Many Voices
Posted on Wednesday, June 17, 2009
Ticks out in force: Doctors say bite complaints up; regular body checks urged
By CHELSEY POLLOCK
Gazette Contributing Writer
PHOTOS FROM Public Health Image Library
Ticks are always out in full force during the warmer months, but the frequency of reported tick bites -- and the Lyme disease they can transmit -- has been increasing in Massachusetts every year. And this summer is already gearing up to be another record-breaker.
Dr. Jerald Feinland, of Valley Medical Group in Easthampton, says that during a recent 12-hour urgent care shift, he saw four patients with tick bites and got an additional four phone calls from patients who were bitten.
"That sort of blew me away," he said. "It was all I could do to keep up with it."
Feinland says that during the summer, his practice usually sees about one case of Lyme disease per week. Though he hasn't had a patient with the tick-transmitted disease yet this year, the number of bites he's seeing is already higher than last year at this time.
In the past week alone, Amherst Medical Associates treated 10 patients with tick bites, according to Dr. Richard Wu. That is more than double the practice's average from last year, of about two to five cases per week, he says.
Becky Willey, a medical assistant at Hampshire County Internal Medicine in South Hadley, says her office has treated more patients so far this year for tick bites than ever before - about 20 or 30 cases since April.
Though none of those patients has yet been diagnosed with Lyme disease, an illness with flu-like symptoms that can become chronic and debilitating, Willey says, it is still too early in the season for blood tests and other evaluative measures to be complete.
Ticks everywhere
Why the increase in bite complaints this season?
It could be due simply to an increased awareness of deer ticks and the Lyme disease they transmit, says Stephen Rich, an entomology professor at University of Massachusetts at Amherst.
"We don't see a huge fluctuation from year to year as far as tick population goes," said Rich, who heads a research team that studies the insects. He added, however, that, in general, the presence of deer, which carry the ticks, has increased across the state as more and more homes have been built in wooded areas. This, says Rich, creates an ideal habitat for deer - open, grassy areas near shrubby forests. "Deer are browsers," he said. "They like the stuff we have by our houses, not big, old standing forests."
Deer ticks, which transmit a bacterium that causes Lyme disease, are small and hard to spot. The nymphs are about the size of a poppy seed and adults the size of a sesame seed.
The other common tick in Massachusetts is the dog tick, which is larger, about the size of a watermelon seed as an adult. Dog ticks can spread the rare Rocky Mountain Fever, but do not transmit Lyme disease, according to the Massachusetts Department of Public Health.
In western Massachusetts, the deer tick is the most dangerous variety, according to the department of public health. However, only about half of the deer ticks in Massachusetts carry the bacterium for Lyme disease and it usually is only spread when the tick is attached for more than 24 hours, says Rich.
The dirty deed
When a tick first attaches, it begins to burrow a small hole into the skin, according to Rich. Then, it "spits and sucks" saliva into the hole until it has created a small pool of blood, he says. Once finished, the tick does what Rich called "the big slurp," and ingests the blood. The whole process takes about 48 to 72 hours, which is why a tick that has been attached for less than a day has likely not had enough time to transmit the disease, says Rich.
One of the first signs of Lyme disease is a bull's-eye rash at the site of the tick bite. However, the rash does not appear in all cases and people often exhibit unexplained fevers or flu-like symptoms.
Fast treatment with antibiotics is key, says state epidemiologist Alfred Demaria, and early action can cure the disease. But, if left untreated, the illness can cause chronic conditions like arthritis, neurological problems and heart problems.
If you've been bitten, the most important thing to do is remove the tick immediately, Demaria says. To do this, use tweezers to grab the tick as close to the skin as possible and pull straight out in a steady motion.
Rich warns against using "old wives' tale" methods to remove the tick, like applying kerosene, petroleum jelly or nail polish or trying to draw the tick out with a lit match. These are ineffective because they take too long to work, he says. "The key is to get it off as soon as possible."
Feinland recommends saving the tick so a doctor can identify it as a deer or dog tick in the event symptoms develop.
Every tick bite does not warrant a trip to the doctor, though.
Demaria says that if the tick has been attached for less than 24 hours an immediate exam is not necessary. It is wise, however, to keep an eye out for symptoms of Lyme disease and call a doctor if they arise.
Be aware
Doctors do not report every case of Lyme disease they diagnose to the state, says Demaria, making it difficult for the Department of Public Health to compile Lyme disease statistics.
In 2007, the last year for which data are available, the department recorded 3,376 confirmed cases of Lyme disease in Massachusetts. This was a 35.4 percent increase from 2006. Hampshire County has had a relatively stable number of reported cases ¿ 71 in 2007, 64 in 2006 and 69 in 2005. But the county's average of 47 cases in 100,000 people is still more than five times the national average of 9.1 per 100,000.
Demaria says that while the state is still putting together statistics, he expects the data will show over 4,000 cases of Lyme disease for 2008.
While pediatricians see Lyme disease among children, youngsters seem less susceptible to long-term effects of tick bites, says Dr. Jonathan Schwab of Northampton Area Pediatrics.
"There is a lot of anxiety that parents have when they hear from the media about chronic Lyme disease," he said. "But, we don't see that in kids."
Of the approximately 30 patients with Lyme disease his office saw last year, most had minor rashes at the site of the tick bite, he says, not extreme symptoms like severely swollen joints or facial paralysis. When children do develop symptoms of Lyme disease, they usually respond well to antibiotics, says Schwab.
Still, he cautions, parents should focus on preventing tick bites.
"Be aware that ticks are all around us," he said. "Check your children every evening for tick bites."
Feinland also recommends daily body checks for ticks, especially after spending time in the wooded or grassy areas where ticks thrive. He also suggests keeping grassy yards cut short, tucking long pants into socks to protect the feet and legs and using a tick repellent, like permethrin, on clothing. DEET repellents can also be used on the skin, but should be applied carefully, he said, because they can be harsh.
Schwab says that tick repellents with less than 12 percent DEET are safe for children, but should be washed off when no longer needed.
An insect repellent containing eucalyptus extract is a more natural alternative to DEET, says Wu, the physician from Amherst. He says that it is nearly as effective as DEET-containing repellents but much gentler.
As tick populations spread, these kinds of preventive measures become increasingly important.
"I think a lot of people don't think [Lyme disease] involves them," said Wu. "They don't appreciate that now there is a risk of Lyme disease from the city of Boston to the campus of UMass."
For more information on ticks and Lyme disease, visit the Centers for Disease Control and Prevention at www.cdc.gov.
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