What to do when you are bitten by a tick
A familiar nemesis is out in force.
Deer ticks are familiar to every gardener, dog walker or trail hiker on Cape Cod, and carry some troublesome infections, like Lyme disease, Babesiosis and Ehrlichiosis, to name a few.
Ticks are always a problem on Cape Cod, explained Cape Cod Hospital Emergency Medicine Physician Brett Sylvia, MD.
“In Urgent Care we see about 120 patients a day and sometimes as many as 30 of them might be tick-related,” he said. “I’m not kidding. When people on the Cape have ticks, they tend to run in because they are scared because Cape Cod is full of ticks that have diseases. And then we have visitors and they don’t know what to do so they come and see us as well.”
Larry Dapsis, an entomologist and tick project coordinator at the Cape Cod Cooperative Extension—who created a ten-part video series on every aspect of protection from ticks, including personal protection, pet protection and yard protection—said the best way to stay safe is to not get bit in the first place.
“Permethrin-treated clothing and footwear is hands-down the most effective tool in the box,” Dapsis said.
You can buy permethrin at garden centers, pharmacies and hardware stores. You spray it on your clothes and your shoes and reapply according to package instructions. Outdoor companies like L.L. Bean also sell clothing that is pretreated with permethrin that last through many wash cycles.
How to Remove a Tick
People are wise to be wary of ticks and the diseases they can carry, Dapsis said. On the Cape about 50 percent of the ticks carry Lyme disease and 10 percent carry the pathogens Anaplasmosis and Babesiosis. Other rarer diseases on the Cape include Relapsing Fever, which is similar to Lyme but with a really high fever, and Powassan Virus. Powassan Virus is very rare, but there have been two deaths on the Cape from it, Dapsis said.
Most people with ticks attached to their body can remove them at home by themselves, Dr. Sylvia said.
“If they can get some sort of fine tipped tweezers and grab the tick as low as they possibly can against the skin and gently pull up, then that’s the best thing that they can do,” he said. “If the tick has been adhered for 36 hours or less, it’s very unlikely to transmit Lyme disease. The other diseases, Babesiosis, Anaplasmosis, those we’re not quite sure how long the tick needs to be adhered to transmit the disease.”
But if a tick is engorged (indicating it has been attached for a while) or part of it breaks off when you try to remove it, a trip to Urgent Care is in order. In the case of small bits of tick remaining, Dr. Sylvia said the recommendation is that you can leave it and it will expel itself naturally. Most patients do not like that option. They want all parts of the tick removed as soon as possible. To do that, he treats the area with a little bit of a numbing medication and then removes it.
The other reason you might want to visit Urgent Care is for a prophylactic prescription of an antibiotic.
“For most people on the Cape if they come in with a tick and have the tick removed within 72 hours, we do prophylactic with doxycycline if there’s not a cause or indication not to, like an allergy or if you’re pregnant,” Dr. Sylvia said. “But we don’t send blood testing right away when people have a tick bite because it usually takes two to three weeks for us to see antibodies in the blood.”
Once the tick is removed, Dr. Sylvia tells patients to watch for the telltale erythema migrans, which is the bulls-eye rash that indicates Lyme disease. The rash, which shows up in 70 to 80 percent of people who get Lyme disease, should appear in a week to 10 days.
Treating Tick Bites
Dr. Sylvia said he frequently treats patients with Lyme disease. Treatment depends on which stage of the disease a patient is in. If the patient has the bulls-eye rash, the preferred treatment is 10 to 14 days of doxycycline, unless the patient is allergic. In that case, he would prescribe amoxicillin or cefuroxime.
Those who are later in the disease will present with symptoms like fevers, chills, headaches, muscle aches and pains and joint aches and pains. They get a three-week course of the antibiotic. At even later stages of the disease, patients can have neurological problems, heart conductor problems or Lyme meningitis. Those patients would get a more extended IV version of the treatment.
The only tick-borne disease that is treated differently is Babesiosis. Babesiosis is a parasite, so patients would be prescribed azithromycin, which is an antibiotic and an anti-parasite medication, he said.
“Honestly, if you come in on Cape Cod and you have those symptoms and it’s the right season we order the blood test, but we usually start treatment right away meaning we don’t wait to start treating until we get the test results,” Dr. Sylvia said. “I had a guy in Urgent Care yesterday who came in with the classic symptoms and he was relatively sick so I took a blood test and we started right away on the doxycycline.”
The risk of disease is higher from nymphs (the tiny young ticks) because they are so small that they might not be detected as quickly, so the danger actually is higher in spring or summer when nymphs are abundant.
If you have been bitten by a tick, you can send it to the TickReport lab at the University of Massachusetts in Amherst to be tested for disease. Opinion is divided on whether that it a good idea. Dapsis is in favor of springing for the $50 test because then you will know what diseases to potentially be on the lookout for, but Dr. Sylvia does not think it is necessary.
“I personally don’t recommend it and the reason being is that most of the time we remove the tick, it’s within 36 hours or so, so if the tick tests positive at the lab for babesiosis or anaplasmosis, it doesn’t mean that you have the disease,” Dr Sylvia said. “We would just recommend watching the person much more closely. But people freak out once they have gotten the test results back from the UMass lab and want to get treated and some of the treatments can be pretty hard core, so we don’t like to jump to that.”
