Later symptoms include irregular heart beat, pain in the joints, dizziness, and weakness in face muscles.

The disease is cause by a bacteria called Borrelia burgdorferi. Antiboitics are generally effective. Multiple cases are possible.

• Neurological involvement (CNS and PNS); noteably siezure, memory loss, confusion, slurred speach, dizzyness, insomnia, etc...
• If you are predisposed to auto-immune disease, Lyme will set it off eventually (there are genetic tests to find out if you are)
• The rash is not always irritable and not always at the site where you were bit; in fact there are cases where there is no detectable rash at all.
• Bell's Paulsy (Unfortunately I'm not positive I spelled that right and am not sure where to check it; it is where one side of your face "droops")
• Numbness and tingling
• Floaters and/or Tunnel Vision

Lyme disease is potentially lethal. In 1990 there were 7943 cases of Lyme disease reported to the CDC by state health departments. In 1999 there were 16473 cases of Lyme disease reported. At first glance those numbers seem to show a significant jump in the amount of Lyme disease. These numbers show that there has been more Lyme disease, which is caused by deer ticks, detected and treated over time. I think that it is a very good thing that Lyme disease is being found more often. The problem now is which areas are most susceptible to Lyme disease and why.

When I was in high school I broke out one morning with a really high fever and didn't want to do anything but sleep. I slept over 20 hours a day the next few days and couldn't keep anything down including water. Anytime I stood up I was light headed, felt like a vice was being squeezed around my head harder while someone was hammering it, and basically lost my balance from a feeling of the room spinning. I went to the doctors about two days after this started, they told me it was just a bad case of the flu. When it didn't get better I went back again and they thought it could have been mono so they took a blood test for mono. After two weeks I broke out in rashes on my legs. The firstdoctor I showed them to said that they were from the high temperature and not to worry about it. At this time I was very worried about it because if I didn't get better soon I would have to go be on an IV in the hospital. The second doctor didn't think it was from the fever but had no clue what it was. My mom, a registered nurse, suggested that it was Lyme disease so they gave me medicine for it and drew more of my blood. After having my blood drawn every other day for about two weeks I felt like taking all of my blood was going to make me worse also. After I was on the medicine for two days I was feeling better and sure enough the results came back positive.

I was shocked that none of the doctors thought of Lyme disease when I had an obvious rash. I was tested three times for mono yet they didn't look further for an answer. I think one of the reasons Lyme disease is such a problem is doctors not being well enough informed about it. If I had Lyme for too much longer I could have had permanent damage to my muscles which given long enough could have caused death.

Lyme disease is most prominent in the northeast United States, namely Massachusetts, Maryland, Pennsylvania, Delaware, New Jersey, New York, Rhode Island, and Connecticut. Since the potentiall fatal disease comes from deer ticks I think that locations that have more woods and forested areas have more of it. I researched how many thousands of acres were used by forest land in each state of the united states in 1997. This information excluded reserved and other forest land duplicated in parks and other special uses of land. It included forested grazing land.

I mapped the thousands of acres of forest in each state and compared it to the Lyme disease map. At first glance there appeared to be no correlation. When I analyzed it further I decided that the some of the smaller states with less area probably had a different ratio of forested land to regular land. I think that that contributes to the amount of Lyme disease because people are closer to the forests and the animals in the forests. Since the data I found didn't include forests in parks that could also change how the results look.

Wisconsin, which is not in the northeast of the United States, has the seventh highest amount of Lyme disease. I think this is due to lots of areas which the deer enjoy and a relatively low population.

There are several possible ways to decrease the amount of Lyme disease. The three main ways to do this would be decreasing the tick population, the deer population, or increasing awareness. I think that increasing awareness is a necessity. As well as that decreasing the deer population would be beneficial in a variety of ways.

Knowledge of Lyme disease should be increased. If more people know about the problem they will be more alert for ticks. In order to raise awareness in the general public the possible deadliness of this disease should be stressed. Teaching about Lyme disease in schools would inform many children in America. Since children usually tell their parents what is going on, the parents will therefore learn. Sending letters home from school about this could also increase awareness. Doctors and nurses also need to be more aware and conscious of Lyme disease. The symptoms of it and possibility for it should be stressed. Missing the symptoms of Lyme disease increases the likelihood of permanent damage. Lyme disease can be easily diagnosed by a blood test.

Public places that have lots of deer, such as parks, trails, and campsites should post information on lyme disease and ticks. A reminder to check for ticks would make more people do it. If people remember to check for ticks they will also be more conscious of the possibility of having a tick on them. These signs should also inform people that if they find a tick that has already gone into their skin they should carefully take it out. Ripping the tick and leaving part of it inside of someone's body will not help to solve anything. After the tick is removed a circle should be drawn around where the tick was. It is important to know where the tick was so that the site can be observed for a bulls eye rash which is the first symptom. This will usually happen within a week or two.

The use of tick repellent can also be helpful in the prevention of Lyme disease. If the tick cannot get onto a person it cannot do them any harm. Long sleeves and pants also help with prevention. Taking these precautions does not mean that one should stop checking for ticks.

Some people believe that rather than worrying about the ticks, people should concern themselves with deer. The deer population is too high causing many problems. The ticks that travel on these animals are the problem. At first there may just be more ticks on the deer that are still there but overtime the tick population would decrease as the deer population continues to decrease.

Since deer are not monogamous shooting more of the does could help reduce the population. This solution would also leave fawns without their mothers so it is not a good idea. Currently there is a limit on how many does can be killed. About eight does are killed for every buck.

Hunting does immediately help solve the problem but afterward it leaves the other deer with more food causing them to be healthier and reproduce better. The deer, left alone, would naturally even themselves out so that they have an equal amount of bucks and does. A lot of people believe that outlawing sport hunting would be a good first step in reducing the deer population. It would allow the male-female ration to even out and it wouldn't give other deer more food to reproduce better from.

A lot of land is used for logging. Natural fires that are used to renew forests aren't burnt with any regularity currently. Logging countries and land management agencies therefore argue that logging is a means of maintaining the forests health. The companies demolish large trees rather than selectively taking trees from different heights. This practice does little to animals that depend on smaller trees for food and cover. It also creates fields of more vegetation for deer which allows the deer population to surge. The deer also find access to vegetation in residential areas and farms. Their access to vegetation needs to be stopped for there to be natural reasons for the deer population to decrease.

Reintroducing natural predators of deer could solve the problem. If we added wolves or mountain lions could help naturally even things out. Allowing natural fires would also help. In order to do that we would need to limit new human habitations around the wildlife areas to prevent damage to us and our property. Controlled burns should also be made a more acceptable wildlife regulation tool. High fencing around vegetation would definitely help decrease the deer population. I feel that we should use fences to limit access to vegetation, allow some game shooting and ban clear-cut logging.

Works Cited
"CDC Disease Chart: Lymes Disease Cases reported to the CDC by State Health Departments, 1990-1999." CDC 1990.
"1999 Census" Census Department. 1999.
http://www.usda.gov/nass/pubs/agr02/02_ch9.pdf Table 9-10
http://www.idausa.org/facts/deercontrol.html Deer pop control

Student Doctor Eugene Eskow sat at the table in the patient lounge, his H & P unfinished. Morning report was less than 6 hours away, there was work left to be done, and I pushed him a bit to finish the write-up. We took call together when we could; we each trusted the other.

Mike, I need to understand the process; I want to get it right.

I rolled my eyes--Gene, for fuck's sake, it's after 2, we have 3 IV's to start, and the sun's coming up soon. Just put down something, a working diagnosis.

He just looked up at me, then back to his paper. He was still getting used to my impatient language, I was still getting used to his methodical ways. The patient was elderly, with multiple problems, multiple organs trying to fail. We had too much work to do, too little sleep, too little time.

He was from a small town, and, as he loved to remind me, had small town ways. He wanted to become a family doctor, not something most of us would dream of during the glamor days of medical school, when anything was still possible. I'm a hick....His smile made him look like a young Bob Hope.

I left him there, muttering obscenities, but I knew he would not budge. Not until he figured out what made his patient sick.

---

The disease became known just as the internet became popular. As is true for any disease, we knew very little about it initially, and diagnosis was difficult in many cases. We had no reliable serologic markers. While the disease has a characteristic rash, not everyone who gets the disease gets the rash. Even more confusing, not everyone who gets infected becomes ill.

Many of the symptoms of Lyme disease are nonspecific--they are symptoms common to a litany of illnesses. Fever, joint pain, headaches, fatigue, memory loss. The neurologic symptoms are particularly troubling, and can be subtle.

The organism causing Lyme disease is sensitive to a variety of antibiotics. Despite this, some people who receive a course of antbiotics continue to be ill. The physician tests the patient's blood, pronounces the Lyme disease cured, but the patient has not been healed. Some doctors trust their lab results more than their patients.

Many patients with chronic symptoms understandably wanted a longer course of treatment; many doctors were happy to oblige. The insurance companies, however, citing lack of evidence of Lyme's disease in many chronically ill patients, refused (again understandably) to cover the cost of treatments.

Some patients see a conspiracy, as noded above. Some doctors see whiney patients. Dr. Eskow saw something else.

Dr. Eskow ended up in family practice in Flemington, New Jersey. He survived medical school with his small town ways intact. He trusts his patients.

Dr. Eskow is a very nice person who listens attentively to his patients concerns.
Jeff, from Virtual Ratings

Lyme Disease is rampant where he practices. He knows the disease as well as anyone in primary care. He also knows his patients. Some of his patients clearly had Lyme disease. The tests said they were cured, but they still had symptoms. Dr. Eskow had an idea.

Bartonella henselae is a bacteria associated with cats, not ticks. Cat Scratch Fever is a disease not usually associated with neurologic symptoms. Still, Dr. Eskow was aware of reports of B. henselae in the same species of mice that carry Lyme's. A Dutch study had already shown B. henselae in European deer ticks.

The same relentless search for answers that caused Dr. Eskow grief as a student provided relief to his patients.

Four patients who had been infected with Lyme Disease yet continued with neurologic symptoms were tested for B. henselae. None of these patients had had known exposure to cats. All 4 tested positive in the blood and spinal fluid for antibodies specific to this bacteria. Even more importantly, all 4 got better when subsequently treated for B. henselae.

I feel this is at least one reason why people can get treated for Lyme and not get better. This is a completely different bacteria that standard Lyme antibiotics will not eradicate.

Eugene Eskow, M.D.

Mike, I need to understand....

Personal observations--classmates at the New Jersey Medical School
Eugene Eskow, MD; Raja-Vemkitesh S. Rao, PhD; Eli Mordechai, PhD, "Concurrent Infection of the Central Nervous System by Borrelia burgdorferi and Bartonella henselae," Arch Neurol. 2001;58:1357-1363. see http://archneur.ama-assn.org/cgi/content/abstract/58/9/1357
Bull's-eye, Targeting Lyme Disease, Excerpts from Vol. 11.5, October, 2001, http://www.geocities.com/ldbullseye/bullseye.html.
Jeff, in Virtual Ratings Review for Doctors, http://www.virtualratings.com/items.asp?item=13792.