Lyme is the disease/illness resulting from being infected by the bacteria Borrelia Burgdorferi. This is currently and more commonly known as a tick borne infection, but there is now mounting evidence that such bacteria may also be passed congenitally.
People have been affected by Lyme worldwide and although it is known to be more prevalent in particular environments, such as woodland or urban areas, you can also contract the infection just as easily in your back garden here in the UK. Ticks are everywhere and although not all carry infection, unfortunately there is no way to distinguish the latter, potentially until its too late.
In some cases after being bitten by an infected tick, one may develop a classic bulls-eye rash (Erythema-Migrans) this is a more commonly known identification for Lyme, but research now shows that this rash occurs in less than 30% of patients infected and therefore should this rash not be present, do not rule out Lyme. Other initial clinical characteristics of infection are flu-like symptoms, joint and muscle pain, headaches, light and sound sensitivity, fever, stiff neck, palpable and tender lymph nodes and extreme fatigue.
Due to the presenting symptoms of Lyme disease being similar to those of other more commonly known conditions, Lyme is often mis-diagnosed or diagnosed at a late stage. Left untreated the bacteria can affect both the neurological and endocrine system, suppress the immune system, cause cardiac complications, as well a musculoskeletal, neuropsychiatric and dermatological problems. It has the ability to cause over 70 recognised symptoms, which can be debilitating and life threatening and this is known as chronic Lyme disease. Ticks also carry an array of co-infections, virus’ and parasites in addition to Borrelia (Lyme), which not only adds to the multitude of symptoms, but also complicates treatment significantly. A chronic infection level of Lyme will more often require long term oral and intravenous antibiotics as well as supportive treatments under the supervision of a Lyme literate medical doctor.
Will all individuals develop chronic/late-stage Lyme? No, not if you are diagnosed early enough. Immediate identification of a tick bite can prevent long term illness and complications. You will need to be treated with appropriate antibiotics for a specified amount of time and this can significantly reduce your risks of the bacteria persisting and causing such havoc in your body.
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Be Tick Aware… In order to reduce the risk of getting bitten in the first place, there are measures of prevention that can be taken to avoid getting these nasty tick borne infections. When ‘out-and-about’ at all times, but especially in the spring/summer months and in grassy areas, use an insect repellent.
Another option is to wear long sleeved tops and long trousers that are tucked into socks. Avoid brushing agains shrubs and leaf litter, and where possible stick to the centre of paths or trails to avoid contact with ticks.
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After outdoor activities, make a concerted effort to check your entire body for ticks, especially places like the waist, ankles, scalp, underarms, and behind the knees and ears. Should you find a tick attached to you, you will want to remove this as soon as possible, but ensure full and careful removal of the insect to reduce further complications.
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Removal of a tick can be done with tweezers, but a tick removal tool can be an easier and more effective removal method. Should you know or suspect a tick bit, please seek medical advice from your GP or health care provider as you will most likely require a short course of antibiotics. If possible take pictures of the embedded tick and/or rashes and log any presenting symptoms, as the more information a doctor has the better chance of a correct and effective diagnosis and treatment.
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If you have a household pet you can also protect them from bringing ticks into the house with a variety of methods such as tick collars, shampoos and spot-on/spray-on tick control treatments.
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Ticks can be the size of a poppy seed and you may not even know you have been bitten until its too late, so check, check and check again! Remember small tick, BIG problem. Prevention is better than cure.
Signs & Symptoms of Lyme
What is believed to be the most common sign of a bite from an infected tick is a rash, specifically one that has an expanding area of redness that is bulls eye shaped. This is known in the medical field as an EM rash (Erythema Migrans). Through on-going research it has become apparent that less than 50% of those with Lyme even get this rash, so don’t base your potential for having Lyme solely on not having this rash.
You may not ever see the tick bite area or the tick itself. There is no established minimum time that a tick has to be attached to an individual in order to transmit Lyme & potentially a whole host of co-infections.
Many will experience flu-like symptoms in the early stages such as chills, fever, fatigue, headache, muscle & joint aches/pains, sore throat and swollen lymph nodes. An EM/bulls eye rash may be present, but can develop up to 3 months post bite or not at all.
Due to the complexities of diagnosing Lyme, specifically in the UK, it can more than often go un-diagnosed or mis-diagnosed.
If this happens it has the potential to make you extremely sick with an extensive range of debilitating symptoms.
Late stage / chronic Lyme often needs aggressive long term treatment, including both oral and intravenous antibiotics. The symptoms that develop just seems to escalate beyond what you think possible, affecting the entire body, on an orthostatic, neurological and cognitive level.
The symptoms that come with Lyme will effect each individual differently for a number of reasons. The level of health pre-bite, genetic dispositions and also depending on the additional tick borne co-infections the tick may be carrying.
Some of the many symptoms you may experience with Chronic Lyme are as follows:
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Impaired Memory
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Cognitive Decline
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Immune Suppression
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Light/Sound Sensitivity
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Insomnia & Night Terrors
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Anxiety & Depression
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Tremors & Twitching
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Fevers & Chills
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Drenching Night Sweats
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Seizures
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Temperature Irregularity
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Blurred & Double Vision
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Bells Palsy
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Ringing Ears
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Nausea & Vomiting
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Headaches & Migraines
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Bladder Infections & Incontinence
The size of a tick can be as small as a grain of rice.
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Costochondritis
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Breast Pain & Tissue Damage
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Menstrual Irregularities
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Severe & Chronic Fatigue
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Heart Palpitations & Rhythm Disturbances
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Air Hunger
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Numbness & Tingling
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Weight Loss/Gain
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Skin Rashes & Infections
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Mouth Ulcers & Gum Infections
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Fainting & Blackouts
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Muscle Weakness
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Stiff Neck
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Digestive Issues
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Systemic Inflammation
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Chemical Sensitivity
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Constipation
Diagnosing & Treating Lyme
Diagnosing Lyme disease has become a complex and highly controversial process. Every country and Doctor seems to have a varied approach and opinion on Lyme. Current two-tier testing methods, especially in the UK are known to be very inaccurate and out dated and therefore incredibly unreliable. This can mean an individual may go un-diagnosed for many months or even years. High numbers of patients are being mis-diagnosed and others never receive a diagnosis. Some patients will seek private laboratory tests overseas, but currently the UK medical system refuses to accept these results, consequentially, this then results in significant costs to individuals on both a physical & mental level. Many are left with no choice but to seek private medical treatment abroad on a long term basis this is mentally challenging, and a huge strain financially.
Due to the inaccuracy of Lyme testing methods causing a high rate of false-negatives, a clinical diagnosis should really be considered. This can then take into consideration a number of factors; symptoms, tick exposure and ones medical history.
Treatment for Lyme is always best started as soon after the bite as possible, while the potential infection is still localised. This will reduce an individuals chance of long term effects or a chronic form of the illness. Should you not see a tick bite but have symptoms suggestive of Lyme and have already followed exclusion of other possible causes a clinical decision to treat should be made.
The NICE treatment guidelines for Lyme disease in the UK were updated in 2018 and this guideline document covers current diagnosis and management of Lyme. It is free to be used by all healthcare professionals in the UK as a framework. The treatment options available and length of treatment times remain extremely limited and front line medical staff knowledge remains limited about this illness and all of these factors contribute to extremely compromised treatment methods or worst case scenario no treatment at all.
NICE Lyme guidelines are available to view online and I highly recommend not only reading these but also printing them off and taking with you to a medical professional such as GP should you suspect Lyme Disease.
NICE Guidelines for Lyme Disease
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Treatment medications, dose, type and length will all vary amongst patients. The longer you are left without treatment the more complex and far longer the whole process takes. If Lyme is treated early and effectively the prognosis is highly positive. Lyme in the late stages however is difficult to predict and treat and the repercussions on a patients health and life can be sheer devastation. There is currently no cure for chronic Lyme, but the consensus amongst Lyme literate doctors is that remission is possible.
Tick Removal
If you are bitten by a tick, it will typically remain attached to its host whether this be an animal or human. Where a tick is attached, a safe and effective method of removal of the tick is paramount.
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An embedded tick is best removed with a specifically designed tick removal tool, but should you not have one a pair of fine tipped tweezers can also work. Where possible wear protective gloves to prevent further transmission.
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If using a tick-tool such as the O’Tom Tick Twister Tool or the Lifesystems Tweezer Tool, it will come with instructions of use. The tick twister has been designed to aid easy removal of the whole tick with a twisting motion, it is designed to not leave any parts behind. It adapts to different size ticks and the way in which it grips around the embedded tick means you are not compressing the body of the insect, preventing breaking the tick in two or aggravating the tick further. When irritating an attached tick it can increase the the back flow of saliva and this risks further transition of infections and organisms found in a ticks saliva. With this in mind care and precision is vitally important.
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If using fine-tipped tweezers, try and grasp the tick as close as possible to the skin. With a steady grip, pull in an upwards motion with an even pressure. Try not to wiggle or yank with any sudden hard movements as this can increase the chances of stressing or breaking the tick, therefore leaving the mouth part still embedded. Should this happen, just repeat the removal step again with the mouth part that is still attached.
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Post removal of tick, ensure you thoroughly clean your hands and the area of skin where you were bitten. This can be done with a mild disinfectant or antiseptic. Ensure the tick is disposed of carefully in a sealed plastic bag or between two strips of sticky tape to prevent it causing any further damage or worse re-offending. Be sure to also disinfect any tools/instruments which have been used in this removal process to prevent further contamination.
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Remember incorrect removal methods can increase the chances of transmission. Partial removal of a tick can result in irritation or increased infection localised to wound area. Worse case scenario this has the potential to develop into a life threatening infection and cause illnesses such as Septicaemia.
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There are methods of tick testing available, but remember this may determine if it is an infected tick but it can't determine if those infections have been transmitted to you, nor will it determine the extent of a potential illness. The tests available to buy online or in outdoors/camping shops to self test a tick vary in price and their accuracy is not known. There are some independent laboratories which may accept the tick for further testing, some require a vet submission, each has its own criteria so it depends on which lab you pick. Public Health England (PHE) currently do not routinely test individual ticks for pathogens such as Lyme, but you can contribute to the Tick Surveillance Scheme by sending in a tick.
For further information on this please visit the PHE online site.
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The O'Tom Tick Twister removal tool
Preventing Lyme Disease
Due to the complexities of diagnosing and treating Lyme disease it becomes extremely important that the whole scenario is avoided in the first place where possible. There are a number of preventative methods which you can try, to help keep you protected against ticks and the nasty infections they have the ability to transmit. Where tick-borne infections and illness are concerned prevention really is better than cure.
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Avoid walking through long grass and areas overgrowth. Where possible stick to pathways and be aware of brushing past bushes.
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Wear insect repellant during outdoor activities on all areas of exposed skin. There are number of insect repellents out there and although most are targeted towards mosquitos, data has shown that many are highly effective against ticks too. A selection of repellants have been tried and tested for their effectiveness against ticks. A research study was performed by Dr. N Seal an Etomologist. The two repellants which came out on top were Mosi-guard and Autan Protection Plus. Mosi-guard is natural and is advertised as safe to use on children.
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Where possible wear long sleeved tops and long trousers which you can tuck into your socks. Light coloured clothing can be a useful option, as it can help make it slightly easier to see any ticks.
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Although ticks will be looking to cling more specifically to areas of exposed skin, they have the ability to cling or climb onto your clothing. If you are knowingly in a high risk area or you regularly partake in hiking or camping, you can purchase tailored clothing which has been pre-treated with permethrin. There is also the option to buy this product and spray your current clothing, but be sure not to spray on skin.
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When removing clothing and taking a shower after being outdoors, ensure you do a thorough tick check. This is best done for people and pets. Remember ticks can be as small as a poppy seed, you may not see them, or potentially you could mistake this tiny insect for a freckle or other skin marking. A magnifying glass can help with this process. Ticks tend to migrate to the warm, moist areas, or creases of skin where they can then bite and feed un-disturbed. With this being the case, make a concerted effort to check behind and in ears, through hair and scalp, behind knees, in the inside of elbows, groin etc. Over checking is better than not checking!
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It is also of key importance to protect your pets from ticks too. There are a number of products created and sold in pet stores. They come in the form of topical oils, dips, sprays and collars. Some well-known topical flea treatment formulas and medications protect against ticks too, so it is worth checking the information leaflet or asking a vet should you need more assistance with this.
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Mosi-guard Tick & Insect Repellent