Tick Tactics

Safeguard your summer fun with these tips

BY KRYSTEN GODFREY MADDOCKS / ILLUSTRATION BY JOHN R. GOODWIN

Three summers ago, our son’s hair stylist found a particularly sneaky tick buried in the nape of my son’s thick brown hair. We have no idea how long it had been hiding there, and now we’re careful to inspect for ticks — and schedule regular haircuts.

While we can’t completely avoid ticks, taking precautions and acting quickly can help us from contracting tickborne diseases. Data tracked by the EPA shows that Lyme disease cases nearly doubled between 1991 and 2018, with New England states experiencing the largest increases in cases, thanks to an abundance of deer ticks in our region, brought on by warmer winters.

“People are more aware that it’s a growing problem, and it’s related to our climate getting hotter,” says Renee Broze, a nurse practitioner at Southern New Hampshire Medical Center’s Immediate Care. “The ticks don’t die off in the wintertime if we don’t have a lot of deep freezes. Looking back this past winter, I can’t remember any time that we experienced significantly low temperatures.”

By following these effective protective measures and understanding how and when you should act, you can stay healthy and enjoy the outdoors this summer.

Protect Yourself

There are simple things you can do to protect yourself, whether you’re hiking, gardening or doing yard work, according to Maddie Miller, MPH, public health information officer at the New Hampshire Department of Health and Human Services.

• Use an EPA-registered repellent. The U.S. Environmental Protection Agency has a tool that lets you search for repellents, such as those that contain DEET and work best against ticks.

• Stay on cleared trails and out of tall grass when possible.

• Wear long pants, long sleeves, a hat and closed-toe shoes.

• Tuck your shirt into your pants and your pants into your socks.

• Wear light colors that make it easier to see ticks on clothing.

• Check yourself and your pets for ticks when you come back inside.

• Shower after returning indoors.

• Dry the clothes you wore in the dryer on high heat to kill any ticks that snuck in.

• If you do find any ticks, remove them promptly.

If you need help, ask a family member to help you check for ticks, and be sure to look in the hidden spots.

“Pay close attention to the skin on your trunk and around your ears and hair line, where ticks particularly like to attach,” Broze says.

How to Remove a Tick

First of all, don’t panic. You also shouldn’t try to rush the process, either.

“Put the tweezers at a 90-degree angle and get them as close to the skin as possible,” Broze says. “And then it’s not a quick movement; it’s a slow one.”

• Grasp the tick’s mouth parts close to the skin with tweezers or a tick spoon.

• Pull the tick slowly upward using a gentle, straight-up motion.

• Cleanse your hands and the area around the tick.

• Apply an antiseptic to the site.

• For photos and step-by-step directions, you can check out this CDC resource: cdc.gov/lyme/removal/index.html.

Sometimes, a piece of the tick breaks off and stays stuck in the skin. Broze suggests putting antibiotic treatment on it and says the small piece usually works itself out over time. If you’re having trouble removing a tick, health care providers can help remove them for you, she says.

Seeking Medical Care

You may get a tick bite and not experience any symptoms, or only notice the bite after finding an embedded tick. Once a tick falls off, you might see a small area of redness that could be itchy or sore.

It’s impossible to know if you were bitten by a tick carrying one of several diseases, including Lyme disease. Depending on the location, anywhere from less than 1% to more than 50% of the ticks in an area may be infected with Lyme disease bacteria, according to Johns Hopkins Medicine. The ticks that most commonly carry Lyme disease are black-legged ticks, also known as deer ticks. In 2018, 50% to 60% of deer ticks sampled across New Hampshire were infected with Borrelia burgdorfer. This bacterium causes Lyme disease, according to the NH Department of Health and Human Services.

• Miller strongly recommends visiting a health care provider if you find an engorged tick on your body. It might have been attached to you for 36 hours or longer. This prompt action can significantly reduce the risk of developing tickborne diseases.

• You should also seek medical attention if you develop an expanding rash or other concerning symptom after being bitten.

• The “Tick Bite Bot” from the Centers for Disease Control and Prevention provides examples of tick bites and can help you decide whether to seek health care. (cdc.gov/ticks/communication-resources/ tick-bite-bot-1.html)

When you visit a provider, you’ll likely receive a dose of the antibiotic if you were bitten by a deer tick, says Dr. John Mendoza, a board-certified infectious disease doctor at Wentworth-Douglass Hospital, part of the Mass General Brigham system. Antibiotics are given to all nonpregnant adults and children who meet all of the following criteria, he says.

• The attached tick is confirmed to be an adult or nymphal deer tick.

• Based on the degree of engorgement or time of exposure, the tick is estimated to have been attached for more than 36 hours.

• Antibiotics can be given within 72 hours of tick removal.

Even if you meet the criteria and receive antibiotic treatment quickly, you might not be out of the woods.

“I tell every patient who comes in seeking a preventive dose of an antibiotic that they still need to watch for up to 60 days for any symptoms of a tick-borne illness,” Broze says.

Recognizing the Symptoms

Early symptoms of Lyme disease, which can appear within three to 30 days after a tick bite, include fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes. These symptoms are often described as flu-like symptoms, according to Miller.

Lyme disease may also present as an expanding rash, commonly called a bullseye rash. This rash can appear on any body area, and its visual presentation may vary. This rash usually expands slowly over several days and can reach up to 12 inches or more; however, not all rashes are a sign of Lyme disease, the CDC says. You can find photos and resources on the CDC website to help you identify whether your rash may indicate Lyme disease.

Testing for Lyme Disease

If you’re experiencing Lyme disease symptoms, it’s important to get tested and seen by a provider immediately. Blood tests can confirm whether or not you have the disease, and the timing of these tests is critical. It’s best to get tested as soon as possible after the onset of symptoms, as it can take several weeks for your body to produce enough antibodies for the test to detect.

“If somebody comes in and they just got bit by a tick, it’s too early to test,” Broze says. “What they’re testing for, particularly for Lyme disease, is antibodies, and your body takes time to make antibodies. You may not test positive for Lyme for up to 60 days. We generally wait at least 10 days from the tick bite to do the test.”

If a provider thinks there’s a chance you are sick with a tickborne illness, you may be treated right away without undergoing testing. People recover much better the earlier they get treated.

Lyme Disease Treatment

Mendoza says the clinical manifestations of Lyme disease can generally be divided into three phases: early localized, early disseminated, and late disease. The clinical features of each stage can overlap, and some patients present in a later stage of Lyme disease without any of the signs or symptoms typically found in the earlier stages.

• Early localized disease is characterized by the appearance of the characteristic bull’s eye skin lesion, with or without flu-like illness. This rash usually occurs within one month following the tick bite.

• If left untreated, the next stage is early disseminated disease, characterized by multiple lesions that typically occur days to weeks after infection and neurologic and cardiac findings (usually weeks to several months after the onset of infection).

• Late Lyme disease can present as intermittent or persistent arthritis involving one or a few large joints, especially the knee, and/ or certain rare neurologic problems (e.g., a numbness or tingling sensation). These may develop months to a few years after the initial infection.

If you do discover you have contracted Lyme disease, there are several different antibiotics you can take to treat it. The duration of your treatment is based on the stage of infection and the types of signs or symptoms you’re experiencing, Miller says.

• According to the CDC, patients treated with antibiotics in the early stages of the infection usually recover rapidly and completely.

• Those treated in the later stages of the disease also respond well to antibiotics. However, some may suffer long-term damage to the nervous system or joints.

• Many people treated for Lyme disease may have lingering symptoms of fatigue, pain, or joint and muscle aches after treatment. These symptoms can last more than six months in a small percentage of cases. While symptoms cannot be cured by longer courses of antibiotics, they generally improve over time.

While they’re a nuisance, ticks shouldn’t dampen your summer fun. Not every tick bite warrants a visit to the doctor or means you’ll contract Lyme disease. If you’re concerned, seek out a health care provider for guidance.

For more information about Lyme disease and other tickborne diseases, visit the New Hampshire Department of Health and Human Services Tickborne Diseases page or the Centers for Disease Control and Prevention website.