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Wellness Corner - Lyme Disease in Sonoma County


Lyme Disease in Sonoma County

by Dr. Gary Pace

As a primary care doctor in Mendocino and Sonoma counties for 20 years now, I have had to learn a fair amount about Lyme disease. In my experience, this topic remains one of the most contentious issues in contemporary medicine. The conventional medical community has adopted a very narrow stance towards the diagnosis of Lyme. Some patient groups have consistently challenged these conservative perspectives by wanting access to more sensitive tests and aggressive treatment.

Prevalence of the Spirochete: A recent article in the Press Democrat discussed a Stanford study analyzing the prevalence of the Lyme spirochete in ticks at Annadel Park. “Researchers found six immature blacklegged ticks, also known as deer ticks, per 100 meters on trails in Annadel, the second-highest concentration of the tiny arachnids reported in the study. “ Nearly 10% of these ticks tested positive for the Borrelia spirochete associated with Lyme. 

A slightly different perspective comes from the Sonoma County Health Department, which regularly checks for the risk of Lyme in ticks that are submitted by the public. Almost 7000 ticks were tested between 2009 and 2014: 80 percent were the deer tick that can carry the Lyme disease-causing bacteria; only 2 percent of these actually had the spirochete. 

Prevalence of the Disease:  The Stanford study confirms what many in the local Lyme activist community have long suspected: there is a much higher risk of contracting Lyme disease in our area than previously thought. The researchers also suspect that the incidence of infested ticks is even higher in Mendocino County given the favorable conditions for tick populations.

Approximately 8 cases of Lyme are reported annually in Sonoma County. Almost certainly a significant under-representation, since in diseases with a disputed diagnosis, getting a clear count of the cases is challenging. 

Acute vs. Chronic: My approach to the diagnosis controversy has been to break it down into acute and chronic categories. The acute disease is fairly uncommon—I have treated 2 cases in the last year—and both sides of the discussion generally agree on the scenario. Someone with fever, joint pain, general malaise, the ‘bulls eye rash,’ and positive testing for Lyme on the conventional testing will generally get treated with antibiotics for a month or more. Quick diagnosis and aggressive treatment can be very helpful in reducing long-term problems.

Disagreements arise in the category of “Chronic Lyme.” In this constellation of symptoms, people generally have long-standing fatigue, chronic pain, depression, and overall malaise. Despite negative testing for Lyme at conventional labs, some specialized companies (namely IgeneX) often get positive Lyme titers for these patients. A variety of treatments are available—herbs, supplements—but mainly aggressive and long-term antibiotic courses are recommended by the people who treat these cases. The mainstream medical community essentially does not recognize this syndrome as a viable diagnosis, and often there are problems getting the antibiotics covered by insurance companies. 

Conclusions: I usually encourage patients to treat quickly if they have a suspicion that they were bitten by a deer tick that has been embedded for 24 hours or more. I generally recommend that people learn what the deer tick looks like, check themselves after being out in the woods or tall grass, and get their hands on appropriate antibiotics if they get bit. Taking one 200 mg dose of doxycycline shortly after getting bit by a deer tick and before symptoms appear has been shown to decrease transmission of Lyme in certain circumstances. If symptoms appear, go get evaluated for treatment.

For chronic Lyme, the much more complex situation, I recommend finding a provider that has a congruent healthcare philosophy with the patient. There are several “Lyme Literate” providers in our area, but the diagnosing and treatment can be very expensive, and extremely controversial and variable. Until there is some real consensus within the medical community, I think this arena will continue to be very frustrating for people who are suffering and can’t get clear answers.


I have Lyme. I live in south Texas . I never saw the tic but I did get tested and I did get bulls eye rash.  I thought only people living way up north would get it.
I had flu-like symptoms for 2 weeks, lost 20lbs, ankle feet and hands got very swollen.  

I was diagnosed with Lyme 3/19. No doctor here knew how to treat it. My primary doctors gave me doxy for two weeks but wouldn't give me anymore
and he wouldn't give anything for my joint pain or swelling. It was so bad I couldn't walk. 

I was seeing a nurse practioner also. Her husband's niece came out with Lyme and they told me about her doctor in Marble Falls, Texas. She is a Lyme-literate Doctor and thinks she me with my Lymes. 

This is a horrible disease and we need to find better testing and treatment fast.

Irma Garcia, South Texas

Dear Dr. Pace,

Thank you for your article on Lyme disease that appeared in the Gazette on Oct. 3, 2015.  I have a few comments. 

The Stanford study you mention actually found a density of 6 nymphal ticks per 30 meters of trail, not 100 meters.  That equates to about a tick every 16 ft. of trail.  That is quite high.  The Press Democrat article misquoted the study, which is where I presume you got your information.   Also, in Annadel they found 5/41 nymphal ticks positive for Borrelia.  That is 12%. One in eight. They were looking for both Borrelia burgdorferi and Borrelia miyamotoi.  They did not look for any of the other nine tick-borne diseases.  So in Annadel, they found a nymphal tick infected with Borrelia about every 130 ft. of trail.  No one has figured out how many ticks are infected when considering all the possible pathogens that are currently known.

The Sonoma County Health Dept. does indeed test ticks for Borrelia, but only B. burgdorferi and those tested are mostly adult ticks.  In California, it is the nymphal ticks that are more highly infected. Furthermore, their test is an IFA test that is only positive if there are approximately 100,000 spirochetes ( the Lyme disease pathogen) in the tick.  I got this information from Mr. Michael Ferris, Lab Director.  Salkeld’s study used a PCR test which is far more sensitive.

Sonoma County has told me they plan to ”continue counting 8-10 cases per year”, suggesting that the case counting process is flawed (to put it kindly).

Someone with a bull’s eye rash is CDC positive and needs no confirmatory lab test.  That patient should be treated without delay.  People who contract Borreliosis due to B. miyamotoi do not, apparently, get a bull’s eye rash and do not test positive on the currently available tests, which even the CDC says are insensitive.  I hope you do not require a positive test result before treating patients who show clinical signs of borreliosis.  Many of the diseases are transmitted in far less time even than the 24 hours you allow, and few people can actually pinpoint how long a tick was attached.  Indeed, many people don’t ever see the tiny, poppy seed sized nymphal tick that bit them, so if they find one tick you might want to assume that they were exposed to unobserved ticks as well, and your “24 hr” window of safety is not useful. 

Igenex Lab probably gets more positive test results because they also test for a California strain of B. burgdorferi, not just the New York strain that all other labs test for.  We are 3,000 miles away and have different strains and species.  What you test for does make a difference.

A single dose of doxycycline is not very effective.  Two doses of time-release doxy is better and a 10% azithromycin cream applied topically is apparently more effective than either.  Perhaps you could review the most current information.

Our west coast ticks are not called deer ticks.  “Deer tick” is a common name for Ixodes scapularis.  Our ticks are Ixodes pacificus.  Guy Kovner  of the Press Democrat made the same mistake. 

Once again, thank you for even bothering to treat patients with Borreliosis- many medical providers won’t do even that much in this County.  Unfortunately, most of them have been misinformed and cannot recognize most of the tick-borne illnesses that occur here.

Karen Miller, Healdsburg

Target Lyme




Hi.  Thank you for your response on the article on Lyme.  Your understanding of the science is much more nuanced than mine-- I am working from the current medical recommendations, some evolution through local experience and reading some of the alternative Lyme literature,  and then the PD article added onto this.  It seems that the prevalence of disease is much more common  than conventional thinking would suggest, more congruent with the data you have.  Hopefully, clinical practice catches up in the near future.
Thanks for your input.

Gary Pace

Hi there, my boyfriend believes he might have lymes disease and his doctor at kaiser says he doesn't know what's wrong with him. We would like him to see a specialist, but don't know where to find one. Do you have any suggestions on where to find a doctor in Sonoma county or any other surrounding counties? We'd greatly appreciate any info possible. Thank you, Bailey.


Hi Bailey and Kevin.  It sounds from your letter to the Gazette that you aren't feeling well and are wondering where to get help.  If you think you have Lyme and you are with Kaiser, the first step would be to get your doctor to run the conventional testing.  If they won't do that, or it is negative, then you have to decide where to go from there.

If you have Kaiser, your insurance won't pay for anyone outside of their system.  So, you will be looking at paying cash.  There are alternative clinics in the area that specialize in Lyme and other chronic conditions.  Hill Park in Sebastopol, Gordon Medical Associates in Santa Rosa are two that are particulalry interested in Lyme.  They work alot with alternative testing, herbs, and supplements.  They can be really expensive-- I think $400 for the first visit, and then all of the treatments.  There is a Lyme-specific doctor in Redwood Valley-- Dr. Gitlin, not sure what he charges.

Those are a few thoughts.  Hope it helps.

Gary Pace