I’m Dr. Patrick O’Connell. This is Sentinel Primary Care, and welcome to the first of my medical talks. So for this first talk I thought, what should I talk about that people would be interested in? I decided to go with a seasonal topic. It’s warm weather. Everybody’s out in the parks or having picnics or working in the yard. And so when you go out to Mother Nature, Mother Nature brings her best and her worst. One of the unpleasant things of Mother Nature is ticks. So that’s our topic for the day.
Ticks are related to spiders. Spiders give me heebie-jeebies. I do not like ticks, but this is an important topic. If you get a tick bite, it’s potentially a big deal. So I thought, let me spend five minutes to give you some useful information. So there’s four things I want to talk about quickly. First, how to avoid tick bites. Second, what do you do with the tick that’s attached? When it’s sucking your blood, how do you get it off? Third, a quick commentary on a couple of the illnesses you might pick up from ticks. And then fourth is some things that might require that you see a doctor.
First, how to not get bitten by ticks. So first is to avoid tick-heavy areas. And so a lot of times this is going to be brushy grasses. The mowed yard is going to have some ticks, but you’re going to get more as you start getting into brush and stuff like that. Second is insect repellent. And you know, I’d use the chemicals. DEET in high concentrations. The 20 percent DEET is going to work a little better than the lower concentration in the spray can that you pick up at the grocery store. And the third one is you might consider if you’re doing activities where there’s a lot of tick exposure, say you’re going backpacking, you might consider an insect repellent called Permethrin, which is one that you can do yourself: It embeds into your clothing and stays there for many washings and makes the clothes themselves insect repellent.
So avoiding the tick areas, the DEET – and especially with the DEET, put it on your legs and ankles because that is usually where you’re going to pick up the ticks. And third is Permethrin in the clothing.
Okay, second, you find a tick on you. It has bitten you; how do you get it off? There are a bunch of home remedies on how to do this, you know, you paint it with Vaseline or whatever. So the way the CDC recommends is get a pair of tweezers, grab the tick as close behind the head as you can, gentle traction and just pull that little sucker out. So instead of waiting to see if Vaseline is going to work or whatever other remedy, just pulled the guy out. If you get tweezers, you can get up really close behind his head. And if you don’t have tweezers, get your fingernails up as close as you can behind the head and pull it out.
Third, a quick commentary on tick-related infections. There’s a bunch of stuff you could get, but three infections to comment on, one of them is Lyme disease. You know, that’s the one that probably gets the most sort of public attention. Lyme is a potentially bad illness. Early on, it’s pretty easy to treat, but a lot of times it can escape detection or diagnosis. And then the late complications can be quite bad. So Lyme is bad and that’s scary. The deer tick is tiny. It’s like the size of a period in a sentence in a book. So small that most people who get bitten by deer ticks don’t even know they’ve been bitten.
The second one I’ll comment on and I’ll set this up in contrast to Lyme disease is one called STARI. You’ve probably never heard of this, but STARI stands for Southern tick-associated rash illness.
But STARI is carried by a different tick, the Lone Star tick. It’s a bigger tick; you can see it. It’s kind of a standard size tick and the females have a white spot in the center of their back. Thus the name the Lone Star tick.
Lyme disease, when it causes a rash you get the red big spot with variable frequency. With STARI, you get the same thing. And what’s interesting is there’s not a lot of Lyme disease in North Carolina. You can get it in North Carolina, but there’s not a ton of it. You got to get up to Virginia and further north. However, we’re right in the middle of STARI country. So if somebody were to come in and see me with a red spot and a tick bite, I can’t tell you which one it is, but there’s a fair chance in this part of the country that it’s STARI. Now the good news with STARI is it doesn’t appear to have the long-term complications that come with Lyme disease, but honestly, there’s a lot that we don’t know about STARI. We don’t know the organism that causes it, for example, but we treat it exactly the same way as we would Lyme disease.
The last infection I’ll mention is a really wicked one called Rocky Mountain spotted fever. Although the name would imply it’s out in the Rocky Mountains, which it is, this is a relatively high-density area for Rocky Mountain spotted fever. Fortunately, there’s not a lot of it but there’s more of it here than there is in a lot of other areas in the country. With Rocky Mountain spotted fever, a lot of times you don’t really get any distinctive symptoms early on. Fever, you feel lousy, a headache – that could be a thousand things. The spots, the rash of Rocky Mountain spotted fever, typically won’t show up until several days into the illness, by which point the person maybe desperately ill. So that’s a tough one. But that’s one that needs a lot of serious attention in this part of the country. So those are the illnesses. Then, pragmatically, the question is, when do I need to be going to get checked out?
First, if you get a rash, a spot, especially around a known tick bite, go get that looked at. Quick comment: if it’s a little nickel, quarter-sized red spot right at the tick bite that’s kind of itchy, that’s not a big deal. That’s actually pretty normal. That’s a local irritant reaction to proteins from the tick. It’s the expanding red spot that needs attention. So go get that looked at.
The other one, because of Rocky Mountain spotted fever is in the summer time or in warm weather in this part of the country, if you got a fever and you feel lousy and you got a headache and you don’t know why. You don’t have a sore throat, you don’t have a stomach bug, get that looked at and do it pretty quickly. Because if that’s going to be Rocky Mountain spotted fever, you’ve got to start treating that one early.
So putting all this together, we’ve talked about how to avoid getting bitten by ticks, how to take out a tick, little bit on a couple of illnesses, and some things to watch for in terms of when you need to be seen by a doctor.
I hope you found this helpful and interesting. Stay tuned for more talks in the future and check us out on the web at sentinelprimarycare.com. I’m Dr. Patrick O’Connell.