Hiking, hunting and raking leaves are autumn activities for thousands of Granite State residents but outdoors enthusiasts are urged to beware because bacteria-laden deer ticks that transmit Lyme disease remain on the prowl until temperatures dip well below 40 degrees.

The warning comes from a pair of local doctors. One is Julia Greenspan N.D., a Merrimack resident and doctor of naturopathy who treats numerous Lyme patients from Merrimack and surrounding areas. She currently serves as the chairwoman for New Hampshire’s Naturopathic Board of Examiners and was named by her peers as one of the state’s best alternative-health doctors in a 2011 feature from New Hampshire Magazine.

Echoing her concerns is Dr. James Savickas D.M.D., a Merrimack dentist whose 20 years of experience has brought him a multitude of dental patients who are currently coping with the disease. Others have faced it in the past.

Savickas was voted by his peers in 2010 and 2011 as a top dentist in the New Hampshire Magazine poll. He is well-versed in Lyme and the need to be ever vigilant when it comes to tick awareness and the needs of patients with Lyme disease. Ticks that transmit Lyme carry in their gut a specific bacterium, borrellia burgdorferi.

“Nasty stuff,” Savickas noted.

According to medical information, when an infected deer tick bites a person, it pierces the person’s skin with its sharp, hollow proboscis. Then, it begins sucking the person’s blood. The bacteria are regurgitated into the person while the insect sups.

Juvenile deer ticks begin feeding when they are the size of a poppy seed. Adults are the size of a sesame seed. They can live more than two years and thrive in warm, moist weather.

“My family just doesn’t go into the woods, even on the trails, unless there is snow on the ground,” said Savickas. “At least, in deep winter, we’re not in danger of coming into contact with active ticks. Currently, I’m seeing quite a few patients with Lyme. It’s a terrible disease and it has to be weighed as a factor in a comprehensive dental treatment plan for anyone with Lyme.”

Headaches, muscle aches, joint pain and joint swelling are tip-offs that Lyme may be present. Bouts of grueling fatigue often occur.

Unfortunately, the symptoms mimic sensations associated with many other diseases. Greenspan and Savickas said people are often misdiagnosed as suffering from multiple sclerosis, Parkinson’s, Alzheimer’s, ALS, lupus and many other conditions.

Greenspan was diagnosed two months ago with the life-altering disease. She emphasized that deer ticks, six-legged insects that are dark in color, remain active until temperatures outdoors drop to below 40 degrees.

Her medical practice, the Greenhouse Naturopathic Medicine in Hollis, is a treatment destination for dozens of locals ages 7-80 who are afflicted with Lyme disease.

Greenspan’s medical establishment is an alternative natural health clinic specializing in the management of acute and chronic disease, including Lyme disease. She said quick identification of symptoms is vital and an identification of the tick can be made, if the offending insect is retrieved, intact and presented for her inspection. Prompt treatment with antibiotics – oral or intravenous – is a remedy. Prevention, of course, is the best defense.

“It certainly is good to enjoy the outdoors but keep a high level of awareness,” said Greenspan. “Dress like a ghost. Wear white clothing, so ticks will be easier to spot. Spray a repellent containing DEET on your clothing, especially on your pant legs. Apply it to clothing, not to your skin. DEET has had some bad press related to side effects, so don’t put it on your skin, but I say, ‘DEET it up.’ And refresh the application every few hours.”

Savickas’ longtime dental assistant Pam Hurley, the doctor’s sister-in-law, spotted a deer tick on her coat after leaving a movie theater not long ago. Jennifer Savickas, the doctor’s wife and the office administrator, keeps a constant vigil on the couple’s young son, Jameson, and also on the family’s pet, Bailey, a golden retriever.

“Thankfully, (Bailey) is a fairly blond dog, so ticks are easy to see,” she said.

Jameson, 9, a fourth-grade student at Reeds Ferry Elementary School, said it’s especially important for kids to be careful when playing outdoor sports. Lyme disease, as reported in many journals, is now a problem in many states.

It was first tracked in the U.S. to a cluster of youngsters in Lyme, Conn. The source of their painful, juvenile arthritis eventually was traced to the infected ticks. Deer, strangely, are said to be immune from Lyme but dogs are susceptible and are routinely tested when taken to animal shelters or veterinarians.

“Do not go in tall grass,” Jameson said. “When we’re playing soccer and somebody kicks the soccer ball into the tall grass, that’s not good. Ticks wait in the grass for someone to grab onto. That’s how people get sick, if it’s the kind of tick that can give you Lyme disease. The ticks get on you and then bite you and pretty soon, you’re sick.”

New Hampshire State Epidemiologist Dr. Sharon Alroy-Preis, headquartered at the Department of Health and Human Services in Concord, echoed Greenspan’s precautions. She helps document statewide reported cases, incidents conforming to a narrow set of guidelines set forth by a major medical group, the Infectious Diseases Society of America. The criteria are used by the Center for Disease Control in tracking Lyme cases.

According to Alroy-Preis, there have been, thus far in 2011, some 691 cases of Lyme disease reported in New Hampshire. There were 477 confirmed and 214 deemed probable, she said. In 2010, the total was 1,335 cases. In 2009, there were 1,417 total cases.

The numbers reflect a long-standing controversy among medical professionals that is ongoing. Greenspan said she and many other Lyme-literate physicians contend that the guidelines used for reporting purposes neglect vast numbers of people suffering outside the guidelines who are coping with chronic symptoms or long-term Lyme.

“I think the main message is that we should be outside, outdoors and active,” Alroy-Preis said. “You just have to remember to always do a follow-up tick exam – head to toe – a really, really thorough search, including the back of the knees and the back of the ears. New Hampshire is a state with the highest incidence of Lyme disease.”

Greenspan agrees and joined Savickas in mentioning that pets playing outdoors should be a part of a family’s Lyme prevention efforts. A pet owner, she said, who routinely uses drops applied behind the animal’s neck to repel fleas or ticks may not realize that repelled ticks will abandon a treated dog or cat and seek other prey such as children or adults.

Oftentimes, said Greenspan, a person bitten by an infected tick will display a red rash of concentric circles shaped like a bull’s-eye. The rash is a tip-off that Lyme disease has been contracted and the bacteria are migrating to other parts of the body. Nevertheless, many patients do not exhibit any rash, and many do not recall being bitten by a tick.

“I didn’t notice any bite and I didn’t get a rash,” said Greenspan, 36, the wife of an engineer and mother of two tots. “I was very tired but I’m a mom. A mom is going to be tired. I had muscle pain. But I work out and thought it was a side effect. But then, I had hip pain, headaches, a ringing in my ears and the feeling bugs were crawling under my skin. I knew something was very wrong.”

Greenspan confirmed her suspicions with more than one blood test. She already is involved in a month-long course of treatment for Lyme. The intravenously delivered antibiotics are hoped to be successful in killing the infection. Treatment durations vary widely, she added.

One of Greenspan’s many Lyme patients is Rachel Bohannan, 19, of Merrimack. Bohannan graduated from Nashua Christian Academy and previously attended Merrimack High where she excelled in soccer and softball despite feeling unwell.

The avid athlete was diagnosed by Dr. Greenspan in June after enduring four years of symptoms that were not alleviated by visits to 14 doctors – medics, Bohannan said, were evidently, insufficiently acquainted with Lyme disease.

“I went through so many doctors and so many drugs that didn’t do any good,” Bohannan said. “It was only when my mom heard about Dr. Greenspan and I had my first appointments that I was finally diagnosed and treated. I feel much better.”

Greenspan said a commonly used blood test – the Elisa test for antibodies – in many cases turns up a report that is negative for Lyme. The problem, agreed Bohannan, Savickas and Greenspan, is that the result can be a false negative. Follow-up with another test – the Western Blot test – administered to determine if the false report is truly false, is rarely prescribed because it is not usually covered by insurance.

Greenspan recommends that anyone who tests negative for Lyme should resist the urge to drop treatment and chalk up their symptoms as generated by something other than Lyme. She warned that in lieu of an extended exploration into the cause of a person’s distress, the patient is too often likely to be dismissed as not having Lyme.

Bohannan and Greenspan recommended seeking information through the International Lyme and Associated Diseases Society (www.ilads.org), a group at the forefront of the battle against Lyme. There also is an informative, award-winning video available through local libraries, “Under Our Skin,” a work researched for four years and directed by Andy Abrahams Wilson. Those interviewed in “Under Our Skin” exhibit many Lyme-induced ravages. Some cannot walk and have to be carried up stairs. Some drool and cannot hold their heads erect when seated in a chair. Oxygen tanks and medical equipment are household accessories for many. And pre-Lyme clips, included to contrast some of the men and women in their better days, show the subjects swimming laps, dancing or enjoying other athletics.

Bohannan admits she faces some stress in balancing work, play, sports and living, in general, while caught up in caring for her physical well being. She works at a Nashua jewelry store. She is a tournament-level softball player. She said she has done well at maintaining her normal activities, despite frequent severe headaches and other effects of the disease. College is on hold, pending a more complete recovery from Lyme.

She said extreme fatigue was a factor before she found treatment. She would be at a tournament game and be on the field, playing her position. Then, she would fall asleep in the dugout after telling her teammates to wake her when it was her turn again to play.

“It is really hard to cope with Lyme,” Bohannan said. “Thankfully, I have a strong personality. I’m doing much better than I ever did before.”

Bohannan noted that deer ticks are just about everywhere in New Hampshire. Woods, lawns, playgrounds, rock walls and fields where sports are played can be “loaded with them,” she said. She recommends athletes check themselves and their equipment frequently.

“Check your duffel bag and your equipment bag,” Bohannan said. “You drag your bag everywhere. You just toss it under the bench and into the dirt. There are always bits of leaves and grass in the bottom – stuff that got in there when you threw in your gloves or some piece of equipment. There could be ticks there, too. And there’s no such thing as being too careful.”

Greenspan urges anyone bitten by any tick, large or small, to seek immediate treatment. She recommends saving the tweezers-detached insect in a clear, plastic bag, along with a water-moistened cotton ball to keep the insect from drying out. Do not drip alcohol on it or any other chemical, she said, or touch it with an extinguished match, for the actions can destroy the bacteria whose presence may determine if the tick was a carrier.

Hurley added that there is no getting around the fact that ticks, along with Lyme disease, are a part of living just about anywhere in New Hampshire.

“There’s nobody around here who doesn’t have Lyme or doesn’t know somebody with Lyme,” said Hurley. “It’s not a rare disease anymore. It’s almost commonplace.”