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Lyme disease in New Brunswick.

N.B. nurses who are parents, nurses in emergency rooms, physicians' offices, cardiac care, medical units or after hour clinics need to be aware about Lyme disease. Think about this:

You are an active 40 year old and suddenly you wake up one morning and can barely get out of bed because of pain in your joints and severe fatigue consumes you to the point that you cannot take part in sports that you enjoy and you are having some difficulty walking. The symptoms get increasingly worse and you are diagnosed with arthritis in your knee. This does not make sense to you, as all your joints are painful and/or swollen, not just your knee. You are put on Celebrex and this relieves some of the symptoms, but you feel unwell. You know that you were bitten by a tick the previous year and ask your physician "Is it possible that I might have Lyme disease?" An Enzyme-linked Immunosorbent Assay (ELISA) is done and the results are negative, but you are getting sicker. In a few months you ask for another ELISA and it is also negative. At your own expense, you send your blood to a Laboratory in California and it returns with a positive result-you have chronic Lyme disease. Now you find that you will not be able to be treated in New Brunswick, so make an appointment to see a specialist in New York, again paying all expenses out of pocket. You are put on a treatment regimen and after 10 months of treatment you are well again, fully restored to health and requiring no medication.

This is an all too familiar story to those of us who attend a Lyme support / advocacy group in Fredericton. This man was one of the lucky ones because he had only been ill for a year he persisted in spite of resistance in getting treatment and he recovered much more quickly than most.

My first encounter with Lyme disease was six years ago when I was asked to administer IV antibiotics to an 11-yea-old girl who was visiting my church from Nova Scotia. For obvious reasons, I was unable to do so, but this sparked an interest in learning more about the disease.

Little did I know that just two years later my son would be diagnosed with chronic Lyme disease and forced to travel to Cape Breton for treatment. There was no physician that he knew of in New Brunswick who would treat him. This physician in Cape Breton no longer treats Lyme patients so, if my son's symptoms return, he will be forced to seek treatment in the U.S.

The reality of Lyme disease in New Brunswick:

* We have hundreds of people in New Brunswick who are suffering with Lyme disease. The over one hundred with whom I have contact range in age from 4-65.

* Children are just as likely to contract Lyme disease as adults; however they will most likely present differently due to their inability to express their pain.

* Lyme disease is a multi-systemic disease and it is often called the "great imitator". This disease can imitate diseases such as MS, Parkinson's, ALS, chronic fatigue syndrome, fibromyalgia, juvenile rheumatoid arthritis, arthritis, lupus and dementia.

* The causative agent of Lyme disease is the spirochete Borrelia Burgdorferi. This bacteria is carried by the black legged tick (deer tick) and is passed on to humans when they are bitten by the tick. After the initial transfer of the bacteria from the tick to the affected individual the spirochetes spread to organs and tissue in the body.

The Black Legged Tick

* Not all black legged ticks carry the bacteria that causes Lyme, however a recent study completed by Dr. Vett Lloyd at Mount Allison University shows that the numbers of ticks in New Brunswick carrying the bacteria has risen from 15% to 40% (www.cbc.ca/news/canada/newbrunswick/ lyme-disease-ticks-spreading-in-new-brunswick-study-says-1.2636136).

* This tick can also carry bacteria causing anaplasmosis, bartonellosis, babesosis and ehrlichiosis. It is not uncommon for Lyme patients in New Brunswick to also have one or more of these co-infections.

* New Brunswickers are at risk of being bitten by this tick anywhere in the province. I believe information published about two "endemic areas" in the province may give people a false sense of security, thus making them less vigilant unless they are visiting these areas.

* The black legged ticks are carried on animals such as mice, squirrels and deer. Larvae and nymphs of the black legged tick readily attach to migratory birds and are transported this way as well.

* The black legged tick takes a blood meal from an infected mammal.

* During the nymph stage the black legged tick is about the size of the period at the end of this sentence so they are easy to miss and because you will not feel them bite, many people do not remember being bitten by a tick.

* Less than 50% of the people I know with Lyme remember being bitten.

Diagnosis of Lyme Disease

* Early diagnosis and treatment of Lyme disease is critical.

* Unfortunately diagnosis is difficult because symptoms vary from patient to patient.

* Some patients present with extreme fatigue and joint pain, others with neurological symptoms ranging from brain fog, numbness and tingling of face and extremities to seizures. Some present with all of these symptoms. Lyme disease can affect all systems: musculoskeletal, cardiac, gastro-intestinal and neurological.

* Lyme Carditis is serious; in 2013, three young men in Eastern U.S. died suddenly, suffering a cardiac arrest. The Centers for Disease Control released information that all three had Lyme disease but had never been diagnosed.

* Health Canada states that incidence of ERYTHEMA MIGRANS occurs in 70-80% of cases, with the bull's eye occurring in 50% of those cases; some recent studies suggest that the bull's eye appearance occurs less frequently (Stonehouse et al. 2007). It is important therefore that clinicians do not rely solely on the presence or absence of a bull's eye rash for their diagnosis (www.phac-aspc.gc.ca/ id-mi/tickinfo-eng.php).

* Testing for Lyme disease in New Brunswick depends on these three factors: 1) a known tick bite, 2) erythema migrans, 3) a history of visiting or living in one of the two identified "endemic areas" in the province identified by Public Health Officials.

* Health Canada issued an alert in October 2012 stating the following "serologic test results are supplemental (emphasis added) to the clinical diagnosis of Lyme disease and should not be the primary basis for making diagnostic or treatment decisions" (www.hc-sc.gc.ca/ dhp-mps/medeff/bulletin/carn-bcei_ v22n4-eng.php#a1).

* I have been in contact with Lyme disease patients who live in all areas of our province. They have been infected in camp grounds, parks, their back yards, lake front properties, etc.

* 1,375 cases of Lyme disease were reported in Maine in 2013. It is estimated that these numbers are conservative (www.cdc.gov/lyme/ stats/chartstables/reportedcases_statelocality.html).

* Lyme has been a reportable disease in Canada since 2009. The Public Health Agency of Canada currently has data for Lyme disease cases reported between 2009 and 2013 *:

* 2009: 144 cases

* 2010: 143 cases

* 2011: 266 cases

* 2012: 338 cases

* 2013: 682 cases

* 2014: The Agency is still validating reports from provinces and territories. The final figure will be confirmed and reflected here (www.phac-aspc.gc.ca/id-mi/ tickinfo-eng.php#sec22).

* Last year, 17 children from Nova Scotia ranging in age from 2-15 were diagnosed with Rheumatoid Arthritis. A rheumatologist at the IWK later discovered all 17 suffered from Lyme disease. Fifteen of these children recovered with antibiotic treatment and two children appear to have possible permanent joint damage. Most of these children did not recall being bitten by a tick and three had experienced a rash. (http:// news.nationalpost.com/2014/04/03/ child-arthritis-cases-spike-as-lymedisease-pushes-further-into-canada)

* A complete list of possible symptoms of Lyme disease and how to safely remove an embedded tick can be found on the website for The Canadian Lyme Disease Foundation (CanLyme: http://canlyme.com/).
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Author:Billings, Louise
Publication:Info Nursing
Article Type:Disease/Disorder overview
Geographic Code:1CNBR
Date:Mar 22, 2015
Words:1338
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