Beth Gottlieb MD Ped Rheumatology wwwDrMDK.com
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Interviewer: If you have a tick bite and you did not notice it and it was on your body for more than a day or two, should you save the tic, should you throw the tic away? What would be the approach to that problem? Interviewee: Unfortunately, there really are not very many places that test the tic anymore that is used to be done and people would be able to examine that tic and determine based on the size of the tic how long it had been attached to the body and what the risk was of getting the infection. It is really not a very practical thing to do. You really need to be expert in that to make any kind of determination. Interviewer: A small, little bite. Interviewee: A tiny tic, a very small tic is unlikely to have been there for a long time and these are tics that are very small as opposed to dog tics, the kinds that you might find on your pet. These tics are very tiny, about the size of a poppy seed or if you took a magic marker and put a dot on your skin, that is about the size of these tics. As they stay attached and they have a blood meal, they do grow in size. So, if it has been there for a while it will look bigger. The important thing to do is to talk to your doctor because your doctor may do a blood test right then as a baseline to see if you have already been exposed to Lyme in the past. Many patients who lived in areas where Lyme disease is very prevalent have already been exposed at some point and they did even know. They never got sick but they may have been exposed. So, by doing that Lyme test, you can tell what the baseline is and then six to eight weeks later that test can be repeated to see if suddenly that patient has become positive. The other things to look for is the very typical rash which looks like a bull’s eye and that rash might be near the tic bite but it does not have to be near it. And that looks like a red patch that slowly expands and it becomes bigger and looks like a ring in the end, just like a bull’s eye. That would be a typical rash of Lyme disease and a physician who is told or sees that the rash on the patient would start antibiotics even regardless of the test results. Interviewer: In pediatrics, what would be the drug you would normally use in a kid about six or seven years old? Interviewee: Yes, the age is important because under a certain age, we do not use certain types of medication because the child is growing and some antibiotics have side effects so under that age, we give very easy medicine like amoxicillin and we give it for weeks and most children do extremely well and it will get rid of the infection. Interviewer: How long is it given? Interviewee: That there is, between two and four weeks. Interviewer: In that range. Interviewee: In that range. Interviewer: If it was an older person, 15 or older, what would you use as your drug of choice? Interviewee: Then the best medicine is an antibiotic called doxycycline and that works very nicely also to get rid of the infection. Interviewer: How long would that be again in general? Interviewee: Again, the same course, about two to four weeks.
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