It is difficult to understand Lyme disease, because there are several steps to making the diagnosis.
When those steps are fulfilled, treatment should be started. Lyme disease begins with a tick bite and then a rash. If it’s not treated at that point, serious problems like facial palsy, arthritis and cardiac rhythm disturbances may occur.
The tick that carries Lyme disease looks like a poppy seed — very small. When you try to brush it off, it may be attached. Get tweezers and place them around the base of the tick. Then simply pull off the tick and dispose of it in the toilet.
You do not need to send the tick anywhere. Remember where the tick was attached and watch that area.
The rash of Lyme disease.
It begins a week or two after the bite, near the site of the bite. It starts small and gets bigger, very red, in a circular manner. It is not especially itchy or painful.
If you had a tick bite and you get an enlarging, non-itchy skin rash, you should call your doctor or go to Urgent Care. This is especially true if you live in New York or New England. If the doctor agrees that the timing is appropriate and the rash is becoming circular and expanding, an antibiotic should be prescribed. The antibiotic (one of several can be prescribed) will prevent the complications of Lyme disease.
You may miss the tick or miss the rash, in which case complications may occur. Weakness of the muscles on one side of the face is one complication, called Bell’s palsy. Bell’s palsy is often due to Lyme disease. In the Northeastern U.S., treatment with antibiotics will help and that kind of Bell’s palsy usually improves.
Arthritis or swelling of joints, may occur. Swelling and pain can occur in any joint and may move from joint-to-joint. Serious heart problems may also occur, usually diagnosed with an EKG.
If you have these later problems, your doctor may want to consult with a rheumatologist regarding treatment. Antibiotics may need to be prolonged and may need to be given intravenously.
The lab tests used to diagnose Lyme disease are not very helpful, at least in the early stages. It takes several weeks for antibodies to show up, so doctors should not wait for that.
The diagnosis is made by the history of a tick bite and an appropriate rash. The rash is known as erythema migrans, and it usually looks like a bull’s eye with a clearing area in the middle of the circle. Other causes of rash, such as mosquito bite, spider bite and shingles, can usually be distinguished by the doctor. Also, most other bites either itch or are painful.
Most primary care providers are familiar with Lyme disease, because many patients are concerned about the possibility of acquiring it. Remember that doctors are often asked to prescribe antibiotics when they are not needed.
If you and the provider decide not to treat possible Lyme disease, keep a close eye on the rash and call the doctor if you are still worried.