“Honey, can you come here?” my husband asked in a slightly panicked voice as he was giving our 3 year old a bath… I rushed upstairs to find him trying to remove a wriggling deer tick from her back.
“Yuuuck!” said the Mommy part of my brain until then the doctor part kicked in: “Eeek, Lyme!!!”
Even though I knew the tick had not been on her long enough to transmit Lyme (we had only gone hiking a couple of hours before), the specter of Lyme disease still loomed in front of me. Now I knew how my patients feel when they come into the office with tick bites!
So, what should you do when you find a tick on you? How can you best prevent Lyme disease?
First of all, the CDCrecommends avoiding wooded and bushy areas, staying on the center of hiking trails and using bug repellant with 20% or more DEET. (Alas, we both strayed off the trail and neglected to put on our bug spray!)
Secondly, check yourself for ticks as soon as you get home and bathe or shower as soon as possible. (Phew, at least we got points for that one!)
Also, check your hiking gear and pets for ticks, as they can ride home on clothing and animals. Tumbling clothes in a dryer on high heat for an hour will kill the little critters.
If you do find an attached tick, use fine tipped tweezers to grasp the tick as close to the skins surface as possible. Pull upward with steady pressure and don’t twist or jerk the tick. If the mouth parts do remain in the skin and you cannot get them out easily, just leave them alone and let the skin heal. A tick cannot transmit Lyme once its body has been separated from the mouth. After removal, thoroughly clean the area with soap.
If the tick has been on you less than 36 hours, then you can stop here. The risk of Lyme transmission is very low in this circumstance; a tick needs to be feeding for at least 36-48 hours.
If you are unsure of how long the tick has been on you or if it is engorged and you cannot reliably identify what kind of tick it is, then save the tick and come in to our urgent care clinic.
We can send the tick for identification and Lyme testing. Only deer ticks carry the Lyme bacteria, so if you have been bitten by a dog tick, you are in the clear.
Since Lyme disease can take up to a week to manifest, we can also give you a prophylactic dose of antibiotics to reduce your risk. The tick needs to be on you for more than 36 hours and you must get in for an appointment within 72 hours; the efficacy of prophylaxis beyond 72 hours is unknown.
You should monitor yourself for 30 days after a tick bite and any rash or flu-like illness should receive prompt medical attention to evaluate for tick-borne illnesses. The good news is that early treatment of Lyme significantly reduces the chances of complications.
Lastly, blood tests after a tick bite are of no value as it takes the body several weeks to mount an immune response to the bacteria and for titers to become positive. So, if you have been bitten by a tick, you do not need blood work.
Luckily, we successfully got the tick off of my daughter, who in typical fashion was as fascinated as I was revolted! We are definitely going to take better care next time we go hiking!
Sources: CDC Lyme Disease and The ISDA 2009 guidelines for The Clinical Assessment, Treatment, and Prevention of Lyme Disease.