Kids walking through a grass field

Time to think about ticks

Posted on Monday, May 21, 2018 by UVM Health Network - CVMC

Almost half the deer ticks in our region carry the bacteria that causes Lyme disease, so it’s important to be careful before and after venturing into tall grass or forests during the spring, summer and fall.

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Before heading into the woods, spray pants, legs and shoes with an insect repellent that contains 20 percent DEET. It comes in different strengths, so check the label when you buy. Be careful not to spray it in the eyes or on the face and use it just when you’re outside. Apply it to shoes and pants, or on the lower legs if you’re wearing shorts. Wash it off when you get home.

A daily tick check for yourself and your family is equally important, since the prompt removal of ticks can prevent transmission of the Lyme bacteria. This is especially important for children who spend more time rolling around in the grass. Get in the habit of giving your children a quick once-over each evening.

Ticks hang on with little pincers in their jaws, but if you apply gentle traction, they’ll usually let go. The best way to remove a tick is to grasp it as close to the skin as possible with tweezers, a store-bought tick removal device or a tissue. Pull gently upward with steady, even pressure until the tick releases. Don’t twist the tick as you remove it.

If a small part of the tick is left behind, that’s OK; this won’t transmit Lyme disease. Like a splinter, what’s left usually works its way out of your skin after a few days or weeks, though it may cause a little itching at the site. Ticks are made of chitin, a type of protein that also forms the shells of crabs and lobsters, and your body is unlikely to absorb it. The American Academy of Infectious Disease recommends not digging out any bits left behind; leave them and simply let your skin heal.

We recommend taking the steps above to remove your own ticks at home, but seeking medical attention if:

Figure 2: Erythema Migrans Rash is present in approximately 70 percent of cases.

Erythema Migrans Rash is present in approximately 70 percent of cases. See other ways rashes can exhibit on the CDC website.

  • You believe a tick was embedded in your skin for longer than a day and a half, especially if the tick was engorged or enlarged.
  • You develop a rash 10 to 14 days after removing one. After removing a tick, wash the site with soap and water. Dispose of the tick by flushing it down the toilet, putting it in a closed plastic bag or other container, or wrapping it tightly in tape and throwing it away. Don’t crush the tick with your fingers.

First and foremost, don’t panic. Even though many ticks carry the Lyme bacteria, very few tick bites — fewer than 5 percent — actually transmit and cause Lyme disease. Still, after any tick bite, even if you’ve removed the tick or most of it, it’s wise to keep an eye on the area for up to two weeks.

Sometimes there’s a bullseye rash, which isn’t the actual bite. Most people come in and say, “I have a bullseye rash,” and what they’re showing us is a red spot the size of a dime or nickel. This is just where the tick bit you. The rash, when you first see it, is typically the size of your palm. It’s around the tick bite site, but the rash itself won’t appear for 10 to 14 days. It’s not raised and doesn’t itch or hurt. In addition to a true bullseye rash, it is important to be mindful around this same period for flu-like symptoms: fever, muscle aches and headache. If any of these signs and symptoms develop, see your medical provider.

During the spring, summer and fall, the CVMC ExpressCare clinics in Waterbury and Berlin treat about two cases of Lyme disease (confirmed by blood test or rash) each week. These patients receive a full course of an appropriate antibiotic, and most patients have an excellent clinical outcome.

Some patients find fully engorged ticks, which may have been attached for more than 36 hours. You should see a health professional if this is the case. The recommended treatment for this scenario is a single dose of an antibiotic. This prophylactic treatment prevents development of Lyme disease in 90 percent of cases.

We encourage you to get outdoors and enjoy Vermont this summer, but be tick smart when you do!

Richard Burgoyne, MD practices family and emergency medicine at CVMC Family Medicine-Waterbury and CVMC ExpressCare. He is the medical director for CVMC’s ExpressCare clinics in Berlin and Waterbury Center.

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