https://www.thechronicleherald.ca/opinion/local-perspectives/donna-lugar-going-outdoors-be-aware-that-ticks-are-starting-to-stir-430692/#.XoH6VeE1ChI.linkedin

DONNA LUGAR: Going outdoors? Be aware that ticks are starting to stir

Black-legged ticks are shown at different stages of feeding. Black-legged ticks, also known as deer ticks, carry the bacteria that causes Lyme disease. FILE PHOTO
Black-legged ticks are shown at different stages of feeding. Black-legged ticks, also known as deer ticks, carry the bacteria that causes Lyme disease. FILE PHOTO – Contributed

DONNA LUGAR

With all the talk about COVID-19, don’t forget your tick protection if de-stressing outside

Although ticks can be active at any time of the year when temperatures permit, they are now becoming more active. When spending any time outdoors, please remember to undertake preventative measures and ensure that you are doing your daily tick checks. Although I realize many are presently spending more time indoors, there are people taking this time to work in their yards and spending more time outdoors with their family and pets. As well, with the closure of groomed trails, beaches, etc., many may head to areas less travelled. Prevention is key!

I frequently receive calls and emails from Nova Scotians throughout the province wondering if they may have Lyme disease. One of the first things I suggest is for them to review a symptom list, either from the Canadian Lyme Disease Foundation website or from any government website that breaks down the three stages of Lyme. I then suggest that they take the Horowitz Lyme-MSIDS Questionnaire disease, which will give them an idea as to whether they may have Lyme and/or a tick-borne disease. As well, in December of 2019, the following research article was posted in Frontiers in Medicine: The General Symptom Questionnaire-30 (GSQ-30): A Brief Measure of Multi-System Symptom Burden in Lyme Disease. This is a very helpful document for both you and your doctor.

Depending on their score on the Horowitz Questionnaire, I then suggest that they go back to their doctor, if they are lucky enough to have one, and request the ELISA blood test for Lyme. However, I also advise that this test has sensitivity and specificity limitations and a negative test does not necessarily mean they do not have Lyme disease.

Of importance to note, there are treatment guidelines for Lyme disease in this province. Unfortunately, it appears that not all doctors are aware of this. Although these guidelines follow the IDSA Guidelines, which are presently being updated, they do not include what I believe to be a very important caveat included in the actual IDSA guidelines:

“It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances.”

It is my opinion that this very important caveat should be included within our guidelines and that your doctor knows that it exists.

Another document that exists that many are not aware of is the N.S. Tick Borne Diseases Response Plan. This plan has a lot of important information. It also notes other potential illnesses that can be transmitted. Just be aware that researchers at Dalhousie have found even more and that they have found things in both the black-legged (deer) and dog (wood) ticks.

If you wish to learn more about Lyme and tick-borne diseases there are now YouTube videos available for most of the presentations made at the Bridgewater Lyme Conference on Nov. 16 and 17, 2019. This YouTube channel also has prevention videos and so much more.

As the Nova Scotia representative of the Canadian Lyme Disease Foundation (CanLyme), you can always reach out to me. My contact info is on the CanLyme website.

On a final note, there is presently a petition making the rounds in Nova Scotia that will hopefully be presented to the Nova Scotia legislature in the fall of this year. There are five asks. If you would be interested in having a copy to help obtain signatures, or are interested in signing, please let me know via donna.lugar@ns.sympatico.ca. The petition is a paper one, as that is what Nova Scotiá’s legislature requires. With the present circumstances, it will take some effort to get a sufficient number of signatures to make the petition worthwhile. Any help you can give would be appreciated.

Remember, ticks can be active all year, depending upon temperatures. Bites are usually painless and many are missed; not everyone gets an erythema migrans rash, of which the bull’s eye is just one manifestation.

Prevention is key, but even the most vigilant can miss a tick. Make yourself knowledgeable.

Donna Lugar is the N.S. representative, CanLyme. She lives in Bedford.

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**Comment**

This article does not mention that there are other treatment guidelines in use by ILADS:  https://www.ilads.org/patient-care/ilads-treatment-guidelines/

If doctors follow the IDSA guidelines, treatment will be short term and typically a mono therapy, rather than an overlapping treatment using numerous antimicrobials for Lyme as well as coinfections for a much longer period of time should symptoms warrant it.

Personally, I have found the Horowitz questionnaire to be far more accurate than current 2-tiered CDC testing which depending upon who’s counting, misses over half of all cases: https://madisonarealymesupportgroup.com/2019/06/07/if-youre-testing-for-lyme-disease-heres-what-you-should-know/

https://madisonarealymesupportgroup.com/2018/12/16/laboratory-testing-for-lyme-disease/

https://madisonarealymesupportgroup.com/2018/09/12/lyme-testing-problems-solutions/

https://madisonarealymesupportgroup.com/2018/01/16/2-tier-lyme-testing-missed-85-7-of-patients-milford-hospital/

https://madisonarealymesupportgroup.com/2018/10/13/direct-test-for-ld-carl-tuttle-chews-up-cdc-spits-them-out/

https://madisonarealymesupportgroup.com/2018/10/12/direct-diagnostic-tests-for-lyme-the-closest-thing-to-an-apology-you-are-ever-going-to-get/

KEY QUOTE: “THESE SEROLOGIC TESTS CANNOT DISTINGUISH ACTIVE INFECTION, PAST INFECTION, OR REINFECTION.”

More on prevention:  https://madisonarealymesupportgroup.com/2019/04/12/tick-prevention-2019/

https://madisonarealymesupportgroup.com/2019/07/18/frequent-prescribed-fires-can-reduce-risk-of-tick-borne-diseases/

https://madisonarealymesupportgroup.com/2020/03/19/are-current-tick-prevention-methods-for-dogs-working/