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Veterinarian says early diagnosis and treatment are critical
LAURA JEAN GRANT
The Cape Breton Post
SYDNEY - A tick found on a Cape Breton dog has tested positive for Lyme disease, making it the first case of its kind on the island.
Dr. Rebecca Korven, of the Cape Breton Veterinary Service, confirmed the diagnosis Friday. She said a Shih Tzu dog from Glace Bay came into the clinic in December with symptoms that included sleepiness and a change in the character of her bark.
“The owner had pulled this thing off of her face a week before and she didn’t know it was a tick and she brought it in with her. Luckily she’d saved it and when I examined the dog she had signs of infection, her temperature was high, her lymph nodes were enlarged and they were swelling from where the tick had been,” she said.
Korven sent the tick in for testing and just recently received the results.
“I got the results back that this tick was positive and this was the first case in Cape Breton ever,” she said.
While awaiting those results Korven began treating the dog for Lyme disease and she got better within a week. The Shih Tzu has so far tested negative for Lyme disease but is being regularly monitored and tested.
“She’s doing very well. As far as we know she has no signs of illness but it’s possible that if not all of the bacteria was killed by the antibiotics she could get sick,” she said.
Korven said she’s doing what she can to raise awareness about the disease, as early diagnosis and treatment are critical in treating it.
“I’m trying to educate people a little bit about what to do if their dog gets a tick and how they can help prevent the disease,” she said.
Korven said the Department of Natural Resources is aware of the case and they believe it may be an isolated case and that the risk to animals and humans is low. She, however, is not so sure.
“The chance of these Lyme-infected ticks establishing a population and living here is pretty high,” she said, noting, “(ticks will) attach, feed for a couple of days and then fall off and then they lay eggs and they don’t usually go from a dog to a person. But if a tick is infected with Lyme all of the eggs that it lays would carry Lyme and they can lay 23,000 eggs in one batch so you can see how quickly it can spread to an area.”
Korven’s advice for pet owners is to check their pet regularly for ticks and if they do find one to bring the pet to a veterinarian. She added a vaccine is also available for dogs to prevent Lyme disease.
New Waterford resident Shaun Burke is president of the Nova Scotia Lyme Disease Association and was diagnosed with Lyme disease in 2004 by a doctor in Vancouver.
In Burke’s opinion, there is a serious lack of awareness about the disease among the public and doctors in Nova Scotia and many people, himself included, were and are being misdiagnosed.
Now that he has a proper diagnosis and treatment, Burke said his prognosis is excellent but he worries about the many people who are living with Lyme disease but don’t know it.
ljgrant@cbpost.com
Free at last: Woman’s 18-year struggle with affliction she couldn’t catch here
By MATTHEW HEINDL
Today staff
Friday October 05, 2007
Sheila Callan suffered for 18 years of her life with Lyme disease, though doctors failed to diagnose it, even after the infamous bullseye rash appeared on her face. Doctors were told that there is no Lyme disease in Alberta, and still believe this today, even as the bacteria appears more often.
Callan, after being told nothing was wrong with her or that no diagnosis was possible, was finally treated in April for Lyme disease in B.C. and continued a second round of treatment two weeks ago.
It’s difficult to believe that the 46-year-old has ever been ill when you meet her now, healthy with a serious disposition. Six months ago, Callan was wheelchair bound, shaking uncontrollably, losing her vision and falling further into illness.
“Even my husband said afterward he was surprised I would live past Christmas (2006), because at that point I was spiraling so far down,” said Callan. “And I think if I hadn’t found this -- I don’t know how much longer I would have lived.”
She was able to receive treatment for the disease only by diagnosing herself, and then consulting a specialist in B.C. and taking a test in the United States.
Lyme disease is the most common disease carried by ticks in the northern hemisphere, and the organism in our region (borrelia burgdorferi) is only recognized in one kind of tick (Ixodes pacificus).
This tick does not colonize in northern Alberta because its unable to survive the winter. Lyme disease is predominately recognized in the northern U.S. and in central Europe. For this reason, the majority of medical professionals in Canada believe lyme disease cases are rare, and if they do exist, are not endemic: caught not here, but on trips outside the country.
In 1990, Shiela Callan was a young active mother starting a family in Fort McMurray with her husband Mel and two little girls, Audrey and Sarah. She took an interest in astronomy that developed into a minor obsession and in her free time. It left her tromping through the forests several times a week.
She became the president of the Fort McMurray Astronomical Society, taking an especially strong interest in meteor observation, which involves lying very still on one’s back for long periods of time. Ticks prefer to climb three feet above the ground in grassy fields, “and I’m pretty sure that’s where I got bit,” she said.
Nearly a year passed without Callan leaving Fort McMurray when a strange circular rash appeared on her head, a classical symptom of Lyme disease that usually appears a few weeks after the disease is contracted.
“Once I got that rash, I never had my health back again,” she said.
Other textbook symptoms of the disease started forming, with arthritic pain and flu-like symptoms, followed by severe vasculidous, or inflammation of the interior brain. The disease moved into her heart, and she soon suffered a stroke.
In 1991, within a year of the rash, Callan was sent to the University of Alberta Hospital in Edmonton for 10 days because so many organs and systems were failing. During that time, she was given a battery of tests and specialists were paraded in to “take a crack at it” and none were able to diagnose it. She finally asked the head physician to explain to her what was going on, and he replied that there was nothing physically wrong and that she would do best to stop obsessing about her health.
He recommended that she take up a hobby. Callan immediately checked herself out of the hospital, a few days before her 30th birthday.
This was the first time that Callan was told her case was hopeless or nonexistent, something that happens often to Lyme disease patients, and she is still visibly defensive about her condition.
Callan provided Today with many of her personal medical records and tests to prove her case. She is more knowledgeable about the disease now than most physicians in Alberta.
“If they caught it then, it would have made such an extraordinary difference in my life,” she said. At one point her family physician, who she said was supportive throughout, explained that some people as ill as she was are never diagnosed, and that it may be the best thing to try to accept it.
“And I looked at the doctor and said ‘yes, that is a sensible thing to do,’ but I never gave up,” said Callan. She doesn’t blame the doctors, though, as they “have to work with the tools they are given.”
Doctors in this region were not educated very much at the time, with no evidence of ticks that carried the disease or any reported localized case, “and never any deep concern for Lyme disease in this area,” said Dr. Alan Nicholson, the Medical Office of Health for Northern Lights Health.
“I’m delighted for her, but getting Lyme disease here 20 years ago -- there is no evidence that the ticks that carry it were here,” said Nicholson. “It’s really doubtful in my own mind whether this is a real entity acquired 20 years ago.”
For the next 15 years, Callan’s decline in health followed a pattern, with the symptoms temporarily subsiding and then returning with a vengeance. Constantly in a wheelchair or with forearm crutches, at times she would have tremors through her body, her head and hands shaking, her vision clouded and a burning sensation would cover her body, and her throat muscles would contract while eating, causing her to choke often and take constant chest infections. She visited more than 30 specialists, all who discounted her having symptoms that fit into their specific fields, but no one could provide a holistic clinical view of her condition.
During most of the time Callan still continued to work and raise her family, and was the valedictorian of her Keyano College graduating class, though “it was extraordinarily difficult.”
In January, while routinely typing her symptoms in an Internet search engine, she came across a link for Lyme in Canada, and found a match for her symptoms.
In April Callan flew out to visit Dr. Ernie Murakami, one of the very few Lyme Disease specialists in Canada. Murakami believes in sound clinical diagnosis as the only way to testing certainty, but has recently come under fire from other B.C. doctors that he is diagnosing too many cases of Lyme disease, generally more than the B.C. government admits to having. But he said cases like Callan’s are very common.
“The average number of patients with previous specialist care … would see about ten specialists at the minimum to try to find out what they’re problem is, and a lot of them are told to see a psychiatrist,” said Murakami. “A lot of them are on antidepressants, and many are suicidal when I first see them.”
After a clinical diagnosis and a series of tests, three Canadian tests which came up negative and an American one, the Western Blot, turned positive.
Callan began taking the most effective in vitro antibiotics available in April, which left her extremely ill for a few weeks. They’re known to cause liver failure.
When Lyme disease bacteria is killed it releases a severe toxin, and the more effective the treatment the more ill a person becomes.
But she left her wheelchair four months ago, after intensive physical therapy, and is returning to the way she remembers being nearly 20 years ago.
“The extraordinary thing is I went from being a woman who was literally, I didn’t know how much longer I was going to live, to the person you see in front of you with only four months of antibiotics.”
Since recovering and without speaking out much, she said people have been approaching her to ask about their own conditions or those of families, such as atypical presentations of multiple sclerosis. But she tells people to see their doctor and be persistent.
Published: Friday, April 04
EDMONTON - During the worst of his illness, Ed Sperling would go into a catatonic state, standing motionless on the sidewalk for long periods before his mom would touch his shoulder or push him gently to move ahead.
At times, his body would twist strangely to stay balanced, his eyes would go unfocused and his brain couldn't make sense of letters, making reading impossible for the voracious reader and math whiz.
"This was Awakenings," said Sperling's mother, Janet, referring to the 1990 movie in which Robert De Niro portrayed a character who was catatonic until a new drug awakened him from encephalitis lethargia.
"This was a living death. His brain was there. The kid is in there, but he's locked into his body."
At first, Janet and her family thought Ed had been brain damaged in January, 2005, after a serious case of sinusitis made him vomit so violently he burst his esophagus and left him with a dangerous level of sodium in his blood.
Tests came back negative for Parkinson's disease and epilepsy. Doctors thought his catatonic state might be seizures, and Ed, then 15, couldn't walk over thresholds, a problem faced by some Parkinson's sufferers. Three tests done in Alberta also came back negative for Lyme disease, caused by bites from bacteria-infected ticks. The disease is rarely fatal in humans but brings on fatigue, fevers, headaches, severe arthritis, abnormal heart beats and other symptoms if left untreated with antibiotics.
But Janet and her husband, both entomologists who study insects at the University of Alberta, kept thinking back to their time in California where they would inspect their four sons regularly for freckle-sized ticks, some almost invisible in skin folds. Janet suspects she missed one in her son's hair.
The family has never experienced problems here, but last summer local veterinarians found 10 black-legged ticks on dogs. Two of those ticks tested positive for the bacteria that causes Lyme disease.
Alberta Health said it was the first time the western black-legged tick, most commonly associated with the disease, was found in Alberta.
The provincial health office immediately notified all physicians to be on the alert for symptoms of the disease, but no other ticks were found and no Lyme cases emerged.
John Tuckwell, spokesman for Alberta Health, said the province has set up a committee to plan a surveillance program in the Edmonton region this summer. Researchers could be out collecting ticks as the heat rises.
"We're very concerned about any disease that can affect human health," Tuckwell said. "We have never had a local case of Lyme disease in Alberta."
Between 1992 and 2006, 19 cases were reported in Alberta, but all the patients had travelled to eastern Europe or the east coasts of Canada and the United States, where ticks carrying the bacteria are common.
Despite this, Janet suspects Alberta has a growing problem and believes many local cases go undiagnosed, partly because local labs are giving out too many false negatives.
When Janet and her husband Felix sent Ed's blood down to a California lab, a positive result returned. Local doctors remained skeptical, despite Ed's continuing deterioration through 2005, Janet said. At some points, he could only have a conversation after someone caught and focused his attention.
Otherwise, his eyes remained glazed, his body movements frozen.
Several doctors said Ed was behaving erratically to get more attention or had psychiatric issues.
Not until late 2005 did a doctor reluctantly put Ed on three months of intravenous antibiotics, then six months of oral medication.
Ed, 18, is now back to his normal self, excelling in school and preparing for engineering at the U of A.
"Lyme disease (or a variant) is here and it's real," said Janet, who has spoken with many Alberta families with similar stories, even ones from northern Alberta where the Lyme-positive tick species has never been found, according to Alberta Health.
"We have endless numbers here in Edmonton and we are the tip of the iceberg. B.C. and Manitoba are way ahead of us."
Janet said Ed isn't included in any Alberta Lyme disease statistics.
He is officially undiagnosed, she said, even though California gave a positive result and the antibiotic regime cured him. That's because the provincial health office requires a blood test to come back from the laboratory with five positive indicators to define Lyme disease, Janet said.
The European standard requires only three indicators.
A study done at the Johns Hopkins University School of Medicine in Baltimore, Md., discovered blood tests positively identify only 50 per cent of people with Lyme disease.
"The tests need to change," Janet said. "We would have so many more positive results and people would get better."
Without help, Ed would have been in a nursing home -- or dead, Janet said.
"I want to make sure the next kid doesn't have the same problem."
jsinnema@thejournal.canwest.com
bravenet.com