Tricky Ticks

Just as COVID-19 is diminishing in our very well-vaccinated region, cases of tick-borne illness are on the rise. In fact, this is one of the worst years for tick-borne illnesses in recent memory. Over the years, we have shared lots of information about prevention, including tips to avoid tick-borne illness. But even those who are very careful get bitten, often without ever knowing when or how. Here’s what you need to know.  

Ticks move on your body and bite you undetected. It is difficult to feel ticks crawling on you, and their bite doesn’t hurt in most cases. The best way to find a tick is to look for it. Learn how to do a tick check.

If you find a tick in your skin, pull it out. A pair of fine tipped tweezers are all you need. Grasp as close to the skin’s surface as possible. Pull upward with steady pressure. For additional details, see the Centers for Disease Control and Prevention’s guide. Clean the bite area and your hand before applying antibiotic ointment. You can dispose of it by putting it in alcohol, placing it in a sealed bag or container, encasing it in tape, or flushing it down the toilet. You do not need to go to the Emergency Department to have a tick removed.

The longer a tick has been on you, the greater the likelihood of infection. It takes at least 10 hours to transmit bacteria from a tick to its host. If a tick is only on you two or three hours, it probably won't have started feeding. Once a tick attaches, it starts feeding and stays on you for about 12 or 18 hours. When it’s full, it falls off.

If you find a tick, you can guess how long it’s been attached. If it is flat, it has likely not been attached for very long. Plump ticks are sometimes referred to as being “engorged.” It is likely that they have been attached much longer. Ticks that have been attached for a very long time sometimes even defecate before falling off, which makes them easier to spot. If you find an engorged tick, call your doctor, who may prescribe a single dose antibiotic to prevent tick-borne illnesses. An antibiotic can keep you from getting Lyme disease, for instance, if you take it within 72 hours of the bite.

Know the symptoms. Symptoms typically arise within 1 – 3 weeks of a bite. (The number of bites is highest in the first week of June, so it makes sense that we would be seeing a rise in illness now.) If you have removed a tick from yourself lately, it’s a good idea to watch for the signs of illness. The most common symptoms are fever and chills, headache, fatigue, muscle aches, and joint aches. About 60 percent of people infected with Lyme disease get a “bullseye” rash. Other rashes are associated with several tick-borne diseases carried by ticks that are uncommon in our area.

You can get sick without knowing that you have been bitten. Ticks are small. Even people who do regular tick checks can miss a tick. Many people are bitten without knowing it. Ticks can feed and fall off undetected. If you have two of the symptoms above, it is wise to call your primary care provider and ask to be tested for tick-borne illness.

Symptoms can be severe. In some cases, tick-borne illness symptoms can be so debilitating that patients find it necessary to go to the Emergency Department. The headache can be so painful that patients find it difficult to stand or eat, which can lead to dehydration.

Earlier treatment relates to better outcomes. The most common tick-borne diseases in our area—Lyme disease and anaplasmosis—are both caused by bacteria. If you test positive for one or both (yes, you can get them at the same time), your doctor will prescribe a longer antibiotics course. Other treatments will be recommended for less common diseases. Most people fully recover. In rare cases, symptoms can last more than 6 months. Continue to take care, even after you are treated and have recovered. You can get infected again as soon as you are well.

My recommendations for outwitting the stealthy tick are long and involved, but they can be boiled down to four steps: prevent, check, watch for symptoms, and treat. Following all of the steps as closely as you can doesn’t mean that you won’t get bitten or that you won’t get sick. It only means that you have the greatest chance of the least possible disruption from tick-borne illnesses.

Donna Barron, RN, is the infection preventionist at Southwestern Vermont Medical Center in Bennington.