Long Island is a hotspot for ticks, Lyme disease and other tick-borne illnesses. Suffolk County, in particular, is considered a high-risk area. Stony Brook Medicine plays a significant role in tick-borne diseases research. The Regional Tick-Borne Disease Resource Center’s Clinic, located in Hampton Bays, offers specialized care for adults and children concerned about tick bites, Lyme disease and other tick-borne illnesses.
The Experts
What You’ll Hear in This Episode
- 00:00 Opening and Introductions
- 1:50 How tick bites happen and how to avoid them
- 3:20 What does a tick bite look like?
- 4:10 Tick removal and identification
- 5:12 Ticks on Long Island and tick-borne diseases and infections
- 7:48 Treatment for tick bites
- 9:45 Symptoms of Lyme Disease
- 11:40 Living with Lyme Disease
- 14:25 Lyme Disease testing
- 16:00 The Stony Brook Lyme Disease Laboratory
- 16:40 Treatment for Lyme Disease
- 17:30 Treatment for children
- 18:20 Precautions when taking Doxycycline
- 19:00 Chronic Lyme Disease
- 23:00 Other tick-borne infections
- 27:15 Alpha-gal syndrome (AGS)
- 30:57 Closing Remarks
Full Transcript
00:00 Opening and Introductions
Announcer
Welcome to HEALTH Yeah!, where experts from Stony Brook Medicine come together to discuss topics ranging from the complex inner workings of an infectious disease to tips and tricks for staying safe and healthy all year long.
Andrew Handel, MD
Hi. Welcome to Stony Brook Medicine’s HEALTH Yeah! podcast series. My name is Dr. Andrew Hendel and I’m a pediatric infectious diseases physician at Stony Brook Children’s Hospital and the Stony Brook Southampton Regional Tick Borne Disease Resource Center.
Today we’ll be discussing all things tick related from how to remove a tick to identifying symptoms of Lyme disease and much more.
It’s no coincidence that we’ll be discussing these topics while sitting in a studio at Stony Brook University, which played a pivotal role in the discovery of Lyme disease and continues to be a major site of tick borne diseases research. With that in mind, I’m joined today by two colleagues, Dr. Sandeep Gandhi and physician assistant Jerry Simons, both with vast experience diagnosing and treating tick borne diseases.
And so with that, let’s get started. Jerry, do you mind introducing yourself?
Gerald Simons, MPAS, DFAAPA, PA-C
Yes. Hi, everybody. Welcome to the podcast. I’m Jerry Simons, PA from the East End on Long Island. I’ve treated almost all kinds of tick diseases over the last 25 years. I’m a founding medical advisor for the Stony Brook Southampton Tick Borne Disease Resource Center. I have a private practice in Southampton and I’m an assistant professor at the Stony Brook Southampton campus.
Andrew Handel, MD
Wonderful. Thanks for joining us today. And Dr. Gandhi, do you mind telling me about yourself?
Sandeep Gandhi, MD, FACP, FIDSA
I am Dr. Sandeep Gandhi. I’m an infectious disease specialist at Stony Brook Southampton Hospital, and I have a tick clinic as well as a hospital-based practice at Southampton Hospital.
1:50 How Tick Bites Happen and How to Avoid Them
Andrew Handel, MD
So, you know, we do hear a lot of questions about ticks and tick-borne infections this time of year. And so, Jerry, I’m hoping you can start us off. Can you tell us first, how do tick bites happen and how can they be avoided?
Gerald Simons, MPAS, DFAAPA, PA-C
Great. What a way to open. And of course, how do ticks happen? Right.
So, again, you have to get in contact with a tick. Ticks do not fly, ticks do not jump. Basically, you have to come in contact with the tick. You’re going to brush up against tall grasses. You’re going to be walking over a wet lawn and that tick is going to be questing. It’s going to be hanging out on a leaf or a branch and you’re going to brush up against it.
Now, we do know that the Lone Star tick is more of an aggressive tick. They can kind of sense your carbon dioxide plume. So that tick, you might actually see it like crawling across your deck. But again, you need that physical contact for the tick to actually get on you, and then it’s going to go and bite you.
It typically will crawl to a warmer area of your body. You’ll find it in your groin, around your butt, the armpit, the neck, something along those lines. These ticks generally do not bite immediately, they kind of crawl around to find one of these warmer spaces.
So think of avoiding tall grasses. Think of avoiding wet grasses and check yourself often. We’ll get into more of this later.
3:20 What Does a Tick Bite Look Like?
Andrew Handel, MD
So, Dr. Gandhi, I’m wondering if you can tell me what does a tick bite look like when it actually happens? What does it look like? And is it normal to have skin changes after the tick is removed?
Sandeep Gandhi, MD, FACP, FIDSA
So when a tick bite occurs, not everyone gets the classic bullseye rash. Only about 60% of the people do, and the other 40% can get a bullseye rash, but that’s not typical. It can manifest itself as a bruise, sometimes it’s just a red spot, and it can present in a variety of ways.
And it takes almost 36 to 48 hours for the tick to transmit Lyme disease. We have about 6-8 common tick related infections in our area. But now worldwide, there are approximately 19 of them.
4:10 Tick Removal and Identification
Andrew Handel, MD
Thank you. You know, one of the questions that I always get asked is what should I do if I do find a tick on myself? And so the first thing I always recommend to people is don’t panic. It’s very common, especially on Long Island, that tick bites will unfortunately happen from time to time. And just because you’ve gotten a tick bite does not mean that you’ll end up with an infection from it.
But there are some precautions you should take in terms of your next steps. So I actually have this handy tick removal kit. And inside the kit, we have tweezers, which are the most important part of removing a tick. If you find a tick on your skin, what you’re going to do is take the tweezers and grasp the tick firmly at the base of the skin, right where the tick’s biting and just pull firmly upwards.
Don’t twist it. Don’t try and squish the tick. Just pull it straight upward. Then you’re going to take the tick, put it inside a Ziploc bag. And what you can do is you can actually, if you have a magnifying glass at home, you can use a magnifying glass to try and get a better sense of what the tick looks like and which one it is.
And then once you have the tick and you’re able to look at it, you can use the tick identification card to try and figure out which tick was actually biting you. And as we’ll talk about, that’s incredibly helpful for figuring out what you do next.
5:12 Ticks on Long Island and Tick-Borne Diseases and Infections
And so, Jerry, maybe you can help me now that we’re talking about what type of tick we’ve identified, can you tell us about the different types of takes on Long Island and why does it matter?
Gerald Simons, MPAS, DFAAPA, PA-C
Right. Yeah, what a big question. So as he said, we want to be able to look at the type of tick that you have, save it in that little plastic bag that you can get in our tick removal kit. There are many different kinds of ticks, but in our area we are in the epicenter of tick-borne disease.
We want to learn about the deer tick, the Lone Star tick, and the dog tick. And each of these ticks have slightly different behaviors, different life cycles, and they can carry different diseases.
Of course, here in the Stony Brook and Long Island area, the Lone Star, the blacklegged or Ixodes tick is the most famous. That’s the one that can bite you and give you Lyme disease, as we said, over 36 hours or so. And it also may give you babesia and it can give you other infections as well.
And the second type of tech is the Lone Star tick. The female has that little white dot on it, which can give you most famously around here, alpha-gal. And then there’s the dog tick. We don’t see as many dog ticks. They’ve kind of been beaten out by the Lone Star tick. But we think of tularemia and rarely but very scary, Rocky Mountain Spotted Fever.
Dr. Gandhi, what other kinds of infections do you see when you’re dealing with these kinds of ticks?
Sandeep Gandhi, MD, FACP, FIDSA
So in our clinic we have seen Borrelia Miyamoto infections and possibly Powassan virus, as well as Anaplasmosis.
And the most common, of course, being Lyme disease, followed by an Anaplasma followed by Babesiosis and Borrelia miyamotoi.
7:48 Treatment for Tick Bites
Andrew Handel, MD
Dr. Gandhi If you do find a tick on you, does that absolutely mean that you’ll end up with a tick infection or that you’ll end up with Lyme disease?
Sandeep Gandhi, MD, FACP, FIDSA
No, it does not. But statistically, in the Long Island area, if you do get bit by a tick, the likelihood of getting Lyme disease is higher than, let’s say, the West Coast or the upper Midwest.
So whenever the prevalence goes beyond a certain percentage, approximately 5%, then prophylaxis with antibiotics such as doxycycline is indicated.
Andrew Handel, MD
And so can you tell us a little bit about when you would recommend that someone get doxycycline?
Sandeep Gandhi, MD, FACP, FIDSA
So if the tick is engorged, if the tick has been on for 36 or 48 hours or more, then it is a possibility that the Lyme organism, Borrelia burgdorferi, has been injected into the body and that is an indication for the doxycycline prophylaxis.
Gerald Simons, MPAS, DFAAPA, PA-C
And I’ll just add on to that. One of the reasons we want to know what tick you have is if you have a dog tick, then we’re not really worried about giving you prophylaxis. If you have the Lone Star tick, we’re more worried about the next hamburger that you might eat. So to Doctor Gandhi’s point about prophylaxis, we’re most vigilant when you’ve got that blacklegged or that deer tick.
And luckily you’re going to have our little index card, so you’ll be able to look and hopefully see what kind of tick you have and then let us know.
Don’t throw your tick out. Save it. We want to know what kind of tick it is.
Andrew Handel, MD
Yeah, absolutely. And one of the good pieces of information or good news about the doxycycline is many people ask, “Do I need to get a full treatment course for Lyme disease?”
Not necessarily. Often, if you removed the tick and you’re not having any symptoms, then we just recommend a single dose of doxycycline and that’s enough to prevent the infection.
Gerald Simons, MPAS, DFAAPA, PA-C
I’ll just point out there are people that like to take a match to their tick. They like to cover the tick with Vaseline. But we know that just pisses the tick off and they may actually regurgitate their germs into you.
So everybody rewind this podcast and watch this again. Pull the tick straight out. Don’t use a match. Don’t use Vaseline alcohol. Just pull it straight out.
Andrew Handel, MD
Yeah, that’s great advice. I’ve had patients who have actually injured themselves in the process and like you’re saying, upset the tick even more, so it makes it more likely that they’ll end up with one of these infections.
9:45 Symptoms of Lyme Disease
If someone has been bitten by a deer tick and they’re at risk of getting Lyme disease, you know, of course, the next question is what symptoms should I look out for?
So there are a large number of symptoms that we do see from Lyme disease, and it really depends on how long it’s been since the tick bite happens. Of course, there’s a lot of range here between different people. But the first thing, the most classic sign that we look for is the target rash or the bull’s eye rash or the erythema migrans.
And so this is a red rash that tends to expand outward and get bigger over the course of a week or so. It’s often not very painful or itchy, but it becomes quite notable, and it happens at the site where the tick actually bit the person.
A few weeks later, if that goes unnoticed or doesn’t happen. Some people will develop meningitis, which can cause them to have really severe headaches. They can have Bell’s palsy, which means that part of the face is actually paralyzed and droopy. And that does get better over time.
Some folks will have carditis where they can have chest pain and palpitations, and they can also actually develop multiple target rashes they can have. I’ve had patients who’ve had a dozen or a couple of dozen target rashes.
And one thing that’s quite common in pediatrics is we see children who come in three or six months after the tick bite and actually have large swollen joints. They actually can develop Lyme arthritis typically in the knee, which can cause pretty severe swelling in the joints. But again, fortunately, we have great antibiotics that can really help those symptoms to improve pretty quickly over time.
Gerald Simons, MPAS, DFAAPA, PA-C
Right. So everybody, if you’re taking notes, that’s worth writing down. There are different kinds of Lyme disease. One person could get Lyme disease and they have facial numbness. Another person could get Lyme disease and their knees swell up. Other people could start with flu-like cold symptoms, and then they start having changes in their heart rhythm.
So not only do we have different kinds of ticks, we have different kinds of Lyme disease, even a different type of Borrelia Miyamotoi can give you these fevers that come and go.
So again, not everyone’s Lyme disease is going to be the same.
11:40 Living with Lyme Disease
Andrew Handel, MD
One thing that people are often very concerned about once they have a Lyme disease diagnosis is can I live a normal life after this? What does this mean for me down the road? And so, Jerry, can you tell us a little bit about how you answer those questions?
Gerald Simons, MPAS, DFAAPA, PA-C
Yeah, what a really great question, because there’s a lot of controversy that’s out there. So all of the data really supports, if we figure out you have Lyme and treat you appropriately and early, you have a great chance – some data says you have more than a 90% chance of just getting over it.
But again, it’s knowing what you have, getting on to it early. And as you pointed out, as we have these newer, different types of antibiotics, we’re able to address, whether it’s deeper neurologic or cardiac symptoms. Some patients may need three weeks or more of an I.V. antibiotic. But again, because there are so many different kinds of Lyme disease, some people may have neurologic. Some people may have arthritic. You know, we on Long Island should have a very low threshold for thinking about Lyme and these different tick infections.
Kind of along those lines, I’ve had people where they’ve had headaches and joint pain and they needed a course of antibiotics and their joints got better. And then we weren’t able to figure out their headache. They needed another antibiotic course and then their headache went away.
So again, with antibiotics, with this vigilant awareness of Lyme disease in this area, yeah, we’re seeing people get over this.
Andrew Handel, MD
Yeah, absolutely. And of course, one thing that’s always important to keep in mind is that there are other diseases and other infections that can cause the same symptoms. Right?
Gerald Simons, MPAS, DFAAPA, PA-C
Right. And exactly. I had one lady, she was convinced she’s like, “Jerry, I’m here for you to tell me I have Lyme disease and give me doxycycline.” I’m like, But wait, your THS is 11, she was hypothyroid and that was causing all of her symptoms. She did have a tick bite, but she had gotten over that. So yeah, there’s a wide array of things that Lyme can imitate other things, but other things can imitate Lyme.
Dr. Gandhi, you probably see that a lot in the clinic.
Sandeep Gandhi, MD, FACP, FIDSA
Yes. So in our clinic I have come across patients who present with headaches, joint complaints, fatigue, muscle aches, and they’re convinced that they have Lyme.
But alternative diagnosis should be considered. And one of the most common alternative diagnoses that I do find is brucellosis. And that’s quite, I wouldn’t say common, but it’s common enough with the symptoms that we can diagnose by a blood test, and it’s very easily treatable.
14:25 Lyme Disease Testing
Andrew Handel, MD
Yeah. And speaking of that blood test, I know a lot of people think that the Lyme disease testing is accurate.
Dr. Gandhi, maybe you can comment a little bit on the accuracy of the Lyme disease test.
Sandeep Gandhi, MD, FACP, FIDSA
Sure. So at the present time, there is no test that tests for the tick or the Lyme disease itself within the blood. It tests for the reaction of the human body to the tick. And that’s a very important concept. And the way we do that is by checking for antibodies.
One is two out of the three AGM, as well as five out of the ten IgG. And the current standard of testing is Lyme modified MTT test. I understand that people really are desperate to diagnose this test for this disease and sometimes they go out of their insurance coverage to pay thousands of dollars to pay for non-FDA approved tests, which I think is a waste of money.
Andrew Handel, MD
Yeah, absolutely. You do have to be careful because as you mentioned, there’s a lot of alternative tests out there that are just not scientifically validated. They’re not known to be accurate and can really mislead people.
You know, like we’re saying, there are people who’ve been diagnosed with Lyme disease when it turns out it’s not what’s causing their symptoms and they’re missing the true diagnosis. So you’ve got to be careful about that.
Gerald Simons, MPAS, DFAAPA, PA-C
On the flip side, I’ll point out if it’s summertime and you have a rash and you have flu symptoms, we may not even do a test. Right? So there are early indications where we wouldn’t do blood work at all, you would just start right on the treatment.
Andrew Handel, MD
Yeah, that’s a great point. There sometimes are families who would want testing, we say, actually, it’s too early to do the test. If the tick bite was just a week ago and you’re having symptoms now, your test is likely negative. But that doesn’t mean that you don’t have Lyme disease.
16:00 The Stony Brook Lyme Disease Laboratory
Gerald Simons, MPAS, DFAAPA, PA-C
And that modified two tiered testing that Dr. Gandhi was talking about the Stony Brook Lyme Disease lab has been leading the way with this test.
They get blood orders from all over the country. I see a FedEx guy coming in and he’s like, this is all blood for the Lyme lab. So definitely the Stony Brook Lyme lab is leading the way. C six peptide, VLSC, Western blot. I’m getting excited.
Andrew Handel, MD
Yeah, absolutely. And that’s not a recent that’s not a recent phenomenon. The Stony Brook Lab has been well known for its testing for decades now.
16:40 Treatment for Lyme Disease
So, Dr. Gandhi, can you tell us a little bit about the treatment options once you do have a Lyme disease diagnosis?
Sandeep Gandhi, MD, FACP, FIDSA
Sure. So the current standard is doxycycline, 100 milligrams twice a day for ten days. It used to be much longer – 21, 28 days. But the current standard is for ten days.
If, let’s say, if an individual is allergic to doxycycline, then alternative antibiotics can be used – amoxicillin, but that duration is for 14 days, as well as cefuroxime, which is an intravenous format and is can be given for 14 to 28 days depending on the condition that manifested.
17:30 Treatment for Children
Andrew Handel, MD
One of the interesting changes that’s happened within the last five, seven years is that for pediatrics, doxycycline was often recommended to not be given to children under eight years old because there are concerns that it would actually stain the teeth and cause permanent dental changes. But actually, we now know that that’s more related to tetracycline, doxycycline’s first cousin rather than doxycycline itself.
And so in children, we do use doxycycline if we need to. You know, we use an alternative antibiotic when it’s available. But if we need to use doxycycline in young kids, then we go ahead and do that. And I’ve seen excellent outcomes in my patients who are treated with that antibiotic.
18:20 Precautions When Taking Doxycycline
Gerald Simons, MPAS, DFAAPA, PA-C
And just remember, especially kids doxycycline can make you sensitive to the sun. So I even have told kids, Sorry, kid, you got to stay inside for a week. We don’t want you getting a bad sunburn.
Andrew Handel, MD
Excellent point. Yeah. What other guidance do you give families or to any patient who’s going to be on doxycycline? Because there’s a lot of precautions that need to be taken.
Gerald Simons, MPAS, DFAAPA, PA-C
Yeah. So, number one, doxycycline and vitamins do not get along. Like if you’re taking calcium, magnesium, separate that from your doxycycline. Number two, people you have watched my other videos know I’m obsessed with the gut microbiome. So I tell people to have yogurt or take a probiotic at a different time of day. So you’re killing germs and you’re restoring some of the good ones.
So avoid the sun. Separate your vitamins and have some yogurt while you’re on doxycycline.
19:00 Chronic Lyme Disease
Andrew Handel, MD
Absolutely. Now, we hit on this a little bit earlier, but another concern that comes up quite frequently is post-treatment, Lyme disease syndrome or what some people call chronic Lyme disease. So, Dr. Gandhi, can you tell us a little bit about your experience with patients who have that diagnosis? What is it and what does it mean for them?
Sandeep Gandhi, MD, FACP, FIDSA
Sure. So the post Lyme syndrome is people who continue to have the signs and symptoms of Lyme disease, but they do not have the organism in them. And that generally is diagnosed about six months after you have Lyme disease and it has been treated.
And what happens is that people are convinced that they still have Lyme disease and they demand antibiotics for the appeasement of the disease, when it’s clear that it is not helpful. In fact, last October, there were six very large institutions, and Stony Brook was one of them, that did a study on this to look for the organisms within the body. And none of these institutions found any organism. So the antibiotics were quite effective and curative.
However, this post Lyme syndrome exists, and what happens is that patients continue to have this, and that could be a variety of reasons. One is that there’s a genetic predisposition. And number two, the post Lyme syndrome does not happen in everyone. Less than 20 percent of the time this happens and it’s selective. What this large study between the six university hospitals found was that they found the substances of the Lyme organism, but not the Lyme organism itself.
So the treatment in this scenario could be an anti-inflammatory, which can be guided by rheumatologists rather than an infectious disease specialist.
Gerald Simons, MPAS, DFAAPA, PA-C
And I would point out a really interesting fact. If you’re taking notes, you want to write this down too. Doxycycline has some anti-inflammatory properties. So many times if you’re taking doxycycline, you know, it could be that you’re getting that ibuprofen-like anti-inflammatory effect.
Andrew Handel, MD
One thing that I explained to families when they’re looking out for symptoms and they say, what does post-treatment Lyme disease syndrome look like, I actually have found that discussing long COVID is helpful because the symptoms are quite similar. People feel fatigued and have what’s often called brain fog. There’s not necessarily a specific symptom on their body that’s bothering them.
It’s just their thinking, their cognition doesn’t seem quite like it used to. And it can be really debilitating. And just like long COVID, as you mentioned, it’s not necessarily an ongoing infection. In fact, we know it’s not an ongoing infection. It’s in some way the immune system that’s overactive and causing those lingering symptoms.
Gerald Simons, MPAS, DFAAPA, PA-C
And kind of along those lines, just an interesting story. I had someone who came in and they were convinced that their Lyme disease was bubbling up and acting up. They’re like, you got me better, but I’ve been sick for two weeks and I think my Lyme disease is back. I’m like, okay, get on the table. We’re going to check you out. He lifts up his shirt and what do we see? He’s got a rash.
Well, you’ve got Lyme disease again. It’s not the old Lyme coming back. You’ve got a Lyme disease right now.
Andrew Handel, MD
Absolutely. You can get repeat infections.
Gerald Simons, MPAS, DFAAPA, PA-C
So here on Long Island, think about that. You know, check yourself and your kids for ticks.
Andrew Handel, MD
Yeah. One of the reassuring things that I always like to tell families is that the chance of post-treatment Lyme disease syndrome and kids is incredibly low.
Again, I treat dozens and dozens of kids every year for Lyme disease, and almost never do I see any lingering post Lyme disease syndrome symptoms. On occasion you can see some arthritis, but outside of that, it’s very, very uncommon. We don’t really understand fully why that is, but there seems to be a difference in immune response for kids.
And so most kids who get Lyme disease, we treat it, they get better. And that’s really the end of it for the vast majority.
So, Dr. Gandhi, can you tell us a little bit about the other tick-borne infections we need to keep an eye out for? There’s Lyme disease, but what about the others?
23:00 Other Tick-Borne Infections
Sandeep Gandhi, MD, FACP, FIDSA
Sure. So in our area, Anaplasmosis does occur and that usually presents with fever, fatigue and a very faint rash.
And it is also known as human granulocytic anaplasmosis (HGA) for those who want to look up the disease. And usually in Southern United States, particularly the Carolinas, you see early ketosis, which is a little more invasive, and that can also present as a very faint rash. So those are the two things. Fortunately, those two organisms are very treatable with doxycycline.
The other common disease that we see with tick-associated infections is Babesiosis, and Babesiosis – people use that as the malaria of Long Island because it infects red blood cells. And characteristically, if you look underneath the microscope of a patient who has Babesiosis, it appears as a maltese cross within the red blood cell. But the distinguishing feature between malaria and Babesiosis is that the Babesiosis can be extracellular, but malaria is intracellular. And that is not treated by doxycycline, but it is treated with zithromax.
So that’s another organism, Borrelia miyamatoi, which presents it’s less than 2% of the ticks there are infected, but it’s much more sudden onset of a bad headache, fevers. But what I have found is that it does not have lingering manifestations of fatigue, headache and malaise and/or joint infections. So it comes on intensely, but it doesn’t linger like Lyme disease.
And the other one is tularemia. I’ve seen one in the hospital, a person from our local county, when golfing with his father, and he came in with an ulcer on his leg, with lymphadenopathy and very high fevers. And once you see that classic ulcer, which is a canker and we said this was tularemia, we confirmed it with the baseline as well as four weeks later.
And again, one of the treatments is also doxycycline. But quinolone such as ciprofloxacin is the treatment for that. And on the rare circumstances, it’s something called the Powassan virus, and that is a dreaded virus. And the transmission of that virus from a tick bite is only 15 minutes.
Unfortunately, it can cause mental slowing over time. There is a diagnostic test, but it is a state involved test and unfortunately there is no cure at the present time.
Andrew Handel, MD
Thank you. It’s incredibly informative. One of the interesting things about Babesiosis, which on Long Island is one of the more common infections for me as a pediatrician, is that actually children who are otherwise healthy are almost never symptomatic from a Babesiosis infection. It’s extremely rare to diagnose a child who has active Babesiosis because their immune system is better at just fighting it off before they even know that they had it.
And so where Babesiosis comes up more for me is in newborn babies whose mothers had it during pregnancy. And so it’s always a good idea for any person who is pregnant and is diagnosed with Lyme disease to have a Babesia test done as well because that Lyme disease pathogen does not get transmitted from a pregnant person to the baby, but Babesiosis absolutely can. And that can be really critical in the babies. So it’s a good idea to always keep that in mind.
Sandeep Gandhi, MD, FACP, FIDSA
And also, it used to be that blood transfusions transmitted Babesiosis about 4 percent of time. But now that our blood supplies are screened for this, it’s highly unlikely that Babesiosis can be transferred. It is very important that people who don’t have spleens, that it’s very important that the Babesiosis gets diagnosed early and treated.
27:15 Alpha-Gal Syndrome (AGS)
Andrew Handel, MD
Thank you. And one more question, Jerry. You mentioned earlier on Alpha Gal syndrome, the red meat allergy, which started coming more and more common on Long Island. So what is that and what can you tell us about it?
Gerald Simons, MPAS, DFAAPA, PA-C
Yeah, so Alpha Gal, everybody has that one friend or family that can’t eat steak and can’t eat a hamburger. And this is transmitted, as we said before, by the Lone Star tick.
You’ll know the Lone Star tick female because there’s that little white dot on it. And when you think about the issue with the transmission from the Lone Star tick, basically it’s giving you a sugar enzyme which is then present preventing you from metabolizing the meat – red meat, hoofed meat specifically. So we think about lamb and pork and beef and anything related to that, anything related to gelatin.
Like kids who love marshmallows. That’s an issue. Or Jell-O. Things along those lines. Anything from cow beef, anything along those lines. The treatment that we have now is that you just have to avoid eating that. And there’s a panel of blood work that we do regularly to look to see if that allergy marker is going down.
We also do know that Alpha gal can have a very quick transmission time. There are people that have had the Lone Star tick and they’re like, I went right home to get my official tick kit. I took it off within 2 hours and then they still have a reaction. One of the heroes of our Tick Center, Dr. Aaron McGinty, has labeled this midnight anaphylaxis. It takes about six or 8 hours for the allergy to really manifest.
The most common thing that I see is GI upset. People eat a hamburger and they have like diarrhea from that or stomach aches or stomach cramps. The most extreme would be a respiratory allergy. And you’ll hear in the Southampton E.R. of people coming in and they actually need to be intubated. They need to have I.V. steroids. So some people can have a really severe Alpha gal allergy.
Again, there’s no peer reviewed literature on this. It’s my own hotheaded idea. But I tell people, if you have a Lone Star tick, don’t eat meat for a month, maybe you won’t activate that allergy. Not Scientific. Just my own idea. I have a panel of about 600 people that have reported back to me. So far it seems to be working. It’s free and harmless. So consider not eating meat after a Lone Star tick bite. It might ruin your best barbecue, but it’s better than an allergy.
One of the things I have seen is adults with new onset irritable bowel syndrome. All of a sudden they’ve developed chronic diarrhea and sensitivity and, it could be related to alpha gal.
Andrew Handel, MD
Yeah, absolutely. And those Lone Star ticks are really the most prevalent ticks on Long Island. We see them everywhere and now often people will be bitten by multiple Lone Star ticks, not just one. So unfortunately this is a growing problem in our area.
Sandeep Gandhi, MD, FACP, FIDSA
Just one point on that. The gelatin, if you’re allergic to that, I think in some rare instances, some vaccinations use gelatin. So if a person has a severe alpha gal allergy, I think that’s a conversation between you and your physician.
Andrew Handel, MD
Absolutely. Any medication that you’re receiving after you’ve been diagnosed with that, you should make sure that there’s no risk you’ll have an allergic reaction to the other medications as well.
30:57 Closing Remarks
And with that, I’d like to thank our panelists, Dr. Sandeep Gandhi and physician assistant Jerry Simons for joining us. And thank our audience for tuning into HEALTH Yeah!
As the weather warms, this is just one more reminder to take precautions for preventing tick bites, avoid walking through tall grasses and brush, wear long sleeves and pants, and apply insect repellents when in high risk areas.
And, of course, make sure to perform daily tick checks. Finally, tick bites are inevitable on Long Island, unfortunately. But don’t panic when it happens. Speak with your health care provider and check the Stony Brook Southampton Regional Tick Borne Disease Resource Center’s websites for more information. Thank you very much for joining us.
Everybody has a special bonus for watching this entire podcast. I’m going to give you a great tip. We spent a lot of time developing this great guide book. It’s chock full of information on Alpha Gal and Lyme, prevention, what to spray yourself with, what to do with your yards, and a special section on your pets. It’s a PDF on our website. Download it today.
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*DISCLAIMER: The information provided in this podcast is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. If you think you may have a medical emergency, call your doctor or emergency services immediately.
