Gail Ingram is an Adult Health Nurse Practitioner, former Girl Scout, and self-proclaimed campfire chef. Using personal experience, she explains how she handles the growing tick, Lyme, and Rocky Mountain Spotted Fever [RMSF] problem in her professional practice.
I just returned from a short trip to Stokes State Forest in New Jersey where I rented a rustic cabin for 3 nights and enjoyed 4 full days of outdoor activity in the woods. Unlike my previous visit to Stokes (when I encountered 6 bears), this time I encountered 7 TICKS. I discovered one crawling on my pants, one on my finger, one on my friend’s leg, another on my bed AFTER I got home, pieces of a tick in my post-camping bathwater, and another climbing up my NYC bathroom wall.
Dog ticks don’t spread Lyme, but they can carry other bacteria, specifically Rocky Mountain Spotted Fever [RMSF]. Note that dog ticks have a silver head.
Prior to this, I had only seen ticks when patients brought them into my office for bacterial analysis. Testing ticks can help determine if a patient is at higher risk for being infected. However, the test results are not definitive for making a diagnosis; there are a lot of variables.
Deer ticks can be infected with the bacteria that cause Lyme. Note that deer ticks have black legs and a black head.
Because I have easy access to medication, I took a single 200mg dose of doxycycline hyclate, a broad-spectrum antibiotic that kills most bacteria spread by ticks. This medication regimen is known to prevent the onset of Lyme disease or RMSF if taken within 72 hours of a tick bite. However, my use of the drug is controversial.
There are providers who won’t prescribe doxycycline for the prevention of tick-borne illnesses unless patients meet specific criteria: Patients must have pulled a tick from their skin and the tick must have been latched on for over 36 hours and/or the patient must present with a rash. This is a simple and popular approach to managing tick bites that was outlined in the 2006 Infectious Disease Society of America’s guidelines. However, I don’t believe that strict adherence to these guidelines is always the best action. Let me explain further by using my own experience.
- Was I bitten? I’m not sure, maybe. Most ticks release an anesthetic when biting, so their activity goes undetected by their victims. It is possible that I was bitten and didn’t feel it. Half of all people infected with RMSF don’t recall having been bitten.
- Were any of the ticks engorged to the degree that I would expect after 36 hours of continuous feeding? I’m uncertain because I couldn’t fully assess the size of the waterlogged tick I found in my bathwater. But more importantly, recent research from 2015 states that infection transmission might be immediate in some cases.
- Did I have a bullseye patch or a spotty rash that is typical of a tick-borne infection? No, not that I could see, but not all tick bites result in a rash. Up to 30% of cases have no skin changes.
Let’s also consider the emotional issues surrounding tick bites. Physical symptoms usually appear within days or weeks of the bite but there have been cases of delayed reactions up to 30 days after exposure. I don’t want the thought of contracting a tick-borne illness to distract me for the next month. I will be concerned that any fatigue or joint pain I experience is the onset of Lyme. And what about the ticks that I brought home with me? They can survive for up to 18 months without feeding. I can’t live in fear, wearing DEET like perfume, and performing tick checks for the next year and a half. That will drive me crazy.
It’s unlikely that I was infected with Lyme, RMSF, or another tick-borne illness during my Stokes trip. But given new evidence, multiple variables, and a dramatic increase in the number of ticks and incidence of illness, I’m not ready to dismiss the small chance that I did. Because I tolerate antibiotics well and doxyclycline has few side effects (it’s often prescribed long-term to control acne), I didn’t hesitate to take it. I know other providers (yes, medical doctors) who do the same thing for their family and friends.
Of course I will continue to be vigilant about preventing tick bites, but I feel better knowing there is a drug in my medicine cabinet that I can fall back on. But what about campers who don’t have their own prescription pads? My advice is to visit your provider and fully explain the situation. If your provider doesn’t have time to listen or to fully explain their position on preventative antibiotics, maybe you have the wrong provider. Some providers don’t understand that guidelines are just that–guidelines. They are a tool to guide a provider’s decision-making, but they aren’t always appropriate for every situation.
It is up to each individual provider to decide, based on a patient’s unique history and experience, if they want to follow the guidelines or not. Safety is the biggest consideration when practicing outside of established guidelines, and your provider should compare the worst possible outcome for each scenario. For me, the risks associated with constant worry and possible infection outweigh the risks of taking a single dose of doxycycline.
A note from NurseGail.com: If you suspect a tick-related infection, see your primary care provider. Doxycycline is well tolerated by most healthy adults excluding pregnant women. The CDC wants you to know, if antibiotics aren’t helping, you might not have Lyme or RMSF.
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