Lyme disease: Should I be concerned?

It's summertime also known as Lyme disease season and your child brings home a tick after playing outside. What do you do?

Stay Calm. It takes days to weeks (The Centers for Disease Control and Prevention says 3 to 30 days) to go from a tick bite to Lyme disease symptoms so there is a lot of time to figure out the best medical course for your child.

People always obsess about how to remove the tick, but the CDC says remove a tick QUICKLY in this manner:

1. Use fine-tipped tweezers to grasp the tick as close to the skin's surface as possible.

2. Pull upward with steady, even pressure. Don't twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth easily with clean tweezers, leave it alone and let the skin heal.

3. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water.

4. Dispose of a live tick by submersing it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the toilet. Never crush a tick with your fingers.

About 96 percent of all Lyme disease in the United States is found along the northeast coast from southern Maine to northern Virginia, and on the border between Wisconsin and Minnesota. This means that if your child gets bitten anywhere else, do not worry about Lyme disease and we can discuss other problems that could arise.

Initial symptoms of untreated Lyme disease span a wide variety of problems including fever, chills, headache, fatigue, muscle or joint aches, and swollen lymph nodes. More specific symptoms are:

1. Erythema migrans a slowly spreading red "bulls-eye" circle around the bite that occurs in over 70 percent of infected individuals

2. Sudden inability to use the muscles on one side of the face (called Bell's or Facial Palsy), which is usually in adults

3.  A single very swollen large joint usually the knee. This is more common in children.

If any of these occur, please call you primary care doctor immediately.

In general, providers do not want to treat tick bites unless the child has symptoms of Lyme disease since Lyme occurs in less than 10 percent of people who are bitten even by ixodes, also called deer ticks— the very tiny creatures who are most likely to be carriers of the disease. Not treating is best at the start especially if the tick was on the skin less than 24 hours. Disease transmission is extremely rare in this case.  Once you do make the decision to treat presumptive Lyme disease, it takes at a minimum of 30 days of oral antibiotics to eradicate the germ.

Testing for Lyme disease, as parents ask me to do all the time, is very difficult since most people who live in the endemic area will test positive for having encountered Lyme disease in the past. The doctor has to do two tests in order: first the Lyme EIA (enzyme immunoassay) which if negative means one does not have Lyme, but if positive only means you need another test called a Lyme Western Blot.  Only if both are positive can one be certain that the patient has Lyme and treat without symptoms.  All the other Lyme diagnostic tests are not reliable although they are often used by people in the "Lyme Treatment Industry" to convince people that they need months to years of treatment with IV antibiotics.

Parents need to have Lyme awareness, not Lyme hysteria, and children need to run around outside.  Remember that if your child is going into brush, long pants help a lot to prevent tick attachment. Here is more information from the CDC on how to check for ticks.

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