Dr. Kaplan Explains Why Lyme Disease Is a Backyard Problem

A mild winter and rising temperatures have created ideal conditions for ticks in Northern Virginia, increasing the risk of Lyme disease and other tick-borne illnesses. Dr. Gary Kaplan explains why the greatest risk may be closer than you think—right at the edge of your backyard—and shares key symptoms, prevention strategies, and the importance of early detection.

‘Have a high index of suspicion’: Northern Va. doctor warns of rising Lyme disease risk as tick season peaks

by Cameron Delean, InsideNoVA

Northern Virginia residents should brace for a surge in Lyme disease and other tick-borne illnesses as warmer weather and a mild winter create ideal conditions for ticks.

“This year we didn’t have a really severe winter,” McLean-based Dr. Gary Kaplan told InsideNoVa this week. “The ticks arrive, and the nymphs, in particular the newborn immature ticks, are the ones that can do the most damage in terms of spreading the disease. They are thriving right now.”

Those nymph-stage ticks are so small that people often never see them.

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“The problem with the nymphs is … they’re little dots that look like a speck of dirt,” Kaplan said. “There’s a high probability of not seeing them, so that’s why [you] take extra precautions.”

Backyard risk

Northern Virginia is a Lyme-endemic area with a “very high concentration of ticks,” Kaplan said, adding that residents don’t need to head deep into the woods to be exposed.

“You don’t have to go hiking on the Appalachian Trail to get Lyme disease, as what a lot of people think,” he said. “The highest risk, especially in this area, [is] at the edge of most people’s backyards.”

He pointed to the region’s sizable deer and white-footed mouse populations as key drivers.

“Those are the creatures that carry Lyme disease and spread it,” Kaplan said. “So, combination of the relatively mild winter, very high concentration of ticks already in the area, and then lots of opportunities for the ticks to come in contact with people.”

Ticks typically wait on tall grass or brush at the edge of yards before latching on.

“Ticks are hitchhikers,” he said. “They climb out the edge, tall grass, and they’ll hop onto you.”

How to lower risk

Kaplan urged homeowners to manage their yards and take basic personal precautions.

“In and around the house, I would make sure that I don’t put wood piles next to the house … because ticks like moist, dark areas,” he said.

Kaplan recommends laying mulch or gravel between lawns and tree lines, using tick repellent such as DEET, considering tick-repellent clothing and wearing light-colored clothes to make ticks easier to spot.

“When you get inside, do a tick check, and you need to look in places where you wouldn’t necessarily think,” Kaplan added, noting behind the knees and around the waistband as common hiding spots. Showering after gardening or yard work can also help remove ticks.

“There’s lots you can do to protect yourself,” he said, “but you’ve got to be cautious, and you’ve got to be attentive.”

Unexpected symptoms

One of the biggest challenges is that early tick-borne illness often looks like something else.

“If you feel like you’ve got a flu in the middle of July, high on your list should be a tick-borne illness,” he said.

Lyme disease can start with fatigue, headache, low-grade fever, neck stiffness and other flu-like complaints. Other tick-borne infections, such as Bartonella, can bring additional neurological symptoms, swollen lymph nodes, purple stretch-mark-like rashes, night sweats and “air hunger,” according to Kaplan.

“You have to think in terms of the fact that many ticks carry multiple diseases, not just one,” Kaplan said. “These different kind of presentations [require a] high index of suspicion in order to be able to diagnose.”

One classic Lyme symptom, the bullseye rash, while a significant indicator to look for, is not always present.

“That bullseye rash only appears in about 25 [to] 30% of people, and it’s not necessarily a classic bullseye,” Kaplan said. “It may look like a bruise, it may look like just a red area. Then it goes away.”

Sudden onset of facial nerve paralysis should also prompt immediate concern.

“Bell’s palsy is a classic symptom of Lyme disease,” he said. “Seeing that kind of a symptom, [you should] immediately think about Lyme disease.”

Chronic Lyme

If Lyme disease is missed or not fully treated, Kaplan said it can progress to chronic disease with serious, lasting consequences.

Over time, patients can develop severe fatigue, brain fog, difficulty concentrating, neck stiffness and joint pain that moves around the body. In later stages, Lyme disease can affect the heart and nervous system.

“Chronic Lyme can be quite devastating and have a lot of severe consequences,” Kaplan said. He added that Lyme getting into the brain can lead to seizures and debilitating headaches.

Most tick-borne diseases are treated with antibiotics, but the specific medication depends on the organism, he said.

Kaplan also warned that some patients and clinicians place too much confidence in early negative test results.

“If you test too soon, you’re going to miss the disease,” he said. “It takes two to three weeks, four weeks before the testing we do is positive, because the testing is based on the immune system’s response to the disease.”

For patients who develop the characteristic bullseye rash, he said, doctors should not wait.

Kaplan said people in Northern Virginia need to recognize the risk and act quickly when symptoms appear.

“Have a high index of suspicion,” he said. “People need to think about this disease.”

A mild winter and rising temperatures have created ideal conditions for ticks in Northern Virginia, increasing the risk of Lyme disease and other tick-borne illnesses. Dr. Gary Kaplan explains why the greatest risk may be closer than you think—right at the edge of your backyard—and shares key symptoms, prevention strategies, and the importance of early detection.