LYME DISEASE PREVENTION

And back on weekend focus with me today is my special guest Sean Douglas, he's the pharmacy manager, clinical services director of the Mountsville Kroger. How are you today, Sean? Going real well, Paul, how about yourself? I'm going pretty good.

I think I got your title, right? I mean, I am professional now and then on the show. Sound perfect. So we're talking about and we hear more and more about this before you came in this morning.

I was talking to one of my co-workers, Lyme disease. And we seem to be hearing more about that this year. It's been a problem for a while, but why this year are we hearing more about it? For years, it's been underappreciated.

It's been around for many years. Starting to the further south, we go originated in New England, Lyme, Connecticut. So years go on, it seems like there's more and more awareness the further south you go. So it's getting into the mid Atlantic, mid West States now.

We're starting to hear more about it. Really, awareness is the biggest thing to combating Lyme disease. So right now, you know, kind of looking at it right now is the we're in the prime season of it. And it lasts several months longer than I thought.

They say from April to September, generally when the green stuff is out, when the trees are in, have the leaves, when the grasses are green, tends to go in grassy areas and wooded areas. So when everything is lush and full, tends to be when the ticks are their most active. Okay. And I was reading on here.

I couldn't believe this, the cases that are reported annually. There are 30,000 cases reported nationally, actually diagnosed nationally. A lot of the Lyme organizations, the organizations that get the information out and track statistics, try to help educate everyone that they believe there are upwards of 10 times more than that. So upwards of 300,000 cases in the U.S.

Of course, most of which are undiagnosed or untreated. Okay. So when I'm reading the information here, you always provide good information. I appreciate that.

Ticks transfer bacteria called, and I'm going to let you tackle this one because I don't know if I can do it. Berelia, bergorphyry. And that is Lyme disease is a bacterial infection. So we get a common cold, it's viral.

You can't treat it with an antibiotic. Lyme disease is a bacterial infection. So from a bacterial standpoint, it is a treatable thing. But the bergorphyry is a spirochete bacteria.

Generally bacteria can come in three shapes, spheres. So they look like a ball, can be a rod, so they look like a stick. Those are the most common. And then the spirochete is very unusual.

It's kind of a miscellaneous category. And that's what the Lyme disease is. And that spirochete, that unusual shape is partly why it can be really hard to treat. And now it can't be transferred, I understand, obviously from person to person or pet to person, right?

Correct. They say, if your spouse has it, you will not get contract Lyme disease from your spouse. Okay. If you're now pets can, dogs, cats, horses, they can contract Lyme disease.

You won't catch the Lyme disease from your pet. However, they can carry the tick from which the tick can get on you. And thus, they can become essentially a carrier of the mode of transfer to you. So if your dog's out playing in the woods, if you ride horses and they roam in the woods, you can pick the ticks up off of your pets.

Okay. And I'm reading here, only deer ticks can transmit, correct? That is correct. I guess they're numerous types of ticks.

Now, like you have numerous types of flies and spiders and so forth. Great. Numerous types of ticks. Only the deer tick can transmit it.

In the west, they call them black-legged ticks. And all those, what they call the nymph and scientific terms, they would call it a nymph, is essentially a baby tick. The baby tick tends to be what transmits the disease. Mm-hmm.

The adult ticks, well, let me step back a second. The nymph, they say, is about the size of a poppy seed. That's hard to believe. So by the time the baby tick, the nymph has bitten us, kind of burrowed its way into our skin.

That poppy seed is really hard to see. The adult ticks, full-grown ticks, much easier to see. Therefore, we tend to see the adult tick. We tend to get the adult tick off of us.

They transmit much less of the disease. Okay. Baby tick being harder to see tends to be the one that typically then is results in us getting to Lyme disease. Okay.

And they have to be in our skin. They say 36 to 48 hours typically to transmit the disease. So we get bit by regular tick. We're taking our shower.

We notice the ticks there. We get it off. Generally not on our skin long enough to transmit the disease. The baby tick, the poppy seed burrows into our skin.

We don't see it. It's there for a couple of days. That's typically how we end up contracting Lyme disease. It's making me feel like I have to check now.

But, you know, removal of ticks because the first thing you want to just like grab it or take whatever you can't. That's not really the right thing to do. The all the Lyme experts out there say trying to burn it with a match, trying to put baby oil on it, the different home remedies, or just trying to drive it with your fingers and pull it out, not the things you want to do. The quicker you get it out and the quicker you can get the entire part out, the more likely you will prevent transmission.

And the the jaws of the tick, the part that bite us, they kind of have a serrated edge. Okay. And it's I guess I would say it's a reverse serration. So it'll go in smoothly.

Okay. But then it's catching as we try to pull it out. Okay. So it's kind of like a steak knife will slide one way on your steak, but the other way is where it's really kind of grind in the meat.

Okay. So the tick will go in smoothly. If we just try to pull it out, those jaws are going to hold the head really well. We have more likelihood of pulling the body off and leaving the head in.

So they actually make tick removal devices. They're very much. I was unaware of them until recently. They're very much like a fine tip tweezers.

They say a fine tip tweezer will work as well. Okay. Fine tip kind of being the tweezer comes to a point as opposed to the tweezer kind of a flat edge to them. So you can kind of get under the head toward where the jaw is squeezing where the jaw is, unlocks, opens up the jaws and allows the whole thing to come out more smoothly.

And you're right. Don't you don't want to burn because I don't think if I've got something you know, half lodged in my arm or I don't want somebody to try to attempt to burn that because then you're going to have a whole other set of issues potentially there. And I've had people say, oh, you know, dump Clorox bleach or peroxide on them and that'll make them come out of there. I don't think any of that works.

But not guaranteed. It may work in some cases, but it's not a foolproof method. Yeah, exactly. And now it I was written here 70 to 80% of people develop a red rash.

Yes. And kind of the hallmark, a lot of general literature, you'll see, we'll talk about a bull's eye rash. Okay. Looks kind of like the target logo.

It's got a dark red spot in the middle, a lighter red spot around it. Okay. It is not always going to be that way. Not everybody develops the rash, but one way it is often diagnosed is someone notices a rash.

The proximity of time, the closer you are to the actual bite, the more likelihood you'll have the dark red spot where the bite, where the tick was. Okay. It'll kind of fade into pinkness and then you'll have a red rash, a darker red spot around the outer part. But that can fade.

It doesn't have to be totally circular. Kind of like if you're looking at a globe how the land masses look different, it can be any kind of asymmetrical shape. But a lot of times people will first realize, you know, I've got some symptoms and oh, by the way, I saw this rash on me and then your doctor will say, oh, that's a good chance we got Lyme disease. We better look at that.

And I'm reading here too, Sean. Again, we're talking with Sean Douglas today on Weekend Focus. All about Lyme disease. Important, you know, very timely here, because I've been hearing more talk about it.

Now it takes four to five weeks for our immune system to create a measurable amount of antibodies. Easy to do this. Many false negative diagnoses, right? Yes.

Lyme disease, it's such a challenge because like with any infection, the sooner you treat it, the easier it's going to be to get rid of the infection. It's amazing to me what Lyme disease can do. I mean, severe cases and I talked to somebody one day and they knew someone that had Lyme disease. It took them a long time to actually get over it once they were treated.

They found out and they were treated. They would like go have a few days they were fined and relapse back into it, have trouble moving their muscles and things. I was just amazed at what that can do. It's unbelievable what you can run into with it.

Bacteria reproduce so quickly. If you could treat it, say during week one, you're going to be treating X number of bacteria. If you don't treat it for, say two months, if it's two months before you get diagnosed, that's been exponentially growing for eight weeks in you. It's going to be a lot harder to treat.

Add in the fact that you're treating a spirochete, which most antibiotics are designed and tested against the balls and the sticks, so to speak, makes it a lot harder to treat that spirochete. The spirochete also can imitate, can change its shape a little bit because it's just kind of like a slinky. It's not a rigid structure, it can move and change and bend and it's pliable, making it harder for the antibiotic to detect. They also, during their replication cycle, the reproductive cycle, is when they tend to be most susceptible to the antibiotics.

That is only every few weeks. So the more bacteria you've got, the harder it's going to be to target that replication cycle. So it's really difficult to treat Lyme disease if you don't catch it early, but the symptoms present as mild flu symptoms. That's what it says to be a lot helpful.

It's kind of hard to see it at first. You go to the doctor or you're feeling I'm just kind of blah, I'm kind of a liaison, I'm fatigued, I've got a headache, I might be a little dizzy, you think you've got the flu, you don't think much of it. Three or four weeks in, you realize you got this rash. Now you go to get tested, but our body hasn't developed enough antibodies.

Test comes back negative. You're saying you don't have Lyme disease. By the time the test would come back positive, it's been replicating and developing for six, seven, eight weeks, most likely. Now we've got a big problem.

Yes. And so when I'm diagnosed, Sean, what are some, you know, I kind of muscle issues and things, what are some of the more major symptoms that it can present Lyme disease? It can affect the joints. You can have what they call Lyme arthritis just because your joints are really achy, real stiff, due to the Lyme.

So they'll call it Lyme arthritis just to differentiate it from more common arthritic conditions. Headaches, it can be neurological, can affect the heart, can affect your memory. The chronic cases or post-treatment Lyme disease cases tend to present very, they're very challenging. People can need to be hospitalized because their body's being challenged so much.

So much pain will go with the joints, with the muscles, with the heart, with the nerve pain, the memory, you know, somebody starts having trouble with the memory. So it can be really hard to treat, take a long time to get over. Kind of a controversial thing is that chronic Lyme or that post-treatment Lyme disease because you know, our normal dog, how we have differentiations. If your doctor's an MD, they're treated, trained one way in school.

If they're a DO, they're trained a different way. It's kind of like the same idea as some people buy into the chronic Lyme, some people don't buy into the chronic Lyme. I bet we can have a whole show on that alone, that topic alone. Yeah, yeah.

And I understand Sean, you know, there can be cases, this would be scary, can be misdiagnosed. Yes, I had mentioned a couple minutes ago how the spirochete is considered, some people consider it the great imitator. Can present itself as a fibromyalgia because of the joint and the muscle aches or even the nerve pain, can present itself as chronic fatigue syndrome, can present itself as MS. So you have some symptoms, you have a negative blood test, people start looking at these other areas, and when they think you have a chronic fatigue syndrome, they're not treating with antibiotics, they're working on the fatigue side of things.

So that's Lyme disease keeps developing in the body and progressing further. And you're getting worse and worse and worse when they're thinking it's one thing when it's really the Lyme disease. Yes. That's scary.

So when it comes to Lyme disease, Sean, prevention, and I know I'm somebody, you know, I need to listen to this because anytime I'm outside, unless I'm running the lawnmower lawn equipment, I'll actually have to, but I always have a t-shirt and shorts on. So it doesn't matter. And most of the time I'll either have flip flops on, I don't even out the edge line of the woods and stuff. I'll step into that with, you know, not properly dressed.

Yeah, there are a couple things that they suggest and for most of it, it's hard to follow these guidelines because the months we're looking at tend to be warmer months. We want less clothes on, right? Less clothes when we're outside. They say if you can wear long sleeve shirts, long pants, you're going to prevent the ticks from getting on you and getting, you know, being able to burrow into your skin.

Second thing, they say wearing a light or bright colored clothing so that dark colored tick on the clothing becomes more noticeable. Okay. To try to repel the ticks, excuse me, we can use DEET, you know, like your deep woods off and that sort of thing on our skin. Natural insect repellent or an insect repellent that will just naturally keep the ticks away.

Sure. There's something called permethrin. I've heard of this. It's the active ingredient in nicks that they use to treat lice.

Okay. You can get some products in the stores that you can spray onto your clothes and that permethrin should repel the ticks from the clothing. Okay. So you can treat your skin, you can treat your clothing, you can cover yourself up with clothing.

Those tend to be the best ways to prevent us from getting the Lyme disease. If you know you're going to be in the woods, it's going to be hot. If it's a really densely wooded area, it's going to be more humid than normal. But if you can cover up a little bit with some bright colored clothing, you're going to protect yourself in the long run.

I'm thinking too, Sean, when you go in your house, in that clothing, you probably should have, you know, someplace close to the door or some place that you can take those clothes off and you don't want to get them in the main part of the house or with your other clothes or around your pets or around your kids because you may not, but they could be in on those clothes somewhere. They definitely can be. And being able, if you've had your dogs out in the, and they can roam in the woods and inspect them when you bring them in, so they're not carrying it in to the bedroom, into the kitchen, around your kids on your living room furniture. Likewise, your clothing, make sure you can change that clothing in your mud room, so to speak, instead of taking those into the main part of the house.

It makes me think too, Sean, about the scalp, too, your hair, because when I was a kid, I remember, I don't know what parent it was, but there was one that was kind of half burrowed into my scalp. I've kept feeling something, and I had one of my parents check, and that's what, and I've been freaked out about them ever since that. I can remember that. That's been years ago, but I can remember it just like it was yesterday, and I never since then, there's little buggers.

I can't stand them. Yeah, I guess, in my case, that's one good advantage to be involved. It's a lot easier to detect them. If you've got a big, big head of hair, then it can be a little harder to detect them up there.

You just spray some deed up there. Yeah, that's it. There you go. That's a good way.

I'm going to get my hair shaved off, and that'll keep that from happening. We kind of touched on treatment. You know, obviously the sooner you can catch it, the better. Yes.

The sooner the better, they do not suggest prophylactic treatment. Okay. So if you're going to be out in the woods, it's best to not say I'm going to take an antibiotic now, go out in the woods. The pro, having the antibiotic first won't last long enough by the time the transmission occurs.

Gotcha. But the sooner you can treat, the more likely you are to control and destroy the bacteria before it can develop in the body. Okay. Is there a common antibiotic they use to treat Lyme disease that seems to be pretty effective?

First line therapy, they say, is doxycycline. Okay. It's been around for years. We don't use a ton of doxycycline.

I don't think I've heard of it. I shouldn't say it used to be. It's a fairly common product as far as it's generic. Okay.

It's not horribly expensive. Okay. Antibiotics tend to go in cycles. You know, we'll see in the 10 B regional, you might see a real popular antibiotic in Pittsburgh, a different one here and a different one yet if you went to Columbus.

Okay. Here we see doxycycline, but it's not a hugely popular one. But higher doses, they generally come as 100 milligram tablets or capsules, taking one of those twice a day or two of those twice a day for at least 20 days. Well, that's a long time.

Due to the time it takes to get the blood levels, the antibody levels in the blood, due to the fact you're working with that replication cycle with the spirochete, which can be as long as three weeks, they say to treat for at least 20 days with really any of the antibiotics. Okay. Don't want to stop at seven days like we would for typical sinus infection or 14 days for say, endomonia. We want to go out to at least 20 days with it.

Okay. And I recognize there's another one. A moxacilone. I do recognize that one.

That seems to be a more common one, at least, you know, I've heard of it. Yes. If a person has difficulty with doxycycline, and doxycycline can cause some nausea, it can cause some sensitivity. Okay.

You need to separate it from antacids, dairy products, or there can be a few little challenges and getting the maximum effect on the doxycycline. Okay. The moxacicillin, azithromycin, which would be your Z-pack, those antibiotics can be effective as well. But again, you need to make sure it's a higher dose, and it has to be for at least the 20 days.

Okay. And again, we're talking with Sean Douglas today on Weekend Focus, talking about Lyme disease. Sean, this is kind of creepy crawly thing. I don't like any of that stuff, but it's important because we hear so much more about Lyme disease in the news, which I guess is a good thing because we're educating people more.

We need to know about this. It makes me think of mosquitoes too, with when we talk about West Nile virus and the things associated with mosquitoes, but ticks are just important. I think we overlook ticks a lot. When it comes to post-treatment Lyme disease or chronic Lyme, what are some things there that can be somewhat controversial with that one?

Yes. They say about 10 to 20% of the patients, people that become infected. And again, we've got 30,000 that are diagnosed, upwards of 3,000 people actually deal with Lyme disease in a given year. So 10 to 20% of those will develop a chronic Lyme or what some people call a post-treatment Lyme disease.

Basically, meaning you've gone through your 20 days, 21 days of treatment. The symptoms haven't subsided, or they subsided and came back. So it's something that people can deal with a longer term. There was one boy I was told about, a high school boy, and he actually dealt with it for roughly two years.

Really? He had played sports in school. I can't begin to imagine. And he was unable to play for what essentially between when he was diagnosed and when he was strong enough to play again, it was about two years.

So there does seem to be some real, if you've come in contact with somebody that has been diagnosed with it, has had the bull's eye, has had the blood test come back positive, has gone through the treatment, you're going to be more likely to buy into the fact there is a chronic Lyme or a post-treatment Lyme disease. The cynical people tend to be ones that have not had anyone close to them actually deal with it. It's one of them you really don't know until it either affects you or hits close to home. You kind of just dismiss it in a way.

A lot of times. And unfortunately, our doctors, nurses, pharmacists, or even you come into a pharmacy with three or four weeks of antibiotic treatment, I think a lot of pharmacists are like, what are you doing? What's your doctor trying to do here? Or if you go to the ER, there might be doctors that are not as familiar with it.

But when you've known somebody through friends of your kids, through friends of yours, through a relative, you start to understand and appreciate how challenging the disease can be. And Sean, while we're talking to you about Lyme disease, if anybody has any questions for you, I know that the Moundsville Kroger there where you are, you're based out of there, the pharmacy there, how can they get in touch with you? What's the phone number? The phone number at the Moundsville Kroger is 304-845-8298.

Really, and if our pharmacist can help you, you want to talk to me, just ask for Sean, and if I'm not there, they'll leave a mess before me to get back with you. Well, and I like it. You know, Kroger, Moundsville Kroger, you take so much time out of your busy schedule. I know each month we have a different topic, but that's what I like you guys.

You know, more than just the pharmacy, you're there educating the public and really, you seem like you stay ahead of what's going on. I almost look like technology. You continue to evolve with the different diseases, the different illnesses, the treatments, and it's almost something that you're writing. It changes daily.

It does. And pharmacy has been evolving a lot in the last, say, 10 years. Kroger is very proactive, trying to stay ahead of the curve. I'm lucky.

You know, I get a lot of students, a lot of West Virginia and Pitt and Duquesne students come and work with me. You know, I've had Aubrey, my one intern has come and done flu shots with me here before. My two partners Bob and Cindy are very proactive. So we pride ourselves in trying to be that liaison for the community, be someone they can talk to and really lean on if they need some advice.

And Sean, there's a couple of here resources references I'd like for you to give out. If anybody wants to learn more about Lyme disease, what we've talked about today, there's plenty of resources on the internet, but we always like to get specific and help out people and point them in the right direction. Yeah, with with Lyme not being a tremendously known topic. You know, I had some background in Lyme disease to kind of pull some statistics and around out my knowledge, I had used two websites, LymeNet.org and that's Lymelymenet.org and Lyme disease.org Lyme again being lyme disease.org.

Perfect. So a couple of different resources. Yeah, you're right. We don't hear enough about it.

And hopefully, you know, with people folks like yourself in Kroger and we continue to spread the word and just educate people because education, we always say it all the time, it's key and early prevent or you know, treating early being caught early with like anything else that's key. Having a little bit of knowledge of what to look for and helping to prevent and catch it early, like you say, that is definitely the key to preventing you. Believe me, you don't want to get to the point where you're in that chronic Lyme because it can be a miserable condition for the person dealing with it and the people around them. Absolutely.

And Sean, it's just hard for me to believe such a little icon, little bugger, such a little thing as a tick can cause such a, you know, become such a big problem for us. It's hard to believe. A little poppy seed can lead to years of agony. Just doesn't seem like hard to imagine.

I think maybe that's why sometimes we don't take it seriously. Like, no, that little thing can't do that. So it's like, yeah, they can because like I said, more on the national news and I've talked to people locally, they've known people that's been affected by Lyme disease, not a pretty picture. So we want to do all we can to avoid it and treat it early if we do because not everything is 100% avoidable.

But as you said, we just, you know, pay attention and keep an eye on things and get to the doctor as soon as we suspect something and maybe even say, hey, I found some ticks on me and let them know. I don't know you spent time in the woods. You might, you know, been exposed to that. And I guess it doesn't have to be in a woods if you're in your grass from your yard and the edge of your yard.

Maybe you're like you said earlier, your pet. So that you just want to be proactive and be mindful and just pay attention. Yeah, if you know you've been in a wooded area, if you have a lot of fields, you've been out in the fields, you start dealing with some chronic fatigue, just total fatigue from the two or three weeks after that. Start checking, is there a tick?

Is there a rash somewhere on the body? If you find anything, please go go to your medics, fresh, your rapid carrier ER, your family doctor and just, you know, have them check out just to make sure you're all right. All right. Well, Sean, I appreciate your body for taking time to be with me today on the show and I look forward to our next segment.

I know it's not going to be too long. We'll be getting into flu shots and flu season and all that fun stuff, right? Hard to believe we've already been talking to our patients about flu shots. Yeah.

All right. Around the corner. Well, thanks, Sean, and thank the folks at Kroger for allowing you to come up and do the segment with me. Thank you.