Debbie Ruprecht expected to enjoy some relaxing time off after retiring last year.

But instead the 47-year-old former special education peer educator at Rockwell Elementary School in Damascus began feeling tremors and nerve spasms.

She went to her doctor thinking she had Parkinson's disease or multiple sclerosis but was diagnosed with Lyme disease instead.

Her doctors say she has likely had the disease for a year before it was diagnosed.

Lyme disease is a bacterial illness that can be transferred when an infected deer tick bites an animal or person. Early stage symptoms include a bull's-eye-shaped rash around the bite mark, achy or swollen joints, and flu-like symptoms, according to the Centers for Disease Control and Prevention.

If left untreated, the disease can be debilitating, even fatal. But most cases are treatable with antibiotics, according to the Centers for Disease Control and Prevention.

Dr. Norton Fishman of Optimal Health Physicians in Rockville, an internal medicine specialist by training, became an accidental expert on Lyme disease after he began seeing patients with the disease who had been misdiagnosed by other physicians. Doctors may miss the diagnosis because it is not something they are looking for, he said. The flu-like symptoms are similar to many other ailments in the early stages of the disease.

"Word gets around," Fishman said, and now about two-thirds of his patients are being treated for Lyme disease.

"This season the tick population seems to be exploding," he said. "I have the sense that the ticks are getting more infected."

Fishman said he is seeing patients who have been bitten in Poolesville, Potomac and even in Washington, D.C., as they walked in Rock Creek Park.

"You truly can call it an epidemic," he said. "I have people coming in with tick bites in December."

Lyme disease is endemic in our area, county health officer Ulder Tillman said Tuesday after a health briefing before the County Council.

The county's disease control official was attending a meeting in Baltimore on Tuesday where statewide health officials were discussing Lyme disease, Tillman said. Within the county, health officials are planning a second Lyme disease task force meeting later this year. The meeting, originally scheduled for May, was rescheduled while the health department dealt with swine flu cases.

Officials at Shady Grove Adventist Hospital in Rockville said that between Jan. 1 and June 15 there were 49 cases of Lyme disease reported at the hospital. During the same period last year, the hospital reported 12 cases. A total of 92 cases were reported in all of 2008, with most of those occurring between September and November, officials said.

Cindy Edward, nurse administrator for Montgomery County's Health and Human Services Department Disease Control Program, confirmed the trend.

"Our numbers are increasing, and have been over the last few years," she said.

The rise could be in part due to better reporting, Edward said, but she does think there is an increase in the number of infections. She also thinks the true number of cases in the county is far greater than what gets reported.

"The reporting for this is very poor," Fishman said. "We're probably only getting about 10 percent of the cases reported."

With increased awareness and proper diagnoses, more people are seeking treatment, Fishman said.

"I do see a lot of the people we're treating get better, even people who have been sick for a long time," Fishman said.

In the last year Ruprecht of Mount Airy has undergone surgery for the co-infections she suffers from as a result of the disease. One co-infection has symptoms that resemble malaria, she said. Treatment requires 40 to 50 pills a day.

Ruprecht also suffers from heart and anxiety problems as a result of the disease affecting her nervous system.

"It's a terrible, terrible disease," Ruprecht said. "Almost everyone I talk to knows someone who has it."

Lyme disease has permeated almost every aspect of her life and her dogs. Four of her five Yorkshire terriers have been infected and two died from the tick-borne illness.

Dr. Jonathan Wenk, an Emergency Department physician at Shady Grove Adventist Hospital in Rockville, said the best way to avoid getting Lyme disease is to avoid getting exposed in the first place.

"A lot of it is common sense stuff," he said. "Avoid wooded areas, tall grassy areas, tuck your pants legs in, check yourself for ticks after you've been out in these areas."

Check your pets as well.

"I've seen people get the disease from their pets," Wenk said.

Because the disease is already endemic to this area, people should not be concerned about overgrown grass and less frequent mowing, Tillman said.

"But the overgrowth means that individuals have to be more committed to doing the recommended things like wearing long pants, long shirts and repellants," she said.

If you do find a tick on yourself or your pet, remove it immediately.

"The best way is with a pair of tweezers, grab the head and pull up with a slow and steady force at a 90-degree angle from the skin," Wenk said. Trying to burn the tick or smother it with alcohol, nail polish or butter, are methods that do not work, he said.

In the county, there are about 46 cases of Lyme disease per 100,000 people, Edward said, which is about on par with the statewide level of 45.1 cases per 100,000 people.

"Some counties, like Kent, have almost 200 cases per 100,000 people," she said.

Staff Writer Janel Davis contributed to this report.

-Symptoms of Lyme disease: fever, headache, fatigue and a bull's-eye-shaped skin rash in the early stages, leading to joint, heart and nerve problems in later stages

-Infection: humans and pets can contract the disease, but only if bitten by a deer tick

-Treatment: antibiotics

-Prevention: avoid wooded or grassy areas, use insect repellant with DEET, check yourself and pets for ticks after spending time in these areas; remove any ticks immediately

Source: Centers for Disease Control and Prevention

Shady Grove Adventist Hospital reported cases:

-Between Jan. 1 and June 15, 2008: 12

-Between Jan. 1 and June 15, 2009: 49

-Total in 2008: 92, with the bulk coming between September and November