Spring in the Canadian Rockies is a time of movement – bears leave their dens, robins, and other migratory birds appear, and crocuses burst through the softening soil. After months of roaming through the mountains, constrained by layers of fleece, down, goggles and helmets, some restless humans are tempted to throw off winter clothes, put on their skimpiest outfits and roll in the first two inch square plot of green grass that appears, celebrating the glorious freedom! Such temptation must be examined with prudence, as migrating animals and warming temperatures also lead to the emergence of ticks, which can carry a potentially devastating tick-borne illness – Lyme disease. Some Alberta ticks are carriers, and in significant numbers. In a recent Alberta surveillance study, veterinarians submitted 960 ticks found on Albertan pets and livestock – 139 were the potential Lyme disease carrying species, black-legged ticks. One in five of the black-legged ticks tested positive for B. burgdorferi, the bacteria that causes Lyme disease.
Translation – when playing in the Rockies in springtime it is highly recommended that you carry bear spray, sunscreen, and a handful of hardy Lyme disease prevention strategies. In fact, knowing where ticks live, how to avoid them, what to do if bitten, and how to identify Lyme symptoms is as significant to mountain safety as avalanche awareness and crevasse rescue skills. With precaution being infected with Lyme is rare, and infection is easily treated. Throwing caution to the wind increases your risk of serious consequences.
Where do ticks live?
Ticks hang out in brushy, overgrown grassy, and wooded habitats, and thrive in spring and early summer. Tick habitat includes back yards, gardens, parks and river valleys, even in cities. You can reduce the chance of encountering urban and residential ticks by removing leaves, tall grass, and brush from surrounding areas.
How do I protect myself when I hang out or travel in tick habitat?
When spending time outdoors, wear light coloured clothing (so ticks are easily seen) and bring an attitude of “long pants tucked into socks and the smell of Permethrin are seriously sexy”. Then wear long pants tucked into your socks and spray clothing with repellent. Also, wear long sleeves and cover (via scarf, hood, trucker hat, Parisian wide brim diva hat, little sisters blue fish and hearts swim cap, etc.), and braid or tie back long hair. As soon as you arrive home, do a thorough tick check of yourself and your gear, take a shower, and throw your clothing into the dryer set on high heat (to ensure that no ticks survive on your clothing).
What does this mean for clothing shedding humans with springtime grass rolling desires?
Find another itch to scratch, or scratch that particular one on a road trip to the desert where temperatures are too high for ticks to survive. Just to cover all the bases, unless you are up for duck taping your clothing to your skin, save bushwhacking up to a secret south facing climbing project for late summer or fall. Besides you are more apt to crush it then anyway.
Even with the most vigilant dedication to trading in long flowing hair and your favourite surf shorts for stringent tick avoidance strategies, a tick may may its way to an armpit or some other hidden area and latch on. DO NOT try to remove it by burning the tick with a match or suffocating it with Vaseline. These methods cause ticks to release their gut contents, increasing the chance of transmitting bacteria to its host (aka YOU). Instead, grab the tick with narrow nose tweezers around it’s mouthparts, as close to the skin as possible, and firmly pull it straight out. DO remove the tick promptly, as the risk of infection increases the longer the tick is attached.
After the tick is removed, ID it to see whether it is a potential Lyme disease carrier (see: http://canlyme.com/lyme-basics/tick-id/). If it is, even if it has only been embedded briefly, consider getting it tested for confirmation and surveillance purposes (see http://www.health.alberta.ca/health-info/lyme-disease.html) and consider seeking immediate preventative treatment.
Be aware that because of medical controversy, opinions on Lyme disease prevention and treatment protocols vary widely. Because a Lyme infection can enter the central nervous system in as little as 12 hours, if bitten, quick decision making is the key to prevention.
Translation: educate yourself on the risks and benefits of different bite treatment protocols before you potentially need them. If you are a procrastinator, consider extra procrastinating elsewhere as a trade off!
Lyme disease treatment protocols: IDSA vs ILADS.
Doctors who follow the Infectious Disease Society of America (IDSA) guidelines usually only provide an antibiotic treatment for a tick bite (even if by a Lyme disease carrying species) if any of the following occurs:
• a tick has been attached for at least twenty four hours,
• flu or arthritic like symptoms,
• a bullseye rash,
• Lyme disease blood tests are positive.
The IDSA recommends only short courses of antibiotic treatment, up to a maximum of three weeks, regardless of result of the blood tests.
However the IDSA guidelines have been critiqued by patient groups, physicians, and international organizations, because of the a) large number of devastating patient experiences who followed IDSA protocols with poor results (i.e., Lyme infections not detected, not adequately treated, or caught so late that the disease was difficult and complex to treat), b) contradictory clinical and research evidence, and c) biased review panels. Because of these shortcomings with the IDSA guidelines, Canada recently passed a law requiring a national Lyme disease strategy to be created based on input from all stakeholders.
Most doctors who specialize in treating tick borne illness (Lyme disease Literate Medical Doctors — LLMDS) follow the protocols of the International Lyme and Associated Diseases Society (ILADS)– “a nonprofit, international, multi-disciplinary medical society, dedicated to the diagnosis, and appropriate treatment of Lyme and its associated diseases.” According to the ILADS protocol, a bite by a potential Lyme carrying tick IS ENOUGH for immediate preventative antibiotic treatment regardless of the duration of the tick attachment. The recommend course of antibiotics for prevention can be can be as short of three weeks but the duration can be longer for the treatment of symptoms.
The consideration behind ILADS viewpoint and protocol includes:
– blood tests may not detect antibodies in the first few weeks of infection
– there are not always immediate signs of illness and in the time it takes to get a tick tested the infection can shift from an easily treatable case to a more complex long term infection that is more difficult to treat
– a bullseye rash is not present in all cases of Lyme
– the recent research demonstrating the presence of Lyme disease bacteria in the mouthparts of ticks, which means that infection may occur during the initial bite (albeit less likely). This is backed up by substantial clinical evidence
Identifying a Lyme infection early.
Following the tick treatment and bite treatment protocols is usually enough to prevent Lyme disease. However, it is possible to miss a tick bite, because bites themselves are painless and ticks in their nymphal and juvenile stages are smaller than a poppy seed or pinhead. Symptoms can also be delayed weeks to years after a bite, potentially causing confusion about the causes of different symptoms.
Being able to identify potential Lyme symptoms can help you to efficiently catch and treat a missed infection. Earlier treatment means an easier and shorter treatment regardless of stage of illness. Prompt identification and treatment can make a significant difference to outcomes in all cases.
Everyone needs to weigh the risks and benefits of treatment choices themselves. It is the author’s opinion, the opinion of ILADS, and many Lyme patients that the risk of missing a Lyme disease infection by not treating the disease at the earliest possible stages, are more serious than the risks of the negative side effects of antibiotics. This is especially true when common side effects of antibiotic treatment can be prevented by probiotics and other supplements.
What are the symptoms of Lyme disease?
It is commonly believed that the most common sign of Lyme disease is inflamed, swollen joints. Although this does occur in a small percentage of people, the majority who have joint involvement experience joint pain that comes and goes, wanders from one area of the body to another and includes pain in the muscles, tendons, and ligaments around the joint. It very often does not include any redness or swelling. Other common symptoms include but are not limited to flu-like symptoms, fatigue, headache, cranial nerve disturbances and visual and/or sound hypersensitivity.
Lyme disease (sometimes called the “great imitator”) also can mimic the symptoms of MS, ALS, Parkinson disease like syndrome, Guillain-Barre like syndrome, seizure, and other neurological conditions, cardiac (heart) conditions, as well as arthritis, ADHD, and various difficult-to-diagnose multi-system syndromes.
A bullseye rash (e.g., http://www.lyme-disease-research-database.com/lyme-disease-rash.html ) does not have be present to make a Lyme disease diagnosis (although on it’s own it is diagnostic of Lyme disease and indicates the need for immediate treatment).
Translation – whether you remember a tick bite, if you have ever spent time in an area with ticks that could carry Lyme disease (which includes endemic areas and anywhere where ticks can be brought in on migratory animals) and begin to exhibit any Lyme disease symptoms that are unexplained by another confirmed medical illness, consider being assessed for Lyme disease by a Lyme disease literate doctor (LLMD). It may require sending your blood work to labs in the States. False negative test results are common in Canadian testing protocols, and if you test negative you will not be assessed further. Also note that no test alone can definitively rule out a Lyme disease infection, so Lyme disease should a clinical diagnosis – most reliably assessed by an experienced LLMD.
Medical resources and tips for navigating the medical system are best found by consulting local Lyme disease patients (e.g., Lyme Disease Association of Alberta, http://www.albertalyme.org/). I personally have a lot of trust in Dr. Marty Ross at the healing arts partnership in Seattle, and the Richmond B.C. Naturopath Dr. Eric Chan.
Bear spray for ticks.
If you have read this far or know all of the above already, you are carrying the equivalent of bear spray for ticks – a significant part of mitigating risk as you play through all seasons in our incredible Rocky Mountains!
For snippets of my story including personal anecdotes about navigating both Lyme disease and the medical system (and random notes about such things as cartooning and Cuba) see my blog at: Foxnsox.wordpress.com. More detailed information about identifying, treating, and preventing Lyme (and other tick borne illnesses) can be found in my e-book: https:// db.tt/CAeTR5p2.
The excellent photo of Ixodes scapularis (Deer Tick) was provided by Macroscopic Solutions under the Creative Commons License. Title was added.