Over the last few months I have sent at least three Letters to the Editor of The Chronicle Herald regarding Lyme and Tick-borne diseases. I am also aware of others that have sent some as well, including one from a research student from Acadia University doing research on ticks, which were also not printed. Why?

At one time The Chronicle Herald printed most letters regarding ticks, Lyme and Tick-borne diseases, as long as they could verify any links included. A quick Google search came up with only three articles in 2020 re Lyme disease which included nothing about Lyme Disease Awareness Month; the number of cases in 2018 (information to that effect was released in late spring – or thereabouts – with 451 cases reported); or how COVID-19 was seriously affecting Lyme disease patients, especially those that had been going to the US for treatment.

So, with all the talk about COVID-19, and pretty much nothing else, don’t forget your tick protection if de-stressing outside.

Although ticks can be active any time of the year when temperatures permit, adults are more active this time of year and will be until temperatures are consistently below 4C (does that even happen anymore in Nova Scotia?). Therefore, when spending any time outdoors, please remember to undertake preventative measures and ensure that you are doing your daily tick checks.

One of the first things I suggest when I receive calls and emails from people wondering if they may have Lyme disease is for them to review a symptom list, either from the Canadian Lyme Disease Foundation website or from any government website that breaks down the three stages of Lyme. I then suggest that they take the Horowitz Lyme-MSIDS Questionnaire – https://www.eomega.org/article/is-it-lyme-disease which will give them an idea as to whether they may have Lyme and/or other Tick-borne diseases. As well, in December of 2019 the following research article was posted in Frontiers in Medicine – “The General Symptom Questionnaire-30 (GSQ-30): A Brief Measure of Multi-System Symptom Burden in Lyme Disease” – https://www.frontiersin.org/articles/10.3389/fmed.2019.00283/full. This is a very helpful document for health care providers when attempting to ascertain whether a patient may, or may not, have a tick-borne disease, or three.

Depending upon the Horowitz Questionnaire score, I then suggest that they go back to their doctor, if they are lucky enough to have one, and request the ELISA blood test for Lyme. However, I also advise that this test has sensitivity and specificity limitations and a negative test does not necessarily mean they do not have Lyme disease – https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/health-product-infowatch/canadian-adverse-reaction-newsletter-volume-22-issue-4-october-2012.html#a1. 

Also of importance to note, is that there are treatment guidelines for Lyme disease in this province – https://novascotia.ca/dhw/cdpc/documents/statement_for_managing_LD.pdf. Unfortunately, it appears that not all doctors are aware of this and that, although these guidelines follow the IDSA Guidelines (which are presently being updated) they do not include what I believe to be a very important caveat noted on the first page of the complete IDSA guidelines: “It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances.” It is my opinion that this very important caveat should be included within our Nova Scotia guidelines document and that your doctor knows that it exists. 

Another document that exists that many are not aware of is the NS “Tick Borne Diseases Response Plan –  https://novascotia.ca/dhw/cdpc/documents/Tick-Borne-Disease-Response-Plan.pdf. This plan has a lot of important information, including other potential illnesses that can potentially be transmitted. Just be aware that researchers at Dalhousie University found even more and that they found things in both the black-legged (deer) and dog (wood) ticks. Although they did not confirm that all of these potential co-infections could be transmitted to humans, there is a chance that they can be if the tick is attached for a sufficient period of time.

If you wish to learn more about Lyme and Tick-borne diseases there are now YouTube videos available for most of the presentations made at the Bridgewater Lyme Conference held on November 16 and 17, 2019 – https://www.youtube.com/channel/UCO3Bd0xDKwUcoBMGyqoDsUg. This YouTube channel also has prevention videos and so much more.
As the NS Representative of the Canadian Lyme Disease Foundation (CanLyme), you can also always reach out to me. My contact info is on the CanLyme website. I am also now a Global Lyme Alliance Lyme Education Ambassador and am willing to educate groups of any size.

On a final note, there is presently a petition making the rounds of Nova Scotia that will hopefully be presented to the Nova Scotia Legislature in the spring of 2021. There are five Asks. If you would be interested in having a copy to help obtain signatures, or are interested in signing, please let me know via donna.lugar@ns.sympatico.ca. The petition is a paper one as that is what is required for the NS Legislature. With the present circumstances, it will take some effort to get a sufficient number of signatures to make the petition worthwhile. Any help you can give would be appreciated.

Remember – ticks can be active all year, depending upon temperatures; bites are usually painless and many are missed; not everyone gets an erythema migrans rash, of which the bull’s eye is just one manifestation; and a negative test does not mean you do not have Lyme or another Lyme-like illness. 

Prevention is key, but even the most vigilant can miss a tick so please make yourself knowledgeable and stay safe.