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Tick bites are good candidates for overtreatment

By Dr John R Dykers
Posted Monday, August 27, 2012

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Siler City, NC - Tick bites are good candidates for overtreatment, but good prevention is even more practical. (Overtreatment is here defined as before diagnostic signs or symptoms or test results are present.) Keep the ticks off you in the first place, and there are many sprays and simple techniques like tucking pants legs into socks and wearing light colored clothes and long sleeves so you can see the tick, and check yourself carefully after coming from an outdoor excursion.

Remember, simple ankle high grass will help ticks get on us, so cut a little closer than is good for the grass. Guinea hens or Seven dust can greatly reduce the number of ticks around your house.

I used to freeze embedded ticks on patients who came to the office for tick removal, using ethyl chloride, and then careful removal with good tweezers.

But, I have read that a cotton swab soaked in liquid soap may be applied to a tick on the skin and remove the tick very easily. Anyone with actual experience with this method, should please post your experience on the Chatham Chatlist.

The more prompt the removal the less the likelyhood of disease, not only Lyme, but also Ehrlichosis and Rocky Mountain Spotted Fever, this last of which I have nicknamed Jim Tatum Disease.

It was mainly because of Jim Tatum that I advocated overtreatment of tick bites even before Lyme disease was known.

Jim Tatum was the famously successful football coach at Maryland who UNC lured to Chapel Hill in a long ago effort to revitalize Carolina football. Jim got sick and was admitted to UNC Hospital and the tick bite was known but the tests for RMSF are slow and non specific. The purists would not treat him without a definite diagnosis and by the time Jim had the diagnostic rash he was too sick to respond to treatment and died.

$2.50 worth of tetracycline (this was before doxycycline) given early and he would have been well and back coaching in 24 hours.

Fortunately all three of these diseases respond to tetracycline or doxycycline and they both have few side effects, most of which can be aborted by stopping the medicine. It probably takes 24 hours after the initial bite of the tick for these infectious organisms to migrate from the carrier tick into the person bitten, but that time frame is not an absolute. When one finds a tick embedded, often by feeling the tick itself or the itch, one may not be reasonably certain of when the tick attached itself.

If you are reasonably certain as your possible exposure is documentedly recent, simply remove the tick quickly (we began by exploring the method of removal) if you can do so easily. Get help if needed to reduce the likelyhood of breaking off part of the tick. Don’t be surprised or alarmed if the bite is a little red and itches for even a few days. If the tick is crawling and has not bitten you, wash it or flick it off outdoors with its brothers and sisters and good riddance.

If you don’t discover the tick until your bath next day, or someone else finds it on you, or you find it on your child, and it is embedded, you are a bona fide emergency for prompt removal and beg, if need be, for early treatment with doxycycline 100 mg twice a day for ten days and recognize that this may be overtreatment, but it is so cheap and easy compared with even a 1;10000 (I added an extra zero) chance of contracting any of these three diseases. That is what I would do to myself, and in the absence of certainty, I always applied the Golden Rule to medical decisions.

Treatment is a little more problematic in children with developing teeth that may be colored by the cycline, tetra or doxy. Early treatment when the innoculum is small is very unlikely to contribute to the development of antibiotic resistance in the wild infectious agent population. There is no vector for these organisms to interact; we are not treating the deer!

Do not be particularly concerned about the type of tick as the science of which species carries which infectious organisms is in flux and has been for 30 years. Big old dog ticks seem to be the least dangerous. It is the little ones that drive you crazy and looking for the one so small you can’t find it!

 
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