With the advent of spring, Lyme disease fears are once again in the news. However, Lyme disease can occur year-round. Lyme disease is caused by bacteria (spirochetes) spread by infected deer ticks. Some towns, such as Andover, are trying to manage the spread of the disease by more closely managing their deer population, although some studies have shown that reducing the deer population has no effect on the incidence of Lyme disease. In Harvard, the Board of Health is making arrangements to have the documentary Under Your Skin shown on the local cable channel—a film that shouldn't be missed.

Lyme disease is most common in the New England, Mid-Atlantic, and Midwest regions of the U.S. It has been reported in every city and town in Massachusetts. Although there is no national mandate for reporting Lyme disease, the Mass. Department of Public Health (MADPH) does require all health-care providers to report confirmed, as well as suspected, cases. According to the MADPH, the number of reported cases has increased yearly, with the last data, from 2009, showing 4,045 cases.

It is thought that ticks must be attached for 24 hours to cause disease. Young ticks (nymphs) are the size of poppy seeds, and adult deer ticks are the size of sesame seeds. Both nymphs and adults carry the organism that causes Lyme disease.

Symptoms of the disease can occur from three to 30 days after attachment of a nymph or tick; a rash at the site of attachment is often the first sign. Flu-like symptoms may also be present (swollen glands, fever, muscle soreness joint pain, headache, and fatigue). Without early diagnosis and treatment, symptoms can persist over months, and even years. Severe cases can involve the central nervous system and heart.

Dr. Carol S. Savage, a family practitioner in Harvard, believes in a multifaceted approach in treating Lyme disease. She says that any client who finds a suspicious-looking tick embedded in his skin is asked to bring the tick into the office. A "tick key," which is helpful in removing the tick, is often provided. The tick is sent to a laboratory that can determine whether that tick is actually carrying the Lyme disease organism. This is very helpful, because if it is negative for the organism, no treatment is necessary.

At her office, Dr. Savage obtains a detailed history of the client, including past medical issues as well as current signs and symptoms. She then performs a physical exam of the patient. Because laboratory tests can be equivocal and results aren't reported immediately, a tentative diagnosis is made, and treatment is started immediately. She says she believes very strongly that early treatment is key in trying to effect a good outcome. She carefully explains to her patients how the bacterium acts, potential problems, and treatment alternatives.

At present, there is no preventative for Lyme disease other than personal diligence in wearing protective clothing and insect repellent. Lymerix, a vaccine, came on the market in 1998, but was pulled off the market due to low demand, as well as safety and efficacy concerns.

There are currently two standards of care in the treatment of Lyme disease. According to Dr. Savage, one standard believes that Lyme disease is a straightforward bacterial infection that can be relatively easy to diagnose, and a cure is effected with a four-week course of antibiotics (usually doxycycline).

The other standard recognizes that Lyme disease and related diseases, which may exist as a co-infection, are complex medical conditions that often require a long-term or repeated course of more than one antibiotic as well as ancillary medications. Dr. Savage is a strong advocate of the latter standard, whose treatment guidelines have been published in the International Lyme and Associated Diseases Society (ILADS). Dr. Savage carefully explains both schools of thought to her patients as well as the risks involved in using antibiotics, the potential need for probiotics and nutritional supplements, the need for the patient's active participation in reporting changes in symptoms, follow-up visits, blood tests, and following through with medication directions.

Dr. Savage says she looks forward to the day when, with further research and case studies, there will be a uniform standard for diagnosis and treatment, especially in the chronic form of the disease.