Transcription:

Bill Klaproth (Host): If you spend time outdoors or have pets that go outdoors; you need to be aware of ticks and tick bites. Now this is a concern because ticks are known to transmit bacteria such as Lyme Disease which is not good. So, let’s find out more with Dr. Douglas MacQueen, an infectious disease specialist at Cayuga Medical Center. Dr. MacQueen thank you for your time. So what steps can someone take to avoid tick bites?

Douglas MacQueen, MD (Guest): Great question this time of the year. We are getting into tick season. The adult deer ticks are out from last fall and the immature or juvenile ticks which are nymphs are going to be coming out shortly. So, the important thing is I think each day when you or your loved ones are outdoors; is to check each other over and do a tick check to find out if you can see any ticks on yourselves, remembering to look in all the places ticks like to end up, that includes the scalp, the back of the neck, under the armpits, between the checks, under the scrotum. They can be anywhere and if you find one; the important thing is to remove it in a timely fashion. It’s not an emergency.

But what you should do is grab some tweezers or a thing called a Tick Twister and with tweezers, you grasp the tick in a spot where it is in your skin and you slowly apply pressure away from your body and hold it there. It could take 30-40 seconds for the thing to finally let go and then it’s gone. With one of these Tick Twisters; they look like the back of a claw hammer kind of and you put it under the tick’s mouth part and twist it out and it kind of corkscrews out. It’s a fine idea to keep the skin clean with soap and water once you’ve done that.

Host: So, where do you find a Tick Twister?

Dr. MacQueen: Good question. Those are available sometimes hardware stores have them, pharmacies. I found them online and they are a couple of bucks. They are pretty convenient. I keep some in the car. I keep them in case we are out hiking and find one on me or the kids or I’ve got some in the medicine cabinet at home.

Host: All right so you gave us some really good information there. So, apply pressure where it’s attached to your skin and it sounds like pull slowly. You said it could take 30 seconds. You are not just trying to rip it off, is that right? So, go slowly. And if it’s in a part of the body you can’t reach, obviously you are going to have to have a spouse or a significant other do it for you.

Dr. MacQueen: Definitely. They can end up in embarrassing spots though so be prepared.

Host: It sounds like it. So, what should be done after getting a tick bite? Say you find one and you slowly extract it; should you go see the doctor at that point?

Dr. MacQueen: Early on I would say no. What you can expect at the site of the tick bite is sometimes nothing, sometimes you can see a little bit of redness and irritation, swelling, itching; and that’s just a bug bite basically. Your body is reacting to the components of the tick saliva and a little allergic reaction there. As long as that goes away over the next couple of days, that’s great. You don’t have to worry about it. If however, over the next few days it starts to become – the area of redness gets bigger and spreads slowly across that area; or if you start feeling sick with fevers, chills or aches; that’s when it’s most important to get checked out by a doctor. The thing we are worried about as you mentioned is we want to make sure that you don’t get an infection that the tick is carrying, some bacteria that it transmits – can transmit to us.

Around here, the biggest concern is Lyme, the most common tick borne infection is Lyme Disease. And so, the question also comes up well should I be on antibiotics right away if I do have a tick bite and should I be seen right away just for the presence of the tick bite. I would say generally no. Monitor for those symptoms and there is always a consideration should I take a couple of antibiotic pills and maybe that would decrease the number of cases of Lyme I might get from ticks. That turns out probably not to work so great.

When it has been studied, it turned out they had to treat about 50 people with tick bites to prevent one case of Lyme. So even if you have the two doses – have a dose of antibiotics after a tick bite; it doesn’t guarantee you are not going to get Lyme. So, the most important thing is to monitor for those symptoms and if you have them; then to get seen by a doctor.

Host: So, if the redness doesn’t go away and if symptoms develop; that’s the time to see the doctor. So, then are those the symptoms of Lyme Disease that you just described?

Dr. MacQueen: That’s right. Those are the symptoms of an early Lyme infection which can be within say four to ten days of a tick bite. It’s the development of this rash, which is often described as a bull’s eye, but doesn’t always look like a bull’s eye. I describe it as is should be roundish, it should be reddish, it can have varying degrees of redness and kind of concentric bands. In the middle it can be a little bit purplish or bubbly looking, and it can be itchy. It can be painful, or you may not feel it at all. And that’s an Erythema migrans or this bull’s eye rash that comes on in early Lyme and not everyone will notice the rash, often because it’s in a location where that tick was, and you never saw it you know between the cheeks or in the scalp some place. So, it is important to keep looking all over the body for those rashes.

Some people also get an illness where they feel like they have the flu. Sort of fevers, body aches, headaches, low energy that comes on around the same time as the rash but not everyone will get those symptoms.

Host: So, what is Lyme Disease and why is it so troublesome?

Dr. MacQueen: So, Lyme is a bacterial infection spread by these ticks called the deer tick. I think it is difficult to recognize sometimes and oftentimes because it’s a seasonal thing; healthcare providers may not be thinking about it when they see this rash, they may think oh it’s a skin infection and not dot on that it could be a Lyme infection.

Oftentimes, healthcare providers may rely on a blood test for a Lyme infection and at the time of the rash, unfortunately the blood test is uniformly negative so it’s of no use. I mean it’s detrimental to even to use it because if you have a Lyme infection, early on the blood test will be negative so if you tell someone oh you don’t have Lyme based on this test; but they really do; you are going to not give them the antibiotic that they should have had.

So, the right answer is, if you have the rash that looks reminiscent of this Erythema migrans or bull’s eye rash; we should give patients antibiotics to treat a Lyme infection. So, I think there’s some confusion around making the diagnosis of Lyme. Lyme can later on, if you are not treated early on; cause some other symptoms that can be neurologic like meningitis, which is not fatal like other forms of bacterial meningitis; but can make you feel pretty miserable, horrible headaches, bad fevers. It can cause a thing called Bell’s Palsy or a facial nerve weakness and it can go on to infect joints, often large joints like the knee or hip and that can show up months later if the infection wasn’t treated initially.

Host: And then how do you treat Lyme Disease?

Dr. MacQueen: Well, the treatment is with antibiotics. There’s a couple of varieties that work great for it. The good news about Lyme Disease is that it’s completely curable at any stage that you detect it. And the duration or length of antibiotic treatment varies depending on what your symptoms are from Lyme at that time. So, early on, we give people seven to ten days of antibiotics. If they have Lyme in a joint like the knee; then they may get up to four to six weeks of antibiotics.

Host: So, are there long-lasting effects to Lyme Disease if you have it and you have it bad where you are talking about it reaching your joints and other things? Does that stay with you for the rest of your life? You said it’s curable; does that mean all of the effects go away too?

Dr. MacQueen: Well the first point is that the bacteria do not stay with you for the rest of your life or long-term even. Some people will feel kind of miserable for a while after having their Lyme infection cured and that’s the same as if you have a bacterial pneumonia. People have that treated; people may feel kind of sick for weeks afterwards. There is an entity called a post-Lyme Syndrome where – that’s being studied pretty extensively now, and we don’t really know exactly why it is people can feel miserable after infections including Lyme; but there is some work going into that.

The good news is that the vast majority of people with Lyme will go back to their usual selves within a few weeks of the infection, probably a few days for most people. And that if someone does have this prolonged kind of misery after a Lyme infection; that does get better, though it can take some months. There is not a form of Lyme, this thing called a chronic Lyme infection which is popular in the media, popular on the internet and the idea being that Lyme is forever. That is not a thing that happens. I would tell this to my relatives, to my loved ones that the important thing for people to know about Lyme is that we can cure it at any phase.

Host: Well thank you for debunking that for us. That’s good news. And as we wrap up Dr. MacQueen, I guess the best advice is to try not to get a tick bite. Let me ask you about bug spray. Because this is a popular topic. What should we look for in a bug spray in addition to making sure we are having long pants and cover up and checking ourselves. What kind of bug spray should we have?

Dr. MacQueen: There are some bug sprays that help repel ticks. They may have to be, just like with mosquitoes; you may have to reapply them frequently to have them work throughout the day. But bug sprays with DEET to put on your skin will repel them. Bug sprays with permethrin that you put on your clothes can also help repel them and a combination of both is probably the best way to go. The places people may be most likely to come across ticks can be even in the backyard if you have deer through the yard, it could be there. But longer grass with brushy areas and a forest canopy over the top are the highest risk areas for coming across ticks. So, when you are in those areas, you really want to focus on bug spray, like you said long pants, tuck the pants into the socks and make sure to do those tick checks.

Host: Really important. Thanks Dr. MacQueen and thank you for your time. And for more information on Lyme Disease or to get connected with one of our providers like Dr. MacQueen, please go to www.cayugamedicalassociates.org. You can also call 607-241-1118. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for other topics of interest to you. This is To Your Health from Cayuga Medical Center. I’m Bill Klaproth. Thanks for listening.