Ticks!
Two days until Memorial Day weekend, the kickoff of fleeing NYC weekly for cooler climes, AKA summer. Whether you’re heading out to the Hamptons or going upstate or to Connecticut, you may well encounter ticks.
Prevention is best, so wear long pants and sleeves as much as possible, and avoid tall grasses. Check head to toe at least once a day. Ticks especially love crevices, so be sure to look EVERYWHERE - between fingers and toes, behind ears, under breasts, between buttocks, and in the groin area.
Growing up in North Carolina, checking for ticks was the norm. There they can transmit Rocky Mountain Spotted Fever. (Yes, this is a hilarious misnomer; please see map below.) I didn’t encounter many tickborne illnesses during medical school in Philadelphia nor during residency in Houston. Of course practicing in Connecticut after training, I diagnosed and treated plenty of Lyme disease.
US maps showing distribution of tickborne diseases
Connecticut locals like my husband grew up checking for ticks just like me. But the transplants from NYC needed a little guidance. One new mother who had recently moved to Redding brought her baby into the office for me to remove a tick! This made me realize I needed to teach tick removal as part of my routine anticipatory guidance.
DO:
Grasp near the head with sharp tweezers. Pull straight out with steady, even pressure.
How to remove a tick
Afterwards, clean the skin with rubbing alcohol.
If it was a deer tick, call your doctor to discuss a dose of preventive antibiotics. Try to figure out how long it was attached, ie. the last time you saw the area with no tick. It typically takes 36 hours attached for a tick to transmit disease, so that’s why checking every 24 hours is so critical.
Tick identification
DO NOT:
Burn the tick while on your skin.
Squeeze or twist the tick’s body while on your skin.
Cover the tick while on your skin with soap, alcohol, Vaseline, nail polish remover, or any other substance.
Bring your doctor the tick. Please! Testing the tick delays diagnosis and treatment, so we don’t do it. Also please don’t bring your doctor a rat (this happened.)
Please do not bring me a rat
WHAT TO WATCH FOR:
It is normal to have redness around the bite initially; this is not a bulls-eye rash.
University of Rhode Island Tick-ology
A bulls-eye rash can appear up to 2-3 weeks after the bite and can be on any part of the body.
Erythema migrans “bulls eye rash”
Erythema migrans on darker skin. Photo credit: Gary Wormser
Please call your doctor if you notice a bulls-eye rash, extreme fatigue, fever/chills, abdominal pain, and/or headache.
If you don’t have a doctor, please consider joining Dr. Dilling Internal Medicine & Pediatrics. I provide convenient, high quality, and comprehensive primary care for all ages here in NYC - from newborns to centenarians.
