Keep the Outdoors, Lose the Ticks

We live in an incredible outdoor playground. There are so many ways to explore and have fun in our mountains and forests or on our water. Hiking, biking, fishing, hunting, camping, canoeing or kayaking, and trail running are all fun and healthy ways to enjoy our beautiful outdoors. That’s why I am always saddened when someone shares that they are avoiding the outdoors out of fear of ticks and tick-borne illnesses.

While you may already know that ticks are not active when the weather is very cold, it might surprise you to learn that the tick life cycle drives them to be more active in the spring and fall. See the graph from the Vermont Department of Health below. That makes now, early fall, a great time to refresh your tick-borne illness prevention efforts.

The most common tick-borne illnesses in our area are Lyme disease and anaplasmosis. Babesiosis is also transmitted by deer ticks but it is less common. While these illnesses can be serious, they are preventable and treatable. Fear of tick-borne illness should not keep you inside.  Here is my four-fold plan for dealing with the threat of tick-borne illnesses:

1. Prevent tick bites.

• Wear long sleeves and long pants when in the woods. It may look odd, but ideally you should tuck your pants into your socks.
• Use an insect repellant with DEET on your exposed skin.  DEET is safe and the only insect repellant proven to help decrease the risk of tick bites.  There are other insect repellents available, but their equivalence to DEET for repelling ticks has not been evaluated.
• Treat a set or two of clothes with permethrin. It’s label may indicate that it is for clothing and gear. Follow the directions, but all you need to do is spray it on your clothes and let it dry.  It does not go directly on your skin.  You can also buy clothing that has already been treated with permethrin.  Permethrin is a great deterrent for ticks and harmless to people and animals when used as directed.
•  After being outside, put your clothes in a dryer on hot for 5 – 10 minutes. This will kill any ticks.  Just washing your clothes may not kill ticks.
• If you have pets, ask your veterinarian about tick-prevention products for them. Treating your pet will make it less likely for them to pick up ticks and carry them into the house.

2. Check for ticks.

• Check for ticks whenever you have been outdoors. Dispose of any ticks you find crawling on your body or clothes. Wearing light-colored clothing may make it easier to spot them.
• Take a shower as soon as possible after your outdoor adventure. You may wash off any ticks that are not yet attached, and are more likely to find a tick that has recently attached.
• Ticks like to hide. Make certain to check all over your body.  Often, it helps to have someone else check parts of you that you can’t see.

3. Remove ticks.

If you find a tick, take it off. Directions can be found at www.cdc.gov/ticks. The sooner you get a tick off of your skin, the less likely it is to make you sick. A tick needs to be attached for at least 36 hours to transmit Lyme disease.  If you find and remove a deer tick that may have been on for over 36 hours, you should contact your health care provider about whether a dose of prophylactic antibiotics to prevent Lyme disease is appropriate.  Remember, however, that in the majority of cases it is the tick bite that is missed that causes illness, not the tick that is found and removed.

4.  Watch for symptoms.

If you remove a tick, watch for symptoms.  Most people who develop Lyme get the classic round red rash (erythema migrans) between 2 – 30 days after a tick bite.  It is normal to have some redness at the site of a tick bite, but it is usually an inch or less in diameter. Any rash over 2 inches in diameter should prompt you to seek medical attention, even if you do not feel sick.  You should also seek medical attention if you develop flu like symptoms (fever, headache, muscle, and joint pains).  Anaplasmosis usually causes fever.  When caught early, Lyme disease, anaplasmosis, and the other tick-borne illnesses are treatable without any long-term consequences.

The benefits of spending time outside far exceed the risks related to ticks and tick borne illnesses, especially if you follow the steps above to mitigate the risk of tick-borne illnesses. For more information, please visit www.cdc.gov/ticks or https://www.healthvermont.gov/disease-control/tickborne-diseases.  

Richard Wiseman, MD, is an internal medicine physician at SVMC Internal Medicine, part of Southwestern Vermont Medical Center in Bennington.