Common Lyme disease Questions and Answers
1. How do I prevent Lyme disease?
Prevention is the best medicine.
It is not convenient to wear long sleeves and pants in the woods during the summer months, but will protect your largest organ, your skin, against mosquitoes, ticks and other biting insects.
Early removal is also key to prevention. After you or your children are outside for the day, a thorough skin check should be conducted including the hairline, skin folds and private areas, where ticks can easily hide. If the tick is removed in less than 48 hours there is a very low risk of contracting Lyme disease.
One dose of antibiotics may be indicated. If the tick is removed in 48 hours or less, there is almost no risk of developing lyme disease. But if the time of exposure is unknown, or it has been more than 48 hours, and if there are no symptoms of Lyme (and no typical rash), one dose of antibiotic may decrease the risk of lyme disease as much as 90%. This is especially valuable in an area of high prevalence of Lyme disease, such as most areas of Connecticut.
2. Can you test the tick?
You can bring the tick , but we treat the patient. We don’t test ticks anymore for Lyme. Seeing the tick can help to tell if it’s a deer tick, and it is more likely to be able to transmit Lyme if it is engorged.
3. Can you test me for Lyme?
We can, but testing is rarely helpful , especially early in the disease. If it’s negative but you have symptoms are you going to be happy with no treatment? If you have no symptoms, you don’t need testing or treatment. We treat most patients for Lyme based on clinical features such as tick exposure, rash, joint pain, fever, headache…, the geographic prevalence of Lyme (Connecticut is a good place to get Lyme) and the likelihood of other illnesses.
4. Why don’t you give me 2 weeks of antibiotics anyway?
We do treat most patients with antibiotics for whom the clinical suspicion of Lyme is relatively high. But we don’t immediately treat all patients with concerns for Lyme disease, since antibiotics can be harmful. Many people treated with doxycycline will have nausea and vomiting, which may be worth the trouble if Lyme is treated or prevented. But if the risk of Lyme is low, it’s not worth the risks of antibiotic exposure or the side effects. We have seen many patients in the summer come in with chest pain (as a known side effect) after being treated with doxycycline. If we don’t know that it was related to the medication, then some of these patients will get more tests that they don’t need.
5. “I don’t go outside and didn’t see any ticks or rash on me so I can’t get Lyme.”
About 1/2 the time when patients are found to have Lyme disease, no tick and no rash was seen. Patients who don’t spend much time outside can be exposed to deer ticks from their dogs and cats. Patients like these with some features of Lyme (joint pain, fever…) may be appropriate for blood tests since clinical features are not conclusive.
6. “If I don’t get treated right away won’t I get Chronic Lyme?”
Chronic Lyme disease is controversial, and not likely to be affected at all by a delay in antibiotics of a few days. Nearly all patients treated appropriately for Lyme will recover and require no further treatment. Few may have longer lasting joint aches, but this will not be affected by long-term doses of antibiotics, and this should not be considered Chronic Lyme.