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Lyme disease on the rise in Rappahannock
Two weeks ago, Mark Pruntel thought he had a head cold. He was battling headaches and a fever while building a stone wall at his father’s house in Middleburg. Pruntel made sure to drink lots of water, eat healthy and get plenty of sleep. In a week, the 42-year-old Rappahannock resident was feeling better.
“After dropping my daughter off at daycare last Monday, I came home and took a nap,” he said. “When I woke up, the left side of my face was completely paralyzed.”
Pruntel, a building contractor, drove from his home in Viewtown to Fauquier Hospital where he received a spinal tap and a number of blood tests. He was quickly diagnosed with Lyme disease, a bacterial infection transmitted by the blacklegged tick, commonly known as the deer tick. His facial paralysis, called Bell’s palsy, is one of a long list of possible symptoms of the disease.
Since starting on antibiotics, Pruntel has witnessed signs of improvement.
“It’s getting better,” he said. “I’m grateful to get better, but I still can’t drive, can’t blink, and I’m just now being able to hold a conversation again.”
Pruntel is one of an increasing number of Rappahannock residents to come down with Lyme disease this year, especially this summer. The Virginia Department of Health already has five reported cases from Rappahannock which is one less than last year's total of six confirmed cases. Overall,the state has 300 confirmed cases so far this year. Last year there was a total of 958 cases, according to health department officials.
“We’ve already had twice the number of Lyme cases this summer as last summer,” said Dr. John McCue of Mountainside Medicine in Washington. “Usually the bulk of Lyme sufferers come to me in the late summer early fall, so we’ve already started at a rapid pace.”
Since the beginning of spring, McCue has diagnosed more than 20 Rappahannock residents with the tick-borne illness. He attributes the recent increase to high moisture levels due to rain this spring and summer.
“It’s quite a diagnostic challenge,” McCue said. “The problem is that we are in a high tick area. In this area, if you have fever or flu symptoms in the spring or summer, call the doctor.”
Authorities within the Shenandoah National Park relate the high rate of Lyme disease in Rappahannock to its proximity to park boundaries – an area with an extremely high deer population.
Rolf Gubler, park biologist and Forest Pest Manager, relates high numbers of deer ticks to high deer densities in the area. “Where there are deer, there are deer ticks,” he said.
State health officials who track the incidence of Lyme disease explained there is a lag time from when a person gets a test and the doctor reports the results to the health department, if the doctor reports it at all.
“If doctors want the cases to be counted, they need to report them to the local health department,” said David Gaines, entomologist with the Virginia Department of Health's Office of Epidemiology.
Most of McCue's patients receive doxycycline to combat Lyme disease. McCue emphasized that about 25 percent of his Lyme cases in the past few years did not have a history of a tick bite. Of the 20 Lyme sufferers this year, only five had the characteristic bulls-eye rash commonly affiliated with the disease, he said.
Carol and Bob Lucking
About a month ago, Carol Lucking of Sperryville began suffering from flu-like symptoms. After a week of little improvement, she went to McCue who put her on doxycycline, an antibiotic commonly used to treat Lyme.
A few days later, Carol’s husband, Bob, felt the same symptoms – headaches, joint and muscle soreness, fatigue. He pulled off a deer tick three days before while finishing construction on his house down Old Hollow Road.
“I wasn’t going to waste any time,” Bob said. “I immediately started taking doxycycline. I know what can happen if you let Lymes go for too long.”
According to the Virginia Department of Health, initial symptoms of Lyme disease include fever, headache, fatigue, and a characteristic bulls-eye rash called erythema migrans. If left untreated, the spirochetes that cause the infection can infiltrate the joints, the heart, and the nervous system.
Kaitlin Krometis
Kaitlin Krometis, a 2008 graduate of Rappahannock County High School, did not catch hers right away.
In February, she began suffering from flu-like symptoms. She was constantly fatigued, sore and achy and had a fever and frequent headaches. After a week, Kaitlin went to Dr. McCue who diagnosed her with a flu-like virus. Three days later, she could not walk. She was in excruciating pain and every joint in her body ached - her knees and ankles were the worst.
Kaitlin went back to Dr. McCue and he immediately diagnosed her with latent second stage Lyme disease and prescribed doxycycline for 30 days. She was diagnosed on symptoms alone said her mother, Kathy.
Kaitlin said she never saw the tick. Dr. McCue ran blood work which confirmed her Lyme disease (the Elisa blood test came back positive and Western Blot, which was run five days later, showed two positive antibodies.
After two weeks on doxycycline, Kaitlin was not responding and her condition worsened, according to her mother. She said she drove her daughter to the University of Virginia Hospital to meet with the Head of Infectious Diseases. He suggested mononucleosis and/or ParvoB-19 both of which she had had as a child and had developed immunity to, according to Kaitlin's mother.
The doctor ran blood work and both tests came back negative, said Kathy. She said the doctor dismissed her daughter's symptoms and her own concerns and went on test results alone.
“I’d think I was better and then a couple days later I felt worse,” Kaitlin said. “I could barely move. Getting out of bed every day was a chore.”
Kaitlin was in and out of school for the next few weeks. After negative tests for lupus and rheumatoid arthritis, Kathy spoke to a pediatric infectious disease specialist at Johns Hopkins in Baltimore by phone who suggested Kaitlin had chronic fatigue syndrome and needed to get more exercise. He said her symptoms were all in her head, said Kathy.
“Again his opinion was based solely on two test results which did not coincide and not her symptoms. I hung up on him,” said Kathy.
“I know my daughter, and she was very very sick,” Kathy said. “And that makes you start thinking, ‘Does she have cancer? What is wrong?’”
Kaitlin’s condition continued to worsen.
At the end of 30 days of doxycycline Kaitlin could barely move from the couch. Kathy said she called Dr. McCue on a Sunday night and he immediately called back.
He conferred with a doctor in Northern Virginia and by the next morning Kaitlin was set up at Fauquier Hospital to have a intravenous PIC-line surgically inserted into her inner bicep that ran up her arm and into her chest.
Strong antibiotics were pumped daily into the PIC-line for 28 days, said Kathy. Her daughter finally began to feel better within days.
Kaitlin missed the last three months of her senior year of high school.
“When I got Lyme's, I never saw a tick, I never saw a bulls-eye, and it was in the middle of winter,” she said.
Had Kaitlin started on antibiotics sooner, Dr. McCue said much of this may have been avoided. Had she gone much longer without intravenous antibiotics, her condition may have become irreversible. Misdiagnosis after misdiagnosis led to a series of complications over that three -month span.
Months later Kaitlin still suffers “post-Lyme syndrome” days with painful joints, headaches and fatigue, according to her mother.
No accurate test
“A big problem is that there is not an accurate test for Lyme,” said Brooke Miller M.D., head of a private practice in Luray. “We usually prescribe antibiotics based on the symptoms, not necessarily a positive blood test.”
According to the National Lyme Disease Association, the tests most doctors rely on miss 44 out of 100 patients suffering from Lyme – a disease nicknamed the “Great Imitator” because its symptoms mimic so many other conditions.
The Food and Drug Administration has published articles about the potential for misdiagnosis of Lyme disease based on the commonly marketed blood tests that detect antibodies to spirochete organisms that cause the disease. A positive test result does not necessarily indicate infection, and a patient with active Lyme may have a negative test result.
Edward Wilman
Edward Wilman fell victim to misdiagnosis in July 2004. He removed a deer tick in the shower right after bushhogging one of his fields in Amissville. Two days later, Wilman came down with a fever of 102 that lasted four days. He went to the doctor and was given a two-week prescription of amoxicillin. A month later he woke up with severely blurred vision in his right eye.
“I went to an ophthalmologist who said I had a blood clot in my right eye, a hemorrhage of the retina that would go away in a matter of weeks,” Wilman said. “Luckily, my wife and I searched the Internet to see if Lyme disease had anything to do with it and found dozens of articles about it.
“I called the ophthalmologist and told him about the correlation and, since he had never heard of it, referred me to Connie Smith who was a specialist in infectious diseases in Winchester.”
Smith ran an MRI and found that spirochetes were eating away his optic nerve. In a matter of days, Wilman would have gone totally blind. A surgeon immediately installed an intravenous PIC-line that pumped antibiotics into his bloodstream. He witnessed signs of improvement within a couple days.
It turned out that the amoxicillin had not successfully eradicated the spirochete bacterium transmitted by deer ticks. As a result, Wilman lost most of the vision in his right eye. For three years afterward, he battled swollen joints, stabbing knee pain, and chronic fatigue – all the result of ineffective medication.
In all, Wilman spent $26,000 in medical bills, of which his insurance company paid half. With proper awareness and a speedy diagnosis, this all may have been avoided.
Wilman gives advice to others that experience tick bites:
“Anyone that suffers from flu-like symptoms in the summer should automatically assume that they’ve got it,” he said. “Assume it’s probably Lyme and deal with the antibiotics from day one.”
McCue gives advice to residents for the prevention of Lyme disease.
“Use common sense. Wear long sleeves and pants when in thick woods or high grass,” he said. “Don’t hike in bathing suits. No bare feet. If you do find a deer tick, pull it off immediately and observe the area. If the bite gets red and itchy or develops a rash, call the doctor and schedule an appointment.”
Jan Clatterbuck and Mary Ann Kuhn of the Rappahannock News contributed to this story.
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