Thursday, July 06, 2006
Lyme disease not as frequent, hard to treat, as reported

By Dr. Anthony Policastro
Nanticoke Memorial Hospital,
Medical director

A few weeks ago I wrote about Rocky Mountain Spotted Fever. It is caused by the dog tick. A question came in about Lyme disease, which is also a tick-caused illness. It is caused by the deer tick. Lyme disease has received a lot of attention in the media. It has been blamed for all sorts of problems. Much of that has been overblown. It is one of the diseases that does not really live up to the hype. The deer tick is very small – about the size of the head of a pin. Therefore, bites are not always that obvious. Most cases occur in New England and the Middle Atlantic states. It was discovered near Lyme, Conn. That is where it received its name. Even in that area it only occurs in 1 in 100 people. In other areas the chances drop to between 1 in 1,000 to 1 in 5,000. We would therefore expect fewer than 10 cases per year in our area. Less than 50 percent of the ticks carry the disease. Therefore, just having a deer tick bite means a less than 50/50 chance that the tick even carries the disease. The tick must feed for at least 36 to 72 hours to transmit the disease. Therefore, frequent tick checks can decrease the likelihood even more. There are various types of Lyme disease symptoms. One is the early local disease. This is a rash at the site of the bite. It usually occurs 7 to 14 days after the bite. It may occur as early as 3 days later. It may occur as late as 30 days later. The rash is in the form of a ring. The ring tends to increase in size over time. It may be associated with symptoms like fever, muscle aches, headaches and tiredness. It usually lasts for 1 to 2 weeks. The second set of symptoms are the early generalized ones. These are in the form of multiple other skin lesions. About one in five patients with the first rash will develop these other lesions. They are smaller in size than the initial lesion. They are more likely to be associated with other symptoms. These symptoms include fever, muscle aches, headaches and tiredness. They also may include red eyes and swollen glands. The patient might also have a variety of neurological symptoms. The most common of these is paralysis of the facial nerve. That results in a condition called Bell's palsy. Lyme disease is one of the less common causes of Bell's palsy. Later symptoms are the ones that have gotten the most attention from the media. They involve primarily arthritis. Joints become swollen and tender. The knee is the joint that is usually affected. Unfortunately, some people have confused arthritis with arthralgia. Arthralgia means pain in the joints without swelling. Lyme disease does not usually cause arthralgia alone. This stage is also less likely to cause the fever, muscle aches, headaches and tiredness that the other stages do. Some patients think that if their joints and muscles ache and they are tired, that it must be Lyme disease. That is not very likely. The diagnosis is easy when there is a tick bite followed by a ring-like expanding skin lesion. No further testing is necessary. In those individuals with a less obvious set of symptoms, it becomes harder. The blood tests that suggest Lyme disease have problems with them. They are sometimes positive for other reasons. For example, one of the tests can be positive if you have had chickenpox. Once a person become positive for a test, that person tends to stay positive forever. That is true for any disease that we recover from. Thus, you cannot look at a blood test to see if the levels are changing. Once there, they are always there. If someone has had a case of Lyme disease a long time ago, that person will still have a positive test. That means there is no way to know if their symptoms are due to an old healed disease or something new. For all these reasons, blood tests are only really helpful when you suspect that someone really has Lyme disease. For people with vague symptoms and no history of tick bite, the tests have little value. Treatment is very effective. Once the diagnosis is made, it can be easily cured. Again the media has suggested otherwise. The reason for that is that people with vague symptoms often have false positive blood tests. When they do not get better, the thought is that the treatment has failed. In reality it is just the fact that they did not have Lyme disease to begin with. That is why the treatment did not get them better. There was a vaccine for a few years. However, the side effects were so high that it was taken off the market. The best approach is to use tick repellent and do tick checks. Then you do not have to worry about all the misinformation that exists on Lyme disease.

Walk along golf course will benefit state MS Society
Imagine enjoying an early evening stroll across the cool and beautiful countryside near Rehoboth Beach. If you can put yourself in this picture, then register now for the AIG MS Twilight Walk at Baywood Greens. Presented by Pot-Nets Communities, this early evening walk begins at the Baywood Greens Clubhouse in Sussex County at 6 p.m. on Friday, July 21. With a recommended minimum pledge of $25, walkers will be raising money for the Delaware Chapter of the National Multiple Sclerosis Society. Registration on the day of the walk begins at 5 p.m.. However, advance registration is recommended either by going online at, or by calling (302) 655-5610. All of the proceeds generated by walkers at the event will fund MS research, programs and services for more than 1,250 Delawareans with MS and their families. As a chronic disease of the central nervous system, multiple sclerosis is unpredictable and disabling. MS is marked by the frequent recurrence of symptoms, which can range from numbness and tingling in the limbs to paralysis and blindness. MS also produces emotional repercussions because of the disease's gradual deterioration of physical functioning in the prime of life. Although the progress, severity and specific symptoms of MS cannot be predicted, advances in research are hopeful. The mission of the National MS Society is to end the devastating effects of multiple sclerosis.

State Division of Health offers tips for flood victims
Delaware's Division of Public Health (DPH) Environmental Health teams stopped door-to-door last week at Hastings Estate Mobile Home Park, Holly View Park and Mobile Gardens in the Seaford area, taking drinking water samples, providing water test kits and sharing information on food safety and mold. Residents should boil water used for drinking and food preparation if their well has been submerged or their water supply has been without power recently. Water test results will be made known to residents as soon as possible. Tetanus/diphtheria shots were given last Friday and Monday, at the Anna C. Shipley State Service Center, in Seaford. DPH provides the following guidance to help residents stay safe in the aftermath of recent floods.
Safe Drinking Water
If you are advised to boil your drinking water, heat water at highest possible temperature so that it bubbles constantly (a rolling boil). Continue to boil water for one minute, then let it cool. Store in clean, covered containers. Residents can also disinfect water using household bleach. Add 1/8 teaspoon (or 8 drops) of regular, unscented, liquid household bleach for each gallon of water, stir it well and let it stand for 30 minutes before using it. Store disinfected water in clean, covered containers. Bottled water is another safe alternative.
Food Safety
Do not eat any food that may have come into contact with flood water. Food containers that are not waterproof include those with screw-caps, snap lids, pull tops, and crimped caps. Also, discard cardboard juice/milk/baby formula boxes and home canned foods if they have come in contact with flood water. Discard canned foods with swelling, leakage, punctures, holes, fractures, extensive deep rusting, or dents that prevent normal stacking or opening. If the freezer thermometer reads 40 degrees F or below, the food is safe and may be refrozen. Do not rely on appearance or odor. If the food still contains ice crystals or is 40¡F or below, it is safe to refreeze or cook. Perishable food such as meat, poultry, seafood, milk, and eggs not kept adequately refrigerated or frozen may cause illness, even when thoroughly cooked. Keeping refrigerator and freezer doors closed as much as possible will keep food cold for about 4 hours. A full freezer will keep the temperature for approximately 48 hours (24 hours if it is half full) if the door remains closed. Discard any perishable food (such as meat, poultry, fish, eggs or leftovers) that has been above 40¡F for two hours or more. Buy dry or block ice to keep the refrigerator as cold as possible if the power is going to be out for a prolonged period of time. Fifty pounds of dry ice should hold an 18-cubic foot fully-stocked freezer cold for two days. If you plan to eat refrigerated or frozen meat, poultry, fish or eggs, cook the food thoroughly to the proper temperature to kill bacteria. Wash fruits and vegetables with water from a safe source before eating. For bottle feeding infants, use prepared, canned baby formula that requires no added water. When using concentrated or powdered formulas, prepare with bottled water if the local water source is potentially contaminated.
Clean Up
Floodwaters can dislodge tanks, drums, pipes and equipment which may contain hazardous materials such as pesticides or propane. Do not attempt to move unidentified dislodged containers without first contacting the local fire department or hazardous materials team. Wash skin that may have been exposed to pesticides and other hazardous chemicals frequently and thoroughly. Call the poison control center for additional instructions. Wear protective gear and clothing, such as heavy shoes or boots, work gloves and safety glasses or goggles to help avoid accidental puncture wounds, cuts, abrasions, eye injuries and chemical exposure. Wear a hard hat when working under structures and trees. Select cool clothing that is cotton and tightly knit; long-sleeved shirts and full-length pant are recommended. Assure proper ventilation when using fuel-burning equipment. Use great caution. Fuel-burning devices in closed areas pose a great risk of carbon monoxide poisoning. Carbon monoxide cannot be seen or smelled, and can be life threatening. Provide plenty of ventilation when using a gas-powered pump for flooded basements or a gas-powered generator for electricity. Install and maintain carbon monoxide detectors. Turn off the main gas valve at the meter if you smell leaking gas. Do not turn on lights or use torches or lanterns since they can ignite the gas. Leave the premises immediately and notify the gas company or the fire department. Thoroughly wash countertops with soap and water, using hot water if available. Rinse, and then sanitize by applying a solution of 1 tablespoon of unscented, liquid chlorine bleach per gallon of water. Allow to air dry.
Flooding is a leading cause of mold growth in homes. DPH offers the following recommendations to head off this growing problem: Open doors and windows or use blowers to force fresh air in. Run dehumidifiers and empty the water pan frequently. After water has been pumped from the basement, shovel out the mud and debris while it is still moist. Hose down walls to remove as much silt as possible before it dries. Floors and walls may need sanitizing, particularly if sewage has entered the basement. Scrub walls and floors with a 10 percent bleach solution or other comparable commercially available disinfectant. Oil stains in basements caused by overturned or damaged oil tanks may be a problem following flooding. Call a professional to remove oil residue. Dealing with garbage and sewage can be challenging. If toilets aren't working use portable units. Beware that sewage can backflow through floor drains into basements. Clean with a disinfectant. Never mix ammonia and chlorine bleach, which produces poisonous chloramine gas. After coming into contact with sewage or floodwater, wash your hands well and use a brush to clean under fingernails.