Patient Instructions from Dr. Richard Maurer and Dr. Sarah Kotzur. Naturopathic Doctors at www.CoastalNaturalHealth.com
We live in an area with prolific deer ticks and these ticks can carry bacteria, the most notorious of which is Borrelia spp. which causes Lyme disease. The tick should be removed by grabbing as close to the head as possible, don’t squeeze the belly. Pull straight out.
The tick will seem imbedded as soon as the “anchors” are set, the tick may take 12-24 hours to start feeding, so there is time to remove the tick before exposure to harmful bacteria. There is a protocol that recommends using a single dose of 200-mg of doxycylcline the day the tick is removed. A study showed that the single dose doxy reduced the rate of rash and symptoms compared with those who did not do the single dose. A concern with this practice is that the people were not followed long-term and the single dose might have only slowed the bacteria down causing a more gradual and complex Lyme disease further down the line. If the single dose is done, I would encourage a blood test a month later to see if there is evidence of immune activity toward Lyme disease. See “Imugen” below.
If the tick was there for greater than 24 hours, there are a few steps to take. Mark the date on the calendar, save the tick for proper ID if you are unsure, and circle the spot on your skin so you remember where it is. The first few days after removal, it is red due to the bite itself, not the bacteria. The “Bulls Eye Rash” shows up in perhaps 60% of the cases and shows up between 3 days and 3 weeks of the bite. So watch carefully. Any fever or joint pain during this time is highly suspect and may warrant immediate treatment.
If there are no symptoms, running a western blot test at Imugen Lab about 3 weeks post-tick bite will catch the infection. But again symptoms in this 3-week period will guide treatment, blood tests are rarely positive prior to 3 weeks post bite.
If you are on anti-histamines, you may not get the tell-tale rash, this makes diagnosis more difficult. If you are on steroids, the suppression of the immune response may also make diagnosis by symptoms more difficult. In these cases, a test at 3 weeks post-tick bite is the best way to proceed.
You need as certain a diagnosis as possible; treatment is typically high dose antibiotics for an extended period of time. The relapse rate with 3-weeks of antibiotics is too high and I therefore use antibiotics for greater than 4-weeks for effective treatment of Lyme disease.
Again, I can’t emphasize enough that early and accurate diagnosis is paramount, so get in to see us or another primary care provider to assess any symptoms that arise in the weeks following a tick bite. The bacteria is pretty vulnerable early-on so it can be effectveily treated with antibiotics and supportive therapies.
Dr. Maurer
