I Got a Tick Bite!
Thursday, June 13, 2013

Dr. Paul Alessi

I got Roy’s phone call late in the afternoon, and I could hear the urgency in his voice.  Roy is an old Yankee who cuts and stacks five cords of wood every fall to use in heating his house in the winter.  He’s not easily scared, but the thought of a tick bite and getting Lyme disease had him concerned. He came to my office with two huge ticks one on each thigh, which were the size of a dime. Roy admitted that they had been there a few weeks! He thought that they were just a rash, until he saw them moving.

He did not have any other symptoms, like fever, joint and muscle aches -- or the typical rash, which is called erythema chronicum migranes (ECM for short).  I removed the ticks, drew blood for a Lyme test and gave him an antibiotic, doxycycline.  I also sent out the ticks for analysis to see if they harbored the Lyme bacteria.

Roy was happy to hear that the tests were negative.  I told Roy that the blood testing often is not diagnostic of getting Lyme disease and many times can be falsely positive.  The blood test is an antibody test.  Antibodies are substances our body’s immune system makes when exposed to something foreign like a bacteria, virus or a parasite.  This exposure can be from many years ago, related to infections the body has already fought off – meaning, not current. Luckily, everything was negative and Roy was fine.

I gave him some pointers on what to do the next time he gets a tick bite. Now, he always does a “tick check” after working in the yard.  We live in area where ticks are everywhere.  Understand that the tick is not what causes Lyme Disease; it's caused by bacteria (Borrelia burgdorferi) that lives in the belly of the tick.  Not all ticks are infected with this bacteria, so don’t panic.  The tick feeds on your skin and regurgitates the bacteria into your body to cause the Lyme infection.  If the tick is removed within 72 hours, it’s unlikely you will get an infection.

When doing a tick check, be sure to examine the areas where ticks generally like to hide. The dark moist areas under the arms, groin, upper thighs, behind the knees and back are prime spots.  When outside, wear long pants and long sleeve shirts.  In the very hot weather, this may not be practical, so use an insect repellent such as Permethrin.  This preparation can be used on the skin and also sprayed on clothing. You can also purchase clothing that is treated with this repellent.  If you have a dog or cat that that’s frequently outside, also check and remove any ticks from them. There is a vaccine available for pets that can be administered by your veterinarian.

If you are bitten and cannot remove the tick, see your doctor.  He or she can remove the tick and there is medication that can be prescribed to prevent an infection if started within 48 hours after the bite.  Roy is now aware of what to look for and has been doing his “tick checks” regularly. He also checks his grandkids when they come over to help grandpa stack the wood.

Dr. Paul Alessi is a board-certified Internal Medicine Physician with the Kennedy Health Alliance in Cherry Hill. To reach him, call 856-406-4091.