Tag: medical

Nova Scotia Pharmacists Can Now Diagnose/Treat Early/Acute Lyme

As of May 1, 2024, Nova Scotia Pharmacists have been able to diagnose and treat Early/Acute Lyme disease. The following is from the Nova Scotia College of Pharmacists website under “Notices”:

“Effective May 1, 2024, pharmacists will be authorized to assess and prescribe for the treatment of early Lyme disease. For clarity, this is in addition to the existing authority to prescribe chemoprophylaxis for the prevention of Lyme disease. Of note:

  • The standards set out:
  • PANS will host an education session on assessing and prescribing for early Lyme disease with Drs. Tasha Ramsey and Emily Black at 7:00 PM on May 7, 2024. For more information and to register, please click on the appropriate link below:
  • PANS has been working with the Department of Health and Wellness on funding for this prescribing, with an expected announcement in May.”

As it is now June 24th and I have yet to see an announcement, I believe it is due to the fact that funding has not yet been finalized for all pharmacies. I have heard via two pharmacists now that some pharmacies are free for this service and some charge. The fee is fairly nominal but is apparently resulting in an announcement not yet being made.

I am given to understand that a person needs to have an erythema migrans (EM) rash for diagnosis so this will continue to eliminate a certain percentage of the population that do not get, or see, a rash, from receiving a prompt diagnosis. As well, I hope that pharmacists have been adequately trained on what constitutes an EM Lyme rash. Some helpful information – https://www.aad.org/public/diseases/a-z/lyme-disease-signs; https://www.cdc.gov/lyme/signs-symptoms/lyme-disease-rashes.html; and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9687974/.

Pharmacists are also required to utilize the NS Lyme Guidelines as prepared by the NS Infectious Disease Expert Group – https://novascotia.ca/dhw/cdpc/documents/statement-management-ld-hga-b-pvi.pdf. Unfortunately, these guidelines recommend following the IDSA Lyme Guidelines – https://www.idsociety.org/practice-guideline/lyme-disease/ – even though the IDSA Lyme Guidelines include a disclaimer under the Notes section that they are guidelines only, are voluntary, and do not supplant physician judgement. The fact that there are at least three other Lyme guidelines available for use is not mentioned.

The three other Lyme guidelines are:

The other issue, of significant note, is that ticks can transmit other things along with, or instead of, Lyme. Hopefully people receiving a diagnosis and treatment of Lyme will be adequately educated on the fact that they should keep note of any new symptoms that might occur and to ensure follow-up if they do have some.

What I Know, And Don’t Know, About Lyme Vaccines

First of all, yes there was once a Lyme vaccine – https://www.aamc.org/news/lyme-disease-rise-why-there-still-no-vaccine#:~:text=LYMErix%2C%20manufactured%20by%20what%20was,FDA%20approved%20it%20in%201998 and a bit more – https://thewalrus.ca/lyme-disease-vaccine/. At present, however, your dog can be vaccinated, but you cannot. It’s interesting that a Lyme vaccine is required if it’s rare, hard to get, and easy to treat, as some doctors will still say. Fortunately, many doctors are now acknowledging that it is a bigger problem then we were once told.

There are a variety of vaccines presently being developed. Some are for humans and some are for mice.

The chatter around Lyme disease vaccines is becoming greater lately. I’m sure it has nothing to do with the fact that Valneva/Pfizer are in Phase 3 of a Lyme vaccine – https://valneva.com/research-development/lyme-disease/; https://valneva.com/press-release/pfizer-and-valneva-complete-recruitment-for-phase-3-valor-trial-for-lyme-disease-vaccine-candidate-vla15/. It looks like it will be the first to market.

From what I have read, including this – https://valneva.com/press-release/valneva-announces-publication-of-lyme-disease-phase-2-trials-in-the-lancet-infectious-diseases/, this vaccine is only for Lyme disease. If that is the case, I do have some worries. What if you are bitten by a tick carrying something instead of, or along with, Lyme? Will the vaccine help, or hinder, diagnosis and treatment of any other potential tick-borne disease? Will it be 100% effective for Lyme? If not, will doctors say you don’t have Lyme because you were vaccinated? They frequently say you don’t have Lyme because the test was negative, even though there are several reasons for a false negative test.

There are actually a number of other human vaccines also in the development stage that I think might have value – https://igenex.com/tick-talk/recent-developments-in-lyme-disease-vaccinations-what-you-need-to-know/. However, these have the same questions as the one above as they are all Lyme related, as far as I can tell.

There is also work underway to vaccinate white-footed mice, a carrier of the Lyme bacteria – https://www.sciencenews.org/article/new-lyme-vaccine-mice-protect-humans & https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3610442/#:~:text=Oral%20vaccination%20of%20white%2Dfooted,burgdorferi%20infection (this is from 2013 and begs the question as to why something hadn’t been developed before now).

This is a bit more on another? vaccine – https://news.uthsc.edu/uthsc-researchers-lyme-disease-intervention-headed-to-market/, https://www.nature.com/articles/s41541-023-00802-y, and https://pubmed.ncbi.nlm.nih.gov/38360853/. This may be one already mentioned as some are quite similar.

This vaccine is confusing me a bit as most research starts with mice – https://www.the-scientist.com/newly-developed-mrna-vaccine-protects-against-lyme-disease-71477. I think it is eventually meant for humans – https://www.cell.com/molecular-therapy-family/molecular-therapy/fulltext/S1525-0016(23)00428-8?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1525001623004288%3Fshowall%3Dtrue.

When I first read about this – https://www.wired.com/story/pill-kills-ticks-lyme-disease-babesiosis-anaplasmosis/ – I immediately thought that I wouldn’t take anything that would kill ticks upon feeding. It would be similar to what dogs can be given apparently. They want the treatment to kill an attached tick within 24 hours of attaching and starting to feed as that is “generally” how long it takes a tick to transmit the Lyme bacteria. Unfortunately, things like Powassan virus can transmit in 15 minutes and less is known about how long it takes other things to be transmitted. So ick re putting something into you that can kill ticks upon a bite and what about the things that can be transmitted more quickly? Lyme can also occasionally be transmitted more quickly. What then?

I’m not a doctor, researcher, etc., yet I have many, many questions. I’m sure I’m not the only one. Perhaps someone more knowledgeable than I can provide input regarding the vaccines under development.

If I read everything correctly, none of the above will have a 100% guarantee that a tick bite will not result in the transmission of tick-borne diseases. Therefore, as always, prevention will be key. We need to learn to live with ticks by undertaking daily preventative measures. It’s a year-round issue in many parts of the world now, including in Nova Scotia. We can’t continue to put our head in the sand and say that it’s no big deal. It can be. It has been for many.

PLEASE take the issue seriously. Learn about the different tick-borne diseases. Educate yourself regarding signs and symptoms. Prevention is key!

Lyme Disease Awareness Month Twitter Posts

I have used a variety of ways to help get the word out about ticks and tick-borne diseases. One of the ways is via Twitter. For the month of May I am, once again, posting a daily post on Twitter. I am going to post them all on here as I post them on Twitter, in case anyone wants to use them on their social media.

Day 1 – Do you know how to properly remove a tick? If not, check out this video – https://www.canada.ca/en/public-health/services/video/lyme-disease-properly-remove-tick.html.

Day 2 – The erythema migrans (EM) Lyme rash can have many forms. It doesn’t always look like a bull’s-eye – https://www.cdc.gov/lyme/resources/NCEZID_rash_poster3r1-508.pdf. (Since this post, I received info from Johns Hopkins about the erythema migrans rash – https://www.hopkinslyme.org/lyme-disease-awareness/lyme-disease-rash-presentations-may-not-be-what-you-think/.

Day 3 – Due to tests that are not 100% accurate, Lyme is supposed to be a clinical diagnosis, with testing supplemental – https://www.canada.ca/en/public-health/services/diseases/lyme-disease.html. This tool is also helpful – https://cep.health/clinical-products/early-lyme-disease/.

Day 4 – Prevention is key when it comes to tick bites. Do you know what to do? Here are some helpful “Tick Bite Prevention” suggestions – https://youtu.be/IorSOPnAnZw?si=umTWcR-8QbIoL6XW.

Day 5 – Lyme carditis is when the Lyme bacteria, Borrelia burgdorferi, attacks the heart. Cases increasing. Dr. Adrian Baranchuk has been trying to raise the alarm – https://www.sciencedirect.com/science/article/pii/S0735109718394427?via%3Dihub; https://www.lookingatlyme.ca/2021/10/41-looking-at-lyme-carditis-with-dr-adrian-baranchuk/.

Day 6 – “Because neurologic involvement in Lyme disease is so common, recognition and timely treatment should be encouraged.” – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10146759/.

Day 7 – “Individuals diagnosed with Lyme borreliosis in the hospital setting had an increased risk of mental disorders, affective disorders, suicide attempts, and suicide.” – https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2021.20091347?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed.

Day 8 – The Canadian Association of Schools of Nursing (CASN) has created a Vector-Borne Diseases E-Resource – https://vbd.casn.ca/. It’s free & can be used by anyone who wishes to learn more.

Day 9 – Why? “The newly revised Nova Scotia Lyme disease provincial case definition is no longer aligned with the 2016 Lyme disease national case definition.” – https://www.canada.ca/en/public-health/services/diseases/lyme-disease/surveillance-lyme-disease.html.

Day 10 – Canada has one of the highest rates of MS in the world. Lyme disease is supposed to be one of the things to rule out. How, when tests are not 100% accurate? https://mscanada.ca/intro-to-ms/diagnosing-multiple-sclerosis#toc–conditions-to-rule-out-.

Day 11 – Lyme & Fibromyalgia can have very similar symptoms. One doesn’t have a test & one has a test that isn’t 100% accurate. Hmmmm! https://www.cdc.gov/lyme/signs_symptoms/index.html, https://www.cdc.gov/arthritis/types/fibromyalgia.htm

Day 12 – Did you know that it’s not just blacklegged ticks, and not just Lyme, that you need to worry about – https://www.cdc.gov/ticks/about/index.html.

Day 13 – The annually reported Canadian confirmed/probable Lyme case numbers are not a true representation of total cases. What is the actual #? We don’t know. Read – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6315539/ & https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7219-x.

Day 14 – It truly is and I wish I knew why – “I realized that there’s this public health debacle around Lyme, and it’s, for lack of a better word, obscene,” Tal says. – https://www.technologyreview.com/2024/02/28/1087617/tackling-long-haul-diseases/.

Day 15 – Multidisciplinary health centres have opened in several locations in Europe for Tick-borne diseases. Needed elsewhere – as long as drs. adequately trained in the topic. This is interesting – https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-09194-3#:~:text=Most%20of%20the%20patients%20(84.8,accepted%20their%20diagnoses%20%5B16%5D.

Day 16 – Consider landscaping to reduce the number of ticks in your yard – https://novascotia.ca/dhw/cdpc/documents/Landscape-Management-Handbook.pdf.

Day 17 – If struggling with symptoms, look at your diet. It can play a huge part in causing/reducing symptoms – https://rawlsmd.com/health-articles/best-diet-lyme-disease; https://www.globallymealliance.org/blog/the-lyme-diet.

Day 18 – “Ongoing surveillance, increased awareness, and education should be encouraged to better define and understand the changing epidemiology of tickborne diseases in Atlantic Canada.” – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9155882/.

Day 19 – If you have a # of symptoms, affecting multiple systems, that come & go, & vary day by day, you might be dealing with tick-borne diseases. These are worth checking out – https://restorativehealthclinic.com/wp-content/uploads/2017/11/Horowitz_LymeDiseaseQuestionnairev.pdf; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6908481/.

Day 20 – If you want to know tick type, there are several reputable places to find out. In Canada, https://www.etick.ca/ is a great resource. Different ticks can carry different things. Not just Lyme. Not just blacklegged ticks.

Day 21 – The IDSA Lyme Guidelines, which doctors are frequently told to follow, have a Note advising that following the Guidelines is voluntary – https://www.idsociety.org/practice-guideline/lyme-disease/#Notes.

Day 22 – Tick testing is only available in Canada via a private company (I think) – https://geneticks.ca/. I highly recommend testing for more than Lyme as TBD’s increasing. Although not a diagnostic tool, it can be helpful.

Day 23 – “Chronic Lyme” – Is it real? – https://www.columbia-lyme.org/chronic-symptoms; and https://www.technologyreview.com/2024/02/28/1087617/tackling-long-haul-diseases/. (There is more.)

Day 24 – There may come a time when employees blame their employer for their illness due to lack of information/protection. FYI – Permethrin uniforms/gear help – https://cupe.ca/ticks-and-tick-borne-illnesses.

Day 25 – Anaplasmosis cases are steadily rising, do you know what it is? – https://nccid.ca/debrief/anaplasmosis/; https://www.cdc.gov/anaplasmosis/about/index.html; https://www.canada.ca/en/public-health/services/diseases/anaplasmosis/health-professionals/national-case-definition.html.

Day 26 – Although still fairly rare, as far as we know, Powassan virus is a potential tick-borne illness, that can transmit quickly. Learn about it – https://www.cdc.gov/powassan/about/index.html#:~:text=Powassan%20virus%20is%20spread%20to,to%20treat%20Powassan%20virus%20disease; and https://www.canada.ca/en/public-health/services/diseases/powassan-virus/risks.html.

Day 27 – Although Bartonella has been found in ticks, debate continues as to whether it transmits – https://www.columbia-lyme.org/bartonellosis, https://www.cdc.gov/bartonella/about/index.html. The photo is from a 2018 slide presentation in Halifax by researchers at Dalhousie.

Day 28 – Babesiosis is a nationally notifiable disease in Canada. Learn about symptoms & treatment – https://www.canada.ca/en/public-health/services/diseases/babesiosis/health-professionals/national-case-definition.html; https://globalnews.ca/news/9601467/ticks-babesiosis-disease-canada/; & https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9155882/.

Day 29 – Bell’s Palsy/facial palsy can be a sign of Lyme disease – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5729143/; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8791801/.

Day 30 – Lyme Arthritis can be misdiagnosed as Juvenile Arthritis & other types of arthritis. This is from almost 10 years ago – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4614091/. Why is knowledge still lacking – https://www.cdc.gov/lyme/hcp/clinical-care/lyme-arthritis.html.

Day 31 – This is the last day of May, but tick awareness/prevention needs to continue. It should be year-round. Don’t be complacent. As other tick-borne illnesses continue to grow, diagnosis & treatment may become even more problematic.

Lots of info in the above. Any help with sharing the word would be very much appreciated. Who knows who you might help. Even one person is worth it.

Lyme on Television

It has been somewhat of an exciting time lately with Lyme being mentioned on “Coronation Street”, “The Bachelor”, and even “Jeopardy”.

I don’t watch any of the above usually but have started watching “The Bachelor” because one of the contestants, Daisy Kent, is very open about her past struggles with Lyme and she also speaks about her treatment, and answers questions, via TikTok, etc. It’s always great when someone speaks up, but it’s amazing when they actually go into detail about their treatment, and where it was received. In Daisy’s case her main treatment was at Klinik St. Georg in Germany.

The “Coronation Street” storyline was developed with the help of Lyme Disease UK – https://lymediseaseuk.com/2024/01/09/coronation-streets-joseph-brown-diagnosed-with-lyme-disease/. It is wonderful when TV shows, movies, etc., include information on Lyme and Tick-Borne diseases, especially when they ensure that the information is accurate.

A recent episode of “Jeopardy” had as a question – “The Quiet Epidemic” makes the case for the existence of the chronic kind of this disease named for a New England Town. The answer is, of course, “What is Lyme disease?” That quick segment provided watchers with a name of a movie that they could watch, as well as highlight Lyme itself.

These may not seem like much, but they are all reaching different audiences and providing education and awareness. I will take it.

There have been many more mentions of ticks, Lyme and Tick-Borne diseases on a number of shows in the past. “House” had an episode with a patient presenting with Tick Paralysis and he found and extricated the tick from a very private location which, by the way, is one of the warm, moist, areas that ticks love. Shows, such as “Friends”, “Brooklyn NIne-Nine”, “New Amsterdam”, and so many more, also raised the topic. Some mentions are not great. It’s not always an overly helpful addition but, again, it does raise the topic, even if not done accurately, or done in a humorous manner.

Where I’m going with this is that anytime you have the opportunity to mention ticks and Tick-Borne diseases, please do so. As well, share what you can, where you can. The more people that have even a basic knowledge, the better. Hopefully, as awareness is raised, less people will end up with Early or Late disseminated Lyme. Cases will be reduced, and those that do end up with a bite will be treated faster and accurately. Here’s hoping anyway.