DR. HOOK- Ticked off: You don't have to live in the Rockies

John Denver's songs confuse me because I think they all sound alike. Nature, nature, nature. For example, I thought the lyrics to "Rocky Mountain High" were "Rocky Mountain High, West Virginia," instead of Colorado. West Virginia is in "Country Roads" (and, yes, I know all the state capitals, but I thought it was poetic license).

Then while my friends were singing "Rocky..." on my professional karaoke machine, they said he was singing about getting high on drugs. Na-uh! I'm so naïve. So why didn't he just sing, "Rocky Mountain Spotted Fever, West Virginia– er, Colorado"?

 Rocky Mountain Spotted Fever (RMSF) sounds like it should only be in the Rockies, but it was first described in Snake River Valley, Idaho. RMSF is in all the Americas, and in the US is most common in the Southeast and the south central states. In fact, I'm writing this article because Anne, a reader and a viewer, asked me to talk about it since her spouse is recovering from RMSF in Charlottesville. 

 The brown dog tick, Rhipicephalus sanguineus, is thought to carry the bacterium (not "bacteria" according to one of my readers– so there you go, doctor!) that causes RMSF. Rickettsia rickettsii is this bacterium, which sounds redundant like that Billy Idol song, "Mony Mony" (may I never hear that song at another wedding).

 So Fido needs to be checked every day before Mr. Tick jumps onto you and bites you. Probably it takes at least 24 hours before a tick can infect you, so people should look for ticks on their own bodies every day, especially those who live in rural or suburban areas. Outdoor types are more at risk for tick bites because ticks like grassy, bushy areas. RMSF is most common in the spring and early summer and in middle-aged white men.

 Once Rickettsia rickettsii infects the body, the incubation period is about 2-14 days. Then flu-like symptoms start, in particular the fever (as in the name of the disease). Body aches, headache, and nausea occur. For kids, severe belly aches are more common. 

 Rash? Oh, yes! That's the funny part of this disease. The rash usually doesn't occur until 3-5 days after the onset of symptoms. (So maybe this disease should be renamed, "Rocky Mountain though more common in the south Fever with a late Spots.")

 The non-itchy rash starts on the wrists and ankles and spreads out to the whole body, including the palms and soles. The tiny red spots become somewhat confluent into large polka dots. ("She wore an itsy bitsy teeny weeny red polka dot...") But in 10 percent of the cases, a rash does not occur. And since the rash comes rather late at times, depending on it for diagnosis can lead to problems. The later a person is treated for RMSF, the higher chance of mortality. Tick-tock-tick-tock– literally.

 Advanced RMSF can cause bleeding, swelling, coughing, gangrene, and neurological problems including seizure. The overall mortality rate is about 3 percent, although one study showed it was 6.5 percent for those treated by day five of illness, and 22.9 percent for those treated after day five.

 Early diagnosis cannot be made from blood tests. So treatment is based on history and physical exam. Bringing in the tick doesn't usually help because a diagnosis isn't going to be made from it.

 Antibiotic is usually effective. Prophylaxis with bug repellent (so you can smell OFF-ful), and wearing long tucked-in pants and long-sleeve shirts (I know, not fashionable) in the "wilderness" can keep ticks off the body.

 So, as far as Anne's husband is concerned, after four weeks in the hospital, I hope he's doing better. If he's ticked off about getting RMSF, well... he was. I would not recommend singing "Sweet Surrender" to cheer his spirits, and especially not "Rocky Mountain High."

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your question.