Ticks can be found in wooded or brushy areas and in tall vegetation, and can jump on unsuspecting dogs and humans. As you probably know, ticks can carry the bacterium that causes Lyme disease. If the condition is treated early, it can be easily cured using antibiotics. Undiagnosed, Lyme disease can spread to the nervous system, joints, and heart and have serious consequences.
This podcast offers Lyme disease protection tips from Gregg Tolliver MD, Medical Director of Infection Control & Chief of Staff at MarinHealth Medical Center. Learn how to repel ticks, how to look for them and remove them, and how to recognize Lyme disease symptoms early, before the illness has a chance to progress.
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Protecting Your Family from Lyme Disease
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Learn more about Gregg Tolliver, MD
Gregg Tolliver, MD
Gregg Tolliver, MD, is the Medical Director of Infection Control & Chief of Staff at MarinHealth Medical Center.Learn more about Gregg Tolliver, MD
Transcription:
Bill Klaproth (Host): It’s great to be outdoors to be outdoors in the summertime, but that also means it’s time to take the necessary precautions to prevent tick bites and Lyme disease, and here to tell us more is, Dr. Gregg Tolliver, the medical director of infection control and chief of staff at Marin General Hospital. Dr. Tolliver, thanks for your time. So, where are these ticks, are there certain hotbeds for ticks in Marin?
Dr. Gregg Tolliver (Guest): Well, in Marin there’s quite a few deer. So, there’s not much for predators for them. So, the ticks are pretty much all over Marin, but especially where the Deer are. So, if you’re interested in knowing where the ticks, you follow Deer, I mean there are few other animals, but if you’re out in the open space, you’re certainly at risk for picking up a tick.
Bill: And they can be found right in people’s backyards then, too, they can make their way there?
Dr. Tolliver: Absolutely, and I recently had a couple interesting cases of tick-borne disease, there were acquired in Marin, and often all season, maybe if they’re if they’re sick enough in the first time in the hospital, where I’m often working, and I ask them, do you have any Deer on your property or around your property? And that gives me an idea of how high their risk is.
Bill: So, we should all be aware of this, and before going outdoors then, what precaution should be taken?
Dr. Tolliver: Well, there’s several different things you want to do. So, you want to wear long sleeve shirts and pants if you can, you want to stay, if you’re out hiking in the middle of the trail, and try to avoid brushing against them grasses in shrub. You want to use some insect repellent, either 20% DEET is what’s recommended by the California Department of Public Health, or picaridin will also work. It’s another insect repellent that’s used here and in Europe for 30 years. You can’t treat your clothing and socks and shoes with something that’s called permethrin. It kills the ticks that climb onto your body and it’s in some clothing are already made with that. When you come back from being outside, you want to check yourself for tick, and look carefully all over when you’re cleaning yourself, maybe in the shower, look for a little brown spot, and if you do all those things, your chances of picking up of tick worn disease are pretty low.
Bill: And especially check the kids too because the ticks can be hiding anywhere on the body, right?
Dr. Tolliver: That’s right, and it’s a good idea to be in that practice, especially for younger kids. Yeah, just watch them. Maybe observe when you’re getting them into the bathtub or what not because they’re not going to notice the tick, and then diagnosing tick worm in children is particularly difficult.
Bill: So, can a tick then be carried into the house by a pet? I’m just thinking about a younger child that may not be frolicking around in the backyard, but a tick can maybe get on a dog and be carried inside the house then, is that possible?
Dr. Tolliver: That’s possible, too. So, that’s why, yeah, you want to come, check your kids pretty frequently. I mean, you want them to be outside enjoying nature and frolicking and being in the dirt, and you want them to be playing with pets and having fun with their dogs and cats. But, yeah, there’s a little bit of risk there. So, you just want to incorporate that into your daily routine.
Bill: So, if you find one on your body or child’s body, how should it be removed?
Dr. Tolliver: Yeah, there are tick removal tools, and to remove a tick you can look online, and or look at a video. Maybe would be the best way, but you basically want to do it pretty carefully, and you get a pair of tweezers or tick removal tool, and you want to pull the tick straight out by trying to grasp as close as you can to the skin and with tweezers or the tick removal tool, and remove the tick. Like, pull straight out and use a firm and steady motion. What’s up with the guideline that?
Bill: And then, how should you dispose of the tick?
Dr. Tolliver: Well, if it’s been there a while, let’s say, a day or two, and there’s maybe, do you have a symptom of illness of rash, you might take that tick and see if you can get it processed by Marin County Public Health, and see if it’s some carrying some disease or not, or you can just put the tick in trash, I suppose.
Bill: So, that’s really good advice. Save it, just in case, maybe put it in a glass jar and keep it.
Dr. Tolliver: If you really need too, yeah. If you’re really concerned about disease, I wouldn’t recommend doing that all the time because it’s Epidemiologically a little bit different here, in Northern California than in say, Connecticut, and or upper New York, say Massachusetts where the ticks there often, they’re on a percentage basis, carry more disease. So, here in Marin County, about one percent ticks have Lyme disease.
Bill: Okay, well that’s good to know, and just in case, what are the signs and symptoms we should be watching out for?
Dr. Tolliver: You don’t have to notice the tick to get Lyme disease. Sometimes people say, “Well, I never saw a tick, so that can’t be the case”, well people ticks. They’re tiny, and so you get that, and you don’t even know. And so, there needs to be some risk. You’ve got to have had some kind of exposure, been outside. It doesn’t take a lot in Marin. So, you just might start out with a little bit of not feeling well, fatigue, maybe there’s no particular focus of illness, but it can often start out with some arthritic pain. So, pain in your neck, pain in one knee, and general malaise. So, it’s pretty non-specific, but often people will notice a rash. You don’t have to have a rash, but something like 50% of times you’ll have a bulls eye rash that’s called erythema migrans, and it’s an oval shaped, expanding, red lesion that is fairly, in fact, pathognomonic a lot of times for Lyme disease.
Bill: And if we do experience any of these symptoms, should we just go see our regular physician?
Dr. Tolliver: Yeah, you should just see your regular physician and generally, they’re going to, especially if you have a rash, you can kind of that’s characteristic of rash for Lyme disease. Erythema migrans, your doctor can just prescribe the usual treatment, which is, doxycycline for a couple of weeks and no further testing is really needed.
Bill: Okay, very good, and when we think of ticks, we think Lyme disease, but are there other tick- borne diseases besides Lyme disease?
Dr. Tolliver: Yep, absolutely that’s a great question. So, I just want to remind people that… Well, science hadn’t even discovered disease till 1977, but clearly it was there for a long time beforehand. So, we’ve just been digging into tick-borne for the past 40-50 years, so Lyme disease is really a Borrelia burgdorferi, and there are other species out there. For example, in Northern California there is a species Borrelia hermsii, and it can cause relapsing fever. So, one example of another tick-borne disease you can have out here, and sometimes near and around Tahoe, where people have been out hiking there or had exposure to rodents, and then fleas or ticks and they get relapsing fever. There are also, onto a couple other common cousins, I would call them of Lyme disease, such as, Anaplasmosis and Ehrlichiosis.
Bill: So, there are potentially serious complications with tick-borne disease if left unchecked?
Dr. Tolliver: That’s right. So, I think for providers and for patients they do want to think about those illnesses and test for them when somebody comes in, who thinks they might’ve had a tick bite or tick-related illness. They want to do that testing for Anaplasmosis and Ehrlichiosis, for Lyme disease, and then all that patient carefully.
Bill: Absolutely. So, wear your long sleeves and long pants, make sure you have repellent with 20% DEET, and check yourself and your kids from head to toe, when you come in. Dr. Tolliver, a pleasure talking with you today. For more information, visit MarinGeneral.org, that’s MarinGeneral.org. This is the Healing Podcast, brought to you by Marin General Hospital. I’m Bill Klaproth, thanks for listening.
Bill Klaproth (Host): It’s great to be outdoors to be outdoors in the summertime, but that also means it’s time to take the necessary precautions to prevent tick bites and Lyme disease, and here to tell us more is, Dr. Gregg Tolliver, the medical director of infection control and chief of staff at Marin General Hospital. Dr. Tolliver, thanks for your time. So, where are these ticks, are there certain hotbeds for ticks in Marin?
Dr. Gregg Tolliver (Guest): Well, in Marin there’s quite a few deer. So, there’s not much for predators for them. So, the ticks are pretty much all over Marin, but especially where the Deer are. So, if you’re interested in knowing where the ticks, you follow Deer, I mean there are few other animals, but if you’re out in the open space, you’re certainly at risk for picking up a tick.
Bill: And they can be found right in people’s backyards then, too, they can make their way there?
Dr. Tolliver: Absolutely, and I recently had a couple interesting cases of tick-borne disease, there were acquired in Marin, and often all season, maybe if they’re if they’re sick enough in the first time in the hospital, where I’m often working, and I ask them, do you have any Deer on your property or around your property? And that gives me an idea of how high their risk is.
Bill: So, we should all be aware of this, and before going outdoors then, what precaution should be taken?
Dr. Tolliver: Well, there’s several different things you want to do. So, you want to wear long sleeve shirts and pants if you can, you want to stay, if you’re out hiking in the middle of the trail, and try to avoid brushing against them grasses in shrub. You want to use some insect repellent, either 20% DEET is what’s recommended by the California Department of Public Health, or picaridin will also work. It’s another insect repellent that’s used here and in Europe for 30 years. You can’t treat your clothing and socks and shoes with something that’s called permethrin. It kills the ticks that climb onto your body and it’s in some clothing are already made with that. When you come back from being outside, you want to check yourself for tick, and look carefully all over when you’re cleaning yourself, maybe in the shower, look for a little brown spot, and if you do all those things, your chances of picking up of tick worn disease are pretty low.
Bill: And especially check the kids too because the ticks can be hiding anywhere on the body, right?
Dr. Tolliver: That’s right, and it’s a good idea to be in that practice, especially for younger kids. Yeah, just watch them. Maybe observe when you’re getting them into the bathtub or what not because they’re not going to notice the tick, and then diagnosing tick worm in children is particularly difficult.
Bill: So, can a tick then be carried into the house by a pet? I’m just thinking about a younger child that may not be frolicking around in the backyard, but a tick can maybe get on a dog and be carried inside the house then, is that possible?
Dr. Tolliver: That’s possible, too. So, that’s why, yeah, you want to come, check your kids pretty frequently. I mean, you want them to be outside enjoying nature and frolicking and being in the dirt, and you want them to be playing with pets and having fun with their dogs and cats. But, yeah, there’s a little bit of risk there. So, you just want to incorporate that into your daily routine.
Bill: So, if you find one on your body or child’s body, how should it be removed?
Dr. Tolliver: Yeah, there are tick removal tools, and to remove a tick you can look online, and or look at a video. Maybe would be the best way, but you basically want to do it pretty carefully, and you get a pair of tweezers or tick removal tool, and you want to pull the tick straight out by trying to grasp as close as you can to the skin and with tweezers or the tick removal tool, and remove the tick. Like, pull straight out and use a firm and steady motion. What’s up with the guideline that?
Bill: And then, how should you dispose of the tick?
Dr. Tolliver: Well, if it’s been there a while, let’s say, a day or two, and there’s maybe, do you have a symptom of illness of rash, you might take that tick and see if you can get it processed by Marin County Public Health, and see if it’s some carrying some disease or not, or you can just put the tick in trash, I suppose.
Bill: So, that’s really good advice. Save it, just in case, maybe put it in a glass jar and keep it.
Dr. Tolliver: If you really need too, yeah. If you’re really concerned about disease, I wouldn’t recommend doing that all the time because it’s Epidemiologically a little bit different here, in Northern California than in say, Connecticut, and or upper New York, say Massachusetts where the ticks there often, they’re on a percentage basis, carry more disease. So, here in Marin County, about one percent ticks have Lyme disease.
Bill: Okay, well that’s good to know, and just in case, what are the signs and symptoms we should be watching out for?
Dr. Tolliver: You don’t have to notice the tick to get Lyme disease. Sometimes people say, “Well, I never saw a tick, so that can’t be the case”, well people ticks. They’re tiny, and so you get that, and you don’t even know. And so, there needs to be some risk. You’ve got to have had some kind of exposure, been outside. It doesn’t take a lot in Marin. So, you just might start out with a little bit of not feeling well, fatigue, maybe there’s no particular focus of illness, but it can often start out with some arthritic pain. So, pain in your neck, pain in one knee, and general malaise. So, it’s pretty non-specific, but often people will notice a rash. You don’t have to have a rash, but something like 50% of times you’ll have a bulls eye rash that’s called erythema migrans, and it’s an oval shaped, expanding, red lesion that is fairly, in fact, pathognomonic a lot of times for Lyme disease.
Bill: And if we do experience any of these symptoms, should we just go see our regular physician?
Dr. Tolliver: Yeah, you should just see your regular physician and generally, they’re going to, especially if you have a rash, you can kind of that’s characteristic of rash for Lyme disease. Erythema migrans, your doctor can just prescribe the usual treatment, which is, doxycycline for a couple of weeks and no further testing is really needed.
Bill: Okay, very good, and when we think of ticks, we think Lyme disease, but are there other tick- borne diseases besides Lyme disease?
Dr. Tolliver: Yep, absolutely that’s a great question. So, I just want to remind people that… Well, science hadn’t even discovered disease till 1977, but clearly it was there for a long time beforehand. So, we’ve just been digging into tick-borne for the past 40-50 years, so Lyme disease is really a Borrelia burgdorferi, and there are other species out there. For example, in Northern California there is a species Borrelia hermsii, and it can cause relapsing fever. So, one example of another tick-borne disease you can have out here, and sometimes near and around Tahoe, where people have been out hiking there or had exposure to rodents, and then fleas or ticks and they get relapsing fever. There are also, onto a couple other common cousins, I would call them of Lyme disease, such as, Anaplasmosis and Ehrlichiosis.
Bill: So, there are potentially serious complications with tick-borne disease if left unchecked?
Dr. Tolliver: That’s right. So, I think for providers and for patients they do want to think about those illnesses and test for them when somebody comes in, who thinks they might’ve had a tick bite or tick-related illness. They want to do that testing for Anaplasmosis and Ehrlichiosis, for Lyme disease, and then all that patient carefully.
Bill: Absolutely. So, wear your long sleeves and long pants, make sure you have repellent with 20% DEET, and check yourself and your kids from head to toe, when you come in. Dr. Tolliver, a pleasure talking with you today. For more information, visit MarinGeneral.org, that’s MarinGeneral.org. This is the Healing Podcast, brought to you by Marin General Hospital. I’m Bill Klaproth, thanks for listening.