Lyme Disease in the Pacific Northwest

“Let me start by saying that having been bitten by a tick before, I took my recent tick bite far too casually, so I decided to post this as a warning to take all tick bites seriously.

On April 22, I hiked Mt. Defiance. On my way home, I felt something under my armpit, so I pulled up my sleeve to discover a tick. I pulled over at Multnomah Falls and with the tweezers on my pocket knife I was able to remove it. Did not think too much about it; after all, Lyme disease in the Pacific Northwest is very rare, less than a dozen cases a year, and I removed him early so I was not worried. Two days later I flew to Maui and developed some of the following symptoms—headache, not over the top but definitely felt like my head was full; a bit of neck stiffness; throat was not sore but dry at night. Hey I was in Hawaii so I figured I had a few too many pints and the sun, so again did not think too much about it. A few Advil took care of the headache so I figured it was no big deal. In addition, the wound looked fine—no evidence of the classic sign of a bullseye, just a small red spot where the tick bit me. After multiple days of a persistent headache, I became concerned that I contracted Lyme disease. The persistent headache concerned me as I NEVER get headaches. I’m 58 and can count the number of times I have gotten a headache on one hand. My internet medical degree told me that something was going on so I consulted with my doctor. Lyme disease is very treatable in the early stages so out of an abundance of caution I got a prescription for amoxicillin. The amoxicillin did the job! It took about two days till it kicked in, but my persistent headache disappeared and I am back to 100 percent. Which leads me to believe that it was Lyme disease. Lesson learned! Next time I will keep the tick so it can be tested and not be so nonchalant about a tick bite. Take it seriously—even though the odds were against it being Lyme, if it was, the consequences of untreated Lyme disease could have been horrid.” –Rico Micallef, Mazama Climb and BCEP leader

by Brian Goldman

Rico did the right thing by playing it safe and seeing a doctor. This article is an overview of Lyme disease—what it is; symptoms; prevention; treatment; prevalence.

What is Lyme Disease?

Lyme disease was first identified in the 1970s in a small town called Lyme, Connecticut. It is a multisystem inflammatory zoonotic disease caused by a spirochete bacterium from the Borrelia genus. A majority of the cases in the U.S. are caused by the Borrelia burgdorferi strain, which is spread by the black-legged tick (Ixodes scapularis) and the western black-legged tick (Ixodes pacificus); these are both commonly known as the deer tick. The archetypal bullseye rash, erythema migrans (EM), was first described over 130 years ago.

The black-legged ticks feed on hosts (usually deer but also mice, squirrels, birds, reptiles, amphibians, and humans) at each of the four stages of life. The highest risk of human infection is not the adult stage (easy to see and pull off the tick) but at the nymph and larval stage. During the eight-legged nymph stage, the tick is a tiny black dot, nearly impossible to see. This nymph has more time to transmit the Borrelia bacteria to an unsuspecting host. Usually, the tick must be attached 24–48 hours to transmit Lyme, but because the nymphs are so tiny they often go unnoticed.

According to some researchers, the rise in Lyme disease cases is related to an increase in mice populations due to warmer temperatures allowing for longer feeding times for the ticks. This

Above:”Ticks on Finger” by fairfaxcounty is licensed with CC BY-ND 2.0.

is bad news for humans. Children are the most rapidly growing demographic to be infected. What are the Symptoms?

Lyme disease symptoms generally have three stages:

First Stage (3–30 days): The early or first stage is typically the bullseye rash (erythema migrans), which appears where the tick bites you. The rash is actually the disease’s bacterial spirochetes proliferating and burrowing under the skin. Patients may have multiple bullseye rashes, although that doesn’t mean there are multiple bites. Not everyone gets the bullseye rash—generally 70–80 percent in all reported cases.

Second Stage: Lyme’s second stage may include flu-like symptoms such as fever, body or joint aches, chills, fatigue, swollen lymph nodes, nausea and vomiting, headache or neurologic deficits like Bell’s palsy that causes one side of the face to droop. If it’s not treated, Lyme can then progress to symptoms such as Lyme carditis, or heart block, meaning your heart’s electrical circuits fail to conduct signals properly. That can require cardiac intervention such as a pacemaker, or even treatment in the intensive care unit.

Third Stage: Patients with late-stage Lyme may also suffer swelling and pain in a single joint, such as the knee. There are also less common neurologic manifestations that may occur such as painful or painless nerve dysfunction. These symptoms can occur months or even years after Lyme disease infection. If left untreated, Lyme sufferers can develop arthritis, neurological symptoms (memory loss, mood swings, irritability, lack of concentration, meningitis). Some develop Post-Treatment Lyme Disease Syndrome, in which symptoms reappear after completion of treatment of the initial disease.

What’s the Difference Between COVID-19 and Lyme Disease Symptoms? Unlike COVID, Lyme does not usually affect the pulmonary system or cause shortness of breath. The tick-borne diseases aren’t going to give you a sore throat or shortness of breath or cough. Lyme is not contagious from person-to-person. How Do I Prevent Lyme Disease?

Try not to get bitten.

Remove the tick as soon as possible. Ticks like warm, moist, dark places, although they can latch anywhere. Places to look include exposed skin, in and around the ears, on the scalp, under the arms (like Rico), around the belly button, in the pubic area, behind the knees and around the waist. Although most experts say ticks need to be latched for 24–48 hours in order for Lyme to be transmitted, new research suggests transmission may occur rapidly upon being bitten, as the spirochete is present in the salivary glands prior to latching. European ticks have been found to have faster transmission times.

There are many myths surrounding how to best remove a tick, including a hot match, Vaseline, kerosene, or fingernail polish. These methods increase the likelihood of the tick regurgitating the bacterium into the host. The proper way to remove a tick is to grasp between the skin and the tick with tweezers and apply slow and steady pressure straight back. If all of the tick does not come out clean, try to remove the remaining parts with tweezers. If that is not possible, leave the remaining parts in the skin and clean with soap and water.

There is debate on whether you should save the tick and send it in for analysis. An infected tick does not mean you have been infected. The results may take too long to return if you do have an infection. You could still get Lyme disease – for example, if another tick bit you.

For those who play or work in the outdoors in tick-infested areas, the CDC recommends the use of insect repellents specific to ticks. The most effective repellents contain 20 percent or more DEET, picaridin, or IR3535. Repellents should be used on exposed skin. Clothing and equipment (tents, boots, etc.) should be treated with products that contain 0.5 percent permethrin. In New England, this author has seen nearly everyone apply both sunscreen and DEET at the trailhead.

There are alternative options, many not approved by the CDC or EPA. Certain essential oils such rosemary, lemongrass, cedar, peppermint, thyme, and geraniol, Neem, and Nootkatone (from Alaskan Yellow Cedar or Grapefruit) are being developed into commercially available tick repellents, but are awaiting EPA approval. The CDC provides information for other natural options.

The human behavior that supports the best likelihood of avoiding tick exposure, other than insect repellent use, is choice of clothing. Wearing long sleeves and pants with pants tucked into socks or gaiters prevents ticks from gaining a foothold. Laundering of clothing, including 20 minutes of high heat, may be enough to kill the ticks hiding in clothes. Impregnating clothing with permethrin may help to reduce the number of attached nymphs by more than 95 percent.

Wear shoes, a hat, socks and light-colored clothing to spot ticks easily. Avoid sitting on the ground or stone walls. Stay in the center of hiking trails avoiding tall grass and open fields.

If clothes require washing first, hot water is recommended. Cold and medium temperatures will not kill ticks.

Shower soon after being outdoors. Showering within two hours of coming indoors has been shown to reduce your risk of getting Lyme disease. Showering may help wash off unattached ticks.

Conduct a full body check upon return from potentially tickinfested areas, including your own backyard. Use a hand-held or full-length mirror to view all parts of your body. You can get ticks from your yard while gardening. Wood piles can harbor ticks. Ticks tend to live in grassy, brushy or wooded areas or even on animals.

Check pets that go outside for ticks, especially in the summer months. Checking your furry friends will help ensure they’re not bringing home unwanted guests. What Happens If I Get Lyme Disease?

According to the NIH, the risk of developing Lyme disease from a tick bite is small, since not all ticks are carriers. According to the NIH, most physicians prefer not to treat patients bitten by ticks with antibiotics unless they develop symptoms of Lyme disease. On the other hand, the NIH says one-fourth of the people who become infected with Lyme disease do not develop the characteristic bullseye rash and many may not even remember having been bitten recently by a tick. If you have suspicious symptoms see your doctor immediately. Your doctor may perform an ELISA (Enzyme-linked immunosorbent assay) test. ELISA detects antibodies to B. burgdorferi. But because it can sometimes provide false-positive results, it’s not used as the sole basis for diagnosis. If the ELISA test continued on next page

Lyme Disease, continued from previous page

is positive, the Western blot test is usually done to confirm the diagnosis. The standard treatment for early-state Lyme disease is doxycycline for adults and children older than eight or amoxicillin or cefuroxime for adults, younger children or breastfeeding women, usually a 14–21 day course of antibiotics. If the disease involves the central nervous system, your doctor may recommend intravenous antibiotics.

Is Lyme Disease in the Pacifi c Northwest?

Recently, Lyme disease has been found in beaches, mostly during the rainy season, in northern California in areas of grass and scrub in quantities that are the same as woodland habitats. Researchers found Borrelia burgdorferi in 4.1 percent of the adult ticks in coastal scrub and 3.9 percent of the adult ticks in woodland areas.

Although most cases are in the Northeastern states, according to the Oregon Health Authority, about 40–80 cases of Lyme disease are diagnosed in Oregon each year, peaking in July or August. In 2015, 120 cases of the disease were reported in dogs. The median age in humans was 37. In Oregon, 63 percent of the cases were female in 2019. There is an upward trend in infections. There could be more local interaction with ticks in the environment. Recent estimates suggest approximately 476,000 people may get Lyme disease annually in the United States.

If the above hasn’t terrified you, let’s close with another tick experience from Mazama Kate Evans.

“Over years of hiking I have been bitten by many ticks, including on the Elk-King traverse, Defiance, Hamilton, and Dog Mountain After I removed the tick on my waist from the Dog Mountain hike, I thought that was the end of the problem, until I saw the bullseye rash on the tick site. Nurse practitioner and Mazama friend Sherry Bourdin confirmed that it was probably Lyme. I saw my doctor. Diagnosis confirmed and doxycycline prescribed with no after effects. I felt very fortunate that my Lyme presented the classic bullseye as 70–80 percent of the cases do. Amy Tan, my shero and one of my favorite writers, was not so lucky. She had undiagnosed Lyme disease for over a year and with her puzzling, debilitating symptoms, her mother’s dementia, and her father’s and brother’s deaths from brain cancer years before, it was an awful time. If you are bitten by a tick do not assume you are Lyme disease free if you do not have a bullseye rash!”

THE HARDEST NON-MAZAMA CLIMB I EVER LED

by Leora Gregory

The hardest climb that I ever led was back in 2011 for the siblings and several friends of a woman who died on Mt. Hood. The father grilled me the evening before the memorial climb as to why I thought that I was capable of taking his surviving offspring up the same mountain that killed his daughter.

By that time, I had led some 35 private climbs of various sizes up mountains, and had attempted various routes up Mt. Hood 52 times, of which 33 were successful, so I wasn’t lacking for experience nor confidence. Besides, I was quite confident in the team that we’d assembled for the climb: in addition to myself, I had three VERY experienced mountaineers (one who was an active member of Portland Mountain Rescue), two additional experienced mountaineers (all friends of the deceased, or involved in the search for her remains); and then the three complete novice siblings with whom I spent a prior day on Mt. Hood training for exactly how we would execute the climb, and one person with some previous ice climbing experience. I was leading the climb because I was the only one without any emotional attachment to the victim, so I could fully concentrate on the climb, itself. If it wasn’t already plain to me, before, how important it was that everything go smoothly, this father’s pained grilling made it clear: I knew that I had to get them all up and down without a scrape. The 15 pounds of the victim’s ashes were distributed among the team members. After several hours, it became clear that not everyone would make it. One of the very experienced folks took the lagging sibling for a private memorial service near the Hogsback, and the rest of us went to the summit for the planned memorial service. The descent went without a hitch, although I stayed behind and walked out one member of the team with a knee issue, while the rest went on ahead. The relief that I felt when that climb was over was IMMENSE. It made me realize just how much angst I had executing the climb. The whole experience really drove home the responsibility that a leader takes on in leading a climb, and how much trust, not only the team members place in leaders, but also, sometimes, their family and friends.

SAYING GOODBYE

SEPTEMBER 10, 1951–APRIL 20, 2021 Ann was raised on the shores of the Columbia River. She grew up with the river as a constant friend and could be spotted cruising the shores in her home-built dinghy with her trusty dog at the bow. Ann graduated from Ann Neuenschwander Madison High and the University of Oregon, where she made lifetime friendships. An intrepid traveler, Ann formed strong bonds around the world as a Peace Corps volunteer. She returned to Portland, becoming an ESL teacher and training aspiring employees better English for advancement. In her time in the Mazamas, 2000–2015, she focused on being a Trail Trip leader, and led 38 hikes over eight years.

Ann inspired those around her to be kind, to enjoy precious moments, and to care deeply for one another. She will be greatly missed by all who were touched by her and those that loved her.

NOVEMBER 27, 1930–JUNE 4, 2021 Elizabeth grew up in Essex, Mass and moved to Portland, Oregon in 1952. Soon after moving to Portland, she met Jim Wendlandt at the Mazama Lodge. She and Jim were a good team, devoted to Elizabeth Wendlandt each other in marriage for 65-years, until his death in 2018. They visited every nook and cranny of Oregon, all 49 other states, the far reaches of Canada, and Europe.

Elizabeth earned a master’s degree in library science from Portland State University and worked as a librarian for Portland Public Schools. When she wasn’t caring for the family, teaching, hiking, quilting, crafting, skiing, breaking out in song or traveling, she was an avid community volunteer. She was editor of the Mazama Monthly Bulletin for a decade. She was an editor of Nick Dodge’s Climbers’ Guide to Oregon. The Mazamas awarded her the Alfred Parker Cup in 1967 for her hard work, ability, and sacrifice on behalf of the organization.