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Archive for the ‘Bites and Stings’ Category

zika virus

I’m quite concerned when the deputy director of the Centers for Disease Control and Prevention states that what authorities are learning about the Zika virus is “scarier than we initially thought.” There is certainly no need to panic at this time, but it does appear that this is a disease that we may eventually have to deal with in our locale. Fortunately, as of this writing, there have been no documented cases of mosquito borne Zika infection originating in California, only a few cases involving people who have returned after traveling to Zika infected areas outside of the U.S.

Zika infection is usually pretty mild. Most people infected with Zika virus won’t even know they have the disease because they won’t have symptoms. Pregnant woman are at greatest risk of complications to their fetuses and there are reports of associated Guillain-Barre syndrome (a rare paralysis of the body in infected adults).

On April 18th, the office of the Santa Cruz County Mosquito and Vector Control (MVC) released a report to the County Board of Supervisors about its local response to mosquitoes, including our native variety, which at this time does not transmit Zika, as well newly discovered more invasive species that have been found in other parts of California and have the potential to transmit Zika. These newer mosquitoes are, unfortunately, more aggressive and tend to bite more during daylight hours. The MVC office is increasing surveillance by setting out more traps throughout the county and asking for the public’s help in reporting any increased activity of mosquitoes biting during the daytime.

At this time the MVC advises us to:

  • Wear long sleeved shirts, pants, socks with shoes, and repellants when outside and anytime mosquitoes are present.
  • Dump and drain standing water sources around your property.
  • Report, to the MVC at 454-2590 any neglected swimming pools and other backyard standing water sources, as well as the observance of day biting mosquitoes.

These are a few of the safe, insect repellants even during pregnancy:

  • DEET (Off! Deep Woods, etc) is the gold standard repellant and is safe for kids over 2 months.
  • The stronger the DEET concentration the longer the time of protection.
  • Picardin (Natrapel, etc.) Less oily feel and odor than DEET but equally effective.
  • Oil of lemon eucalyptus (Cutter Lemon of Eucalyptus, etc.) for age 3 years and older.
  • Permethrin can be used on clothing or gear but not on skin.

If you are using sunscreen, apply it before using an insect repellant. When applying any repellant to children, spray it onto your hands and then apply to a child’s face.

Even if they do not feel sick, travelers returning to the United Sates from an area with Zika, should take steps to prevent mosquito bites for up to 3 weeks so as to not spread Zika to mosquitoes that could spread the virus to other people.

Again, no major need for worry about Zika virus in our community at this time, but it will probably arrive in the near future and we must be alert to this problem and begin to practice good mosquito bite protection practices.

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Tick Bites

tick bite

In Santa Cruz County, it is reported that less than five percent of the mature Western black-legged ticks and a somewhat higher percentage of the nymphal (baby) stage, carry the Lyme bacteria. Although many people worry after being bitten by a tick, the risk of acquiring an infection is quite low. In this article I’d like to discuss the tick bite and signs and symptoms of Lyme disease.

Neither the tick’s body nor its head burrows into the skin. Instead, the tick attaches by its mouthparts. An infected tick can transmit an infection only after it has been attached, taken blood from its host, and fed for 24 to 48 hours. If you find a tick on you that is unattached and non-engorged, it is unlikely to have transmitted an infection. Look carefully for the immature nymphal ticks, which are the size of a sesame seed. It helps to shower after clearing brush or walking in wild lands.

The proper method of removing a tick is to use a fine pair of tweezers and grasp the tick as close to the skin as possible. Pull it straight out, gently but firmly, without jerking or twisting. After removing the tick, wash your hands and the skin around the bite thoroughly with soap and water.

If, after removal, you see anything remaining in the skin, this represents tiny mouthparts of the tick. It is not the tick’s “head” and it cannot increase the risk of transmission of Lyme disease once the tick body is removed. If you are unable to remove the mouth parts easily, as you would a splinter, leave it alone and the skin should eventually heal. If you are concerned see your doctor.

Quite often, after an obvious tick bite, a red rash may develop at the site of the bite within the first 24 to 48 hours. A rash that develops this quickly after the bite is usually an allergic reaction to the saliva of the tick. It rarely grows beyond 2 inches, needs no treatment and disappears within a few days.

The actual Lyme’s rash, called erythema migrans, is reported to occur in up to 80 percent of infected tick bites. It is described as a red rash that is usually neither itchy nor painful. It develops a few days to a few weeks after a tick bite and is likely to be the first sign of Lyme disease. The rash most often continues to get larger over a period of time and will grow to be well over 2 inches, possibly 8 to 12 inches or more, and may last for several weeks. This rash may sometimes develop a pale appearance in the center, causing a bull’s eye shape.

Either during the time of the rash or shortly thereafter, other symptoms of Lyme disease may appear which resemble these common flu-like symptoms: fever and chills, malaise (achiness), headache, and achy joints.

The rash and/or the above flu-like symptoms may indicate early Lyme disease and you should see your doctor. When recognized during this early stage, most infections can be adequately treated.

If the above symptoms do not occur, are not recognized or are not treated properly, then one might develop late Lyme disease which can more severely affect different parts of the body such as the  joints, the nervous system, and the heart, to mention a few.

The bottom line is that whether you are aware of a recent tick bite or not, if you develop an unusual, unexplainable rash or if you develop flu-like symptoms (without respiratory symptoms), especially outside of the flu season, you should visit your doctor and discuss the possibility of Lyme disease.

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Late summer is the time we see more yellow jackets buzzing around us. These stinging insects are attracted to our delicious picnic food and are more aggressive than the common honeybee, but neither one usually attacks randomly. They sting defensively when they or their nests are threatened. They also sting when stepped on, sat upon or in some way provoked.

Yellow jackets can sting multiple times and do not leave behind their stingers. This is in contrast to the honeybee, which leaves its stinger in its victim. (It is now recommended to remove the stinger as quickly as possible, using one’s fingers to pull it out.)

Stings are very painful and are best treated by immediately placing ice over the sting. Taking the antihistamine Benadryl may also be helpful.

A reaction to the sting may occur within hours or days after the sting. It may be manifested by redness and swelling of just a small area around the sting or by a much larger reaction, often involving an entire arm or leg. This is just a toxic reaction to the venom and will resolve on its own in a matter of days. It is not an allergic reaction and, though it may feel uncomfortable, will cause no harm.

A sting on the face may cause worrisome swelling but is not dangerous. A sting inside the mouth or throat, however, can be quite serious and needs to be treated promptly. In this case, I would advise calling 911 to receive prompt evaluation and emergency treatment.

Serious, life-threatening reactions to a sting may occur within minutes or several hours. Usually, the worse the reaction, the sooner it occurs. Those who have a serious sting reaction should seek consultation with a physician who can prescribe an injectable adrenaline kit, such as an Epipen. This shot can be self-administered if one is having a potentially life-threatening reaction to a sting.

In summary, here’s what to do when stung:

– Pull the stinger out as quickly as possible, if it remains in the flesh.

– Get out of the vicinity of stinging insects, as fast and as far as possible.

– Apply ice compress to the sting.

– Take Benadryl by mouth.

– Call 911 if you experience a swollen tongue or throat with difficulty swallowing; tight breathing or shortness of breath; a feeling of faintness; or severe hives

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In my most recent column, I discussed the topic of rabies, especially what one should do if bitten by a possibly rabid animal. Now, I would like to describe animal bites in general.

The law requires that the local animal control office be contacted when any person or animal is bitten by another animal, whether the biting animal is wild or domestic. The phone number for the local Santa Cruz animal control office is 454-7303.

When a bite victim seeks medical treatment, the treating physician must also, by law, fill out an animal bite form and send it immediately to animal control. That is true even if the bite is from one’s own pet. An animal control officer will investigate and advise the animal owner about quarantining the animal, which is usually done at the owner’s home. Regardless of the animal’s vaccination history, it will be observed daily for 10 days following the bite for signs of rabies. If the isolated dog or cat is deemed healthy after 10 days, there is no risk of rabies from the original bite wound, and the bitten victim will not need to undergo the series of shots to prevent rabies.

Some animal bite statistics to consider:

More than 3 million animal bites are reported each year.

Emergency rooms see 300,000 animal-bite-related visits each year, costing about $160 million.

Eighty percent of bites are from dogs, 10 percent from cats and remaining 10 percent from other animals.

Children are the most frequent victims of dog bites, especially boys between 5 and 9 years old.

At least 50 percent of dog bites are from a family dog or a dog belonging to a neighbor.

Men are more frequently bitten by dogs than women (3 to 1), and women are more frequently bitten by cats (3 to 1).

Dog owners should be aware that many homeowner insurance policies will not cover certain biting-prone dog species and will often drop coverage or increase premiums after a single dog bite.

In general, dog bites cause less infection than cat bites. This is because dogs’ teeth are duller and less able to penetrate the flesh deeply, while cats’ teeth are sharper, proportionally longer and able to sink deeper. Infections are often evident after fewer than 24 hours.

Bites to the face, although cosmetically worrisome, are least prone to infection, and bites to the hands and fingers are most likely to become infected.

Seek medical treatment immediately for a bite anywhere on the body from any animal if:

**The wound is gaping (wide open).

** The wound won’t stop bleeding. (Always apply pressure first.)

**You have cosmetic concerns.

**You have a weakened immune system.

**The wound already appears infected.

**You need a tetanus booster.

I want to emphasize that if you have suffered what you believe to be more than just a superficial to bite to the hand from any source, be it a dog, a human, or especially a cat, see your doctor for wound evaluation and treatment as soon as possible.

You will most likely be treated with antibiotics before an infection develops. Hand infections — especially from bites — may be a cause for hospitalization if not treated promptly and aggressively.

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Two bats with rabies have recently been found in a Scotts Valley neighborhood. Is this cause for alarm? Not really, but it calls for a heightened awareness of what rabies is, how it is transmitted and what needs to be done for a known exposure.

Rabies is an infection caused by a virus. It is usually passed on to humans through the bite of a rabid (that is, rabies-infected) animal. Rarely, it can be transmitted if the saliva of an infected animal comes in contact with a break in the skin, such as a scratch, or with mucus membranes, such as the eyes, mouth or nose.

Once the virus enters a body, it travels along a nerve to the spinal cord and brain, where it causes encephalitis (brain infection). Once this happens, it is usually 100 percent fatal. That’s what makes this such a serious, although thankfully rare, disease. Although it might take one to three months for symptoms of rabies to show up, immediate treatment is necessary.

Rabies causes as many as 35,000 deaths worldwide each year, mostly in developing countries. Due to effective animal control and vaccinations begun in the 1940s, the incidence of rabies in our domestic animals in the U.S. has decreased dramatically. Dogs and cats now account for only 3 percent of animal rabies. Contrary to common thinking, cats are more rabies-prone than dogs. However, the incidence of rabies among wild animals has increased and poses our greatest concern.

To show how rare this disease is, the last case of human rabies reported from an exposure in California was in 2003. Although any mammal could be infected with rabies, in California, it is usually found in bats, skunks and, to a lesser extent, foxes. It is extremely rare in rodents, such as squirrels, rats, mice and chipmunks.

If you have been bitten by a possibly rabid animal, wash the wound immediately with soap and water. Then get professional treatment.

In Santa Cruz County, the only option for immediate treatment is a visit to the Dominican Hospital emergency room. This facility stocks a medication called “human rabies immune globulin,” which is an injection that must be given as soon as possible after a rabies exposure to protect your body from developing the infection. At the same time, you will be given the first of five necessary rabies vaccines, which will continue over the course of a month. These shots are given in the arm. This is a vast improvement from the much-feared older method of giving 20 to 30 shots in the abdomen.

After the initial emergency room treatment, I would advise that you immediately call your health insurance provider to see if the next four vaccine shots will be covered by insurance, and if so, you could go to most any urgent-care clinic for the necessary treatment.

For those without insurance, the local county health clinic on Emeline Avenue also stocks the necessary post-exposure vaccine. They charge $215 for each of the four injections and a nominal nursing visit charge to give the injection. The county clinic just needs an order from a physician for the clinic nurse to give the shots. Call 454-4114 to arrange this treatment, and remember that the timing is critical.

My next column will discuss how animal bites are reported to the authorities and what pet owners need to know if their pet has bitten someone or has been bitten by a possibly rabid animal.

Signs an animal might have rabies

**A wild animal seems unusually tame or unafraid and approaches you.

**A nocturnal animal, such as a bat or skunk, is found outdoors during the daytime.

**A pet develops difficulty eating, drinking, walking, or acting unusually strange.

**A bat is unable to fly or has been caught by a domestic dog or cat.

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In my July 16 column, I explained what to do when you’re bitten by a tick. Today, I will describe the symptoms of Lyme disease, which is carried by some ticks.

Quite often, after an obvious tick bite, a red rash may develop at the site of the bite within the first 24 to 48 hours. A rash that develops this quickly after the bite is usually an allergic reaction to the saliva of the tick. It rarely grows beyond 2 inches, needs no treatment and disappears within a few days.

The actual Lyme’s rash, called erythema migrans, is reported to occur in up to 80 percent of infected tick bites. Some would argue that it occurs less often. It is described as a red rash that is usually neither itchy nor painful. It develops a few days to a few weeks after a tick bite and is likely to be the first sign of Lyme disease. The rash most often continues to get larger over a period of time and will grow to be well over 2 inches, possibly 8 to 12 inches or more, and may last for several weeks. This rash may sometimes develop a pale appearance in the center, causing a bull’s eye shape, but this does not happen consistently enough to be a sure sign of Lyme disease.

Either during the time of the rash or shortly thereafter, other symptoms of Lyme disease may appear, which resemble common flu-like symptoms:

**Fever and chills

**Malaise (achiness)

**Headache

**Achy joints

The rash and the above flu-like symptoms are considered early Lyme disease. When treated properly during this stage, most infections are completely cured.

If the above symptoms do not occur, are not recognized or are not treated properly, then one might develop late Lyme disease manifested by the following signs:

**Severely painful joints

**Involvement of the nervous system, including Bell’s palsy (facial paralysis) and inflammation of the brain, spinal cord and peripheral nerves (known respectively as encephalitis, meningitis and peripheral neuropathy.)

n Heart problems, such as serious irregularities of the heart rhythm and inflammation of the heart muscle

Treatment for late Lyme disease involves months of heavy duty antibiotics with no guarantee of a complete cure.

Over the years of my practice, I have come to realize what a difficult and incompletely understood disease Lyme is. It is difficult to diagnose, because a significant number of those with Lyme disease don’t even recall being bitten by a tick. “Typical” symptoms may actually be very atypical or not present at all. Laboratory tests are not as accurate as we would like, and there is disagreement as to which tests are best.

There is also controversy as to the most effective treatment for early and late Lyme disease. There are “Lyme specialists” whose opinions vary greatly and whose treatment may seem excessive compared with traditional practitioners.

I personally follow the more traditional route, but because I feel that we don’t yet have all the answers on Lyme disease, I am open to “non-traditional” therapy as long as it seems to have good results and causes no harm. Research continues to improve the best treatment for this disease.

The bottom line is that whether you are aware of a recent tick bite or not, if you develop an unusual, unexplainable rash or if you develop flu-like symptoms, especially outside of the flu season, you should visit your doctor and discuss the possibility of Lyme disease.

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What is one to do after being bitten by a tick?

Ticks are tiny arachnids closely related to mites. There are many types of ticks in the United States, many of which are capable of transmitting infections. The risk of developing any of those infections depends on the type of tick, the geographical location, the season of the year and, especially in the case of Lyme disease, how long the tick was attached to the skin.

The risk of illness depends a great deal on where one lives or visits. People in a few areas of the United States are at a high risk of Lyme disease, especially in the mid-Atlantic, upper Midwestern states and several counties in northwestern California.

In Santa Cruz County, it is reported that 5 percent of ticks carry the Lyme bacteria, with the area around Nicene Marks State Park in Aptos having a somewhat higher concentration of Lyme risk.

Although many people worry after being bitten by a tick, the risk of acquiring an infection is quite low, even if the tick has been attached to the skin, has fed and actually carries the infectious Lyme germ.

Neither the tick’s body nor its head burrows into the skin. Instead, the tick attaches by its mouthparts. An infected tick can transmit an infection only after it has been attached, taken blood from its host and fed for 24 to 48 hours. An unattached, non-engorged tick can not have transmitted an infection.

There are an untold number of popular methods for removing an attached tick, including burning the tick, applying nail polish to its body, smothering it with oil and twisting it either clockwise or counterclockwise, and so on. These methods are ineffective and may cause the tick to inject more of its infected fluids into its host, thus increasing the chance of infection.

The proper method of removing a tick is to use a fine pair of tweezers and grasp the tick as close to the skin as possible. Pull it straight out, gently but firmly, without jerking or twisting. After removing the tick, wash your hands and the skin around the bite thoroughly with soap and water.

If, after removal, you see anything remaining in the skin, this represents tiny mouthparts of the tick. It is not the tick’s “head,” and it cannot increase the risk of transmission of Lyme disease once the tick body is removed.

There is some controversy concerning what to do if the tick’s mouthparts have remained in the skin. Technically, these mouthparts are no worse than having a small wooden splinter in your skin. Don’t waste your time trying to pull them out with a pair of tweezers, since the mouthparts are stuck together with small barbs and actually glued together.

If you’re brave, you can attempt to remove them after cleaning the area with alcohol, using a sterilized needle to tease them out as you would a splinter. If the bite was in a noncosmetic (unseen) area, the mouthparts can be left alone and will most likely fall out over time; but there is the chance they won’t and may leave a small bump. If the bite site is in a noticeable part of the body and you do not wish to deal with it, you can visit your doctor and have them removed.

Once the tick has been removed, it can be sent to a laboratory to have it tested for Lyme disease, but the tests are not perfect and may give either a false positive or false negative result, which can lead to confusion as to how to proceed with further treatment. Furthermore, it’s possible to have been infected by another tick of which you were never aware, and if symptoms should arise after the known tick tests negative, there’s a risk you might not seek treatment, believing you are not infected.

Therefore, it is more important to learn to recognize the symptoms of Lyme disease, because they might show up even after a negative test result. Anyone who exhibits Lyme symptoms needs to seek immediate evaluation and treatment from a doctor. I will discuss more about signs and symptoms of Lyme disease in a future column.

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