A Guide to Ticks and Tick-Borne Diseases on Nantucket

Insights from Nantucket’s Leading Expert, Dr. Tim Lepore

When it comes to ticks and tick-borne diseases, few places experience such a high incidence rate as Nantucket, Massachusetts. This small, picturesque island is not only a popular tourist destination, but it’s also a hotbed for tick activity and related illnesses. To shed light on this critical public health issue, we recently spoke with Dr. Tim Lepore, the Chief of Surgery at Nantucket Cottage Hospital—and an all-around authority on ticks, Lyme disease, Babesia, and more. Dr. Lepore has been treating and studying these diseases for decades. His keen insights into the role of deer, mice, and even cats in the tick lifecycle offer a fascinating and essential look at how we can protect ourselves.

In this blog post, we’ll explore Dr. Lepore’s experiences with tick-borne diseases, delve into strategies to reduce tick encounters and underscore the best tick protection methods available, including Insect Shield® permethrin-treated apparel. 

Key Takeaways 

• Practice thorough tick checks every day

• Wear permethrin-treated clothing to repel ticks

• Keep brush and tall grass away from your home’s perimeter

• Learn the symptoms of Lyme disease, Babesiosis, Anaplasmosis, Tularemia, and Alpha-Gal syndrome

• When in doubt, seek medical advice—early treatment makes all the difference

The Tick Explosion on Nantucket

As Dr. Lepore explains, Nantucket is a “perfect storm” for ticks—specifically the Blacklegged Tick (also known as the deer tick). The island’s environment provides ideal conditions:

1. High Deer Population
   Nantucket’s deer population has ballooned over the last century, creating ample opportunities for ticks to feed and reproduce. Dr. Lepore has long advocated for additional deer hunts to thin out the population—an approach proven to reduce tick density in other areas. However, public opinion is divided: while some recognize the public health benefit, others find it difficult to reconcile with the island’s idyllic image of deer roaming freely.

2. Dense Vegetation and Habitat
   Historically, Nantucket was more open, resembling something closer to a golf course than a forest. Over the years, the brush and woody areas have grown considerably. Ticks thrive in these shaded, moist habitats, making wooded edges, tall grasses, and overgrown backyards prime real estate for tick activity.

3. Seasonal Influx of Visitors
   The island’s population booms in the summer. People come to Nantucket expecting a scenic escape, yet it’s precisely in these lush environments where ticks reside. Visitors often aren’t aware of the necessary precautions—like doing daily tick checks or using permethrin-treated clothing—until it’s too late.

Tick-Borne Diseases at a Glance

While Lyme disease is perhaps the most well-known tick-borne illness, Dr. Lepore highlights several other pathogens transmitted by ticks that are just as concerning:

1. Lyme Disease

• Caused by the bacterium Borrelia burgdorferi.

• Frequently presents with a bull’s-eye rash, though many never notice a rash or tick bite.

• Can lead to joint pain, heart issues (like heart block), and neurological symptoms (such as facial palsy).

2. Babesiosis

• Sometimes referred to as a “malaria-like” illness, caused by a parasite that invades red blood cells.

• Symptoms can include high fever, chills, and severe sweats.

• Dr. Lepore helped pioneer a more tolerable treatment regimen of Atovaquone and Azithromycin, replacing older, harsher therapies.

3. Anaplasmosis 

• A bacterial infection that often causes fever, chills, and severe flu-like symptoms.

• Can be serious, particularly in older adults or those with compromised immune systems.

4. Tularemia

• Also called “rabbit fever.”

• Dr. Lepore has seen an uptick (no pun intended) in tularemia cases, some of which are transmitted by lone star ticks.

• Symptoms vary widely, from skin ulcers and swollen lymph glands to pneumonia-like presentations.

5. Alpha-Gal Syndrome

• Carried primarily by lone star ticks.

• Causes an allergic reaction to red meat, typically hours after consumption.

• Can be life-changing and is increasingly common outside the traditional “tick belt.”

Why Are Ticks Such a Problem?

Ticks have a complex lifecycle involving multiple hosts. Often, one of the biggest misconceptions is that a single tick species transmits all diseases. In reality, Blacklegged (deer) Ticks, Lone Star Ticks, and even the American Dog Tick can each carry distinct pathogens.

• Deer: Essential for adult ticks to take their final blood meal. The more deer in an area, the more opportunities ticks have to feed, mate, and lay thousands of eggs.

• White-footed Mice: Serve as reservoirs for pathogens like Borrelia burgdorferi (which causes Lyme). Interestingly, mice carry the bacteria but generally do not suffer ill effects.

According to Dr. Lepore, if deer were eradicated from the island, tick populations would plunge. Realistically, however, large-scale culling programs are controversial and often face resistance.

Efforts to Control Tick-Borne Diseases: From Mice to Genetics

Controlling the host animals is only one piece of the puzzle. As Dr. Lepore mentions:

• Mouse Immunization Projects
  Researchers from MIT and other institutions have explored immunizing the local white-footed mice so that ticks feeding on them won’t acquire or transmit certain pathogens. Ideally, if mice are protected, the pathogen transmission cycle is broken.

• One approach uses standard immunization by injecting mice.

• Another more advanced (and controversial) approach involves using CRISPR gene-editing technology to pass on tick-bite immunity through mouse generations.

• Caution with Spraying
  Some people advocate spraying insecticides to kill ticks. However, Nantucket relies on a sole-source aquifer, meaning these chemicals could contaminate the water supply. Additionally, daytime spraying harms essential pollinators like bees.

Top Tips for Tick Protection

Despite the potential future solutions, the most immediate and effective methods for the general public center around personal prevention. Here’s what Dr. Lepore (and most public-health experts) recommend:

1. Daily Tick Checks

• “It's the tick you don't see that gets you,” says Dr. Lepore.

• Perform thorough tick checks after spending time outdoors—especially in brushy or wooded areas.

• Enlist a partner or use a mirror for hard-to-see spots (behind the ears, behind knees, on the back, etc.).

2. Wear Protective Clothing

• Light-colored clothing makes ticks easier to spot.

• Tuck pants into socks; it may look a little “dorky,” but it prevents ticks from crawling up pant legs.

• Use permethrin-treated gear, such as Insect Shield® clothing, which repels ticks. This is one of the simplest ways to reduce bites.

3. Be Mindful of Pets

• Cats are meticulous groomers and can flick off ticks in your home. Dogs, although less efficient groomers, can carry ticks inside on their fur.

• Keep cats indoors, if possible, to reduce the chance of them bringing ticks back.

• Use veterinarian-approved tick prevention on pets, and always check them after they’ve been outside.

4. Modify Your Yard

• Ticks thrive in shaded, humid environments with tall grass or dense brush.

• Keep lawns trimmed and create clear borders (mulch or gravel) between play areas and wooded edges.

• Cut back brush piles to reduce tick hotspots near your home.

5. Throw Your Clothes in the Dryer

• Since ticks are small, you might not find them all. Throwing your clothes in the dryer after you get home can kill any remaining ticks if they are still hiding on your clothes.

6. Proper Tick Removal

• If you find a tick, use fine-tipped tweezers to grasp it close to the skin’s surface. Pull upward with steady pressure.

• Clean the bite area with rubbing alcohol or soap and water.

Permethrin-Treated Clothing: Giving you a leg up against the ticks

One of the simplest methods for tick protection is wearing permethrin-treated clothing. Insect Shield® binds permethrin into the fabric, making it long-lasting and effective against ticks.

Dr. Lepore also recommends spraying your shoes with permethrin spray once a month. “That alone can dramatically decrease your chance of a tick getting on you.” Insect Shield® Permethrin Spray makes it easy and simple to treat your shoes and other gear with permethrin to help protect against ticks and other insects.

If you’re spending time in tick-endemic areas (Nantucket, the Northeast, the Upper Midwest, and parts of the Southeast with lone star ticks), consider wearing permethrin-treated pants and socks, as well as spraying your shoes with permethrin spray.

When to Seek Medical Help

It’s crucial to seek professional medical advice if you suspect you’ve been bitten by a tick and develop any of the following symptoms:

• Bull’s-Eye Rash: Classic Lyme sign (though remember not everyone sees this).

• Fever, Chills, and Fatigue: Could be Lyme, Babesia, Anaplasmosis, or another infection.

• Joint Swelling: Especially the knee—can appear months after the initial bite.

• Neurological Symptoms: Facial palsy, dizziness, or other nerve-related problems.

• Severe Headaches or Neck Stiffness: Could indicate more serious complications.

According to Dr. Lepore, diagnosing tick-borne diseases often requires a thorough history—especially a travel history. Let healthcare providers know if you’ve spent time in tick-heavy regions like Nantucket or the surrounding coastal areas. Lab tests can help identify infections, but clinical suspicion and prompt treatment are key.

The Future of Tick Control

Dr. Lepore remains hopeful about science-based solutions such as immunizing the mouse population. However, he emphasizes that “the long game” for controlling tick-borne illnesses could take years—if not decades—to yield results. In the meantime, personal protection and community awareness are our strongest defenses.

• Public Awareness: Educating visitors and residents is crucial. Nantucket’s success in reducing cases will hinge on individuals taking daily, proactive measures rather than relying solely on large-scale interventions like culling deer or genetically modifying mice.

• Research Advances: Partnerships between Nantucket Cottage Hospital, Tufts, Yale, and other institutions aim to develop new treatments and prevention strategies. Dr. Lepore’s work in refining Babesia treatment (with Atovaquone and Azithromycin) is a testament to the progress that can be made when clinicians and researchers collaborate.

• Balancing Ecology & Human Health: Nantucket’s delicate ecosystem must be preserved while also protecting people from serious illnesses. This tightrope walk informs every decision on whether to spray insecticides, allow additional hunts, or release gene-edited mice.

Conclusion

If you’re planning a trip to Nantucket or live in any tick-endemic region, remember that tick prevention starts with you. Daily checks, permethrin-treated clothing (like Insect Shield® apparel), and general awareness of your surroundings go a long way in preventing tick bites. Dr. Lepore’s decades of experience treating Lyme disease, Babesia, Anaplasmosis, and other tick-borne illnesses underscore the importance of vigilance.

While future solutions—such as mouse immunization or expanded deer management—offer hope, they won’t replace the immediate need for personal protection. Take a page from Dr. Lepore’s book: keep your yard tidy, do routine “tick checks,” wear protective gear, and stay informed about the early signs of tick-borne disease. With these measures in place, you can enjoy the great outdoors (and even Nantucket’s beautiful landscapes) while minimizing your risk.

Shop Insect Shield's full assortment of repellent clothing

Transcript of the Interview

Mary: Hi, this is Mary at Insect Shield and I am so excited to be here today with Dr. Tim Lepore. He is the Chief Surgeon, Chief of Surgery at the Nantucket Cottage Hospital. Thank you so much for joining me.

Dr. Tim Lepore: me. Absolutely. I'm going to

Mary: Absolutely. So I'm going to do a quick introduction and then feel free to add anything because I've been learning about you and reading about you and what you do is very inspirational and just I was thinking, like, you're a renaissance man, so it's, it's really cool, everything.

So besides being a, you know, a surgeon, you're also the high school physician, addiction specialist, an occasional veterinarian, you've done a lot of obstetrician work, a lot of birds and birthing tick disease expert, which is what we're going to concentrate on today. There's a book that's been written about you, Island Practice by Pam Bellick, which I highly, highly recommend.

Marathon runner, avid hunter you just, you do it all.

Dr. Tim Lepore: Yes, I stay pretty busy. Yes, I

Mary: Yeah, that's, I love it. That's fantastic. So obviously, you know, You, you have expertise in many fields, but we want to talk about ticks because you have been working with ticks, probably some of the longest in the country in a place where ticks and tick borne disease have been a real problem.

Dr. Tim Lepore: Yes, we probably have the highest incidence of Lyme disease in the country. It's slanted a little because it's on a population base of 10, 000 according to the government. But 4th of July we have 60, 000 people here who are out being tick attractants. No, so when,

Mary: So, so when, yes when you arrived in Nantucket in 1983 and I know just to backtrack for folks, 1975 is when Lyme disease was first It's like originally diagnosed in Connecticut to my understanding.

Dr. Tim Lepore: the, really, in terms of tick diseases, in 1969, Andy Spielman came out to Nan Tuckett from the Harvard School of Public Health. Because there was a case of a woman who had no travel history who came down with what looked like malaria. Now it turned out it was Babesia. And so Andy came out here and with some of his students from Harvard School of Public Health and they were able to put together this.

tick disease that hadn't been seen before. There were a few cases in Europe, in shepherds and things like that, and they all died, but there's, this was a malarial like illness. He was able to identify the deer ticks, which had not been out here, and make the connection that they needed the mouse and the mouse for the reservoir for Babesia, and the deer were needed for a final blood meal. Then in the mid 70s Alan Steer described what turned out to be Lyme disease in Connecticut. He was a rheumatology fellow, and he was attracted to this area where during the summer, the kids would come down with these rashes, and a lot of them seemed to get better with an antibiotic, but he got interested and then in, I think it was 1980 the spirochete was identified by Woolly Bug Dorothy, a tick from Long Island.

So then in the mid 90s Sam Telford and myself described Anaplasma out here another tick borne disease. So what, I've been here for most of the history of the tick diseases. I'm, I worked with, now I got involved because Andy Spielman wanted me to get patients who had a tick borne disease to talk to his students.

And then met all these guys that were going into tick research and that's where it started.

Mary: So, I mean, were people coming, so, but it's a, you knew about tick borne disease early 80s, you're there. Are people coming in with these kind of strange symptoms? I mean, and we know not everyone gets the bullseye rash, like, so you, like, you, you learned on the job, like, what to look for, for these different between Lyme and anemic plasmosis, like.

What's happening with folks because it's got to be tricky to diagnose because a lot of times people are like oh I never had a tick on me at all

Dr. Tim Lepore: It's the tick you don't see that gets you. 

Mary: That's exactly right, yes

Dr. Tim Lepore: in the front, but they're not quite as good looking behind on their back and other parts. So I always say, if you want to say you haven't had a tick and you make sure you have. a significant other or a good friend to look in the parts that you can't see.

But I got interested because I would see people, for example, with Babesia, that would come in with bed shaking chills night sweats, and temperatures of 104. They were sick. And then, you had Lyme disease, which is frustrating in that you may not I've had people with one rash most commonly, but I've had people with 40 rashes because the spirochete became blood borne and went in multiple places.

I've had people show up with a facial palsy. I've had people show up, the archetype is the 10 year old that comes in with a swollen knee in December because they got bitten in June or July. And anaplasma along the way can present very much Babesia. They tend to be sicker than the people with Lyme disease, but it's just interesting.

I remember a 21 year old girl that came in with heart block with Lyme disease. We see a 21 year old with a heart rate of 30. It gets very interesting. And, I

Mary: And, I mean, I think the thing too, I'm not, in Nantucket, so do you see, I mean, the three, so Anaplasmosis, Babesia, and Lyme, like, you're seeing a lot, cause I mean, those two, I mean, I've talked to a lot of different tick folks, but those two are mentioned, but often like, kind of, oh, they exist also, or is it, kind of,

Dr. Tim Lepore: you have it, it gets very interesting.

Mary: work?

Right.

Dr. Tim Lepore: you look like you've been hit by a truck, it it catches your attention. Lyme disease, because it can be tricky to diagnose. If somebody comes in with a bullseye rash, you can see that across the room, but if they show up with a swollen knee, In December, the ticks aren't really doing much and you got a lot of clothes on.

You have to think of other things, you think of Lyme disease but you have to be aware of it. The same thing with a facial palsy. I've had people, I had the son of a plastic surgeon come in with a facial palsy, and his father was quite sure it was belts. Palsy. And I said, no, out on Nantucket, it's more likely to be Lyme disease.

And I was right. It's always interesting. There are various presentations. and it depends what part of the country you're from. When we affiliated with Mass General the mothership. They had our tech technicians go up to learn how to stain for Babesia. And so Mass General Attack said how many cases do you have?

And I've had 50 cases in a year, whereas Mass General had about five cases. It gets interesting. We, it's a very different. situation out here because people are in close proximity to deer, to ticks, to mice and so the circle of life goes on. We have maybe, the deer, state deer biologist thinks we have 10, 000 deer.

Mary: Hmm.

Dr. Tim Lepore: And as a matter of fact at 1. 30 this afternoon, They're having a meeting up at the Fish and Wildlife to see whether we should have another hunt to cut down the deer population. Because

Mary: because I was, yeah, yeah, no, sorry, because I know that you even back in 2004 or so was the first, you advocated and rallied to have some extra hunts and really have been, been promoting that and with limited, some success and some, some not as success. Like, so how did, yeah, tell us that's how that came about.

Like, let's really go after the deer.

Dr. Tim Lepore: the deer are integral. If the deer were wiped out these tick diseases would really go down to a very low level. At that time, I thought there were 50 deer per square mile. And so I said, why don't we try and get an extra hunt?

Mary: Wait, let me ask, so if there's, if there were 50 per square mile, how many, and right now you have, you said there's 10, 000 deer?

Dr. Tim Lepore: Ha. That is what the deer biologist

Mary: And how many square miles do you have?

Dr. Tim Lepore: do you have?

Mary: Okay, wow, so, okay, so the increase is, that's huge.

Dr. Tim Lepore: huge. It is an enormous number of deer. I said, let's have an extra deer hunt. It was the only place in the continental United States in February that you could hunt deer. The state gave out 900 permits. And we had three feet of snow the week before. People came out here from Michigan and the big woods. They came out from Texas where they hunt very differently. And all of a sudden, they're hunting on an island that can be very congested. It is hard to get to a place on the island where you can't see a house. So that gets interesting. So the deer hunt was successful. We got 250 deer. And when I brought it up the next year, the selectmen, I refer to as invertebrates because I lacked the backbone to repeat it, refused to have another deer hunt. Deer were wiped out on Nantucket about a thousand AD. In 1922, there was a deer swimming in the Sound, because they can swim.

And that was Old Buck, so they brought him ashore. And after a year or two, they felt bad because Old Buck didn't have any friends. They introduced, this is all true, they introduced eight does from Michigan. And it got out of hand from there. At that time, Nantucket was more, looked like a golf course because there were 20, 000 sheep here for a hundred years. After a time, the brush grew up. Everybody wanted to be able to get a piece of And get some privacy and let the brush grow up. So it becomes impenetrable in places. In 1935, they had the first deer hunt, and a fellow was shot and killed on the first day. So the residents got together, called Governor Curley, who called off the hunt at that point.

Mary: Gotcha.

Dr. Tim Lepore: Now, the deer park, it was, at that time, it was more like a golf course. And so It was a giant deer park, and people came, had very different opinions on the utility of a hunt. At this point in time, the brush has grown up, the deer have a great place to live, the mice have a great place to live, and the ticks, which require humidity and shade, have a great place to live.

Mary: Right.

Dr. Tim Lepore: You won't find a deer. I won't find a tick on a golf course in the fairway.

Mary: Right.

Dr. Tim Lepore: get into the rough, that's where the ticks are. Where it's shaded and moist. Because they desiccate very easily in the grass. So they're not gonna, you're not gonna get a tick on you from the grass. But if you let the brush grow up to your house and you let your kids out, they're gonna come home with ticks.

Mary: Right. And then the deer, I mean, and deer are, I'm sure they're everywhere probably walking down all the streets

Dr. Tim Lepore: walking down

Mary: I mean, I, I live in, yeah, in a suburban neighborhood in North Carolina and we've got deer all, all over the

Dr. Tim Lepore: Carolina and we've got deer all over the place. Yes. It is becoming a real problem. Whether the state approves an extra hunt remains to be seen because we take between And let's say there are 800 deer taken legally between archery, shotgun, and muzzleloading. Now how many are hit by cars I wouldn't even project. And if somebody's silly enough to be poaching that's maybe, there's a thousand deer taken out. That doesn't put a dent. in the size of the herd. So they may have an extra hunt, but I will tell you, even people that have had a tick borne disease think that Bambi was a documentary. That's the problem.

Mary: Yeah. Yeah, it is. Because I live, I now look at deer differently with everything I've learned about. Ticks and I and with people and they're like, look at that cute deer. I'm like, no, it's not, it's not like some cute little deer. No, it, that's not how it works here.

Dr. Tim Lepore: like, Oh, look at that cute deer. I'm like, no, it's not like some cute little deer. No, it's not how it works. These tick diseases would really decrease in numbers, okay?

Because there aren't that many ticks. However, the population is, I said, as I said, very ambivalent about it. And I've had interesting discussions at town meeting about it. Besides calling

Mary: So if you

Dr. Tim Lepore: selectmen invertebrates.

Mary: Right, right.

Dr. Tim Lepore: you can't, so

Mary: So if you can't, if so, if that is, that one outlet option is not, you know, going as, as well as one would hope, what? So what else? So I know that there's so you, do you mean. Are you just educating everyone that comes in, like, you know, use repellents, check yourself, tuck your pants in kind of, is that messaging getting across?

Dr. Tim Lepore: No, I've spoken in a number of forums. And I say the basic thing is tick checks. Okay. Human nature being what it is, people are lazy.

Mary: Yep,

Dr. Tim Lepore: and they don't do tick checks. Like I said, you need a good friend, a spouse, to look at the parts where the sun doesn't shine. Because you may pick a tick off your thigh, but you're missing the one on your back.

Mary: right,

Dr. Tim Lepore: And, it's wonderful to take young children and give them a bath every night and take a look. But when they get to be 14, it really isn't an option. That's my basic thing. Do tick checks. Do people do it? No, because people are inherently lazy. The second thing is using protective gear. You use permethrin impregnated clothes insect shield stuff, and avoid ticky areas. As I said, the ticks are not omnipresent. They're in the shaded, humid areas. If you cut back your brush, you reduce your risk.

Mary: right,

Dr. Tim Lepore: If you

Mary: right.

Dr. Tim Lepore: make it Attractive to deer by planting succulents and other things that they like, you'll have fewer deer on your property, fewer ticks. But, unfortunately, people, that's too easy. People like to plant what they like to plant.

And then reducing the deer population, but that's a non starter. So what we're left with are tick checks. Preventive clothing, avoiding ticky areas. You can pick out the ticky areas. They're right outside my office. Because the hospital doesn't cut it, cut the brush back. The ticks are there.

The deer are there. And it's an attractive nuisance.

Mary: Do you find that now though, with more talk about tics and tic borne disease just in the news, are more people coming into the hospital or coming in like, I think I might, there was a tic on me, I'm worried about the tic, is that like, good or bad, are you doing a lot, spending a lot of time like, helping people check their tics, like, has that changed?

Dr. Tim Lepore: I think if people arrive at the Nantucket Airport, once they drive off the asphalt, they're quite sure that they have a tick borne disease. You have to sit down, take a history have they been in the brush? Have they, do they have a cat that goes outside? Because cats are better groomers than dogs.

A tick will get on a dog, get a blood meal, fall off in the house and die because the humidity is too low. A cat, on the other hand, Because they are better groomers, they curl up next to you and flick off a partially fed tick, which then gives you a tick borne

Mary: haven't heard that one.

Dr. Tim Lepore: I try and emphasize these things, I don't think cats should go outside.

And if you have a dog, probably your risk, there is a finite risk but dogs aren't good groomers. These are all things you can look at and do. Wear light colored clothes, tuck your pants into your socks. Now, I tell people, you may look a little dorky, but you know what? You won't be coming to see Lepre for antibiotics.

Mary: Right.

Dr. Tim Lepore: But, it's too easy. Putting your clothes in the dryer for a period of time can help. Get rid of the ticks that are on your clothes. These are all things you can do, but they're too easy to do. And people At the peak tick season, people are on vacation. They mistake the island for Disney World. Except it's Disney World with ticks. Yes.

Mary: Yes. And you see, yeah, I mean, and I also wondered, do you, are you getting now, I mean, is like AlphaGal, are you getting the Lone Star tick now?

Dr. Tim Lepore: seeing that. Lone Stars are a recent addition. Now let

Mary: Now let me ask, I mean, is that coming, does that, because obviously you guys, you're an island, so are people bringing, did the Lone Star Tick get on something and then come over? Like how does it, how does the tick get

Dr. Tim Lepore: Star ticks came up from Narragansett Bay, Prudence Island. They were very prominent there. Then they were over in Tuckernuck, which is an island probably at best a half a mile away. Tuckernuck is infested. But it's only in the last year or two that we've seen lone star ticks.

Now, lone stars bring a whole other series of problems. The one I see I'm seeing more of. This year I had 10 cases of tularemia.

Mary: Oh, I'm not familiar with tularemia. What's

Dr. Tim Lepore: also called rabbit fever. There was no tularemia in New England until the 20s when the hunters had run out of cottontail rabbits to hunt. So they imported 65, 000 black eared jackrabbits from Kansas. A certain percentage of whom were carrying tularemia or tularemia infected ticks. So 1935 was the first case over on the Cape. And I had to hunt for ten years to find about eight cases. And then all of a sudden this year I had ten cases. I had a couple kids playing with a dead rabbit.

Okay, that explains that. But I also had a 90 year old out in her garden, and I don't think she was getting wild and crazy and playing with rabbits, and she came down with pneumonic tularemia. You have to be aware of it. I had a young woman come in with a rash that somebody in the emergency room told her was Lyme disease.

I looked at it, it wasn't Lyme disease, it was tularemia. But you, there are all these other diseases that are coming in. Ehrlichia Tularemia, and a couple of others that are coming in with Lone Stars. We don't have a large number of Lone Stars, but I've seen, actually one of my receptionists has Alpha Gal and the meat allergy.

So we're going to see more of that, but again, you have to think about it. You can sit down and treat somebody for the, particularly the GI symptoms and not think about alpha gal and that they've been bitten by a lone star tick. So we're going to see more of that as the lone stars come.

Yeah, no, that

Mary: Yeah, no, that's, AlphaGal's really seems to be, The Lone Star Ticket is making, it's a lot of headlines these days. Yeah, I mean, I guess it's, it's, you know, I think, Talking to someone like you, so many, so much expertise with, with tics and it, it all comes down to education, doing the tic checks, doing some protection.

So, I mean, our goal is the more different people we have, experts like you just saying, this is all you have to do and it's not that hard and you can really protect yourself. You know, it's, it, and it, and pretty easily

Dr. Tim Lepore: it, pretty easily.

Mary: the other. So. I know, so obviously there's ticks, but I, I believe you've also done work on mosquitoes.

So that is another, and I was, or you used to, what did you, you were like always, you were finding mosquitoes or

Dr. Tim Lepore: I'm always looking for things. I was trapping mosquitos, looking for eosinequine encephalitis. We didn't

Mary: Which, there was a lot of that, but this year, that became the topic in the news, the EEE, yes, in

Dr. Tim Lepore: And we've had one case. A long time ago. But I'm out there looking. I was looking My first case of tularemia was a guy that lived on a boat, worked on a boat, and he probably got bitten by a green head fly. Because he had a big ulcer on his back. It was a fair skinned guy, blonde hair, and I was sure it was a malignancy, but then it dawned on me.

He had all of these lymph nodes, so I aspirated one of the lymph nodes and we found tularemia. So why do

Mary: So how do you, like, is that like a, like you take blood and then you actually like look at the blood and you see the, like what the tularemia,

Dr. Tim Lepore: tularemia? No, what I did was I sent it to my compatriot at Tufts Veterinary School, who has a very high end laboratory, and can look at these things.

That's because it is spread, it can be spread as an aerosol, tularemia, it is a level one bioweapon.

Mary: Oh.

Dr. Tim Lepore: and probably what I did was something probably semi illegal by sending the specimen over to them. But I was pretty sure that's what it was when I saw the notes. And this fellow came in late in the afternoon with this big ulcer on his back. I had to think about it, but it came to me that night. That's what it was. I aspirated a node and sent it off. It's, it is, tick diseases are fascinating.

Mary: Yes. And that there's so many, and I think There's so many different diseases and also that the different ticks are carrying different germs. So I think the one thing that we fight a lot, the misconception like, Oh, I was bitten by a tick. Now I'm going to have Lyme disease immediately, where yeah, maybe you have something, but it's not Lyme because you weren't bitten by the tick that is, could, could even give you a Lyme disease.

Dr. Tim Lepore: You always have to think, and the other kicker in this is we are a sole source aquifer, okay? We're sitting on the water we're going to drink. We're not getting water from the mainland and pipes. It is all water beneath the island. If we go out spraying for ticks at some point in time we'll be drinking that.

And plus you kill, if you go out and you spray during the day, you kill all of the bees. Spraying I just really disagree with. You could spray at night, but I think we have Our approach to tick borne diseases, we have to make sure we don't poison ourselves. Permethrin is a, from chrysanthemums but that doesn't mean I want to drink it.

Now,

Mary: Right. Exactly. Now, and there's one, so I know, so there's, you know, you have the hunt that, you know, maybe you'll have another hunt. That's one, you know, kind of way to, if you can call the deer, educate the people. And then I saw there was two other things I wanted to ask you about and get your kind of what happened with that.

I know that some folks from MIT came out at some point and they were trying to inoculate the mice. Is there, and then,

Dr. Tim Lepore: going

Mary: There was kind of, it looked like it was almost, it was going to happen and then it didn't happen and then there's new talk of that. Is that something that you've been involved with?

Dr. Tim Lepore: I think I was in the, I was very involved with the tick vaccine. The Lyme vaccine back in the 90s,

Mary: Oh, okay.

Dr. Tim Lepore: we immunized a couple of hundred people and it was very effective. However and the problem was that Lyme disease at that point in time was believed to be primarily in the New England coast, but now it's spread.

And so the lawyers got involved and For the cost of dealing with the lawyers and et cetera, it, the vaccine went away. It was a very effective vaccine. It was a safe vaccine. That went away. The mice versus ticks approach immunizing the mice is really a great idea. Now. It has been discussed several times on Nantucket. The only people to really raise an objection were the anti GMO people. Because one of the ideas was to use the CRISPR gene to insert it into the genetic material of the mouse.

So it would be passed on to all the other little mice. So people objected to that. So the plan was then to initially get Nantucket white footed mice, immunize them, get 50, 000 of them, release them in the spring on Nantucket because the mouse population is at its lowest at that point. And then over 10 years, because the immunized mice would mate with, I like to call the townie mice.

And over

Mary: An adventure, right, okay.

Dr. Tim Lepore: the effect of the immunized mice would go out about 10 years. By that time, hopefully the people, anti GMO people would be more accepting. of producing a genetically modified mouse. Now, there are people that are concerned about birds of prey that feed on the mice because they think maybe something bad will happen.

I, they people at MIT are being very careful. They come to town meetings and say, look. Not often, but occasionally, these types of experiments have gone wrong. Now, that may mean you end up with a mouse the size of a Labrador,

Mary: right.

Dr. Tim Lepore: or something like that. I think they're taking a very safe approach.

If we can try the initial experiment with highly immune mice, you can probably get an old freighter. And fill it up with mice and get 50, 000 immune mice and see the effect. The, in using the CRISPR gene is a different process because, theoretically, there are ways to control the extent of its effects to, you can confine it to an area. You can confine it to lasting so many reproductions. There's all kinds of things you can do with the CRISPR gene. The work is going on right now. I think they have proven they can do it with lab mice.

Mary: Hmm, hmm.

Dr. Tim Lepore: the white footed mouse may be a little more difficult because they're Probably not as closely related to the laboratory mice as had been hoped.

Mary: Right, gotcha. I mean, it, yeah.

Dr. Tim Lepore: potentially a little closer related to hamsters. But I think that will keep them busy for a

Mary: Right. One, do you think that, so, I mean, things like the hunt or this for Nantucket because it's an island, does that make it more, like, this could work? I mean, is something like culling, I mean, culling a deer population on, like, you know, in a, in a big, you know, in kind of mainland, would that, is that as much of an option or is this kind of more for Nantucket because you do have the luxury of, you know, water borders?

Hmm.

Dr. Tim Lepore: I think it, it should be attempted first on a small area, like Nantucket or Tuckanuck.

The deer hunt, realistically, I would say is probably going to be a non starter. Like I said, Bambi wasn't a documentary. I'm hopeful that the mouse research bears out. But we're talking, that's the long game, because we're talking 10 or 15 years from

Mary: You've got a lot of generations

Dr. Tim Lepore: Yeah, and you've got a lot of people getting Lyme disease, Babesia and Anaplasma.

And

Mary: and hopefully can get the word out for people that they can protect themselves. And you gotta know what you're looking for. And like, and like you said, small things. Cutting the brush back.

I mean there's just little things one can do to make themselves so much safer at home. And like, it just, you know. And we even say like, you know, spraying your shoes with Permethrin once a month. That alone can dramatically decrease your chance of a tick getting on you. And it's not that hard. It takes all of, you know, 30 seconds.

Dr. Tim Lepore: And I recommend the insect resistant clothes because it's easy. And, the military's been doing that for 50 years

Mary: Yeah.

Dr. Tim Lepore: more and so I think that's another a way to do it and you know you just have to be aware that if you go in ticky areas you may get a tic on you.

And

Mary: Have you found, too, I mean now with so many people on Nantucket having having either tick borne disease or someone like in their family or a close friend, has that changed people's behaviors at all when they see other people maybe going through this or,

Dr. Tim Lepore: It is,

Mary: short term?

Dr. Tim Lepore: People want an easy answer and until the island sinks in another four or five hundred years, we're going to have a problem and people may be, everybody's familiar with somebody that's had Lyme

Mary: Right. Yeah.

Dr. Tim Lepore: Or seen people that have had Lyme disease and Babeser and Anaplasma.

Everybody's seen them, but they still get it.

Mary: Right.

Dr. Tim Lepore: They still get it, and People play with dead rabbits. Why? I don't

Mary: Ha ha ha.

Dr. Tim Lepore: people have gotten too leery of me and trying to break up two dogs that are fighting over a dead rabbit, but I wouldn't recommend it. So people have short memories and they want to go out and they want to do what they want to do and all of a sudden they're surprised again.

Oh, I guess I got Lyme disease or I guess I got Babesia. They're looking

Mary: Well, I guess, I mean, they're lucky there in Antucka to have a doctor like you, though, that I think that's also just like, in the healthcare world that people are, professionals are saying, where have you been? What have you been doing? could there potentially be a tick borne disease that you're carrying?

Dr. Tim Lepore: People don't get travel histories and then all of a sudden I get a call from France, or I get a call from, the state of Washington or Wyoming. But, because somebody asked have you been on the Antarctic or the Vineyard? And then all of a sudden it gets a little easier, but then I get a call, how the hell do I treat this?

Mary: Right. Okay.

Dr. Tim Lepore: And then I have to talk to them about that. It's interesting being here, and, And seeing these tick borne diseases, because I think they're fascinating. And I like to go and ferret things out. It's I work with Tufts Medical School, Tufts Veterinary School with Mass General and with Yale School of Public Health.

We came up with the treatment for Babesia. Before it was quinine and cleusin and people just got so sick with that they decided that they'd let Babesia run its course. So we came up with a treatment with Etovacuonin and Zithromax that is very tolerable. Although the Etovacuonin is a little bit like library paste and yellow.

But people get better. We treat them for a week. It's just It's interesting, and I like to stick my nose in things and see what's going on. It sounds

Mary: Well, it sounds like you've, within that, you've done, made a lot of great changes and you've like saved many, many people's lives and, and given them a new, new outlooks. Cause I was, some of the people that you've also treated that They've like walked in thinking they were dying and you were like probably one of the only ones that could that were able to diagnose them and say, okay, no, you're not dying.

We're going to figure it out and we're going to help you. So

Dr. Tim Lepore: No it's. Interesting It's just interesting being here and having this patient population and you get to ferret things out.

If you don't think of it, you won't diagnose it. No,

Mary: Right. No, that's fantastic. Well, I know, I know you have a meeting to get to in a little bit, so I don't want to keep too much longer, but thank you for just sharing your knowledge and your history with you know, tick borne disease. You probably, in the U. S., one of the people working on it the longest, and it's really cool that you got, we could talk to you about that and hear

Dr. Tim Lepore: I'm,

Mary: Oops.

Dr. Tim Lepore: I am one of many but I happen to be in a hotbed of it.

Mary: Yeah. Yeah.

Dr. Tim Lepore: There are people doing a lot of research,

Mary: hmm. Yeah. Hmm.

Dr. Tim Lepore: we developed the Etovicon Zithromax protocol. was writing a big article about Babesia. And he called me up. The article was in the New England Journal. He called me up and he said, Tim, what's the Etova clone look like? I had to tell him it looks like yellow library paste. And probably tastes just the same. So a lot of people I work with are in laboratories but they haven't seen a deer. Except a white mouse in the lab. They don't see the white footed mouse, deer mouse.

Mary: Well, and I hear, I mean, and you really see exactly how many ticks are on deer, because I understand you go, when people are coming in from the hunts, with the deer, you go and like take, look at the deer and you scoop up the ticks off the deer's belly. So you really see how many ticks, like, so how many ticks are typically on a deer?

Now I just changed.

Dr. Tim Lepore: The most I've taken off, and I just finally got tired, was 165 females

Mary: Wow.

Dr. Tim Lepore: one big buck. And I've gone out, I go down to the deer checking station, because the first week of shotgun everybody has to bring the deer their age, weight, and sex. I go down there and pick ticks off the deer as they come by. I have to keep it moving though, because they checked 160 deer the first day of shotgun this year.

And each

Mary: And then, and now, and each, each female tick, if she, what, it's like 2, 000 eggs she can lay. And you caught 165 just female ticks, so multiply that out if you're good at

Dr. Tim Lepore: Yeah, and that's off of one deer.

Mary: right, fun deer, right, okay. Alright, I just changed, so, but I'm gonna let you guys go. But really, thank you so much for your time.

We might call on you again if we have some, love to just hear more of your, your tick stories. Just, you know, kind of the world of insects and then how insects intersect with the humans and disease and because we need insects But we also don't want people getting sick

Dr. Tim Lepore: I haven't found a great ha, usefulness of having all these ticks.

Mary: I have to tell you I asked one of our other a doctor that works at the SUNY

Dr. Tim Lepore: Their college of

Mary: Their their College of Forestry and I did ask him do we need ticks and he said I don't think we do.

Like, we, mosquitoes, there's some that have, he's like, but ticks, we have not found a reason, now, maybe there was one at some point, but now, that we could, like, they're not helping our, you know, they're not part of that, that population of we need

Dr. Tim Lepore: We don't understand their position,

Mary: Or maybe, right, exactly, maybe we don't understand.

Yeah, maybe if we got rid of them,

Dr. Tim Lepore: and still dislike them.

Mary: right, exactly, so. Well, thank you so much really appreciate your time.

Dr. Tim Lepore: Fun talking to

Mary: Yeah, absolutely, thanks.