12 Aug Lyme Disease!
Summer time! We’re hiking and picnicking! And, we’re exposed to ticks!
The blacklegged deer tick (Ixodes scapularis) is the main carrier of Lyme in our region. In its nymph phase, which predominates in the summer, it can be as small as a poppyseed.
Why the worry?
A 2018 report from the Centers for Disease Control reported that tickborne diseases have DOUBLED in the past 13 years. Lyme disease (carried by the Borrelia spirochete in the saliva of deer ticks) accounts for 82% of all tickborne diseases. But deer ticks can carry a multitude of other diseases (those most common in our region are Babesia and Anaplasma). Though the incidence of Lyme disease is highest in the Northeast, every state in our Nation has reported cases of Lyme disease. The authors of the CDC report note that reported cases likely represent a fraction of the actual cases. When we estimate the actual number of cases of Lyme in our country, they are truly frightening!
A substantial subset of people will develop chronic Lyme disease when bitten by ticks. Lyme disease (along with mold-borne illness) is one of the “great imitators”; it can cause an array of symptoms that can be difficult to identify and can result in life-altering disability.
Prevention is key:
1. Stick to the middle of well-cleared paths. Ticks live in grassy, brush-covered areas.
Resist the temptation to wander off the trail.
2. Full coverage is key!
Be sure to wear long pants and long sleeves. Tuck socks into your pant legs. Wear a hat too. Light-colored clothing makes spotting ticks easier.
3. Apply and reapply an effective tick repellent.
Here’s where things get tricky. DEET is highly effective against insects of all kinds, but it is a potent neurotoxin. If you’re an outdoor person, treating your clothing (NOT your skin) with permethrin is effective. Various essential oils have been found to be effective at repelling ticks. Among them are lemon eucalyptus and tansy. I recommend BiteBlocker. It has been found to have efficacy comparable with 30% DEET (at least when it comes to repelling mosquitos) though it requires more frequent reapplication. I recommend applying every 1.5-2 hours; more often if you’re swimming or sweating.
4. Do frequent “Quick Checks for Ticks” while on the trail.
In the ideal world, there would be no ticks. Beyond that wishful thinking, the next best scenario is you finding the tick before it has a chance to attach and transmit its saliva. We’re not certain of how long it takes for ticks to transmit infections once they’ve bitten. We do know that if a tick is attached for longer than 24 hours, particularly beyond 24 hours, it is more likely to transmit Lyme but it can happen in just a few hours. Check your neck, hairline, scalp, and any exposed skin. Know that the nymph form of the deer tick will literally look like a speck or dirt or a tiny freckle. Be observant and vigilant.
5. Shower and wash your clothing and gear as soon as you get home.
Take a shower as soon as you get home. Do a careful tick check of your entire body paying attention to warm, moist, dark areas (ears, scalp, navel, armpit, groin). This summer, my daughter removed a tick from her leg and put it in a sealed Ziplock bag. It was alive, inside that Ziplock baggie 3 weeks later! These pre-historic creatures are hard to kill! Wash your clothes and put them in the dryer on high for at least half an hour to kill any ticks that remain on your clothing or gear.
6. Check your pets.
Pets can carry ticks into your home after being outside. Ticks can also infect your pets with Lyme disease! Who knew?
If you do find a tick:
- Using fine-tipped tweezers, grasp the tick as close to the skin surface as possible. Apply gentle, even pressure away from the skin. Wait for the tick to release its hold. Do your best to remove the entire tick (including the head). Place it in a sealed Ziplock bag. DO NOT use Vaseline, gasoline, nail polish, or alcohol. Do NOT crush, squeeze, or try to burn the tick. If you’re not gentle with the tick, it may regurgitate more of its infection-carrying saliva into your body!
- Wash the area with soap and warm water and apply an antiseptic (like Neosporin or tea tree oil).
- If the head of the tick remains embedded, go to your local urgent care for a doctor to remove the tick completely.
To treat or not to treat?:
When you find an attached tick, it’s difficult to know whether or not to treat. Not all ticks carry Lyme or other disease-causing agents. Even if they do, you may not have been infected. Here’s what I recommend:
- Get the tick tested for Lyme and other tickborne infections. I recommend MDL labs. They are a NJ-based, FDA-accredited lab. It can take up to 4 weeks for symptoms of Lyme to develop. Antibodies will not develop and accurately reflect an infection for between two and sick weeks- that means you will not definitively know whether you’ve been infected for up to a month and a half. Getting an idea of whether the tick that bit you is infected with Lyme or any other infections can help make you aware of what symptoms to watch out for and whether you should be treated.
- Consider Antibiotics: The CDC recommends a single 200mg dose of Doxycyline given within 72 hours of tick attachment as a preventive strategy. The CDC has shown that this approach effectively prevents the classic bullseye Lyme rash within four weeks of a tick bite. But does preventing the rash mean we’ve prevented a Lyme disease infection? Most Lyme-literate doctors believe this single dose will not be adequate to kill the dormant cyst form of the Borrelia spirochete. These doctors recommend a 3 week course to prevent Lyme infection.
What’s my take?
I would much rather heal the gut after a three week course of antibiotics that deal with the consequences of chronic Lyme disease. Herbal anti-microbials may also be a good option- alone or as an adjunct to the antibiotics.
Watch for symptoms:
Up to four weeks after a tick bite, watch for the symptoms of Lyme disease. But know that many people who develop chronic Lyme do not remember a tick bite at all, so be on the lookout for these symptoms regardless of whether you know you’ve been bitten.