Getting Ticked Off About Lyme Disease by Carolyn Cosmos ìAs long as you catch it early, youíre going to be OK,î said Becky Archer, 34, who recovered from Lyme disease last year. But if you donít catch it early, you may not be so fortunate. Lyme disease is the seasonís sleeper illness, the most common insect- and spider-borne malady in the country, with some 16,000 infections occurring in the United States each year and more than 145,000 cases reported since 1982. However, the disease receives far less attention than severe acute respiratory syndrome (SARS) or West Nile virusóand because its early symptoms are easy to miss, the lack of knowledge could wind up permanently harming your health. Lyme disease is a fairly nasty inflammatory disease that people contract from an infected tick. A deer tick (also called a black-legged tick), which lives in wooded and brushy areas and even lawns, attaches to a personís skin, burrows in, makes a meal of your blood, and leaves behind a disease bacterium called borrelia burgdorferi. Although the first stage of a Lyme disease infection may resemble a mild case of the flu, if left untreated, the disease can cause serious harm. In later stages, it can spread to the joints and nervous system and result in facial paralysis, skin sores, memory problems, depression and cardiac difficulties. The disease can also become chronic and cause painful flare-ups for years to come. Archer, who lives in Maryland, was lucky. She got her diagnosis within a few weeks of the infection when she told her doctor about a mysterious sense of fatigue with vague aches and pains. Put on an antibiotic for 21 days, she completely recovered. A friend of Archerís was not so fortunate. ìThey didnít catch it early, and he was hospitalized with open lesions on his legs,î Archer said. ìHe gets recurring flare-ups now, open sores, joint pains.î Archer says she never saw the tick that gave her the diseaseóa pre-adult ìnymphî most likely to bite a person is the size of a poppy seedóeven though she and her husband, both hikers and environmentalists, routinely do a ìtick checkî when they return from the woods or even complete a round of gardening. Archer also never saw the rash thatís typical of early Lyme disease. ìMaybe it was on the back of my neck or in my hair,î she speculated. Called erythema migrans, the characteristic rash looks like a red bullís eye and consists of a red ring around a red spot. Blotchy rashes also occur, and neither type itches. Because a tick likes to hide, it may head for creases or hidden spots in the skin, inching upward on a personís lower body, crawling on either skin or clothes as it looks for a spot to settle down. Although cases of Lyme disease are cropping up all across the country, with small clusters in northern California and Wisconsin, infected deer ticks are most common along the Atlantic seaboard from New England to Virginia, according to the Centers for Disease Control and Prevention (CDC) in Atlanta. (The disease is named after Lyme, a town in Connecticut where it was first identified.) According to the CDC, in the year 2000, there were 3,773 cases of Lyme disease in Connecticut alone. There were also 688 cases in Maryland and 149 in Virginia. (In 2002, the number of cases in Virginia shot up to 259, according to the Virginia Department of Health.) And by the beginning of July this year, the area had five official cases in Washington, D.C., 15 in Virginia and 191 in Maryland. ìMost experts believe the actual number of cases is much higher,î perhaps three to 10 times greater than the official numbers, warned David Weld, executive director of the American Lyme Disease Foundation. How to Prevent Lyme disease When youíre in tick turf, especially if youíre hiking in the woods or walking on grass, wear long sleeves, tuck your pants into your socks, and use DEET or a Permethrin spray on your clothes, said Karon Damewood, a registered nurse and chief of Zoonotic Diseases with the Maryland Department of Health and Mental Hygiene in Baltimore. You can spray DEET on your skin and clothes, and Permethrin sprayed on clothes can last for a couple of weeks, both repelling and killing ticks. Damewood and Weld recommend frequent tick checks. At the end of the day, scan your clothes and skin and also your children and dogs for ticks. Have somebody check your scalp and look at the back of your neck as well. Ticks must be attached to your body roughly 36 to 48 hours before they can transmit the disease, so early removal can be critical. Archer, however, is skeptical of the tick check. Ticks, especially at the nymph stage, are so small ìyouíre not going to find them,î she said. Weld and Damewood agree that theyíre easy to miss, but as Damewood pointed out, ìItís better than nothing.î In addition to taking a shower, which may wash off what a tick check missed, you can do a ìtactileî skin check. Damewood advises rubbing your fingers over your skin looking for small bumps, especially in skin creases. And, finally, because ticks can in fact be difficult to detect, you should be on the lookout for symptoms of early Lyme disease and go to a doctor immediately if you have them, especially during the summer months and even into the early fall. Symptoms of Lyme disease can crop up after three to 32 days of exposure. Headache, fatigue, general aches and the typical bullís eye or blotchy rash are common early on. As the disease progresses, pain in your joints, a stiff neck and enlarged lymph glands can signal trouble. There is currently no available vaccine for Lyme disease. Although the Food and Drug Administration approved GlaxoSmithKlineís LYMErix vaccine in December 1998, the manufacturer, faced with poor sales and a lawsuit, removed it from the market in February 2002. For more information on Lyme disease, please visit the Centers for Disease Control and Preventionís Lyme disease page at www.cdc.gov/ncidod/dvbid/lyme or the American Lyme Disease Foundation, Inc. at www.aldf.com/lyme.asp. Carolyn Cosmos is a freelance writer in Washington, D.C.