Here we will discuss several important steps to reduce the likelihood of a tick-borne infection when finding an attached tick. The "yank, wait and see" approach isn't one that I recommend, especially if you are in an endemic area (and PA is considered endemic). There are steps you can take! Below is a graphic that summarizes the details given below. Be prepared. Have a plan of action so you know what to do. We found out ourselves, it isn't a matter of if, but when. Lyme and tickborne diseases are nothing to mess around with. I'll add this here too, always seek medical testing and advice from your chosen medical professional upon the discovery of an attached tick.
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| Action Plan for an Attached Tick. (click to enlarge image) |
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Reader's Summary:
- Get your Tick Bite Action Kit
- Detach the tick
- Identify Tick species
- Send tick for pathogen testing
- Initial treatment of bite site after tick removal
- Treatment of person after bite
- What would a doctor say about treatment after a tick bite?
- Symptoms to watch for after a bite -there are so many! Here are just a few.
- What are the risks of getting an infection
- Before you head to the doctor
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- Get your Tick Bite Action Kit (details on how to assemble your own kit coming soon)
- Detach the tick
- There are several methods and tools for removing a tick.
- Tweezers/tick tool
- Many use a standard pair of tweezers. To remove a tick with tweezers, grab the tick as close to the skin as possible, and pull the tick straight out. https://www.lymedisease.org/lyme-basics/ticks/tick-removal/ I have a tick lasso tool called TRIX Lasso. You lasso the tick, tighten the tool around it as close to the skin as possible, and twist it out intact.
- Massage
- Some have said that rubbing in a circle "around" the tick will cause it to loosen and back itself out. From what I have read, it is not clear as to whether in this process would cause the tick to vomit its guts the same way it would if it had been covered with an essential oil or burned with a match (the way people use to remove them, and you should never do).
- Place detached tick into a small plastic zipper top bag. At this point the tick may still be alive. If it is not placed in a bag, and is still alive, it could crawl right back on you and bite again! Bag it!
- Identify Tick species
- Identifying tick species
- Here is an excellent resource for identifying ticks (male/female, breed, maturity, engorged) This chart from the University of Rhode Island is one of the best charts for identifying that I have seen. http://www.tickencounter.org/tick_identification
- **Identify the tick** Identify the type of tick to determine the risk, but remember that with all attached ticks there is a risk.
- Send tick for pathogen testing We send every attached tick in for testing. Knowing what you have been potentially exposed to will be invaluable information if you develop symptoms. Put the extra money into the best tick testing you can afford! There are several places you can mail the tick to for pathogen testing. Prices range from free to >$250 depending on what you want the tick tested for (lyme, coinfections, etc.)
- **First testing option** Free testing for Pennsylvania residents through the lab at East Stroudsburg University. https://www.ticklab.org The lab will test for 4 pathogens(including Lyme) and you have the option of adding more testing for a $50 or $125 fee depending on which option you choose (I recommend the $125 option). The service currently has a turnaround time of less than 24 hrs. They will keep these ticks for two years, so if additional testing is needed later on, you can order more.
- Tick Check is the lab who received funding from PA to start the "TickLab" testing shown above. They are based out of East Stroudsburg, PA and is a good option for those in PA to get quicker results. They will also fax a copy of your results to your doctor. https://www.tickchek.com/
- A fee of $50-$200 for testing with UMass https://www.tickreport.com/
- Initial treatment of bite site after tick removal
- Clay pack on site of bite
- Andrographis mixed with Bentonite Clay to make a paste. Apply this to the site of the bite and cover with cotton or Bandaid. Leave on area of bite for 24 hrs to pull the toxins out of the bite site.
- Treatment of person after bite to reduce chance of getting Lyme or coinfection. While I can't, and won't, say that you will not get a pathogen from the tick, supporting your immune system is the best way to help your body fight off whatever it is exposed to.
- Herbal supplements
- Astragalus, a food grade herb, to prevent lyme. Caution, in acute lyme, it can cause the symptoms to get worse. Stephen Buhner comments on the use of Astragalus to prevent infection after a bite, "Astragalus 3,000 mg daily for 30 days, 1,000 mg daily thereafter, indefinitely."
- Homeopathic
- Ledum Palsture is the most common homeopathic remedy used with a tick bite. Here is a resource to guide your use of them, if you choose to use them in your action plan.
- Pharmaceutical
- Generally, most physicians will not order prophylactic Lyme antibiotics. However, if you are in an endemic area (PA is considered endemic now), the standard guidelines are different and Lyme literate doctors will often prescribe a 21-30 day round of antibiotics (Doxycycline for adults, and amoxicillin for children). It is your choice as to whether you want to take this approach. We evaluate this based on whether the tick is attached, and what the testing shows.
- Mixed treatments
- What would a doctor say about treatment after a tick bite?
- Standard doctors will pull the tick, and tell you to watch for symptoms which include rash, fever, or joint pain.
- What does ILADS say about treating tick bites? Well, they reviewed their treatment guidelines in 2014. "The optimal treatment regimen for the management of known tick bites, EM rashes and persistent disease has not yet been determined. Accordingly, it is too early to standardize restrictive protocols. - See more at: http://www.ilads.org/lyme/treatment-guideline.php#sthash.nSV560V0.dpuf"
- A doctor may prescribe 21 day dose of Doxycycline, depending on what type of tick it was, the area you are in, how long it was attached, whether it was engorged, etc.
- Symptoms to watch for after a bite -there are so many! Here are just a few.
- Lyme
- Rash. According to the ILADS treatment guidelines, "Erythema migrans (EM) is diagnostic of Bb infection, but is present in fewer than half.""The EM rash will begin four days to several weeks after the bite,and may be associated with constitutional symptoms""After a tick bite, serologic tests (ELISA. IFA, western blots, etc.) are not expected to become positive until several weeks have passed. Therefore, if EM [this is the "lyme rash"] is present, treatment must begin immediately, and one should not wait for results of Borrelia tests. You should not miss the chance to treat early disease, for this is when the success rate is the highest. Indeed, many knowledgeable clinicians will not even order a Borrelia test in this circumstance."
- Fever
- Weakness
- Bell's Palsy
- Coinfections
- There are numerous coinfections. Check out this link for a list of coinfections, and their 'normal' symptoms. https://www.tickchek.com/info/tick-borne-diseases
- Generally-
- Bartonella - Striae marks like red stretch marks, mental changes
- Babesia - Night sweats, air hunger
- Erlichia - Fever
- Reoccurring fever in the afternoons is another Borellia symptom(Borellia Burgdorferi is the Borellia strain that causes Lyme, but is not the only Borellia that ticks can carry. IgeneX will test for several other Borellia strains.)
- What are the risks of getting an infection
- There is simply no absolute answer to this. What we do know is this...if you have been bitten, there is a risk.
- Is it important to act quickly when bitten? What are the risks of not doing anything? http://www.newyorker.com/magazine/2013/07/01/the-lyme-wars
- Time of attachment
- There is no set time where having a tick attached bears no risk of disease transmission. Keep this in mind if you are told that you are safe because attachment time was less than 24-48 hrs. "A literature review has determined that in animal models, transmission can occur in <16 hours, and the minimum attachment time for transmission of infection has never been established." "These factors support anecdotal evidence that Borrelia infection can occur in humans within a short time after tick attachment." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4278789/
- Type of tick
- Any tick can carry Lyme, but coinfections can be specific to species. https://www.tickchek.com/info/tick-identification
- Before you head to the doctor, print off the ILADS treatment guidelines to show your doctor. Better yet, print it now, read it over, and become familiar with it so you will already have the information in your head before a tick bite event happens. http://www.ilads.org/lyme/treatment-guideline.php
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We recently had the opportunity to implement this plan of action for a tick that a family member found embedded. We identified it as a dog tick, and we sent it off for testing. The testing came back negative for Lyme and coinfections. But, we did implement the steps above to prevent any disease, just in case.
My personal view on action after a bite at this point in time, being in an endemic Lyme area, is, if the tick is attached, it would be wise for us to go ahead and take the Doxycycline protocol. Antibiotics can be very useful in acute Lyme infections (as well as coinfections). Waiting 4 weeks after a bite, doing nothing, while waiting to see if there are symptoms, gives the Lyme a chance to become chronic. In the case of a chronic Lyme infection, antibiotics may be less useful. The risk isn't worth it to me, so we implement this plan of action as a way to do what we can to minimize the risk of an untreatable infection.
Every person makes the decision that is right for them. You will make decisions based on information you have, and the situation you find yourself in. Perhaps in the years to come, a more concrete effective(!) treatment plan will come out. For now, we do not have a treatment that is 100% effective.
The Pennsylvania Lyme Network is an excellent resource for prevention, treatment, and general information on tick borne diseases. http://palyme.org/
*The disclaimer: This information is not intended as medical advice, and you should seek the advice of your chosen medical professional on matters regarding your own personal health.*
