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» LymeNet Flash » Questions and Discussion » Medical Questions » Ok, so I need a plan - tick removal & testing 101

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Author Topic: Ok, so I need a plan - tick removal & testing 101
baileygirl
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I need a plan of attack. If one of my kids has a tick (or me or hubby) what should I do? Remove it with tweezers? Toss the tick in a ziploc bag for testing? I need a plan since the warm weather is here and I am sure the ticks are too...
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R62
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I have a tick bag with alcohol pads, tweezers, magnifying glass. I think iodine would be a good addition as well from what I have read.. after the fact. I am comtemplating the homeopathy thread here.. and need to order. Also thinking to start the kids on astragalus. I wonder what else would be good in a tick kit.

We send our ticks to Igenex to be tested.

http://www.igenex.com/ticktest.htm

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TF
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I bought this cheap tick remover based on advice I got here years ago. It works great. Even on the littlest ticks. It just takes patience. You keep pulling the tick up until it releases.

http://www.rei.com/product/407279

I always have this with me wherever I go. Plus, there is one in the kitchen for when I am not around.

If you find a tick really stuck on someone, you may want to keep that tick. Just put it in a container with a wet cotton ball.

You can send it to Igenex, but that means you are waiting for about a month to find out if it had lyme or other coinfections.

The other alternative is to call your doc and try to get antibiotics based on the bite alone.

Or, do both.

My lyme doc recommends wearing a tick repellant at all times outdoors and checking yourself all over as soon as you come indoors--best way is to take a shower and look. Avon makes a good tick repellant. My lyme doc recommended it.

Also, we treat our yard a number of times per year with something that kills ticks. You can buy these things at WalMart. Granules (for the ground, including flower beds) and spray (for the bushes) with trazicide. The more you can cut down on the number of ticks in the yard, the better.

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bettyg
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this might help you also; print it off; lots of good info in it.

Betty G's LYME/TICK BROCHURE with 2 LDA brochures combined together plus other stuff from Betty including:


lyme books, support groups, lyme/co-infection illnesses, symptoms, diagnosis, treatments, hunting/gardening ... how to dress; how to remove ticks, etc.

prints out to 9 pages 2 columns per page!

i also used on page 10 the front/back side of TICK CARD that lda has!! very helpful!
***********************

http://flash.lymenet.org/scripts/ultimatebb.cgi?ubb=get_topic;f=1;t=045337

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baileygirl
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Thanks! )
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Geneal
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Remember, Lymetoo sent her tick to Igenex.

It tested negative for Lyme.

She tested positive for Lyme after that.

PCR testing on ticks isn't that accurate either.

I say save your money and do antibiotics.

Could you ever say for certain that even when a tick tests

Negative that your child wasn't exposed?

I just wouldn't chance it.

Hugs,

Geneal

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bettyg
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here's KIDS treatment which i just copied for someone else so will apply it to yours as well.

from burrascano's 08 lyme guidelines; page 18...
for CHILDREN!!
*******************

ANTIBIOTIC CHOICES AND DOSES


ORAL THERAPY: Always check blood levels when using agents marked with an *, and adjust dose to
achieve a peak level above ten and a trough greater than three. Because of this, the doses listed below
may have to be raised. Consider Doxycycline first in early Lyme due to concern for Ehrlichia co-infections.


*Amoxicillin- Adults: 1g q8h plus probenecid 500mg q8h; doses up to 6 grams daily are
often needed

Pregnancy: 1g q6h and adjust.

Children: 50 mg/kg/day divided into q8h doses.

*Doxycycline- Adults: 200 mg bid with food; doses of up to 600 mg daily are often
needed, as doxycycline is only effective at high blood levels.

Not for children or in pregnancy.
***********************************

If levels are too low at tolerated doses, give parenterally or change to another
drug.

*Cefuroxime axetil- Oral alternative that may be effective in amoxicillin and doxycycline
failures. Useful in EM rashes co-infected with common skin pathogens.

Adults and pregnancy: 1g q12h and adjust. Children: 125 to 500 mg q12h
based on weight.

Tetracycline- Adults only, and not in pregnancy. 500 mg tid to qid

Erythromycin- Poor response and not recommended.

Azithromycin- Adults: 500 to 1200 mg/d. Adolescents: 250 to 500 mg/d

Add hydroxychloroquine, 200-400 mg/d, or amantadine 100-200 mg/d

Cannot be used in pregnancy or in younger children.
**********************************************************

Overall, poor results when administered orally

Clarithromycin- Adults: 250 to 500 mg q6h plus hydroxychloroquine, 200-400 mg/d,
or amantadine 100-200 mg/d.

Cannot be used in pregnancy or in younger
children.***************************************

Clinically more effective than azithromycin

Telithromycin- Adolescents and adults: 800 mg once daily
Do not need to use amantadine or hydroxychloroquine
*************************************************************

So far, the most effective drug of this class, and possibly the best oral agent if tolerated. Expect strong and quite prolonged Herxheimer reactions.

Must watch for drug interactions (CYP3A-4 inhibitor), check the QTc interval, and monitor liver enzymes.

Not to be used in pregnancy.
**********************************

*Augmentin- Standard Augmentin cannot exceed three tablets daily due to the clavulanate, thus is given with amoxicillin, so that the total dose of the amoxicillin
component is as listed above for amoxicillin.

This combination can be effective when Bb beta lactamase is felt to be significant.

*Augmentin XR 1000- This is a time-release formulation and thus is a better choice than
standard Augmentin.

Dose- 1000 mg q 8 h, to 2000 mg q 12 h based on blood levels.

Chloramphenicol- Not recommended as not proven and potentially toxic.

Metronidazole: 500 to 1500 mg daily in divided doses. Non-pregnant adults only.
****************************

PARENTERAL THERAPY

Ceftriaxone- Risk of biliary sludging (therefore often Actigall is co-administered- one to three tablets daily).

Adults and pregnancy: 2g q12 h, 4 days in a row each week

This watermark does not appear in the registered version - http://www.clicktoconvert.com

MANAGING LYME DISEASE, 16h edition, October, 2008

Page 19 of 37

Children: 75 mg/kg/day up to 2g/day

Cefotaxime- Comparable efficacy to ceftriaxone; no biliary complications.

Adults and pregnancy: 6g to 12g daily. Can be given q 8 h as divided doses, but a continuous infusion may be more efficacious.

When exceeding 6 g daily, use pulsed-dose schedule

Children: 90 to 180 mg/kg/day dosed q6h (preferred) or q8h, not to exceed 12 g daily.
**********************************

*Doxycycline- Requires central line as is caustic.

Surprisingly effective, probably because blood levels are higher when given parenterally and single large daily doses optimize kinetics of killing with this drug.
Always measure blood levels.

Adults: Start at 400 mg q24h and adjust based on levels.

Cannot be used in pregnancy or in younger children.
**********************************************************

Azithromycin- Requires central line as is caustic.

Dose: 500 to 1000 mg daily in adolescents and adults.

Penicillin G- IV penicillin G is minimally effective and not recommended.
**************************

Benzathine penicillin- Surprisingly effective IM alternative to oral therapy.

May need to begin at lower doses as strong, prolonged (6 or more week) Herxheimer-like reactions have been observed.

Adults: 1.2 million U- three to four doses weekly.

Adolescents: 1.2 to 3.6 million U weekly.

May be used in pregnancy.
*******************************

Vancomycin- observed to be one of the best drugs in treating Lyme, but potential toxicity limits its use.
It is a perfect candidate for pulse therapy to minimize these concerns.

Use standard doses nd confirm levels.

Primaxin and Unisyn- similar in efficacy to cefotaxime, but often work when cephalosporins have failed.
Must be given q6 to q8 hours.

Cefuroxime- useful but not demonstrably better than ceftriaxone or cefotaxime.

*Ampicillin IV- more effective than penicillin G. Must be given q6 hours.


TREATMENT CATEGORIES

PROPHYLAXIS of high risk groups- education and preventive measures. Antibiotics are not given.


TICK BITES - Embedded Deer Tick With No Signs or Symptoms of Lyme (see appendix):

Decide to treat based on the type of tick, whether it came from an endemic area, how it was removed,
and length of attachment (anecdotally, as little as four hours of attachment can transmit pathogens).

The risk of transmission is greater if the tick is engorged, or of it was removed improperly allowing the tick's contents to spill into the bite wound.

High-risk bites are treated as follows (remember the possibility of co-infection!):
*********************************************

1) Adults: Oral therapy for 28 days.

2) Pregnancy: Amoxicillin 1000 mg q6h for 6 weeks. Test for Babesia, Bartonella and Ehrlichia.

Alternative: Cefuroxime axetil 1000 mg q12h for 6 weeks.

3) Young Children: Oral therapy for 28 days.
***************************************************

EARLY LOCALIZED - Single erythema migrans with no constitutional symptoms:

1) Adults: oral therapy- must continue until symptom and sign free for at least one month,
with a 6 week minimum.

2) Pregnancy: 1st and 2nd trimesters: I.V. X 30 days then oral X 6 weeks

3rd trimester: Oral therapy X 6+ weeks as above.

Any trimester- test for Babesia and Ehrlichia


3) Children: oral therapy for 6+ weeks.
*******************************************

DISSEMINATED DISEASE - Multiple lesions, constitutional symptoms, lymphadenopathy, or any other

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MANAGING LYME DISEASE, 16h edition, October, 2008
Page 20 of 37

manifestations of dissemination.

EARLY DISSEMINATED: Milder symptoms present for less than one year and not complicated by immune
deficiency or prior steroid treatment:

1) Adults: oral therapy until no active disease for 4 to 8 weeks (4-6 months typical)

2) Pregnancy: As in localized disease, but treat throughout pregnancy.

3) Children: Oral therapy with duration based upon clinical response.


PARENTERAL ALTERNATIVES for more ill patients and those unresponsive to or intolerant of oral
medications:

1) Adults and children: I.V. therapy until clearly improved, with a 6 week minimum.

Follow with oral therapy or IM benzathine penicillin until no active disease for 6-8 weeks.

I.V. may have to be resumed if oral or IM therapy fails.


2) Pregnancy: IV then oral therapy as above.


LATE DISSEMINATED: present greater than one year, more severely ill patients, and those with prior
significant steroid therapy or any other cause of impaired immunity:

1) Adults and pregnancy: extended I.V. therapy (14 or more weeks), then oral or IM, if effective, to same endpoint.

Combination therapy with at least two dissimilar antibiotics almost always needed.


2) Children: IV therapy for 6 or more weeks, then oral or IM follow up as above. Combination therapy usually needed.

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Lymetoo
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Yep. As Geneal said, tick testing is NOT a sure thing. Besides... they can harbor many more diseases than just one.

Get those tweezers ready and call the dr if need be! I got on abx immediately after that bite. [This was years after my initial lyme infection.]

--------------------
--Lymetutu--
Opinions, not medical advice!

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Marnie
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This is what I PERSONALLY would do:


A long time ago, a doctor in Canada recommended injecting lidocaine under the tick...and easing it out.

I think he was right. This is why:

http://cat.inist.fr/?aModele=afficheN&cpsidt=13414380

Bb's toxins look to ***inhibit the release of acetylcholine.***

Lidocaine looks to trigger acetylcholine.

Bb prefers glutamate.

In a jam...lidocaine...Anbesol teething gel. Read the ingredients.

Now...don't put that ON TOP OF THE TICK, but in a circle on the skin around it.

Very carefully remove the tick and try hard not to break it apart or squish it.

Save it and get it analyzed by a lab for the presence of Bb.

Now...directly over the area of attachment, do this:

Wet a 4x4 gauze pad and open an activated charcoal capsule and sprinke the activated charcoal on the pad (carefully...it is very very messy). Now apply the pad to the direct area where the tick was applied. Cover that with some plastic wrap (to keep it moist, so the skin can absorb the activated charcoal) and tape it down with some paper tape.

Leave this in place for several hours.

The skin will be slightly grey/black for awhile, so if you don't like this "look", you can scrub it off with a washcloth and oxyclean solution.

Activated charcoal absorbs toxins.

Get prophylactic abx. Doxy or amoxicillin.

Prevention: Yard spray. Lily of the Valley Cologne (can be sprayed on clothes) or Pine tree oil (comes as a soap). Hats. Long pants tucked into boots esp. when hiking. Preventative measures for you dog, if you own one.

Good link (prevention ideas):

http://www.cdc.gov/nasd/docs/d000901-d001000/d000960/d000960.html

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jam338
LymeNet Contributor
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Somewhere I recently read someone's suggestion of using a snake bite kit for tick bites...sucking out the venom, etc. Makes sense, but have no idea if it works. It is $15, a price that pales in comparison to treating lyme illness, so could be worth the investment.

http://www.rei.com/product/407144

Posts: 495 | From SF Bay area, CA | Registered: Dec 2007  |  IP: Logged | Report this post to a Moderator
   

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