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The Myths of Lyme Disease: Separating Fact from Fiction for Military Personnel

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The Myths of Lyme Disease: Separating Fact from Fiction for Military Personnel Dolli Lane, 96th Medical Group laboratory technician, reviews sample through microscope November 19, 2015, at Eglin Air Force Base, Florida, after recently discovering rare spirally twisted bacteria, known to cause tickborne relapsing fever, and cultured by Centers for Disease Control (U.S. Air Force/Ilka Cole) o one is immune to, and there is no cure for, tickborne diseases. The Myths of N Just one tick bite can destroy a person’s career. At age 43, Air Force Colonel Nicole Malachowski was Lyme Disease found unfit for duty due to neurologi- cal damage resulting from a tickborne disease. Colonel Malachowski was the Separating Fact from Fiction first woman to fly with the Thunder- birds and then commanded the 333rd for Military Personnel Fighter Squadron. She also served as the deputy director for U.S. Air Force By Montgomery McFate Readiness and Training in the Office of the Under Secretary of Defense for Personnel and Readiness and as the executive director of the White House I love everything in the world. Except for ticks. “Joining Forces” Initiative (2015– —DALAI LAMA Dr. Montgomery McFate is a Professor at the U.S. Naval War College. JFQ 100, 1st Quarter 2021 McFate 73 2016).1 While she was commanding an link between the arthritic symptoms and many of the most recent medical studies F-15 fighter squadron, Colonel Mala- the bite of an insect. In the early 1980s, indicate that Lyme can evade detection chowski began experiencing a rapid Dr. Wilhelm Burgdorfer discovered that and cause severe chronic symptoms.) As onset of multiple symptoms. She wrote the causative agent of Lyme infection a result of the so-called Lyme wars, the that she suffered from was a spirochete type of bacteria, subse- disease itself has become shrouded in a quently named Borrelia burgdorferi in his number of myths. Separating fact from intractable pain, insurmountable fatigue, honor. After extensive field investigations, fiction is critical for military personnel cognitive dysfunction and major problems Ixodes scapularis, commonly referred to and their families since members of the with my speech and short-term memory. I as the deer tick or blacklegged tick, was Armed Services could face a heightened endured disorientation, confusion, anxiety identified as the main vector of Lyme risk of contracting Lyme disease based on and even moments of temporary paralysis. infection east of the Rocky Mountains. their occupations, locations, and recre- I was unsafe to be left alone. I could not In areas west of the Rocky Mountains, ational activities. play with my children, care for myself, or Ixodes pacificus, also known as the west- interact with my husband. There were ern blacklegged tick, was the primary It Is Not That Severe: False times I would have welcomed death. I vector. Lyme disease can produce a wide thought I was tough as a combat-proven Lyme disease is now a serious epi- variety of symptoms, but typical signs fighter pilot but tickborne illness destroyed demic in the United States, with positive of infection are a round red rash at the me. It brought me to my knees and ruth- lab tests reported from all 50 states and site of the tick bite, fatigue, swollen lessly broke me.2 Washington, DC.6 The CDC calculates joints, headache, fever, night sweats, annual U.S. incidence at more than cognitive impairment, and sensitivity Servicemembers are particularly 300,000 cases; however, true incidence to light.11 Many medical professionals at risk for Lyme disease; they live, is certainly higher.7 Although the major- in the United States tend to minimize work, and play on bases where Lyme is ity of cases have been reported from the the dangers of Lyme and may mistak- rampant. Some 75 percent of all U.S. northeastern part of the country, infected enly believe that the symptoms of the military installations are located in states ticks can be found in about 50 percent disease are not severe. For example, in where 99 percent of the approximately of U.S. counties.8 An increase in both the words of Dr. Katerina Silverblatt of 500,000 tickborne disease cases reported temperature and humidity as a result of Heights Pediatrics in Brooklyn, “We’ve to the Centers for Disease Control and climate change is predicted to increase never had a complication from Lyme Prevention (CDC) from 2004 to 2016 the number of Lyme cases by more than that would be of any consequence.”12 occurred.3 Moreover, training drills often 20 percent in the coming decades.9 In On the contrary, many complications take place in woods and fields that harbor short, Lyme disease has already reached from Lyme disease are severe indeed. a variety of tick species. In their leisure epidemic proportions in the United For example, the spirochete bacteria of time, many Servicemembers and veterans, States, and the situation will certainly get Lyme disease can penetrate the heart, and their families, also enjoy hunting, worse. As the disease spreads, military even causing death.13 Dr. Neil Spector, fishing, camping, and hiking in the great personnel, veterans, and their families will who taught medicine at Duke University, outdoors, which increases their risk of be at even higher risk for contracting the began experiencing muscle pain, fatigue, encountering ticks.4 Lyme disease is most disease. and irregular heartbeat.14 Doctors who prevalent in rural counties with relatively More than 40 years after children in treated him could find nothing wrong high socioeconomic status, abundant for- Connecticut began getting sick from tick and dismissed his symptoms as stress estation, wet conditions, and mid-range bites, there is still no cure for many of the related. “I was confused,” recalled Dr. temperatures. These American counties people who have been bitten. A bitter Spector. “Should I believe a team of doc- tend to be exactly the sort of places where political battle has ensued in the United tors assuring me that nothing was wrong? veterans like to retire, and indeed, “Lyme States among professional medical orga- Or follow my gut instinct exhorting me disease incidence rates were higher in nizations, patient advocates, and even the to unearth the mystery responsible for counties with greater military veteran CDC concerning the origin, diagnosis, my downwardly spiraling health? I was population compositions.”5 and treatment of the disease. Mainstream beginning to question my sanity.” Left Commonly referred to as Lyme medical opinion has been that there is undiagnosed and untreated, the Lyme disease, Lyme borreliosis was first dis- no such thing as chronic Lyme because bacteria entered his heart. Only a heart covered in the United States in Lyme, the bacteria could not survive treatment transplant initially saved Dr. Spector’s life, Connecticut, in 1976. More than 20 with antibiotics, evade detection, and but he lost his battle with Lyme disease in children developed what doctors initially cause ongoing symptoms.10 However, June 2020.15 His experience was not un- mistook for a juvenile form of rheuma- individuals who suffer from the disease usual: Cardiac manifestations of Borrelia toid arthritis. Strangely, each of these and patient advocacy organizations point burgdorferi infection occur in up to 8 per- children had exhibited a rash resembling to their own experiences as evidence that cent of patients,16 with most of the severe a bull’s eye, which led the doctors to see a the disease may linger for years. (Indeed, cases occurring in men of military age.17 74 Commentary / The Myths of Lyme Disease JFQ 100, 1st Quarter 2021 Technical Sergeant Jessica Roofe, 86th Aerospace Medicine Squadron NCO in charge of epidemiology, prepares tick to be sent for testing, September 9, 2016, at Ramstein Air Base, Germany (U.S. Air Force/Tryphena Mayhugh) In addition to heart problems, Lyme might play a role in the suicide risk for psychogenic fugue state. My life was being can affect the brain. Lyme bacteria can Lyme patients, but scientists also believe destroyed by Lyme disease and no one had cross the blood-brain barrier, infecting that biological effects of Lyme on the a clue. At work, I had been highly awarded the central nervous system. This mani- nervous system (including brain inflam- throughout my career, but it became a real festation of the disease—called Lyme mation, neuronal dysfunction, and white struggle and I did not understand why. neuroborreliosis—occurs in up to 15 matter encephalopathy) could be a fac- When I went to work that morning, I was percent of patients bitten by an infected tor.23 One study demonstrated 33 percent tired, frustrated, and in a state of dread tick.18 Symptoms include meningitis, of late-stage Lyme disease patients were and fear, and I drove 100 miles past the facial palsy, encephalitis, and stroke.19 suicidal, and by conservative calculations, base. I only drank a small amount of the When Lyme disease infects the central about 1,200 people infected with Lyme scotch; the bottle was still nearly full. I have nervous system, it may also cause severe commit suicide each year.24 The risk of never been a big drinker and as a result I psychiatric symptoms such as psycho- suicide is highest in children. One study fell asleep on the beach. I woke up the next sis, schizophrenia, hallucinations, and demonstrated 41 percent of children who day wondering how I got there and why dementia.20 In 2011, researchers at the had been diagnosed with Lyme disease and drove back to the base and turned my- International Alzheimer’s Research had suicidal thoughts and 11 percent had self in for Away Without Leave.
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