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FOR MORE INFORMATION ON BABESIOSIS, EHRLICHIOSIS, LYME DISEASE, ROCKY MOUNTAIN SPOTTED FEVER, AND OTHER TICK-BORNE DISEASES, PERFORM KEYWORD SEARCHES ON THE WEBSITE OF THE CENTERS FOR DISEASE CONTROL: WWW.CDC.GOV. MASSAGE Cautions regarding massage for a client who has Lyme disease include several issues. Because the joint inflammation can be acute and painful, this obviously limits intrusive bodywork in painful areas. Any neurological defect, especially numbness or tingling, requires adjustments because the client may not be able to give accurate feedback about pressure or comfort. And finally, cardiovascular complications may make some types of massage impractical. Communicating with the client's healthcare team can inform these choices for everyone's best benefit. OTHER TICK-BORNE DISEASES B. Burgdorferi is not the only pathogen that ticks can share with other hosts. In fact, a single tick bite can transfer several microbial pathogens that can cause a wide range of diseases. Below is a short list of other tick-borne infections that are found in the United States. Because they are not as common as Lyme disease, they may not be well- researched, and less is understood about how they affect human function. EHRLICHIOSIS Ehrlichiosis is infection with any of a group of bacteria in the genus Ehrlichia. Lone star ticks and black legged ticks are vectors. It was first identified in 1935 and can affect dogs, cattle, sheep, goats, and horses, as well as humans. Early signs resemble those of Lyme disease, but when it occurs in young children a spotty rash may be present as well. Ehrlichiosis can cause extensive damage to several body systems and must be treated aggressively, especially in immunocompromised people. It is responsive to antibiotics, but these must be administered as quickly as possible to minimize the risk of organ damage. BABESIOSIS Babesiosis is an infection with one of a group of protozoa called Babesia. This pathogen has part of its life cycle in the blood of common white-footed mice. In a secondary mammalian host, it invades and disables red blood cells in a mechanism that is similar to the protozoa that cause malaria. Indeed, symptoms of babesiosis mimic malaria to the extent that it can be difficult to distinguish between the two. Babesiosis is most dangerous for people who are immunocompromised. In the United States it occurs in the same regions where Lyme disease is prevalent. It is treatable, and most patients recover fully. ROCKY MOUNTAIN SPOTTED FEVER Rocky Mountain spotted fever (RMSF) is an infection with a bacterium called Rickettsia rickettsii. This was named for Howard T. Ricketts, an early pathologist who ironically died of typhus, another rickettsial disease. RMSF is spread through the bite of the American dog tick, the Rocky Mountain wood tick, and other species of hard ticks. Its name is a bit misleading: it was first identified in the Snake River Valley of Idaho, but it ranges from Canada to South America. It is especially common in Florida, Georgia, Oklahoma, North Carolina, and South Carolina. RMSF is rare (about 250–1,200 cases are reported each year), but quite serious. R. rickettsii live and multiply in the endothelial linings of blood vessels, resulting in localized internal bleeding. On the skin, this shows as a spotty rash: a nickname for this infection is "black measles." Internally, it can cause extensive organ damage. Fortunately, it is sensitive to antibiotics, and can be treated successfully if caught early. SOUTHERN TICK-ASSOCIATED RASH ILLNESS A final tick-borne illness creates a similar rash to that seen with Lyme disease, but the causative agent has not been identified. This is Southern tick- associated rash illness (STARI), and it is spread by lone star ticks. Unlike Lyme disease, it does not cause arthritic, cardiovascular, or neurological problems. It is treatable with antibiotics. FURTHER STUDY NEEDED It's hard to make a case that ticks are anything but disgusting, nasty, disease-carrying parasites. But the truth is, they were here first. We are now dealing with tick-borne infections in greater numbers than ever before, because we have expanded into territory where we become their accidental hosts. Further, tick saliva is rich with a number of fascinating substances: analgesics, anti-inflammatories, and anticoagulants that allow them to suck our blood without our even noticing. As we study them we are adding to our own arsenal of potentially beneficial chemicals that may someday promote, rather than threaten, our health. teaches several courses at the Myotherapy College of Utah and is approved by the NCTMB as a provider of continuing education. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2009), now in its fourth edition, which is used in massage schools worldwide. Werner is available at www.ruthwerner.com or wernerworkshops@ruthwerner.com. Ruth Werner is a writer and educator who NOTE 1. Dave Simser, "Got Blood? Deer Ticks (Ixodes scapularis) and Lyme Disease (Borrelia burgdorferi)," Conservation Perspectives: The On-line Journal of the New England Chapter of the Society for Conservation Biology Inc. 2005. www.nescb.org/epublications/spring2001/ gotblood.html (accessed summer 2008). visit massageandbodywork.com to access your digital magazine 111