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Ep. 124 - LiveWell Talk On...Lyme Disease (Kristin Baker, DNP, ARNP & Dr. Ahmed Abu Al-Foul)

episode 124

Ep. 124 - LiveWell Talk On...Lyme Disease

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Host:
 Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital

Guests: Kristin Baker, DNP, ARNP and Dr. Ahmed Abu Al-Foul, UnityPoint Clinic Multi-Specialty

Dr. Arnold:
This is LiveWell Talk On Lyme disease. I'm Dr. Dustin Arnold, chief medical officer at UnityPoint Health-St. Luke's Hospital. Lyme disease is one that's in the news occasionally and seems to be on some level, a mysterious illness that afflicts patients and they go on for the rest of their lives with this chronic Lyme phenomenon. And there's a lot of myth and misinformation regarding Lyme disease. Basically, thanks to the internet and to clarify some of these myths and provide us evidence-based direction. I have with me today, Kristin Baker, nurse practitioner with infectious disease and Dr. Ahmed Abu Al-Foul, infectious disease specialist. Welcome.

Kristin Baker:
Hello.

Dr. Abu Al-Foul:
Thank you.

Dr. Arnold:
Lyme disease is one of those phenomenons that, much like multiple sclerosis, there appears to be kind of this perceived relapsing remission and there was a lot of misinformation out there. What is Lyme disease?

Kristin Baker:
Lyme disease is an infection that's caused by a bacterium called borrelia. It's the most common tick borne illness. It causes a rash. It's more prevalent in certain states, in areas that they're called hotspots.

Dr. Arnold:
What are some of those hotspots?

Kristin Baker:
Northern California, the Midwest. You can acquire Lyme disease after being bitten by a deer tick usually carried by a mouse or a deer. Some risk factors is being in tall grass or bushes. A lot of people think that they can jump or fly onto you, which is not true. Like I said, usually you rub up against a tall grass or a bush.

Dr. Arnold:
And correct me if I'm wrong, but the deer tick is tiny compared to the wood tick right? By about a tenth of the size.

Kristin Baker:
Yeah.

Dr. Arnold:
Okay, because sometimes I think people get bitten by wood tick and then they believe they have Lyme disease.

Kristin Baker:
Yes, that's correct. And you don't need to keep the tick, but if you think you've been exposed or bitten, it's really important to look at that tick and kind of know the characteristics of the tick. Which will help the provider that you eventually go to. You can describe what it looked like and that will help them to determine if you need treatment or not.

Dr. Arnold:

Kristin, what does the rash look like? And does the rash occur where the tick bit the individual?

Kristin Baker:
It can, otherwise it can be disseminated, which means it can be kind of all over the body. It doesn't necessarily mean where you've been bitten. But in the medical field we call it a bullseye rash. Which means that there's central clearing, that it will be flesh color in the middle and then it's red around the premises. And that's the typical classical bullseye rash from being bitten by a tick. It doesn't necessarily mean one of two things. If you've been bitten, you don't necessarily get the rash, but if you do have the rash, see your health care provider. And if you have the rash, there's serology or blood tests that can be done. But if you have the rash, you don't necessarily need blood tests. Your provider can give you treatment based on your history and the clinical exam.

Dr. Arnold:
So if, being the outdoorsman that I am, hashtag sarcasm, I go out in the field and get bitten by a tick. How soon after that bite does the rash or symptoms start?

Kristin Baker:
Typically the rash or excuse me, the tick needs to be attached for a day and a half before.

Dr. Arnold:
So it's not a casual bite. I mean it's truly implantation.

Kristin Baker:
Yes, exactly. So it has to be on you for a day. Typically a day and a half. And then what I or what we advise patients, if you've been out in a wooded area, if you're a deer hunter or you live by predisposing factors. You know, you live in an area that has a lot of trees and shrubs or you've been doing a lot of gardening. When you come in, make sure that you're looking for the ticks. Wear light colored clothing, which can help kind of identify ticks, make sure that you're wearing long sleeves, hats, long pants when you're outside. We like to tell patients to tuck their pants into their socks. That can be beneficial as well. And like I said, when you come in from the outdoors, check yourself over. If your kiddos have been outside with you to make sure that you're checking them over. Throw your clothes in the wash, make sure that you are taking a shower with warm soapy water when you come in from outdoors. Another good point is, you can take your clothes and put them in the dryer for around four minutes. And that can really help eliminate your risk factors for getting bitten by a tick. And if you do find a tick on you, use tweezers to take it off and then make sure that you're washing that area where you found the tick with a warm soapy water as well.

Dr. Arnold:
So if I have a tick bite, it's a deer tick. It's been there day and a half, I take it off. Do I need to be worried about Lyme disease? Does I need to come see my favorite infectious disease clinic or do I wait for symptoms?

Dr. Abu Al-Foul:
If you have a tick bite, as you said, this is a scenario that there's a risk of Lyme disease. We don't have to wait for the symptoms. We can initiate treatment. Usually we have something called Lyme disease approval access, where we can give you an oral doxycycline for one day and that should take care of this.

Dr. Arnold:
And then let's say I don't have the rash and I start to develop fevers and joint aches. How do those patients present? Just like that with a fever and ongoing joint aches or arthralgia?

Kristin Baker:
Sure, there's a lot of patients that present like that that actually don't come in with the bullseye classical textbook rash. Again, we ask you your history, have predisposing factors, have you been outside, have you been to these areas? And then like I said before, that there are blood tests that we can do. If there is a suspicion of that. A couple of them are called. The first one we would do would be the Elsa test. And then if that was confirmatory, then the Western blot test, which would confirm that.

Dr. Arnold:
So it requires two blood tests to confirm?

Kristin Baker:
Yes.

Dr. Abu Al-Foul:
Yeah, I think if we want to answer this question, usually Lyme disease, we have acute form and we have chronic form. The acute can be localized and can be disseminated. So the acute localized, basically you have the classical bullseye rash. And it's only one spot that you can look at and that will be like acute localized Lyme disease. Sometimes those people, they may not have fevers, they may not have systemic symptoms. It's only the rash. If you have acute disseminated Lyme disease, which means the bacteria is all over your body. In such kind of scenario you'll have high fevers. Sometimes like you have really bad joint pain, muscle pain. Some people they can develop acute meningitis by Lyme disease and those people may present with really bad headaches and neck stiffness. The other thing they may have nerve pulses. Basically when you examine they may have double vision, because of that. This is like, we call it acute CNS Lyme disease. The other possibility is heart involvement. So people they may present with carditis and usually that will get inflammation. It's inflammation of the heart. But usually the Lyme disease will affect the conduction system of the heart and basically they may present with a first degree heart block or sometimes complete heart block and that could be a serious complication of acute Lyme disease. The third form is the chronic form. If you say you have a tick bite, you have no symptoms to alert you that there's something going on with me. And then maybe the chronic form will be like arthritis where people will present with thoroughly bad joint like swelling and pain. And that's the chronic form of the Lyme disease.

Dr. Arnold:
And the chronic form can be treated with antibiotics as well?

Dr. Abu Al-Foul:
Definitely, it's arthritis. I mean, you can give them like the IV antibiotics. Sometimes there's a mix between what is called post Lyme disease syndrome. And the chronic form of the infection. The chronic form, definitely if it's in the arthritis, you can treat them with antibiotics, whether oral or IV. And then they will get better. The post Lyme disease, we found that after the acute infection, sometimes people they may have some symptoms of like muscle pain, joint pain, but usually it should not last that long, usually like a few weeks, few months, and then people will get better.

Dr. Arnold:
I think all clinicians have had the encounter of someone that believes they have chronic relapsing Lyme disease. And that's an argument that's hard to win with the patient because they believe that. And I know, you know, that we have a stewardship policy and antibiotics and sometimes we decline antibiotics from physicians that are trying to treat chronic Lyme disease because they is just no evidence for it. And you know, there's also been some physicians that have had trouble with licensing board because of advertising to do this. And that's a real problem. Do patients get referred to you with this relapsing Lyme disease very often?

Kristin Baker:
First of all, there is no strict criteria for defining chronic Lyme disease and evidence shows that antibiotics beyond the currently recommended amounts don't improve symptoms.

Dr. Arnold:
I don't know if you remember Dr. Abu-Al-Foul, when you were working at the wound clinic. We had a person present, they wanted to do hyperbarics for their Lyme disease. You know, I think the take home point in those patients is make sure they don't have something else.

Kristin Baker:
Yes, many of the symptoms can overlap. So you do definitely, if you are having those vague symptoms, you need to see a health care provider because again, many of those symptoms overlap and so we need to rule out other things.

Dr. Arnold:
I diagnosed MS one time. Multiple sclerosis in a patient who was convinced they had relapsing Lyme disease and they had MS. Classic. There's no vaccination for Lyme disease is there?

Dr. Abu Al-Foul:
There was, but there's nothing to be used right now. But there was like in the past they were like talking about the Lyme disease vaccine and it wasn't developed. I don't think it's effective. It's the same like the HIV vaccine.

Dr. Arnold:
And is there a repellent for ticks?

Kristin Baker:
There is, I should have mentioned that earlier with prevention. That we would recommend using Deets. And you can also do a permethrin tool where you can soak your, there's protocols out there on the internet, but you can soak your clothes in permethrin if you're like a deer hunter out in the woods a lot. That would help to eliminate your risk for getting bitten by a deer tick.

Dr. Arnold:
Are our family pets? Our dogs, do they get Lyme disease? Can they, I mean, we put flea and tick on them every month, but is that something that they could transmit?

Dr. Abu Al-Foul:
Well, I'm not a vet to talk about that. Yeah, I'm going to just leave that question to the vets. But it's a possibility.

Dr. Arnold:
Well next time we'll have a vet. And I think one thing, I know the answer to this, but Lyme disease is not transmittable person to person.

Dr. Abu Al-Foul:
No, it is not. It is not transmitted from one to another person. Let me just say, no, it is not true. It is not a communicable disease from a human to human. Even sometimes we have pregnant ladies come into the office and they're having concerns about it like being transmitted to the baby. And usually we don't have, so far the studies didn't show that Lyme disease can be transmitted to the baby. Because the bacteria of the Lyme disease, basically it's along the line, it's like similar to the syphilis. It's the same kind of bacteria there. So the syphilis can be transmitted to the baby, but you know, the Lyme disease, it does not. So there's no risk.

Dr. Arnold:
That's good information. Where did the name Lyme disease come from?

Dr. Abu Al-Foul:
Lyme is a town in a Connecticut.

Dr. Arnold:
Is that where the first case was?

Dr. Abu Al-Foul:
Exactly, yeah. It's the first cases I think. And then they call it Lyme disease after that.

Dr. Arnold:
So it's not related to some sort of citrus fluid or fruits. It's not related to limes? And there's no lemon disease that we know of?

Dr. Abu Al-Foul:
Not yet.

Dr. Arnold:
Okay, alright. Well that's something that we can look forward to. This great information. That was Kristen Baker, nurse practitioner and Dr. Ahmed Abu Al-Foul, infectious disease specialist. Providing clarity and direction and guidance for individuals think they may be afflicted with Lyme disease. If you have a topic you'd like to suggest for our LiveWell Talk On podcast, shoot us an email at stlukescr@unitypoint.org, and we encourage you to tell your family, friends, neighbors about our podcast. Until next time, be well.