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Don’t Let Ticks Scare You

What to do about ticks and your outdoor life

Last year, five-year-old Max woke up with a low-grade fever. Assuming it was a viral infection, his mom, Janet, monitored him closely. As she watched, her tender-hearted and normally active child became very lethargic.

Max’s pediatrician ordered tests for both Lyme disease and COVID-19. Both results were negative. Janet never found a tick on Max, but they live in a region where ticks bearing Lyme disease are common. While waiting for the results, Max developed multiple circular rashes.

Between flare-ups, Max (right) was able to enjoy a season of skiing with his brother.

This was not the classic bull’s eye rash often associated with Lyme disease, but Lyme disease can cause a variety of different rashes. The appearance of the rash confirmed the pediatrician’s suspicion that Max had Lyme.

Max began a course of antibiotics and his fever disappeared. A month later, his knee swelled and his joints ached. The Lyme disease had returned.

Over the next six months, Max experienced three flare-ups, one in his knee, one in his neck, and one in his hip. Each time, he was forced to rest, forgoing usual activities such as skiing. Steadily, Max improved with antibiotics and herbal remedies.

One year later, Max has no symptoms of Lyme and has not had any flare-ups since February. The experience has left both him and his family shaken but not afraid.

“I thought I would be fearful about going outside, but I’m not,” Janet says. “Fear isn’t going to protect my kids. They can get a tick anywhere. The best thing we can do is educate ourselves.”

Ticks typically live in grassy areas near woodlands. They crawl up the grass to “quest” for a host.

Tick-Borne Diseases: An Increasing Problem

Max’s story is not unique. Since 2004, the number of people infected with tick-borne diseases has doubled, and in 2019, the CDC estimates that 50,000 people suffered from tick-borne illness. Cases of Lyme disease have been reported in all 50 states.

For many, ticks present a huge hurdle to outside fun. To an extent, their fear is justified. Not only are these bloodsuckers gross, but some also carry dangerous diseases.

The alternative, an indoor lifestyle, is also not fun or healthy. In fact, more physicians are writing “nature prescriptions” to encourage families to spend more time outdoors. For Janet’s family, the idea of living indoors is both mental and physically unhealthy.

Our goal as parents should be to prevent tick bites and reduce the likelihood of contracting tick-borne illnesses with smart solutions and early interventions.

These goals also drive Alexis Chesney, a neuropathic physician, who practices in southern Vermont – one of the epi-centers of Lyme disease.

“I am passionate about acute tick-borne disease and prevention,” Chesney explains. She belongs to ILADS, the International Lyme and Associated Diseases Society. This collection of doctors and other practitioners specialize in studying and treating Lyme disease.

While not every doctor in ILADS agrees with all of Chesney’s approaches, the society together strives to support research and improved treatment and diagnosis of tick-borne diseases.

Two black-legged female ticks crawl up this boot. Image courtesy of CDC.

How to keep ticks off kids

The best way to protect yourself from ticks is a two-step armor of insecticide-treated clothing (using permethrin) and repellent. 

Permethrin — Proven to protect against ticks

One of the best defenses again tick bites is permethrin-treated clothing. One study found that ticks were about 74% less likely to bite a person wearing permethrin-treated socks and shoes.

Permethrin is an insecticide, which kills many ticks on contact. This is especially helpful during the ticks’ nymph – or teenage — stage of life.

As a nymph, most ticks are barely visible – no larger than a poppy seed or a speck of dirt. This is particularly true of the nymph deer tick, the tick known to carry Lyme disease.

How hard tiny are these nymphs? See if you can spot the five ticks the CDC hid on this muffin.

I may never eat a poppy seed muffin again. Image courtesy of the CDC

These itty-bitty nymphs can squeeze between clothing fibers and reach the skin. Many people who contract Lyme don’t even know they have been bitten. Janet never found the tick that bit Max.

If the nymph contacts clothing fibers impregnated with permethrin, the nymphs die. Research has shown that approximately 70% of tick nymphs died after contacting treated clothing. The ones that didn’t die were severely impaired.

While the nymph stage is most vulnerable to permethrin, all life stages of the tick were affected by the insecticide. Permethrin appears to irritate ticks’ feet and then affects their nervous system. One minute of contact with permethrin-laced clothing caused the ticks to move unnaturally for the rest of the day.

After contacting permethrin-treated clothing, many ticks simply tumbled off. Frequently they died. Those cannot bite effectively. Even a day later, the ticks were still impaired and moving unnaturally.

Once my family watched ticks scrambling onto each other’s backs to avoid touching treated my son’s socks during a hike. We easily swiped them off his leg before they could bite.

Mid-ride tick check!

Is permethrin safe for the whole family?

Permethrin interferes with a tick’s nervous system, which is significantly different from a human nervous system. Most mammals are not harmed by permethrin. (Strangely cats are.)  

A human’s body can break down ingested permethrin, rendering it harmless. Not that I recommend you eat it! But the EPA says not to worry if your toddler chews on your treated socks.

The amount of permethrin used to treat clothing is minuscule, and studies show that the person wearing the clothes has a very small exposure to the pesticide. Even pregnant or nursing women are unlikely to be harmed by permethrin-treated clothes.

Purchase pre-treated clothing to avoid ticks

The easiest way to get permethrin-laced hiking gear is to purchase it. Many companies are beginning to offer pre-treated clothing.

My mother loves her wool Farm to Feet socks. Not only do these cozy socks stay warm when wet, thanks to the wool, they also protect the wearer from tick-borne illnesses.

Insect Shield and ExOfficio also carry treated clothing as does REI.

Send your clothes to be treated

If you’d rather wear your favorite hiking clothes into tick territory, you can send your clothing to a company like Insect Shield. For $8.99 they will treat your clothing using a method that persists for up to 70 washes!

Use DIY Permethrin Spray

Even if you buy treated clothes, I recommend purchasing some permethrin spray for your shoes. Our family has decided to treat both our shoes and clothing at home. When shopping for a spray, purchase one designed to adhere to fibers with a dilution of %0.5. Agricultural permethrin sprays may not bind properly to clothing. Both Sawyer and Insect Shield carry sprays designed for this application.

Wash and dry the items you want to treat. Working outside or in a well-ventilated area, spray thoroughly your items. Use gloves and cover your skin while applying permethrin as it might be harmful while it’s wet before it bounds to the clothing.

Preparing shoes for their monthly treatment.

Allow the clothing to air dry before wearing.

These at-home treatments last only five to six washes or five to six weeks, whichever comes first. I created a reminder in my online calendar so I can remember when to treat our clothes.

After you finished with your clothing, treat your other gear. Spray your hats, sleeping bags, tents, and backpacks. This prevents ticks from riding home with you.

Make yourself not appetizing to ticks

It’s great to kill or disable ticks that crawl on you, but it’s much but better to avoid them entirely. That’s the role of insect repellents.

Insect repellents prevent ticks from finding you because ticks and other insects rely on their sense of smell and taste to find their next meal. The repellents mask your scent and make you much less appealing to parasites.

A chocolate cake that smells like dirt is not appealing to a human and a human smelling like DEET – or other repellents — is unappetizing to a tick.

The CDC has approved several repellents as both effective and safe in the battle against bites. These include DEET, picaridin, IR3535, Oil of Lemon Eucalyptus (OLE), para-menthane-dial, or 2-undercanone. The EPA has created a tool to help identify which repellent is best for you.

Chesney prefers Cedarcide, a natural insect repellent using cedar oil. This essential-oil based repellent is safe for toddlers and young children. However, its effectiveness fades quickly, and Cedarcide must be re-applied every one to two hours.

To keep ticks away don’t fear the spray!

Treat your pet

The final step to preventing tick bites is to treat your furry companions. Talk to your veterinarian about prescribing an oral or topical tick treatment. A tick collar will also kill ticks that contact your pet and, in some cases, may be used with oral or topical treatments. (Check with your veterinarian!)    

Chesney recommends spraying a bandana or shirt with permethrin for your dog to wear while hiking. This extra measure will deter ticks from catching a ride.

What to do after a hike in tick territory

Once you return from you adventure, there are few things you can do to protect yourself from tick bites. Before you enter the house, scan you boots, pants and other items for hitch hiking ticks. Then immediately remove your clothes.

Dry clothes then wash

To kill any ticks in your clothes, reverse the usual pattern of washing then drying your clothes for six minutes on high heat. Ticks are much more sensitive to heat than water, so send your hiking clothes for a spin in your dryer before washing them.   

Check EVERYWHERE for Ticks

Once the snow melts, we check ourselves and our children for ticks every night. Ticks love nooks and crannies. Look in the belly buttons, behind the ears, in the hair, under the armpits, and behind the knees.

If your children are older, have them check their more intimate regions every time they use the bathroom.

Take a shower

If you shower within two hours of being in a tick’s habitat, you reduce your chances of contracting a tick-borne illness. The water might wash off an unattached tick and it’s a perfect time to feel for ticks.

What to do if your child is bitten by a tick (or you are!)

Bummer. Even with precautions and checks, some ticks manage to get their spear-like mouthparts into your or your child’s skin. What now?

First, don’t freak out – especially if the tick is on your child. You don’t want your child to fear ticks or the outdoors. Instead, take a deep breath and remember that ticks are simply doing what ticks do. They are a part of the ecosystem and have a natural desire to eat.

Now that you are calmer, it’s time to kill that bugger. 

Chesney recommends six steps after a tick bite.

Step 1: Safely remove and identify the tick

The CDC recommends using tweezers to remove a tick. A tick key like this one may be used instead.

Place the tweezers or key as close to the skin as possible and lift straight up. Don’t twist as this might remove the body from the head, leaving part of the tick in the skin. If the tick does break, use the tweezers to remove the head. If you cannot remove all of the head, leave it alone. The skin will still heal.

Kill the tick by crushing it or placing it in a sealed container. Our family prefers to kill ticks in jars of soapy water.

Afterwards, wash your hands thoroughly. 

CDC graphic illustrating how to remove a tick.

Identify the Tick

Once you have dispatched the tick, it’s time to act like a scientist. Use the CDC’s site to identify the tick.

Different ticks carry different pathogens. If you know what bit you, you can monitor for the symptoms associated with diseases that tick is known to carry.

In some regions, only one or two types of ticks carry harmful pathogens. In the northeast, the black-legged deer ticks carry Lyme disease, but American dog ticks are not known to carry any pathogens. If you live in a more southern state, dog ticks may carry Rocky Mountain spotted fever.

Record the Bite

Record the date, type of tick, the site of the bite, and an estimate of how long the tick was attached. I use Google Keep to store tick data but a paper calendar or planner works just as well.

Step 2: Tick First aid

Care for the wound caused by the bite by disinfecting the area.

You may use rubbing alcohol, but Chensey prefers to use the herbal tincture, Andrographis. As an added benefit, Chesney patients report that Andrographis reduces itching and irritation after the bite.

Don’t neglect this step as the area around the tick might be a source of disease! The attached tick spends some time in the area eating and, yes, pooping. Gross. Clean it well.

Step 3: Consider testing the tick

While somewhat controversial, Chesney recommends saving the tick in a sealed container and labeling with the date. She then sends the ticks to a lab for testing.

The information gained through testing can be helpful. If the tick was not carrying a tick-borne illness, you can rest more easily.

When a tick is found to carry a specific disease, it is not a guarantee that the person with the bite has transacted the disease. Instead, it helps both patient and doctor know which symptoms to expect if the person is infected.

Like nearly everything related to tick-borne illnesses, the practice of testing ticks for diseases is controversial. Some practitioners do not recommend it because the tests have some false negatives and positives – giving either false hope or false fears.  

Step 4: Begin a Prophylaxis Protocol

Often a doctor will decide to prescribe preventive antibiotics if the tick has been attached for longer than 48 hours. ILADS does not recommend this practice as it may only mute symptoms and delay diagnosis.

Instead, ILADS and Chesney urge patients to take 20 days of antibiotics to ensure that the disease is prevented.

Chesney also recommends a gentler alternative to antibiotics for a bite. She has created an herbal prophylaxis protocol specific to each tick bite. Her book, Preventing Lyme and Other Tick-Borne Diseases outlines specific protocols for each type of tick.

Step 5: Watch For Symptoms

Carefully monitor the person with the bite for changes in his or her health. Fevers, aches, and chills may signal a tick-borne illness, especially if they begin within 30 days after a known tick bite.

Look for rashes or lesions around the bite because these often accompany Lyme disease. A rash appears in 50% of Lyme cases, Chesney explains. Although the rash is often shaped like a bull’s eye, it could take a variety of forms. The rash could be circular, oval, or linear. It could have a ring or be completely pink. Or it could have raised bumps.

We considered ourselves fortunate because our son developed the classic bull’s eye rash. It made diagnosis and treatment much easier.

Other symptoms of tick-borne illness include new joint pain, headaches, or fatigue.

Step 6: Consider Testing for Lyme

A test may help confirm a diagnosis of a tick-borne illness, but Chesney urges that both the patient and doctor take care to ensure that they have selected the correct test.

Not all tick-borne illnesses are Lyme or even Rocky Mountain Fever. If you have Anaplasmosis, which is also spread by deer ticks, but test for Lyme, then the test will be negative.

A test may also come back with a false negative if administered too early, even if symptoms are present. The body needs time to develop antibodies that will appear on a test.

Testing can give insight into whether the symptoms you are experiencing are caused by the summer flu or a tick-borne illness, but it should not be used as a definite diagnosis. These tests are known to give unreliable results.

Life After a Tick-Borne Illness

Fortunately, most tick-borne illnesses can be treated with antibiotics. However, patients should expect a slow and uneven recovery, especially if the disease is caught weeks, months, or years after the first infection.

After his round of antibiotics and herbal medications, Max has fully recovered. While he is careful to check for ticks, he still loves being outdoors. He continues to enjoy mountain biking, hiking, and swimming.

Janet spoke with me from a lakeside beach. As she watched her children swim, she explained that we cannot protect our children from every danger. We can only act wisely and teach them to be wise in turn.

She says, “We will not let fear take away our ability to enjoy nature.”

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Don’t Let Ticks Scare You

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