Or: Common Sense Ain’t So Common
Excerpt from my new book!
Why do you suppose these tiny arachnids inspire such fear and trembling? I don’t have the answer, but I know they do. We see dozens of people in the ER each summer with one attached to their skin, or anxious parents who bring their children to the department with one embedded in their scalp, or maybe just crawling around. Sometimes they can’t point out the creepy offender but want us to check the child just the same. And it’s not just the summer-time. As I write this, it’s December in South Carolina and I found one yesterday crawling on my leg.
So what do we do if we find one of these critters attached to our child’s skin? There’s one safe and effective method, and several bad ones.
Johnny Green sat on the ER stretcher, his legs dangling over the edge and swinging back and forth. His mother stood beside her four-year-old son with arms folded across her chest and head shaking.
“Mrs. Green, I’m Dr. Lesslie. What can we do for Johnny this afternoon?”
The complaint on his chart read “problem with scalp”, which wasn’t very helpful.
“Hmm, hmm,” she responded, looking down at Johnny and shaking her head with impatient determination.
“I should never have listened to my brother Jake,” she huffed.
“Uncle Jake,” Johnny corrected her.
“Well your Uncle Jake got you into this fix, and just where is he?”
“Hold on a second,” I interjected. “What’s the problem with Johnny’s scalp?”
“It’s more like the back of his head, and it started with a tick.”
She unfolded her arms and stepped closer to the boy. He jumped as she fingered the back of his head.
“So he had a tick bite?” I moved to one side of Johnny, trying to get a look at his scalp.
“That’s right,” she answered, not looking up from her examination. “He’s always outside in the woods, and he came in this morning scratching the back of his head. That’s when I noticed the tick.”
“Ow!” Johnny hollered, pulling back from his mother and blocking any chance I had of seeing whatever had necessitated this visit.
“That critter was stuck tight, and I tried to pull it off with my fingers. Well, that didn’t work so I tried some of my daughter’s eyebrow tweezers. No luck there either. That’s when I remembered something I read somewhere about using kerosene. Didn’t have any of that stuff, but I got some gasoline out of a can in the garage and dabbed some on. I waited a couple of minutes, but nothing happened. That’s when Jake—Uncle Jake—walked in. I told him what was going on and he reached in his pocket and pulled out a box a matches. ‘Here, try this,’ he said. ‘Light it, blow it out, and while it’s still good and hot, touch it to the back-side of the tick. That’ll get him movin’.’”
I knew what was coming next. Gently, I took the boy’s head in my hands and examined his scalp.
“That’s when Johnny’s hair caught on fire,” Mrs. Green said matter-of-factly. “Never seen that boy move faster in my life. He took off down the hall, hair on fire, and hollerin’ loud enough to wake the dead.”
No wonder. On the back of his head was a silver-dollar-sized area of singed hair and mildly blistered scalp. But no tick.
“Next time, Mrs. Green, let me tell you the best way to do this.”
In case you’re still wondering, the best and safest way to remove a tick is to simply use some small, toothless tweezers. Gently grasp the body of the tick, pull slowly and gently, and you’ll be successful. Don’t squeeze the tweezers, since some believe this might cause bacteria-laden saliva to be forced from the tick’s mouth and into the skin. Check closely to be sure the mouth-parts (two small pinchers) are still attached to the tick, and you’re done. If you’re not sure, use some soap and water and a face-cloth and do some scrubbing. Then take a close look. If any doubt remains, it might be good to have your doctor take a look as well. This isn’t a 911 call—twenty-four to forty-eight hours is a safe window. But there are a couple of potential complications to be aware of.
A simple skin infection can occur at the site of the bite. Telltale signs will be swelling, redness, and maybe some drainage. More troubling is the potential for two serious infections—Rocky Mountain Spotted Fever (RMSF) and Lyme’s Disease. RMSF is somewhat of a misnomer, since it occurs throughout the country, and not just west of the Rockies. We see it here in the Carolinas as well. And while Lyme’s Disease was named after a town in Connecticut where it was first noted, deer have carried the offending organism far beyond the confines of the Northeast.
That brings up the issue of what to do if you child has a tick bite. Should she be given antibiotics or get some blood work done? And what about sending the tick (if you have it) to the state health department for testing? The last part is easy to answer. Most states (maybe all) are no longer testing ticks for RMSF or Lyme’s Disease. It’s costly, takes too much time, and is not all that accurate. The question of getting blood work is almost as easy. Immediate testing won’t do any good. It’s too soon for anything to turn up in your child’s system, so this would be a waste of money and tears. The real question has to do with using a prophylactic antibiotic. In many parts of our country where these diseases are relatively common, I think it makes sense to give one or two doses of an appropriate medication that would prevent these problems. Good evidence exists that Doxycycline (over the age of eight years) is safe and effective, as is Amoxicillin for those children younger than eight. For those children who might be allergic to these drugs, there are other choices. The other option is watchful waiting, something that most parents (myself included) are not very good at.
So, if you find a tick on your child, reach for your tweezers and don’t call Uncle Jake. No gasoline, no fire, and no scorched scalp.
“Seek advice but use your common sense.”
Yiddish Proverb
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