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Cottage Life

5 things I wish I’d known before renting a cottage for the first time

Photo by Natali55522/Shutterstock

For many, spending time at the cottage is something they’ve always known—their cottage has been passed down for generations. For others, they’ll visit a friend’s cottage or they know someone who knows someone. Then there’s the rest of us. The wonderful privilege of growing up with summers at the cottage wasn’t an experience I grew up with. But after a very long lockdown last year, I wanted to take a vacation where I could safely include my parents in without risking their health. Renting a cottage felt like the perfect escape, but if you didn’t grow up going to a cottage like me, it can be tricky navigating it for the first time. I learned quite a bit during this first experience. Here’s what I wish I had known before I booked the trip. 

What do you get for the price of the rental? 

When we were looking for the perfect cottage, the one thing we knew we really wanted was to be right on a lake—and while many listings marketed a lake—the more we would dig into it, we would often find that the lake was actually a 10-minute walk or a 5-minute drive away. Other things to note: does it have a TV or any entertainment? Does it include access to a barbecue, laundry, firewood, life jackets, canoes, and other supplies, or does those require an additional fee? Make sure you read the fine print before you commit, or you might find yourself disappointed on arrival.

How accessible is the rental? 

The cottage we ended up renting was in a heavily wooded and isolated area near the tiny town of Severn Bridge, Ont. While the listing did mention that the area around the cabin was quite rocky, we didn’t realize just how inaccessible it truly was for anyone with mobility issues until we were there. My mom has bad knees and wasn’t able to come sit by the fire, as the firepit was located on steep, slanted, rocky ground. If accessibility is an issue for anyone in your party, make sure the place that you’re booking will work for them. 

What is the food and supplies situation? 

The cottage owners noted they would supply little things like salt and pepper, but we ended up bringing many items that we didn’t need. This can be tricky, but if possible, request exact information on what supplies will and will not be provided from your host so you don’t unnecessarily overpack.  

What is the safety situation around the lake? 

The instructional guidebook provided on arrival said that we had to wear life jackets on the lake at all times. Our cottage was on a small lake with no beach area—a dock was the only way to access the water. Powerboats were plentiful on the lake, which could create safety issues if you were without a life jacket. 

What is the rental’s access to the outside world? 

Our cottage had Wi-Fi, which was a non-negotiable for us when we were looking for a place to rent, but the location was hard to find. We had to follow special directions from the owner on the drive up to find it hidden deep into a sprawling wooded area, which made us want to heading back into town should we have needed anything or wanted to explore. This also made me slightly nervous that if anything went wrong, emergency services might have a hard time finding the place quickly. 

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Cottage Life

First test run for proposed train route between Toronto and cottage country

Photo Courtesy of Twitter/Ontario Ministry of Transportation

Ontario cottagers may soon have a new way to travel to and from the cottage.

Early Monday morning, Ontario Northland, a provincially-owned transport operator, sent a test train from North Bay to Toronto’s Union Station and back.

The test was used to gather information on the route, evaluating track conditions and verifying transit times between stops, the Ministry of Transportation said in an email.

As part of the test, the train travelled through Huntsville, Bracebridge, Gravenhurst, Washago, Gormley, and Langstaff, carrying 15 passengers and a small number of employees who operated equipment and collected data.

Notable passengers included Parry Sound-Muskoka MPP Norm Miller, Nipissing MPP Vic Fedeli, Ontario Northland president Corina Moore, and several northern Ontario mayors from stops along the proposed route.

The entire route, which was first proposed in a May 2021 government report, would include 13-stops, and go as far north as Timmins.

Train passage between Toronto and northern Ontario isn’t a new concept, though. In fact, this same route was serviced by Ontario Northland until 2012 when the Dalton McGuinty government cancelled the service, claiming it was financially unprofitable.

In 2018, current Ontario Premier, Doug Ford, revisited the idea of northeastern rail service in his election campaign. When the provincial government released their 2021 budget last March, Ford pledged $5 million towards planning and designing a rail service that catered to northern communities.

“We made a commitment to return passenger rail to the North and we are one step closer to fulfilling that commitment,” Vic Fideli said in a May press release.

“Improved passenger rail would provide people across Parry Sound-Muskoka with another way to travel both north and south to access services and it would give visitors to our local tourism operators a comfortable way to travel to the area,” Norm Miller added.

Train service would run based on seasonal travel demands, ranging from four to seven days a week. An added benefit would be that passengers coming from the North could travel overnight to maximize their day in the Toronto area and reduce the need for overnight accommodations.

No date has been announced for when train service will open to the public, but according to the Ministry of Transportation, their goal is to use the data collected from the test run to update their current business case—a report that forecasts costs, revenue, and ridership figures—by 2022, making the train route available by the mid-2020s.

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Cottage Life

Fall candles to keep at the cottage

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If you’re spending nights indoors at the cottage, what better way to elevate the ambience than with candles?  Not only are they the ultimate mood lighting, but they can bring comforting scents (think: campfire, pumpkin spices, s’mores, and even bourbon) to you on demand. Here are the fall candles you need to keep at the cottage.

soja and co smores candle Photo courtesy of Soja&Co

S'mores and firewood soy candle

This Canadian-made, 100 per cent soy wax candle smells more like a cottage than the cottage itself. Breathe in notes of milk chocolate, roasted coffee, marshmallow and vanilla.

Buy from Soja & Co.
$33

voluspa candle for fall cottage candles Photo courtesy of Voluspa/Indigo

Baltic amber

This elaborately packaged candle isn’t just a pretty case. The coconut-blend wax is infused with the rich aroma of amber, sandalwood and vanilla orchid.

 

 

Buy from Indigo
$43

pumpkin candle for fall candles Photo courtesy of Indigo

Pumpkin patch candle

This soy wax blend candle has a burn time of up to 48 hours. Translation: you can enjoy the aroma of pumpkin, cinnamon, and brown sugar for days on end.

Buy from Indigo
$29.50

mala fall candle for cottage Photo courtesy of Mala The Brand/Indigo

Coffee cream candle

Coffee lovers, rejoice! This Vancouver-made candle blends together the scent of creamy sweet vanilla, cloves, and freshly roasted coffee.

 

Buy from Indigo
$35

autumn sage fall cottage candle

Copper sage candle

This chic copper bowl candle will dress up any coffee table while it infuses your space with autumnal sage. Perfect for fall at the cottage.

Buy from Bed Bath and Beyond
$30
$14.99

milk jar fall cottage candle Photo courtesy of Milk Jar

Maple butter candle

Hand-poured in Calgary, this collab candle created by two Canadian businesses (Local Laundry Apparel x Milk Jar Candle Co.) is infused with maple butter. Doesn’t get much more homegrown than that, eh?

Buy from Milk Jar Candle Co.
$27

candle for fall cottage candles Photo courtesy of Urban Outfitters

Bourbon brulee

This candle has notes of bourbon, spice, vanilla, and caramel. Plus, it comes in a pretty jar you can repurpose afterwards.

 

Buy from Urban Outfitters
$24

homie candle for fall cottage candles Photo courtesy of Province of Canada

Oatmeal soy candle

This natural soy wax candle has 60 hours of burn time. Plus, it’s designed to smell just like home, with notes of oatmeal, milk and brown sugar.

 

Buy from Province of Canada
$42

candle for fall cottage candles Photo courtesy of La Jolie Muse/ Walmart

Apple and spice candle

This vegan candle combines the scents of apple, bergamot, rosemary and sandalwood to up the fall coziness level of your cottage.

 

 

Buy from Walmart
$21.99

pumpkin candle for fall candles Photo courtesy of Kim and Pom/Amazon

Pumpkin and spice candle

This vegan candle blends pumpkin, cinnamon, nutmeg, cloves and rum together to create a warm inviting scent.

 

Buy from Amazon
$29.99

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Cottage Life

The transitional jackets you need this season—in popular styles

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Transitional jackets are a necessity for dealing with Canada’s temperamental fall season. One day, it could be sunny enough for a flimsy denim jacket, the next, temperatures are below freezing with a chance of snow. We’ve picked out these popular styles that meet all of your needs. Whether you’re looking for warmth, water resistant fabrics or breathe ability, these jackets have got you covered (literally).

 

 

 

transitional jacket for fall maroon Courtesy of Woods/Sportchek
jackets

Woods puffer jacket

This pack-able lightweight jacket is all about the details, like tech fleece armpits and spandex cuff inserts.

 

Buy from SportChek
$200

columbia transitional jacket Photo courtesy of Columbia Sportswear

Columbia down jacket

This warm jacket has waterproof fabric with sealed seams, and a thermal reflective lining to keep you warm and dry.

Buy from Columbia Sportswear
$349.99
$262.49

roots transitional jacket Photo courtesy of Roots

Roots wool jacket

This wool-blend jacket is an oversized update of their iconic plaid jacket. Add a puffer jacket underneath as an extra layer to stay cozy on colder days.

Buy from Roots
$148

leather jacket for transitional jacket Photo courtesy of Noize

Vegan leather jacket

This vegan leather jacket is a wardrobe staple. You can style it with big wool sweaters in vibrant colours.

Buy from Noize
$150.00
$90

fjallraven jacket from MEC Photo courtesy of Fjallraven/MEC

Fjallraven jacket

For those unusually warm fall days, you need this jacket.

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Buy from MEC
$249.95

fleece for transitional jacket Photo courtesy of alder/MEC

Fleece

This cozy fleece is 100 per cent recycled. Wear it as a jacket on mild days, or use it as a shell when it gets chilly.

 

 

Buy from MEC
$189.95
$150.97

noize wool jacket Photo courtesy of Noize

Vegan wool jacket

This faux-wool coat is suitable for temperatures up to -5°C.

 

Buy from Noize
$265
$159

free people packable pullover transitional jacket Photo courtesy of Free People

Free People pullover

Functional and fashionable, this water-resistant, wrinkle-proof pullover actually folds into its own pocket, making a travel pillow.

 

 

Buy from Free People
$211.68

adidas vest for transitional jacket Photo courtesy of adidas

Vest

Technically a golf vest, this is perfect for brisk, active days outdoors, since it doesn’t restrict your range of motion. It is filled with 80 per cent duck down and 20 per cent feathers.

Buy from Adidas
$200

northface shacket for transitional jackets Photo courtesy of The North Face/MEC

The North Face wool jacket

This ultra-cozy, relaxed jacket works on its own, or with a vest or shell on chillier days.

Buy from SAIL
$249.99

lululemon transitional jacket Photo courtesy of Lululemon

Lululemon lightweight jacket

This PrimaLoft insulated jacket comes in three colours: green, lavender, and black.

Buy from Lululemon
$228

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Cottage Life

Wild Profile: Meet the red-throated loon

By Wolfgang Kruck/Shutterstock

If you’re asking, “What the heck is a red-throated loon?” you’re probably not alone. This smaller, paler diving bird is a cousin of the Canadian-famous common loon. But the red-throated loon is far less known, and definitely less photographed. One reason? Red-throats breed in the north. The only time a cottager is likely to spot one is when the birds journey south in the fall, stopping along the way at large water bodies including the Great Lakes.

Like other loons, the red-throated loon is a strong swimmer but terrible at walking on land. This is because its legs are positioned far back on its body. No matter—fish-eating loons were designed to dive for their dinner. Or, in the red-throat’s case fly, then dive. They often locate prey while flying—sometimes in flocks. Then, they drop rapidly into the water when they spot a school of fish. Red-throated loons have thin, dagger-like bills (all the better for spearing a meal).

Red-throated loons are more masterful fliers than their common cousins. At least, they’re better at getting airborne. Other loons need a long runway of water to “patter” along before they can take off; red-throats can spring into the sky. This means that they can use small tundra and taiga lakes, or even ponds, for nesting.

Just like the common loon, a red-throated loon loses its red eyes and breeding colours—a rust-coloured neck patch—in the winter. Their generic greyness makes nonbreeding common loons and nonbreeding red-throated loons tricky to tell apart during the cold season. Look closely: a common loon still has a mostly-dark face and neck, with only a blaze of white down the front. A red-throat has more white on its face and neck, with a more black-and-white speckled back. The latter is smaller, with a sinewy neck, a slighter build, and pointier wings.

Cottage Q&A: Why are these loons gathering in groups?

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Cottage Life

5 different ways you can cook a turkey

Photo courtesy of Karepa Stock on Shutterstock

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While the familiar taste of oven-roasted turkey is classic, there’s a case to be made for getting creative with your cooking. If you’re trying to add some flavour or just shake things up a bit, try these unconventional cooking methods. Who knows? You might cook up a new family tradition.

airfryer for 5 ways to cook a turkey Photo courtesy of Kalorik/Walmart
appliances

Air fryer

Air frying has been a popular trend this year. If you’ve used one, you know that you can get a crisp texture without boatloads of unhealthy oil. For turkey, you’ll want to be sure your air fryer is big enough to do the whole bird. And since an air fryer typically cooks food faster, this may not need to be an all day task.

Buy from Walmart
$239.97
$199.97

turkey frier for 5 ways to cook a turkey Photo courtesy of Char Broil/Walmart

Deep fried

This oil-less propane fryer was made specifically to cook a turkey—and it shows. It has infrared cooking tech that eliminates hot and cold spots and helps achieve a perfectly cooked turkey every time. Just read the glowing reviews (deliciously cooked meals, minimal clean up). Best part? No nasty oil splatters.

 

Buy from Amazon
$244

rotisserie for 5 ways to cook a turkey Photo courtesy of Char-Broil/Amazon

Grilled rotisserie turkey

The barbecued turkey trend has been floating around for a while. If you’re after a delicious smoky flavour, try a rotisserie. The meat will baste in its own juices as it rotates.

Buy from Amazon
$42.99

smoker for 5 ways to cook a turkey Photo courtesy of

Smoked turkey

Infuse your turkey with a uniquely rich flavour by smoking it. This propane smoker has a built-in temperature gauge and is perfect for the backyard. You can cook not one but two turkeys in it, too.

 

Buy from Home Depot
$359

Sous vide for 5 different ways to cook a turkey Photo courtesy of Avona Culinary/Amazon

Sous vide turkey

The French cooking method involves enclosing food in a vacuum-sealed bag and cooking it in temperature-controlled water. The benefits? An even cook. If you’re curious about trying this on a whole turkey (or in parts), get yourself a device like this one and start researching methods.

 

 

Buy from Amazon
$434.87

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Cottage Life

Cottage Q&A: Basement flooding damage

By cunaplus/Shutterstock

How do we repair damage from basement flooding? Our cottage has a fully-insulated basement with a concrete floor. Thanks to a sump well and proper drainage, this basement has stayed warm and dry for years. But in 2019-2020 there were record-high water levels on the Great Lakes. The water table rose to just under our floor. As the water table started to drop, a white powder appeared on the floor, and also around support pillars and internal block walls. What is this white powder, and how do we remove it? Once that is done, is there a product we could use to coat the floor?—Bob and Joan Bowman, Sauble Beach, Ont.

The white powder is likely efflorescence: the visible salts and minerals left behind when water evaporates. It’s not pretty, but it won’t hurt you.

Try cleaning it with vinegar and a scrub brush—that should remove it. If not, you could use a dedicated efflorescence cleaner. (Check hardware or home reno stores.) 

Is your cottage at high risk of flooding?

As an absolute last resort, you could “upgrade to muriatic acid,” says Roger Frost of Napoleon Home Inspections in Barrie. (But PSA: it’s terrifyingly caustic stuff. The expert advice on using it ranges from “Cover every part of yourself in protection; consider installing an eye-wash station” to “Don’t touch it. Don’t even look at it.” We’d rather live with the white powder.)  

After cleaning, you could coat the floor with an epoxy paint, but it can be prone to flaking, peeling, and blistering—that might look uglier than leaving the basement bare. And it’s not going to provide much waterproofing. 

Cottage Q&A: A wet crawl space solution

“Stopping water from coming in is the best solution, and that could be impossible if the water table rises again,” says Frost.

Still, you have a few choices to handle future dampness problems, says Don Fugler, a building scientist formerly with the Canada Mortgage and Housing Corporation (CMHC): regular cleaning to deal with any stains, a “false floor” to hide the stains, or installing a pump to work with the sump and keep the water several inches lower than the floor. “But be aware that, if you are trying to stem the movement of water from a Great Lake, that pump might be running continuously for weeks,” says Fugler. A more extreme option would be to change the basement into an isolated crawl space, he says. Excessive? Maybe, but cottage country could be in store for decades more of high-water levels and flooding. “Who knows what eventually will happen with a changing climate?”

This article was originally published in the August/September 2021 issue of Cottage Life magazine.

Got a question for Cottage Q&A? Send it to answers@cottagelife.com.

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Cottage Life

7 books for kids who love pond hockey

Arotes decorus, parasitoid wasp macro on blue background

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Intro goes here

Cover of Isobel's Stanley Cup book Photo courtesy Indigo
book

Isobel’s Stanley Cup

By Kristin Butcher
Set in 1893 in Ottawa, this is the story of Isobel, who wants to play hockey but her father won’t let her because she’s a girl. She helps her older brothers practice for their big game—improving her own skills along the way—and gets some advice from a historically inspired Isobel Stanley. When a chance opens up to play in the game, she must work around her father’s rules and risk his ire to play the game she loves.

Buy from Indigo
$8.95

Buy from Amazon
$8.95

The Hockey Tree book cover
books

The Hockey Tree

By David Ward. Illustrated by Brian Deines
Set on Humboldt Lake, Saskatchewan, this story of a brother and sister playing on the frozen lake is set to become a classic. When they lose their puck in an ice-fishing hole, they are ready to give up and go home. But their father teaches them an old hockey-lover’s trick that saves the day. Younger readers will love this very Canadian story and beautiful pictures.

Buy from Indigo
$7.99

Buy from Amazon
$7.91

The Hockey Sweather book cover
books

The Hockey Sweater

By Roch Carrier. Illustrated by Sheldon Cohen
No list of kids books on hockey would be complete without this classic, which brings to life the age-old rivalry of the Montreal Canadiens and the Toronto Maple Leafs. Through the eyes of a boy whose love for hockey is eclipsed only by his love for his hero, Rocket Richard. But he must endure the worst indignity when his mother orders the wrong team’s jersey.

Buy from Indigo
$10.99

Buy from Amazon
$10.88

Wild Pond Hockey book cover
books

Wild Pond Hockey

By Jeffrey Domm
Veteran nature writer and artist has clearly had a lot of fun wondering what if hockey were invented by animals. Starring a pair of ravens and a curious wolf pack, this playful book tells of a truly wild hockey game.

Buy from Indigo
$12.95

Buy from Amazon
$10.02

When the Moon Comes book cover
books

When the Moon Comes

By Paul Harbridge. Illustrated by Matt James
A band of kids wait for their moment when the ice on the beaver-flooded pond is finally frozen solid, then they trek through the deep snow—past farms, logging trails, and tamarack—to find their ultimate rink ready for a glorious backwoods skate under the full moon.

Buy from Indigo
$21.99

Buy from Amazon
$21.77

Bobby Orr and the Hand-Me-Down Skates book cover
books

Bobby Orr and the Hand-Me-Down Skates

By Kara Kootstra and Bobby Orr. Illustrated by Jennifer Phelan
Hockey fans of all ages will love this story of young Bobby, who is obsessed with hockey and who has asked for a new pair of skates for his birthday. But instead of the shiny new pair he imagines, he receives a pair of hand-me-down ones, worn and scuffed. Once Bobby gives them a try, he and the skates become a perfect match, and he can’t imagine skating without them. When the new pair arrive, what will Bobby do?

Buy from Indigo
$21.99

Buy from Amazon
$21.77

Clean Sweep! book cover
books

Clean Sweep!

By Monica Kulling. Illustrated by Renné Benoit
This is the story of how Frank Zamboni invented the ice-clearing machine that bears his name. Frank and his brother and cousin opened a skating rink in 1940, but it took their crews more than an hour to resurface the rink while skaters waited. After nine years of designing and redesigning, and a whole lot of perseverance, Frank invented the familiar machine we all know and love—and wish we had when we’re shovelling our lakeside rinks!

Buy from Indigo
$9.50

Over the Boards book cover
books

Over the Boards

By Hayley Wickenheiser
The greatest women’s hockey player of all time shares the lessons she’s learned on and off the ice over her spectacular career—which included disappointments and setbacks as well as five Olympic medals in ice hockey—and into her new calling as a medical doctor. You can read an excerpt of the book in the Winter 2021 issue of Cottage Life. Older readers, teens, and adults will appreciate the stories, insights, and wisdom from this Canadian champion of grit and determination.

Buy from Indigo
$20.00

Buy from Amazon
$17.49

Did we miss your favourite? Let us know at edit@cottagelife.com

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Indoor games to play with your dog this winter

Photo by TeamDAF/Shutterstock

For fans of winter, the cottage can be a wonderland, and many dogs agree. They love to frolic in the frosty snow. But there is such a thing as weather that is too cold for your dog. We’re here to help you know when it’s time to stay inside and what indoor games you can play with your dog.

How cold is too cold?

Not all dogs can tolerate cold the same way. For example, Alaskan malamutes originated in the north and have the coat to thrive at temps as low as minus 10 Celsius. On the other hand, greyhounds originated in Egypt, and their lean bodies are designed for high-speed chases, not enduring the cold. They would appreciate a coat even at plus 10 degrees Celsius.

In general, temperatures at 0 Celsius and below have the potential to be dangerous. If it’s too cold for you, it’s probably too cold for your dog. But there are other factors to consider. Senior dogs and puppies feel the cold more, as do smaller dogs and those with thinner coats. And don’t forget about wet weather or the wind chill, both of which can make typically tolerable temperatures too cold for your pet.

Sweaters, jackets, and boots can all help make your dog more comfortable outside, but it’s still important to watch them for signs they’ve had enough, such as shivering, whining, or holding their paws off the ground. And before venturing into the cold for prolonged activity, speak to your vet about your individual dog’s tolerance.

6 ways to exercise your dog in the winter

Dogs need enrichment indoors

Dogs require both physical exercise and mental simulation year-round, even on chilly winter days. If they don’t get enough, they become bored and prone to problem behaviours—not to mention weight gain, stiff joints, and other health issues. Plus, the time you spend exercising or playing with your dog strengthens the dog-owner bond.

But how do you ensure your dog’s brain and body get exercise when you’re stuck indoors? It can be as simple as playing fetch up and down the stairs or ramping up your training sessions. Your dog will benefit from any play or positive attention. However, we have some fun indoor dog games indoor to keep winter exciting.

Build an indoor agility course

The sport of agility is simply an obstacle course for dogs, and you can easily create your own with items around the house. Turn large cardboard boxes into tunnels, balance a broom handle on two piles of books to make a jump, or have your dog walk across cushions to challenge their balance. Never force your dog to tackle an obstacle. Lure them with treats or a toy and reward them for trying.

Teach a new trick

Trick training is just for fun, so you and your dog can enjoy the process and forget about the results. And if your dog does master a new trick, you have something to show off to friends and family. Try teaching behaviours like spin or bow that stretch your dog’s muscles as well as their brain. Or what about working on a freestyle routine? That’s dancing with your dog to music, and it’s a terrific way for you both to exercise.

Play tug-of-war

Tug-of-war is beloved by most dogs because it taps into their predatory instincts. But relax; it won’t create aggression. (Although it’s not an appropriate choice for dogs who already have aggression or resource guarding issues.) Indoor dog games, like tug-of-war with rules, helps dogs learn emotional self-control. Teach your dog to drop things on cue so you can end the game when you want.

Provide your dog with puzzle toys

Puzzle toys require your dog to problem-solve. For example, they might need to lift a flap to expose hidden food. These toys challenge your dog’s brain as they figure out what they’re supposed to do. If puzzle toys are new to your dog, start with easier options until your dog gets the hang of problem-solving.

Play hide-and-seek

Hide-and-seek allows your dog to use their powerful sense of smell. Play together by placing your dog in a sit-stay, then hide from them. Call their name and let them follow their nose. Or you can hide a treat or toy for your dog to find. Either way, start with easy hiding places, then slowly increase the challenge.

Try scent work

Scent work is the search for hidden odours. It’s a great mental workout that taps into your dog’s instincts. This indoor dog game can be as simple as hiding a tea bag or toy for your dog to find, or you can invest in essential oils, like birch, to replicate competition scent work. Your first step is teaching your dog to associate the smell with rewards. Then hide the container holding the odour in increasingly concealed locations.

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Cottage Life

Lyme carditis: when Lyme disease affects heart function

Lyme disease is a tick-born infection caused by bacteria known as Borrelia burgdorferi. Lyme carditis is an early manifestation of Lyme disease that can occur two to six weeks after the tick bite.

Approximately five to 10 per cent of patients presenting to family doctors’ clinics or emergency departments with symptoms of Lyme disease may develop Lyme carditis. The prevalence of Lyme disease in Canada continues to increase year after year. Nearly 2,700 people were diagnosed with Lyme disease in 2019, but the number of reported cases may not reflect the actual number of cases.

How Lyme carditis affects the heart

Lyme carditis most commonly manifests as high-degree atrioventricular block: a complete shut-down of the electrical system of the heart that can evolve rapidly over minutes, hours or days, producing severe symptoms like fainting, extreme dizziness or sudden death.

Less frequently, other serious cardiovascular manifestations may be present, such as:

  • sinus node disease, marked by alterations to the heart’s “motor” or natural pacemaker,
  • atrial fibrillation, which is a disorganization of the cardiac rhythm that increases the risk of stroke,
  • bundle branch blocks, or lesions in the distal cables of the heart that can interrupt electrical impulses, and
  • myocarditis, pericarditis or endocarditis, which are different degrees of inflammation of the layers of the cardiac walls.

Some of these manifestations can be so severe that total cardiac dysfunction may rapidly occur, and the patient may die despite medical efforts. Sometimes a heart transplant is the only option.

Diagnosing and treating Lyme carditis

The initial symptoms of Lyme disease can be mistaken for other common infections or allergic reactions. Delayed diagnosis and delayed initiation of proper treatment can lead to serious Lyme disease presentations including Lyme carditis in all its forms.

We need ongoing education at all levels (medical and nursing schools, community, governments) to close the gap in knowledge and ensure all participants in the health-care system aware of this preventable condition.

The good news is that prompt diagnosis and appropriate antibiotic therapy leads to a much better prognosis. Lyme carditis responds very effectively to treatment, completely eliminating the cardiac manifestations, with a very favourable prognosis in both short- and long-term followup. We now know that when antibiotics are used according to guidelines, the prognosis two years after the infection reveals no residual disease in the heart.

It is important to remember that most heart conduction abnormalities caused by Lyme carditis resolve with appropriate antibiotic therapy without requiring the implantation of permanent pacemakers. As most patients presenting with Lyme carditis are young and otherwise healthy, any medical strategy that could prevent the need to implant a pacemaker for the rest of their lives is welcomed.

Confirming Lyme disease in the age of COVID-19

The current COVID-19 pandemic is posing a new challenge in the diagnosis of Lyme disease. The two conditions have a lot of overlapping symptoms, such as fever, malaise, generalized pain and lack of energy. During these times, it’s advisable to rule out COVID-19 first before embarking on any other test.

Asking focused questions about personal lifestyle may help guiding the diagnosis of Lyme disease. Some key questions include:

Skin examinations and ECGs

Thorough dermatological examination can clarify difficult cases. This happened in my clinic recently, when a nurse practitioner decided to run a full skin examination and discovered typical bull’s-eye rashes on the patient’s back.

Once the diagnosis is suspected, cardiovascular symptoms such as dizziness, palpitations, fainting or near fainting, chest pain and shortness of breath should be investigated. If the patient reports any of these symptoms, along with any other factors suggesting Lyme disease, a 12-lead ECG (the simple and inexpensive electrocardiogram) should be performed.

Quite recently, a team from the United States did 12-lead ECG to a large series of pediatric patients presenting to the emergency department with high-suspicion of Lyme disease, and discovered that nearly 30 per cent of them had some conduction disturbance. Any evidence of electrical disturbance should prompt admission in hospital for a course of intravenous antibiotics while waiting the results of serological tests.

From the other perspective, any patient presenting with unexpected high-degree atrioventricular block (full electrical shut down of the electrical system of the heart), the way to test for Lyme carditis is by running a risk score called SILC (Suspicious Index in Lyme Carditis), which was developed at Queen’s University and is now used worldwide.

SILC score is based on the risk factor acronym COSTAR (Constitutional symptoms, Outdoor activities/endemic region, Sex male, Tick bite, Age < 50, Rash), which may help in determining the likelihood of early Lyme carditis.

We need to keep teaching and learning about Lyme carditis. In addition to ongoing education, curricula in medical and nursing schools should be updated immediately to be sure that all new health-care providers are trained in the rapid recognition of this condition. When to order serological tests, how to check for cardiovascular symptoms and the value of the 12-lead ECG are all important steps in the management of Lyme carditis.

The effort to eradicate Lyme disease should involve physicians and nurses, patients and families, rigorous science and political decisions for sound policy implementation.The Conversation

 

This article by Adrian Baranchuk, Professor of Medicine, Queen’s University, Ontario, is republished from The Conversation under a Creative Commons license. Read the original article.