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BREAKING NEWS: HAN & PVH Make a Difficult Decision to Close Obstetrics Service

After many months of careful deliberation, the Boards at both Health Access Network and Penobscot Valley Hospital have made the difficult decision to discontinue labor and delivery services at the Lincoln hospital. The obstetrical service will close effective May 1, 2015.

This decision was made after extensive review of area demographics, obstetrical volumes, cost and staffing. With less than 70 babies delivered at PVH in 2013, an aging population, the negative financial position of the OB service, and changes in physician practices, the organizations recognized there was no other feasible option but to discontinue this service.

“This decision was not made lightly,” notes PVH Chief Executive Officer Gary Poquette. “Multidisciplinary committees and consultants have reviewed the labor and delivery service, and our community just doesn’t have a sufficient number of newborns to sustain this service. That fact, combined with the recent physician decisions, leaves us no other choice.”

PVH is one of only a dozen Critical Access Hospitals in the state still currently providing labor and delivery services. Many have exited the business for similar reasons, attributing their decisions to financial constraints, decreased demand, and difficulty recruiting and maintaining clinical staff.

Penobscot Valley Hospital will likely never get out of the baby business entirely. “Some babies just can’t wait,” states PVH Chief of Emergency Medicine and Chief Medical Officer David Dumont, MD. “Their moms present to the emergency department [ED] in the final stages of labor. Although not ideal, our ED is trained to perform deliveries in emergent situations and will maintain equipment on-hand to provide initial care for a newborn and the mother.”

“Childbirth itself is a very small part of the overall pregnancy experience. Our family practice providers at Health Access Network will continue to provide comprehensive prenatal and postnatal care to patients in our area and will work closely with the provider who will be performing delivery,” adds HAN Chief Executive Officer Bill Diggins, RN.

The two organizations would like the community to know:
Health Access Network physicians are personally contacting all current OB patients to discuss their options for prenatal care and delivery.
Health Access Network will continue to provide prenatal care to women through their family practice physicians.
Penobscot Valley Hospital will continue to conduct prenatal testing in the laboratory and ultrasounds in the imaging department.

Health Access Network and Penobscot Valley Hospital are working resolutely with area facilities including Eastern Maine Medical Center to enhance access to their OB providers and ensure a smooth transition of care for all local women.

Mr. Poquette reiterated that “the hospital is committed to provide local access to quality care for the residents of the Lincoln Lakes Region. We hope to be able to continue providing seamless care for OB patients, who can receive excellent prenatal care locally and an excellent delivery experience at EMMC.”

“Our obstetrical, family medicine, surgical and pediatric providers as well as clinical staff have all given outstanding care to the community since the hospital opened,” adds Dumont.

The public is welcome to attend a Community Forum on Wednesday, December 3 at 6:00pm in the Mattanawcook Academy Cafeteria. Representatives from both Health Access Network and Penobscot Valley Hospital will be on-hand to address the community’s concerns on the obstetrical service closure and provide information to patients on the transition of care. For more information, contact Penobscot Valley Hospital Administration at (207) 794-3321. 

 

Preventing the spread of infectious disease

There is no avoiding the topic of infectious disease in the media these days. News coverage on Ebola, enterovirus, influenza and other super bugs has us all on high alert. Here at Penobscot Valley Hospital, infection prevention is always a top priority, and we take time during National Infection Prevention Week from October 19-25 to celebrate all that our staff do to keep the facility and patients safe.

Earlier this month, I sat down with our Lead Environmental Services Technician, Linda Hollified, who explained a new quality assurance method she’s implemented to test the effectiveness of cleaning products before switching suppliers. Linda’s project involves use of the Glo Germ product, a safe tool that casts a revealing glow under a special UV light.

After a patient has been discharged, the PVH Environmental Services Team goes to work wiping down all surfaces in the room before admit the next patient. Sometimes, Linda will enter the room before the staff to place her special Glo Germ solution on at least ten surfaces of the room. Staff will then fully disinfect the room which takes two members around one hour, and they note whether they used the current wipes or new samples they are testing. After, Linda returns with the UV light to test the effectiveness of the wipes and see if any of the Glo Germ powder resides on the surfaces. Her project showed an improved effectiveness with the new wipes and so the team has implemented new methods of cleaning the facility based on what type of infection we might be facing.

“The Environmental Services Team at PVH is a wonderful group of dedicated individuals who keep our facility shining. Their standards and expectations are exceptional. They take pride in performing specialized cleaning methods to disinfect each type of pathogen according to Centers for Disease Control and Prevention recommendations,” states PVH Infection Prevention Practitioner Sherry McCafferty, RN.

PVH staff members also work to prevent infection by:
- Vaccinations – For example, PVH was recognized by the Maine CDC for our exceptionally high number employees receiving the influenza vaccination. At PVH, 96% received influenza vaccinations, well above the national average of 66.9% as reported by the CDC for 2011-2012 flu season.
- Observations – Staff members pose as “mystery shoppers” and record clinical staff performing proper hand hygiene methods including hand washing before and after patient contact. Recent observations recorded in July 2014 were at 98.9%, well above the CDC’s national hand hygiene rates of 56.6% compliance.
- Precautions – If you are visiting a patient who has been placed on precautions, we provide free personal protective equipment and instructions on the outside of the door before you enter the patient’s room. Please follow all safety instructions to help keep yourself and our patients safe. If you are sick, please do not visit patients in the hospital.
- Education – We all work to minimize the spread of disease and post educational posters on hand hygiene and cough etiquette. We also visit schools to provide education to the students.

On October 9, McCafferty visited Robin Corbin’s first grade class at the Lee/Winn Elementary School to demonstrate proper hand hygiene. Students got to use the special Glo Germ to see how quickly germs can spread from your hands to your face, highlighting the importance of hand washing. The students also completed artwork which is on display this week in the main lobby near the Cafeteria at Penobscot Valley Hospital. We encourage you to stop in and see how our area’s children perceive germs.

PVH staff would like to remind the community that the best way to prevent the spread of infection is to perform proper hand hygiene using soap and water or an alcohol-based hand sanitizer and scrub for 15 seconds. Influenza season is here – the first diagnosed case in Maine occurred last week so if you haven’t already received your flu shot, now is the time. Contact your doctor’s office or visit one of our local pharmacies for your vaccination. Penobscot Valley Primary Care (including Drs. Alessi, Freid, Nobel, and PAs Bill Head and Revaz Boukia) patients may walk in to the Medical Arts Building weekdays from 8:30am to 4:30pm to receive their influenza vaccination. With infectious disease on all of our minds, take time to practice these basic prevention tips to help stop the spread of disease.

The Environmental Services Team at PVH (l to r: Nancy Guiod, Linda Hollifield, Rhonda Kimball, Missy Bean, and Sabrina Fogg) keep up-to-date on current infections going around in our community and implement various cleaning methods to prevent the spread of infection. (Photo courtesy of Penobscot Valley Hospital)

Ebola map

CLICK HERE for a map of where Ebola cases have been reported.

PTs offer advice on posture

by Martine LeGassey, Doctor of Physical Therapy

Did you know that posture affects more than just your spine?

Good posture plays an important role in breathing, digestion, cognition and an overall sense of well-being. Faulty posture can cause back and/or neck pain, headaches, TMJ (jaw) dysfunction, respiratory problems, constipation, decreased memory and fatigue.

As you probably already know, there are many factors that contribute to poor posture, including:
Prolonged sitting, especially in a non-ergonomic chair or workstation (Also, men should not sit with a wallet in your back pocket!)
Prolonged standing
Awkward sleep positions and low quality mattress or pillow
Carrying a heavy load, including: backpacks on one shoulder, heavy briefcases or purses
A good general rule is that your load should not exceed 10% of your body weight.
Restrictive clothing (tight/wide belts, jeans worn low over the hips, non-supportive footwear)
Diseases such as obesity, osteoporosis, arthritis, also poor nutrition
Accidents and injuries
Low self-confidence or self-esteem

So what can you do to keep your posture as healthy as possible? Becoming aware of your positional faults is the first step to improving your posture. Behavioral modifications, workplace ergonomic assessments, investing in the proper footwear, clothing and mattress/pillows can help tremendously.

Frequent exercise, including daily stretching and strengthening is also important for keeping your physique in perfect balance.

During the month of October, the team at the PVH Rehab & Wellness Center in downtown Lincoln is celebrating National Physical Therapy Month and would like to remind the community about their Independent Gym Program. With approval from your doctor, you can become a member of our gym for just $25 per month which includes a quarterly check-in with one of the PVH physical therapists to monitor progress on your workout routine. Call the PVH Rehab & Wellness Center at (207) 794-7228 for more information on the Independent Gym Program or visit www.pvhme.org/gym.  

How Physical Therapy Helps You Recover

by Katie Neal, Physical Therapist

(Lincoln, ME) October is National Physical Therapy Month and staff at Penobscot Valley Hospital would like to remind you that we offer physical therapy services from highly educated and state licensed physical therapists.
Who are physical therapists and what do they do?
We are healthcare professionals who love to help people reduce the limitations they may be having. These limitations may include pain or decrease of mobility or strength at one or more areas of the body. Physical therapy (PT) services are designed to help people recover more effectively from acute trauma, surgery, recent or congenital illness, work or sports-related musculoskeletal injuries, motor vehicle accidents, chronic pain and disease. Research is supporting the use of physical therapy to avoid expensive surgery and reducing the need for long-term use of medications.
We are teachers working one-on-one with our patients to manage and prevent problems. Each physical therapy patient will have an evaluation and assessment followed by a plan to address the areas of pain, decreased mobility, or strength. We work with patients to transition to a more active, independent lifestyle as their conditions improve.

The physical therapists who are employed by Penobscot Valley Hospital work on Main Street in the Mini Mall seeing outpatients as well as at the hospital, treating the acute and skilled care inpatients who stay over night. Staff at the PVH Rehabilitation & Wellness Center use several different tools and techniques to diagnose and treat your injuries. These tools range from several hands-on techniques to more advanced medical equipment. The center has special machinery to help with your recovery, including a universal gym, aerobic equipment, NUSTEP, treadmill, and pediatric equipment.
Our staff serves all ages from pediatrics to the geriatric population. We are committed to helping our patients regain the independence they desire. We believe the comfort and convenience of these services, performed close to home with family, are vital for patients to reach optimal rehabilitation.

Meet our team

Margie Butterly, PT graduated from the University of Colorado with a Bachelor’s Degree in PT. She specializes in manual therapy and particularly enjoys treating orthopedic and elderly patients.

Kristina Clark, PT, DPT, GCS received a Doctor of Physical Therapy Degree from SUNY Upstate Medical University. She enjoys working with people of all ages, especially older adults.

Martine LeGassey, PT, DPT received a Bachelor’s Degree in Kinesiology and a Doctorate in Physical Therapy, both from Husson University. She enjoys helping athletes recover from injury and working with older adults to manage their gait or balance disorders.

Katie Neal, PT, OCS has been a physical therapist at PVH since 1997. She is a graduate of the University of New England and enjoys working with all different ages and all types of patients.

Linda Osborne, PT, DPT received a Doctorate in Physical Therapy from Husson University. She has been working at PVH since 2004 and enjoys patients of all ages.

The physical therapists at the PVH Rehab & Wellness Center will be collaborating on an informative article each week through the month of October, offering you a snapshot into the PT world. Each of us would like to help you maintain your optimum health and movement abilities. Let us know what we can do to help you by calling (207) 794-7228! You may also check out www.pvhme.org/rehab or www.Facebook.com/PVHME for the latest information as we celebrate National Physical Therapy Month. 

Staff at the Penobscot Valley Hospital Rehab & Wellness Center are celebrating National Physical Therapy Month and plan to publish weekly articles in the paper so you can learn more about posture, body mechanics and staying healthy. (l to r) Physical therapists Katie Neal, Kristina Clark, Martine LeGassey, Margie Butterly; Director of Rehab Services Mike Butterfield; and Secretary Kelly Wakefield; (absent) Linda Osborne.  

Cases of Whooping Cough on the Rise

September 22  - According to the Maine Centers for Disease Control, there have been over 250 cases of pertussis (whooping cough) reported in Maine this year and Penobscot County is one of seven Maine counties reporting a high prevalence of this disease. The majority of cases are occurring in children from infancy to young adulthood. 


Pertussis is a highly communicable, vaccine-preventable disease that can last for many weeks. It is spread from person to person through the air. Classic pertussis symptoms are similar to a cold (sneezing, runny nose, low-grade fever, and a cough). After one or two weeks, the cough often gets worse. For example:
The cough occurs in sudden, uncontrollable bursts where one cough follows the next without a break for breath.
Many children will make a high-pitched whooping sound when breathing in after a coughing episode. Whooping is less common in infants and adults.
After a coughing spell, the person may vomit.
The person may look blue in the face and have difficulty breathing.
The cough is often worse at night.
Between coughing spells, the person seems well, but the illness is exhausting over time.
Over time, coughing spells become less frequent, but may continue for several weeks or months.

Pertussis can cause serious illness and can even be life-threatening, especially in infants. Early treatment of pertussis is very important and may lessen symptoms. More than half of infants less than 1 year of age with pertussis require hospitalization.

PVH Infection Prevention Practitioner, Sherry McCafferty, RN states “The best way to prevent pertussis is to get vaccinated. Ask your doctor if you are up to date on your pertussis vaccination which is DTaP for infants and children and Tdap for pre-teens through adults.”

The Centers for Disease Control and Prevention reports that protection from childhood pertussis vaccines still appears to be excellent during the first few years after vaccination. In general, DTaP vaccination is effective for up to 8 or 9 out of 10 children who receive it, but protection fades over time. Outbreaks and epidemics being seen around the country are consistent with what is seen as vaccine protection wears off. It is most likely that the change in pertussis vaccines (from whole cell to acellular in the 1990s) along with better diagnostics and increased reporting are driving the resurgence of pertussis throughout the United States.

Penobscot Valley Hospital encourages all employees to become vaccinated against pertussis to help prevent the spread of disease. To date, 88% of all employees at PVH have received their Tdap vaccine. Parents, grandparents, teachers, daycare providers and others in close contact with children should also receive the vaccine from their doctors.

For more information on pertussis or to hear an audio clip of a child with whooping cough, visit our Facebook page at www.facebook.com/PVHME or www.cdc.gov/pertussis.

 

 

New Service in Town: Audiology

Penobscot Valley Hospital is pleased to welcome Audiologist Chris Clukey to the downtown Rehab & Wellness Center on Fridays starting September 19, 2014. Mr. Clukey will be providing complete hearing evaluations and hearing aids for adults, as well as hearing aid cleanings on all models, battery sales, and hearing aid trade-in discounts.

Chris is a Maine native who graduated with the outstanding student award from one of the top Audiology programs in the nation at The University of Memphis. With 15 years of experience in the industry, Chris has seen many advancements in technology and now offers iPhone-compatible hearing devices. Many of the hearing aids he sells are very affordable with prices ranging from $400 to $2,800. Working people might also be eligible for free hearing aids through the Maine Rehab Services program.

“Common signs of hearing deterioration include listening to the television too loudly, asking others to constantly repeat themselves, and not participating in conversation as much as they used to,” states Clukey. “If you notice these signs of hearing loss with your loved one, it might be time for a hearing evaluation.”

Hearing evaluations are conducted in a spacious new hearing booth recently installed in the PVH Rehab & Wellness Center. Clukey recommends people receive a hearing evaluation every two years. Those with hearing aids should visit every six months for hearing aid adjustments.

Those interested in more information about hearing evaluations or hearing aids may call the Rehab Center at 794-7228 to set up an appointment or walk-in’s are accepted on Fridays from 9am to 4pm beginning September 19. Evening hours are also available by appointment. The PVH Rehab & Wellness Center is located across from Marden’s at 37 Main Street in Lincoln. Visit www.pvhme.org/audiology to learn more. 

Chris Clukey will begin providing hearing exams and hearing aid services for the Lincoln region on Fridays at the PVH Rehab & Wellness Center on Main Street starting September 19.

Lyme disease

Ticks are shown larger than actual size.

What is Lyme Disease?

Lyme disease (LD) is an infection caused by Borrelia burgdorferi, a type of bacterium called a spirochete (pronounced spy-ro-keet) that is carried by deer ticks. An infected tick can transmit the spirochete to the humans and animals it bites. Untreated, the bacterium travels through the bloodstream, establishes itself in various body tissues, and can cause a number of symptoms, some of which are severe.

LD manifests itself as a multisystem inflammatory disease that affects the skin in its early, localized stage, and spreads to the joints, nervous system and, to a lesser extent, other organ systems in its later,
disseminated stages. If diagnosed and treated early with antibiotics, LD is almost always readily cured. Generally, LD in its later stages can also be treated effectively, but because the rate of disease progression and individual response to treatment varies from one patient to the next, some patients may have symptoms that linger for months or even years following treatment. In rare instances, LD causes permanent damage.

Although LD is now the most common arthropod-borne illness in the U.S. (more than 150,000 cases have been reported to the Centers for Disease Control and Prevention [CDC] since 1982), its diagnosis and treatment can be challenging for clinicians due to its diverse manifestations and the limitations of currently available serological (blood) tests.

The prevalence of LD in the northeast and upper mid-west is due to the presence of large numbers of the deer tick's preferred hosts - white-footed mice and deer - and their proximity to humans. White-footed mice serve as the principal "reservoirs of infection" on which many larval and nymphal (juvenile) ticks feed and become infected with the LD spirochete. An infected tick can then transmit infection the next time it feeds on another host (e.g., an unsuspecting human).

Borrelia burgdorferi
The LD spirochete, Borrelia burgdorferi, infects other species of ticks but is known to be transmitted to humans and other animals only by the deer tick (also known as the black-legged tick) and the related Western black-legged tick. Studies have shown that an infected tick normally cannot begin transmitting the spirochete until it has been attached to its host about 36-48 hours; the best line of defense against LD, therefore, is to examine yourself at least once daily and remove any ticks before they become engorged (swollen) with blood.

Generally, if you discover a deer tick attached to your skin that has not yet become engorged, it has not been there long enough to transmit the LD spirochete. Nevertheless, it is advisable to be alert in case any symptoms do appear; a red rash (especially surrounding the tick bite), flu-like symptoms, or joint pains in the first month following any deer tick bite could signal the onset of LD.

Manifestations of what we now call Lyme disease were first reported in medical literature in Europe in 1883. Over the years, various clinical signs of this illness have been noted as separate medical conditions: acrodermatitis, chronica atrophicans (ACA), lymphadenosis benigna cutis (LABC), erythema migrans (EM), and lymphocytic meningradiculitis (Bannwarth's syndrome). However, these diverse manifestations were not recognized as indicators of a single infectious illness until 1975, when LD was described following an outbreak of apparent juvenile arthritis, preceded by a rash, among residents of Lyme, Connecticut.

Where is Lyme Disease Prevalent?

LD is spreading slowly along and inland from the upper east coast, as well as in the upper midwest. The mode of spread is not entirely clear and is probably due to a number of factors such as bird migration, mobility of deer and other large mammals, and infected ticks dropping off of pets as people travel around the country. It is also prevalent in northern California and Oregon coast, but there is little evidence of spread.

In order to assess LD risk you should know whether infected deer ticks are active in your area or in places you may visit. The population density and percentage of infected ticks that may transmit LD vary markedly from one region of the country to another. There is even great variation from county to county within a state and from area to area within a county. For example, less than 5% of adult ticks south of Maryland are infected with B. burgdorferi, while up to 50% are infected in hyperendemic areas (areas with a high tick infection rate) of the northeast. The tick infection rate in Pacific coastal states is between 2% and 4%.

U.S. Range Maps and Statistics

To view U.S. Range Maps and Statistics for Lyme disease, click here.

Symptoms

The spirochetal agent of Lyme disease, Borrelia burgdoferi, is transmitted to humans through a bite of a nymphal stage deer tick Ixodes scapularis (or Ixodes pacificus on the West Coast). The duration of tick attachment and feeding is a key factor in transmission. Proper identification of tick species and feeding duration aids in determining the probability of infection and the risk of developing Lyme disease.

Spirochete transmission poster: how long has that tick been feeding on you?

The early symptoms of LD can be mild and easily overlooked. People who are aware of the risk of LD in their communities and who do not ignore the sometimes subtle early symptoms are most likely to seek medical attention and treatment early enough to be assured of a full recovery.


The first symptom is usually an expanding rash (called erythema migrans, or EM, in medical terms) which is thought to occur in 80% to 90% of all LD cases. An EM rash generally has the following characteristics:
Usually (but not always) radiates from the site of the tickbite
Appears either as a solid red expanding rash or blotch, OR a central spot surrounded by clear skin that is in turn ringed by an expanding red rash (looks like a bull's-eye)
Appears an average of 1 to 2 weeks (range = 3 to 30 days) after disease transmission
Has an average diameter of 5 to 6 inches
(range = 2 inches to 2 feet)
Persists for about 3 to 5 weeks
May or may not be warm to the touch
Is usually not painful or itchy
EM rashes appearing on brown-skinned or sun-tanned patients may be more difficult to identify because of decreased contrast between light-skinned tones and the red rash. A dark, bruise-like appearance is more common on dark-skinned patients.

Ticks will attach anywhere on the body, but prefer body creases such as the armpit, groin, back of the knee, and nape of the neck; rashes will therefore often appear in (but are not restricted to) these areas. Please note that multiple rashes may, in some cases, appear elsewhere on the body some time after the initial rash, or, in a few cases, in the absence of an initial rash.

Around the time the rash appears, other symptoms such as joint pains, chills, fever, and fatigue are common, but they may not seem serious enough to require medical attention. These symptoms may be brief, only to recur as a broader spectrum of symptoms as the disease progresses.

As the LD spirochete continues spreading through the body, a number of other symptoms including severe fatigue, a stiff, aching neck, and peripheral nervous system (PNS) involvement such as tingling or numbness in the extremities or facial palsy (paralysis) can occur.

The more severe, potentially debilitating symptoms of later-stage LD may occur weeks, months, or, in a few cases, years after a tick bite. These can include severe headaches, painful arthritis and swelling of joints, cardiac abnormalities, and central nervous system (CNS) involvement leading to cognitive (mental) disorders.

The following is a checklist of common symptoms seen in various stages of LD:

Localized Early (Acute) Stage:

Solid red or bull's-eye rash, usually at site of bite
Swelling of lymph glands near tick bite
Generalized achiness
Headache
Early Disseminated Stage:

Two or more rashes not at site of bite
Migrating pains in joints/tendons
Headache
Stiff, aching neck
Facial palsy (facial paralysis similar to Bell's palsy)
Tingling or numbness in extremities
Multiple enlarged lymph glands
Abnormal pulse
Sore throat
Changes in vision
Fever of 100 to 102 F
Severe fatigue
Late Stage:

Arthritis (pain/swelling) of one or two large joints
Disabling neurological disorders (disorientation; confusion; dizziness; short-term memory loss; inability to concentrate, finish sentences or follow conversations; mental "fog")
Numbness in arms/hands or legs/feet
Diagnosis

If you think you have LD symptoms you should see your physician immediately. The EM rash, which may occur in up to 90% of the reported cases, is a specific feature of LD, and treatment should begin immediately.

Even in the absence of an EM rash, diagnosis of early LD should be made on the basis of symptoms and evidence of a tick bite, not blood tests, which can often give false results if performed in the first month after initial infection (later on, the tests are more reliable). If you live in an endemic area, have symptoms consistent with early LD and suspect recent exposure to a tick, present your suspicion to your doctor so that he or she may make a more informed diagnosis.

If early symptoms are undetected or ignored, you may develop more severe symptoms weeks, months or perhaps years after you were infected. In this case, the CDC recommends using the ELISA and Western-blot blood tests to determine whether you are infected. These tests, as noted above, are considered more reliable and accurate when performed at least a month after initial infection, although no test is 100% accurate.

If you have neurological symptoms or swollen joints your doctor may, in addition, recommend a PCR (Polymerase Chain Reaction) test via a spinal tap or withdrawal of synovial fluid from an affected joint. This test amplifies the DNA of the spirochete and will usually indicate its presence.

Treatment

Recommended courses and duration of treatment for both early and late Lyme symptoms are shown in our Table of Recommended Antibiotics and Dosages (see also table footnotes).

Early treatment of LD (within the first few weeks after initial infection) is straightforward and almost always results in a full cure. Treatment begun after the first three weeks will also likely provide a cure, but the cure rate decreases the longer treatment is delayed.

Doxycycline, amoxicillin and ceftin are the three oral antibiotics most highly recommended for treatment of all but a few symptoms of LD. A recent study of Lyme arthritis in the New England Journal of Medicine indicates that a four-week course of oral doxycycline is just as effective in treating late LD, and much less expensive, than a similar course of intravenous Ceftriaxone (Rocephin) unless neurological or severe cardiac abnormalities are present. If these symptoms are present, the study recommends immediate intravenous (IV) treatment.

Treatment of late-Lyme patients can be more complicated. Usually LD in its later stages can be treated effectively, but individual variation in the rate of disease progression and response to treatment may, in some cases, render standard antibiotic treatment regimens ineffective. In a small percentage of late-Lyme patients, the disease may persist for many months or even years. These patients will experience slow improvement and resolution of their persisting symptoms following oral or IV treatment that eliminated the infection.

Although treatment approaches for patients with late-stage LD have become a matter of considerable debate, many physicians and the Infectious Disease Society of America recognize that, in some cases, several courses of either oral or IV (depending on the symptoms presented) antibiotic treatment may be indicated. However, long-term IV treatment courses (longer than the recommended 4-6 weeks) are not usually advised due to adverse side effects. While there is some speculation that long-term courses may be more effective than the recommended 4-6 weeks, there is currently no scientific evidence to support this assertion. Click here for an article from the New England Journal of Medicine which presents clinical recommendations in the treatment and prevention of early Lyme disease.

Prevention & Control

Larval and nymphal deer ticks often hide in shady, moist ground litter, but adults can often be found above the ground clinging to tall grass, brush, and shrubs. They also inhabit lawns and gardens, especially at the edges of woodlands and around old stone walls where deer and white-footed mice, the ticks' preferred hosts, thrive. Within the endemic range of B. burgdorferi (the spirochete that infects the deer tick and causes LD), no natural, vegetated area can be considered completely free of infected ticks.

Deer ticks cannot jump or fly, and do not drop from above onto a passing animal. Potential hosts (which include all wild birds and mammals, domestic animals, and humans) acquire ticks only by direct contact with them. Once a tick latches onto human skin it generally climbs upward until it reaches a protected or creased area, often the back of the knee, groin, navel, armpit, ears, or nape of the neck. It then begins the process of inserting its mouthparts into the skin until it reaches the blood supply.

In tick-infested areas, the best precaution against LD is to avoid contact with soil, leaf litter and vegetation as much as possible. However, if you garden, hike, camp, hunt, work outdoors or otherwise spend time in woods, brush or overgrown fields, you should use a combination of precautions to dramatically reduce your chances of getting Lyme disease:

First, using color and size as indicators, learn how to distinguish between:

Deer tick larva, nymph and adultDeer tick larva (top),
nymph (right) and adult (left).
deer tick* nymphs and adults
deer ticks and two other common tick species - dog ticks and Lone Star ticks (neither of which is known to transmit Lyme disease)

*Deer ticks are found east of the Rockies; their look-alike close relatives, the western black-legged ticks, are found and can transmit Lyme disease west of the Rockies.
dog tick.
Dog tick. lone star tick.
Lone star tick.
Then, when spending time outdoors, make these easy precautions part of your routine:

Wear enclosed shoes and light-colored clothing with a tight weave to spot ticks easily
Scan clothes and any exposed skin frequently for ticks while outdoors
Stay on cleared, well-traveled trails
Use insect repellant containing DEET (Diethyl-meta-toluamide) on skin or clothes if you intend to go off-trail or into overgrown areas
Avoid sitting directly on the ground or on stone walls (havens for ticks and their hosts)
Keep long hair tied back, especially when gardening
Do a final, full-body tick-check at the end of the day (also check children and pets)
When taking the above precautions, consider these important facts:

If you tuck long pants into socks and shirts into pants, be aware that ticks that contact your clothes will climb upward in search of exposed skin. This means they may climb to hidden areas of the head and neck if not intercepted first; spot-check clothes frequently.
Clothes can be sprayed with either DEET or Permethrin. Only DEET can be used on exposed skin, but never in high concentrations; follow the manufacturer's directions.
Upon returning home, clothes can be spun in the dryer for 20 minutes to kill any unseen ticks
A shower and shampoo may help to remove crawling ticks, but will not remove attached ticks. Inspect yourself and your children carefully after a shower. Keep in mind that nymphal deer ticks are the size of poppy seeds; adult deer ticks are the size of apple seeds.
Any contact with vegetation, even playing in the yard, can result in exposure to ticks, so careful daily self-inspection is necessary whenever you engage in outdoor activities and the temperature exceeds 45° F (the temperature above which deer ticks are active). Frequent tick checks should be followed by a systematic, whole-body examination each night before going to bed. Performed consistently, this ritual is perhaps the single most effective current method for prevention of Lyme disease.

If you DO find a tick attached to your skin, there is no need to panic. Not all ticks are infected, and studies of infected deer ticks have shown that they begin transmitting Lyme disease an average of 36 to 48 hours after attachment.Therefore, your chances of contracting LD are greatly reduced if you remove a tick within the first 48 hours. Remember, too, that nearly all of early diagnosed Lyme disease cases are easily treated and cured.

To remove a tick, follow these steps:

Using a pair of pointed precision* tweezers, grasp the tick by the head or mouthparts right where they enter the skin. DO NOT grasp the tick by the body.
Without jerking, pull firmly and steadily directly outward. DO NOT twist the tick out or apply petroleum jelly, a hot match, alcohol or any other irritant to the tick in an attempt to get it to back out.
Place the tick in a vial or jar of alcohol to kill it.
Clean the bite wound with disinfectant.

*Keep in mind that certain types of fine-pointed tweezers, especially those that are etched, or rasped, at the tips, may not be effective in removing nymphal deer ticks. Choose unrasped fine-pointed tweezers whose tips align tightly when pressed firmly together.
Then, monitor the site of the bite for the appearance of a rash beginning 3 to 30 days after the bite. At the same time, learn about the other early symptoms of Lyme disease and watch to see if they appear in about the same timeframe. If a rash or other early symptoms develop, see a physician immediately.

Finally, prevention is not limited to personal precautions. Those who enjoy spending time in their yards can reduce the tick population around the home by:

keeping lawns mowed and edges trimmed
clearing brush, leaf litter and tall grass around houses and at the edges of gardens and open stone walls
stacking woodpiles neatly in a dry location and preferably off the ground
clearing all leaf litter (including the remains of perennials) out of the garden in the fall
having a licensed professional spray the residential environment (only the areas frequented by humans) with an insecticide in late May (to control nymphs) and optionally in September (to control adults). 

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