Well, welcome back to another episode of Your Mom on Drugs.
I am the son, Joshua Klaus.
And I'm the mom, Jennifer Seltzer.
And we're going to be on Drugs today.
Well, kind of today.
This is a very interesting episode.
We're going to be doing an episode on Lyme disease.
Now the reason I wanted to do this episode in Austin, Texas, where I live, there's this
music festival called Austin City Limits.
And one of the performers there was the one and only Shania Twain.
And apparently, I didn't know this, but someone brought it up to me that she suffered from
chronic Lyme disease.
I think for about 20 years, her vocal cords were kind of shot from this condition.
And I didn't even know that was a thing.
I just thought that you kind of got bit by a tick and you got Lyme disease and something
happened, but I had no detail.
So the idea that something like that could stick around in your system was really interesting
to me.
And I didn't know how prevalent it was.
I didn't know how bad it could be.
So obviously, I called up my favorite mom on drugs and I said, Mom, we need to do an
episode on Lyme disease because I think it'd be really interesting.
And you know, Mom, I want you to let people know what you found out.
Like, what are some of the basics of Lyme disease?
OK, here we go.
So it was really interesting to look into this subject matter because it was not something
that I knew a whole lot about.
Lyme disease is actually the most common vector borne disease in the United States.
And you say, what's a vector borne disease?
Well, a vector is something is a life form that serves as an intermediary.
I'm sorry, it's a life form that serves as an intermediary to transmit an infectious
germ from animals to humans.
So they will.
So this vector organism can get infected by disease causing pathogens.
So maybe it's a rodent that they may get infected by.
And then once they're infected, then they can transmit that germ to a human host throughout
their life whenever they come in contact with a human host.
So there are about three.
So you say, OK, well, what are some of the more common vector organisms that we're familiar
with are going to be mosquitoes and ticks.
And the types of diseases that we see from this are malaria, dengue fever, yellow fever,
plague and Lyme disease.
OK, so it's not the actual insect or arachnid that is giving you the disease.
They actually carry a disease inside of them that then gets inside of your body.
That's what it means to be a vector.
Well, yes.
So basically, they're the go between.
So they went and they fed on a mouse or something that had Lyme disease, the bacteria for Lyme
disease, and then they then ultimately bite you.
And then you are able to get Lyme disease at that point then.
And so does that make sense?
So they're so they're here.
So they didn't initially that the tick didn't initially have Lyme disease.
But as we get into their lifestyle, we'll understand why they would then be more vulnerable
to get Lyme disease as a result of feeding on a rodent and then ultimately bringing it
to us.
Gotcha.
But they're not actually carrying Lyme disease.
They're carrying a pathogen that presents itself as Lyme disease.
They carry the bacteria for Lyme disease.
OK, all right.
Well, this reminds me of a fun story.
I remember learning about this in my undergrad degree.
There is trying to even remember the name.
I think it's called like trypsinosis or something like this.
I can't remember the name, but I remember that mice or rodents are naturally scared
of cats.
They'll see cats.
And actually, a lot of times it's actually the there's a chemical in the cat's urine
that they smell it and like, oh, don't go near there because there's going to be a feline
nearby.
But there's this pathogen that infects rodents that basically changes the neurological structure
of their brain to actually be attracted towards this urine to be like, oh, this is nice.
What is this?
They want to get curious towards it.
And obviously, this leads them to the feline, which then eats the rodent.
But actually, the parasite within the rodent wants to get inside of the cat that actually
completes its life cycle to go inside and to actually become, you know, as we all know,
organisms have life cycles to go from eggs to, you know, infants and some variety to
adults and then to complete the cycle.
So I thought that was really cool.
So it seems like in this case, the rodent was the vector to get itself to get this thing
inside of the tick is the vector.
No, in the example.
Oh, you're pardon me.
Yes.
OK, yes.
Yes.
So to go back to the tick example.
Yeah, the tick would be the the go between, like you said.
Yes.
So life seems to have these really interesting pathways like I'm living here, but I need
to get here.
So how do I do it?
Yeah, that's amazing.
It is.
And interestingly, so so in the United States, there are anywhere from three hundred thousand
to four hundred and seventy five thousand or so cases of Lyme disease every year.
Most of them are are located in the northeast eastern part of the United States or the Midwest
or the or some of the states in the northwestern part of the United States.
It's not that common in Texas.
So be like if people from Texas, since we live in Texas, you and I, but people may be
traveling to the northeast.
Yes.
Where would they encounter these organisms?
So so let me just backtrack just a little bit.
So the Lyme disease disease is called caused by a bacterium called Borrelia burgdorferi
burgdorferi.
We're just going to call it Lyme disease.
Borrelia burgdorferi, that sounds right.
So I probably don't have the enunciation exactly correct.
And I should have listened to how people say that.
So so that's the bacteria.
So it's a bacterial disease.
And it like I said, it's transmitted to humans through the bite of the black legged tick.
And this tick is in the eastern United States, like I said.
And it also can be found in the Midwest and mid Atlantic states.
And it's also in northern California, Oregon and Washington.
And so but we do get that by traveling there, not knowing we got bit by a tick and then
coming back and get and then starting to become symptomatic.
And then you'll get part of the statistics for your particular state.
Interesting, so you could be diagnosed in Texas as having Lyme disease, but if have
contracted Lyme disease from a tick, and maybe a place that you traveled, right, just because
a lot of these species don't necessarily reside predominantly in our state, they kind of live
more in these maybe more northern woody areas.
That's correct.
Okay.
So it's really it's really I found this so fascinating this lifecycle of this tick.
So like you said, Josh, some organisms have multiple life cycles.
So the tick is is falls into that category as being an organism with multiple life cycles.
They have four life stages, the egg, the larva, the nymph, and the adult.
And the so fascinating the adult ticks are the size of a sesame seed.
So think about when you go get that bagel, the sesame seed on there, that's the size
of the tick.
But then all the nymph stage, which is the one before the adult stage is the size of
a poppy seed.
So those little poppy seeds on your on your bagel are smaller than that.
So you can imagine it being very hard to know sometimes that you've actually been bitten
by a tick because they're so small.
Interestingly too, after the eggs hatch, those larva and nymph stages have to have blood
to develop to the next stage.
So there we have the reason why we've got to have, you know, a they become a vector
because they're looking for something to feed on that has blood.
And most of the time they're going to find a rodent to do that.
Also to before Josh, I know you want to say something, but also to the mama, the female
ticks have to also feed on blood to be able to lay eggs.
The male ticks, no, they don't have to, but the females have to eat blood to lay their
eggs and then the larva and the nymph stages have to feed on blood to go to the next stage.
That's really interesting.
And one of the things I read about this type of tick is that they only feed really a couple
of times in their lifetime.
They actually have a two year lifespan.
So to go from egg to adult and all the stages in between is about two years.
And I think they only need to feed four or five times.
Okay.
That's interesting.
I did not read that.
So that's real.
Yes.
They're mostly active in the spring summertime, like April, the nymphs are April to July when
they're most active and the adults are most active in spring and fall time.
So and interestingly too, the female ticks, if they're infected, they don't pass it onto
their offspring to the eggs.
So that's the interesting way that it is.
And this is another, this is kind of a misunderstanding.
Yes.
Ticks definitely feed on deer to get blood from deer, but deer are not a source of the
Lyme disease pathogen.
They don't carry that bacteria.
So while the ticks can use the blood from the deer to go to the next stage, they did
not get Lyme disease from the deer.
So that was really interesting.
Gotcha.
So the reservoir for this bacteria, the Borrelia burgdorferi is going to be a rodent.
So they'll bite the rodent, maybe get the blood from that.
And then if they have blood inside of them to bite a human, that's most likely going
to be the way it transfers.
Right.
But remember that the larva and the nymph stages have to have blood to go to the next
stage so they could feed on the blood from a deer.
But I mean, primarily I guess the nymph stage would because the larva would have already
had to have gotten it from a rodent.
Because the nymph could or the or the momma could feed on blood from a deer, but they
didn't get it from the deer.
They'd already gotten it from someplace else.
So yeah, that's a good point.
And maybe people are thinking like, well, how does something so small get on something
so large?
You know, and the thing that's so large, either a rodent, deer or human, not notice it.
And like my mom said, I think it's really crucial to consider how small these things
are.
Like I saw a picture of a dime, like a dime, like a coin and the letter E on like United
States, the nymph of this tick is smaller than that letter E on your dime.
So if you're looking at a coin, let's say from far away, can you see the letter E?
And if you can't, you probably can't see this nymph.
And also imagine that if it bites you, the mouth of this tick is so small that your nervous
system, you know, to signal pain is probably too small for you even to register that you're
getting bit.
Oh, and I've got so much more information about that too.
It's so cool.
Hold on.
Let me just add one other thing is that also the tick has to be normally attached to a
human for 36 to 48 hours before the bacteria can actually be transmitted.
So removing a tick quickly, if you actually can see it within 24 hours is going to help
prevent getting Lyme disease.
But so this is so fascinating.
So you talk about how on earth can this tick get onto these larger animals?
So they can't fly or jump.
So they will instead maybe rest on grass or shrubs.
And they call that questing.
So they've got their positioned and so they can hang there and they hang on there by their
lower legs.
And then their upper legs, their upper pair of legs are outstretched waiting to climb
onto a passing host.
And then when the host brushes by, there they are, they climb aboard and then they find
a suitable place to bite the host.
So this is a whole process.
So they will then, they're getting ready to feed can take anywhere from 10 minutes to
two hours.
So they find a feeding spot, they grasp onto the skin and they cut into the surface of
the skin and then they insert a feeding tube.
And sometimes they'll also, they can, they can secrete a cement like stuff substance
so that that helps them to stick there.
And then they also can have out of their saliva, there's something in their chemical saliva,
a chemical in their saliva that kind of serves as an anesthetic so people might not even
feel the bite.
I mean, it's just fascinating and stuff.
So you've got, I'd say if you're a person that is, I'm thinking, we think about hunters
a lot because they're going to be looking for, they're going to be out with deer a lot.
That would be something that you want to be watching for is having your buddies search
your bodies for, you know, ticks after you're done to make sure that you don't see anything
like that, even something such as small little dot and stuff.
Yeah.
It almost seems like seeing it would almost be borderline impossible.
So maybe just making the natural assumption that if you go outside, you might have a tick
on you and to take preventative, I'm sure we'll get to preventative measures later on.
Yes.
I, you know what your description, I think people forget that ticks are a type of arthropod
called an arachnid and people might be familiar with one type of arachnid called a spider.
Then spiders have eight legs or eight appendages and so do ticks.
So it's really, I picture a tick waiting on this leaf very much like a spider waits in
its web, you know, to wait for its prey to come by and then it enacts its predatory act.
So I like that it has a kind of a similar strategy as well.
That's amazing.
It really is.
And they feed for several days, you know, to get enough, you know, of their nourishment.
And their anesthetic obviously is great for, you know, not letting the host know.
I mean, it's so similar to like when a virus goes inside of you and you don't want to let
the host know of the symptoms right away or the host immune system because that would
alert it to the presence.
So you kind of want to be a little sneaky at first before you kind of take over.
Yeah.
That's really interesting.
So once they produce this feeding process, they'll drop off and then they'll prepare
for the next life stage and then they'll transition into the next life stage and then whoever
they feed on next, because they can obviously get our blood as well too to go to the next
stage as well too.
So yeah, so throughout its life, once they're infected, they can transmit Lyme disease.
But like Josh said, they usually have a lifespan of only around two to three years and stuff.
So I still think that's really remarkable for something as small as an insect or sorry,
not an insect and, you know, a tiny little arachnid.
Because sometimes I think about there are certain insects that only live to be like
a week old.
Yes.
So the fact that one of these small things can live to be, you know, two years is pretty
incredible.
Right.
So remember too, that, you know, removing them quickly can reduce the chances of getting
Lyme disease because it can take some time for the bacteria to move from the tick to
the host.
All right.
So we've talked about the tick and how it can bite and essentially get our blood.
But I imagine within the transfer of our blood going into their body, they're also transferring
things inside of us.
And I think that is the potentially the bacteria that you were mentioning.
Right.
The bacteria that causes Lyme disease.
Right.
When they are feeding, they're also like, that's how the bacteria gets into us as well.
Yes.
Okay.
So do you want to kind of go into, you know, I wish maybe, I don't know if you just want
to give a brief, you know, summary of, you know, just kind of basic infection, like why
a bacteria entering inside.
We don't have to do that.
Don't worry about it.
Or you can do that.
Yeah.
Well, I mean, we've talked about this before with viruses and, and, um, you, you have to
remember that your body, it doesn't feel like much, but to the outside world and all the
creatures, it's a reservoir for a lot of yummy things.
So the reason the tick wants your blood is that your blood is full of a lot of nutrients,
a lot of glucose, especially if you've eaten some of my mom's amazing cookies.
So they hope to catch me on that day.
So there's a lot of nutrients in the human body.
And so a lot of creatures are trying to take advantage of that.
And your body has developed a lot of defenses against that, whether it's your skin or your
immune system.
And so when a lot of those barriers have been broken, um, then you essentially open yourself
up to being a buffet for a lot of these organisms.
So this bacteria will basically enter into the skin where it's been cut open, get into
the bloodstream.
And as you know about the bloodstream, it, or maybe you don't, it's essentially just,
just connection of intricate plumbing that's pumped by your heart to essentially go through
all about your body to deliver two main things, you know, nutrients and oxygen.
And there are certain areas of your body where certain bacteria thrive and do well.
And some of those bacteria are quite helpful, um, especially in your gut.
Uh, but there are some places where they're not helpful.
Um, like your brain, you don't want a lot of bacteria up there because it can cause
things like sepsis.
Um, and, uh, you know, crazy enough, you know, the, one of the reasons why these ticks can
actually carry these bacteria and not have Lyme disease themselves is that they've actually
kind of developed this cooperative relationship where the tick, the tick actually has this
genetic profile where it's able to kind of tampen down the population of, uh, B. burgdorferi.
And, but when it goes into a human, we don't have this genetic profile.
Cause last time I checked, I'm not a tick.
Um, and so we, we basically don't have this innate immunity against it.
So it goes into our bloodstream and then it goes to an area of our body where it essentially
presents itself potentially as a disease.
And so I'm going to pass it over to my mom on drugs to kind of present the, the description
of this disease, which we call Lyme disease.
Once this bacteria is inside of us.
Okay.
But what, one other piece of information, let me share, um, before we, I'm going to
start talking about signs and symptoms of Lyme disease is that, uh, being in Texas,
we really do have a low incidence rate of Lyme disease.
So you're again, you're talking about why on earth, I mean, so Shania Twain is not going
to come, you know, visit us, you know, every week or whatever.
But the thing is most of the cases in Texas are going to be what we call imported.
Um, and that means that someone has trans has, has traveled to one of those areas that
is more where Lyme disease is more prevalent.
Went on a hunting trip, went on a hiking vacation and got exposed and then came back and then
got diagnosed after that.
So that's why we talk about that.
Probably everybody should be aware of what it looks like if you develop signs and symptoms
of Lyme disease, especially if you're a traveler, you like the outdoors and that kind of thing.
So, so, um, moving into the signs and symptoms of Lyme disease, the signs and symptoms will
develop anywhere from three to 30 days after the tick bite starts out with some non-specific
symptoms, things like fever, chills, headache, malaise, which is kind of, you know, feeling
tired and just kind of draggy.
You can have some muscle and joint aches.
You can have some swollen lymph nodes, but the key, um, the key diagnostic clinical symptom
is what we call erythema migrans.
And it's a skin manifestation that is going to occur in the 70 to 80% of people who have
been infected with Lyme disease.
Usually the average onset of erythema migrans is within seven days of being bit by the tick.
And it would, it looks kind of like a bullseye.
So you've got kind of a red center area, then the bacteria, the symptom will start clearing,
but then you've got this outer ring as well too.
Now not everybody is going to get this classic erythema migrans, um, uh, skin manifestation,
but like I said, it happens in about 70 to 80% of people.
And it may not also look exactly classically because that's just the way the human body
is.
It can feel warm to the touch, but it's not itchy or painful.
And it can appear on any part of the body, but it's most commonly seen in your thigh
area, your groin area, or actually, actually your axilla, which is under your arms as well.
Um, and it can occur in multiple places.
In two to 18% of cases, people can have more than one, um, um, uh, demonstration of erythema
migrans.
Um, this, like I said, this classic rash is not present in all patients or it could look
somewhat different, but just be aware of that, that that's going to be a real key diagnostic
tool if you have this particular rash when you manifest as Lyme disease.
So those are kind of the things that you look at early on.
And if by chance this gets missed or you don't manifest the typical symptoms, if you have
later signs and symptoms that are anywhere from days to months after the tick bite, then
you can have some more serious issues associated with Lyme disease.
You can have a severe headache or neck stiffness.
You can have other, my, uh, those erythema migraine rashes all over the body as well.
You can have some neurologic symptoms.
So one of the things that we see, I think more in children, but you can also see in
an adult is called facial palsy, which means there's some weakness on one or both sides
of your face.
You have a lot loss of muscle tone or kind of a droopy look.
Um, also you can get arthritis.
So you, this bacteria can get in your joints and cause the pain and the swelling associated
with an arthritis, especially in the knees or other large joints like your shoulder or
your elbow or your ankle.
You can have intermittent bone joint and muscle pain.
You can also have, this is pretty serious.
You can also have Lyme carditis where that bacteria gets into your heart muscle and that's,
that's really not good.
And again, some other neurologic symptoms are, uh, I should have included those when
I talked about the facial palsy, but you can have some dizziness.
You can have brain and spinal cord inflammation.
You can have meningitis.
You can also have some nerve pain, shooting pains and numbness that that are tingling
that go out to your hands and feet as well too.
So again, catching it earlier and managing it earlier is pretty much what we want to
do, but there are, so to avoid some of these more serious, uh, uh, manifestations of the
disease.
Yeah.
I think it seems like the main prevention is to prevent the, from bacteria from getting
inside the bloodstream in the first place, which is to essentially, as mom mentioned
earlier, ticks can be feeding up to you said, 48 hours, 48 hours.
So within 48 hours of going on a hike, you know, maybe somewhere in the Northeast or
the Northwest, it would be good to maybe do a check and see what's on you.
Yeah.
It's, uh, we've talked a bit about this in other episodes, but there are these things
in your, um, near, near your, you know, basically in your head called cranial nerves.
And there's, uh, I can't remember how many there are 12 of them.
And yeah, if you get infected in some of these, then they're going to present themselves as
neurological symptoms, which I believe led to, you know, Ms. Twain's, uh, inability to
use her vocal cords.
Cause basically one of those nerves got affected by this bacteria.
And uh, yeah, if it infects that and chronically infects it, then you're not going to be able
to have access to that.
Um, then basically becomes a game of diminishing that inflammation to a point where you can
be functional again.
So that's scary stuff.
It is.
I'd say, you know, I'd say they're most probably preventive way to, if you are someone that
goes outside is to make sure you wear protective clothing, um, to, to keep the tick, you know,
as a barrier between you and the tick.
I I'm not, I apologize.
I did not look this up.
I don't know if there are repellents that can be used to repel ticks.
I didn't look up that.
So I'm not sure of that.
There are, um, struggling to name, find the name.
We can post it in our notes, but there are certain sprays that you can spray on your
clothing that essentially act as a mild nerve agent against the, uh, the insect or tick
itself.
And remember, this is just one type of tick.
There's many other types of tick that carry other types of diseases, things like a Rocky
mountain spotted fever.
Um, there is, um, what's another one I'm thinking of is like babbiosis or basically,
yes.
Yeah, there's, there's many different types of diseases because different types of ticks
carry different bacteria because those ticks are, you know, they, they've, they've evolved
to essentially have different bacteria live inside of them.
Um, so sometimes something even manifesting itself, if you don't have, that's why the
understanding that big target ring, you know, arithmetic migrans is, is really a big indicator
for Lyme disease because if you just have the malaise or fatigue, um, after being bit
by a tick, it could be one of these other types of diseases that do present similar
symptoms to Lyme disease, but might actually be Lyme disease.
But Lyme disease is definitely the most prevalent, which is why we're talking about it.
Right.
And so like, like Josh said, there are different types of ticks.
This, this is like we said, the black leg tick, or it can sometimes be called the deer
tick, which is a little bit of a misnomer, but you know, they do, you do find them on
deer, but deer are not the, the, uh, cause of the Lyme disease.
Yeah.
I think it's their main source of blood, but it's definitely not the source of the, the
bacteria.
Right.
So let's talk then, I know we've talked a little bit about some prevention, but now
let's talk about if you, if you have some of these symptoms, how on earth do you get
diagnosed with Lyme disease?
Most of the time it is going to be a clinical diagnosis.
So we're looking at those signs and symptoms.
So for sure, if you've got this erythema in migrants, it's going to be a pretty good diagnostic
tool that you have Lyme disease.
Um, if you, if you, you're going to, you're going to also people who are evaluating you
for your signs and symptoms, healthcare professionals will also be wanting a history of where you've
been.
Did you have a chance to be exposed to this black leg tick?
Um, do they're going to rule out other illnesses that have similar symptoms?
And then it, so then it gets down to, are there any lab tests that you can do to identify
whether or not you have Lyme disease or not?
And it's kind of tricky.
Um, basically you're again, you're there, you're, if you have a really low kind of,
uh, present low, low risk presentation, like you've got fever and body aches, but nothing
else, you're not going to run a diagnostic test.
And if you have erythema migrants, which is pretty highly specific, then you're not going
to run diagnostic tests.
We're, we're looking to run diagnostic tests in that middle ground area where maybe people
have just some more non-specific symptoms.
Maybe they've got some joint pain or whatever and stuff.
So you're going to, you're, you may then pick that there are those, those patients out to
do this diagnostic testing with it.
And it's a two step testing process.
The first part of the testing is going to be what we call a, um, they call it an ELISA
test.
And basically what the ELISA test E L I S A test is doing is it's measuring antibodies
to Borrelia or Dauphiri.
And so, uh, and it, but it can take a little bit of time for those antibodies to develop
to the bacteria.
So if you measure it too early, you're going to get a negative test.
So you may have to wait a couple of weeks to, until you've got an antibody level that's
going to measure on this test.
And if you get kind of a equivocal kind of like a plus one is maybe it's positive or
positive tests from this ELISA test, then you run the second test, which is usually
a, what they call a Western blot test.
And this test is actually measuring immunoglobulins in our circulation, primarily IgM, immunoglobulin
M and IgG, immunoglobulin G. These are the ones that are going to manifest when the Lyme,
when you have Lyme disease, but they're not, there is within the first 30 days, you can
measure both of those immunoglobulins.
And if you get a positive test with that ELISA test, and then you get the positive measurements
of these immune globulins with the Western blot, then you have a pretty definitive diagnosis
of having Lyme disease.
But know too that after 30 days, the IgM is no longer as reliable because IgM can be elevated
in other kinds of infections as well too.
And it also can stay around in someone's body for a long time after they've had Lyme disease.
So, so you might be looking for IgG in a 30 to 60 day time period after you've manifesting
symptoms, but IgM won't be a good monitor anymore.
And also these, these immune globulin levels, you can't measure to determine cure because
they can hang around or they can be elevated with other disease states as well too.
So it can be in this little window, they can help diagnose it, but after that, they're
not as useful.
Yeah, it almost seems to be like an ancillary tool to help along with the ELISA diagnosis
as well.
Kind of reminds me of like when you got COVID tested for PCR or even the antibody tests,
it was the, sometimes you would get these false positives, especially the PCR because
that DNA of the SARS-CoV-2 virus could, could stick around for a really long time.
So even when you weren't infectious anymore, you could still register positive as well.
So you're kind of looking for, I mean, the thing with science, a lot of people think
it's like it's a lucid alien truth, but science is really about eliminating possibilities.
So that's, it's always just kind of saying like, all right, does this test say this thing?
It doesn't.
Okay, let's move on to the next test.
So, cause there's a lot of things that can make you sick.
And you're trying to isolate which thing is the actual cause.
And the way to do that is by eliminating possibilities.
So you don't want to treat somebody for a condition that they don't have, cause you
could, one, make something worse or two, basically waste your time.
So there's a lot.
And I'm sure they're not cheap to run these tests as well either.
So, so you're looking for that patient that has been potentially exposed to this black
lead tick, black legged tick.
And then they're showing some of the symptoms, but they've got maybe some, maybe they don't
have that classic erythema migrans rash.
They've got some other things going on and you've got to try to decide whether or not
am I ruling Lyme disease in or am I ruling it out?
And so you would choose those patients.
Primarily it's patients that have arthritic, arthritis type symptoms is what I read a lot
about that that would use, you would use this.
That makes sense.
And even things like meningitis, cause there's a lot of bacteria or viruses that can cause
meningitis.
So you're wondering which thing is causing it.
Right.
You could do that.
Yes.
So, so let's, let's move on to like, okay, so we've got some signs and symptoms.
We know we were exposed to this tick because we were out in the Northeast hunting or hiking.
How do, how on earth do we treat this disease?
So it is actually because it's a bacteria, it can be treated with the antibiotics and
the earlier you do it, the earlier your diagnosis and the earlier you receive the proper antibiotic
therapy, it can, it's going to help prevent those late Lyme disease symptoms or presentations.
It's not a hundred percent though, because people can get treated and then they can end
up with some persistent symptoms afterwards.
It's a, it's a nasty disease.
So, so, but you want to try to catch it earlier on.
And so if you're just targeting people that just have the rash with the erythema migrans,
with non-specific symptoms, there are three key antibiotics that are used.
It's doxycycline, amoxicillin, or cefuroxine.
And one's a tetracycline, one's a penicillin, and one's cephalosporin.
And they can be given orally, usually for two weeks.
The doxycycline can be given for about 10 days and you use, you use these same antibiotics
in both adults and children.
And again, the treatments, the dosages can be modified based on the age of the patient,
whether or not they're pregnant, other underlying health conditions or allergic or allergy,
you need allergies to medication.
So you would modify it accordingly.
Are things like doxycycline, amoxicillin, are those the brand names?
No, those are the generic names.
The generic names.
All the, the doxycycline, amoxicillin, and cefuroxine are all generic names.
Okay.
They're, they're older drugs, so I'm not even sure they have a brand name drug to them anymore.
But you said they're derivatives of penicillin.
Well, amoxicillin is a penicillin, but doxycycline is what we call a tetracycline.
Okay.
And cephalo, cepheuroxine is a cephalosporin.
Those are just classes of drugs.
Gotcha.
Classes of antibiotics.
And it, most patients, if you treat them early on with Lyme disease, they will recover rapidly
and completely.
So that's going to be your basic Lyme disease patients.
If you have some neurologic symptoms associated with Lyme disease, let's take, for example,
the facial palsy, so that drooping face.
You also can treat patients orally with doxycycline, both adults and children, for up to three
weeks.
And hopefully you'll get some improvement and, and, and cure in that.
As you know, and, and, and then, but if you have something like Lyme meningitis or you
have more of those neurologic symptoms, like you've got fainting, tingling in your hands
and feet or kind of nerve pain kind of feeling and stuff, then you can also use oral therapy
with doxycycline for up to three weeks in adults and children, or you may need some
intravenous antibiotic therapy.
The drug that's used typically is another cephalosporin called ceftriaxone, which is
a parenteral or an intravenous antibiotic.
And again, you'd use that for three weeks.
Most patients, if you treat with both these, in these neurologic symptoms can be, they
can recover, but if you delay treatment again, and we can understand why treatment can be
delayed because you might not manifest the symptoms, you know, like, like a textbook
or it could take some time to figure out, oh, let's do this.
Cause they, you're going through a whole long, what, well, what could it be this or could
it be this?
And so then they may have some permanent nervous system damage as a result of the effects on
the nervous system from this bacteria.
So trying to catch it early, trying to keep that at the forefront of if you've got some
of these symptoms or, you know, you've been to these places, you just want to be aware
of that.
I think it's really important to re to emphasize to when, when you've been diagnosed with any
type of bacterial infection, you're not taking the treatment to match the symptoms.
So for example, if you're taking it for three weeks and let's say after two weeks, you feel
better.
Should you stop?
No.
And why is that?
The reason that you don't stop is that maybe there are still a few bacteria hanging around
and if you stop, they could then develop some mechanisms within their little bacterial cell
wall that would cause resistance to antibiotics.
So that if you then try it, started taking it again, those antibiotics might not work.
So even if you've diminished the bacteria down to 1% of its original population, that
1%, if not taken care of, then just like mom said, that 1% will have a resistance to the
antibiotic and then those become multiply and they then they'll kind of take over and
that's, that's a, that's a problem.
So it's really important to complete your regimen of antibiotics if you've been prescribed
them.
Those patients that develop heart symptoms associated with Lyme disease, that's a pretty
serious thing.
You can have, you know, arrhythmias, you can have heart block.
So it's pretty serious.
So the recommendation is that you're going to treat those patients immediately and you're
not going to wait for any type of test results because you do the test results, but you're
going to go ahead and already start them in their antibiotic therapy.
And if you need to stop it because the tests are negative, that's much better than waiting
because they could get far worse if they, if they don't know that this is specifically
because these symptoms can get more severe and anything with your heart can be, you know,
kind of troubling and stuff.
So again, you can do, you can actually treat it milder heart symptoms with the oral that
those either any of those three antibiotics orally in kids and adults for 21 days, the
doxycycline, amoxicillin, or staphyroxine.
But if you have more serious heart symptoms, then you're going to use the intravenous therapy
with the ceftriaxone up to up for three weeks.
The last area of, you know, target or the last targeted area that the Lyme bacteria
can interfere with is going to be our joints, so Lyme arthritis.
And so again, the doxycycline, amoxicillin, or staphyroxine oral therapies can be used
in adults and children for this night.
Now we've got to increase it for four week therapy, 28 days.
If you have improving but persistent symptoms in your joints, you could end up needing an
additional 28 days of therapy, of oral therapy.
Sometimes what healthcare providers will do if after that first 28 days of therapy, you've
got some improvement but not great, they may switch you to intravenous therapy.
And for sure, if you did not have a response to oral therapy in the first 28 days, they
will change you over to ceftriaxone for 28 days to try to see if that's going to help
manage those symptoms.
Again, if you don't deal with this promptly, then you can have permanent joint damage as
a result of the Lyme disease.
Okay.
And I imagine intravenous is just, it helps get those drugs to the location, maybe more
effectively.
Faster and more effectively.
You bypass having to have a drug absorbed through your gut and all that stuff, so it
does.
It's more, you might get more higher concentrations of medication to those targeted areas.
Absolutely.
Okay.
So, Josh alluded to, I mean, some patients can have persistent symptoms despite being
treated.
The jury's kind of out as to whether or not giving additional antibiotic therapy helps.
And so there's no bottom line recommendation for that as far as that's concerned.
So that's kind of a persistent infection, but there is also another condition that can
happen with patients that have had Lyme disease, and they call it post-treatment Lyme disease
symptom.
Post-treatment Lyme disease syndrome, or PTLDS.
And these are patients that can have persistent disabling symptoms despite having had appropriate
antibiotic therapy.
So it's symptoms that may sound familiar to people, fatigue, pain, and neurocognitive
disturbances.
They're going to sound very similar to the first disease like this that I remember learning
about was chronic fatigue syndrome.
And then after that, you had fibromyalgia, and then you had long COVID syndrome.
They all have kind of that similar type of nondescript symptoms where you're not 100%
and you don't feel well and you're not exactly sure why.
And note, there's nothing that can be actually identified when you go to your healthcare
provider that's like, well, it could be this or it could be this.
It's really frustrating.
Some of the theories as to why this happens with Lyme disease as with these other conditions
is that it could be an autoimmune response that your body's having to those symptoms
after the infection is completely gone.
Or one theory was that you could have a persistent but very difficult to identify infection.
That's kind of like, yeah, maybe.
Also, it could be that certain patient characteristics may be more prone to have this persistent
Lyme disease syndrome, or it also could potentially be associated with certain behavioral characteristics
such as depression or anxiety.
But there's no 100%.
Absolutely if you have this, you're going to get this long Lyme disease syndrome, instead
for post treatment Lyme disease syndrome.
Yeah, that's well said.
We forget that we are a giant ecosystem, our bodies, and just like a jungle or a city,
it kind of all looks the same on the outside, but if you really analyze the interior contents,
it could be a bit different.
I remember reading a paper one time that 95% of humans are infected with Epstein-Barr virus.
It's a virus that is prevalent in most people.
But for some population, the combination of Epstein-Barr virus along with an immune response
to a pathogen led to more autoimmune events, especially things like multiple sclerosis.
Honestly, it just seems like a bit of bad luck.
Certain people's immune systems just tend to... We saw this a lot with long COVID,
just some people had a prolonged immune response even though the signal was gone from the infection
being inside.
As my mom alluded, could it be that there's a persistent infection or is the signal from
our body being sent to basically constantly be in an immune response state?
I think the jury's still out on that, but I think with almost the entire globe being
subjected to SARS-CoV-2, hopefully we'll have some answers about autoimmune diseases because
we have members of our family who suffer from these things.
It's so difficult to see someone suffer and have no idea how to relieve them.
It could be from Lyme disease or some of those things, but we forget that you can be infected
with a lot of things at once.
Sometimes the combination of those things can lead to outcomes you didn't expect.
Biology can be a mystery.
Yeah.
Diagnosing people sometimes can be quite a challenge.
I say to this, this post-treatment Lyme disease syndrome is frustrating for the patients that
end up getting this because there's no specific treatment for this.
You're going to treat patients, additional antibiotic therapy.
They've done several studies looking to see whether or not if you give them additional
antibiotics, if it'll help and it doesn't.
Giving additional antibiotics is not the answer for these patients.
Usually again, it's one of those things you're going to manage that particular patient's
symptoms that are present and encouragement, maybe support groups to help get through that.
Usually these patients will get better over time, but what that time is, it can be years
in some patients.
That's frustrating, I know.
I did not see a percentage of patients as to who get this.
I don't think it's a huge number of patients, but again, it's still there.
It's something to just keep aware of in patients that have had Lyme disease that you're hoping
that your therapies work, but if they come back and say, I still don't feel 100%, that's
certainly part of the disease state as well.
Yeah, that's really well said.
Let me tell you a couple of misunderstandings or myths or little pearls about Lyme disease.
I thought these were really interesting.
I alluded to this earlier, the male tick does not engorge or eat on blood.
Although they're infected like the female, they're not involved in transmitting the infection
as they don't require a blood meal to survive.
Then they die after mating.
That's their job is to mate and then they're done and stuff.
The male blackleg ticks are not going to give you Lyme disease, only the females, the nymphs
and the larva, the larva and the nymphs.
You cannot acquire Lyme disease through touching, kissing or sexual activity with a Lyme infected
person.
That's not how you get the disease.
Remember, it's through the bite of an infected tick.
Untreated Lyme disease in pregnancy can lead to placental infection, but the spread from
the mom to the fetus is actually really rare.
The appropriate antibiotics that can be given to the mom, there have been no cases of showing
increased adverse fetal outcomes at this point with moms that might acquire Lyme disease.
If they're treated, then the baby's going to be okay.
This was really interesting.
Lyme disease can survive in blood stored for donation.
Patients with Lyme disease should not donate blood.
That might be a screening question because as of now, in the data that I read, there
have been no cases associated with blood transfusions currently.
I'm sure that must be a question when you're going to donate blood as far as whether or
not you've been currently diagnosed with Lyme disease.
Yeah.
I wonder if they'll do one of those Western blot or ELISA tests on the blood before they
transfer.
They could.
They could say, well, we might as well check this before we donate it.
Yeah, they could.
Interestingly too, dogs and cats can get Lyme disease, but they don't transmit the disease
to their owners.
The dog or the cat itself cannot transmit the disease to the owner, but remember, dogs
and cats can bring ticks in.
You're going to want to still be inspecting your animal for ticks, even though these things
are really small, or treat your animal or do prevention for ticks with your animal to
reduce your chance for getting Lyme disease.
Wash that dog.
Wash that dog, treat that dog, a little tick collar, whatever might be the norm up in the-
Yeah, I've read those are really effective.
I think between 70 and 80% reduction in ticks on the animal because as you know, animals
just get everywhere.
That's right.
They do.
That's another interesting little pearl.
Lyme disease cannot be acquired by eating game meat, but we always want to make sure
that we cook game meat sufficiently.
Interestingly too though, you got to keep, so your game meat can't give you Lyme disease,
cook it great, but because you're a hunter, you're going to be out exposed with potentially
deer.
You're going to want to do preventive measures or make sure you're checked for ticks because
of that particular activity, hunting activity.
Yeah, I've read that if you obviously wear clothing that covers most of your skin or
the area that the tick would want to bite on, but if your clothes have ticks on them,
you know, obviously by touching them, you can transfer, but I read if you throw your
clothes in the dryer for 10 minutes, the heat from the dryer will kill the ticks.
So if you put those clothes on again, you kind of reduce the risk greatly of having
the ticks on your clothes.
So against any mother's advice as far as laundry, you put them in the dryer first and then in
the washing machine.
That's yeah, I guess if you don't want to wash it, I mean, you could obviously just
wash it and then put it in the dryer.
But if you're like, I just want a quick kick till kick, kick, tick kill tick.
Yeah, we go.
There you go.
Then you just do that.
There you go.
And then the last, no, so I then one other pearl is that there are no reports of Lyme
disease being transmitted through the air, through food, through water or mosquito bites,
fly bites or lice.
So we're getting it specifically through this particular tick.
And then as Joshua has alluded to, there are other tick types.
There's specifically the Lone Star tick, the American Dog tick, the Rocky Mountain Wood
tick, the Rocky Mountain Wood tick or the Brown Dog tick.
They don't transmit Lyme disease, but there are other tick borne diseases.
Like he said, Rocky Mountain spotted fever is one, tularemia is another one.
There are several other ones as well too.
So there are other.
So if you are exposed to any ticks, you definitely want to remove them to minimize getting other
tick borne diseases.
That's well said.
Yeah.
Disease is not great.
So we've kind of come to the end of this discussion about Lyme disease.
So the takeaways that I have come up with for this are that Lyme disease is not common
in Texas and it's usually diagnosed in patients who have acquired it outside of Texas.
But it's something to put in a differential diagnosis for those patients that travel and
that there's a potential risk for having been exposed to this black-legged tick.
Deer are not infected with Lyme disease and don't transmit Lyme disease to humans, but
serve as a blood source for infected ticks.
Lyme disease could be difficult to diagnose as the tick stage involving and transmitting
the disease is very small.
So we've just got to be aware of that when we go hunting or hiking.
And then patients with symptoms of Lyme disease should be treated as soon as possible with
antibiotics to minimize long-term complications.
I think that's a great summary.
Yeah.
So because we don't want to prevent people from going outside, it's one of the best things
you can do.
But if you are going to go outside in the Northeast or somewhere in a wooded area, and
if you're going up against some brush, remember how small these ticks are.
So just kind of assume that you're getting a tick on you and then just take precautions
to get them off.
And then if you start noticing symptoms, it'd be nice to get checked out by a healthcare
professional.
Thank you so much, Josh.
Oh, thank you so much.
It was another wonderful discussion today.
So yes, I agree.
This is such an interesting organism and we hope you'll stay safe out there while also
having fun.
This has been another episode of Your Mom on Drugs.
My name's Josh.
I'm Jennifer.
And we will see you next time.
Bye bye.