At the Height of the Tick Season, An Expert Explains the Danger Signals and Treatment of Lyme Disease
Dr. Daniel W. Rahn, 40, clinical director of the Lyme Disease Program and associate professor of medicine in the section of rheumatology at Yale University, is a leading authority on the new disease. Married to Lana, 39, a homemaker, and the father of three children, 8, 5 and 3 years old, he treats several hundred Lyme disease sufferers a year. In his New Haven office Rahn spoke with writer-reporter Andrew Abrahams about protection against the tick and how the disease can be managed.
Is the public overly alarmed about Lyme disease?
There is a disproportionate amount of hysteria about the disease, relative to the real risk. People who have symptoms and are diagnosed early get treated and recover entirely. They may be susceptible to infection later on, but even then the treatment is fairly effective. A lot of people who have nonspecific, chronic complaints have some other illness and are blaming Lyme disease.
Why is Lyme disease so hard to diagnose?
We have no means to detect the infection directly. But diagnosis is easy when there is a skin lesion.
So how can you tell if you have the disease?
There are basically three stages of infection, but any stage can occur without the preceding ones. Usually, in stage 1, along with flulike symptoms, you get a skin rash with a bright red border. That symptom can get better spontaneously, after a few days or as long as a few weeks, but there is an 80 percent chance the symptoms will recur. Antibiotic treatment usually wipes out the infection at this stage. Stage 2, weeks or even months later, is far more serious and affects the nervous system. Meningitis may occur. General symptoms include irritability, stiff neck and difficulty in concentrating. Someone may complain of elbow pain one day, knee pain the next.
And the third stage?
In the third stage more chronic problems can develop. Arthritis appears eventually in more than half the patients. There can be numbness, tingling or a burning kind of pain. You might feel it in an arm, around the trunk of the body or down one leg. There can be inflammation of the brain itself, which can cause memory loss or lack of concentration. But we believe these more serious neurological symptoms don't occur too often.
How can you best treat Lyme disease?
Antibiotics are used in each stage. In the second and third stages, higher doses are administered, often intravenously.
What spreads the disease?
The ticks feed on deer, as well as on some 50 species of songbirds; the birds transport the tick to new places.
What precautions can you take?
Be aware when you are at risk—in high grasses, meadows or walking in the woods. Wear long pants and tuck your pants into the socks. There are also effective tick repellants that contain an ingredient called DEET. But a word of caution: DEET is absorbed in small amounts through your skin and can cause convulsions in children, so apply the repellants sparingly. You might also use a spray containing permethrin, which you spray on clothing but not on the skin. At the end of the day, do a tick check on the family. The tick has to be embedded for many hours to transmit the infection. Most often, a tick feeds and drops off unnoticed. If you find one and it is not engorged with blood, the chances that it has transmitted the disease are very low. Use tweezers and pull it off. If some of the head remains under the skin, that is not cause for alarm because the infecting organism is in the midgut of the deer tick.
Can Lyme disease be eradicated?
The disease is treatable, but we need a vaccine to conquer it. Vaccine work is progressing, and there are encouraging results from tests suggesting that we can prevent the disease by pretreating animals with immune serum. We're hopeful that in not too many years a vaccine will be available for human use.