TiCC Service is a group of health-care specialists working together to diagnose and treat tick-borne disease in Manitoba. The service helps patients by connecting their primary care provider to appropriate health professionals, including specialists (internal medicine, rheumatology, medical microbiology, psychology, naturopathy, and pharmacy), who will be involved in a collaborative approach to their care.

Tick-borne diseases are becoming increasingly common in Manitoba. While early treatment is usually successful, it can be challenging to manage late Lyme and other infections related to a tick bite. Symptoms of late Lyme are often like those of many other chronic conditions making diagnosis and treatment difficult. TiCC Service was developed to streamline, coordinate, and improve client centered care.

To meet entrance criteria for TiCC Service, the patient must:

• Be a Manitoba resident and be registered with Manitoba Health
• Have a primary care provider, or be registered with a Home Clinic,
• Have had three symptoms of tick-borne illness for longer than three months
• Be 17 years* or older

* For patients under 17 years, TiCC Service will provide contact information for a pediatrician with special interest in tick-borne diseases.

Everyone is different and has different health histories. Therefore, two people with the same diagnosis of chronic Lyme can have different symptoms and illness presentations. That being said, common symptoms related to tick-borne diseases include, but are not limited to: fever, erythema migrans rash, fatigue, headache, sweats and chills, muscle pain, joint pain and swelling, nausea, difficulty with memory and concentration, decreased coordination, depression, dizziness, irritability, bone pain, numbness and tingling, sensitivity to light, sleep disturbances or visual disturbances.

Referrals to TiCC Service are made by your health-care provider (family physician, nurse practitioner, physician assistant).

Referrals to TiCC Service are consult based. This means health-care providers can contact TiCC Service for advice on how to manage tick borne illnesses. TiCC Service improves access to and coordinates specialists’ advice but does not take over patient care. Once TiCC Service has developed a plan of care for you, your health-care provider will receive a copy and will continue to manage your ongoing care.

TiCC service is a consult service, it does not take over patient care. Your health-care provider will always be available for pre-existing health concerns, and new health concerns.

The primary care nurse with TiCC Service is a patient advocate and is available to provide a connection between patient and TiCC Service medical lead. For serious and life-threatening health concerns always go to your nearest emergency department or call 911.

Length of enrollment with TiCC Service is based on the individual, their diagnosis, and response to treatment. Therefore, one person’s length of enrollment may differ from the next. You will always be under the care of your primary care provider, and the service will remain available to you both, as needed.

Once accepted into TiCC Service, much of your care will be provided remotely. Appointments with the primary care nurse are by telephone. The primary care nurse will obtain a detailed patient history and answer any questions you may have about TiCC Service. You will be asked to complete health questionnaires. These questionnaires provide a baseline to your health status and are helpful in determining effectiveness of treatment. The questionnaires can be delivered electronically or by paper mail.

Appointments with TiCC Service medical lead, internal medicine specialist Dr. S Goulet, will be longer than typical medical appointments. Some appointments with the medical lead can be scheduled virtually and others will need to be scheduled onsite at the Winnipeg office location. Virtual vs onsite appointments are determined on a case by case basis.

In some cases, Dr. Goulet may want to consult other specialists to seek their input and recommendations. This consultation occurs as a virtual meeting, known as Multidisciplinary Specialist Rounds, where there is representation from medical microbiology, rheumatology, psychology, pharmacy, and naturopathy. If required, TiCC Service can expedite setting up an appointment with the necessary specialists.

The TiCC Service medical lead will receive information regarding your appointments with the other medical specialists. In turn, your primary care provider will also receive this information.

Your health-care provider will receive a summary of the interaction between yourself and the TiCC Service medical lead. This summary will indicate any diagnostic, treatment, and plans for follow up. Should you be referred to Virtual Care Rounds with the specialists, your health-care provider will be invited to participate. If your health-care provider is unable to attend the Virtual Care Rounds, they will still be provided with a summary, indicating any additional diagnostic workup, additional referrals required, and plans for care.

A care plan is a written statement of your individual needs identified during a care assessment. Information found on a care plan could include medication schedule, plans for bloodwork or diagnostic testing, plans for additional referrals, general health recommendations, plans for follow up or program discharge, and program contact information should you have questions or concerns.

You can find a primary care provider using the Family Doctor Finder. Once registered, either online or by phone, you will be connected with a home clinic and family doctor.

No. Entrance into TiCC Service is focused on clinical symptoms.

There are three strains of Borrelia Manitoba, two other strains of bacterial tick-borne diseases (Anaplasmosis and Babesiosis), and a viral tick-borne disease has also been found in Manitoba.

Information on the emergence of these new tick-borne diseases can be found at gov.mb.ca/health/publichealth/cdc/tickborne/index.html.

If your physician would prefer the TiCC Service to do these additional investigations, you can ask for a referral, and we would ensure that they are evaluated.

For clients whose health care provider is reluctant to refer to TiCC Service, we suggest contacting the program at 204-940-1975 or [email protected]. TiCC Service will need your name, a brief history, current symptoms, plus the name and contact information for your health-care provider.

If appropriate, your health-care provider will receive a letter from TiCC Service outlining a positive blood test is not required for referral and acceptance to the service is based on clinical symptoms. The letter also explains how the service works, benefit of enrollment, and where to find the referral form.

Ultimately, referral to TiCC Service must come from your health care provider.

A definitive diagnosis of Lyme is not required to access TiCC Services. It is the role of our medical lead, internal medicine specialist Dr. S. Goulet, to perform a comprehensive assessment that will rule out contributors for otherwise medically unexplained symptoms.

There are several medical specialists involved with TiCC Service. Specialists currently involved include internal medicine, medical microbiology, rheumatology, psychology, naturopathy, and pharmacy. Additional specialists will be consulted, as required.

The medical lead for TiCC Service is internal medicine specialist, Dr. S. Goulet. In some cases, Dr. Goulet may want to consult other specialists to seek their input and recommendations. This consultation occurs as a virtual meeting where there is representation from each of the specialist groups listed above. If required, TiCC Service can expedite setting up an appointment with the necessary specialists.

Research proposals will be considered if aimed at improving the overall care and management of patients presenting with possible late Lyme disease and/ or other emerging diseases. Any research associated with the TiCC Service will follow the appropriate ethical procedures and patient approvals.