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Clinician’s Corner: Lyme Disease

Pennsylvania, for the third straight year, is leading the nation in number cases of Lyme disease.  Now that winter has released its clutches on our state, everyone is headed to the great outdoors either for picnics, hiking, camping and even less enjoyable, gardening and mowing the lawn!  Many of our patients are coming to Thompson Pharmacy with questions about Lyme disease.

CAUSE: by the bacterium Borrelia burgdorferi and is transmitted to humans by the bite of infected blacklegged ticks (Ixodes scapularis) more commonly referred to as the “deer tick”.  SYMPTOMS: include fever, headache, fatigue, and a characteristic skin rash called erythema migrans, which occurs 3-30 days after the tick bite.  The rash is sometimes called a “bulls-eye” rash.

THE RASH

  • May occur anywhere on the body, and appears in approximately 70 to 80 percent of infected persons—(so unfortunately 20-30% of the time it does NOT appear)
  • Begins at the site of a tick bite after a delay of 3 to 30 days (average is about 7 days)
  • Expands gradually over a period of days reaching up to 12 inches or more (30 cm) across
  • May feel warm to the touch but is rarely itchy or painful
  • Sometimes clears as it enlarges, resulting in a target or “bull’s-eye” appearance

PREVENTION:   “An ounce of prevention is worth a pound of cure”- Benjamin Franklin

  • Wear high socks, long pants and long sleeve lightweight shirts. Best if color is white or very light to spot ticks easier. Walk in the center of a trail, and avoid tall grasses in fields and meadows.
  • Checking for ticks: Check legs and feet frequently. Know how to spot and identify ticks.  Nymphal ticks are as small as a poppyseed.  Use bright light and magnifying glass.  Check each other in hard to see areas, especially folds of skin.
  • Pets: use a scheduled tick killing shampoo. Brush pet daily outside the house.

INSPECTION:

  • Bathe or shower as soon as possible after coming indoors (preferably within 2 hours) to wash off and more easily find ticks that are crawling on you.
  • Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.
  • Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and day packs.
  • Tumble clothes in a dryer on high heat for an hour to kill remaining ticks

TICK REMOVAL:  Removal with tweezers and magnifying glass. Wear gloves place tweezers on head of tick as near skin as possible.  Pull slowly, steadily and upward.  Don’t twist, squeeze, jerk or crush tick.  Save tick in jar or vial.  Wash site of removal with soap and water. Do not use matches, petroleum jelly, gasoline, kerosene, nail polish remover.  Thompson Pharmacy has two tick removal devices, the “Tick Twister” and the “Ticked Off Tick Remover Spoon”

INSECT REPELLANTS:

DEET (N,N-diethyl-3-methylbenzamide)  can be used directly to the skin. Use repellents that contain 20 to 30% DEET (N, N-diethyl-m-toluamide) on exposed skin and clothing for protection that lasts up to several hours. Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth.  Thompson Pharmacy has a full line of DEET repellants, which are THE most effective for keeping ticks away.

Permethrin Clothing and Gear Repellant: Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents with products containing 0.5% permethrin. It remains protective through several washings.  Permethrin is available OTC as a solution for application to clothing.  We have available at Thompson Pharmacy Sawyer Clothing Insect Repellant. Once applied to clothing it remains effective for up to 6 weeks, even after several launderings.  Good for clothes that are exposed to tick infested areas.  Effective against ticks that carry Lyme disease and Rocky Mountain Spotted Fever. Repellant should be applied outdoors and before clothing is worn; hang clothing, spray and let dry two hours (four in humid conditions).

My wife and I spray our suitcases With Sawyer Clothing and Gear Repellant before heading on vacation even if we are going to a hotel.  Even the nicest hotels can be plagued with bedbugs, and the Permethrin will keep them out of your suitcase.