Friday, April 8, 2016

Tick Bites:Prevention and Action Plan (update)

Ah, the twisted thinking of an advice nurse. For most folks, spring brings to mind warmer weather, longer days, lovely flowers etc. Me? I think,"Here comes tick season."  Nurse Lainey found one on her own ear just this week. She considered getting rid of her dogs immediately, but they are too cute, so they get to stay.

Indeed the calls are already coming in and I have spoken to a half dozen patients about tick bites just this week. It makes sense. With the nicer weather more of my patients are out there taking walks, hiking and enjoying the beautiful area that we live in. I think the extra rain this season has contributed to some early tick sightings. Ticks can be an issue all year long, but the nymphs are born in the spring. These tiny little ticks are the ones most likely to transmit diseases. Of the many varieties of ticks out there, the ones responsible for the majority of  disease transmission are the deer ticks. If you want to impress folks at your next cocktail party, our local deer tick is officially identified as the ixodes pacificus.

Although only a small percentage of tick bites are harmful, the diseases can have a major health impact, so we need to pay attention. There are multiple types of bacteria responsible for tick borne illnesses. In fact, this year a new one was discovered in Minnesota, Wisconsin and North Dakota. Ticks here in California are known to transmit several different diseases, including Lyme. There are many conflicting reports, but recent studies coming out the past couple of  years suggest that the rates for tick borne diseases are  higher in California than previously thought.

Check out this little tick Guide:

The key is prevention.

If you are going to be walking or hiking in densely wooded areas try to stay in the middle of the path. Avoid wood piles and logs. Light colored long sleeves and long pants are recommended. Spray the clothing with the bug repellent Permethrin. This is okay for anyone over 2 months of age. Use Deet on exposed skin, avoiding hands, eyes, and mouth.

But let's face it, on a hot day we are not going to have our bodies covered completely, so here is the deal....

Everyone needs to get a naked head-to-toe body check after a walk in the woods. If you are camping, do a full body check daily. Ticks can hide in out of the way places on your body. Don't forget to check the scalp. If you are dealing with thick darker hair, you can rub your fingertips along the scalp and feel for any bumps. Check in between the fingers,toes and behind the ears. Check armpits and belly buttons as well. You really need to be very thorough. Many of the ticks are very tiny and hard to see. Be familiar with little moles and freckles so you can recognize a new spot which might be a little tick.

If you are returning to your home after a hike, take all clothing and put everything in a hot dryer for 60 minutes to kill any wandering ticks. Don’t forget to check the car seat!

It is very important to remove the tick as quickly as possible. If a tick is removed within 4 hours of the bite, the chances of any disease transmission are SIGNIFICANTLY decreased. For Lyme disease, the tick generally needs to be attached for more than 24 hours to be a concern.

If you do find a tick, please stay calm. I can still remember vividly, years ago, a mom carrying her toddler into the office screaming (the mom, not the kid) "HELP ME GET THIS THING OUT OF MY BABY!"  Hey, arachnophobia is appropriate in this case, because ticks are indeed arachnids (the spider family), but put on a brave face for your child.

The best way to remove a tick is with tweezers or a special tick removing tool. Grasp the tick as close to the skin as you can and firmly pull up and away. Do not twist. The Public Health department councils that you should not try any of the folk remedies such as Vaseline, burning match.. etc. If you own a dog or go hiking frequently, do yourself a favor and get one of the tick removing tools. You can get them pretty cheaply from any sporting good or pet store. Amazon has a ton of different brands. I do not have a favorite (or you can do what Nurse Lainey did, which is just give a loud #@%$ and yank it off.)

Once the tick is out, clean the area with an antiseptic soap, apply a dab of Neosporin and then keep watch on the area to make sure there is no infection.

Okay, We got a tick bite. We removed it, but now what???   

  • watch the site for sign of local infection

  • observe for 30 days, If there is any odd rash, flu like illness, aches, or fever it is important to notify your doctor. We will want to know the date of the bite, and if possible the region where the tick came from. Any recent travels could provide important data.

Unfortunately the blood tests for tick borne diseases such as Lyme are initially not all that helpful. To start off with, you can get both false positive and false negative results (making it pretty useless.)  It turns out that once you have symptoms several weeks after the bite, the tests for Lyme are apt to be more accurate, but that isn't all that useful right after the tick encounter when we are trying to decide whether or not to treat.

Rather than testing the patient, I would focus on the tick. If you do a lot of hiking, keep a little baggy in a pocket of a backpack or diaper bag so that you have a place to stick any ticks that you remove.  

The Sonoma County Health Department will identify the tick for free to see if it is the type you need to be worried about. They will also take it a step further and test it for Lyme disease. They charge a  fee of $31 (such a deal.) They don't test the ticks for other illnesses. They do the testing every Thursday and they will have the results by Friday. They say that about 1-3% of the ticks test positive.
Read the instructions on their website for how to send the tick

As many of you have heard me say time and time again, ask a question and get multiple opinions and answers. Kerry Padgett at the California Department of Public Health in Richmond California has been identifying ticks for our patients for many years. The folks over there don’t test the tick. A tick testing positive doesn’t necessarily mean that it was on long enough to transmit a disease. A tick testing negative for Lyme may be infected with the Lyme like illness that we can’t test for yet.

They are happy to tell you if it is a tick that you need to be on alert for. You can send the tick to:

Kerry A. Padgett, Ph.D.
Supervising Public Health Biologist
California Department of Public Health
Division of Communicable Disease Control
Vector Borne Disease Section
850 Marina Bay Parkway
Richmond, CA 94804

Kerry shared the link below for all sorts of tick related info including some activities for kids.

Here is the bottom line. Regardless of whether or not you get the tick tested....

Watch the person who has been bitten very carefully for the next 4-5 weeks. If there are any suspicious symptoms within the month following a tick bite you absolutely want to speak to your doctor about doing a course of antibiotics. Reactions that are a cause for concern would be a bulls eye rash around the tick bite site and/or any type of flu symptoms. Some of the less frequent tick borne illnesses might have a more diffuse rash. Not everyone gets all symptoms.

We don't want to treat every tick bite with antibiotics for obvious reasons. As with everything, we need to strive for balance. We can't keep our kids in a box. Go out there and enjoy the hike, but then do that thorough body check and you should be fine. If you are a pet owner and you treat your pet with one of the flea and tick treatments, keep in mind that those ticks may leave the pet and go find someplace else to hang out

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