Adirondack Sports July 2023

JULY 2023 35
By Paul E. Lemanski,
MD, MS, FACP
NON-MEDICATED LIFE
Preventing Lyme Disease
Medicines are a mainstay of
American life and the healthcare
system not only because they are
perceived to work by the individuals
taking them, but also because their
benefit may be shown by the objective
assessment of scientific study.
Clinical research trials have shown
that some of the medicines of Western
science may reduce the risk of Type
2 diabetes, heart attacks, strokes and
cardiovascular death.
In the first 109 installments of the
Non-Medicated Life, a healthy lifestyle
has been shown to accomplish naturally
for the majority of individuals most
of the benefits of medications in the
prevention of the chronic medical conditions
mentioned above. In addition,
however, healthy lifestyle choices may
also help prevent you from contracting
several infectious diseases, including
Lyme disease. Because Lyme disease
is so widespread, the transmission so
insidious, and the consequences so
serious when recognized only later in
its course, it is important to determine
how simple actions and behaviors may
actually help prevent Lyme disease in
the first place.
Lyme disease results from the
transmission to a human of a corkshaped
microscopic organism called
a spirochete during the blood meal
of an infected tick. The Lyme disease
spirochete, Borrelia burgdorferi, was
first described in Lyme, Connecticut in
1977 and became a reportable disease
US NATIONAL PARKS SERVICE
Editor’s Note: This is the 110th in a
series on optimal diet and lifestyle
to help prevent and treat disease.
Any planned change in diet, exercise
or treatment should be discussed
with and approved by your personal
physician before implementation. The
help of a registered dietitian in the
implementation of dietary changes is
strongly recommended.
in the US in 1991; currently it is endemic
in much of the Northeastern US.
Preventing Lyme disease, which does
require some effort, begins with understanding
its phases and the seriousness of
it. Lyme disease is a multisystem disease
with clinical manifestations divided into
three phases: early localized, early disseminated,
and late disease. Early localized
disease may begin a few days to one
month after a tick bite and manifestations
may include a target or bull’s eye rash,
fatigue, mild headache, myalgias, arthralgias,
and localized lymph node swelling.
Early disseminated disease may occur
weeks to months after a tick bite and manifestation
may rarely include heart electrical
conduction abnormalities, mild heart
failure, and inflammation of the sack surrounding
the heart.
Fifteen-percent of infected, untreated
patients may also manifest neurological
disease such as infection of the membranes
surrounding the brain with headache
and stiff neck, as well as peripheral
nerve symptoms of numbness or weakness.
Sixty-percent of infected, untreated
patients may have migratory joint pains
without frank swelling or redness. Late
Lyme disease typically involves intermittent
or persistent arthritis with pain,
swelling, and warmth in one or more large
joints. Lyme disease consequences can be
disabling and life altering and make efforts
at prevention all the more important.
As we acknowledge its seriousness,
we must also point out that transmission
of Lyme disease may be insidious.
Individuals may present with late-stage
Lyme and never recall a preceding tick
bite. Lyme ticks are quite small, but if
identified and removed the risk of transmission
drops significantly. Moreover,
treatment with a single dose of 200 mg of
doxycycline within 72 hours of a bite may
completely prevent infection. For this reason,
prevention of Lyme disease begins
with heightened awareness and a willingness
to engage in careful self-examination
especially after potential exposure in
areas in which Lyme is endemic.
Heightened awareness begins with
recognizing the habitat of Lyme ticks and
considering avoiding those areas of high
tick density. Ticks like to climb tall grasses
and plants that allow them to hitch a ride
when a passing human or dog brushes
against vegetation. For example, if hiking
or walking, staying to the center of a trail or
path, away from vegetation can significantly
reduce possible exposure. Heightened
awareness also includes checking for and
removing ticks from both humans and
dogs after outdoor activities. While dogs
may be immunized against Lyme and may
wear an insecticide laden collar, it is still
possible for Lyme ticks to hitch a ride and
subsequently bite a human.
Routinely removing clothes after outdoor
activities allows for careful self-examination
using a mirror to help in viewing
your back; examination of your scalp
can be aided by a comb to part hair or a
willing helper. During such self-examination
placing your clothes in a dryer on
high heat for five minutes will kill ticks and
allow the clothes to be used again without
washing. For those who do not have
someone to help, the practice of routinely
bathing within two hours of outdoor activities
can remove ticks before they have
had a chance to settle and bite.
Prevention of Lyme disease is also
aided by the use of protective clothing.
Long pants, long-sleeve shirts, and
light-colored clothing may allow ticks to
be identified and removed before biting. If
the clothes are also treated with the insect
repellent permethrin, a study of 700 case
patients and 1,000 controls, indicated an
effectiveness of 40% in preventing Lyme
disease. Among 82 outdoor workers studied
in Rhode Island and Massachusetts,
factory-impregnated permethrin clothing
reduced tick bites by 58%.
Prevention of Lyme disease is also
aided by the use of tick repellents on
exposed skin. Products containing
DEET have been shown to effectively
repel ticks and are generally well tolerated
and safe when used on intact,
exposed skin. Picaridin, a synthetic
compound, based on natural plant
extract also is effective, but, perhaps,
less so than DEET. The use of tick repellents
on intact, exposed skin in combination
with the use of permethrin
impregnated clothing probably offers
the best tolerated, most effective barrier
protection against Lyme ticks.
Finally, it is important to point out
that prolonged outdoor summer activities
such as hiking in heavy brush,
camping, and golfing with multiple forays
into the rough, may expose an individual
in endemic areas to a high-risk
for Lyme disease; even in the absence
of a tick bite or a symptom. It may, in
my opinion, be a wise policy to discuss
with your physician obtaining a blood
test for Lyme at the end of a summer of
such high-risk exposure.
In summary, Lyme disease is a
multisystem disease with serious
health consequences. It’s prudent to
take steps to minimize high-risk exposure
to Lyme ticks. Such steps include
avoidance of high tick density habitats,
a careful examination and early
removal of Lyme ticks after exposure, a
shower within two hours of exposure,
the use of permethrin treated clothing,
and the use of DEET or Picaridin on
intact, exposed skin. After a tick bite in
an endemic area, treatment with doxycycline
within 72 hours of the bite may
prevent infection. After prolonged,
high-risk exposure,
even in the absence
of a bite or a symptom,
your physician
may recommend
blood testing for
Lyme disease.
Paul E. Lemanski,
MD, MS, FACP is
a board-certified internist practicing
internal medicine and lifestyle
medicine in Albany. Paul has a
master’s degree in human nutrition,
he’s an assistant clinical professor of
medicine at Albany Medical College,
and a fellow of the American College of
Physicians (plemanski3@gmail.com).