Ticks And Lyme Disease - Letter

I’ve had many calls about tick exposures and Lyme treatment in the last few weeks, and thought it might be helpful to share what I know. Not a substitute for talking to your own practitioner, of course.

Avoid ticks. Use DEET around your ankles and wrists, and tuck pants into socks, wear long sleeved shirts.

Avoid attachment. Full body check each evening. As part of this, do a “body scan” asking yourself if you feel new areas of pain or itching.

Avoid feeding. Ticks have a hard time boring into our skin, and it typically takes them hours to get firmly attached. Then they have to secrete chemicals and biologicals that break down our tissue to create a little lake of blood to feed from. It takes even longer, perhaps up to 24 hours, before they exchange the germs that cause Lyme and other diseases into our blood. So if you can relatively easily remove a tick, it probably hasn’t infected you yet.

Know your ticks. Worst is the tiny young tick (nymph) stage of Ixodes (deer type), that appears black but actually has a dark red body and very dark brown “cape.”  Dog ticks, which are larger and have a lacy white shawl, may cause damage, and a red splotch where they have attached, and even infection if you don’t get the head, but don’t generally carry serious human pathogens.

Know your symptoms. Be body conscious. If you feel a strange localized pain, or itch, check very carefully. The tiny nymphs may look like a little scab, and can be scratched off pretty easily.  Ticks secrete many chemicals designed to cause inflammation and tissue damage, but the amount of reaction (reddening, swelling, necrosis, itch, pain) depends on your immune system. A very local red rash within hours, and a central 1-2 mm area of real tissue damage and scabbing does NOT mean you have Lyme. The Erythrema Migrans rash of Lyme is an larger (5-10 centimeter) annular rosy red ring (like a donut) that appears a week or more after the exposure.

How to get the tick off? A small tweezers, enough magnification and light, and a steady hand are needed. Grip the tick as close to the skin as you can get, and pull gently and firmly. Twisting, burning, applying chemicals, et cetera are generally a waste of time and can leave a part of a dead tick or actually increase the transfer of germs to you.

Special gadgets aren’t necessary. If a piece of the tick remains embedded, it will eventually be pushed out as your skin heals, but in such cases you might consider the full dose of doxycycline, which means calling or visiting your practitioner who prescribes. Saving the tick to show is a good idea if you have any question…trapping them in a folded piece of clear tape works well. Testing the tick for Borrelia is often not available, expensive, and the results don’t really change decision making.

Should  you take doxycycline? Yes, if the “definitely a deer tick” came from a “red” zone like Cape Cod or parts of Northern California, and if you had trouble getting it off. But as long as it’s within 24 hours and the deer tick didn’t appear engorged, one dose of 200 mg doxycycline seems to be highly effective in killing the germs. But often the answer is NO! No, don’t take even the prophylactic dose of doxycycline if Lyme is rarely reported in your area, and if the tick was barely attached and if you found it within 6 hours of your exposure time.

How much doxycycline? The standard treatment for early Lyme, meaning the “definitely a deer tick” was engorged, and/or had been on for over 24 hours, and was from a “red” zone, or you notice a  quite large annular red ring a week or so after a tick bite, or you feel really achy in most of your joints, or you have a flu-like illness with headaches within a week or so: 100 mg doxycycline twice a day for 21 days...three weeks.

What about testing? False positives and negatives, but if you want maximum vigilance, you could ask for a Lyme antibody by Eliza test, and then again in one to two months.  If the first test is negative, and the second positive, you should consult your practitioner.

Is chronic Lyme real?  Definitely yes for those who have it. It’s true that many people who have terrible debilitating symptoms like joint pain, headaches, and brain fog don’t have Lyme disease.  It’s also true that some people with what has been diagnosed as chronic Lyme don’t respond to antibiotics. But for all those suffering who don’t have Lyme, there are many people who DO have it, and could be helped by treatment if their practitioners thought about the possibility.

Consult your medical practitioner. Lyme disease, Babeosis, Erlichiosis, Anaplasmosis and others can all create serious medical problems. If you are concerned, or have further questions, you should contact your own medical practitioner.

Dr. Alan Steinbach
Mast Road
Woods Hole

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