Tick check

Spring is in the air here in New England. Of course, thanks to our changing climates, spring has been in the air for periods in October, December, and a brief burst in January as well. But Spring is officially in the air now, so says the calendar, the big digital thermometers outside banks, and the mushy ground beneath my feet.

This means one very significant thing to me - It's time to start checking for ticks.

Deer tick on finger, from the ALDF site

Some people would call my tick awareness paranoia. I suspect those people have either not had Lyme Disease or have been the lucky ones who respond immediately and thoroughly to the short course of oral antibiotics that the insurance companies advocate as sufficient treatment for everyone. For many people who catch Lyme Disease, it is anything but that easy.

I also was once very ignorant about this disease. I had heard about it. I even remember knowing implicitly that there was some stigma attached to it. When I realized I had it, I thought "Well that sucks, but Ok. I'll call my doctor, get medicine, and it will go away. End of story." This was not the end of story for me, and it isn't for many many people.

The stigma is quite real. I blame it mostly on greed based treatment protocols put forth by insurance companies, on doctors who work for those same insurance companies (as consultants) and who then engage in Lyme research as if they had not conflict of interest, and on the overall deterioration of medicine in the era of managed care. I do think some of the stigma results from the unfortunate fact that Lyme can have some pretty messed up neurological manifestations (e.g. "musical hallucinations"and schizophrenia type behavior). This makes Lyme patients easy to dismiss for some health care providers because they sometimes commit the deadly sin of ACTING IRRATIONAL when feel they are being treated negligently, callously, dismissively, or disrespectfully.

The controversy comes out in blazes when it comes to the set of people who experience symptoms of what is called either "chronic Lyme" or "post Lyme syndrome". These people are anything but a homogenous groups. Some are treated but continue to suffer symptoms of Lyme. There is research suggesting that these people have certain genetic differences from others who respond to the antibiotics. Some people affected by the "chronic Lyme" controversy receive late and disputed diagnoses, which gives the disease time to become neurological. In that set are people like the American author Amy Tan.

Lyme disease can affect your joints, your nervous system, your eyes, and your heart. If you acquire Lyme disease, you should be prepared to educate yourself and possibly your physician, and to advocate for yourself to get the treatment that you need as soon as possible. The best way to deal with Lyme disease is NOT to catch it. This is hard if you live someplace like New England or Pennsylvania, where Lyme is just about everywhere. But to help reduce the risk of acquiring Lyme and all the rotten stuff it entails, there are some facts you should know and precautions you should take.

Where can you catch it?
You do not have to be Nature Boy or Girl to be at risk in a Lyme area. I caught it patting a cat on the front lawn of my apartment building. I've been on Lyme message boards and groups with people who caught it in the suburbs or on a short trip to the country. This map (from the CDC website) shows US occurences of the tick that carries Lyme disease - anywhere there are mice, squirrels, birds, or deer is a place where you can encounter ticks carrying the bacteria that causes Lyme (yeah, they're called "deer ticks" but they aren't that fussy about their hosts). If you want to see the CDC's stats on Lyme by state, you can go here. Or you can take my word for it that if you live in the Northeastern part of the US, you should assume you live in a Lyme heavy area and that even sitting in a landscaped suburban park might expose you to Lyme carrying ticks and hence Lyme disease.

If you are concerned now, I have done what I set out to do. My goal is not to scare the shit out of you but to alert you like I wish someone had alerted me before I caught Lyme. Here are some precautions any sensible person should take.

Prevention:
If you are going to be in areas with tick risk, wear light-colored clothing so that ticks can be spotted more easily and removed before becoming attached. Wearing long-sleeved shirts and tucking pants into socks or boot tops may help keep ticks from reaching your skin. Hats or kerchiefs over the hair are good if you will be in an area with lots of tree cover. Ticks are usually located close to the ground, so wearing high rubber boots may provide additional protection. Before coming into the house or car, pat down or shake out your clothes (pants especially) to knock off any ticks. You should also change your clothes after being outdoors.

Use insect repellents containing DEET (n,n-diethyl-m toluamide) on clothes and exposed skin. Supposedly, DEET can be used safely on children and adults but should be applied according to Environmental Protection Agency (EPA) guidelines to reduce the possibility of toxicity. It's your call. I try to be environmentally conscious, but I do use DEET on my pants, socks, and shoes if I'm going to be out.

Your pets can catch Lyme. Your vet can recommend tick and flea prevention products and advise about Lyme testing for pets. Combing and/or toweling the animal outside before it comes it is a good idea too to keep them from bringing ticks into the house.

Perform tick checks!
You really do have to get totally naked to do this, preferably with a partner because trust me, it is not easy to see all your parts. If there's no one you want to play doctor with, you can use a hand mirror.

Where to look:
Ticks often climb until they hit a barrier. With me, it stopped at my bra strap. When you do a tick check, make sure you look especially around areas where socks, underwear, hair lines, or skin folds make a likely tick site.

What to do if you find a tick on you:
The website I took some of this information from has instructions on how to remove a tick. It can be summed up easily: You do not want to punish the tick, just remove it. Use fine tipped tweezers, grab it as close to your skin as possible, and pull gently and smoothly. If you can't get it off easily, you can go to your doctor or urgent care and have them take it off.

Most websites say you don't need prophylactic antibiotics if you find a tick on you. This one actually mentions the "cost effectiveness" as a consideration of treating prophyactically with antibiotics, so at least they are honest about the reasoning behind the recommendation. Honestly, and I don't say this lightly, If I were to find another tick on me, I would seriously consider killing myself. My asshole landlord said if he got it again, he'd shoot himself. My opinion on taking three weeks worth of antibiotics if bitten by a tick? HELL YES. If I had to blow Donald Rumsfeld to get the antibiotics, still HELL YES.

And now, the Lyme Photo Album:

Here's a "group of ticks' picture from the American Lyme Disease Foundation. It's a family portrait of the Deer Tick (larva, nymph, and adult).
Here are some examples of Lyme rashes from Dermatlas.
They can be subtle:


...or not: