*update in OP* Pulled tick off DS this morning - see doc?

[sf333]

I found an embedded tick on my DS's head this morning. :(

I did my best to pull it out without breaking off the head but unfortunately, I'm pretty sure at least part of it is still in his skin as there is a dark spot there and it seemed as if it broke as I pulled it out. His skin is red and raised. The tick was not engorged. I'm pretty sure it's a deer tick based on the size and the markings (I looked at images online). I kept it as well.

I just called our doc and the nurse said the doc may want him to come in. Is this necessary? I thought they would tell me to keep an eye on his skin and on him (for any signs of Lyme, etc). I'm fine with bringing him in if needed, just wondering what everyone's thoughts and experiences are with this.

*Update*

I wanted to provide an update in case anyone else finds themselves in the same situation.

I took DS into our regular doc yesterday. He looked at the bite and basically said, keep an eye on it, watch for symptoms and go home. After doing some reading and getting some advice from Melbel (who was so helpful and I am so grateful to), I called the office back and said I wanted him to go on antibiotics. I was told no by not only him but another doc in the practice.

I then searched for local Lyme support groups (based on Melbel's advice) and got in contact with a few. I was given some names of local docs who are "Lyme literate." We were - amazingly - given an appointment today. DS was seen and given an Rx for amoxicillin. The tick is also being tested and we should have the results in a week.

If anyone needs to find a doc who is educated in Lyme, I found this site very helpful: http://www.chroniclymedisease.com/llmd-referrals

One more thing that I learned - Lyme literate docs prefer to keep a low profile due to the controversy surrounding Lyme and its treatment. Therefore, you have to jump through some hoops to get names of docs, they are not readily available on forums/sites. Just an FYI.

[kep]

Yes, you really need to make sure you get all of it out. If it had all come out in one piece, generally you are okay to watch and wait. I would go in.

[KLD313]

This very same thing just happened to a friend of mine. I urged her to go to the Dr. She did, and when he pulled the rest of the tick out the bullseye showed up immediately and they're treating her for Lyme. I would go just to be safe.

[sf333]

I just called back and made an appt. The nurse said that, in general, their practice is no longer removing tick heads because it can do more damage to the skin and increase chances of infection. Talk about conflicting info. Should I request that he remove it when we go in? You can see part of it on the surface of his scalp so I don't imagine it's too deep.

[maestramommy]

I would request it.

[Melbel]

I would request removal and prophylactic antibiotics. A large percentage of people do not get a tell tale Lyme bullseye rash, they may get a rash where it is hidden under hair, or the rash appears weeks later, after an infection has become disseminated (and much harder to treat). Lyme and other tick born infections (there are numerous) have been shown to have been transmitted in far less time than the CDC suggests. It is not worth the risk IMO.

[trales]

For the future have a bunch of these lying around. You will never not get the head out again.

http://www.amazon.com/Contech-300000772-Tick-Twister-Pro/dp/B000VUSV6Y/ref=pd_sim_petsupplies_4

These have to be the best product in the world. I have one in each car, one in each bathroom, one in the first aid kit and one under the kitchen sink. You can also get them from your vet. Super easy to use, do not hurt, easy to use on a squirming animal or child. You just hook and twist.

[Melbel]

A timely post from the Georgia Lyme group happened to cross my feed:

A Centers for Disease Control study published last year found "when treatment was delayed until 24 h after tick removal, only 47% of mice were protected; prophylactic treatment was totally ineffective when delivered ≥2 days after tick removal." In another study, a small dose of antibiotics stopped the rash from forming but not necessarily the infection. What's worse, taking an inadequate amount of antibiotics very early on in infection may halt the immune response, stopping antibodies from forming against Lyme bacteria though not clearing the actual infection itself. People who are treated with inadequate treatment early on therefore may not test positive by antibody test but may still be infected, creating a diagnostic nightmare when symptoms manifest.

Some doctors feel it is better to treat a tick bite with 21 to 30 days of antibiotic therapy or not to treat a tick bite at all and take a wait and see approach. Read more about this controversy at these links below:

http://www.democraticunderground.com/11422067

http://www.ncbi.nlm.nih.gov/pubmed/22421585

The first link is not the most eloquent source, but provides information for a springboard for further research.

[sf333]

I would request removal and prophylactic antibiotics. A large percentage of people do not get a tell tale Lyme bullseye rash, they may get a rash where it is hidden under hair, or the rash appears weeks later, after an infection has become disseminated (and much harder to treat). Lyme and other tick born infections (there are numerous) have been shown to have been transmitted in far less time than the CDC suggests. It is not worth the risk IMO.

I wish I had seen this before his appt. The doctor said that they don't treat with abx unless they know (or have evidence) that the tick was attached for 36 hours. He also did not remove it and said that it's best to leave it alone as removal would incur more damage to the skin and allow for a greater risk of infection.

Sigh. I'm really not sure what to do now. Go back? Also, Melbel, what reasons do you know of to remove the head?

Thank you so much for your input!

[sf333]

For the future have a bunch of these lying around. You will never not get the head out again.

http://www.amazon.com/Contech-300000772-Tick-Twister-Pro/dp/B000VUSV6Y/ref=pd_sim_petsupplies_4

These have to be the best product in the world. I have one in each car, one in each bathroom, one in the first aid kit and one under the kitchen sink. You can also get them from your vet. Super easy to use, do not hurt, easy to use on a squirming animal or child. You just hook and twist.

They're in my cart. Thanks. :)

[Melbel]

I wish I had seen this before his appt. The doctor said that they don't treat with abx unless they know (or have evidence) that the tick was attached for 36 hours. He also did not remove it and said that it's best to leave it alone as removal would incur more damage to the skin and allow for a greater risk of infection.

Sigh. I'm really not sure what to do now. Go back? Also, Melbel, what reasons do you know of to remove the head?

Thank you so much for your input!

If the mouth along with the salivary glands still attached to it remain in the skin, there are chances the pathogenic bacteria can gain entry.

Can you see a different doctor (dermatologist, other doctor in group, acute care)? Where are you located? Feel free to PM me location if you prefer.

ETA: The fact that the tick was not properly removed also weighs toward prophylactic treatment due to the fact that (1) the salivary glands may still be embedded; and (2) there is a greater likelihood that the tick was squeezed, causing it to regurgitate pathogens (even if it was not attached for long).

[mackmama]

For the future have a bunch of these lying around. You will never not get the head out again.

http://www.amazon.com/Contech-300000772-Tick-Twister-Pro/dp/B000VUSV6Y/ref=pd_sim_petsupplies_4

These have to be the best product in the world. I have one in each car, one in each bathroom, one in the first aid kit and one under the kitchen sink. You can also get them from your vet. Super easy to use, do not hurt, easy to use on a squirming animal or child. You just hook and twist.

Any idea how the Contech product compares to this one by Coghlans? http://www.coghlans.com/products/tick-remover-0015 My vet uses and recommends the latter. I'd like to make sure I get the best one that's easiest to use. In the past I've used products that rarely remove the whole tick.

Also - I couldn't find a video to show how to use the Contech one. I'm a visual learner (esp when I'm freaking out about how to extract a tick). Do you know of a video?

[trales]

I have only ever used the one that looks like the back of a hammer. I have no idea how the other one works.


I hook it under the tick, as you would if you were using a hammer to remove a nail, and then I twist, and the tick, head, legs and all pops right out. I then flush them down the toilet.

[mackmama]

I have only ever used the one that looks like the back of a hammer. I have no idea how the other one works.


I hook it under the tick, as you would if you were using a hammer to remove a nail, and then I twist, and the tick, head, legs and all pops right out. I then flush them down the toilet.

So are you twisting while pulling?

[trales]

Yes I am.

[mackmama]

Ok thx! Sorry to hijack OP.

[sf333]

bump for update

[mackmama]

Fantastic update - and thank you for providing the link. Way to go for being proactive and getting your DC on the meds!

[Melbel]

Copying some info from our PM - What great news!

I am so happy you followed up and that the support groups were helpful. It is possible the tick did not have Lyme (or other tick born diseases). It is also possible that no disease was transmitted. But, it is not worth the risk IME. Our son is doing so much better, but still has neurological deficits even a year after treatment. He had a neuro follow up today and will undergo testing in a few months to figure out where he stands. Meanwhile, the neurologist just glazes over when I try to help inform him, including providing research showing that some of the routine meds for migraine/vertigo prophylactic treatment can cause severe side effects, including autonomic nervous system damage, in children with Lyme (this is exactly what happened to our son which makes me angry because they refused to test him for Lyme before giving him the contra-indicated medication; this is due to the mitochondrial damage that often goes hand in hand with LD).

Through our ordeal, and the countless tales of others, we have learned that most doctors do not take the risk of Lyme seriously, even in highly endemic areas like the OP where over 50% of the ticks in the state have tested positive for Lyme (around 40% for her county). Meanwhile, many of the doctors who do take the risk seriously, have to keep a low profile to avoid scrutiny by insurance companies and CDC/IDSA driven medical boards. If the consequences were not so severe, it would not be so alarming. It blows my mind that even if you are lucky enough to get Lyme testing, the tests still miss about 1/2 of the actual cases (which prompted the new VA law).

Prevention is definitely the key. Prophylactic treatment may be warranted in situations where the tick was attached for more than 6 hours, was not removed properly, shows signs of engorgement, and/or if it is an endemic area. Once an infection has become disseminated, it is much more difficult to eradicate.

Note that other ticks can transmit diseases too (i.e. the common dog tick can transmit Rocky Mountain Spotted Fever, a potentially life threatening disease).

[Momit]

OP your update is fascinating. I had no idea Lyme literate docs are some kind of black sheep in their field. I'm very grateful for the info from you, Melbel and others so I will know what to do if we are dealing with a tick bite.

[MSWR0319]

So glad you got the meds! DH and I have both had Lyme within the last three years. I'm terrified the kids will get it and don't know what I'll do if I find a tick on them. There are no LL doctors even close to us, but I will find a way to get them meds.

[LizLemon]

OP your update is fascinating. I had no idea Lyme literate docs are some kind of black sheep in their field. I'm very grateful for the info from you, Melbel and others so I will know what to do if we are dealing with a tick bite.

I don't want to get on Mel's bad list but there are doctors who are truly knowledgeable about Lyme and there are also doctors who have a cottage industry of diagnosing almost everyone who walks through their clinic door with Lyme, putting people on IV antibiotics for months, etc. These are the people that infectious disease doctors tend to not think highly of.

[westwoodmom04]

I don't want to get on Mel's bad list but there are doctors who are truly knowledgeable about Lyme and there are also doctors who have a cottage industry of diagnosing almost everyone who walks through their clinic door with Lyme, putting people on IV antibiotics for months, etc. These are the people that infectious disease doctors tend to not think highly of.

I too am a little suspicious of a doctor who you've never seen before but who is free to see you immediately and give you antibiotics with no symptoms other than a tick bite. I've had lyme's disease, and I can understand your desire to not have your kid get sick, but there is also a danger of antibiotics losing their efficacy when they are given when not necessary.

[trales]

We saw a ll doc, who was a really bad doc trying to feed off people's fears and illness. We felt he was wrong and went to see an infectious disease doc who treats Lyme very aggressively but won't put herself in any camp. She treated DH for his symptoms and as an individual. Whereas the ll doc treated everyone as if they were the same and his treatment was the miracle cure. I feel strongly he should not have a license to practice as he gives Lyme advocates and good docs a really bad name.

DH was treated aggressively and is now 2 years out fully recovered and doing amazing. She still checks in with us once a year.

Because of this I think looking and asking for a good doc is more important than finding someone with a label.

[sf333]

I too am a little suspicious of a doctor who you've never seen before but who is free to see you immediately and give you antibiotics with no symptoms other than a tick bite. I've had lyme's disease, and I can understand your desire to not have your kid get sick, but there is also a danger of antibiotics losing their efficacy when they are given when not necessary.

Please don't assume that I take this lightly. My son has been on antibiotics two other times in his life (he turns 5 this weekend). I am VERY hesitant to use antibiotics for my children. The doctor's decision to prescribe antibiotics was based on a number of factors, not just a simple tick bite. The practice that I went to follows ILADS treatment guidelines. They also keep a few 10 min "tick check" appts available in their schedule for situations like mine. For other issues, there is a wait.

Ultimately, I did what I felt was best for my son in this situation.

[Melbel]

I don't want to get on Mel's bad list but there are doctors who are truly knowledgeable about Lyme and there are also doctors who have a cottage industry of diagnosing almost everyone who walks through their clinic door with Lyme, putting people on IV antibiotics for months, etc. These are the people that infectious disease doctors tend to not think highly of.

There are good and bad on both sides of the aisle. Not all mainstream doctors are "bad" either. Mainstream doctors (particularly infectious disease doctors) generally feel confined by the IDSA guidelines which only provide for a few weeks of antibiotic treatment before you are "cured" regardless of the duration of infection, number of co-infections, immune health etc. (these guidelines were the subject of an antitrust action by the attorney general of CT). Doctors should be able to use clinical judgment depending on individual patient's needs, rather than being constrained to a one size fits all protocol that fails so many. I am thoroughly convinced that my son would be in a wheelchair now if we had not gotten him to an LLMD. He was not walking many days, had memory lapses of up to a month, missed many months of school and had excruciating headaches, yet his doctors offered him no answers.

FWIW, while they may be out there, I have yet to meet (or even hear of) a LLMD who diagnoses everyone with Lyme and requires IV antibiotics (months or otherwise). We have not used any IV meds. With all of the Lyme support groups, bad doctors earn a bad reputation quickly. LLMDs tend to follow a different standard of care (ILADS) than the IDSA which creates an immediate divide. We chose the standard of care that actually worked for our family.

[Melbel]

I too am a little suspicious of a doctor who you've never seen before but who is free to see you immediately and give you antibiotics with no symptoms other than a tick bite. I've had lyme's disease, and I can understand your desire to not have your kid get sick, but there is also a danger of antibiotics losing their efficacy when they are given when not necessary.


Please don't assume that I take this lightly. My son has been on antibiotics two other times in his life (he turns 5 this weekend). I am VERY hesitant to use antibiotics for my children. The doctor's decision to prescribe antibiotics was based on a number of factors, not just a simple tick bite. The practice that I went to follows ILADS treatment guidelines. They also keep a few 10 min "tick check" appts available in their schedule for situations like mine. For other issues, there is a wait.

Ultimately, I did what I felt was best for my son in this situation.

Thank goodness LLMD keeps these appointments open. It is critical to understand that there is a narrow window of time to start prophylactic antibiotics for them to be effective against Lyme Disease (not lyme's disease for what its worth). LLMDs understand this reality, and work to prevent a disseminated disease. If the doctor was greedy/dishonest, it would be in his/her best interest not to treat right away. They would earn much more for longer term treatment of a disseminated infection. I would gladly trade a few weeks of preventative antibiotics for our son, rather than his prolonged treatment course (not to mention the fact that he could have permanent neurological damage due to the spreading of the infection to his brain).

The OP had an embedded tick that was removed incorrectly (likely causing the contents of the tick to enter her son) in a highly endemic area where about 1/2 the ticks test positive for Lyme. I applaud the OP for her efforts to protect her son, as well as the LLMD who was kind enough to help her.

[Momit]

I was going to say I should have been more clear. Of course, as in any profession there are going to be good LL docs and not so good ones. I didn't mean to say that being LL in itself makes someone a good doctor.

But if I (or DH or DS) had been bitten by a suspected deer tick, I would absolutely get a second opinion if my regular doc dismissed me without even testing for Lyme. I would happily go on antibiotics while waiting on a test result if it meant my chances for a successful recovery could be increased. I don't take antibiotics lightly either, but in this case the reward far outweighs the risk IMO.

[Melbel]

I was going to say I should have been more clear. Of course, as in any profession there are going to be good LL docs and not so good ones. I didn't mean to say that being LL in itself makes someone a good doctor.

But if I (or DH or DS) had been bitten by a suspected deer tick, I would absolutely get a second opinion if my regular doc dismissed me without even testing for Lyme. I would happily go on antibiotics while waiting on a test result if it meant my chances for a successful recovery could be increased. I don't take antibiotics lightly either, but in this case the reward far outweighs the risk IMO.

Just FYI, per many peer reviewed studies, the testing for Lyme is extremely unreliable in the first 4-6 weeks because your immune system has yet to generate an immune response (the Lyme tests are for immune response, not the actual bacteria). By the time you would test positive for Lyme, the disease would be disseminated. Prophylactic antibiotics are not ideal, but the options are limited given the current state of testing. Hopefully in the future the testing will become more precise. Until then, it is a balancing of the risks/benefits which will vary depending on the particular circumstances.

ETA: The testing of the tick is not the most reliable either (normally just for LD, not the other tick born infections). We need much more reliable tests!

[mom2224]

So- help guys. My boys spend hours outside each day. I've pulled ticks off that aren't embedded. What do I do if I find a tick that is embedded? I know my pediatrician would blow it off. Should I ask for something specific? I want to be prepared when this happens. I know it will happen because we spend A LOT of time outdoors. There aren't any Lyme specific doctors close to me. Just wanting to be prepared...

[OKKiddo]

Are any of these Lyme literate physicians a Family Practice Dr (or Pediatrician) who takes Tricare? We're switching from Prime to Standard and need a good physician. :)

[Melbel]

So- help guys. My boys spend hours outside each day. I've pulled ticks off that aren't embedded. What do I do if I find a tick that is embedded? I know my pediatrician would blow it off. Should I ask for something specific? I want to be prepared when this happens. I know it will happen because we spend A LOT of time outdoors. There aren't any Lyme specific doctors close to me. Just wanting to be prepared...

Prevention is your best defense.

There are great recommendations here, including instructions on removing a tick: http://www.lymedisease.org/lyme101/prevention/lyme_prevention.html

There are tick removal tools that help to remove the entire tick.

There are Lyme support groups in NC that can help guide you if necessary.

Doxycycline is often given for children over age 8. Amoxicillin and augmentin are typically given to children under 8. The decision on whether to treat with antibiotics will depend on the particular situation.

[hillview]

They're in my cart. Thanks. :)
:yeahthat:

[Melbel]

I have only ever used the one that looks like the back of a hammer. I have no idea how the other one works.


I hook it under the tick, as you would if you were using a hammer to remove a nail, and then I twist, and the tick, head, legs and all pops right out. I then flush them down the toilet.


So are you twisting while pulling?


Yes I am.


The sites I follow discourage twisting because you are more likely to break off the mouth (which is tapered similar to an anchor screw). It is better to pull straight out without twisting IMO.

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