It’s once again the time of year to protect yourself against tick bites, particularly if you’re in a rural area and/or one where Lyme disease is more prevalent. There’s no need to panic, as Lyme is often avoidable and treatable, but knowledge is key—so be sure you’re informed, and tuck those pants into your socks before tromping out into the forest!
Pictured above is a wood tick, which does not carry Lyme disease, but is nevertheless gross.
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Prevention. Most ticks do not carry Lyme disease, and the transmission rate is low even in those deer ticks that may carry Lyme. Still, don’t assume that Brooklyn is free from infected deer ticks just because we don’t have deer. Scientists have confirmed the presence of these ticks in NYC, with the highest density being found in Staten Island. In addition, one PSP member points out that there is a risk of ticks ending up in Brooklyn via travelers or visitors from outside the city:
“Lyme carrying deer ticks do travel to NYC via people and dogs who have gone to Long Island, upstate, etc. They can fall off and then reattach to you here in Brooklyn. Lovely! My son picked one up in Prospect Park or thereabouts when he was about 1.5. Brought the tick to our pediatrician and it tested positive for Lyme. And our dr. wasn’t surprised, though I was. It happens. We hadn’t traveled out of the city in more than a month when he got it.”
Whether you’re in Prospect Park or the forests of Vermont, it’s important to limit the amount of skin you’re exposing when exploring wooded areas. Wear light-colored long sleeves and long pants when possible, and tie up your hair or put on a hat. Tuck your shirt into your pants, tuck your pant legs into your socks, and spray your socks with permethrin insect repellent and exposed skin with DEET. When you head inside, remove your clothes, put them in the wash (or tumble dry them on high for an hour), and take a shower, as ticks can crawl around on clothing and skin for hours before latching on.
If you've got a lawn in NYC, or if you're spending time outside of the city, be sure to keep your lawn mowed, cut overgrown brush, and clear leaf litter to reduce the places where ticks can hide. Wear long pants when mowing the lawn, and don't forget a hat, as ticks can crawl up branches and grass to grab onto a passing host!
Tips on repellent:
Perform a thorough tick check with the help of a mirror before bed every night, paying special attention to hidden areas and skin folds around the joints, the navel, behind the ears, under the arms, in the genital area, and in the hairline. If you do find a tick crawling around or already attached, remove it promptly and properly. To do so, grasp the tick with a tweezer near its head and pull steadily without crushing it. Do not apply Vaseline, squeeze the tick, or do anything else funky, as you may cause the tick to release more infected saliva. Once removed, flush the tick down the toilet and disinfect the bite with antiseptic. Alternatively, you can save the tick in a bag and get it tested for Lyme, but know that the CDC generally does not recommend you do so.
If you find yourself constantly yanking out ticks, you may want to invest in a removal device such as a Tick Key. One member reports, "My dad is an avid hiker encountering ticks on a regular basis and he swears by this tick key. Is a few dollars, but makes removal an absolute breeze."
Testing and diagnosis. See your doctor if you develop symptoms of Lyme disease, even if you never saw the actual tick and/or you didn’t develop the characteristic bulls-eye rash. As one member who’s an urgent care PA explains,
“The percentage of people that recall seeing a tick is not super high, and not everyone gets the bullseye rash. The best thing to do if unsure is to draw blood to test for Lyme, start treatment if someone has suspicious symptoms, and redraw Lyme titers in 2-3 weeks if the initial test is negative, because it can take a while to show up in the blood. The old wisdom was that once someone showed symptoms, their tests would be positive is now known not to be true.”
You might even consider having everyone in your family take a blood test at the end of the summer season, regardless of the presence of symptoms. Lyme disease is most easily treated if it's caught within the first few months, so doing a round of testing each October can help keep you from letting an infection go unchecked.
Here’s some info from the CDC on diagnosing and testing for Lyme:
When assessing a patient for Lyme disease, health care providers should consider:
The CDC currently recommends a two-step testing process for Lyme disease. Both steps are required and can be done using the same blood sample. If this first step is negative, no further testing is recommended. If the first step is positive or indeterminate (sometimes called “equivocal”), the second step should be performed. The overall result is positive only when the first test is positive (or equivocal) and the second test is positive (or for some tests equivocal).
Key points to remember
By the way: Lyme is unfortunately not the only illness you can contract from ticks, so check with your doctor if you’re experiencing symptoms to determine whether you need additional tests. As one member points out, “it’s very important to get treated for other infections carried by ticks: In our neck of the woods, the most common are Ehrlichia/Anaplasma, Babesia, and Bartonella.”
Stay calm. If you live in an endemic area, you are likely to get many tick bites. Follow best practices for prevention; use single dose prophylaxis for bites only per your doctor’s recommendation; and stick to the treatment guidelines recommended by CDC, as there are a lot of unproven treatment approaches circulating that are not necessarily helpful. Avoid scaremongering websites. There is a lot of public fear and misinformation about Lyme, and unfortunately a cottage industry in misdiagnosis and questionable treatment. Fortunately, in reality, Lyme is well understood, simple to take precautions against, and fairly easily treatable.
Tick-related resources:
Remember the golden rules:
Thank you to PSP Medical Liaison Dr. Philippa Gordon for her tick expertise!