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Physicians at Southwestern Vermont Medical Center, in cooperation with the Vermont Department of Health, have responded to the need for information about tick-borne illnesses by presenting an educational events on the subject. The first one was held in Manchester in July. A second was held in Wilmington on October 10, 2017. For those who could not make the presentations or who would like a review of the most important elements of the talk, we have these “tick takeaways.”
The most common tick-borne illnesses affecting our region are Lyme disease and anaplasmosis. Both are caused by bacteria ticks carry, and both are on the rise in Vermont and the surrounding area. You can get one, or both, as well as a handful of less common tick-borne diseases from the same bite. Because of the tick life cycle, the number of tick bites peaks in May and June and again in late October and November. Perhaps because of the amount of time they spend outdoors, elementary-school-aged children and retirees are most at risk.
The most important thing you can do is to avoid getting bitten by a tick in the first place. Avoid wooded and bushy areas and those with tall grass or leaf litter. (If you enjoy hiking, walk in the center of the trail.) Use a repellent that contains 20 percent or more DEET, picaridin, or IR3535 on exposed skin, and follow the directions on the package. You can also treat your clothing with permethrin,
which both repels and kills ticks. It is very effective against tick bites and poses no threat to humans. It is often marketed for “clothing and gear.” One treatment, following to the directions on the package, can last up to six washings.
Keep your yard mowed and free from brush or leaves. You can also place tick-control tubes around your yard. You can make them yourself or buy them online. They use cotton treated with permethrin. Mice use the cotton to build their nests. The permethrin kills the ticks without harming the mice.
Your next line of defense is to keep those ticks that found you from biting you. Change clothes when you come inside. Wash them in hot water and tumble dry. If possible, bathe or shower within 2 hours of coming indoors, as well. Conduct a thorough tick check. Deer tick nymphs look as small as a poppy seed on your skin. They can hide in and behind ears, under arms, in the groin, and behind the knees. Check yourself, have a family member check your back and other areas that are difficult to see, and check your children carefully.
If you find a tick on your skin, remove it immediately. In most cases, you have at least 24 hours to find and remove a feeding tick before it transmits and infection. Use pointy tweezers or an aftermarket tick removal device. Grab the tick as close to the skin as possible, and pull it straight upwards. Do not use any lubricants or hot objects. Mouthparts remaining in your skin does not increase the chances of infection. They will come out on their own. Disinfect the area with alcohol or other disinfectant. Identify the tick using online resources, if possible. Then flush it down the sink or toilet.
Know the symptoms and seek treatment immediately. Not all ticks are infected, so being bitten does not guarantee that you will get a tick-borne illness. Conversely, many of those who receive a tick-borne illness diagnosis don’t recall having been bitten. It’s important to know the symptoms and watch for them. Symptoms of Lyme and anaplasmosis are similar. They include flu-like symptoms, like fever and fatigue; head, neck, and joint aches; and enlarged lymph nodes. Only about 25 percent of people who are diagnosed with Lyme disease get the characteristic “bull’s eye” rash. Usually the symptoms come on suddenly.
If you do notice symptoms, see your doctor right away. The time between infection and treatment can make a difference in how long symptoms last. Depending on a number of factors, your doctor may choose to treat you for tick-borne disease or have you tested for tick-borne illness or both. By following your doctor’s instructions and taking any prescriptions as directed, you will very likely feel better within just a few days. Once you are feeling better, resume all of your tick-bite prevention efforts. Having had a tick-borne illness once does not protect you from being infected again.
Trey Dobson, MD is an emergency physician and chief medical officer at Southwestern Vermont Medical Center and medical director at Dartmouth-Hitchcock Putnam Physicians. “Health Matters” is a column meant to educate readers about their personal health, public health matters, and public policy as it affects health care. For more articles like this one, visit svhealthcare.org/wellnessconnection.