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Prevention
Most ticks do not carry Lyme disease, and the transmission rate is low even in those deer ticks that may carry Lyme. (Learn more about transmission rates on the CDC website.) Still, don’t assume that Brooklyn is free from infected deer ticks just because we don’t have deer. Scientists have confirmed the presence of these ticks in NYC, with the highest density being found in Staten Island. In addition, one PSP member points out that there is a risk of ticks ending up in Brooklyn via travelers or visitors from outside the city:
“Lyme carrying deer ticks do travel to NYC via people and dogs who have gone to Long Island, upstate, etc. They can fall off and then reattach to you here in Brooklyn. Lovely! My son picked one up in Prospect Park or thereabouts when he was about 1.5. Brought the tick to our pediatrician and it tested positive for Lyme. And our dr. wasn’t surprised, though I was. It happens. We hadn’t traveled out of the city in more than a month when he got it.”
Whether you’re in Prospect Park or the forests of Vermont, it’s important to limit the amount of skin you’re exposing when exploring wooded areas. Wear light-colored long sleeves and long pants when possible, and tie up your hair or put on a hat. Tuck your shirt into your pants, tuck your pant legs into your socks, and spray your socks with permethrin insect repellent and exposed skin with DEET. When you head inside, remove your clothes, put them in the wash (or tumble dry them on high for an hour), and take a shower, as ticks can crawl around on clothing and skin for hours before latching on.
If you've got a lawn in NYC, or if you're spending time outside of the city, be sure to keep your lawn mowed, cut overgrown brush, and clear leaf litter to reduce the places where ticks can hide. Wear long pants when mowing the lawn, and don't forget a hat, as ticks can crawl up branches and grass to grab onto a passing host!
Tips on repellent:
- Use insect repellent containing DEET, such as Cutter and Off, but never use products that have more than 30% DEET.
- Repellents containing picaridin and oil of lemon eucalyptus have been known to be effective, but note that picaridin has not been conclusively proven effective against ticks.
- Permethrin products can be applied to clothing/boots (not to skin). They actually kill ticks that come in contact with the treated clothing, and usually stay effective through several washings.
- Use flea and tick repellents on your pet. Speak to your veterinarian for guidance on appropriate products.
- Sawyer Products SP544 Premium Insect Repellent with 20% Picaridin, Pump Spray, (ranked #1 or #2 by Consumer Report).
- Fairy Tales Lice Rosemary Spray, kyolic oil, lavender oils, etc. were recommended to avoid chemicals and have different levels of effectiveness
- You can buy clothes pre-treated with permethrin from brands like Insect Shield. One member says: "We've gotten our daughters pants from this company to wear when we spend extended time upstate near/in the woods during the height of tick season. They seem to work well and bring peace of mind."
Perform a thorough tick check with the help of a mirror before bed every night, paying special attention to hidden areas and skin folds around the joints, the navel, behind the ears, under the arms, in the genital area, and in the hairline. If you do find a tick crawling around or already attached, remove it promptly and properly. To do so, grasp the tick with a tweezer near its head and pull steadily without crushing it. Do not apply Vaseline, squeeze the tick, or do anything else funky, as you may cause the tick to release more infected saliva. Once removed, flush the tick down the toilet and disinfect the bite with antiseptic. Alternatively, you can save the tick in a bag and get it tested for Lyme, but know that the CDC generally does not recommend you do so.
If you find yourself constantly yanking out ticks, you may want to invest in a removal device such as a Tick Key. One member reports, "My dad is an avid hiker encountering ticks on a regular basis and he swears by this tick key. Is a few dollars, but makes removal an absolute breeze."
Testing and diagnosis
See your doctor if you develop symptoms of Lyme disease, even if you never saw the actual tick and/or you didn’t develop the characteristic bulls-eye rash. As one member who’s an urgent care PA explains,
“The percentage of people that recall seeing a tick is not super high, and not everyone gets the bullseye rash. The best thing to do if unsure is to draw blood to test for Lyme, start treatment if someone has suspicious symptoms, and redraw Lyme titers in 2-3 weeks if the initial test is negative, because it can take a while to show up in the blood. The old wisdom was that once someone showed symptoms, their tests would be positive is now known not to be true.”
You might even consider having everyone in your family take a blood test at the end of the summer season, regardless of the presence of symptoms. Lyme disease is most easily treated if it's caught within the first few months, so doing a round of testing each October can help keep you from letting an infection go unchecked.
Here’s some info from the CDC on diagnosing and testing for Lyme:
When assessing a patient for Lyme disease, health care providers should consider:
- Signs and symptoms
- Likelihood of exposure to infected blacklegged ticks
- Possibility that other illnesses may cause similar symptoms
- Results of laboratory tests
The CDC currently recommends a two-step testing process for Lyme disease. Both steps are required and can be done using the same blood sample. If this first step is negative, no further testing is recommended. If the first step is positive or indeterminate (sometimes called “equivocal”), the second step should be performed. The overall result is positive only when the first test is positive (or equivocal) and the second test is positive (or for some tests equivocal).
Key points to remember
- Most Lyme disease tests are designed to detect antibodies made by the body in response to infection.
- Antibodies can take several weeks to develop, so patients may test negative if infected only recently.
- Antibodies normally persist in the blood for months or even years after the infection is gone; therefore, the test cannot be used to determine cure.
- Infection with other diseases, including some tickborne diseases, or some viral, bacterial, or autoimmune diseases, can result in false positive test results.
- Some tests give results for two types of antibody, IgM and IgG. Positive IgM results should be disregarded if the patient has been ill for more than 30 days.
By the way: Lyme is unfortunately not the only illness you can contract from ticks, so check with your doctor if you’re experiencing symptoms to determine whether you need additional tests. As one member points out, “it’s very important to get treated for other infections carried by ticks: In our neck of the woods, the most common are Ehrlichia/Anaplasma, Babesia, and Bartonella.”
Stay calm
If you live in an endemic area, you are likely to get many tick bites. Follow best practices for prevention; use single dose prophylaxis for bites only per your doctor’s recommendation; and stick to the treatment guidelines recommended by CDC, as there are a lot of unproven treatment approaches circulating that are not necessarily helpful. Avoid scaremongering websites. There is a lot of public fear and misinformation about Lyme, and unfortunately a cottage industry in misdiagnosis and questionable treatment. Fortunately, in reality, Lyme is well understood, simple to take precautions against, and fairly easily treatable.
Tick-related resources
- CDC
- Mayo Clinic
- NYC Department of Health
- All About Ticks workbook for kids from the NYC DoH
- Here’s a photo of a tick bite from WebMD (warning—it’s gross!)
- WYNC Tick Talk: How To Protect Yourself From Lyme
- TickSpotters: If you take a good photo of the tick, they can ID it for you, which helps you understand the level of risk involved with the bite. They also have a helpful key with images to help you ID the tick yourself.
Remember the golden rules:
Thank you to PSP Medical Liaison Dr. Philippa Gordon for her tick expertise!
