Tick Season
Tick bites are a major source of disease and anxiety in the High Country. Over the past several years the prevalence of tick-borne illness has rapidly increased.
Key Takeaways
Check yourself for ticks every day, especially if you’ve been off the beaten path.
Ticks can be warded off with insect repellant, similar to mosquitoes and flies
If you find a tick remove it carefully, without crushing it. Take a picture or identify it yourself.
If you find an attached tick you may benefit from a prophylactic single dose of an antibiotic to lower the risk of developing a tick-borne illness. The earlier the better.
This Quick Guide from Cornell is an easy reference for Tick Identification
I grew up in Western North Carolina and have spent nearly my entire life in North Carolina, exploring just about every patch of forest or body of water. I’ve had numerous tick bites and we never made a big deal about any of them - and fortunately I’ve never suffered from a tick-borne illness. Unfortunately those days are long gone. Tick bites are clearly a major source of disease, both acute and chronic, and the trend has increased rapidly in the High Country.
If you clicked on the link above and read all the way to the bottom you can see that NC is home to a variety of ticks and the diseases they cause. There are two well-established diseases: Lyme Disease and Rocky Mountain Spotted Fever. Over the past several years Ehrlichiosis, Babesiosis and Anaplasmosis have also been diagnosed locally. There is also a surprising manifestation of tick-borne illness called Alpha-Gal.
Let’s start with a classic case of tick-borne illness. A healthy child in the high country who explores outside and resists bathing finds a tick attached under his armpit. It’s already moderately engorged (has been attached for >24 hours). His parents remove the tick and go on with life. They never notice a rash. The child develops a fever, but other kids in the house have a viral respiratory illness, so mom and dad don’t think much of it. They all get better, but he doesn’t. His parents take him to the doctor, who also notices tender joints and a targetoid rash under his armpit. He starts doxycycline and by day 3-4 he feels back to normal, and after two weeks he’s all done - with mom and dad more vigilant and less accommodating to shower-free days!
This is a classic case of Lyme disease. Fortunately almost every case of properly treated acute Lyme Disease can be cured.
A rash is not always present and is harder to recognize in persons with darker skin
Classic signs of Lyme are: Rash/Fever/Malaise/Joint pain/Headaches -> neurologic complications -> cardiac complications
We had our own run-in with Lyme disease in the Summer of 2024. My (at the time) 10yo developed a nagging headache. As a physician/father it was honestly very difficult to know the right way to move forward: The headaches weren’t consistent, and he still did plenty of normal boy things. Was this lingering effects from a concussion he suffered earlier in the year? Was this just an excuse to not do things he didn’t want to do? When we realized that he hadn’t jumped on the trampoline in weeks we knew we were dealing with a real problem. At the recommendation of a local neurologist we proceeded with testing for tick-borne illness and to my surprise his Lyme Ab was positive. Within 3 days of starting treatment with doxycycline he was significantly improved. He went through a total 3 week course and has done well since.
The tick bite happened while we were scrambling up the side of this mountain.
His only known tick bite was 3 months before, while we were hiking in Scotland. That tick was removed within 12 hours.
What should I have done?
I should have made a point to identify the tick.
I should have been a better-prepared doctor dad - either using insect repellant before we started our trek
I should have given him a single-dose prophylactic doxycycline at the time we removed the tick.
How about our other kids who had more ticks than him? None ever displayed any symptoms, without any treatment.
What could have happened if his treatment were further delayed? Some people eventually improve without any particular treatment. Some continue to decline with worsening headaches (Lyme Encephalitis) or cardiac manifestations. It is now the standard of care to check a tick panel for any patients presenting with complete heart block - a potentially fatal condition which usually requires a pacemaker to correct.
Chronic Lyme: This is still a controversial topic. My personal belief is that Lyme serves as a scapegoat for other, more difficult to understand conditions. At this point I advocate for early presumptive treatment of acute manifestations, but I defer to Infectious Disease or Rheumatologists to direct atypical courses of treatment.
Alpha-Gal
Several years ago a good friend called me to talk through why he might have trouble swallowing. After multiple doctor visits and lab tests it was established that he had a relatively rare condition called Alpha-Gal - an allergy that can develop after a tick bite. It can cause narrowing of the esophagus, (which explained his choking episodes) as well an allergic reaction to mammalian meat proteins. This “allergy” can be lifelong or can improve after several months. In his case it lasted 10 years!
Other Infections
The standard tick-borne panel tests for multiple other infections including Rocky Mountain Spotted Fever, Ehrlichiosis, Babesiosis and Anaplasma. Many tick-borne infections are polymicrobial - meaning that more than one organism is present - and though most of the infections are treated with the same antibiotic, (doxycycline) comprehensive testing is ideal.
Important Links
Tick Testing - Costs about $100, probably not necessary but is available
