1. Parental Surveillance Guide to Lyme’s Disease CONFIDENTIAL1

2. 2 Agenda Establish objectives for this seminar Define Lyme’s disease Discuss warning signs Know your options for treatment Understand test results Discuss long term affects Share prevention strategies

3. CONFIDENTIAL3 Objectives Gain awareness of disease in your area. Know how to identify symptoms. Identify a step wise approach in finding the diagnose. Understand what your doctor is telling you. Apply prevention strategies. Learn where to get help in the state of Maryland.

4. CONFIDENTIAL4 Lyme’s in your backyard? The Center for Disease Control and Prevention (CDC, 2011) listed the top 8 states with the highest number of reported Lyme’s disease cases. Pennsylvania New York New Jersey Massachusetts Connecticut Wisconsin Rhode Island Maryland Minnesota

5. Lyme’s disease on the rise Reports in Maryland has more than doubled in the last 10 years. The number of reported cases in Maryland increased from 691 to 1,235, during 2003 to 2005 (CDC, 2011a). The number peaked in 2007 at 2,576 cases and the last report in 2009 revealed 1,466 cases (CDC, 2011a). Most common among boys ages 5-9 years old The true incidence of Lyme’s disease in not know. –See link for further readinghttp://www.accessmedicine.comhttp://www.accessmedicine.com CONFIDENTIAL5

6. 6 What is Lyme’s Disease? Tick borne infection B.burgdorferi. Transmitted by Ixodes Tick Ixodes Scapularus: Most common East Coast Reservoir deer, rodents Tick cycle Feed once during each three stages »Larvaelate summer »Nymphfollowing spring-early summer »Adultlate fall

7. Red Flag Warning Signs Bulls eye lesion Fatigue Flu-like symptoms –Not having the energy to play with friends –Wanting to go to bed –Continually expressing their legs are sore CONFIDENTIAL7

8. 8 Figure 1.Pictures of erythema migrans. From “American Lyme’s disease foundaton,” 1993, Journal of Science, (260), p. 1610-1616. Reprinted with permission. Figure 2. Classic erythema migrans. From” eMedicine,” 2008. Image reprinted with permission. Target Lesion Do not dismiss other lesions There is no one form of erythema migrams

9. First remove the TIC CONFIDENTIAL9

10. What to expect Late disease Second Stage Early Stage 2-3 years 2-4 months 2-3 weeks CONFIDENTIAL10

11. Lingering Lyme’s Disease Your child’s symptoms What is normal Legs Ache “Growing pains” Decrease in appetite Picky eaters CONFIDENTIAL11 Your child’s symptoms What is NOT normal Legs Ache Juvenile Arthritis Decrease in appetite Fatigue Temperature

12. Lab Results Conclusive Results (+) ELISA (+) Western Blot (-) Symptoms after treatment Inconclusive Results (-) ELISA (-) Western Blot (+) Symptoms after treatment Things to consider PCR test Juvenile arthritis symptoms may persist Antibiotics are not the choice of treatment. CONFIDENTIAL12

13. Where to bring your child No insurance Try to avoid the emergency room Refer to Clinical List for Maryland Doctors http://www.needymeds.org/free_ clinics.taf?_function=list&state=m dhttp://www.needymeds.org/free_ clinics.taf?_function=list&state=m d Insurance Go to your pediatrician Rheumatologist in Maryland http://www.hopkinschildrens.org/ staffDetail.aspx?id=3112http://www.hopkinschildrens.org/ staffDetail.aspx CONFIDENTIAL13

14. CONFIDENTIAL14 Prevention Strategies Check your children Must check for specific rashes Avoid tick-infected areas High season in your area Does bug spray help with ticks?

15. CONFIDENTIAL15 Patient Education Material Pediatric Information –http://www.uptodate.com/contents/patient-information-lyme- disease-the- basics?source=search_result&search=lyme%27s+disease&s electedTitle=21%7E150http://www.uptodate.com/contents/patient-information-lyme- disease-the- basics?source=search_result&search=lyme%27s+disease&s electedTitle=21%7E150 Lyme’s Disease Specialists Holtorf Medical Group »http://aitrk3.holtorfmed.com/lyme- disease.html?aitrk=HM3&teng=go&geng=lyme&aeng=ly me3&keng=lyme%20disease&meng=phttp://aitrk3.holtorfmed.com/lyme- disease.html?aitrk=HM3&teng=go&geng=lyme&aeng=ly me3&keng=lyme%20disease&meng=p Lyme’s Disease: Supplements and More The Healing Arts Partnership »http://www.treatlyme.net/http://www.treatlyme.net/ American Lyme’s Disease Foundation »http://www.aldf.com/lyme.shtmlhttp://www.aldf.com/lyme.shtml

16. Reference CONFIDENTIAL16 1. Center for Disease Control and Prevention. Morbidity and mortality weekly report. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5623a1.htm 2. McPhee, S., Maxine, A., & Radow, M. (2011). Current medical diagnosis and treatment. Retrieved from http://www.accessmedicine.com/content.aspx?aID=18802&searchStr=ly me+disease 3. Shapiro, E. (2011). Lyme disease: Clinical manifestations in children. Retrieved on October 16 th 2011 from http://www.uptodate.com/contents/lyme-disease-clinical-manifestations- in- children?source=search_result&search=lyme%27s+disease&selectedTitle =1%7E150 3. 4.

17. CONFIDENTIAL17 Questions and answers