Wagng War-DVMs push public awareness, legislation to target tick disease

GAITHERSBURG, MD.— When fibrosis hardened Pat Dickinson's lungs in late 2004, doctors struggled to isolate her illness. Two years later, the 55-year-old dog owner credits a veterinarian's education for avoiding a lung transplant and even death.

Cheating death: Pat Dickinson credits her veterinarian for recognizing the tick-borne disease that almost claimed her life along with her dog, Barbie. The case is helping to mobilize veterinarians in a push to bring the threat to the forefront of human medicine.

It turns out Dickinson was positive for Babesia, Ehrlichia and Lyme disease, only diagnosed after Dr. Wendy Walker, a Washington DC-area DVM, prompted her to get tested. And while the story might seem remarkable, it's not far-fetched.

When it comes to human medicine, experts say tick-borne diseases are often overlooked, misdiagnosed and never addressed. Now the once-understated phenomenon is receiving national attention.

Veterinary scientists say disease-carrying ticks are migrating like never before, with populations bolstered by warmer temperatures, rising deer populations and reforestation. At the same time, Congress is jumping on the awareness bandwagon. Federal legislation seeks to establish prevention, education and research regarding tick-borne diseases by establishing the Tick-Borne Diseases Advisory Committee, a myriad of federal agencies under the Department of Health and Human Services. HR 3427 and S 1479 calls for developing diagnostic tests and surveillance that requires the reporting of human cases to the Centers for Disease Control and Prevention (CDC). It also seeks $20 million through 2010 for research, prevention and educational materials, the legislation says.

Spreading the word: Dr. Wendy Walker, of Olney, Md., advocates testing when it comes to client cases of tick-borne disease. "You have to look beyond the Lyme," she says.

But government watchdogs like the American Veterinary Medical Association's Dr. Mark Lutschaunig say the bills, originally introduced in 2005, are saddled by an overworked Congress busy with an election year. "It would be difficult to see this passed at this point," the Governmental Relations Division director contends.

That news hasn't slowed Walker, who like a handful of her colleagues, is on a mission to educate the public as well as professionals in human medicine. The small animal practitioner says she's seen at least six clients go undiagnosed with tick-borne diseases. And while she attempts to lobby Congress, it appears the Maryland governor's office is interested in joining Walker's efforts to raise awareness.

"My concern began a year ago when we started having to tell clients to get tested for Ehrlichia," says Walker, owner of Town and Country Animal Clinic in Olney, Md., and president of the Maryland Veterinary Medical Association. "This is serious because we're not just talking about Lyme anymore. The problem is the medical community doesn't have the testing, knowledge and education that veterinarians have on tick-borne diseases. I can't believe how many clients I have who are debilitated for life. It shouldn't be up to us to diagnose them."

On the forefront

But that's just what's happening, says Dr. Edward Breitschwerdt, professor and head of North Carolina State University's vector-borne disease diagnostic lab. An expert in tick-borne diseases, he's attempting to build a coalition of veterinary experts to represent and address companion animal diseases, especially zoonotic agents.

On alert: Veterinarians like Dr. Wendy Walker are pushing lawmakers to enact tick-borne disease awareness campaigns.

"In veterinary medicine we don't have a Centers for Disease Control and Prevention for animals," he says. "We really don't have an infrastructure for companion animal infectious disease or for researchers to work on them."

With that in mind, Breitschwerdt says he's not surprised by human medicine's alleged lack of information on tick-related illnesses. It's not unusual for veterinarians have superior knowledge because they're trained in insect and arthropod vectors that transmit infectious agents, he says.

Yet, that doesn't make disease recognition easy, even for DVMs. Symptoms of tick-borne illnesses can vary from patient-to-patient. And in states like North Carolina, dogs easily can contract four tick species. From there, the problem is two-fold: single ticks transmitting more than one organism and animals getting multiple ticks that transmit multiple viruses and protozoa, Breitschwerdt contends.

"My belief is that academic veterinary medicine and human medicine need to work more closely to understand tick-borne illnesses," he says. "The more we understand tick transmission in the dog, the better we'll understand the diseases in humans. The same organisms affect both animals and humans in most cases."

Tick expansion

And most of those organisms were just discovered in the last decade. According to Dr. Michael Dryden, a Kansas State University professor of veterinary parasitology, four main ticks plague animal and human medicine: the lone star tick carries Ehrlichia chaffensis, the most common form of human ehrlichiosis in the United States; the black-legged or deer-tick carries Lyme disease; the American dog tick is the primary vector of Rocky Mountain spotted fever, and the brown dog tick is known for Babesia and Ehrlichia canis but usually is not a vector to humans in North America.

Dryden, who built his career on flea research, now says he's focusing on ticks and their migration patterns. Like Breitschwerdt, he cites the lack of statistics on tick populations and illness cases. Still, he believes ticks are spreading.

"I think there's a perception by many of us that veterinarians are seeing more tick-borne diseases all the time, but it's all anecdotal," Dryden says. "There appears to be an expansion of the ranges and density of several tick species in North America due to climactic changes, wildlife populations and conservation efforts. There are more forests today than there were 100 years ago. With hunting restrictions, we also have an estimated 30-million white-tail deer. That's almost 100 times more than we had 30 years ago."

Deer, a primary reproductive host for black-legged and lone star ticks, are closing in on the nation's growing number of suburbanites, Dryden says. Human habits are facilitating instances of disease contraction, Breitschwerdt adds.

"I think things are clearly getting worse," he says. "So many people enjoy their half acre, but it also puts them in direct contact with ticks. At any given night a raccoon can run onto your property, a tick can drop off, lay eggs and start a cycle in your backyard. We're not talking about something that hasn't been going on for millions of years. What we are talking about is our changing relationship with nature."

Dryden adds that dogs do not transmit tick-borne illnesses — a fact the public needs to understand. "You have to be walking in the area where they're at to get these diseases," he says.

Survival, perseverance

Dickinson, who lives on a wooded lot, doesn't remember getting bitten or seeing the typical bulls-eye ring that signals Lyme infection. Yet she does recall seeing six physicians before being told to expect a three- to five-year lifespan. Now she, too, wants to raise awareness.

"A year ago, I had 50-percent lung function and couldn't make it to the mail box," she says. "Conventional doctors didn't believe ticks had anything to do with my illness. But I found someone to treat the diseases, and today, I'm at 70-percent lung capacity. There's definitely something to this tick thing. Now I've got my life back."