Here at 45 degrees north, tick season is practically year round. Any time the ground isn’t frozen, ticks may be present and looking for a host to feed on. One found me in May. This is not unusual. Nor is it unusual to be faced with conflicting choices about what to do when that happens.
But this time, I learned some things that may change my approach to tick bites in the future – just in time for the surge in tick activity we expect every autumn.
The backstory. My husband and I are people who do things outdoors, including hikes in the woods, gardening, hunting and fishing. And we’re dog people. Every dog we’ve had for the past 40 years has suffered a tick-borne illness. When a canine vaccination against Lyme became available, it became a line item on our regular veterinary care budget. The current canine in our family regularly tests positive for anaplasmosis, another tick-borne illness.
We know people, too, who have had tick-borne illnesses. Back when those were still uncommon in this part of the country, it took a lot longer to get a diagnosis and treatment. So we learned to tuck our pant legs into our socks, wear light-colored clothing to make creepy crawlies easier to spot, strip on the porch, and perform tick checks after being out and about. Those prevention measures are just routine now.
Prevention was particularly important to us in the 30 years we were self-employed people paying out-of-pocket for high-deductible health insurance with premiums that dwarfed our mortgage payment. We didn’t think we could afford to be without health insurance. But to keep it, we really couldn’t afford to use it for anything that wasn’t pretty darn serious.
During that time, I had one tick bite that produced what seemed to be the bullseye rash associated with Lyme. So I went to the doctor, who prescribed a course of antibiotics. That year I had already been treated with oral antibiotics for a stubborn chronic skin condition and again for bronchitis that persisted, leading to a secondary infection. I was grateful that modern medicine has effective tools for treating those conditions. But all that was expensive. My digestive system was upset for ages. And I worried about becoming a human Petri dish that might grow antibiotic-resistant bacteria.
Years passed. We removed countless ticks from ourselves – mostly before they had a chance to attach. Occasionally, I would miss one, which I would pull off and save in a baggie just in case. But we seemed to be managing our life okay with the strip-on-the-porch protocol. Until this May.
The bite. In May, I missed a tick the size of a sesame seed that found its way into the deepest part of the crease at the back of my left knee. I didn’t see it, didn’t feel it, and didn’t knock it off in the shower or when I toweled dry. When I woke up scratching, I could feel a tiny bump. My husband could see then that it was a tick. He pulled it off for me, taking skin with it.
Since it had been so firmly attached, I saved the tick in a plastic bag marked with the date. Later that day, we took a picture of the area where the tick had been attached. There was a small bruise there. And it itched – my typical response to insect bites.
The itch got worse. There was redness and swelling – so much swelling that I finally had my husband outline the edges of the inflammation with a Sharpie so we would know if it continued to grow. It didn’t look like a bullseye. But a week after the bite, I took my still-crawling-in-the-baggie tick and went to the walk-in clinic.
Prophylactic treatment. If I had sought help sooner, chances are I would have received a single prophylactic dose of doxycycline. That’s a pretty common protocol now in my area – whether or not a bullseye rash is present. It’s considered a safe, effective way to reduce the potential for Lyme disease after a high-risk bite. The CDC suggests that providers consider it when the bite occurred in an area where ticks are likely to be infected with Borrelia burgdorferi, a bacterial species known to cause Lyme disease in humans. Other factors considered include:
In Wisconsin, ticks may be present and looking for a host to feed on any time the ground isn’t frozen – even in winter. (Photo by Donna Kallner)
If the bite may have been from an Ixodes tick (around here we call that a blacklegged or deer tick).
If the tick’s body was engorged with blood.
If the tick was removed within the past 72 hours.
A friend told me that’s what her doctor prescribed for a tick bite she had around the same time as mine. Unfortunately, by then mine was beyond the 72-hour window.
What I did instead. Instead of calling my primary care provider (a nurse practitioner), I went to the walk-in clinic. The physician’s assistant who saw me there prescribed a 10-day course of doxycycline. That, he explained, could help protect against Lyme but would also be an appropriate treatment if the rash were from cellulitis, a bacterial infection of the skin.
My symptoms were limited to an itchy rash that was raised, warm, and grew to the size of a fist at the back of my knee. But I had no fever or chills, which are common symptoms of tick-borne diseases. And I had experienced no headache, fatigue, muscle aches, or new joint pain before going to the walk-in. In the absence of those symptoms, a Lyme test could be an option, the PA said. Or I could take doxycycline for 10 days, monitor for symptoms, and follow up with my PCP.
So I took the doxy. I increased my intake of probiotic fermented foods. And I was super careful to cover up outdoors but still managed to get a painful sunburn on my hands.
But the redness, swelling, and itching behind my knee did go away.
The follow-up. When I followed up with my PCP, I did report fatigue. The timing strongly suggested that symptom was related to exposure to wildfire smoke rather than tick-borne illness. She reviewed clinical notes and my description of the rash I experienced after the tick bite. After talking with her, I felt pretty confident that it was, in fact, cellulitis resulting from the break in the skin caused by the tick bite rather than a symptom of tick-borne illness.
Nevertheless, I asked about testing for Lyme. And once again, my symptoms did not seem to indicate the need for testing at that time.
Testing, testing… Nowadays if you go to a clinic with a respiratory virus, they can pretty quickly determine if it’s RSV, Influenza A, or Covid. The same is not true of Lyme disease, which relies on a blood test that detects antibodies to the Lyme bacteria. It can take several weeks after infection to make enough antibodies to be detected by the test. In the meantime, an expensive antibody test can come back falsely negative. Even if someone has received the prophylactic single dose of doxy, they can develop symptoms of Lyme or co-infections. They need to continue monitoring for the possibility of tick-borne illness – especially when symptoms of tick-borne illness are easy to mistake for a “summer flu”.
Once infected blood does test positive for antibodies, it’s likely to continue to test positive for months to years – even when the bacteria are no longer present. Unfortunately, those antibodies don’t reliably prevent re-infection if you’re bitten by another infected tick.
Beyond Lyme. Lyme is not the only tick-borne disease. The “big three” in Wisconsin are Lyme, anaplasmosis, and babesiosis. Ehrlichiosis is uncommon here, but a new agent of ehrlichiosis called EMLA has been reported. Rocky Mountain Spotted Fever is rare here, and most people infected with it were exposed elsewhere. Some tick-borne illnesses can be transmitted in far less time than Lyme.
A person can actually have more than one tick-borne disease at a time. That’s called co-infection. The most common co-infection with Lyme disease here is anaplasmosis, which rarely causes a rash. Some co-infections require treatment different from Lyme. So it’s important to take monitoring symptoms seriously, and to see your healthcare provider if disease symptoms don’t seem to go away after taking antibiotics.
Target the source. I learned one more thing from my recent tick bite. The University of Wisconsin (UW) advises targeting the mice that serve as important hosts for ticks as well as sources of the Lyme spirochete and other pathogens. The UW trials suggest that the abundance of ticks on mice can be reduced by providing nest material treated with an insecticide.
An extra-strong El Niño weather pattern is forecast this year, which in Wisconsin probably means a mild winter is coming. And mild winters here always seem to result in a boom in the populations of both mice and ticks the next year. So I think we’ll be investing in “Tick Tubes” to place in our yard and outbuildings. If those help reduce our potential exposures to ticks and tick-borne illnesses, I’ll be happy.
But we’ll still be stripping on the porch after spending time in the woods.
Donna Kallner writes from Langlade County in rural northern Wisconsin.
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