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Lyme disease -- is it simply one tick away?

San Diego Union-Tribune, The (CA) - Thursday, December 17, 1992
Author: CHERYL CLARK, Staff Writer

While clearing coastal sage along a hiking trail in Black Mountain Park west of Rancho Penasquitos last January, Sierra Club volunteer Mike Fry recalls being "really attacked by ticks."

They were all over his dog, and that night Fry used tweezers to extract a particularly obstinate one -- about the size of a lentil bean -- out of his own chest.

He thought nothing of it until a red, 3-inch ring appeared around the bite a few days later. And a week after that, muscle aches and joint pain set in that he could not explain. Fry knew they were symptoms of Lyme disease , but he "didn't think there was Lyme disease in San Diego County."

"I'm an avid cross-country skier, and it's normal to have a few aches after a weekend of exertion, but this was worse," he said. "I was wringing my hands in pain."

Fry, 49, was seen at Kaiser Permanente by a physician's assistant who ordered a blood test for Lyme disease antibodies. Even though the test was negative, the Poway resident was given a 30-day prescription for antibiotics and now feels fine. Fry is sure he had Lyme disease .

While most cases of Lyme disease in the United States have been found in the Northeast and Midwest, an increasing number are being reported from California, primarily along the Northern California coast.

And county health officials are increasingly seeing evidence that the disease has spread south. " Lyme disease is definitely here," said Dr. Donald Ramras, San Diego County health officer.

An infected tick that carries the Lyme disease spirochete bacteria was isolated near Camp Pendleton last year, and, ever since, San Diego County health officials have been warning outdoor lovers to guard against tick bites and be aware of Lyme disease symptoms.

In an extensive search through grassy and wooded areas of the county this year, field inspectors collected 200 samples of western black-legged ticks, which can carry the bacteria. Eight ticks -- from DeLuz, Camp Pendleton, Penasquitos Canyon, Lake Wohlford near Escondido and sites in the Cuyamaca and Laguna mountains -- were found to be infected.

Ticks feed by biting skin and taking in blood. The chance of being bitten increases during cooler months, from November to March, when the small, tear-drop shaped mites proliferate in humid, grassy areas along the coast and in the foothill chaparral. They find their prey by climbing to the tips of grass and brush and waiting for a warm-blooded animal to pass by.

County officials warn hikers to choose wide trails and to avoid trail edges as well as brushy and grassy areas. They suggest keeping grass mown around homes and in rural areas.

They also advise wearing long pants and long-sleeved clothing, with pants tucked into boots or socks and shirts tucked into pants. Clothing should be light-colored so western black-legged ticks can be easily spotted. The female is reddish brown with black legs and is about one-eighth of an inch long in size; the males are smaller and brownish black.

In the last 4 1/2 years, only 14 cases of Lyme disease have been counted among San Diego County residents, Ramras said. Six of those patients are believed to have acquired the bacteria from ticks in San Diego County.

But many cases also may be undiagnosed.

Dr. William Norcross, a family practitioner with UCSD Medical Center, acknowledged that many physicians in the county may fail to recognize early symptoms of the disease because it is so new to the region.

"They know from reading textbooks what the symptoms are. But it's a bit of a jump from reading about something and actually seeing it," he said.

"I think it's going to require sensitivity on the part of the physician to ask questions that give the tip-off -- about whether patients have been in an area where they might have been bitten by a tick," Norcross said.

A second Poway resident remembers only too well how difficult it can be to get a diagnosis.

Camper Mike Fry, 35, who coincidentally shares both a name and the experience of Lyme disease with Sierra Club hiker Mike Fry, says he suffered for a year and a half until he convinced his doctor to test and treat him. Initially, the physician had discounted the likelihood that a tick bite in 1988 while camping near Santa Barbara could have been the source of his symptoms. "I got to the point where I couldn't pull the clutch on my motorcycle. My joints were on fire," he said, but he recovered after heavy doses of antibiotics.

Early symptoms of Lyme disease include headache, fatigue, swollen lymph nodes, stiff neck, a fever and the feeling of coming down with the flu, said Dr. Robert Murray, communicable disease expert with the state Department of Health Services in Berkeley.

Months after being infected, a person may develop neurological and musculoskeletal problems, such as facial twitching and pain in the joints. Sometimes, the symptoms clear by themselves but they often require treatment with antibiotics, Murray said.

A common long-term symptom of Lyme disease is the development of intermittent arthritis, which appears and disappears for several years, health officials say.

There also is difficulty in getting a positive blood test. The currently used test that detects evidence that the body has launched an immune response against the bacteria is overly sensitive to other antibodies, and reflects many false positives. It also may reflect false negatives.

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