Artemis Health Guide

Heatwave Advice

Whilst many of us like to enjoy the sun and hot weather, we should make sure we do it safely and remember certain groups of people are more vulnerable than others to the effects of heat or ultraviolet radiation. Extreme heat can force the body into overdrive as it tries to stay cool through perspiration and evaporation. Young children and older people are particularly at risk. Overexposure to sun is equally dangerous, with effects ranging from mild sunburn to skin cancer. It doesn’t have to be hot for the UV index to be high.

Make sure you know what to do

Before a heatwave

Ensure you have plenty of cold fluids available.
During a heatwave

Try to keep your house cool, closing blinds or curtains can help.
At night, keep your sleeping area well ventilated. Night cooling is important as it allows the body to recuperate.
Try to stay cool by taking cool showers or baths and/or sprinkle yourself several times a day with cold water.
Avoid too much exercise, which can cause heat exhaustion or heat stroke, and can even be fatal. Watch for signs of heat stress — an early sign is fatigue.
Drink plenty of fluids, but not alcohol, which dehydrates the body.
Try to eat as you normally would. Not eating properly may exacerbate health-related problems.
If driving, keep your vehicle well ventilated to avoid drowsiness. Take plenty of water with you and have regular rest breaks.
If you have elderly neighbours who may be at risk during a heatwave, try to visit them daily.
If you do go out, try and avoid the hottest part of the day (11 a.m. to 3 p.m.) and seek shade where possible. Avoid being in the sun for long stretches.
Before going out in the sun

Check you have appropriate sun cream for your particular type of skin.
During sunny weather

The UV index (the strength of the sun) can be high at many times of the year — it doesn’t have to be hot. The UV index can be strong through cloud even when the sun isn’t directly shining.
If you go out, wear lightweight, light-coloured clothing, high factor sunscreen and a wide-brimmed hat.
Avoid being in the sun for long stretches.
Reapply an appropriate factor sun cream at regular intervals during the day.
Do not leave children or animals in parked cars.

Even on cool days, strong sunshine can make car interiors very hot.
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Leptospirosis Advice

Although we are all seasoned Field Archers, there are a few little nasties out there that come with the territory of shooting in woodland.

These articles are in no way a comprehensive guide of what you should do, but are more designed to make you aware of the two listed diseases.

These articles are taken from Lyme Disease Action website and The Leptospirosis Information Centre website. Please consult these two expert website’s and of course your doctor.

The Lyme Disease Action website also has PDF leaflets about Lyme’s Disease and ticks, also a fantastic poster to print out for the club house wall.

Leptospirosis (Weil’s Disease)

Human leptospirosis can be a difficult infection to describe, as the symptoms can vary dramatically between patients. Some symptoms are extremely common, but only a small number of patients will experience the severe life-threatening illness known as Weil’s disease. The severity of the infection depends on the age and general health of the patient, plus the serovar (strain) of bacteria involved and the number of bacteria that entered the patient’s body.

The infection is usually systemic (affecting the whole body) and causes a sudden fever. In mild cases it lasts a few days, following a pattern similar to flu but often in two phases – a period of illness lasting a few days, then a slight recovery, then a second period of illness. In mild cases the second phase lasts a short time and the patient recovers, but in severe types the illness develops and progresses rapidly, leading to organ failure and often death if not treated with intervention and support.

Incubation time

From the time you were infected with the bacteria, there is a period where it has to reproduce enough to cause illness – called the ‘incubation time’. With human leptospirosis this is typically 3 to 21 days, with most patients developing illness after about 3 to 14 days. It does not usually take more than 28 days, but in rare cases very long incubation periods have been reported. It generally cannot show illness in less than 24 hours unless the volume of bacteria taken into the bloodstream was massively larger than normal.

First stage

Leptospirosis starts suddenly, with a severe headache, redness in the eyes, muscle pains, fatigue and nausea and a fever of 39°C (102°F) or above. There is sometimes a red non-blanching pinprick rash on the skin, similar to that seen in meningitis. Young children can be tired or distressed and may show an aversion to bright light. The severe headache is almost always present and can be incapacitating. Nausea may or may not cause vomiting. Muscle pains can be extreme and are often particularly bad in the calf and back areas – muscles will be sore to move and to touch. A rapid pulse is also common in the first few days.

The skin rash develops in the first one or two days and often the skin is warm and pink just beforehand, with the patient complaining of feeling warm. Rashes can occur anywhere but in some cases are confined to local regions of skin such as the front of the legs. Sometimes they will be itchy, but rashes are only seen in about 30% of all cases so the lack of any rash is not too significant.

Psychological changes are often seen, with patients feeling depressed, confused, aggressive and sometimes psychotic – with schizophrenia and hallucinations, personality changes and violence.

This phase lasts between three and five days, then the patient (temporarily) recovers. During this phase the bacteria are active in the patient’s bloodstream (so it is sometimes called the septecaemic phase) and so can be detected by lab tests.

Second stage

In many mild cases this doesn’t happen at all, but where the infection is more severe, the patient enters a second phase of illness after a few days of apprent recovery. The initial symptoms and fever return, accompanied with chest and abdominal pain, some renal problems and psychological changes. Increased symptoms of meningitis are often seen with neck stiffness and vomiting, but in most mild cases the patient will not suffer kidney or liver failure and will eventually recover. There may be a sore throat and dry cough, with a litle blood. With treatment, mild cases will recover within a few weeks.

During this second phase the bacteria are only really active in the tissues of the patient, and so can be difficult to find in the bloodstream, making lab tests a problem. This second phase is usually called the ’tissue’ or ‘immune’ phase.

Severe infections

In cases of particularly virulent serovars or patients with poor health, the infection follows a different pattern and the patient develops very rapid and severe symptoms from the start, without much of a remission. Symptoms are the same as for the mild type but more pronounced, and multiple organs are damaged – liver and kidney failure can occur within 10 days, leading to jaundice and death if not treated. Hemorrhages are common (including bleeding from the mouth, eyes and other mucous membranes), plus infection of the heart and significant internal bleeding. Dialysis is the most important intervention and the patient will require antibiotics and hospital admission in order to stand a chance of survival. Death, when it occurs, is usually due to heart, liver or respiratory failure. Severe infections are often called ‘icteric’ because of the presence of jaundice, and these are the only cases that can really be called Weil’s disease.

Recovery

Patients with mild infections recover quite quickly, so are usually feeling OK after a few weeks, but they can suffer from fatigue and depression for a while and may be at risk from persistent infection. Patients with the more severe infections can take several weeks to recover, as removing the bacteria is not the problem – they will have caused damage to the body’s tissues that take time to heal. Although some patients can die, with medical treatment the chances of survival are good – though patients that have had a severe illness may suffer long-term symptoms due to organ damage that cannot completely heal. Psychological changes (mood swings, depression, psychoses) are common for a few months following recovery.

Immunity

Patients that survive infection will develop some immunity, but only to the serovar that infected them and some closely-related ones. They can still be infected by other strains, and the immunity lasts no more than ten years in humans. There is a very small possibility of auto-immune reactions to the bacteria if patients are reinfected again, but the main concern of patients is that they can suffer from medium-term symptoms due to persisistent infection which are almost impossible to treat.

Treatment of human leptospirosis – guide for the public

Treatment for acute illness in humans is in two parts – an antibiotic to control the bacteria and general support of the patient’s internal organs so they maintain their ability to recover while the bacteria are removed.

Antibiotics
Leptospirosis can be treated by a wide range of antibiotics, and medical staff will select the best based on availability, the patient’s age and any other medications they may be taking. In mild cases the medication will be given by mouth adn the patient can stay at home, but in severe infections the antibiotics are often given directly into the bloodstream via a drip (IV) and so require them to remain in hospital. This is also important to allow them to be monitored as the infection progresses.

In many cases, penicillin is used – but if the patient is allergic then a number of alternatives are available as well. It is very important to take antibiotics as prescribed – do not miss any doses and take all the doses even if you feel that you’ve recovered. Stopping a course of antibiotics before the end can lead to resistant bacteria taking hold and causing very severe illness. The dose of antibiotic will be calculated based on the patient’s age and body mass, and medical staff do not need to know the exact strain of leptospira involved before beginning treatment – indeed it should be started before test results are returned if the patient has a high probability of being infected.

Other medications
Often patients will have severe headaches, fever and nausea in the first week or two, and these can be controlled by normal non-prescription medicines. In some cases medical staff may prescribe additional programs of medication to help with liver or kidney function, or to support deficiencies in diet.

Hospital care
In severe infections the patient will be admitted to hospital, and may need to be intensively supported for a few weeks. Patients can require dialysis, fluids and painkillers plus help with their breathing. In very rare cases patients can become psychologically disturbed and may need sedation for their own safety. The infection is not particularly contagious and so patients are not usually isolated and can receive visitors as their condition permits.

General recovery
Recovery can take a while, and a lot of patients find they suffer from fatigue and depression for a few months after recovery, requiring support. Maintaining a healthy diet with all the proper vitamins and minerals is very important during recovery, and patients that feel fatigued should rest as much as they need to – fighting it off and continuing to work can make recovery a lot slower.

Persistent human leptospirosis – guide for the public

Persistent infection is a situation where the patient has recovered from an acute illness, but shows some long-term health effects caused by the bacteria remaining in isolated areas of the body, long after the immune system has removed them from the bloodstream and general tissues. It is different from a carrier state as the patient is not infectious to others, but persistent human leptospirosis (PHL) is far more common than previously thought.

These long-term issues are not only a factor of leptospirosis – other infections from bacteria in the same order, such as Lyme disease, often show health problems for several years after recovery.

Symptoms of PHL
Symptoms vary a great deal between patients, with some being almost incapacitated and others noticing nothing. The reported symptoms are listed below, with the most common first:-

Depression, from mild personality changes to quite severe clinical disorders and suicides.
Fatigue, often quite pronounced and debilitating
Headaches, resembling migraines but not always particularly severe.
Eye pain, with or without any inflammation, sometimes with vision disturbances.
Psychological changes, including mood swings, short tempers, rarely OCD.
PIEM, parainfectious encephalomyelitis, is seen in quite a few cases. This is damage to the nervous system and manifests in different ways, so patients can show symptoms of meningitis, epilepsy, balance problems, muscle weakness and vision disturbance. It can mimic the symptoms of multiple sclerosis.
Causes of PHL
There are two reasons for ill health following a bacterial infection:-

Tissue damage

During the acute illness, bacteria cause damage to tissues in the patient’s body, by a combination of toxins and damage to the blood supply. This can lead to long-term changes in the function of internal organs but is not directly related to the bacteria, only to the damage they cause. Reduction in function of the liver and kidneys is one such outcome, but where the tissue damage is not too severe the body will heal over time.

Bacterial residency

In the body there are certain places, called immunologically privileged sites (IPSs) where the immune system is not very active, and bacteria can survive long after they have been killed in the rest of the body. These sites are usually places without a direct blood supply, such as the fluids within the eyeball and the structures of the brain and nervous system. In the rest of the body, the patient’s immune system reacts to leptospires and creates antibodies that will ensure they are killed within a few days, however in IPSs the supply of these antibodies, and the white blood cells that do the killing, are reduced. Bacteria can ‘hide’ in these sites but are kept trapped by the active immune system, so the symptoms tend to be concentrated on the same organs. We have very little direct evidence for the time bacteria can survive in this way, but it is certainly several months or years.

While they are present, leptospires in IPSs have two effects – they still leak toxins into the tissues, albeit at a quite low level, and this can cause slight inflammation or reduction in tissue viabililty. More importantly they can continually trigger the immune system at the border of the IPS, and the immune response to this constant prodding of white blood cells can be more severe than is required – in some cases it will cause an autoimmune response where the body’s immune system starts to attack ‘self’. It’s common for patients with PHL to show unexpected severe symptoms when exposed to leptospires a second time, as the autoimmune response is activated. It’s particularly true in the eyes and is the cause of recurrent symptoms in horses.

Treatment
There is no working treatment for PHL at this time which has shown itself to be effective on every patient – research conducted in recent years has shown promise in developing an immunological treatment program, however in the majority of cases supportive care is given. Maintaining a healthy diet with full nutritional balance is very important, and symptoms can be treated in isolation (with painkillers, etc.) but in many cases a repeat program of antibiotics has been able to increase the speed of recovery. The difficulty is that medication will only act on the persistent bacteria, and so any long-term tissue damage caused by the infection will need to heal at a natural rate – this can take several years and in severe infections there can be some permanent damage to tissues. Patients suffering poor helth after a leptospirosis infection should always discuss the issue of PHL with their physician, if necessary via a referral to a specialist in infectious and autoimmune disease. The symptoms are expected to reduce over time even without treatment, and so in many patients with only minor reduction in health it can simply be a waiting game.

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Lyme Disease Advice

What is Lyme Disease ?

Lyme Disease is an infectious disease caused by the bacterium Borrelia burgdorferi sensu lato.
Lyme Disease can be transmitted to humans by the bite of an infected tick.
Lyme Disease has a clinical diagnosis.
Lyme Disease cannot be ruled out by any current test.
Lyme Disease symptoms can include fever, headache, fatigue, and a skin rash called Erythema Migrans.
Lyme Disease if left untreated, can spread to joints, the heart, and the nervous system.
Lyme Disease is systemic, it can affect the whole body.
Lyme Disease symptoms overlap with those of many other diseases.
Lyme Disease can be difficult to diagnose.
Lyme Disease is treated with antibiotics.
Lyme Disease was named in 1975, after a number of cases occurred in Old Lyme, Connecticut.
Lyme Disease is not only American, it exists worldwide.
Lyme Disease is not a new disease, it was known in Europe under different names in the early 1900’s.
Lyme Disease is not spelt Lymes Disease, Limes Disease or Lime Disease.
Lyme Disease can be classified as Lyme Borreliosis, or a Neuro Borreliosis or Borreliosis.
Lyme Disease is systemic, it can affect the whole body. This lists the possible symptoms.

Abdominal Pain, Achiness (Generalised), Acrodermatitis Chronica Atrophicans/ ACA, Alcohol – Extreme Effects Of, Anorexia, Anxiety Attacks, Arthritis, Back Pain, Balance Problems, Bell’s Palsy, Bladder Problems, Blindness, Blood Pressure – Raised, Bone Erosion, Bone Pain, Bowel Problems, Bradycardia – Slow Heart Beat, Brain Fog, Breast Discharge, Breast Pain, Breathlessness – Air Hunger, Carpal Tunnel Syndrome, Chest Pain, Chills, Cholesterol – Raised, Choroiditis, Clicking Joints, Cold Feet, Confusion, Conjunctivitis, Constipation, Costochondritis / Ribcage Pain, Cough (Non-Productive), Cramps, Deafness / Hearing Loss, Dental Pain,
Depression, Diarrhoea, Difficulty Concentrating, Disorientation, Diverticulosis / Spastic Colon, Dizziness, Dyslexia, Ear Pains, Encephalitis/ Encephalopathy, Erythema Migrans Rash, Facial Pain, Facial Palsy, Fasciculations / Muscle Twitches, Fatigue, Fever,
Fibromyalgia, Floaters, Flu-Like Symptoms, Fluctuations of Symptoms, Foot Pain, Forgetfulness, Hair Loss, Hallucinations, Headache, Hearing Loss, Heart Block, Heart Problems – ECG Abnormalities, Heartburn, Hepatitis, Herxheimer, Hoarseness, Hyper Sensitive Hearing, Hyperacusis – Sound sensitivity, Inability to Concentrate, Inability to Remember Words, Insomnia, Involuntary, Jerking, Limbs and Trunk, Iritis, Irritable Bowel, Jaw pain/ Temporomandibular joint disord, Joint Problems, Joint Swelling, Knee Joint Pain, Libido – Loss Of, Light Sensitivity, Liver Problems – Raised Enzymes, Malar (Facial) Rash, Marked Personality Changes,
Memory Loss, Meniere’s Disease, Meningitis, Menstrual Irregularities, Miosis – Decreased Pupil Size, Mood Swings, Motion Sickness, Muscle Aches, Muscle Spasm, Myoclonic (Involuntary) Jerking, Nausea, Neck Pain, Nerve Conduction Defects, Nightmares, Numbness, Optic Neuropathy, Palpitations, Panic Attacks, Paraesthesia / Abnormal Skin Sensations, Paranoia, Photophobia, PMS – Pre-Menstrual Syndrome, Psychiatric Problems, Ptosis – Drooping Eyelid, Rash, Retinal vasculitis, Reynauld’s Syndrome – Cold Hands & Feet, Seizure, Shivering, Shooting Pains, Shortness of Breath, Shoulder Pain, Skin Sensitivity, Sleep – Excessive, Sleep Apnoea, Sleep Disturbances, Sleep Inability, Slurring of Speech, Smell Sensitivity, Sore Throats, Speech – Slurred, Slow, Speech Errors, Spinal Disc Problems, Stiff Joints, Stiff Neck, Swallowing Difficulty / Dysphagia, Sweating (Profuse), Swollen Glands, Symptom Flares – Approx 4 Weekly, Tachycardia – Fast Heart Beat, Tendonitis, Testicular Pain, Tingling of Extremities,
Tinnitus / Ringing in Ears, TMJ – Jaw Pain / Stiffness, Tongue Numbness, Tongue Pain, Tooth Pains, Tremors / Shaking, Uveitis,
Vasculitis – Circulation Problems, Vertigo, Vibration Sensitivity, Visual Disturbances, Vomiting, Weakness or Paralysis, Weight Gain, Weight Loss, Word Bloc.

Information on Involvement of the Human Brain and Central Nervous System

As more becomes known about the possible long-term effects of neurological Lyme disease, also known as Lyme borreliosis, it becomes imperative that both the general public and medical professionals are made more aware of this disease.

The organisms that cause Lyme disease in Europe include at least three species within the bacterial genus Borrelia. These are Borrelia burgdorferi sensu stricto, Borrelia garinii and Borrelia afzelii.

People with this disease may develop an extensive range of symptoms that affect both the body and the mind. In many cases these symptoms are similar to those that may develop in the disease syphilis. This is because these bacterial (spirochaetal) diseases are closely related.

What is the Role of the Doctor?

Doctors from many disciplines need to be aware of the infections caused by these bacteria. Otherwise, the crucial diagnosis of Lyme disease may be missed.

If left untreated, there is a high risk that the patient will start suffering a great range of bodily and mental symptoms. The mental symptoms that develop may mimic other brain disorders. They can occur in any person at any age, including children. Therefore it is essential that doctors diagnose their patients correctly and offer the right treatments as soon as possible.

What are ticks and what do they look like?

Ticks are small, blood sucking arthropods related to spiders, mites and scorpions. There are many different species of tick living in Britain, each preferring to feed on the blood of different animal hosts. If given the opportunity some of them will feed on human blood too.

There are 3 stages of the life-cycle: larva, nymph, and adult.

To the naked eye the larvae look like specks of soot, while nymphs are slightly larger, pinhead or poppy seed size. With their eight legs, adult ticks resemble small spiders.

Once an adult tick has started to feed, its body will become filled with blood. As the blood sac fills it generally becomes lighter in colour and can reach the size of a small pea, generally grey in colour. The tick bite itself is totally painless and most people will only know they have been bitten if they become aware of a feeding adult tick attached to them. However, it is the pinhead size nymph that is the most likely to bite you.

What do ticks eat?

Ticks feed on the blood of just about any bird or mammal and some reptiles too. They pick up Lyme disease and other infections from these animals, e.g. mice, voles, squirrels, blackbirds, pheasants and seabirds, which naturally carry the diseases. Ticks carry more diseases than any other invertebrate host. If an infected tick subsequently bites you, it may transfer one or more of the diseases into your bloodstream.

A tick can be born with the disease that its infected mother tick carries. So, all three stages of the life cycle, larva, nymph and adult, are capable of transmitting disease.

When are ticks active?

Cold temperatures reduce tick activity, so ticks are most active from April to October. During warm winters & in certain areas of Britain, ticks ‘quest’ for blood throughout the whole year. Ticks may survive for more than a year without food & their bodies can remain in a dormant state for long periods. Because their bodies dry out easily, lack of moisture can be fatal to them at these times, e.g. hot, dry summers & very cold or dry winters.

Where are ticks active?

Ticks can survive in many places but prefer slightly moist, shady areas such as grass, bracken, bushes and leaf litter. This is also where the animals they feed on are most likely to visit. Ticks can be found in both rural and urban locations. They are least likely to live in short grass or dry heather.

Do all ticks carry diseases?

There are ‘hotspot’ locations throughout Britain where tick activity has been linked with cases of one or more of the tick-borne diseases. The reality is that we do not know what percentage of ticks are infected in such areas. Even less is known about other areas of the country where ticks may be present in large numbers but the link between ticks and disease symptoms has not been made. For example, not many people realise that Lyme disease is known to be present in central London parks.

Where & for how long will the tick bite me?

Many people are unaware that they have been bitten because the ticks are tiny and their bites are usually painless. Ticks can attach anywhere on your body, so you do need to check all over. For adults it is particularly important to check armpits, groin, navel, neck and head. In addition, on children, ticks are also frequently found on the head at the hairline.

There are ongoing debates as to how long a tick must remain attached to you before transmitting a disease. The minimum length of time is not known, but it is certainly an outdated fallacy that a tick must remain attached for two days. It makes sense that the longer a tick is attached, the more chance you have of being infected by any disease that it carries. However, some research has shown that at least one of the tick-borne diseases, Ehrlichia can be transferred almost immediately.

If an infected tick bites me, will I become ill?

The majority of people who are bitten by a tick, do not experience disease symptoms. In some instances this will be because the tick was not infected. In other cases people can remain asymptomatic (without symptoms) although they do actually carry the disease. Some of these people may never have symptoms, while others can start to experience illness at a later time in their life. However, some victims can start feeling noticeably ill within days or weeks of being bitten. The majority of people may never make the link between their illness and a tick bite.

What diseases can a tick carry?

Three of the diseases that can be caught from a tick bite in Britain are, Lyme borreliosis, Babesiosis and Ehrlichiosis. Globally, the list of diseases is much longer.

Lyme disease or Lyme borreliosis [bore-EL-ee-OH-sis] is caused by bacteria called Borrelia. Early symptoms can develop within weeks. They may include tiredness, chills, fever, headache, muscle and/or joint pain, swollen lymph glands and blurred vision. A characteristic skin rash called erythema migrans may appear. It is generally a circular rash that may clear in the centre, resulting in a “Bull’s eye” appearance. It can expand and move around the body.

If early symptoms are not recognised, serious complications can develop weeks, months, or even years later. Later stage symptoms include arthritis in the large joints, which can recur over many years. Nervous system problems are common, e.g. numbness, meningitis (with fever, stiff neck and severe headache), Bell’s palsy (paralysis of the facial muscles) and memory problems. Some people experience irregularities of the heart rhythm.

Lyme disease should be diagnosed by a physical examination and medical history. This clinical diagnosis may in some cases be supported by laboratory testing. Diagnosis based on tests alone is not reliable – a negative result does not mean that the disease is not present. Symptoms can mimic those of other diseases. Diagnosis is easiest when there is a skin rash but this occurs in under 50% of patients.

Babesiosis [bab-EE-see-OH-sis] is caused by the Babesia parasite, an organism similar to that causing malaria. This attacks the red blood cells and its existence can only be shown by laboratory identification of the parasite. Symptoms, if any, begin with tiredness, loss of appetite and a general ill feeling. In severe cases, as the infection progresses, fever, drenching sweats, muscle aches and headache can follow, leading to complications such as very low blood pressure, liver problems, severe haemolytic anaemia (a breakdown of red blood cells) and kidney failure. Other cases usually have a milder illness and often get better on their own. The symptoms can take from 1 to 12 months after the tick bite to appear and can last from several days to several months.

Ehrlichiosis [air-LICK-ee-OH-sis] is a bacterial attack upon the white blood cells. Symptoms usually appear 3 to 16 days after a tick bite. The most common symptoms are sudden high fever, tiredness, major muscle aches, severe headache, and, in some cases, a rash. Diagnosis is difficult, even in severe cases. Diagnostic tests are not widely available and the diagnosis of Ehrlichiosis is usually based on symptoms and a history of exposure to ticks. Severely ill patients can develop abnormally low numbers of white blood cells or platelets and kidney failure.

Some ticks carry all three of the above diseases at the same time and can transfer them to you in a single bite. The resulting symptoms can be extremely confusing and liable to misdiagnosis. Treatment in such cases is very difficult.

How many people remain undiagnosed or misdiagnosed?

There is a widespread lack of knowledge and awareness in Britain regarding tick-borne diseases. Many people with typical symptoms will not actually be tested for the presence of even the most common of the diseases. For those who are tested for one or more of the possible diseases, a negative (and thus inconclusive) test will generally result in further investigation being abandoned. Few people will be lucky enough to see a GP with sufficient knowledge to give a clinical diagnosis, i.e. based on symptoms, knowledge of a tick bite event, etc.

For many years, criticism has been aimed at the clinical unreliability of laboratory tests. It is suggested that official statistics for prevalence of tick-borne diseases in Britain are an underestimate of the true picture.

It is likely that the majority of people suffering from tick-borne diseases do not receive treatment at all because they remain undiagnosed or misdiagnosed.

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In Britain, medical education is highly variable regarding diseases transmitted by ticks. Much reference literature about diagnosis and treatment protocols requires updating. It may be left to you, the patient, to continue to emphasise that symptoms were linked to a tick bite.

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Can I avoid ticks?

It is very difficult to avoid ticks totally because they can be found in urban parks and gardens, as well as typical countryside locations. It is possible for you or your pets to bring ticks into your home. The best strategy is ‘awareness’. Check yourself for ticks whenever you have visited a place where they may have been present. Do this both immediately and for up to three days after any outdoor visit. This may allow you to see any adult tick that has attached. Once it has started to feed, its blood-engorged body will make it very visible. If you find a tick, remove it as soon as possible.

Ticks can locate their prey by detecting host body heat, carbon dioxide and ammonia. They may crawl towards a stationary host or stretch out their front legs, equipped with tiny ‘grappling hooks’ in order to attach to a passing host. So anything you can do to thwart these tactics may help you to avoid tick bites. There are many suggestions about how to stop ticks reaching your skin but there has been little measurement of their effectiveness. Awareness still remains the best strategy.

You should make it more difficult for a tick to reach your skin by wearing shoes rather than sandals and tuck long trousers into socks.
Ticks can be more easily seen on white or light-coloured clothing.
Avoid a tick’s favourite places by walking in the middle of paths and check yourself after sitting on logs or leaning against tree trunks.
Use a light coloured blanket for picnic, it is then easier to check for ticks.
Check your pets for ticks when they come into the house and especially keep them off bedding and soft furnishings. Consider using anti-tick pesticides for pets, consult your veterinary surgeon for advice.
Consider spraying your clothing with an effective anti-tick pesticide. There are a variety in outdoor shops and chemists. Make sure you follow the instructions carefully.
How do I remove a tick?

Your main aims are to remove all parts of the tick’s body and to prevent it releasing additional saliva or regurgitating its stomach contents into your bite wound.

DO use a proprietary tick removal tool. The two types of removal tool available are illustrated below. These tools will grip the head of the tick.

 

* Alternative Methods : With pointed tweezers grasp the tick as close to the skin as possible without squeezing the tick’s body, pull the tick out without twisting – there may be considerable resistance.

Illustrations are for general guidance and do not represent any particular species.

If no tools are available, rather than delay use a cotton thread – Tie a single loop of cotton around the tick’s mouthparts, as close to the skin as possible, then pull gently upwards and outwards.

DO commence by cleansing the tweezers with antiseptic. After tick removal, cleanse the bite site and the tweezers with antiseptic.

DO wash hands thoroughly afterwards.

DO save the tick in a container in case you develop symptoms later (label with date and location). The Health Protection Agency are currently running a scheme to investigate ticks, details available at www.lymediseaseaction.org.uk/information/tick.htm or from the HPA at www.hpa.org.uk.

DO NOT squeeze or twist the body of the tick, as this may cause the head and body to separate, leaving the head embedded in your skin.

DO NOT use your fingernails to remove a tick. Infection can enter via any breaks in your skin, e.g. Close to the fingernail.

DO NOT crush the tick’s body, as this may cause it to regurgitate its infected stomach contents into the bite wound.

DO NOT try to burn the tick off, apply petroleum jelly, nail polish or any other chemical. Any of these methods can cause discomfort to the tick, resulting in regurgitation, or saliva release.

What is the recognised treatment regime in Lyme Disease?

The LDA follows the Ilads (International Lyme and Associated Diseases Society) guidelines on treatment of Lyme Disease. This is view is supported by Clinical Answers, the NLH’S Primary Care Question Answering Service* for the NHS.

The following extract is taken from a Q&A are dated 14th September 2005.

http://www.clinicalanswers.nhs.uk/index.cfm?question=1104

What is the recognised treatment regime in Lyme Disease?

“The early use of antibiotics can prevent persistent, recurrent, and refractory Lyme disease.

The duration of therapy should be guided by clinical response, rather than by an arbitrary (i.e., 30 day) treatment course.

The practice of stopping antibiotics to allow for delayed recovery is not recommended for persistent Lyme disease. In these cases, it is reasonable to continue treatment for several months after clinical and laboratory abnormalities have begun to resolve and symptoms have disappeared.”

However, the full section in the guideline gives much more detail and we recommend you read that (http://www.guidelines.gov/summary/summary.aspx?view_id=1&doc_id=4836)

These may seem long winded, but its worth reading, looking at the respective websites and doing a little independent research.

This is for your own good, we love shooting, lets keep us shooting in good health.