How to avoid Ticks – and Lyme disease – during the hiking season

The topic of tick bites and Lyme disease is a serious one, and several of our close friends have contracted Lyme disease and have suffered terribly from it over the years.

TICKS
As a hiking guide, I am exposed to the type of terrain where Lyme disease transmitting ticks exist, if not thrive, and as our hiking trips get under way, I thought that it would be appropriate to discuss this matter.
We are no experts on Lyme or any other medical condition, most if not all I will post has been gleaned from the internet and sources will be documented, but it is always good to summarize all the information out there in one place.
First we will look at how to prevent tick bites, then we deal with what to do in case you have been bitten, and finally, we will discuss Lyme disease and other diseases transmitted by ticks.

Ticks are part of the arachnids family, they are external parasites, living mainly off the blood of mammals and birds. They are different varieties of ticks, and they can transmit some serious diseases.
Ticks can be found almost anywhere in the world. However, they need warm, humid places to develop, and obviously the density of potential ‘hosts’ must be high enough for them to survive.
Ideal places for them are woodlands, highly vegetated areas, grasslands, and a solid population of deer inhabiting these areas.

Tick season is predominantly between April and September, just when everybody else is outdoors as well, of course.

Ticks have eight legs, just like spiders, and their body is segmented into two parts, one with its head and the mouth parts, and a second part including the digestive tract, legs, and reproductive organs. Initially small, the digestive tract is the one that swells up like a balloon once the tick has started to siphon off your blood.

HOW TO PREVENT TICK BITES

First of all, here are the easy answers:

1: Wear light-coloured long pants, and stick them into your socks. Wear long-sleeved, light-coloured shirts, and tuck them into your pants. Wear a hat! The light colours will help finding ticks on your clothing, as they are predominantly dark.
2: Stay on trails, walk in the middle of the trails, do not meander through grasslands, and avoid touching branches and brushes with any part of your body, as ticks will let themselves drop onto potential hosts upon contact.
3: Shower or bathe as soon as possible after being outdoors, if possible within 2 hours, as ticks on your body can be found much easier, and if they haven’t latched on yet, they simply get washed off.
4: Conduct a full body tick check, especially under arms, in and around the ears, inside your belly-button, behind the knees, between the legs, around the waist, and especially in the hair. Ticks like moist, warm places!

5: Check everybody in the family: kids, and especially pets who do roam through the brush, upon their arrival at home. Ticks can hitch a ride on a pet, and latch on to a person once they are in your home. Also check backpacks or anything else t hat was with you on your outdoor adventures. Some recommend to tumble dry all clothing on high heat for an hour, to kill any leftover ticks that haven’t been spotted yet.

Here is a more controversial prevention method: chemical insect repellants:

1: DEET: Use products with a minimum of 20% DEET, and apply it directly to your skin. Also apply on children except in the face and hands. It is recommended that repellants used on children should not exceed 30% of DEET in the product.
The US Centers for Disease Control and Prevention website has more information, as well as a list of repellants that are registered with EPA (Environmental Protection Agency) and are deemed okay to use.

2: Permethrin: Permethrin would be sprayed onto your and/or your childrens’ clothing before heading out. It is an insect repellant that kills ticks upon contact.

The Lyme Net Europe website has a good article about the pros and cons of DEET and Permethrin:
http://www.lymeneteurope.org/info/deet-versus-permethrin-as-a-tick-repellent

WHAT TO DO WHEN YOU FIND A TICK ATTACHED TO YOUR SKIN
Again, Lyme Net Europe has a thorough description on how to remove ticks:
http://www.lymeneteurope.org/info/tick-removal

Remember:
1: Use tweezers with thin ends, or fine point tweezers. Do not use the regular flat tip, household tweezers!
1: Try to get the tick as close or on the head as possible

2: Use your tweezers from the side
3: Steady, consistent pull. As many ticks will not let go super-easily, you will probably feel the pull on your skin, which will lift up as well until the tick lets go.
4: If the head or other pieces of the tick are still in the skin, try to remove them as well. If this doesn’t work, go to a doctor to get the leftovers removed.
4: If you want to get the tick tested, put it in a sealed container. If not, also, put it into a sealed bag, container or similar, and throw it in the garbage.
5: Disinfect the bitten area with 70% Iodine or alcohol, AND disinfect your tweezers!
6: If you don’t want to remove the tick yourself, or can’t do it, go to your doctor promptly to have him remove the tick.
7: Check the bite location regularly for any signs of rashes.
8: If you do develop symptoms of irritation, fever, rashes, etc, go to your doctor immediately. Also record when and how you or anyone in your family was bitten, and how long approximately the tick has been buried in the skin.

WHAT IS LYME DISEASE, AND HOW CAN IT BE DIAGNOSED?

Lyme disease is the most common zoonotic disease in North America and Europe. Zoonotic means a disease which can be  transmitted from animals to humans. This is what the King County Medical Board says about it.

“Zoonotic diseases (also called zoonoses) are infectious diseases that can be spread from animals to humans. There are many zoonotic diseases, and their threat to human health is growing due to increasing global movement of people and animals and the effects of human populations expanding into previously undeveloped wildlife habitats.  Climatic change may also lead to greater zoonotic diseases threats.”

“Lyme disease is a bacterial illness caused by a bacterium called a “spirochete.” In the United States, the actual name of the bacterium is Borrelia burgdorferi. In Europe, another bacterium, Borrelia afzelii, also causes Lyme disease. Certain ticks found on deer harbor the bacterium in their stomachs. Lyme disease is spread by these ticks when they bite the skin, which permits the bacterium to infect the body. Lyme disease is not contagious from an affected person to someone else. Lyme disease can cause abnormalities in the skin, joints, heart, and nervous system.” Medicinenet.com.

Lyme Disease is transmitted by ticks, and requires the tick to latch on and bite the person or animal. Transmission apparently depends on how long the tick stays attached but again, there does not seem to be any conclusive evidence at the moment giving a particular length of time. The most repeated information is that during the first 24 hours, it is unlikely that the tick is transmitting any pathogen.

Lyme apparently has been around for thousands of years. The “Ice Man” or Otzi, found nearly 20 years ago and thought to have lived nearly 5000 years ago was found to be carrying the Lyme disease bacterium. Interesting to say the least!

http://contagions.wordpress.com/2012/07/29/metagenomics-lyme-disease-and-the-tyrolean-icemans-tattoos/

MOST AFFECTED REGIONS:
Lyme disease most often occurs-in the United States along the Atlantic coast, the Midwest, and parts of Oregon and California. The main affected areas in Canada are parts of southern Manitoba, southern and eastern Ontario, southwestern Quebec, New Brunswick and Nova Scotia. British Columbia is also affected, mainly Vancouver Island, and the lower mainland and the Fraser Valley.

What are the signs and symptoms of Lyme Disease?

For my 3 friends with Lyme disease, there we no clear signs of Lyme disease. They were either diagnosed with Lupus or MS, or some other ailment such as chronic fatigue, but no doctor ever looked into the possibility that it could be Lyme.
At times, I would ski with them only to watch them topple over on the flats, unable to figure out why they could not go in a straight line.

I must add that the province of Alberta in Canada, where we live, is not considered endemic to the bacteria that causes Lyme, although since last year Alberta Health and Wellness does recognise that Lyme can indeed be transmitted by ticks in Alberta as well:
http://www.health.alberta.ca/health-info/lyme-disease.html

This situation obviously made it very difficult for my friends, and it took them many frustrating sessions to different doctors in Europe and in the US ( not to mention thousands of dollars in lost wages and expenses) before they were diagnosed and treated for Lyme.

“I contracted Lyme disease sometime during the 21 years that I was guiding for Outward Bound in Colorado.  I had a number of tick bites but never had a bull’s eye rash.  I do remember getting a horrible flu one summer and in retrospect I’m sure that was the infection date, about 20 years ago.  Over the past 10 years I have gotten progressively sicker, with fatigue so severe that it ended my career as a professional skier; I went from running a 3:17 marathon to not being able to walk around the block or even twist a jar open.  My symptoms have included joint pain, muscle weakness, brain fog, thyroid and adrenal dysfunction, and most recently memory loss. I’ve seen about 12 doctors and 3 actually tested me for Lyme, but they used the notoriously unreliable ELISA test and I got false negative results.  I’ve been misdiagnosed with Chronic Fatigue Syndrome and Fibromyalgia, and tested for Parkinson’s, MS and Lupus. The worst part of the whole process was being told repeatedly that I was simply depressed, this was “all in my head” and I was making mountains out of molehills.   When I started getting sick I had just won two world championships in extreme skiing, but I was being told this was the normal aging process.

 This Fall I watched my personality start to change, constantly feeling anxious and overwhelmed, then my memory got really bad.  I actually left my skis at the ski area but reported them stolen from my car the next day because I couldn’t remember going skiing.  I couldn’t afford to get any sicker or lose any more of my mind, and I knew I had Lyme.  So I found a Doctor in Calgary who was willing to order the ‘gold standard’ lab test from IGeneX in California and paid for it out of pocket.  I got my diagnosis and found a Lyme specialist in Seattle, Dr Marty Ross.  I have been on antibiotics for 2 months now and I have some pretty crappy days with vomiting, vertigo and nerve pain but I also know I’m getting better.  I went for a 15 minute run yesterday and loved it, though I reckon I’ll wait a while until I let Louis kick my butt on the trails this summer… “     Maegan Carney

Here is a pretty good link to what many of the signs and symptoms are. Again, there is a myriad of symptoms, and many  people are treated for the wrong ailment.

http://arthritis.webmd.com/tc/lyme-disease-symptoms

In France, where I lived for many years, doctors do not hesitate to assume that a tick bite could lead to Lyme and then would prescribe a course of antibiotics. I am  not saying that systematic use of antibiotics is good, but the French doctors I have dealt with, always thought that Lyme could be a possibility and therefore, were unwilling to take any chances.

If you have the time, look at this trailer from the film Under our Skin.

http://www.youtube.com/watch?v=sxWgS0XLVqw

Links to official websites:

Centre for Disease Control and Prevention, USA:
http://www.cdc.gov/lyme/

Public Health Agency of Canada
http://www.phac-aspc.gc.ca/id-mi/lyme-eng.php

LymeNet Europe
http://www.lymeneteurope.org/