job. That would pay for him to go to school and choose another career. Matt Bisbee, press secretary for Johnson, said the office is looking into his complaint.
Buchanan said waiting is the hardest part. But few things have been easy the last seven years.
�I just want a chance to prove to people how Lyme can just tear at your life, and move toward fully supporting my family,� he said.
|
Quote of the Month Knowledge is power.
- Thomas Hobbes |
Working for the ODNR Division of Wildlife is much like being part of a large, extended family�when some one hurts we all hurt, and respond. Eight-year-old Hayden Banbury, the son of Trumbull County Wildlife Officer Brian Banbury, contracted Lyme Disease four years ago and has struggled with its effects ever since.
�One minute he�ll be running laps around the house like any normal young boy, and the next I�ll have to carry him inside,� Brian said.
A benefit dinner was held in Hayden�s honor a year ago. Division of Wildlife employees and sportsmen raised $50,000 to help pay for Hayden�s many medical expenses not covered by insurance. Today, Hayden is doing better, but could suffer recurring symptoms of the disease for years.
Photo Caption: Eight-year-old Hayden Banbury often shows no signs of the Lyme disease that he contracted four years ago. However, his father, Turmbull County Wildlife Officer Brian Banbury, knows only too well that Hayden�s severe, flu-like symptoms may reoccur at any time.
Outdoorsmen and women should be aware that Lyme disease is transmitted to humans by the deer tick, as small in size as the period at the end of this sentence. A total of 620 cases of Lyme Disease was reported in Ohio from 1984 through 1999. The disease gets its name from the place where it was first recognized in 1975, Lyme Connecticut.
�It is the fastest-growing infectious disease in the United States,� said Ann Hirschberg, coordinator of the Greater Cleveland Lyme Disease Support Group. �Found in all 50 states and around the world, more than 150,000 cases have been reported nationwide. The Centers for Disease Control estimates the real number of cases is at least 10 times those reported.� she said.
Lyme disease produces flu-like symptoms at first, which gradually become much worse. In some people a �bulls-eye� rash occurs at the site of the tick bite. Although its symptoms can mimic those of other diseases, Lyme disease is treated with antibiotics and is not known to be contagious. Prompt diagnosis and treatment are most important in stopping the disease before it spreads throughout the body.
How can you protect yourself from Lyme disease while outdoors? Here are some suggestions from the Ohio Department of Health:
� Use an insect repellent on your clothing containing 245%-35% DEET
� Wear long pants and tuck the pants� legs into your socks. Light colored clothing makes it easier to spot ticks.
� Check for ticks often while outdoors. Crawling ticks (ticks not yet attached to your skin) can simply be brushed off.
Ticks can be killed by heat. Once home, remove your clothes and put them in a dryer at high heat for half an hour.
How to Remove an Attached Tick
If you do find a tick attached to your skin, don�t panic. Hurriedly jerking the pest off of you may leave its mouthparts imbedded in your skin. Instead, firmly grasp the tick by the head with a pair of tweezers, as close to the skin as possible. Avoid squeezing the tick�s abdomen and pull straight out, don�t twist. Save the tick in a sealable plastic bag for identification. Clean the bite area with antiseptic. Wash your hands thoroughly and then check with a physician.
(Note: Live ticks removed from a person will be identified and tested by the Vector-borne Disease Unit of the Ohio Department of Health, telephone: 614-752-1029.)
LDAOhio, headed by President Carol Long, has a new newsletter, �Lyme Lync� available to members. Please join LDAOhio. Call 614-475-8960 or e-mail [email protected] for more information. Ohio needs this strong statewide voice.
Pamphlets and tick cards were handed out and tick removers were sold at the �Dog Days� event at the Cleveland Museum of Natural History
The Dayton Daily News June 17 article, �`Lyme baffles doctors� by Kevin Lamb featured Dottie Hammersley, her mom Barbara and Debbie Parrett. Great work !
A very big �Thank You� to all the veterinarians and wildlife rehabilitators who participated in the GCLDSG Tick Study. The study will be completed by the end of September.
The heightened worldwide recognition of the health burden of tickborne infection derives largely from the increasing incidence of Lyme disease, human babesiosis, and human granulocytic ehrlichiosis, both individually and in concert. Because these infections share the same rodent reservoir and tick vector hosts, they can be cotransmitted to human hosts. Indeed, human coinfections involving various combinations of these pathogens are common, and some tend to be particularly severe. Diagnostic procedures and clinical management of the resulting disease syndrome is rendered complex by the diversity of pathogens involved and by the unusual diversity and duration of symptoms.
Press release - August 17, 2001
NEW YORK, August 15 - The Medical Society of the State of New York (MSSNY), on behalf of its 27,000 member physicians, today is filing six separate legal actions against six of the largest managed care insurance carriers in New York. The actions are being filed in New York State Supreme Court and request injunctive relief from a series of destructive, ongoing practices by managed care insurance carriers.
In addition, six class action lawsuits are also being filed on behalf of individual physician members of MSSNY - against the same six managed care insurance carriers - seeking monetary damages for the alleged abusive practices.
The suits brought against Aetna, Cigna, Empire Blue Cross/Blue Shield, Excellus, Oxford and United HealthCare claim that the companies systematically harm both patients and physicians by systematically engaging in illegal practices and routinely breaching the terms of contracts with physicians. The six firms control almost half of the managed care contracts in New York.
The suits specifically point to the insurance carriers� continual arbitrary denial of medically necessary care, capricious reductions in reimbursement claims, subjective downcoding and bundling of claims, as well as utilization of computer programs that deny claims based on arbitrary guidelines.
In addition, the suits point to the failure of the carriers to provide adequate staffing for the volume of claims being submitted and to their failure to provide information to physicians about how claims decisions are made.
Commenting on the legal action, MSSNY President Robert Bonvino, MD, from Staten Island, called the legal action �the culmination of years of intransigence by the managed care insurance carriers and their utter disregard for the rights of the patients and physicians. It is a sad comment on the way these insurance carriers conduct business,� Dr. Bonvino said, �that we have to go to the court system to force them to live up to their obligations. However, our patients can be assured of continuity of quality medical care only if we address the balance of interests between profit-focused carriers and medically necessary physician decisions. The continued intrusion of insurance bureaucrats in the patient-physician relationship is destructive and must be stopped.�
Former MSSNY President and Rochester, NY, orthopedic surgeon William A. Dolan, MD, said the efforts over the years to seek redress through legislative and regulatory actions have failed to abate managed care abuses. �Every physician in New York State has a story to tell about managed care companies and their casual disregard for both the needs of patients and their contractual obligations to physicians. This series of legal actions is unfortunate but necessary because managed care insurance carriers have taken the position that second-guessing physicians is a business tool for cost control. This has to stop.�
The lawsuits being filed today are among the largest class actions ever filed by a state medical society. The Medical Society of the State of New York is the largest physician organization in the state. Representing the society as the lead firm in the litigation is Milberg Weiss Bershad Hynes & Lerach LLP.
Additional information about this litigation and the medical society can be found on MSSNY�s Web site at: www.mssny.org.
Like most people, I often think of my pets� ailments in terms of illnesses or injuries that I have experienced myself. When explaining a diagnosis or treatment for a dog to its owner, I find it helpful to draw an analogy in human terms so that the client may better appreciate what their companion is feeling and how we can help. A recent experience with Babesia infection in one of my four-legged patients and my bi-pedal parent brought the analogy very close to home.
�Jasper�, a typically loving and gentle track retiree was adopted by a very caring client and presented to me in May of this year. A recent antibody titer for Babesia had been provided to the new owner and revealed antibodies present in the dog�s blood against the organism at a dilution of 1:160. Although there had not been sufficient contact between owner and pet to identify subtle changes in his behavior, Jasper exhibited no obvious symptoms of illness during his examination. After consultation with several veterinary infectious disease/internal medicine specialists I did not encourage Jasper�s owner to treat him based on this single, positive antibody titer.
My next exposure to Babesia occurred in August when my mother was taken ill by a presumed case of Lyme disease. Her symptoms of fever, chills, muscle pain and residence in New York City and frequent travel to Long Island made Lyme disease the most logical diagnosis to her health care team. A normally energetic and independent woman, my mother found it difficult to express the pain and fatigue that required her hospitalization for over one week. Tests revealed no antibodies to Lyme disease but Babesia organisms were found on her red blood cells resulting in a progressive anemia. Treatment with two antibiotics, clindamycin intravenously and doxycycline orally, and an anti-malarial drug called quinine resulted in her eventual discharge from the hospital without the need for a transfusion.
Babesia is a single-celled, protozoal organism transmitted to dogs and people through the bite of an infected tick. There are approximately seventy different types or species of Babesia but the two of greatest significance to canine disease are Babesia gibsoni and B. canis. The Babesia species that infects humans is different but once infected, the symptoms experienced by people and dogs may be similar. Infection with Babesia is much more likely in the southern United States and especially the Gulf Coast states. Young puppies and greyhounds appear to be more susceptible to infection than other individuals but this may be a function of the location of racing tracks, which bring greyhounds to the South. As the geographic range of the deer tick and brown dog tick, major transmitters of Babesia, expands so will the incidence of cases in places other than the South.
Once infected, the dog may experience fever, lethargy, lymph node enlargement, anemia, depressed platelet count, vomiting or even death. Adult dogs have a better prognosis for recovery from this acute stage than do puppies. Without treatment the dog will progress into a subclinical stage in which there is a recognizable antibody titer but subtle or no clinical symptoms. Over time, symptoms including decreased appetite, occasional fever, weight loss and a general loss of body condition will become apparent as the dog experiences an increasing parasite load in the chronic phase of the infection. Other reported, but atypical symptoms of Babesia infection include diarrhea/constipation, respiratory distress, fluid accumulation in the abdomen, edema, back pain, jaw pain and even seizures.
When we consider the wide range of clinical symptoms that may be present with Babesia infection, it would be very difficult to make a diagnosis without supportive lab data. Anemia and low platelet count may be noted on a complete blood count and serum chemistries may reveal liver enzyme changes and increases in bilirubin levels (by-product of red blood cell destruction). It is rare to find the parasite on blood film exam under the microscope in subclinically infected pets. A single antibody titer of 1:80 is considered positive for either B. canis or B. gibsoni infection. Young pups and adult dogs only recently infected with the organism may have negative titers, necessitating a follow-up titer to confirm diagnosis.
Controversy abounds regarding when to treat and which medication to use. Although not approved for general use in the United States, the drug Imidocarb dipropionate is available to veterinarians who apply to use the drug under the FDA�s Compassionate Investigational New Animal Drug Exemption. In personal contacts with Dr. Doug Gorman, a veterinarian using Imidocarb to treat symptomatic and asymptomatic positive titer dogs, he reports good success with this therapy. Usually a single injection of the drug into the muscle is all that is required but occasionally a second injection may be needed at a later date if symptoms reoccur. Side effects are minimal and include local discomfort at the site of injection, drooling and occasional vomiting. It is recommended that the patient be observed in the animal hospital the day of the injection for development of any of these side effects.
The decision about when to treat is a little more complicated. Given the subtlety of symptoms in subclinically infected dogs and the risk these animals pose to other dogs as parasite reservoirs, many argue for treatment with any single positive titer. As more data is collected on the safety and efficacy of Imidocarb, this may become the most reasonable recommendation.
Prevention is best accomplished by understanding and limiting risk factors for Babesia infection. Transplacental transmission from mother to pups means antibody screening of breeding females is important to control infection within the kennel. Blood transfusions also may result in organism transfer so thorough screening of all blood donors is imperative. Most dogs are infected by a bite from an infected tick. The tick must feed uninterrupted for 2-3 days for complete transmission of Babesia to occur, so daily tick removal is helpful. Although a vaccine against B. canis has been developed in Europe, reports of its efficacy are variable.
Jasper was re-presented to me recently by his very observant owner who told me that his appetite had returned and that he was back to being his happy, social self. She reported the improvement as dramatic and fast. Although he never showed any indication of anemia, his titer did rise to 1:320 and treatment with Imidocarb by Dr. Gorman resolved his symptoms. His titer will likely stay positive for months after treatment.
My mother has shown steady improvement in her energy level and blood counts in the two months since her hospitalization. Her infection was likely the result of a tick bite while gardening on the East End of Long Island. One lesson I�ve learned as a result of this experience is that as our world grows ever smaller, diseases previously thought to be unique to other locales have a tendency to move into our own backyards.
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