{"id":5995,"date":"2025-10-03T19:18:02","date_gmt":"2025-10-03T23:18:02","guid":{"rendered":"http:\/\/betsiecurrent.com\/?p=5995"},"modified":"2025-10-03T19:43:36","modified_gmt":"2025-10-03T23:43:36","slug":"anaplasmosis-a-new-to-us-tick-borne-disease-in-northern-michigan","status":"publish","type":"post","link":"http:\/\/betsiecurrent.com\/index.php\/anaplasmosis-a-new-to-us-tick-borne-disease-in-northern-michigan\/","title":{"rendered":"Anaplasmosis"},"content":{"rendered":"\n

A new-to-us tick-borne disease in Northern Michigan<\/em><\/h2>\n\n\n\n

By Aubrey Ann Parker
Current Editor<\/strong>

\u201cI\u2019ve had Lyme disease before,\u201d says Gerard Grabowski (64) of Bear Lake. \u201cThis was different.\u201d

Back in June 2022, Grabowski was having night sweats, and they were getting progressively worse.

\u201cHe was sick for almost three weeks before we realized what was going on,\u201d says his wife, Jan Shireman (64). \u201cDuring the day, he\u2019d feel okay again.\u201d

Grabowski interjects:

\u201cWith Lyme, I felt bad all the time.\u201d

A tall and lanky man, Grabowski is fit\u2014he spends his winters cross-country skiing and his summers working outside.

Already considered thin, when he lost 30 pounds in less than a month, his wife recalls telling him:
\u201cGerard, I\u2019m terrified. I think you might have cancer. You are losing weight rapidly.\u201d

That is when he went to seek treatment.

It was Maryann Smith, a physician assistant at the Crystal Lake Clinic in Manistee, who diagnosed Grabowski with anaplasmosis, a tick-borne disease that is actually carried by the same black-legged tick (Ixodes scapularis)\u2014known commonly as a \u201cdeer tick\u201d\u2014as carries Lyme disease. Grabowski says he was prescribed doxycycline, an oral antibiotic, twice daily.

\u201cIt reminds us that we are not at the top of the food chain,\u201d Grabowski says. \u201cWe never found a tick on me. We are people of the soil, so we have to be outside where the mice and the deer and everything live, too, so we are pretty vigilant about checking.\u201d

Grabowski says that the disease created \u201csuch a debilitating brain and body connection,\u201d so that he \u201ccouldn\u2019t think straight.\u201d

\u201cThat was the first year it had even been in Manistee County,\u201d Grabowski says. There were 13 confirmed and suspected cases that year, according to local health district records. \u201cAnd then Bernie was a few months after me.\u201d

Grabowski is talking about Bernie Ware (75), a farmer who lives just down the road who was hospitalized for five days with anaplasmosis.

\u201cHe lost an incredible amount of weight, too. And he\u2019s 12 years older than us,\u201d Grabowski says, \u201cIt almost took him out. He was skinny.\u201d

Bernie Ware\u2019s wife, Sandee Ware (70), explains:

\u201cHe started to seem off. He was still in a collar, because he had broken his neck earlier in the year. This was near the time he was getting the collar off. It was October, and he was leaving for a men\u2019s weekend. I remember thinking he seemed confused, like he couldn\u2019t figure out how to turn the oven off and on, and that was odd. That was on a Thursday, and he left on Friday. He came back on Sunday, and he\u2019d been miserable all weekend with a fever and chills. So I took him to the [emergency room] on Monday.\u201d
She says that she dropped her husband at the door of Munson in Traverse City, and she went to park the car.<\/p>\n\n\n\n


\u201cThey asked him why he was there, and he was confused and just said a fever. So they tested him, and it
was only 99. It had been going way high and way low, so at that point, it was within the normal range,\u201d Sandee Ware says. \u201cHe immediately went downhill, and he was out of his head and his body. It was really scary.\u201d

By Wednesday, now two and a half days into his hospital stay, Sandee Ware asked the physicians if they thought it maybe had to do with a tick bite from six weeks prior to his initial symptoms.

\u201cThat\u2019s when they got the specialist, the infectious disease doctor,\u201d says Sandee Ware, who keeps every single tick that the couple pulls off of each other, taping them to a piece of paper and writing down the date and other information, just in case it was ever needed for a moment just like this.

At this point, Bernie Ware was prescribed doxycycline on Wednesday, and he was discharged from the hospital on Friday.

\u201cI could tell within an hour it was working,\u201d Sandee Ware says. But it was still a long road to recovery. \u201cHe couldn\u2019t walk or do anything. He came home with a walker.\u201d

A blood test was sent to Mayo Clinic in Minnesota on that same Wednesday that he began the new antibiotic, and the results came back the next week as positive for anaplasmosis.

Now more than two years later, the Wares continue to work outside and practice active measures to keep ticks at bay.

\u201cStill, I had a bite every month from February to November last year,\u201d Sandee Ware says.

It Hits Home<\/strong>
Grabowski and Ware are not alone; The Betsie Current spoke with several others in Northern Michigan who were diagnosed with anaplasmosis themselves, or their pets were. We also spoke to doctors, veterinarians, and the local health departments, as well as combing reports on the subject.
All of this research started because we had quite a scare ourselves last fall when we got back from a Halloween party.

Around 6 p.m., we had left our 2.5-year-old dog, Indie, in the back-of-the-house upstairs bedroom, so as to minimize her disturbance by trick-or-treaters coming and going on the street while we were gone.
When we got back around midnight, six hours later, she was acting odd\u2014she was shaking, and she just seemed a little goofy.

We wrote it off as anxious nerves from the hundreds of people who had descended upon the streets of Frankfort earlier in the evening\u2014she probably had felt the need to \u201cstand guard\u201d and defend the house.
The next morning, she was still not right, though\u2014she was still shaking, plus now we could tell that she was lethargic, barely getting out of bed. Typically, we are greeted with a wagging tail and a happy girl, who is ready to meet the day.

But there was no tail-wagging.

I immediately called Betsie River Veterinary Clinic in Benzonia, and Dr. Susan Daly was able to get her in right away. Indie was running a fever\u2014107 degrees Fahrenheit, when a dog is typically between 100 to 103 degrees.
<\/p>\n\n\n\n

\"Anaplasmosis<\/figure>\n\n\n\n

Before she even ran the blood test, Dr. Daly called it: \u201cI think this is anaplasmosis. It\u2019s a tick-borne disease.\u201d

We, of course, had heard of Lyme disease, and we work pretty hard to prevent it: Indie has had the Lyme vaccine that is available for dogs\u2014though, unfortunately, not humans\u2014and she takes oral tick medication monthly. Plus, we are very diligent in checking her for ticks when we get home after an outing in the woods. At this point in her young life, I think that we had only ever found three ticks attached to her.

One of those had been attached just four days before this had all started; it had only been attached for fewer than three hours, so it was not engorged, and we had not worried much about it, since conventional wisdom is that it typically it takes 24 to 48 hours for an attached tick to transmit Lyme disease\u2014plus, she had been vaccinated against Lyme.

At that point, we had never even heard of anaplasmosis.

The official literature, depending on what source you are reading, says that it takes between 12 to 36 hours for a tick to convey anaplasmosis into its host, but Dr. Daly told us that her work in the field is contradicting that. Moreover, she is now seeing anaplasmosis cases rising faster than Lyme disease rates.

\u201cThe presence of anaplasmosis [in dogs] has increased every year, while Lyme has tapered off,\u201d Daly says

\u201cPeople are better at fighting [Lyme] now; better at tick control, and it takes a day to transmit from the tick once it\u2019s attached to a host\u2014they\u2019re less likely to get it, as long as the tick doesn\u2019t stay on too long.\u201d
Obviously it helps that there is also a vaccine for Lyme\u2014and none currently for anaplasmosis.

But Daly believes there is more to it than that, and she hopes that more studies will be done soon as an update on the transmission times for anaplasmosis, because of what she is seeing in her office.

\u201cWe see anaplasmosis frequently in dogs who are on oral tick medication,\u201d says Daly, who explains that these oral medications claim to be killing attached ticks within a shorter time window than the 12 to 36 hours reported for anaplasmosis to enter the dog\u2019s bloodstream.

Cornell University\u2019s College of Veterinary Medicine\u2019s website says:

\u201cOral preventatives containing isoxazoline (e.g. Nexgard, Simparica, Credelio, Bravecto) do not prevent tick attachment, but they have a relatively fast tick kill time. The tick kill time is important to note because of the diseases that can be spread if a tick remains attached and alive too long.

Meanwhile, PetMD\u2019s website says:

\u201cOral tick medications typically start killing ticks within a few hours, with some beginning to work in as little as 30 minutes for some medications. For example, Credelio can begin killing ticks within four hours, while Simparica can kill ticks within eight hours. Some medications, like Bravecto, may take up to 12 hours to kill all attached ticks.\u201d

The point is: there seems to be a disconnect between the time that official reports say it takes for anaplasmosis to be transmitted from a tick to a host and the time that the pharmaceutical industry says that the oral tick medications are killing attached ticks\u2014and it seems like more research in this area is needed to better understand this discrepancy.

The Betsie Current <\/em>reached out to a tick specialist scientist at Michigan State University for more information, but as of press time, had not heard back.

With what she knows at this point in time, Daly says it is especially important to be diligent in other, additional ways\u2014not simply giving an oral tick medication or trying to make sure that attached ticks are removed before they become engorged. Those are great things to do, but there is more that can be done.

Additionally, Daly is encouraging dog owners to also use tick collars or potentially other topical solutions.
\u201cWhen I have people come into the office who have dogs on an oral flea and tick medicine, I talk to them about repellency, too,\u201d Daly explains. \u201cAdvantix has permethrin in it. Or Vectra, which is marketed through veterinarians. Or collars like Serestro, which last for eight months. They work pretty well for most dogs, unless they swim a lot. There are some others that have deltamethrin instead; I don\u2019t know comparatively if they are as good. They might do the job okay, too.\u201d

Will some of the natural repellency products work?

\u201cI don\u2019t know,\u201d Daly says. \u201cThey might. I haven\u2019t used them or put them to the test.\u201d

Are there topical solutions like this for humans, too?

\u201cThere is permethrin-impregnated clothing,\u201d Daly says. \u201cYou can also get a spray; take your pants out and spray them, and it will stay on for more than 20 washings. One of my clients came in who had been hunting with his dog, and the dog had 30 ticks on him; the hunter was wearing coveralls with permethrin coating, and he had no ticks on him. It is pretty effective.\u201d

It may be anecdotal, but our household is deciding to lean in\u2014better to be safe than sorry.

After our big scare with Indie last fall, we have decided that she will be wearing a tick collar when she is out, at least in the spring and fall, and maybe in the height of summer, depending on how many ticks we are pulling off her at that point. (We find that the number tends to go down in summer heat.)

We do not want any repeats with anaplasmosis, if we can help it.

When Indie was sick last fall, Dr. Daly prescribed 10 days of doxycycline, given twice a day. For the first dose, she had us give Indie two pills, to try to knock down the fever.

It worked.

Within just a couple of hours, Indie was not shaking anymore\u2014that had been the fever\u2014and she was actually wagging her tail a bit, and she was slightly less lethargic. It took two to three days before she was back to normal, running and playing.

But fast-forward to less than a month later, at Thanksgiving dinner, we were told that my partner Jordan\u2019s uncle, Tim Burke (72), was in the emergency room at Munson in Traverse City, potentially for a heart attack or maybe a stroke.

A few days later, however, we were told that, in fact, Uncle Tim had been diagnosed with anaplasmosis: the same disease that had made Indie so sick at Halloween!

At that point, we started to hear of more and more of our human and dog friends in Benzie and Manistee counties who had had run-ins with this new-to-us tick-borne disease\u2014Gerard Grabowski, Bernie Ware, both men in their 60s and 70s, like Uncle Tim. But we also heard of a mid-40s woman in Frankfort, and a couple of friends\u2019 dogs, including one that had died.

I began to dig around and research a bit, and to my surprise, I could not find any media outlets really reporting on what seemed to be a striking increase in cases locally; all I could find were general press releases from various health offices.

Thus I set out to tell what is sure to become an ongoing story for our area.

Cases Increase
<\/strong>A study was published in November 2024 by the Bureau of Infectious Disease Prevention\u2019s Emerging & Zoonotic Infectious Disease Section (EZID) within the Michigan Department of Health & Human Services that chronicled five years from 2019 to 2023.

Caused by viruses, bacteria, parasites, and fungi, zoonotic diseases can be transmitted between animals and humans directly or via a vector, like mosquitoes or ticks.

In addition to things that you have likely heard of\u2014such as anthrax, dengue fever, head lice, malaria, West Nile, rabies, and harmful algal blooms\u2014the EZID report also featured things you may have never heard of, such as various fungal diseases, spotted fever, and invasive aedes mosquitoes.

There was also a whole section on tick-borne diseases, such as Lyme disease\u2014something that, unfortunately, we are quite familiar with now in Northern Michigan.

\u201cFrom anaplasmosis to Zika virus\u2026\u201d says the first page of the report.

That first disease is now on the rise here, too.

Confirmed human cases of anaplasmosis in Michigan have increased more than 10-fold over the past decade: four cases in 2014, seven in 2016, 14 in 2017, 14 in 2018, 13 in 2019, 18 in 2020, 58 in 2021, 54 in 2022, and 67 in 2023. (A footnote says that all data for 2023 are \u201cprovisional,\u201d pending final review, and that, if we include both the \u201cconfirmed\u201d and \u201cprobable\u201d cases, the number rises to 115 from 67.)

Anaplasmosis is now the second-most common tick-borne disease in Michigan, following Lyme disease, which has confirmed cases most intense along the western coastline of Michigan, especially in southwestern Michigan, and also in the western portion of the Upper Peninsula.

Generally, anaplasmosis follows this same pattern. Currently, Michigan counties with the highest incidence of anaplasmosis border Wisconsin, though cases are creeping up along the western edge of the Lower Peninsula, as well; 35 counties had 115 confirmed and probable cases of anaplasmosis in 2023. Eight of those counties had their first cases in 2023.

This follows the trend of other tick-borne diseases over the period from 2019 to 2023: Babesiosis (also from the black-legged tick) increased from one to 10 cases; Ehrlichia (from the lone star tick) increased from two to six cases; and Lyme disease increased from 424 to 1,146 cases. (There are two other Ehrlichiosis types that had zero cases across the board, and Rickettsial disease, also known as Rocky Mountain Spotted Fever, caused by the American dog tick, actually decreased from 10 to three cases. However, the report notes that, in most cases, Ehrlichia and Spotted Fever were acquired while traveling out of state.)<\/p>\n\n\n\n

Benzie and Beyond
<\/strong>\u201cThere was only one confirmed case of anaplasmosis in Benzie and Leelanau counties in 2023,\u201d says Dr. Josh Meyerson, medical director for three local health departments: Benzie-Leelanau District Health Department, District Health Department 4, and Northwest Michigan Health Department. \u201cBut in 2024, there were four confirmed cases in Benzie and six in Leelanau. So we are seeing a definite increase.\u201d
Notable: A confirmed case of anaplasmosis means that a blood sample has been taken and shipped to a clinical laboratory\u2014such as Mayo Clinic in Minnesota, like in the case of Bernie Ware\u2014for testing and has come back positive.

In Manistee County, 2022 was the beginning of anaplasmosis being documented, and there were 13 \u201cconfirmed and suspected\u201d cases\u2014including both Gerard Grabowski and Bernie Ware. Then there were eight cases in 2023, seven in 2024, and there have been two so far in 2025, according to Claire Janson, communicable disease coordinator for District Health Department 10, which is the largest geographic health department in Michigan, serving 10 counties including Crawford, Kalkaska, Lake, Manistee, Mason, Mecosta, Missaukee, Newaygo, Oceana, and Wexford.

\u201cThe counties with the largest increases [over the past two years] were in the Western [Upper Peninsula] and Benzie and Manistee counties. Benzie is considered a relative hotspot. Why? I don\u2019t exactly know,\u201d Myerson says.

He admits it could be that area physicians are more well-versed in this relatively new disease than other areas, so they know to look for it. Additionally, it could be that there is a greater number of black-legged ticks here that are infected and carrying the bacteria that causes the illness.

Likely, it is a combination of both these factors.

\u201cI think most people know all about Lyme and have not heard about anaplasmosis,\u201d Meyerson says. \u201cWe have tried to do a little bit of awareness for the general public and have provided information to the area doctors, so they are knowledgeable. What we do know is that more cases are being reported to us from that area.\u201d

When asked what his office was doing to help get the word out, Meyerson responded:

\u201cIn 2023, the state put out information about anaplasmosis, the second most common tick-borne disease after Lyme disease, and I sent a notice to all of the area healthcare providers highlighting the rise in cases here.\u201d

Meyerson explains that there is always the possibility that a tick infected with Lyme disease could also be co-infected with anaplasmosis, and vice versa; they are not exclusive. He notes that the symptoms show up slightly different, but that both are treated with the same antibiotic: doxycycline.

Not everyone who is diagnosed with Lyme or with anaplasmosis gets a formal test done, however; sometimes, healthcare providers might give a clinical diagnosis that is based on symptoms alone, like in the case of Gerard Grabowski. In these instances, these cases are counted as \u201csuspected\u201d and not \u201cconfirmed.\u201d

\u201cSome people may be getting treated for Lyme disease, but they actually have anaplasmosis. Since they\u2019re both treated with the same antibiotic, unless there is a test, it might get counted as one instead of the other,\u201d Meyerson says. \u201cTo confirm it, you have to test specifically for it.\u201d

Regardless of whether a case is diagnosed with a test or with symptoms, both Lyme and anaplasmosis are considered \u201cmandatory reporting,\u201d meaning that healthcare practitioners must alert the local health department.

\u201cWe get reports one of two ways,\u201d Myserson says. \u201cIf they order labs and they are positive, it is more automatic that it gets sent to us. Nobody has to remember to call the health department. Sometimes, the diagnosis is clinical, so we count on the doctors to report to us by calling or faxing. If you are a citizen and you\u2019re worried about it, you can ask your doctor if they reported it. But from a personal health perspective, it won\u2019t make a difference.\u201d

Could numbers be higher than those reported? Of course.

\u201cWe know that we don\u2019t have all of the cases,\u201d Meyerson says.\u201d If we had four [confirmed] cases reported [last year in Benzie County], we know that there are more cases out there\u2014but we can look at the trends. We know it\u2019s increasing.\u201d

Prevention for both Lyme and anaplasmosis is the same, though, Meyerson notes.

\u201cAvoiding tick-infested areas, staying on the trail. There are ways to protect your pets and yourself using insect repellent and protective clothing and doing tick checks frequently, and removing them promptly if you find them on you or attached,\u201d he says.

If someone wonders whether the tick that bit them has the potential to be infected with anaplasmosis, their local health department can help to identify the tick, or people can submit a picture online via the Michigan Department of Health and Human Services (MDHHS) website.

\u201cA lot of times, someone shares a tick that they found over the weekend that they\u2019re concerned about,\u201d Meyerson says. \u201cAnd it was a big dog tick. You can\u2019t get Lyme disease or anaplasmosis from it, so you don\u2019t have to worry.\u201d

He adds:

\u201cWe generally don\u2019t test the tick for the bacteria. That\u2019s not something that is routinely done. For a while, the state was doing that, as they were learning about the epidemiology. That takes pretty special testing and can\u2019t be done in a normal human microbiology lab.\u201d

He says that the Benzie-Leelanau District Health Department does have an environmental health sanitarian who is doing some surveillance for ticks in the area

Local Practitioners
<\/strong>\u201cWe are seeing a slight increase [in anaplasmosis cases], but we started at a low spot,\u201d says Dr. Brian McComb (55), chief medical officer for Munson Healthcare\u2019s south region. \u201cIt\u2019s not a huge number of patients. It\u2019s not something that I was seeing every summer, but I haven\u2019t practiced in an office for the last 2.5 years. It is slowly on the rise, though.\u201d

When asked about the rise in cases specifically in some regions like Benzie and Manistee counties, McComb responds:

\u201cIt is not uncommon to see some clusters here and there. A group of ticks hanging out together, sharing that bacteria. It tends to grow once it gets established.\u201d

I share the severity of the cases that I have heard about: Gerard Grabowski, Bernie Ware, Uncle Tim Burke, even our dog.

\u201cThe vast majority of people will kick it,\u201d McComb says. \u201cIt\u2019s a very low percentage of people who struggle; people with pre-existing conditions, those over the age of 65, or if they have some autoimmune systemic thing going on\u2014people with long-term symptoms from disease or medications are going to be more susceptible.\u201d

That was definitely the case with Uncle Tim; as it turns out, he had walking pneumonia, which his physicians believe contributed to why he got so sick and why it took him so long to get better\u2014he spent two and a half weeks at Munson in Traverse City and then two additional weeks in the rehab facility at Paul Oliver in Frankfort. He lost 40 pounds in those first 14 days, and he had all kinds of other complications like needing dialysis.

But it had all started with just feeling kind of crummy: like in Grabowski\u2019s and Ware\u2019s cases, Burke would have symptoms that were fleeting\u2014they would sometimes disappear altogether.

\u201cAnaplasmosis is usually very similar to flu-like symptoms: fevers, chills, muscle aches, nausea, vomiting,\u201d McComb explains. \u201cFatigue is a prevalent symptom, but it\u2019s hard to quantify. Diagnosis is usually clinical, meaning that they are showing symptoms and have access or exposure to ticks, or they\u2019ve had recent bites. Then the suspicion goes up. Testing that can be done. There are tests available that can be done\u2014polymerase chain reaction [PCR] tests, but those are tricky to get through insurance, most of the time.\u201d

And they have to be sent out to a lab, as Myerson had told me.

When it comes to the numbers being reported, McComb says:

\u201cPeople get treated, but it doesn\u2019t always get reported, so those numbers could be off. It\u2019s hard to know for sure.\u201d

As for prevention, McComb recommends removing leaf clutter from your yard and getting rid of habitats where ticks like to hang out; wearing clothes with tighter collars and sleeves, to keep them from getting a foothold on your skin.

\u201cIf you\u2019re out and there are likely ticks, check periodically, even before you get back to your vehicle, don\u2019t wait,\u201d McComb says. \u201cJust do a quick check. Any time that you\u2019ve been in the woods. Check in the shower when you get back. The key is to get the tick off as quickly as you can. Sometimes, they are on there for several days before people notice them.\u201d

Meanwhile, Dr. Jake Flynn of Crystal Lake Clinic\u2019s Interlochen office had this to say:

\u201cFive years ago, we were seeing relatively low rates of tick-borne diseases, but we\u2019ve seen a huge spike. There are so many reasons that we\u2019ve seen an increase; honestly, the [COVID-19] pandemic got a lot of people outside more. Which is great, generally. Spending time outside is great. But you can look at maps from five years ago, and these diseases that were mostly on the East Coast have migrated to the Midwest, and it\u2019s a real concern.\u201d

He advises that if people are feeling poorly this summer, they should go see their primary healthcare provider.

\u201cYes, the fatality is less than 1 percent, but it\u2019s not zero,\u201d he says. \u201cAnd it can be prevented if we see you early, if you get labs done early. Then the fatality can be zero, if you just go see your doctor if you think you\u2019ve been exposed to a tick. And even if you don\u2019t find a tick on you, if you\u2019re feeling malaise, fatigue, fever, muscle aches. Don\u2019t delay. Go be seen. Let\u2019s find out what you\u2019re dealing with.\u201d

He agrees with others interviewed in this article that many people are aware of Lyme disease and the recognizable red bulls-eye symptom, but he finds that fewer people are aware of the newer diseases to this region, such as anaplasmosis.

\u201cIt\u2019s so easy to think that you just have the \u2018crud,\u2019or a summer cold. But if you live in the woods or you play in the woods or you\u2019re just outside a lot, we\u2019re going to look into that, to make sure that it\u2019s not something that could be disastrous. We might prescribe some preliminary, routine labs to start,\u201d he says. \u201cWhat you\u2019re going to see is a decrease in white blood cell count and in platelet count and an increase in liver enzymes. So, if we put the whole story together: you\u2019ve had a tick on you, you\u2019ve had these symptoms of malaise and fever, etc. and now there are these labs coming back, we try to do a PCR lab to find out if it\u2019s Lyme, anaplasmosis, or another tick-borne disease.\u201d

He adds:

\u201cThe great thing is that it\u2019s the same treatment for all three: doxycycline. Detection and treatment early is key. It\u2019s critical. It could take five minutes for us to see you, order labs, or not, or just treat you. It doesn\u2019t take long, and it doesn\u2019t take a lot of effort with our expertise to give you a prompt diagnosis and treatment plan. We can get you in the same day for something like this, if you suspect it.\u201d

In closing: if you are someone who is outside a lot, and you are feeling sick, do not hesitate to advocate for yourself and head into your primary care practitioner\u2019s office asking about anaplasmosis.

Featured Photo Caption:<\/strong> Sick as a dog. Photo by Aubrey Ann Parker.<\/p>\n","protected":false},"excerpt":{"rendered":"

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