Finding Lyme Literate Doctors (LLMD), IGeneX Tick Talk
How to Find Doctors Who Can Help with Your Tick-Borne Disease
- 1 How to Find Doctors Who Can Help with Your Tick-Borne Disease
- 2 Tips for Finding a Doctor for Your Tick-Borne Disease
- 3 How to Approach Your Non-LLMD Doctor
- 4 Treatment Starts with Accurate Diagnosis
- 5 How soon should you see a doctor after a tick bite?
- 6 How soon should you see a doctor after a tick bite?
- 7 Allergic reaction
- 8 Get on top of your general health
- 9 Tick paralysis
- 10 Tick-borne disease
- 11 How to remove a tick from a person
- 12 Next steps
- 13 Links
- 14 Do I Need to Go to the ER to Remove a Tick?
- 15 Interview Transcript
- 16 I’ve Been Bitten By a Tick! What Do I Do?
- 17 What kind of ticks should I watch out for?
- 18 How do I prevent tick bites?
- 19 What if I find a tick on my skin?
- 20 What do I do after I’ve been bitten?
- 21 What do I do if I think I have Lyme disease?
- 22 Antibiotics Can Prevent Lyme Disease
Diagnosing and treating a tick-borne disease can be highly complex. Having a doctor who is trained and experienced in caring for patients with these illnesses can help ensure that you achieve the best possible health outcome. Luckily, there is a growing number of Lyme disease experts who can provide diagnostic testing and proper treatment for Lyme and other tick-borne diseases.
However, where do you start? What do you look for in a doctor? What specialist treats Lyme disease and other tick-borne diseases? What questions should you ask? The following article provides some useful suggestions to help you answer these and other questions so you can find and connect to the right doctor for your needs.
Tips for Finding a Doctor for Your Tick-Borne Disease
1. Identify doctors trained in the diagnosis and treatment of tick-borne diseases.
You can access a variety of online resources and directories to locate doctors who are specifically trained in identifying and treating tick-borne illnesses. These do not have to be infectious disease specialists – they can be physicians from any practice area who simply have extensive experience with tick-borne diseases.
It is particularly important to find a Lyme expert if you suspect that you may have Lyme disease, since it is the most frequently misdiagnosed of all tick-borne diseases. Finding a Lyme-literate medical doctor (LLMD)—a physician who is familiar with the vast range of symptoms that may indicate infection at various stages of the disease, as well as potential coinfections and other complexities—can help ensure that you get the right treatment, right away.
To find a doctor who is also a Lyme expert, you may want to explore the following resources:
Note: Some of these organizations may require you to submit a form or create a login to access their databases.
2. Do your research and get referrals.
You can learn a lot just by researching doctors and reading patient reviews online. You can also connect with other patients through local and online support groups for various tick-borne diseases. Asking other patients to recommend or share their own experiences with different doctors can be particularly helpful when you’re trying to locate and learn about physicians who specialize in various tick-borne illnesses.
The following sites can connect you to online support-group forums or help you identify different tick-borne support groups in the United States:
3. Call ahead and ask questions.
Even if you find a doctor who specializes in treating tick-borne diseases, you will want to ask some questions before making an appointment and committing your time and money. A few basic questions to consider asking upfront include the following:
- What is your experience in treating patients with tick-borne diseases?
- How do you diagnose diseases? Do you use any specific labs or lab tests to confirm diagnosis?
- Do you test for coinfections?
- Do you use traditional antibiotics and/or herbals?
- Do you have any patient success stories you can share?
- Do you strictly adhere to CDC test interpretation criteria or are you open to alternative criteria?
If you’d like to find a LLMD and want to know more about how to vet them, read the Tick Talk blog, What Makes a Doctor Lyme Literate?
4. Be prepared for your doctor visit.
You can improve your chances of having an accurate diagnosis and effective treatment by providing your doctor with as much information as you can from the very start. The following checklist can be a good reminder of what to bring and discuss with your physician at your first visit:
- Have the tick tested and/or identified:If you were able to remove or find the tick that bit you, seal it in a glass or plastic container and consider sending it to IGeneX for testing. Additionally, photograph the tick and/or have the species identified ahead of time if possible. Knowing what kind of tick bit you and, in particular, whether it has tested positive for a tick-borne disease can be extremely helpful for your doctor’s diagnostic process. If the tick is still being tested when you see your doctor, you still may be able to start treatment based on the severity of your symptoms.
- Note possible exposure: Write down the places and dates that you believe you were exposed to ticks—and the possible date and time of day when the engorged tick attached and fell off or was removed.
- Track your symptoms: Keep a running log of all symptoms you’ve noticed since the tick bite, even if you’re no longer experiencing them. Be sure to include the days/times when symptoms appeared (and disappeared). For additional help, you can use IGeneX’s Symptom Checker.
- Take pictures: Take pictures of any rashes or blisters that you may have noticed at the site of the tick bite or elsewhere on your body.
How to Approach Your Non-LLMD Doctor
For various reasons, you may choose to consult with a doctor who doesn’t specialize in Lyme disease or other tick-borne diseases.
If so, be sure to be as proactive as possible in providing information that could help in diagnosing your disease, and always feel free to share resources that you find in your own research to prompt discussions about any aspect of your diagnosis or treatment, including more advanced testing options.
If your doctor does not believe Lyme disease exists, reach out to another doctor for a second opinion.
Treatment Starts with Accurate Diagnosis
The only way to get the proper treatment for your tick-borne disease is to get the right diagnosis in the first place – and one of the best ways to do that is, if possible, to see a physician who’s experienced with tick-borne diseases. Accurate diagnosis also requires high quality testing at a reputable lab. Learn more about why doctors and patients trust the tests offered by IGeneX.
How soon should you see a doctor after a tick bite?
How soon should you see a doctor after a tick bite?
If you have a tick bite and are not sure on whether you need to see a doctor, we recommend reading this article to understand your situation better.
Each individual reacts differently to tick bites, and some symptoms may only appear days or weeks after the tick bite. As a general precaution, you should see a doctor as soon as possible after a tick bite.
If you are unable to identify what kind of tick was responsible for biting you or how long the tick has been attached to your body for, it is recommended to go to the doctors as soon as you are aware of the tick bite.
Tick bites can trigger allergic reactions including anaphylactic shock as well as the passing of other contracted diseases that may be dangerous or even fatal.
Further, allergic reactions should also be taken into consideration due to individual reactions including swelling of the throat which may lead to difficulties in breathing or even collapse.
It is important to immediately seek medical attention where symptoms of an allergic reaction occur. In cases where you have experienced a previous tick bite that caused a reaction, it is always a good idea to be prepared for the future by having useful equipment at hand.
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Tick paralysis in humans is rare in Australia and caused by the paralysis tick (Ixodes holocyclus). It is responsible for over 95% of bites on humans in the eastern states of Australia. Paralysis ticks are not known to be found in WA, SA or the NT.
Early symptoms of tick paralysis may include:
- Flu-like symptoms
- Tender lymph nodes
- Weak limbs
- Partial facial paralysis
If you are experiencing any of these symptoms, see a doctor immediately.
There have been serious cases of tick-borne diseases occurring in Australia such as the Flinders Island spotted fever in Tasmania and the Queensland tick typhus.
Other serious illnesses passed on by ticks include lyme disease, although there is little evidence that it occurs in Australia.
How to remove a tick from a person
It is highly recommended to remove the tick as quickly as possible but with care and precision. The priority during the removal process is to avoid any tick remnants left in your body, such as its teeth.
- Grasp the tick with a fine-tipped tweezer as close to the surface of the skin as possible
- Steadily pull the tweezers upward avoiding any breakage of the tick’s mouth parts
- Do note that the longer the tick has been attached to your body, the higher the risk of any transmission of diseases
If you are concerned about a tick bite, are having trouble removing the tick or are unsure if you have removed it fully, see a doctor.
HealthEngine can help you find and book an appointment with your regular GP or another experienced professional at a practice near you.
This article is for informational purposes only and should not be taken as medical advice. If in doubt, HealthEngine always recommends consulting with a registered health practitioner.
Q: Where can I find GP clinics?
A: Use HealthEngine to find and book your next GP appointment. Click on the following locations to find a GP clinic in your state or territory.
This article is for informational purposes only and should not be taken as medical advice. If in doubt, HealthEngine recommends consulting with a registered health practitioner.
Do I Need to Go to the ER to Remove a Tick?
Coming home from an outdoor adventure and seeing a tick can be a scary thing. What’s the best way to remove a tick, and when do you need to visit a doctor? Dr. Troy Madsen shares when it’s appropriate to visit the doctor, and what treatments are available if a tick bites you.
Interviewer: You come back from a hike and you find that you have a tick on you. Is that something that you need to go see a doctor for? We’ll talk about that next on The Scope.
Announcer: This is «From the Frontlines with Emergency Room Physician Dr. Troy Madsen» on The Scope.
Interviewer: Dr. Troy Madsen is an emergency room physician at University of Utah Health Care. If you ever get a tick on you, is that something you need to go see a doctor about? Or is it something you can just kind of take care of on your own? Should I be a «do it myself» kind of guy with a tick or come see you?
Dr. Madsen: It’s not an uncommon question. It’s more of these questions where I may have a family member ask me this sort of thing, like, «I went out hiking. There’s this tick.»
Interviewer: Do you go to the ER for a tick?
Dr. Madsen: I wouldn’t. Generally, not. It’s probably something you could see your doctor for. But there are certain things you’re looking for. When we think about ticks, we think about infections. We’re fortunate in Utah that the more serious infections you think about with ticks aren’t really such a big issue, like Lyme disease and Rocky Mountain spotted fever, which is funny. It’s called Rocky Mountain spotted fever, but it’s not so much in the Rocky Mountains. I think it was discovered in Denver and that’s how it got its name. But it’s more in the Southeast that that’s an issue.
But regardless, if someone comes and they say, «Hey, I had this tick on me,» I’m asking them, «How long was it on you?» They may not know exactly, but they may say, «Okay. I was camping. I’ve been home for two days.» If that’s the case, I’ll say, okay, it’s probably been on there at least 48 hours. Typically in those cases, we give antibiotics to prevent any kind of infection from the tick. Kind of the rule of thumb is if the tick’s been there for 24 to 36 hours, we’ll start antibiotics just to prevent an infection.
Now, if you’ve had a tick and it’s been on you and you look at that spot where the tick was located and you start to see redness around there, like a circular sort of rash, maybe some puss in that wound that have kind of built up, then I’m more concerned, number one, about an infection from the tick, like a head being embedded in the wound. Or, number two, an infection that a tick has transmitted to you, like Lyme disease. Again, reasons to see a doctor.
But I think the bottom line is if you see a tick on yourself, let’s say you’re out camping, you pulled the tick off, you get rid of the tick, you don’t need to feel like you need to rush right into the ER. Unless you’re seeing some of these other things.
Interviewer: So is that the way to get rid of it? Just pull it out gently with tweezers? My dad used to go to the gas cans. I lived out on a ranch and he’d put gas in a a baby food jar and turn it upside down on the tick until it backed out. Or I’ve heard maybe nail polish. You put nail polish on them and they have to back out.
Dr. Madsen: Yeah, I’ve heard these things too. Some people have said to put petroleum jelly on it because the tick breathes through its body. I’m not a tick expert. There are probably tick experts out there that are cringing as I say this.
Interviewer: So we don’t know if they breathe through their body or not, is what we’re saying.
Dr. Madsen: I’ve heard people say that and then the tick will back out. I think one of the challenges with those is sometimes, it just makes the tick sit there and just makes it kind of moist. And then it becomes harder to pull it out. The thing I’ve learned is just to grab some tweezers, grasp down by the tick’s head.
Interviewer: As close to the head as you can get, close to the skin, probably.
Dr. Madsen: Yep. And then just pull directly back.
Interviewer: Pull straight out.
Dr. Madsen: Pull straight out and then drop the tick in some water, like a toilet or something like that so it’s not climbing on someone else or climbing on your pet. Just so you’re drowning the tick and getting rid of it.
Interviewer: And if you end up doing that, breaking the head off, then you need to go see a doctor? No?
Dr. Madsen: Possibly.
Interviewer: The body could handle that? Is that what you’re . . .
Dr. Madsen: If you did break the head off and you came in, I would probably put you on an antibiotic for a few days and tell you to watch for signs of infection. But the reality is the head’s probably not going to be that deep where it’s going to cause any major issues. And it’s probably just going to work its way out within a few days anyway.
Interviewer: So watch it for those other symptoms you talked about.
Dr. Madsen: Watch for those other symptoms, primarily. You’re right. If you came in, I would probably say, «You’ve got the tick head still in there. Let’s just put you on something for a few days just to prevent any infection from that.»
Interviewer: But an urgent care could handle that?
Dr. Madsen: Exactly.
Interviewer: All right. Or a doctor the next day.
Dr. Madsen: Exactly, yeah. Not an emergent thing to get into an ER.
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I’ve Been Bitten By a Tick! What Do I Do?
More than a dozen tick-borne diseases from a variety of ticks have been identified in the US alone. Some you’ve heard of—Lyme disease and Rocky Mountain spotted fever—while some are less familiar—babesiosis, anaplasmosis, and Heartland virus.
The most common is Lyme disease, caused by a spiral-shaped bacterium, or spirochete, called Borrelia burgdorferi. While the incidence of Lyme disease is rapidly growing, the good news is that most tick bites can be prevented or treated.
What kind of ticks should I watch out for?
Black-legged Ixodes ticks carry the Lyme disease bacterium and like to feed off various animal hosts. The highly infectious young nymphs prefer the white-footed mouse while the larger, less infectious adults have a predilection for deer. Since these animals live in wooded areas with tall grass, you should avoid these places.
How do I prevent tick bites?
The first step is to avoid wooded areas, but if you’re a hiker or camper, minimize your risk by walking in the middle of paths and trails. Use insect repellent containing 20 to 30 percent DEET on all exposed skin and clothing, tuck pant legs into your socks, and wear long-sleeved shirts. Clothing treated with 0.5 percent permethrin, another repellent, will stay effective through several wash and dry cycles. And don’t forget your pets. Not only are pets susceptible to many diseases from ticks, they can also bring ticks into your home. Talk to your veterinarian about monthly flea and tick repellent treatments and if you have a yard, treat it with acaricides. One spraying in late spring will reduce the number of nymphs, and another in October will reduce adult ticks.
What if I find a tick on my skin?
Don’t panic—not all ticks are capable of spreading Lyme disease. Ixodes nymphs are the size of a poppy seed and have black legs while adults are much larger, often a half inch long. The good news is that because the Borrelia spirochete lives in the midgut of the tick, and it takes at least 36 hours for the spirochetes to migrate to the tick’s salivary glands. Therefore, it’s very rare to get Lyme disease unless the tick is attached to your skin for at least 36 to 48 hours. In most cases of Lyme disease, the evidence suggests that the tick was attached for at least 72 hours.
No matter how long the tick has been attached, you want to get it off. Use tweezers or small forceps (or your fingers if no other tool is available), grasp the tick close to the skin and pull up firmly with steady pressure—no squeezing or twisting, which could push more saliva into the wound. Disinfect the skin and wash your hands with soap and water. If it looks like parts of the mouth are still in your skin, don’t worry—these aren’t dangerous and your body will expel them.
What do I do after I’ve been bitten?
If you know the tick has been attached for less than 36 hours, you have little concern. If it has been longer or you’re not sure, there are a couple of options:
In carefully prescribed situations, you can take a single dose of doxycycline (200 mg), an antibiotic. This can significantly lower the risk of Lyme disease, but only makes sense if all of the following conditions are met:
- The tick is a nymph or adult Ixodes tick
- You know it has been attached for more than 36 hours and you can take the doxycycline within 72 hours of it being removed
- At least 20 percent of ticks in your area are infected with the Borrelia spirochete (this is the case in much of New England, the Mid-Atlantic states, Wisconsin, and Minnesota)
- You don’t have any conditions that prevent you from taking doxycyline (no other antibiotic will work)
Watch and Wait
More commonly, even in persons who meet all the criteria above, a watch and wait approach is fine. For the next 30 days keep an eye on the bite site for a rash and any flu-like symptoms (fever, muscle aches, etc). The typical Lyme disease rash, called erythema migrans, is usually painless and expands slowly over several days to resemble a bull’s-eye. A simple, small red lesion at the site of a tick bite is normal and doesn’t necessarily mean you have Lyme disease.
What do I do if I think I have Lyme disease?
If a rash or flu-like symptoms develop, see your healthcare provider. But don’t worry—diagnosed at this stage, Lyme disease is essentially 100 percent curable with antibiotic therapy.
Not every Lyme rash has all the classic features, so don’t hesitate to have your healthcare provider check it out if you’re unsure.
Antibiotics Can Prevent Lyme Disease
B O S T O N, June 12, 2001 — For the first time, doctors have shown that a quick dose of antibiotics can ward off Lyme disease after a tick bite, but they caution against overusing the treatment.
Some physicians already give antibiotics to people who are bitten by deer ticks, the bugs that spread Lyme disease. However, many experts oppose this, because there has been no clear evidence the treatment actually prevents the disease, even though antibiotics can clear up Lyme disease once it occurs.
Now there is proof the approach works. A study conducted in New York’s Westchester County, where Lyme disease is common, found that just two pills of doxycycline are highly effective if given within three days of a bite.
«Ours is the first study to show that Lyme disease can be prevented after a tick bite,» said the study’s chief author, Dr. Robert B. Nadelman of New York Medical College in Valhalla, N.Y.
The study, to be published in the July 12 issue of the New England Journal of Medicine, was released on the journal’s Web site early today because of its importance.
About 15,000 cases of Lyme disease are reported annually in the United States, mostly in the Northeast from Maine to Maryland; the Midwest in Wisconsin and Minnesota, and the West in northern California and Oregon.
Tick Bites Rarely Lead to Infection
While confirming the effectiveness of so-called prophylactic antibiotics, the study also shows that even in a Lyme-infested area, deer tick bites rarely result in infection. In fact, only nymphal stage bugs filled with blood posed a risk.
The latest study involved 482 people who had removed an Ixodes scapularis tick — the deer tick — from their bodies within the previous 72 hours and took it with them to the doctor for identification. They were randomly given either a 200-milligram dose of doxycycline or dummy pills.
The antibiotic was 87 percent effective at preventing Lyme disease, even though the overall risk was low, just 3 percent among those getting the dummy pills. This means it would be necessary to treat about 40 people to prevent one case of Lyme disease.
Still, Nadelman said it may make sense to treat people if they are bitten by a blood-filled nymphal stage deer tick in an area where Lyme disease is common.
Deer ticks go through three stages. Larval stage ticks have six legs, while nymphal and adult ticks have eight. An unfed nymphal tick is the size of a poppy seed and an adult the size of a sesame seed. Nymphal ticks exist in most places only from May through July.
Lyme disease causes fatigue, fever and joint pain that can persist for weeks, and some patients develop severe arthritis. Lyme also can badly damage the heart and nervous system if it goes untreated by antibiotics.
Signs include rash and flulike symptoms. Daily tick checks, vaccinations and insect repellent are recommended as preventive measures.
The idea of giving antibiotics to tick bite victims even before they show signs of Lyme disease has long been controversial. Last year, the Infectious Diseases Society of America released guidelines saying this should not be done routinely.
«Guidelines are made to be revised and revisited,» said Nadelman, who helped draw up last year’s recommendations. However, he said doctors should use antibiotics judiciously, because the medicine can cause nausea, especially if taken on an empty stomach.
«The danger is whether it will be used in situations where there is a very low chance of someone having Lyme disease,» said Dr. Alan Barbour of the University of California at Irvine.
«People hear about this and ask their doctor, and the doctor is more likely than not to go along with their requests.»
Barbour said doctors should be taught in medical school how to identify deer ticks. Some confuse them with other creatures, such as tiny spiders, lice and other more common kinds of ticks.
Most people who get Lyme disease can be cured with antibiotics, although occasionally people have lingering symptoms. Other research in the journal from Dr. Mark S. Klempner of Boston University School of Medicine found that prolonged antibiotic treatment is ineffective against this condition.