Dr. Guiteras wrote a medical advice column for the Chapel Hill Herald from 1980 to 2000. He is now reviving the column for the CHFM website. The opinions expressed herein are those of the author, not necessarily those of the management of CHFM; even so, you can trust what you read here. If you have a question that you would like to have considered for this monthly column, send it to questions@chapelhillfamilymedicine.com. We will consider it for reply and reserve the right to edit the question to suit our needs. Please do not use this email address for any other purpose. Question: I recently pulled two ticks from my midsection. The warm weather has them active already this year. I have not been in the woods, just in my yard, puttering in the garden. Is there cause for increased concern about ticks this year? What can I do to avoid them? Answer: You don’t have to go to the woods to get ticks. You don’t even have to go outside. I once plucked a tick from a man’s forehead at a cocktail party and I know he hadn’t seen sunlight in a week. He blamed his toy poodle. Ticks went on the offensive early this year. A mild winter and dry spring have put them on the warpath quicker than you can say Dick Cheney. Country dwellers tell me they have seen more ticks than usual this year but your story shows that urban residents have their share of tick encounters. Ticks prefer long grass and brush, hanging out there in what entomologists call the “questing” position. There, they await almost any warm-blooded body and hop aboard when opportunity arrives. If opportunity is of the Homo sapiens variety, the tick heads for a warm, dark nook where it settles in for a meal of blood, taking 6 to 10 hours for the repast. I’ve noticed ticks have become more prurient in their interest in human anatomy. In the good old days, they seemed satisfied with prosaic sites like the scalp or calf. Now they seem to search out more exotic and private spots. Who can explain this deviant behaviour? Have they been watching too much TV? Or, is it simply a breakdown of traditional tick family values? We’ll let the tick sociologists figure it out. In the meantime, do your best to protect yourself and your loved ones from these despicable little creatures, described by scientists as “obligate blood-sucking ectoparasites.” No, we are not setting up for a bad joke about lawyers or health insurance executives. Instead, we advise, when working in the yard or walking in field or wood, that you wear light-colored clothing (the better to see them with) and tuck trousers legs into socks and shirt-tail into pants. Long sleeves are also recommended. This goofy, Paul Bunyan clothing style keeps the little devils moving upward on clothing, giving you more time to spot them before attachment. A good bug repellent helps. Sprays containing DEET or permethrin applied to shoes, pants legs and shirts cuffs are effective. Several times a day, inspect yourself and your children, paying close attention to the scalp. If this conjures images of baboon family grooming and seems like more trouble than it’s worth, let me assure you that if it spares you from a case of Rocky Mountain Spotted Fever or Lyme Disease, then it is well worth the time and effort. If a tick attaches, take it off but keep your wits about you. It’s not an emergency. I’ve seen people freak out on discovering a tick, clawing at it, screaming, running around as if a snapping turtle were biting their rear ends. Some people try the hot match trick or the kerosene soak, neither a good idea alone and much worse when tried together (no kidding; I’ve seen what happens when somebody does this). Better to stay calm, find the family tweezers, grab the dreadful blood-sucking ectoparasite at its mouth, close to the skin and gently but firmly pull it away. Lyme Disease gets all the press, and it’s nothing to trifle with, but Rocky Mountain Spotted Fever (RMSF) is still far more prevalent in North Carolina. From 2003 to 2005 there were 1338 cases of RMSF in our State and 327 cases of Lyme Disease. Both diseases are probably vastly under-reported. RMSF causes an acute illness characterized by headache, fever, muscle aches and , later, rash. Don’t wait for the rash. If you feel these symptoms, get yourself to a doctor, pronto. Early treatment greatly improves outcome. Remember this: if you get what feels like “flu” in the summer, it may well be RMSF which is a fearsome and sometimes fatal illness. Lyme Disease often begins with a red, spreading rash around the tick bite. If you see this, you need to see a doctor. Lyme also has an early, acute phase, featuring headache, fever, muscle ache, much like RMSF. Acute Lyme also need medical attention. The antibiotics doxycycline or amoxicillin work well. An important goal is to prevent chronic infection with Lyme, which may cause arthritis or neurologic or cardiac complications. It’s nothing you want to mess with. Thanks for your question. It is timely and will help remind people to beware the tick. If other readers have questions, let me know and I’ll try to give a sensible answer. TOP Chapel Hill Family Medicine, PA · 120 Conner Drive · Suite 200 · Chapel Hill, NC 27514 Phone 919-967-8291 · Fax 919-967-3627