Prevention of Lyme Disease

Watch out for those ticks! The unseasonable warm winter is expected to contribute to a very high tick population this year. Additionally the incidence of Lyme Disease has been significantly increasing in recent years. In our Urgent Care clinic last year we saw at least twice as many cases of Lyme Disease than expected.
Don’t let those trends stop you from getting out and enjoying the great outdoors.  With a bit of caution and some knowledge about ticks and Lyme Disease, you will be able to help protect yourself.
First a few basics; Ticks are actually arthropods – not insects, but insect repellent sprays do help repel ticks. Use your bug sprays – and also wear light colored clothing – which makes it easier to spot attached ticks. Most importantly of all do a thorough whole body exam of yourself (or your loved one) after outdoor activities, or at the end of the day. Ticks need to be attached and biting for at least 36-48 hours in order to transmit Lyme Disease.
Ticks are not all alike. Lyme Disease, and several other diseases prevalent in our area, are only transmitted by one type of tick. The Ixodes species of tick, commonly called the “deer tick”, is quite small. These ticks are usually 3 mm or smaller (about the size of a sesame seed) and often have an orange black color on their back. The more common “wood ticks” (common dog ticks) are much larger. Good photos of ticks are now easily found with a simple Google search on the computer.
If you have a tick attached to your skin the best way to remove it is with a tweezers. Squeeze as close to your skin on the head of the tick with the tweezers and firmly pull it off. We no longer recommend using Vaseline, or trying to burn a tick to remove it. Also, don’t worry about the small black mouth parts that often remain – our bodies do a great job of clearing these.
We get several patients per day presenting to our clinic with concerns because of a recent tick bite.  Remember – if the tick was not attached and feeding on you for over 36 hours, then contracting Lyme Disease would be extremely unlikely. If you try to do daily skin exams for ticks, then you will likely find and remove any ticks prior to the 36 hour window.
For tick bites that seem likely to have exceeded 36 hours there is an option of prophylactic antibiotics. Like many things in medicine there is some controversy over using prophylactic antibiotics for tick bites. Because of the high prevalence of Lyme Disease in Southeastern Massachusetts – having a high risk tick bite would be worth discussing with a health care provider. Treating with a single antibiotic might be considered if a case meets these 3 criteria: 1) Probable deer tick – Ixodes species 2) Likely attached for over 36 hours 3) Must present for treatment within 3 days of the bite. 
It might be helpful to bring the tick in to your medical visit.
Most tick bites do not need prophylactic treatment.  With a bit of diligence, most ticks can be found and removed on the same day of exposure.  If someone were to develop symptoms of Lyme, these usually develop within 2-4 weeks of exposure.  Many patients would develop the classic round red rash called erythema migrans.  Other common symptoms include fever, headache and diffuse muscle and joint pains. Lyme Disease can present in many different ways; its diagnosis can be difficult in some presentations. Suspicious symptoms should be evaluated by your health care provider. 
I suspect that we will see a record year for cases of Lyme Disease in our area.  Remember the basics for prevention. 1) Use bug spray 2) Wear light colored clothing to spot ticks as they catch a ride 3) Check your skin thoroughly for ticks – all over!! And if you get a deer tick bite that may have been attached for over 36 hours, then plan a visit to a health care provider to consider prophylactic treatment.
David W. Parker, MD Family Practice Physician is the Chief of Urgent Care at Harbor Medical Associates, 541 Main Street, Suite 414, So. Weymouth, MA.  This Urgent Care Center is a walk-in clinic open 7 days/week to all Harbor Medical Associates patients. Also open to non-Harbor Medical Associates patients based on health plan. Please visit www.harbormedical.com for more information.