In recent years, more and more patients come to hospital emergency departments across the country asking for tick removal. Knowing the possible dangers, especially infection with Borrelia or the tick-borne encephalitis virus (TBE), we became afraid. Doctors say that fear often turns into hysteria and terrified patients appear at emergency rooms, demanding immediate removal of the tick from the navel or groin. And when a doctor or a nurse goes to work, it turns out to be just a fluff or a scab … So the first rule when you suspect a tick bite is: don’t panic.
- If we are unable to remove the tick by ourselves, it is best to seek help in overnight medical care facilities or in the GP clinic.
- Self-observation after removing the tick should last two to four weeks
- We do not have to test the removed ticks for Lyme disease
- The doctor recommends that everyone who works or is very often in the forest vaccinated against tick-borne encephalitis
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How to proceed so that the walk in the forest does not end with enormous stress caused by a small arachnid, advises Dr. Michał Jan Dworzyński, an emergency medicine specialist working at the Hospital Emergency Department of WWCOiT named after M. Kopernik in Łódź.
Monika Zieleniewska, MedTvoiLokony: Is the waiting room in the emergency department where you work often occupied by patients reporting ticks?
Dr. Michał Jan Dworzyński: Fortunately not. It seems to me that the appeals not to come to emergency departments, especially large facilities, with a tick problem, have worked. It is true that I work in Lodz in the center of a large city and there are fewer people with ticks coming to us. I believe that patients who undergo tick removal surgery prefer to go to the family doctor or to the overnight emergency care, although I suspect that if we had asked doctors from emergency departments in district hospitals, it would have been different.
If we are not to rush with a tick stuck in the skin at the ED, where to seek help?
First, let’s not panic. Virtually anyone can deal with such a situation on their own, as well as with a minor cut, sore throat or skin abrasion as a result of wearing uncomfortable shoes. This is the same category of emergencies. Anyone with elementary knowledge should first try to cope on their own.
The method of removing the tick is described in detail, e.g. on the Internet. Only in case of trouble, one should contact the medics. Of course, emergency departments are open to anyone seeking help, but it must be remembered that they are primarily aimed at saving health and life. Someone who wants to remove a tick should consider looking for help elsewhere, after all, we have well-functioning overnight medical centers and GP clinics. Let’s incorporate common sense and head to those places that will easily deal with a trivial medical incident.
When, then, should we seek help from a doctor?
First of all, after removing the tick, you should start self-observation, approaching it with common sense. An alarming sign is the formation of skin changes in the form of erythema or redness in the area where the parasite has entered and local soreness, and these changes are progressing. I am not talking about a slight reddening at the point where the injection was made, but about reddening elsewhere or increasing redness at the injection site; especially with erythema of more than 5 cm in diameter. Then we should really consider making an appointment with a family doctor for consultation.
When such erythema is observed, it is worth noting, e.g. with a pen on the skin, how big the change on a specific day is and compare its size on the next day. We can also take photos with a mobile phone, adding a reference point, e.g. by applying a ruler or a match, so that you can see whether the change is growing, how its color and appearance change. Such documentation can later help the doctor or even the patient himself to make a decision about further treatment.
Another reason to see a doctor is if you develop a fever, tiring malaise or flu-like symptoms within a few weeks after the bite. Don’t forget to inform your GP that they may be tick-related.
The third indication for a medical consultation is to leave a large fragment of the arachnid in the skin, which we cannot pull out. Again: I am not talking about a millimeter fragment, but a large fragment, especially when its presence causes significant inflammation. These three signals should prompt us to contact a specialist. And it is still not the case that we have to rush for help at night. It is enough to make an appointment with the doctor, e.g. in two days. Even if he or she decides that the situation requires treatment, there will be enough time to implement it.
Playing surgeon can turn out to be dangerous?
I would suggest not to pull out larger fragments of the tick’s mouthpiece on your own. Do not rummage in the skin with contaminated needles. I know from experience that those fragments stuck in the skin are very difficult to remove and even here at the ED, their removal usually ends with a need to cut out a tiny piece of skin with a needle or a scalpel along with what is in it. This can hurt, especially if the tick is stuck in a sensitive area.
I understand that such a procedure performed by a doctor is short?
Yes, but the doctor will not always want to remove this residue, as it may traumatize the tissues so much that the legitimacy of the procedure will be questioned. Sometimes such a fragment remains for observation. Besides, the body removes foreign bodies itself. The same happens with a tick fragment as with a splinter stuck in the skin. It packs, pus forms around the foreign body and then the foreign body is removed with it. We wash such a shift with a disinfectant several times a day and it is enough.
How long should we watch each other?
Two to four weeks after being bitten. If something goes wrong you should make an appointment with a doctor who needs a good interview. We inform him what happened, when it happened and what was the development of the disease symptoms. This will give him full insight into the situation and make it easier to make the right decision. That is why it is worth remembering when the next events occurred, but it is certainly a good idea to take some common sense and calmness.
Coming back to removing the tick yourself. Do we focus on a tool purchased at a pharmacy or drugstore?
First of all, it is worth opening the Internet and looking for videos or picture instructions on removing the tick, e.g. on the websites of the Ministry of Health or the National Health Fund. It is worth getting acquainted with them just in case before a trip to the forest, so as not to be unnecessarily nervous afterwards.
The key is to remove the tick relatively quickly, but to remove it, you need to find it first. If we were in the forest, it is best to watch ourselves in the evening. Especially check the groin, genitals, armpits, neck, hairy skin and areas behind the knees. There, ticks have the best access to the skin.
If we find a tick, we don’t panic. The risk of contracting any serious disease after a single bite is negligible. In addition, it drops the more the faster the tick is removed. I’m not talking about minutes, but about time in hours. So if we find a tick in the forest, and we do not have tweezers or any other tool with us, we calmly go home and try to remove it with good lighting.
You definitely shouldn’t lubricate it with anything. Also, do not try to remove it with fingers or other devices that are not intended for it. In my opinion, the best way to remove a tick is to grab it as close to the skin as possible with a pair of narrow-tipped tweezers and remove it by firmly pulling it straight up. No twisting.
And there is a school that advises to twist after all.
There is, but everyone is lost, which way to turn … In fact, to remove a small tick, because most often we find ticks that have recently stuck in, tweezers are completely enough.
Is it worth buying special forceps at the pharmacy?
Of course. All dedicated devices with different operating mechanisms are highly recommended. Their operation is modeled on a crowbar or a nail extractor, or they have a special loop in which a tick is caught. Before going into the forest, it is a good idea to protect yourself and prepare a pair of narrow-ended tweezers or one of these devices. If we decide to use a tick trap, we should first read the manual carefully.
Tools for removing ticks are available from Medonet Market. You will find here both a handy kit for ticks, mosquitoes and flies, as well as a repellent spray + preparation for freezing and removing ticks.
Before we start removing the tick, we wash our hands and the instrument or tweezers should also be clean and disinfected. Remember that after removing the tick, the area where the injection has been injected should be disinfected either with hydrogen peroxide or a spirit containing alcohol. Hydrogen peroxide or a preparation containing alcohol is the best, but if the pharmacist tells us otherwise, it will also work.
It is enough to disinfect once?
I suggest once after removing the tick and repeat the disinfection of this small morning several times a day.
You will find preparations for disinfecting wounds in Medonet Market: Microdacyn Wound Care – a preparation for disinfecting wounds and Octenilin for cleaning and disinfecting wounds.
I am worried when a tick enters the back of my neck. Then what?
In fact, medical or nursing help may be needed when a tick sticks into an area to which we have limited access. If we have it in the hair on the head or near the buttocks, in the buttock crack or on the back surface of the knee, it is difficult to operate efficiently there. In such a situation, I do indeed see indications for going to the overnight emergency care. If we try to get rid of the parasite ourselves, we can dismember it.
What to do with the tick that we have removed?
Commercial testing for Lyme disease, for example, is available, but routine testing for ticks is not recommended. I believe that the risk of Lyme infection is small, even if the tick was a carrier. My position is that we can forget about tick testing.
So we crush him and throw him away?
Yes, we should throw it away and that’s it.
Since we are concerned about tick-borne encephalitis, maybe it is worth getting vaccinated?
There is no vaccination for Lyme disease, for tick-borne encephalitis. Risks should be considered prior to vaccination. It seems to me that if we go for a walk in the forest or pick mushrooms every now and then, the risk of infection is small. On the other hand, if we work in the forest, we go there often and do not walk on paved roads, but go deeper into the forest, rubbing against plants or walking into tall grass, the risk of catching a tick, and thus becoming infected, increases.
In medicine, we cannot say anything 100%, we always estimate the risk. By eating unhealthy food, we increase the risk of ischemic heart disease or stroke, but we do not give it to ourselves for sure. I am an advocate of vaccinations and would recommend them to all who visit the forest relatively often. In this case, I would get vaccinated because tick-borne encephalitis, although not common, is indeed a dangerous disease.
If we have doubts as to whether it is worth getting vaccinated, I recommend that you make an appointment with your family doctor and discuss this option with him. In my opinion, when someone goes on vacation and plans to spend the whole month in the forest, they should consider vaccination.
Nevertheless, we do not forget about protective measures against going to the forest.
Of course, it should be emphasized how important prevention is. Why should we stress about pulling out a tick when we can protect ourselves against it. When going to the woods, we wear closed shoes, long pants and long sleeves, preferably with welts around the ankles and wrists. It is good to take some headgear as well. Make sure to use a repellent.
There are a lot of tick repellants, and most of them are highly effective. A typical repellent with proven effectiveness is DEET, available in pharmacies and drugstores. Before using the selected preparation, we should read the leaflet with the instructions for use, because some are applied directly to the skin, and others only to the clothes. You should also remember to wash the area where you used it with soap and water after using the repellent and after returning home.
You will find DEET, or N, N-Diethyl-m-toluamide, in the MUGGA Mosquito & Ticulus Kit. 50% spray DEET + Spray 9,5 percent You can buy DEET in Medonet Market.
We encourage you to listen to the latest episode of the RESET podcast. This time Joanna Kozłowska, author of the book High Sensitivity. A Guide for Those Who Feel Too Much »says that high sensitivity is not a disease or dysfunction – it’s just a set of characteristics that affect the way you perceive and perceive the world. What are the genetics of WWO? What are the perks of being highly sensitive? How to act with your high sensitivity? You will find out by listening to the latest episode of our podcast.