Thank you for your interesting and well-done article on Lyme disease and other tick-borne disorders in Maine by Michael O’D. Moore in the March 30-31 edition of the Bangor Daily News. Your information was well-researched and is a good step forward in raising awareness of the problem existing here in our own back yard.

Respectfully, I would add that Ixodes tick activity begins to increase in April (or if the season is particularly mild, before that) when the adult females from the prior season who have not taken a blood meal begin questing. Generally by late April, early May, the nymphal ticks begin to become active, with the peak diagnosis of early Lyme cases coming four to six weeks later in June and July. The nymphs remain active till around August; larval ticks become active mid-summer, and a new group of adult ticks begin questing in or about September.

Tick checks are a crucial step in detecting the attached ticks and must include not only visual inspection of the body with attention to the “hot spots”: behind the knee, armpits, groin, scalp line, behind the ear, in folds of flesh, but also palpation, that is, feeling for the very small, poppy seed sized nymphs. Fewer than 50 percent of those diagnosed with Lyme disease recall a tick bite (not surprising if the tick most likely to be responsible is the size of the period at the end of this sentence).

Almost equally uncommon is the recognition of a rash at the site of the tick attachment, for which there are a number of explanations, but which may help to explain how some individuals can go long periods of time without being diagnosed properly. But, as is well illustrated in Dickey’s story, even if you observe a tick attachment and have a rash, the unfamiliarity on the part of Maine physicians with Lyme disease and the pitfalls inherent in its diagnosis plays an important part in the disease not being treated early, when it is most able to be eradicated or well controlled. I have had many individuals tell me of their plights in being diagnosed, including the contention by well-respected clinicians that “we don’t have Lyme disease here,” or “there have only been three cases of Lyme in the state.” All evidence to the contrary.

Medicine changes slowly, maybe we all change slowly. Still, if the continued message from individuals in authority remains that there is not a significant problem in Maine, I fear we will sentence people to unnecessary morbidity. Certainly parts of Maine already have case rates similar to those in southern New England. And while much of the state, using current data, appears to present lower risk, it is not NO risk.

Tick hygiene is wise – everywhere. It should be like buckling your seat belt, putting on a life jacket, or wearing a bike helmet. Most of the times you do it, it turns out to have been unnecessary. But you still do it every time because you can’t be certain which time it will be necessary. Statistics are interesting that way, aren’t they? Even when something is a low likelihood event, when it happens to you, the likelihood is 100 percent.

Beatrice M. Szantyr, M.D. lives in Lincoln.