many of us have come tolive in this part of the country because wewanted to foster that strong relationship in our liveswith our environment. and it's probably no time wherewe do that to such a degree as we do during the summer. it's not hard to imagine wakingup here in the morning, and seeing the real purple coloryou see in the mountains. with the mist, the reefs ofmist around it, to drive and see cows and green fields.
it's not the way it is folks. that's not what the reality is. i'm here to tell you that thereare plagues, miseries, scourges, and even heatrash out there. [laugh]. so let's talk about somethingthat i know that's on everybody's mind: tick borneillnesses are something that's very important to thehealth of our community. let's talk about, in theorder that we're most familiar with them in this area. lyme disease is caused by atick called by various names.
it's the black-legged tick.it's ixodes scapularis. it's also known asthe deer tick, more commonly known as the deer tick. it's in the same, all theticks are in the same family of arthropods, which makes themrelated to spiders and scorpions so they're in good company. now for those of you who reallyare attached to the hudson valley and feel that maybe i wasbeing a little bit harsh, you're probably right.
because of the 880 varieties ofticks in the world, there's only three of them that cause seriousdisease in this part of our country, and we're goingto talk about those. all ticks are obligateblood feeders. which means that they must havea blood meal every time they want to move on intheir lifestyle. so for a tick to cause lymedisease, they really have to be attached, a deer tick rather,to cause lyme disease, has to be attached for atleast 24 to 36 hours.
and that's a criticalfactor and we'll come back and amplify that. after they've been attachedfor 24 to 36 hours, they are capable of passing thelyme disease bacteria. and it can take anywhere fromthree days to three weeks to develop signs of lyme disease. and when one does develop it,the first stages are what's called early lyme disease, andthat's manifest by headaches, fever, muscle aches.
just feeling tired all thetime, and more often than not, probably about 80%of the time, a rash. so untreated, 50 to 60% of thosepeople will develop arthritis, of the infected people, will develop arthritis,several months later. now although the early symptoms,which can develop in three days to three weeks, includejoint aches, that's not necessarily arthritis. that's arthralgia, but arthritiscan develop several months later
and be persistent for years. 15% of people developneurologic findings. and those include bell'spalsy, you know, where one side of the face is drooping. people go to bed feelingfine the night before, wake up the next morning andtheir face is drooping. they can't make their uppereyelids work properly. they can't wrinkletheir foreheads. most often, that will respond tothe proper antibiotic therapy,
which we will talk about. and then 10% of people who haveuntreated lyme disease develop serious heart involvement. the heart can become inflamed. the heart rate can be abnormalbecause infection infects the nervous system of the heart. so these are realserious considerations. it's believed that as high as25% of people in the hudson valley can test positive, willtest positive for evidence for having had lyme disease.
the next illness i want totalk about is ehrlichiosis, and that's also caused by the sametick that causes lyme disease. the deer tick, the blacklegged tick, ixodes. this also only gets passed whenan infected tick is attached for 24 to 36 hours minimum. symptoms don't developfor anywhere until after five to ten days. so it's a little bit slowerto develop and the way this presents is with a verysevere headache, a higher
fever than one anticipateswith lyme disease. also this terrible weakness,and feeling ill all over. but in a sense, veryspecific lab test findings. when somebody suspects acase of ehrlichiosis, which is not manifest by thatecm, that early rash. there's blood tests to be done. you do a blood count,and that'll often show a low white blood cell count. a low platelet count, and alow red cell count, anemia.
there's certain tests that canbe done for this and treatment that we can talk about again. antibiotics for lyme diseaseare basic doxycycline taken for three weeks, is theway we used to do it. there's current literaturethat says anywhere from ten to 14 days may be adequate. not everybody's switchingover to the newer findings. many people are stilltreating for 21 days. same thing for a ehrlichiosis.
14 to 21 days of therapywith doxycycline be the treatment of choice for that. the next is rockymountain spotted fever. rocky mountain spottedfever is not something you're going encounter here. just real quickly, itdoes cause a high fever. it causes a veryparticular kind of rash. different than the lyme rash. it causes a rash thatbegins on the wrists,
and the ankles, and it's adeep purplish spotty rash that can then spreadto cover the whole body. this can be a fatal disease,and it can be quickly fatal. also treatable by doxycycline. so we're fortunatethere's one antibiotic that can cover all of those. and the last disease isbabesiosis, not seen very commonly, but it has been foundin cape cod, massachusetts, and we know it's going to spread,and it's going to be here.
this is caused by adifferent kind of bacteria. this is a malarial like disease. that causes very high fevers,shaking chills, and it causes the destruction ofred blood cells. so also a serious illness. now to understand why and howto deal with lyme disease. what we'll be able to do is talkabout the life cycle of ticks. when ticks are first hatched,they're more like an insect because, they're six legged. they're hatched in summertime.
the young, the young larva. and, what they must do, theymust have a feeding in august. by august they must havefed on a host animal. because the larva are so tiny,they're smaller then the period at the end of a sentence. they typically don't get highenough up to feed on larger animals, they feed on mice. and keep that in mind when i'mtalking about mice because this will come into play a little bitlater when we talk about some
other aspects of lyme disease. once they feed on the mice,those are the ticks that will survive to the following spring. what they do is they burrow intothe leaf litter, and they remain there dormant, in the leaflitter until the next year. when in may or june, havingsuccessfully fed on a blood meal, probably froma white-footed mouse. they now molt, they matureinto something called a nymph. and the nymph is about this,nymphal larva, nymphal ticks are
about the size of a period,at the end of a sentence. once again, the nymphmust feed on a blood meal. because they're a littlebit bigger, they get higher up in the forest floor. they get up on littlebranches and, shrubbery and so they often fall off. they still use mice, theyoften go on deer and sometimes they go on humans. they're truly problematicwhen they attach to
a human to feed on becausethey are so hard to see. and if they're infectedfrom their first blood meal. when ticks are bornthey're not infected. but after they feed on a bloodmeal from an infected animal like a white-footed mouse ora deer, then they can become infected and they canpass that onto you. so what they wanna do is they'regoing to find a blood meal sometime after may or june, andso in early spring is when we see our first flush of casesof nymphal caused lyme disease.
so they can go on birds,on mice, even on reptiles. i was surprised to read that,they'll go on any vertebrate, it doesn't have to be a mammal. is what i read for the firsttime in preparing for this. they'll then fall off, andmature in the fall, they'll then molt. again, so if they had thatblood meal, now they'll molt and they'll become an adult. the adults, because they'rebigger, will go higher up in to
the forest and we're more likelyto contact them then, but if they don't contact us whatthey really want to do is get on a deer. the white-tailed deer inour communities, and on the white-tailed deer they mate. the males and females mate onthe deer, lay their eggs, and then they die. and then those eggs fall to theground, into the leaf mulch. and in the following spring, orthe following summer, i'm sorry.
in the following summer,new larva appear. so a female can lay hundreds andhundreds and thousands of eggs. any questions? yes. (man)how many, how, how manycases of lyme disease did you get so far this summer? (dr. stutt) i'd ask the healthdepartment to tell us. (jane piasek, rn) it's adifficult question to answer. we typically in delaware countyhaven't had a lot of lyme disease, but in the lasttwo years it's been
noted to be increasing. the health department has verystrict guidelines on what they consider a confirmedcase of lyme disease. so your doctor might diagnoseyou with lyme disease, but it might not fit the criteria. so you have to fitcertain criteria. so i would say last year we mayhave had eight health department confirmed cases, but manypeople treated for lyme disease. and i have been toldthat that's on the rise.
you know i always thought, andmaybe, doctor, you know, does the climate, does our coldclimate keep lyme disease down here, as opposed toconnecticut and westchester, and some of those other placeswhere it's more common. (dr. stutt) it used to seem tobe the case, 15, 20 years ago, we're only seeing itdown on long island. then it moved up to westchester. and i know now that it'sall up to green county and columbia county.
(jane piasek, rn) a lot of ourearlier cases a couple years ago seemed to have contracted itperhaps in long island, like travel to a place where it wasmore common, but we are seeing people get lyme disease here. (woman) what kind oftests are taken and how accurate are the tests? (dr.stutt)good question.the most common test is an elisa test. it'san antibody test. and that by itself issort of like a screen.
if that comes back positive,and there are multiple markers that they're looking for, then it gets sent for a western blot. and thatwestern blot, if a number of those markers are positive, getsreported as positive. (jane piasek, rn) if you have aphysician-diagnosed lyme disease rash, the rash that doctorstutt was talking about, if it's diagnosed as the lyme diseaserash, you don't need the lab tests for further proof. that is proof enough at thelevel of the state, but as he
said not everybodygets the rash so (dr. stutt) and the way wepractice in the emergency department is, if we see therash, we frequently don't even order the test. there's no need to. we'lljust initiate treatment. or if there's enough suspicionbased on the patient's history, we'll just go ahead and do that. what we have here are two ofthe most common ticks that affect people in our area.
this is up there justfor size comparison. that is a match. these are relativelyunengorged adult ticks. this is a dog tick withbrownish red legs and a brownish-colored shield. that's called a scutum,latin word for shield. this is a deer tick, anadult female deer tick with black legs, hence theblack-legged tick name, and it has a very dark shield.
when ticks bite you, when theyattach to you, they secrete three different things; ananesthetic agent, so you don't feel them biting you. their saliva has ananesthetic agent. it has an anticoagulant, so yourblood flows more easily so it doesn't clot off right away. you know if you justscratched yourself it would maybe bleed for a tenth ofa second, a second. then it would stop becauseof the coagulant
effects of your body. tickshave an anticoagulant. and the last thing that theyhave, is they secrete a cement through their saliva. so it holds their head in place. so, the reason we know these arefemales is that the scutum, the shield, is small. and this ties in to thewhole physiology of ticks, the whole life of ticks, becausemales, this scutum is hard. males, the scutumcovers the whole back. they can't feed long enough.and let's talk about this.
when they attach, and theyburrow in, and they cement themselves in, and they'vegiven you the anticoagulant, and the anesthetic. after they've fed for 24 to36 hours, that's why that's a magic number. they start to regurgitatetheir stomach contents. and it's their stomach contentsthat have the bacteria. more ticks. once again, the head of a match,and this is an unengorged adult
female unengorged, andthis is an engorged tick. this is a fat full tick. the yellow area is wherethe black-legged tick is most dominant. you can't go anywhere inthe northeast and the whole eastern coastline andavoid getting ticks. many of you can probablyrecognize these from your own experience. these are the rash ofearly lyme disease.
the typical appearance is of abulls eye, red center, white, and then a red periphery. bulls eye rash, and this isshowing this to be, 70, 66, six centimeters. i've seen some as bigas the palm of my hand. and it's possible to see onehere, and then see multiple on the legs, on the chest, onthe arms, in the armpit. it doesn't occur just assingle entity sometimes. sometimes there are multiple,multiple bulls eyes.
it has nothing to do withhow severe the disease is. it's just some peoplereact differently. another bulls eye, actuallya multiple bulls eye, because here's a red center, aclearing, a red ring, clearing, and yet a bigger red ring. right here, is whatwe call the sicular. it almost looks like a blistersurrounded by erythema, which is redness. so just anothermanifestation of that rash.
so, here's a question:what are some of the remedies that people have here? how do people get their ticksoff? they irritate it. sometimes people put chemicals on it. sometimes they burn it. sometimes they try tosmother it. don't do it. if you irritate it,what's it going do? everybody together, what'sthe tick going to do? it's going vomit. so when you do take a tick outthere's one approach that's the
best and there's severaldifferent ways to do it. so the way that i use in theemergency department and in my home is the narrowest sharpestpair of tweezers i can find. and the idea it to grab the tickbelow its body, you don't want to squeeze it's stomach. you never want tosqueeze its stomach. grab it as close tothe skin as possible. what i do is i press down withthe instrument on the skin, so that i get as muchskin down low.
then i close the tweezers or theclamp on the head and then, with constant, non-twistingpressure, i pull the tick out. what happens ifyou leave the head? can the head giveyou lyme disease? no. it has to be ableto regurgitate. and it can't regurgitateif it doesn't have a body. so after you've done this,wash this with soapy water. alcohol if you think that'sgoing to be better, but soapy water is good enough.
i had some slides thatshow people throwing a tick into the garbage. iput them in the toilet. i wrap them in toilet paperand put them into the toilet. i don't want them climbing outand re-infesting my household, or my dog, or my cat,or my kids, or me. so what if the head stays in? you can try digging outyourself, if you have some clean way to do it. if not, come to the doctor, cometo the emergency department.
let us do it. coming back to what thehealth department said. now, you've got the tick out. should you save it orshould you throw it away? well, i'm hoping thatyou're going to be able to identify the tick, yourself. you can recognize the differencebetween a dog tick, brown legs, brownish body,verses the deer tick. it has that tan lookingshield and black legs.
the things we reallywant to know are, was that tick engorged?was it swollen? can you tell me, definitely,that if you come out this evening and go home and find outyou have a tick attached to your wrist, you know it wasn't therethis morning, because when you were eating you werelooking at your hand. when you were brushing yourteeth, you know that there wasn't a tick over here. if you know that the tick wasn'tthere for 24 to 36 hours, you're
not going to get lyme disease. if the tick is notengorged, you're not going to get lyme disease. if it's not a deer tick, you'renot going to get lyme disease. things that you can considerwithout seeking medical help. if you can't identify it, andyou think the tick may have been engorged or may have been therelonger than 24 hours, bring it to your physician, or tothe health department to send to the state.ticks are big business.
this is actually a littleplastic lasso that you put around the tick. put it around the tick and youpull it tight around its head, and then you lift it out. here's a little key, so you canalways have it on your keychain. no matter where you are, youcan save people from tick bites. and, this is a spoon. you can use it for sugarin the morning, and ticks in the afternoon.
so what are we goingto do about this epidemic of ticks that we have? what you can do aroundyour household, and in the environmental aspect, is clearthe brush away from your house. don't leave brush, debris,old leaves around your house. clean it up, keep the grassshort close to your house. don't let it grow long. if you have paths that go intothe wood, if you take your compost out into the wood, ifyou walk your dogs into the
woods, cut a wide enough pathso there aren't ticks hanging on the long grasses and the longweeds that can brush on you. how far can a tick jump? if you're walking in thewoods, how far can a tick jump? no more than thisdesk it can jump. they can't. they crawl. so you have to brushagainst something, either with your legs, anarticle of your clothing, or with a branch touchyour head like i did. they can't jump. do wearlight colored clothing.
the reason for that isso you can see the tick. tuck in your pantsinto your socks. when i come in, i wash allmy clothes in hot water. i dry my clothes at thehighest dry setting. you can treat your indoor pets,the pets that go indoors and outdoors, you can treatthem with tickicides. so let's say, you founda tick on yourself. you think it may have been thereas long as 36 hours, because that was the last time youwere out of the house working
in your rose garden. and when you find it,it's a big fat deer tick. and you do remove it.what should you do? you should see a medicalprovider, within 72 hours. because, if you have a tick,and it's a deer tick, and it's engorged, and it's been attachedfor 24, 36 hours, you should be treated with doxycycline. it's an antibiotic, 200milligrams, one dose, and it's almost 100% effective againstpreventing lyme disease.
and that brings usto our next topic. more than 400 people,every year, die in the united states because ofheat related illnesses. more people die from heatrelated illnesses than if you combined hurricanes,tornadoes, blizzards, extreme cold weather, lightning, floods. combine all those and there'sstill more people are dying from heat exposure everyyear in this country. it takes the body somewherebetween seven to ten days
to accommodate to elevatedlevels of heat. now certainly there are placesin the world that are much hotter than 103 degreeson a daily basis. so why is it such a big deal inkingston, if it touches a 103, 104 degrees? because we're notacclimated to it. now, we define extremeheat as a temperature that's substantially higher. we associate it with a higherhumidity than usual in any given place. and there'sa lot to look at here.
this is air temperaturegoing up from 85 degrees up to 105 degrees. and humidity going from0% up to 100% humidity. as the humidity goes up, and astemperature goes up, the two of them together it's almosta direct relationship. the red is the critical area. this is apparenttemperature, this is not the real temperature. so, if it's, oh, let's saya normal summer day,
humidity is what, about 65%?and it's 95 degrees. that's the equivalent ofbeing a 119 degrees in terms of your exposure.and that's an area of danger. 105 to 129, in apparentheat is a danger period. extreme danger iswhen we get here. and that's not unobtainable. all it takes is atemperature of 100 degrees, with a humidity, a 75% humidity. and that's not a bigdeal in the summer.
so what are the heatrelated illnesses? they're really a continuum. there's no clear cut off,when heat cramps become heat exhaustion, becomes heat stroke. some basic concepts. your body is always making heat. you have a basal metabolic rate. that's caused by yourcirculation, it's caused by your thyroid. it'scaused by your skin. there's a very intricaterelationship between your skin, your brain, yournerves, your blood flow.
and it's always being checked. when we're not balancing ourheat production and our heat loss. ourmotors are shut off. we become drastically ill.we can collapse. we can die. if the air temperature is lessthan your body heat, you're going to radiate heataway from your body. once the two of them are equal. and the way, what happens is,as our bodies warm up, the brain sends signals for the bloodvessels to open up and pump
faster, to bring more bloodto the surface of the skin. what happens to us is whenair temperature and our body temperatures are the same,you can't radiate heat away. where's it going to go? and what we startto do then is sweat. and when we start to sweat,there's a liquid interface between our bodies and thegaseous environment outside. and we can evaporate, ifthe humidity isn't high. heat cramps. heatcramps are cramps.
they're cramps inthe big muscles. in the abdominal muscles,the back muscles, the arms, and the legs. usually occurs in healthy,active people, who are exerting themselves too muchin the hot weather. manifests by diffusesweating. they get pale. you get somewhat pale, notas, not dramatically pale, but get somewhat pale.and get dizzy. the way to fix that is stop theactivity, don't go back to the
activity for several hours,replace your fluids, and go to a cool environment. the next level up is heatexhaustion, and this usually occurs after several daysof elevated temperatures. again it's often healthy peoplewho are out, active, and about, and generating more heat. few people die fromheat exhaustion. things to look out for in heatexhaustion are the way people present, they're sweating,they're pale, they're cramping.
all the signs of heat cramps,but they're very fatigued, they're dizzy andthey may pass out. next step up is heat stroke. heat stroke ispotentially lethal. it's manifest by all of theabove; the cramping, the weakness, the power,but there's no sweating. temperature is oftenas high as 105 and 106. the basic treatment forall of these, for all of them is the same.get somebody to a
cool environment.stop their activity. you give fluids to people withheat cramps and heat exhaustion. you don't give fluids topeople who have heat stroke. they should not be drinking. they're going to needhospital care, they're going to need emergency care. they're going to need it assoon as possible, where they'll get intravenous fluids. who's at risk? the young, infants particularly.
they have veryineffective sweating. they have increasedmetabolic activity and they can't fend for themselves. they can't go geta bottle of water. they can't leave the placethey are to go to a cooler environment.leaving kids in cars. what happens is, kid inthe car, temperature can go up ten degrees in ten minutes. it can go up 30degrees in 20 minutes.
and if it's 93 degrees out, andthat car becomes 115 degrees, that's not survivablefor very long. the infirmed, they'retaking medications. they have decreasedcardiac output, decreased cardiac reserves. their skin isn't as responsiveto the blood vessel demands, to cool off as well. andthen, finally, the elderly. limited cardiac capability, theyhave pre-existing illnesses, they may be taking medications. so, what do we do to treat this?
first of all, it's importantto avoid alcohol and caffeine. alcohol and caffeineact as diuretics, they make you urinate. they decrease yourvolume, your blood volume. if you have decreased bloodvolume, you can't pump blood to the skin to exchange heat. replace your fluids. replace your fluidsprophylactically. don't wait till you'refeeling weak and tired. if you know you're going tobe outdoors, walking, hiking,
playing tennis, or stuckin a hot room like this. take your fluids beforehand. keep them replenished. don't give anybody who's inheatstroke, i told you not to give them fluids. don'tgive them aspirin. don't give them tylenol. don't give them motrin,ibuprofen, aleve, naprosyn, any of those drugs. and the reason is, heatstroke causes damage to the kidneys and liver.
tylenol is dangerousto an injured liver. aspirin and the non-steroidals,like motrin and ibuprofen are dangerous to the kidneys. rhus toxicodendron. that includes poison ivy,poison sumac, and poison oak. so, there's three waysyou can get poison ivy. direct contact by touching it. the other way is indirect. there's also inhalation.that can be very dangerous. people often burnpoison ivy branches.
burning thick bushes of it,the smoke from that can be very toxic and get into your lungsand cause an extreme slowing of your heart. once again, you hear everythingwe talked about tonight, the best treatment is reallyprevention, avoidance. this is the typical poisonivy plant; three leaves. let me point something out, not only is it three leaves, but the middle leaf is always on a longer stem. the leaves of poisonivy are notched.
and it grows just abouteverywhere except in margaretville and thesouthwest.(laughter) some of the mythsabout poison ivy. if you had poison ivy onyour hand, your blisters and everything and you were to touchme, would i get poison ivy? can't get poison ivy from that. you can only get poisonivy from the oil. now, if you had fresh poison ivyon your hand, not the blisters you have, but fresh poisonivy, then you came over
and touched my face. then i can get poison ivy fromthe oil that was spread to me. i get it less than you hadit on your hand, because i'm having less of an exposure. thank you all very muchfor your attention.
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