Lyme disease is the number one vector-borne disease in Canada. In our country, there are nearly 1,000 reported new cases each year. In 2015, over 91% of cases were recorded from 3 provinces: Ontario, Nova Scotia and Québec. In the past three years, I have diagnosed three people with Lyme Disease. The cause of Lyme is the bacteria Borrelia burgdorferi, and the most common vector for this bacteria are tick bites.
Ticks carry many different bacteria, parasites, and viruses which can cause severe acute and chronic illness in humans.
Awareness of the problem is the first step towards controlling the epidemic. It is of critical importance that you understand how to prevent and manage tick bites. If you can avoid the tick bite, or at least be proactive in responding when a bite occurs, you can drastically reduce chances of contracting Lyme Disease.
In this article, you are going to learn some simple ways to decrease the risk of tick bites and how to do tick checks, as well as the proper way to remove a tick. I will also discuss how to identify different types of ticks, which can help a doctor understand the risk of transmission of various bugs, as well as how and where to send a tick for testing to identify infections that it may have been carrying.
With this information, you can potentially save yourself and your family from a serious chronic infection with potentially severe multisystem health issues and even death.
Awareness of the problem is key
Peak tick season is during the spring and summer months in Ontario, especially after rain. The rain is a time of increased tick questing and feeding activity.
My wife and I love nature, and we try to remain active in the outdoors.
To avoid ticks, there are some simple things that you can do.
- When going hiking, walk in the centre of the path and avoid grasses, even tall ones. When in search of a blood meal, ticks like to climb up to the outer tips of the grass, turn themselves around, and wave their legs around, waiting to catch a ride. This behaviour is called questing.
- Ticks also gather in fallen leaves and under logs, where you may go sit to enjoy a break on a hike.
There are a number of different options for repellants.
- Lemon eucalyptus oil is a potentially safe and effective natural repellent.
- Permethrin, which is made from chrysanthemums, is also a good option. Treating clothing, shoes, and sleeping bags with this can be helpful. Treatments can last many wash cycles so that it can be effective over a period of time.
- DEET is also effective for more extreme exposure situations but is more toxic, so it should be used with caution.
Checking for Ticks
When returning from being outdoors in tick-endemic areas, which can also include city parks and lawns at home, consider the following:
- Change your clothes and put the used clothes in the dryer for 20 minutes, shower and tick check.
- Do tick checks thoroughly on your children and partner including behind ears, under fingernails, under toenails, belly button, groin area, hairline, and armpits.
- Check your children before bed if they have been playing outside.
- Nymph ticks are poppy-seed sized, and one frequently cannot tell that it is a tick without a magnifying glass. An iPhone can be used a magnifier.
- Be mindful of your pets, as they can bring ticks into the house.
How to remove a tick
Once you have identified that a tick bite has occurred, it is imperative to understand the proper tick removal technique.
Having the right tweezers on hand is critical, and I recommend purchasing the TickEase tweezers. These tweezers are made explicitly for tick removal.
Below are 3 steps for roving a tick:
- Insert the tweezers as close to the skin as possible.
- Pinch off the mouth part of the tick and gently lift perpendicular to where the tick is attached.
- Provide some traction and just wait for the tick to release.
This procedure can take a few minutes if the tick is well attached.
Don’t squeeze the body of the tick. Don’t twist it, burn it, put any oil on it. These actions can increase the risk of infection, as the tick might regurgitate its stomach contents into the bite area.
There is a nice information sheet on tick removal on the Bay Area Lyme Foundation website.
Once removed, place the tick in a Ziploc bag with a moist paper towel and save the tick for identification and pathogen testing.
If possible, try to identify the tick at home using a resource like the Rhode Island TickEncounter.
The type of tick can help a doctor:
- Know which pathogens are possibly present.
- Help make decisions on whether or not to treat while waiting for the results of the tick testing. Information on the type of tick can also be helpful if the tick was lost and not able to be tested.
Sometimes tick identification will be very easy based on the features present. Sometimes, however, it will be tough and require an expert to identify the tick.
After removing the tick, I recommend sending the tick for pathogen testing. Testing is particularly important because early treatment can make a big difference in outcomes in preventing chronic infection.
In Ontario, Public Health Ontario performs tick testing.
After a tick bite
After a tick bite, watch for any unusual symptoms. The Bay Area Lyme Foundation has an excellent handout on signs of Lyme Disease on their website.
The purpose of this article is not to discuss when and how to treat after a tick bite. However, if you are concerned, you need to consult with a Lyme literate practitioner. You can find Lyme practitioners through the ILADS website.
Lyme disease and the associated co-infections are a growing problem in Ontario. Ticks and tick bites are the most common vector for these infections, and awareness of how to prevent and manage a tick bite is of critical importance in helping avert severe acute and chronic illness in your patients. In this article, we discussed ways to keep yourself protected when out in nature and how to perform thorough tick checks. Also, we examined the management of tick bites, including specific instructions for proper removal of the tick, how to identify it, what kind of tick was involved and testing the tick for pathogens.
This article is not intended to provide medical advice, diagnosis or treatment.
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