Although many people in the Northeastern U.S. have become more familiar with the term Lyme disease, most still don’t know the signs and symptoms of this infection. This is not surprising. Lyme can have many manifestations, often fooling doctors for months or years before an accurate diagnosis is made. As with most health problems, the earlier the proper diagnosis is made, the better the outlook for a full recovery.

Lyme disease was first recognized and named in 1975, when a cluster of cases were identified in the town of Lyme, Connecticut. Since then it has been identified in 47 states, Europe and Asia. In the U.S. the highest concentration of cases occur in the northeast, along the coast from Maine to Maryland, as well as Wisconsin, Minnesota and California. All of this means that those of us from New York and New Jersey are right in the thick of it.

A bacterium called Borrelia burgdorferi causes the disease. The bacterium is spread by the bite of the deer tick. These are very small ticks that range in size from that of a poppy seed when young (nymph), to the size of a slightly larger sesame seed as an adult. These ticks love to live in underbrush in woods, high weeds and bushes. In addition to being carried by deer, they also hitch rides on mice, squirrels, birds and other small animals.

Deer ticks are most active in the early spring (when they are also the smallest), leading most cases of Lyme to be diagnosed in early and mid-summer. Unfortunately, the tiny nymphs are probably responsible for upwards of 60% of the cases that occur. For this reason, 40-60% of those diagnosed with Lyme disease have no recollection of ever getting a tick bite.

Lyme disease develops in stages, and usually starts with a large red spot on the thigh, buttock, trunk or armpit, the most common site of a bite. After this spot appears, a rash often spreads over other parts of the body. (Some 40% of Lyme cases don’t display any rash or redness at all, misleading many clinicians).

Many who have contracted Lyme will feel symptoms of a mild flu, fatigue, chills, headache, stiff neck, and muscle or joint aches. Less commonly they may develop a sore throat, nausea, chronic fatigue or swollen lymph nodes. The symptoms may come and go, leading many people to avoid going to their doctor till much later.

The next stage of Lyme disease can occur weeks to months later and involves joint pain and swelling, especially in the knees and other large joints. In rare cases, Lyme can lead to neurological symptoms, meningitis, paralysis of the facial nerve, or infection of the covering around the heart. Once Lyme has entered the third stage (months to years after initial infection) it may become very difficult to treat, leading to chronic fatigue, and episodes of arthritis that flare up and resolve for years on end.

Diagnosing Lyme disease can be very difficult. The current blood tests that are available are very unreliable, often giving false negatives and false positives. The tests may need to be repeated often over time to arrive at a definitive diagnosis. Since time is of the essence when treating it, most doctors will treat based on the patient’s symptoms and history of possible exposure.

Although pinpointing “classic” Lyme symptoms and the course of the disease may be difficult, treatment, if begun early enough, is not. All stages of the disease respond to antibiotics. In the early stages oral antibiotics such as doxycycline are usually prescribed for up to a month. The vast majority of these cases result in a full cure. For more advanced stages intravenous antibiotics may be needed. The longer the disease goes untreated, the more aggressive the treatment needs to be.

Overall, prevention and quick action are most important. When outdoors in areas of underbrush or weeds, be sure to wear shoes, socks and long pants. Light colored clothing is best, allowing the ticks to be more visible. Wear an approved tick repellant when exposure is likely, and always inspect yourself and children after being outdoors.

Ticks like to hide in skin folds like the groin, armpits, and along the base of the skull and behind the ears. If you find one, don’t panic. If they have bitten you, remove the tick with a tweezers by grasping them behind the head and gently pulling them out. Do not use heat or chemicals to remove them, and avoid squashing them while the head is still under the skin, this may transmit infection.

Many ticks do not begin transmitting infection unless they have been attached for over 24 hours. Also, remember that not all ticks are infected with the bacteria. Save the tick for possible testing, and it is a good idea to alert your family physician that you have been bitten so they may monitor you for any signs or symptoms. Recently, many doctors have been recommending a one-time double dose of doxycycline, due to recent studies that show that this may cut the infection rate up to 80%.