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Community Health Needs Assessment

Tick Talk

Release Date: 08/03/2015

By Susan Piotti, PA-C, Physician Assistant, Inland Family Care

There truly is a seasonal flavor to my job as a Physician Assistant in primary care and the emergency room. In the last four-five years, tick season has expanded to spring, summer, and fall.

Ten years ago we scoffed at concerns regarding Lyme disease after a patient came to us with a tick bite. We’d ask, “Where do you think you got it?” as any local tick was of doubtful concern. Deer ticks (also known as the Black Legged tick) were rare enough that we would send picked ticks, or even scrambled body parts, to the State for identification. But unfortunately, that’s no longer the case. Deer ticks are as common as the harmless (but equally hideous) dog tick or wood tick, and unfortunately, Lyme disease has become as common in Central Maine as many other parts of New England.

The deer tick is a very tiny and ravenous creature, riding around on a deer or other warm animal; it’ll hide in the grass (often on the grass tips) or woods (usually along a trail, like a deer trail), and swiftly crawl up a leg.  It has several stages of growth; the tiniest immature ticks are the size of a period. According to the CDC, most humans are infected through the bites of immature ticks called nymphs. The next size up can be the size of a poppy seed. Even at its largest, it is still pretty small – about the size of a small apple seed - so that most people have no idea they have been bitten. The tick is usually found when the unsuspecting human scratches at a small, irritating place and finds out that thing they thought was an ordinary mole has legs, and the legs are waving around in the air. That’s where I seem to come in.

It isn’t terribly difficult removing ticks once embedded, but it can be tricky. There are tick removers available; small, spoon-like scoopers with a narrow slit on the leading edge to trap the tick and scoop it out. I find that they are too big and bulky for the diminutive deer tick. I prefer to use the tiny tweezer trick.  You carefully grasp the nearly buried head of the tick (hence why its legs are always waving in the air), hold firmly, and pull up so that the tick, frustrated, will let its jaw parts open (they are jagged and rock hard like fish hooks). If successful, it will come out in one piece. If not, you are left with jaw parts, and a foreign body that can be challenging to remove. I can often lift one edge with a needle and flick it out, but it is a nuisance and no one likes to see me coming at them with a needle.  In the past, if that didn’t work we would dig at them fervently; now I often just leave them alone if there seems to be too much excavating involved. The excess body part always comes out on its own eventually, usually without much fuss. And an embedded jaw, devoid of tick, cannot give you Lyme disease.

I have had some pretty interesting situations with patients and ticks. My most time-consuming case was a man who had been fiddle-heading. He came in to be “checked” after his wife found a tick on his back. In the end, I removed 23 ticks from his back! Awkwardly, we talked briefly about combing through other body parts and he and I agreed, now one-hour later, that he and his wife could do those in their own spare time.

Unfortunately, Lyme disease is not a funny subject. Many people suffer from persistent pain and fatigue years or decades after the bite. Luckily you can take measures to avoid tick bites and still enjoy time in the outdoors! Wear long pants, socks and shoes and long sleeved shirts and evenly apply bug spray before walking in the grass or woods. Tuck your pants into your shoes and when you get home, closely inspect your clothes and then your skin for any ticks. Have someone help you with parts you can’t see. I suggest even rubbing your skin with your hand to feel for any tiny bumps you may not have noticed.  If you discover that a tick has been attached for 36-48 hours, please contact your healthcare provider – no need to visit the emergency room if it can be avoided.

Certainly not every deer tick carries the Lyme infection, but there is no sense taking a chance. So get ticked off! And take action to protect yourself against ticks so you and your family can have a wonderful, safe summer!

Susan Piotti is a Physician Assistant (PA) at Inland Family Care in Unity. She has been a PA for 27 years. To learn more about ticks in Maine, visit www.Maine.gov – Division of Infectious Diseases. Or visit inlandhospital.org  for local resources for staying healthy.