Tick Bites and Lyme Disease

by Pediatric Primary Care //May 3, 2017 //

Spring is upon us!  As we try to cure our wintertime cabin fever by getting outside, it’s important to remember that humans aren’t the only ones who enjoy the warmer weather.  As the temperature climbs, lots of pests and critters start becoming more active.  One bug in particular, the deer (or black-legged) tick, is of particular concern since they have the ability to transmit Lyme disease, and tick bites are a common cause for seeking medical care in the spring and summer months.  Please read on for some more information on tick bites and Lyme disease.

 

Preventing tick bites: The best way to deal with a tick bite….is to not get one in the first place!  Here are some tips for preventing tick bites.

  • Cover up! Limit exposed skin by wearing long sleeves and pants.  Also, wearing light-colored clothing will make it easier to spot those pesky ticks if they do get on you.
  • Use an effective bug spray.
    1. Using a bug spray that has between 10-30% DEET has been proven to prevent tick bites. The lower the percentage of DEET, the more frequently it will have to be applied.  There is no benefit to using a percentage higher than 30%.  DEET-based repellants can be used on children older than 2 months of age.  For more information on bug sprays, check out this post:  http://middleburypediatric.org/dr-pacos-pointers-avoiding-bug-bites/
    2. There is also some evidence that using insect repellents made from essential oils, such as eucalyptus or soy bean oil, is also effective at preventing tick bites, however they don’t last quite as long so need to be re-applied frequently.
    3. Treating clothing and other outdoor gear, such as sleeping bags and tents, with permethrin helps prevent ticks from crawling on them (which keeps them further away from your skin!).

Dealing with tick bites: If, despite your best efforts, you do find a tick on yourself or your child, don’t panic!  The risk of getting Lyme disease is still very low, and is directly related to how long the tick has been attached.  Ticks are only able to transmit Lyme disease after they start feeding, and they don’t start feeding until they’ve been attached for 36-48 hours.  Even if a tick is engorged (which means it has started feeding), the chance of it transmitting Lyme disease is still only about 1%.  So, all of this is to say that if you are bitten by a tick, time is on your side.  Here are some other tips for dealing with tick bites:

  • Find them early! Get in the habit of doing a head to toe tick check every time you or your children come in from being outside.  It can also be helpful to shower or bathe soon after coming inside; not only does this give you an opportunity to do a good tick search, but also lets you wash off any ticks that may be crawling on you that haven’t yet attached to the skin.
  • Remove ticks correctly: If you do find an attached tick, use a set of fine-tipped tweezers to remove it. Grasp it as close to the skin as possible and pull upward in a smooth, steady fashion.  Try not to twist or jerk while you do this, as this can lead to small mouth pieces being left in the skin, but if that does happen it’s ok, your body will work them out on its own, and they are not able to transmit Lyme disease.  Once the tick is out, wash the area with soap and water.
    1. Avoid other techniques, such as painting the tick with nail polish or Vaseline or heating them up. The goal is to detach the tick from your skin, and these methods result in the tick staying attached and can lead to other problems, like burns.

Monitoring for Lyme disease: As discussed above, the chances of a tick bite leading to Lyme disease are pretty slim, but it’s still important to know what to be watching for.  Symptoms of Lyme disease can show up at any point in the first 30 days after a tick bite, so if you do get one, it can be helpful to mark it on the calendar so that you know how long to be watching out for the following:

  • Erythema migrans (or EM) rash: This is the classic symptom of Lyme disease, and will occur in 70-80% of people infected with Lyme. This is a red, circular rash that usually shows up a few days after a tick bite and then expands little by little.
    1. Over time, the rash may clear in the center, giving it the classic “bullseye” look.
    2. This rash may be warm to the touch, but is not painful or itchy
    3. After a tick bite, it’s normal to have a small red bump at the site (similar to a mosquito bite) for the first 1-2 days. This should not be confused with the EM rash.
  • Other symptoms of Lyme disease include fevers, chills, headaches, fatigue, muscle aches, joint aches and joint swelling. These can also show up at any time in the first 30 days following a tick bite.
    1. It’s important to remember that while these symptoms can be seen with Lyme disease, they can also be due to many other things, so having any one of these symptoms does not necessarily mean you have Lyme disease. If you are having these symptoms, you should talk to your doctor.
  • Blood tests for Lyme disease: There are blood tests that can be used to help diagnose Lyme disease, but they have to be done within a specific time frame to be helpful. Doing the blood test either too early or too late can make the results unreliable, so talk to your doctor about whether a blood test is needed.

 

Treating Lyme disease: The good news about Lyme disease is that once it is identified, it can be effectively treated with antibiotics.  People over 8 years old are usually treated with an antibiotic called doxycycline, and kids under 8 are given amoxicillin.  Both antibiotics are effective treatments for Lyme disease.  People are usually treated with 3 weeks of antibiotics, and the majority of the time their symptoms are totally gone by the time they are done with the antibiotics.  Rarely, people can have some lingering symptoms that take up to 6 months to go away, but giving additional antibiotics has not been proven to help them go away any faster.  After you treat Lyme disease appropriately, the bacteria is completely gone from your body and is not able to cause any long-term problems.

  • Sometimes, a single dose of the antibiotic doxycycline can be given to prevent Lyme disease, before any symptoms show up. This has only been proven to be effective in very specific situations, where all of the following are true:
    1. The tick is able to be identified as a deer tick and
    2. The tick has been attached for at least 36 hours and
    3. The antibiotic can be given within 72 hours of the tick being removed and
    4. You are able to take doxycycline: While both doxycycline and amoxicillin can be used to treat Lyme disease, only doxycycline has been proven to be able to prevent it. So, kids under 8 years old, women who are pregnant or breast feeding, or people with doxycycline allergies are not candidates for taking the preventative dose of antibiotics.

 

So, do your best to avoid tick bites this summer, but if a tick does get past your defenses, get it off as soon as possible, know what symptoms to watch for, and if you are concerned that you may have Lyme disease, talk to your doctor about getting started on treatment.  As always, if you have any questions or concerns, feel free to give us a call.  Have fun and be safe out there!

 

For more information about Lyme disease, check out these websites:

https://www.cdc.gov/lyme/

http://www.healthvermont.gov/immunizations-infectious-disease/mosquito-tick-zoonotic-diseases/lyme-disease

https://www.uptodate.com/contents/lyme-disease-the-basics?source=search_result&search=lyme%20disease&selectedTitle=1~150

https://www.uptodate.com/contents/lyme-disease-prevention-beyond-the-basics?source=related_link

https://www.uptodate.com/contents/lyme-disease-symptoms-and-diagnosis-beyond-the-basics?source=related_link

https://www.uptodate.com/contents/lyme-disease-treatment-beyond-the-basics?source=related_link

https://www.uptodate.com/contents/what-to-do-after-a-tick-bite-to-prevent-lyme-disease-beyond-the-basics?source=related_link

 

Dr. Paco’s Pointers: Avoiding Bug Bites

by Pediatric Primary Care // April 24, 2017


Bug bites can be a real pain! While most mosquito, fly, and tick bites cause only mild irritation, they can also cause more serious reactions and, rarely, lead to diseases such as Lyme disease. While it’s impossible to prevent every single bug bite, the tips below can help.
-Avoid areas that attract flying insects. Flying insects like to hang out around garbage cans, stagnant water, and flowerbeds.
-If your child will be in an area where they are likely to be exposed to insects, have them wear light-weight long pants and long-sleeved shirts, shoes, and socks. If you have a baby, using mosquito netting over their stroller or baby carrier is a good way to protect them.
-Repair or replace any door or window screens that are broken or have holes in them.
-Use appropriate insect repellent:
-Insect repellents that contain DEET are the most effective defense against insect bites. There are a variety of products available that have different amounts of DEET in them, but a safe amount for kids over 2 months of age is between 10-30%. Babies under 2 months of age should not use any products that contain DEET.
-Apply the bug spray to the outside of your child’s clothes and on exposed areas of skin only. To apply it to their face, put a small amount on your fingers and then rub it on their face, avoiding their eyes and mouth. When they come back inside, wash any areas that have bug spray on them with soap and water, and wash their clothes before they wear them again.
-Avoid products that are a combination of sunscreen and insect repellent. Sunscreen needs to be re-applied frequently, but applying insect repellent that often can be dangerous.
-Remember that bug spray does not protect against stinging insects such as bees, hornets, and wasps. This is especially important to remember if your child has an allergy to bees or other stinging insects.
You can find more information about steering clear of these little pests here.

Have questions about bug bites? Feel free to call us!

Does Your Child Have a Cough?
by Pediatric Primary Care // January 23, 2017

Does your child have a cough? This time of year, chances are the answer to that question is “Yes!” Coughs can be a major pain: they make kids uncomfortable, disrupt sleep for everyone at home and are one of the most common reasons that parents take the time to bring their kids to the doctor’s office.  And while parents are understandably concerned about their coughing child, the good news is that the vast majority of the time, kids’ coughs are due to cold viruses and will go away on their own.

The bad news is that the cough may not go away as fast as we’d all like it to.  Cold viruses follow a fairly typical pattern: 3-5 days of fevers, snotty nose and generally feeling knocked down a few pegs, then, as these symptoms all start to improve, the coughing begins.  With any one cold, you can expect this cough to last for at least 2 weeks, sometimes longer, before it goes away.  And, since there is nothing kids love sharing more than their germs, they will often catch another cold before their cough has a chance to go away completely, starting the clock all over again.

So, that naturally begs the question “Is there anything out there that will make my kid’s cough go away faster?” And the answer to that question is, unfortunately, “nope.”  This may be hard to believe given the hundreds of cough medicines available in any pharmacy, but there has never been a single cough medicine that has been shown to decrease coughing in any significant way.  A lot of cold medicines also have a combination of ingredients and can include things like acetaminophen (which is also known as Tylenol); if kids are also taking just plain old Tylenol, they can accidentally get too much of it if they take the cold medicine as well.  So, since cough medicines don’t really work, and they are potentially risky to give to a child, we as pediatricians do not recommend using them.

That may be discouraging, but if you think about it, it’s actually a good thing.  A cough is our body’s natural defense system against germs attacking our respiratory tree.  Cold viruses produce mucus in our nose, throat and lungs, and bacteria love mucus.  When you cough, you are getting the mucus up and out of your airways before the bacteria have a chance to set up shop, multiply and cause more serious infections like pneumonia.  You can certainly try soothing your child’s throat with plenty of fluids, humidified air, and some honey (as long as they are older than 1 year), but completely stopping a cough, even if possible, would probably not be a good idea.  This might not help with your family’s sleep deprivation, but hopefully you can take some comfort knowing that your child’s natural anti-bacteria systems are working properly.

Lastly, it’s important to remember that while most coughs are caused by cold viruses, not all coughs are created equal.  Kids with asthma who are coughing may need inhaler medicines for their lungs, and in rare cases kids can develop pneumonia that requires antibiotics to treat.  If your child has a fever for longer than 5 days or looks like they are having a hard time breathing (breathing fast, sucking in between or below their ribs when breathing, using their belly to breathe, flaring their nostrils or looking blue), please call us right away.  If you have any other concerns about your child’s cough (or anything else for that matter!), don’t hesitate to give us a call or make an appointment to come see us!