Infectious Disease, Lifestyle Medicine, Preventive Medicine

Beat Ticks in the Battle Against Lyme Disease

Ticks abound! The warmer summer weather brings the ticks out in full force, so it’s time to get smart about Lyme disease.

What exactly is lyme disease?

Lyme disease is an infection caused by the Borrelia bacteria. Infected ticks, usually found in tall grasses and woods, attach themselves to our skin, then transmit the bacteria into our bodies while they’re feeding. The bacteria multiply rapidly, then within two or three days, can spread through the bloodstream wreaking havoc on joints, skin, heart, and brain. Left untreated, and even in some people who receive appropriate treatment, Lyme disease can cause debilitating symptoms years down the road. 

What would I feel if I was infected?

The classic sign that you’ve been infected with Lyme disease is a hot, red rash at the site of a tick bite that expands over several days or weeks, sometimes reaching more than 20 cm (diameter) in size. Often, the rash clears or pales in the center, creating a bull’s-eye pattern

However, one in five people who are infected with Lyme disease don’t develop this classic rash. You may only notice other, less specific symptoms, such as:

  • fatigue
  • muscle or joint pain
  • headache
  • neck stiffness
  • low appetite
  • enlarged lymph nodes
  • fever

These symptoms, and the bull’s-eye rash, can occur anywhere from three to 30 days following infection. Pro tip: gut and respiratory symptoms are not typical, and are usually indicative of a different diagnosis. 

Weeks to months later, more serious signs and symptoms can occur, including: 

  • worsening pain
  • muscle weakness (for example, drooping facial muscles)
  • tingling and numbness
  • Lyme rashes occurring at distant skin sites
  • palpitations or irregular heartbeat
  • dizziness
  • problems with cognition and short-term memory
  • meningitis

There can be a huge time lapse between getting a tick bite and the onset of symptoms, which can make diagnosing Lyme disease difficult. Still more troubling, many people who are diagnosed don’t recall having a tick bite in the first place (especially children!). After all, ticks are tiny and their bites can go unrecognized.

How can I protect myself from ticks?

Since it’s transmitted through contact with infected ticks, the best way to prevent Lyme disease is to prevent bites. The problem though, is that ticks aren’t just found deep in the forest — you can run into them in your backyard. 

Follow these tips to keep ticks away: 

1) If you’re venturing into long grass, brush, or wooded areas, wear long pants tucked into your socks (fashion statement!), and tuck your shirt into your pants. 

2) Wear insect repellent. Worried about potential hazardous health effects of DEET? Put your mind at ease by knowing that the Environmental Working Group (EWG) (the authorities in advising how to choose products that are friendly to the health of humans and the earth alike), still recommend DEET. Used in advised concentrations, sprayed in well-ventilated areas, and re-applied properly, its risks are outweighed by the benefits it provides by protecting against ticks and mosquito-borne illnesses. That said, in some, daily use of DEET has been associated with rashes, dizziness, headaches, and difficulty concentrating. Keep tabs on your health while using any repellent and if you notice adverse effects, think about using an alternative. 

Another option is picaridin, which is also recommended by the EWG. It’s effective, generally well-tolerated, and has a less toxic odour than DEET. Check out this database to help find products that are right for you.

ADULTS: For all-day protection, choose products with 20-30% DEET, or 20% picaridin. Choose a lower concentration if you need less protection time: DEET <10% provides 1-2 hours of protection while picaridin 10% provides 5-12 hours of protection.

CHILDREN: Health Canada recommends that children under the age of 12 can apply picaridin in the same concentration, but DEET should be used at a concentration of 5-10%, applied up to three times daily in children over the age of three, but only once daily in those younger. Insect repellent should not be used on children under the age of six months.

3) After time outdoors in tick-prone areas, thoroughly check your body, kids, pets, clothing, and gear for ticks, especially in the warmer months. Shower within 2 hours of coming indoors, and do a tick check while you’re at it — this is also a good way to remove remaining insect repellent from your skin.

ADULTS: For all-day protection, choose products with 20-30% DEET, or 20% picaridin. Choose a lower concentration if you need less protection time: DEET <10% provides 1-2 hours of protection while picaridin 10% provides 5-12 hours of protection.

CHILDREN: Health Canada recommends that children under the age of 12 can apply picaridin in the same concentration, but DEET should be used at a concentration of 5-10%, applied up to three times daily in children over the age of three, but only once daily in those younger. Insect repellent should not be used on children under the age of six months.

4) After time outdoors in tick-prone areas, thoroughly check your body, kids, pets, clothing, and gear for ticks, especially in the warmer months. Shower within 2 hours of coming indoors, and do a tick check while you’re at it — this is also a good way to remove remaining insect repellent from your skin. 

Tick attack! I’ve been bitten! What next?

It’s essential that you quickly remove your tick, then keep him in a small container for identification and possible testing. 

To remove: Grasp your tick firmly with a pair of tweezers as close to the skin as possible, and pull upwards, perpendicular to the skin until it’s removed. Mouth parts may remain, which can also be removed with tweezers. If you can’t get them off, leave them be and they will come out on their own. Clean the area with alcohol or soap and water. 

ID your tick: You’ll need to know if your tick is of a species that carries Lyme. Visit TickEncounters, run through the University of Rhode Island, where you can enter all the information about your tick, the location you were bitten, and even submit a photo. They reply within one to three days, confirming your tick species and advising on whether or not you should consider treatment.

Should I be treated with antibiotics?

This is a tricky question, steeped in controversy throughout the medical community. Conventional guidance to doctors, as advised by the CDC, is that ticks are slow to transmit Lyme bacteria, so if you’re confident that it your tick was attached for less than 24 hours, there’s no need for treatment. Unsure? The CDC recommends talking to your doctor about a possible single dose of antibiotics to prevent Lyme disease. Certainly, if you develop signs and symptoms of Lyme disease, a full course of antibiotic treatment is recommended.

However, over the past few years, the International Lyme and Associated Diseases Society (ILADS), has brought forth recommendations that all people with tick bites from species known to carry Lyme should consider antibiotic treatment for 20 days. They’re concerned that ticks may transmit Lyme much more quickly than previously believed, it can be extremely difficult for people to estimate tick attachment time, and since Lyme signs and symptoms are nonspecific, they may go unnoticed or undiagnosed.

It’s then up to each patient to weigh up the risks and benefits of treatment. There’s no question that antibiotics are effective against Lyme disease; however, they are associated with side effects and health hazards ranging from yeast infections and mild diarrhea to life-threatening gut infections, allergic reactions, and an increased risk of autoimmune disease, such as arthritis.

And this is likely just the tip of the iceberg — there’s an entire human genome project related to studying our bodies’ good bacteria and the role it plays in our health. Wiping out your body’s good bacteria can have disastrous consequences. Finally, over-using antibiotics contributes to antibiotic resistance, so that when you or your loved ones need them for severe illness, they may not be effective.

The bottom line?

Despite these differing treatment guidelines, one thing that we all agree on is that the best way to combat Lyme is to prevent tick bites altogether. Be diligent with protective measures, and if you’re bitten, take the appropriate steps to identify your tick to see if you may be at risk.

Become educated about the signs and symptoms of Lyme disease, so that whether or not you recall a tick bite, you can flag any worrisome symptoms and bring them to the attention of your healthcare provider. Remember, both the CDC and ILADS recommend antibiotics for suspected Lyme disease, based on symptoms.

In the end, it’s key that you work together with a trusted healthcare provider to weigh your specific risks and benefits of treatment following a tick bite. They’ll take into your personal health history and circumstances surrounding your bite in advising treatment — helping you make an informed decision. Pro tip: whenever you opt for antibiotics, be sure to protect your gut with probiotics!

We all need to do our part in battling ticks to combat Lyme disease. This summer, beat the heat (and ticks!) — and stay healthy.

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