NEWS: Debate over Lyme in Texas

21st September 2009

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The Dallas Morning News reports that "Debate continues over whether Lyme disease is a threat in Texas."


 

 

 

 

Debate continues over whether Lyme disease is a threat in Texas


03:08 PM CDT on Monday, September 21, 2009

By LINDSAY KALTER / The Dallas Morning News
lkalter@dallasnews.com

For 50 years, David Kocurek watched as his body mysteriously turned on him.

 

Starting at the age of 7, he suffered from debilitating ailments: Relentless headaches. Fractured molars from involuntary teeth-grinding. Gastrointestinal problems caused him to lose 40 pounds.

After seeing 26 different physicians and being misdiagnosed with Parkinson’s disease, Kocurek discovered a diagnosis that he says fit: Lyme disease, a bacterial illness that is transmitted through bites from infected deer ticks.

And that makes him part of a long-running and nasty national argument that both sides say is becoming increasingly hostile.

Kocurek, 60, a lifelong Texas resident who lives in Colleyville, serves as officer and treasurer of the Texas Lyme Disease Association. He and many physicians believe that the risk of contracting Lyme disease in Texas is vastly underestimated. But other experts – representing mainstream thinking and backed by well-known medical journals – confidently say that it presents little or no threat to Texas residents.

The Texas question is a little-reported part of arguments about treatment of the disease that have raged for years on the East Coast, where Lyme is more clearly established. But the stakes are high.

The doctors who say Lyme is a minimal threat say their opponents over-diagnose the disease to gain patients and might miss actual health problems. Their foes say people are suffering because poor research has resulted in a dearth of accurate information.

 

Key factors

 

The onset of Lyme disease, caused by the bacterium Borrelia burgdorferi, is usually signaled by a circular rash and flulike symptoms. If the disease is not treated with antibiotics, it can affect the immune system and cause a wide range of problems.

There were 27,444 reported cases of Lyme disease in the United States in 2007, according to the Centers for Disease Control and Prevention. Most of those cases occurred in northeastern states.

Dr. Justin Radolf, a professor at the University of Connecticut Health Center who previously worked at UT Southwestern Medical Center, is among the experts who say the risk in Texas is insignificant.

The key factor, he says, is that Texas does not have enough animals from which the disease-bearing ticks feed, or areas for them to reside. "You just don’t have many wooded areas in Texas," he says. "It’s very open. The vegetation is different than what’s normally required to support the bacterium."

Durland Fish, professor of epidemiology at Yale School of Public Health, agrees. He says that even in the wooded areas of East Texas, the chance of getting Lyme disease is minimal. While deer ticks in the Northeast feed on humans, they have been shown to prefer reptiles in the South. And tests that seek nymphal-stage ticks – the main carriers of the bacterium – "hardly ever" collect them in the South.

The CDC classifies Texas as a low-to-no-risk area and reports that in-state cases have not exceeded 100 since 2002.

 

Another view

 

But Phillip Williamson, director for tick-borne disease research at the University of North Texas Health and Science Center in Fort Worth, sees two problems with those estimates.

First, he says, standard methods of predicting Lyme disease are based on the number of deer ticks, which are rare in Texas. Williamson says this underestimates the actual risk.

Secondly, for people to qualify as Lyme patients by the CDC, Williamson says they must register positive on two separate tests that he considers largely unreliable: the Enzyme-Linked Immunosorbent Assay (ELISA), which measures concentrations of a particular antibody, and the Western blot, which helps determine the molecular weight of a protein and measure amounts of the protein present. He argues that both tests look for antibodies to the Lyme bacterium, which he says is good at evading the immune system and changes often, producing antibodies that tests might miss.

Dr. Bessie Owens, a doctor of osteopathic medicine in Rowlett, says she sees about five Lyme disease patients each day, although she goes beyond standard methodology to identify the disease: In addition to using the Western blot, she tests for a vitamin D deficiency, which she says is common in Lyme patients. She also checks for a low natural killer-cell count; some doctors believe the production of these infection-fighting cells is suppressed by the Lyme bacterium.

She says she has personal experience with the illness: In 2007 she was found to have degenerative arthritis and given steroid injections in her hands, which worsened her condition. Like Kocurek, she researched potential illnesses until she concluded that Lyme disease best explained her symptoms. She tested negative the first time around on the Western blot, but a later test came back positive.

She is on three antibiotics and said her health is improving. Kocurek, who just finished up five years of antibiotics treatment, said he is nearly recovered.

Like other doctors from this camp, Owens thinks Lyme disease is often overlooked, and is "especially under-diagnosed in Texas, but also nationwide."

 

Examining claims

 

Backed by established research, Radolf calls the natural killer-cell and vitamin D tests that Owens relies on "baloney." He believes there are doctors who loosely hand out Lyme diagnoses for the benefit of their practices.

But Owens says the exact opposite is true. "Lyme patients are very high-maintenance."

To further complicate the diagnostic process, many other tick-borne infections cause Lyme-like symptoms. Fish, the epidemiology professor, says the Lone Star tick is Texas’ major carrier of tick-borne disease. It carries the bacteria Borrelia lonestari.

The initial symptoms of an infection from the Lone Star tick are the same as those caused by Lyme: a circular rash, fever and aches. Williamson and others argue that it should be considered a form of Lyme. Fish and others say it is not.

 

What to do?

 

Although the debate in Texas has not made headlines, controversy about Lyme disease has raged nationally.

Dr. Allen Steere, professor of rheumatology at Harvard University, is credited with discovering the disease in the late 1970s in Lyme, Conn. Radolf says that the controversy surrounding Lyme disease began in the late 1980s and reached a new level in the early 1990s, when Steere and colleagues said it was over-diagnosed. The backlash included death threats against Steere.

Each camp agrees that the chance of reconciling the differing viewpoints is nil.

Fish said there will always be sick people who wrongly believe that they are infected with Lyme. "They still have the Flat Earth Society," he says. "You can’t argue with that kind of illogic."

Kocurek, who says his symptoms affected him socially and professionally for nearly his entire life, says too much emphasis in medical science has been on prevention, and insufficient research has been conducted on prevalence and treatment.

"The most disturbing thing is that some of these physicians are absolutely brilliant, but they are so entrenched in dogma that they don’t look at the literature critically."

Radolf says while there are professionals who can respectfully disagree, the debate is becoming increasingly "nasty and contentious."

"It’s reached a new peak of ferocity," he said.

Ticks and Lyme disease

Lyme disease is a tick-borne illness, common in wooded and grassy regions of the country, particularly the Northeast, Midwest and some areas in the Northwest.

The early-stage symptoms include fever, fatigue, aches and in many cases a bull’s-eye rash.

Lyme disease is treated with antibiotics, although there are disagreements over how long the treatment should last. Some believe that a few weeks of treatment is sufficient, and others believe it takes months or even years to knock out the infection.

To prevent tick bites, cover up in wooded areas with light-colored clothes, so ticks are easier to see. Check skin frequently, and remove any ticks with tweezers, not fingers.

For more information, visit www.lymediseaseassociation.org or www.cdc.gov/ncidod/dvbid/Lyme/ .

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Comments

6 thoughts on “NEWS: Debate over Lyme in Texas

  1. My 9 yr old came home today from butterfly catching on the renner & 75 park in north dallas area, and found a tick attached to her upper cheat; she panicked pulled off the tick and threw to ground. Wife and I put it in a vial while quite alive and the put in isopropyl alc. How concerned should we be and what steps are advised? ( will check for rash for next 3 days… Should go to doc for those tests, when?)

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