Marin/Sonoma Mosquito & Vector Control District
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Thursday, May 8, 2007;   D1, D3

    Spring brings warming weather and glorious green fields to the Bay Area, beckoning people outdoors to hike and camp and generally enjoy nature.
    But it's also the season of perennial warnings about insect-borne diseases, including the dreaded tick bite that could impart Lyme disease.
    Lyme disease, if left untreated, can become a debilitating chronic illness, but it is relatively rare in Sonoma County.
    "I take care of Lyme disease patients all the time. But the number is extremely low compared to the number of people bitten by a tick," said Dr. Gary Green, an infectious-disease specialist at Kaiser Medical Center in Santa Rosa.
    That doesn't mean you shouldn't take precautions, Green emphasized. "You don't want to be one of those who gets an infection."
    If ever there were a cautionary tale about that risk, it's the story of Wendy Ramage, a 29-year-old Santa Rosa woman who didn't discover she had Lyme disease until four years after coming down with a series of mysterious, increasingly debilitating ailments.
    In 1998, while attending Sonoma State University, she began to suffer an inordinate number of colds, headaches and "sharp, shooting" abdominal pains.
    At the time, she chalked it up to the stress and hard work of trying to get into graduate school. But her immune system seemed to be getting weaker, and she struggled with recurrent sinus and yeast infections.
    She graduated summa cum laude from SSU and went on to study for a master's degree in clinical psychology at University of Texas in Austin.
    But the illnesses continued, and doctors couldn't figure out what was wrong. By 2001, Ramage was so weak at times she couldn't even shower or raise her arms to shampoo her hair. "My arms ached and my lymph nodes hurt really bad," she recalled.
    Her mother helped her fly home to California for the start of a series of doctor's appointments and testing. Over the ensuing months, she was misdiagnosed with chronic fatigue syndrome and treated for various infections. Her health worsened as she suffered fainting spells, headaches, nausea and "lots of tremors."
    It wasn't until 2002, when a nurse suggested testing for Lyme disease, that she found out she had it. In addition, her doctor found Erlichiosis, another rare tick-borne disease that causes fevers and swollen lymph nodes.
    Lyme disease is sometimes referred to as "the Great Imitator," according to Wendy's doctor, Raphael Stricker of San Francisco, a hematologist and immunotherapist who is president of the International Lyme and Associated Diseases Society.
    He said it is sometimes confused with chronic fatigue, fibromyalgia, lupus, multiple sclerosis, Lou Gehrig's disease, even depression and Alzheimer's.
    Stricker, who has more than 1,000 patients he treats for Lyme disease, believes the actual number of cases is far higher than the approximately 100 reported annually in California, or the more than 23,000 reported nationwide in 2005. He calls Lyme disease a "hidden epidemic," and advocates for better testing and reporting procedures, and improved training for doctors so they will recognize the symptoms.
    The disease was first identified as a distinct infection in the mid-1970s in Lyme, Conn., thus giving it its name.
    There are several kinds of ticks in Sonoma County, but the best known is the Western black-legged tick, which carries Lyme disease.
    The danger of contracting the illness is highest in May and June, when the small, immature nymph form of the tick is active.
    The nymphs are so tiny -- about the size of a poppy seed -- that they are less likely to be detected and removed in time to prevent infection. Also, more people are outdoors in spring than in the winter, when adult ticks are active.

    The adult form of the tick, which is active October through March, can also transmit disease but it is larger and easier to see -- about the size of the letter "o" in this sentence.

  Photo composite from the State Department of Health Services shows the sizes of the Western black-legged tick. From left: a nymph, an adult male, an adult female.

    In Sonoma County, only about 1 percent of adult ticks and 5 percent of nymphs are infected with the Lyme disease bacteria, Green said.
    Lyme disease is not as common in California as in other parts of the country. The Golden State, although the nation's most populous, fares better -- only 81 cases were reported to the state Department of Health Services in 2006.
    That is much lower than rates that occur in Lyme disease hot spots in the Northeast and Mid-Atlantic states. Fewer than 10 cases of Lyme disease a year are reported in Sonoma County.
    But the tick infection rate can vary widely in areas of Northern California. Anne Kjemtrup, an epidemiologist with the state Department of Health Services, said that in some spots of Trinity, Humboldt and Mendocino counties, up to 40 percent of nymphal ticks have the Lyme bacterium.
    The key to staying healthy is preventing the tick from biting you and, if it does bite, picking it off as quickly as possible. Generally speaking, the tick has to be attached and feeding for several hours before it can transmit a disease. With the Lyme disease-carrying black-legged tick, it's 24 hours.
    "That means you've got 24 hours from the time it attaches to pull the tick off," said Leigh Hall, deputy health officer at the county health department.
    Lyme disease can be cured if it is diagnosed early and treated with oral antibiotics. However a small percentage of patients have symptoms that last months to years after treatment, according to the Centers for Disease Control.
    Fewer than half of all patients recall being bitten, according to the International Lyme and Associated Diseases Society.
    Ramage never knew she had been bitten, but suspects it was on one of her frequent trips to the Sonoma Coast, a prime spot for tick infestation. And she never detected the telltale rash that many but not all bite victims get -- the bull's-eye of concentric, red circles at the site of the bite."
    A couple months of oral antibiotic treatment wiped out the Erlichiosis but not the Lyme, she said, because the late stages are neurological. She then underwent 16 months of daily intravenous doses of antibiotics.
    Gallstones are a common side effect of such intense antibiotic treatment. A gallbladder attack ensued, along with an operation to remove the organ.
    At the end of 2003, Ramage was hospitalized for a suspected tumor on her pituitary gland. Instead of a tumor, a scan found some lesions on her brain from the Lyme disease.
    To make matters worse, years into the treatment, doctors also found she had another rare tick-transmitted disease -- the malaria-like Babesiosis.
    Despite all the aggressive treatment, Ramage said she still has Babesia and Lyme.
    "I retest often," she said, adding that for a patient like herself "it's still unclear whether you could ever be Lyme-free."
    Ramage lives now with her mother and father, both school teachers, and receives Social Security disability payments.
    Her stamina has improved, but she has lost her independence and doesn't like being "a professional patient."
    "It feels surreal to me," said Ramage, who finds herself asking "gosh, is this my life?"
    "I would go to the moon and back," she said, "if I could be well again."

    Staff Writer Carol Benfell contributed to this report. You can reach Staff Writer Clark Mason at 521-5214 or clark.mason@pressdemocrat.com.