TECHNICALLY SPEAKING: Lyme Disease: A Firsthand Account

Practice what you preach" is a good adage when you do it, but there is a high price if you don’t. The importance of safety and personal protection cannot be overemphasized in our industry, but it is one area that is highly neglected.

With the advent of reduced-risk pesticides, such as baits and low-concentration formulations, we have become complacent with regard to pesticides and their use. Likewise, we live in a society that is relatively free of communicable and vector-borne diseases and, thus we have become complacent (at least I have) regarding personal protective measures.

I spent 22 years in the U.S. Army working in pest management and preventive medicine. I taught preventive medicine specialists, physicians and pest management professionals about Lyme disease, its signs and symptoms, tick biology and behavior and preventive measures. But you know what? I got Lyme disease!

What began as a skin infection (my diagnosis) in April 2000 rapidly developed into a large oval welt and rash with a hard center. The severe discomfort of the rash, which was located on the inner-posterior portion of my left leg, caused me to seek medical attention. Unfortunately my family practice physician "bought into" my diagnosis, confirming that I had a skin infection that he assured me would resolve after a short course of antibiotics. It did (so I thought).

Six months later, I noticed a significant loss of flexibility in my lower extremities and stiffness in my joints. I suffered a general malaise and found myself readily dozing off, even on my 30-minute ride home from work. Something obviously was wrong.

AN ANSWER. A friend of mine, Sandra Evans, who works for the U.S. Army Center for Health Promotion and Preventive Medicine, unbeknownst to her, perhaps saved me from years of suffering and possible permanent disability from Lyme disease. In a Lyme disease presentation in Snowbird, Utah, last summer, she mentioned that not all rashes associated with Lyme disease are characterized by a bulls-eye. Reflecting on her description of atypical rashes and my current symptoms, I returned to my physician and insisted on a blood test for Lyme disease. Three days later I received confirmation for a positive titer for Lyme disease.

Thus began the next phase of this disease — treatment. My physician started me on a three-week course of antibiotic (minocycline), but there was no improvement. A second three-week course of the same antibiotic continued to result in no improvement in my symptoms and no change in my titer. I learned later that in the short-term, the titer is not the measure of successful treatment.

Next, I requested a referral to an infectious disease specialist, who immediately placed me on intravenous (IV) antibiotic therapy. This involved the insertion of a 20-cm mid-line catheter into my forearm and a one hour per day infusion of another antibiotic (ceftriaxone) for the next three weeks. Finally, after the first week of IV antibiotics, my symptoms began to improve, i.e., I regained some flexibility, the joint pain decreased and I was less drowsy. By the end of the third week of IV antibiotics, my symptoms had practically vanished and I appeared to be on my way to recovery. According to my infectious disease physician, the success of treatment is measured by the improvement in symptoms and not a reduction in antibody titer, which can remain high for months after the patient is asymptomatic.

The IV therapy was completed, however, the story continues. I remain on a two-month course of yet another antibiotic (doxycycline) and, barring any recurrence of symptoms, that will be the end of treatment.

There is no doubt in my mind, four months down the road from Lyme disease diagnosis, that the adage, "an ounce of prevention is worth a pound of cure," is true. If I had practiced the preventive measures I pontificated to my students (or if I had listened to my wife screaming for me to use preventive measures), I would have saved a lot of time, discomfort and possible disability.

PREVENTIVE TIPS. My infection did not result from an occupational exposure but from living on a farm where deer mice, deer and ticks are common and from my not using personal protective measures. In our profession we risk exposure to arthropod-borne diseases, animal and human pathogens and chemical exposures, but, by following some basic measures, we can protect ourselves. For Lyme disease, one should:

Avoid Infested Areas. While this is not always possible, attempts should be made to avoid areas infested with ticks, deer mice and other animals. Such areas are overgrown with weeds, grasses and shrubs. Be cautious of transition zones between landscaped areas and natural habitats.

Body Checks. Check yourself and/or have someone check those hard-to-reach areas for ticks every time you return from a potential habitat. If an infected tick is removed within 24 hours of attachment, it is unlikely that Lyme disease will be transmitted. Attached ticks should be removed carefully with forceps by grasping the tick’s mouthparts at the point of attachment to the skin and gently pulling the tick’s mouthparts out of the skin. Be careful not to grasp the body of the tick (squeezing could inject its body contents).

Wear Clothing Properly. It is easier to spot ticks on light-colored clothing. Long pants tucked into the top of the socks and a shirt with long sleeves rolled down should be worn.

Wear Repellent. DEET should be applied to the skin and reapplied periodically, depending on how heavily you perspire and whether you are working in water. Permethrin should be applied to all clothing and shoes and reapplied after every washing (although tests have shown that treatment will last five washes). Do not apply permethrin directly to the skin.

Recognize the Symptoms. The most readily recognized symptom is a bulls-eye rash that may be several inches in diameter; however, it occurs in only 60 percent of infected individuals. Some rashes, like mine, do not have a bulls-eye center. Be suspicious of flu-like symptoms (e.g., headache, aches, fever and extreme fatigue), especially in summer. If you have been bitten by a small tick and these symptoms appear, consult your physician immediately and don’t be reluctant to suggest Lyme disease as a possibility, since 17,000 cases are reported every year.

Be careful (and listen to your wife)!

The author is technical director of American Pest Management, Takoma Park, Md. He can be reached at rkramer@pctonline.com or 301/891-2600.