No one is thinking about tick bites and Lyme disease this time of year….which means it’s a fine time for a PSA that Lyme disease can be tricky and devastating; it’s not something you want, trust me and probably any other healthcare practitioner who sees it in their practice; and you can still get bitten by ticks in winter. Gasp! The good news: it’s not hard to get prepared about what the issues are, if you do a little bit of research now and have a plan of what to do in advance of finding a tick.
Last night, my friend found the above tick on his torso. He had been in the woods in Massachusetts that morning, before taking a bus back to New York City. (Side note: the CDC names New England, the mid-Atlantic, and upper Midwest as higher risk areas.) After he removed the tick, I took a bunch of photos of it (on my open Healing Touch program notebook, as it happened, so you can read a little about the hara line and multidimensionality if you want), and started reading up on what to do at the tick bite moment.
You see, I am almost never there at the time of a known tick bite. As I am not a medical doctor, my scope of practice doesn't include advising on medical diagnoses or treatments, so I’m not the first stop for people who have tick bites. I work with people healing from chronic Lyme disease who are well into a long, and usually exhausting, treatment process: they are 1, 2, 25 years into chronic Lyme, at various stages, with various co-infections, and wildly varying physical/emotional/spiritual manifestations. Chronic Lyme is a whole different thing from a tick bite.
I humbly realized last night that I lived in California for too long in a time when Lyme was not present there, and since being back in New York for 7 years, have become way too much of a city person. I no longer had a tick bite plan for myself, which, last night, struck me as a very important, insane, and dangerous oversight! I mean, I have several friends and current patients dealing with chronic Lyme that they think they got from tick bites that happened in....Brooklyn. So of course I dug right in and read all day.
Here’s what I learned: the info out there about what to do if you find a tick on you is….inconclusive. Contradictory, to say the least. Not surprising, given the overall debate within the medical community about Lyme. (Not familiar with that debate? The TL;DR version is that some people don't think chronic Lyme is even a thing, some do, and no one agrees on either the symptoms or the treatments. High drama, highly inflammatory remarks and positions, and so on.)
So, back to what to do if you find a tick. Some medical entities, using a commonly-cited figure that 2% of tick bites result in Lyme disease, want us to not worry at all. Saying to yourself, "No big deal, I'll probably be in the 98%" is really not a great plan, because, first of all, *I couldn't find where that 2% number comes from in the first place* so I couldn't assess what it really means. For example, are we talking known tick bites, and known Lyme disease? Are we talking all ticks, or only the black-legged variety that actually transmit Lyme? Etc. Also, there are other potentially dangerous infections that you don't want that are also transmitted via tick bite; a few common ones are bartonellosis, babesiosis, and Ehrlichiosis.
Some medical entities advise waiting a few days up to a month for a hallmark bull’s eye or other Lyme rash to appear before seeking treatment. The problem with that is between 27-80% of people who end up with Lyme disease develop such a rash….which means 20-73% don’t. So, from a common sense/math perspective, waiting a month for a rash to either appear or not appear before checking in with an MD doesn’t sound like a great strategy, does it?
You might also wait for things like fatigue and flu-like symptoms (fever, chills, headache, swollen lymph glands) to develop. The problem with that is, like rashes, these may not develop at all. In addition, they may fly under the radar and go unnoticed, especially if you’re under a lot of stress anyway, or are fatigued for other reasons. Keep in mind that flu-like symptoms can indicate the onset of so many diseases, or none; if you report them to your MD, they may not flag the symptoms as potentially Lyme-related because they could be considering many other possibilities. My conclusion: waiting for flu-like symptoms to maybe or maybe not develop before checking in with an MD doesn't feel like a solid strategy.
Here’s what you can look into now, pre-tick bite:
- Turn your outdoor excursions into routines by wearing proper protective clothing and getting in the habit of doing comprehensive tick checks if you live in a higher risk area.
- Learn how to properly remove ticks. Hint: it’s not by pulling them off with your fingers as quickly as you can while yelling “just get it off me!” Lyme disease websites often cite 36-48 hours as the range of time a deer tick needs to be attached before potentially transmitting Lyme, fyi, though some studies cite 24 hours and some remain silent on a time frame.
- Familiarize yourself with the infamous erythema migrans (aka “bull’s eye” rash) that may follow a tick bite by anywhere from 3-30 days.
- Identify a few MDs in your area who are Lyme-literate, as your PCP may not have been trained in it. You can use your friend google or directories like this one to find local doctors.
- Read up on the different guidelines available for how to deal with both tick bites with no Lyme rashes or other symptoms, and early Lyme rashes and symptoms. There is no agreed-upon standard treatment, so it’s important to be informed about the range of options. Because information and research about Lyme is accelerating rapidly, bring your smart person's critical mind to any organization’s guidelines that haven’t been updated in the past few years, at the longest. One commonly cited organization's guidelines are 8 years old, for example. (Just to remind you what was going on 8 years ago and how much has changed since then, we were less than a year into President Obama's first term, and Instagram didn't exist yet, so....)
- Be prepared to save the tick. At the very least, identifying the type and age of the tick helps narrow down potential risks and infections. Some MDs recommend testing ticks for common Lyme coinfections, and some don’t, as the results can range from inconclusive to unhelpful or to just too slow/late to matter at all. Either way, it doesn’t hurt to save the tick just in case.
I first heard about Lyme disease in the late 1980s. I grew up in Connecticut, amidst acres of woods, and my parents had promised my sister and me a treehouse. A treehouse! I had elaborate dreams of moving out of our house and into the treehouse, living there Swiss Family Robinson-style, that consisted mostly of me reading books to my stuffed animals, who would be thrilled to once again be outside -- in their native habitat, of course.
And yet, a treehouse never materialized. My parents had heard about Lyme disease on the news and decided that, given all the deer -- and the occasional sick or dead deer -- on our property, it was too risky. They didn’t want us to get tick bites.
Then, in the summer of 1992, I went to camp in upstate New York. I have regrettably forgotten our beloved bunk counselor’s name, but I remember both her super cool hair scrunchies and her Lyme disease clearly: at 16, she had already been sick for a few years, with crippling fatigue, swelling and edema, and chronic joint and body pain. She had been a promising athlete, but now her joints were so inflamed and painful that she sometimes had to use crutches to get around. There were plenty of days where the bunk would all leave for breakfast and she would stay behind in bed...and there she’d still be when we returned again in the evening.
I’m sharing these stories because, somehow, way before I became familiar with chronic Lyme through East Asian medicine, I have always had an awareness that Lyme disease was serious, not to be trifled with. “Don’t get Lyme disease” was the clearly imprinted message.
However, “don’t get Lyme disease” and "don't get a tick bite" are not serviceable prevention or early treatment plans, in case you were still wondering. So, please, make one for yourself, using the prompts above, and let me know what you learn!