I hiked in the NJ Pine Barrens yesterday, including picking high bush blueberries, and we later removed from me thirty five ticks that were small to tiny, as well as three medium sized ones, several hours after the visit was over. About two thirds of them were attached.
I don’t want Lyme disease. I’ve had it once, with the classic bullseye rash and other typical symptoms, and it was treated with antibiotics and went away. I don’t have any symptoms, rashes or otherwise, but it’s only been about 24 hours.
Is this worth calling my doctor for? What’s he going to do, in the absence of symptoms – give me antibiotics, or just tell me to watch for symptoms?
By the way, I sprayed with 100% DEET twice, and was clothed in long pants. The online advice is to wear full coverage clothing, but ALL the ticks I had on me were inside my clothing, so I don’t get understand the advice. I read that there are about 16 strains of Lyme, and people that get it often get it again, though other strains. People don’t get reinfected with the same strain often. My Lyme was over 15 years ago, though, and I didn’t read anything about immunity lasting more than about 9 years. I also read that Lyme is endemic in the Pine Barrens. I also read that ticks don’t give you Lyme unless they feed long enough to be full, at which point they may regurgitate some stomach contents back into your blood stream, and this takes about 24 hours. I don’t think I have any ticks on me now so this may mean I’m in the clear.
Also, in online discussions about ticks I hear outdoors types saying things like “this was my third tick bite this year”, and I don’t understand what gives. I probably average about 2 or 3 tick bites a week, and I don’t think of myself as all that outdoorsy.
I’ll tell you the same thing my doctor told me when I showed up with the big bullseye rash. “It may or my not be Lyme disease, but it’s something a million units of penicillin will clear right up.”
Your doctor will probably take one of two approaches:
-Keep an eye on it and let me know if you see any rashes, or
-Here, have some antibiotics just in case
It’s tricky - as you probably know the bulls eye rash only appears in a proportion of lyme cases, so it’s quite possible to contract it without having any symptoms in the immediate days after the tick bite.
That said, doctors have to be responsible with antibiotic use - bloke showing up having being bitten by a tick but with no lyme symptoms doesn’t generarlly fit the bill for a perscription, IMHO.
In your case, though, I think I would visit the doctor. Twenty tick bites in an area of endemic lyme would swing the balance in favour of some prophylactic antibiotics, again IMHO.
It’s quite distinct from one tick, say, in an area where lyme is uncommon.
Did you have your pants firmly tucked into your socks? You can also use very tightly woven clothing like this: http://www.rynoskin.com/ or clothes with permethrin embedded. I know a ranger who duct tapes his pants to his boots every day!
*"The chances that you might get Lyme disease from a single tick bite depend on the type of tick, where you acquired it, and how long it was attached to you. Many types of ticks bite people in the U.S., but only blacklegged ticks transmit the bacteria that cause Lyme disease. Furthermore, only blacklegged ticks in the highly endemic areas of the northeastern and north central U.S. are commonly infected. Finally, blacklegged ticks need to be attached for at least 24 hours before they can transmit Lyme disease. This is why it’s so important to remove them promptly and to check your body daily for ticks if you live in an endemic area.
If you develop illness within a few weeks of a tick bite, see your health care provider right away. Common symptoms of Lyme disease include a rash, fever, body aches, facial paralysis, and arthritis. Ticks can also transmit other diseases, so it’s important to be alert for any illness that follows a tick bite."*
At a minimum, I’d be alert for any symptoms that might be associated with Lyme disease. It’s possible your doc, noting the large number of ticks in an endemic area might propose prophylactic antibiotic treatment (or not) - you could ask.
I’ve had quite a few ticks on me over the years, what with having dogs and gardening a lot, never sought out antibiotic treatment and never had any problems associated with Lyme. But I also don’t live in an area that’s known for much Lyme disease.
The OP really needs to find a better tick repellent, or else choose somewhere else to hike. Dang, that’s a lot of ticks.
Only 60% of people who get Lyme disease get any rash at all, and of those that do, only about half get the classic bulls eye. I don’t know if my experience is typical or not, but while I did get a bulls eye, it only looked like that for four hours. After that it was just a big pink rash.
If you get “the flu” (fever, aches, fatigue, chills, more aches, so many aches…) within the next month, I’d see a doctor regardless of whether or not a rash shows up. The sooner you get on antibiotics if you have it, the better.
I’m curious about the fact that you can get it more than once, though. Does the bacteria that causes Lyme disease mutate fast and make the antibodies you developed from being infected before useless, or do people who get it more than once tend to pick it up in different geographical locations so that the bacteria isn’t the same as the first place they got it?
Partly it may be different strains - there appear to be at least 17 versions of Borrelia burgdorferi alone. For what it is it’s apparently a genetically complex critter. Partly it is that the spirochaete in question is a tricksy beast, with a number of dodges that allow it to eel around your immune system like varying its surface proteins when under immune attack ( though this last may be more an issue with relapse than reinfection )
Ironically the more promptly you rid yourself of the bacteria, the more you apparently leave yourself open to reinfection. Folks that have had a long-term Lyme disease infection ( long enough for a particular strong antigen to be produced ) apparently develop enough of a resistance that reinfection is uncommon. Of course in the meantime it has wrecked your body. But short term infections - you get a bullseye and act promptly, the doctor prescribes antibiotics which eradicate the infection - don’t seem give your immune system enough time to develop an effective counter. Apparently syphilis, another nasty spirochaete, works in much the same way.
Yes, it most certainly is worth bugging the Dr about. Assuming, of course, that you develop some sort of symptoms, rash or no rash.
Short version: I had a tick bite on my ankle in 2007, the ankle swelled within 2 days. I had no rash but developed several of the other flu-like symptoms. My (former) Dr ran the standard ELISA test which came back negative (which is apparently not uncommon), and told me I didn’t have Lyme.
I continued to feel progressively worse over the next three years, and asked him several more times about Lyme. He put me on antidepressants, told me I was a typical middle aged woman, that I had too much stress in my life, and that I should exercise, lose some weight and get some counseling. Flat out refused to re-test for Lyme and denied that it could be possible. Meanwhile, my brains were turning to mush, I was having to sleep in the ladies room lounge during my lunch, forgetting how to do my job, experiencing joint pain, headaches, balance issues, etc.
Finally saw a Lyme specialist and was diagnosed in 2010. I was on antibiotics for 16 months and I finally got my brain and life back. Never saw that condescending asshole ex-doc again.
I still have joint issues which probably won’t go away.
So, yeah. Follow up if you start experiencing symptoms. I know that more MDs are willing to treat early based on a variety of symptoms and don’t view the rash alone as the holy grail of Lyme infection. Good luck, I hope you don’t get sick!
One should not need a “Lyme specialist” to properly diagnose Lyme disease (note that false negatives can occur with any test).
The danger is that in avoiding a supposedly insensitive primary care provider, one can wind up in the hands of a “Lyme-literate doctor” whose diagnostic standards are (to put it kindly) vague, and who puts people on long-term high-powered antibiotics for “chronic Lyme disease”, an entity which has not been found to exist.
I don’t consider my situation to be “chronic Lyme” but “untreated Lyme”. It didn’t have to be that way. Fortunately, I do think more MDs are now willing to treat people based on their symptoms. I wish it had been different for me.
I don’t know where your doctor is getting his information. Standard treatment for erythema chronica migricans (the bullseye rash) with penicillins requires 14-21 days of therapy and there is no standard indication for penicillin (oral amoxicillin is preferred). Penicillin can be used for neurologic Lyme, but in a dose of approximately 20 million units daily divided into 4 doses given over 14-28 days. cite
The closest I can come in a study in pregnant women that treated for 14 days with 20 million units daily. If your doctor has a cite for one million units of penicillin being effective treatment for ECM, I’d love to see it.
It did freak out the dental hygenist when I went in for my regular checkup that week and told her I was currently being treated. After a hurried conference, my dentist assured her everything was cool.
Psychobunny, I may have misremembered the exact dose, but not the overall impact of the quote.
Billions of people got bitten by a tick without getting lime disease or long term infection.
And you already had infection from tick born bacteria, so are probably equipped with stronger than average immunity…
and you have are smart enough to come on here, so you have a sensible diet too ?
Just wait for an illness before worrying.
The best tick defense is one of the pyrethrin based repellents. You spray your clothing and let it dry overnight. It then works for 2+ weeks. It makes the difference between finding 40 ticks on you or finding 0. Any sporting goods store that sells hunting gear should have it.
The ticks in NJ are insane btw. Cosmic balance for your outstanding sweet corn I suppose.
Tucking your pants into your socks makes a big difference, too. And is completely safe and takes no prep.
Personally, if you removed all the ticks within a couple of hours, and don’t develop any symptoms, I wouldn’t worry. Apparently, the people who research Lyme get bitten all the time, but are meticulous about removing ticks and pretty much never come down with it.
But if you want a test, your doctor should let you have it. I got tested a while ago when I developed arthritis syptoms somewhat suddenly. Negative. They told me it can take a while for antibodies to develop, and if I didn’t get better, I should be retested in a few weeks, so I was, and it was still negative.
Eventually, the arthritis cleared up. I still have no idea what it was, or why it struck. Neither do my doctors. But I’m pretty sure it wasn’t Lyme.
