• Medicine

Bug Off—How to Avoid Lyme Disease

By Dr. John Jones
Medical Director
Simplicity Urgent Care

It seems like it takes just about as long to get the kids out of the house in the summer as it does in the winter. I often ask myself why. After all, there are no coats to put on, no boots to find, no solitary gloves to track down.

But as an ER doc and pediatric specialist, I know that we all need lines of defense against the warm-weather elements just as we do when it’s cold outside. Thank goodness for sunscreen (learn more here)—and another effective weapon, bug spray.

The reason is simple: Our children are at the highest risk of contracting Lyme disease during the summer, because they are tasty to hungry ticks. While young kids certainly know when something bites them—because it hurts—they aren’t quite old enough to explain the origin of the pain. That leaves parents in the dark, until problematic symptoms appear.

So while there have been some concerns about the chemicals in bug sprays containing DEET (see the EPA’s fact sheet about the regulatory history of DEET)), in my medical opinion, those worries pale in comparison to the prevalence of deer ticks (Ixodes) that swarm during humid DC summers.

Why are ticks so threatening?

Ticks carry the bacterial spirochete Borrellia burgdorferi, which causes Lyme disease. Since 2007, there has been a significant up-tick, with a 37 percent increase from 2009 to 2010 alone.

1. The infection has spread southward and westward from Northern Virginia.

2. Physicians are more aware of Lyme disease, and as a result are testing more often for the illness.

3. We know now that in 2009, in fact, 95 percent of the cases of Lyme disease occurred in 12 states—which include Virginia and Maryland.

Why is a diagnosis of Lyme disease challenging to diagnose?

Like our kids, statistics tell us that fewer than 50 percent of people remember being bitten by a tick.

And since the illness affects multiple systems in the body—such as the skin, muscles, nerves, and occasionally heart—it can look very different in different people. The classic finding in a patient is the rash (erythema migrans), which looks like a bull’s-eye on the skin.

Unfortunately, not all erythema migrans rashes have the central clearing that appears in the classic form of the rash. In fact, the infection can take three to 30 days to take hold, and when it does, the patient usually has flu-like symptoms, with body aches, fever, and feeling weak.

Later manifestations of Lyme disease can include swollen joints (monoarticular arthritis), meningitis, or an infection of the heart called carditis.

Lab testing is challenging as well because all tests look at a secondary marker in the blood, which indicates if you have been infected and your body has mounted an immune response (antibody response).

But the earlier you catch the disease, the easier it is to treat and avoid long-term chronic sequelae. Below, my fellow ER doc and business partner, Dr. John Maguire, offers tips on what to do in case you encounter a tick.

Questions? Don’t hesitate to contact me by email.

What to Do If You or Your Kids Gets Bitten By One of These Little Bloodsuckers

By Dr. John Maguire
Simplicity Urgent Care

Ticks aren’t pretty. And their bites can be life-threatening. So what can you do if you or your kids get bitten by one?

1. First, don’t panic. The tick has to be attached for at least 36 hours before it can transmit the infection to you.

2. If you do find an attached tick, use a pair of tweezers to remove the tick from as close to the skin as possible. Use gentle pressure to remove it rather than a rapid jerking motion. Then wash the area thoroughly with soap and water.

3. If the tick has been attached longer than 36 hours or if you are unsure, your physician can prescribe doxycycline to adults and children over 8 years, as long as the medicine is begun within 72 hours of exposure.

4. Children under 8 and pregnant woman are not generally treated proactively; instead they are only treated if a rash does appear. Amoxicillin or doxycycline is typically prescribed for 14 days for anyone who develops the rash.

5. Later manifestations of Lyme disease can require IV antibiotics daily for 14 days. Obviously, much easier to treat early rather than wait.

6. The Centers for Disease Control and Prevention also suggests a screening test called an ELISA immunoassay, followed by a confirmatory “western immunoblot” for both positive and equivocal results. This is because the preliminary test has a large number of false positives so the confirmatory test is required. It takes your body from three to eight weeks to develop the antibodies that are tested for with the test, so if you have been recently exposed to Lyme, your blood tests will be negative.

How can you avoid Lyme disease?

The CDC has a good website on Lyme disease that suggests a three-pronged approach to preventing tick bites.

Avoid direct contact by steering clear of woody and bushy areas, and if you do go on a summer hike—walk in the center of trails.

Repel ticks with DEET or Permethrin. Use repellent and make sure you keep your children covered.

If ticks land on the skin, find and remove ticks as quickly as possible by pulling them free.

Bathe or shower to wash off the ticks, and do a careful check of your kids at bath time. Also be sure to look at your kids’ gear and at pets for ticks. They like to jump.

Click here for more information about avoiding Lyme disease.

About Simplicity Urgent Care

Simplicity Urgent Care is a neighborhood center that is open evenings and weekends, and never requires an appointment.

Located at 3263 Columbia Pike in Arlington, our goal is to provide a medical center where you can see a doctor any day of the week—whether or not you have insurance.

From treating sore throats and cold-and-flu symptoms to cuts and abrasions, strains and sprains, and urinary tract infections, the doctors on our staff provide fast, friendly care, as well as immunizations, X-rays, drug screenings, travel medicine, and more.

For more information, visit www.simplicityurgentcare.com.