Lyme Disease Guidelines for 2023
Up to 50% of the black-legged ticks in the KFL&A region carry Borrelia, the bacteria associated with Lyme disease.1 Ticks also carry an incredible number of other infections – many of which we’re just starting to understand. Treat every tick bite with immune-supportive measures and know when to request antibiotics from your doctor. Review these updated 2023 guidelines and reach out if you’re uncertain or need additional support.
Preventing tick bites:
1. Wear light-coloured clothing (to make ticks more visible), with pants tucked into socks when traveling in tall grasses and wooded areas.
2. A repellent product containing 30% DEET is officially recommended for adults. For children younger than 12 years, Health Canada recommends using a product with 10% DEET. However, the repelling effects at this concentration may only last for 1 to 2 hours and frequent application is not approved. Alternate approved chemicals for children older than 6 months, or sensitive individuals, include products with Icaridin (e.g. Avon Skin So Soft, some MEC and OFF! brand products). Apply repellents to your clothing and gear, and avoid your skin.
3. Permethrin-infused clothing is now available in Canada. Permethrin is a potent insecticide with serious environmental consequences and cumulative health effects, but its convenience requires serious consideration in your prevention plan. (Factory-treated clothing is considered effective for up to 70 washes!) If you do wear this clothing, be sure to keep wet clothing away from your skin.
4. A new and natural tick repellant has just been approved in Canada: Tick Attack by AtlanTick. This is now available at KIHC! Reapply liberally at least every 5 hours and consider wearing lava bead jewelry that you’ve soaked with your tick spray, to help reduce the number of times you need to reapply.
5. If you’d like to make your own: Mix 25 drops of each of these essential oils into 4oz of high-proof alcohol (such as Spirytus at the LCBO): Lemon Eucalyptus oil (Eucalyptus citriodora), Labrador tea oil (Rhododendron tomentosum), Juniper (Juniperus virginia), and Marjoram (Origanum majorana). Keep in a dark glass spritzer bottle and apply liberally over clothing and shoes. Just like the less concentrated DEET products, you may need to reapply a few times a day. (You want to smell the essential oil.)
6. Do not apply sunscreen and insect repellent together. It can increase the skin’s absorption of harmful chemicals. (This shouldn’t be a concern if you’re using the repellents over your clothing, and sun screen on your skin. Visit our website for information about safe sunscreens.)
7. Do tick checks every time you come in from outside. Look in skin folds and moist areas, including armpits, belly buttons, and behind ears. Be sure to check pets and children’s toys (e.g. blankets). Go over your clothes with a lint roller and take a shower to wash off unattached ticks (and insect repellent!) within 2 hours of coming home from a tick habitat.
8. Putting your clothes in the dryer on high heat for at least 15 minutes might help remove ticks, particularly if you use wool dryer balls to help separate clothing and encourage thorough heat distribution.
What to do if you have a tick bite:
1. If you find a tick attached to your skin, gently remove it straight out with tweezers or Tick Twister, by the head and as close to the skin as possible without squeezing or twisting it. (Do not try to kill the tick while it is attached to you.) TIP: If the tick is still alive and attached to your skin, grab it gently with the Tick Twister or Tweezers, gently pull up on the skin, and hold for a few seconds. The tick will often slowly release itself.
2. KFL&A public health no longer accepts ticks for testing, but identifying the type of tick could be helpful if you were to develop symptoms later. You can also use this free e-tick app for identification.
3. Mailing the tick away for private analysis of infections can be helpful, but a negative test result doesn’t mean you’re in the clear. Researchers are regularly identifying new infections (including viruses) inside ticks, and these might not be tested for at the lab. Read more about pathogens in ticks, here. Treat every tick bite in some manner and support your immune system regardless of what testing can identify in a tick.
4. Clean with soap and water and apply an antiseptic (or Andrographis tincture) to the bite area. Then apply a bentonite clay paste for 12 to 24 hours.
5. Take a photo of the bite area to help you recall the location and date of the bite, should a rash or other symptom appear over the coming weeks. A rash that disappears within 2 days of removing the tick is considered a normal response to a bite and is not evidence of Lyme disease. A Lyme disease-associated rash often expands from the bite site in a circular pattern over days to weeks. It is usually not itchy or painful. (Some people with Lyme Disease do not develop a rash.) You can read more about Lyme rashes, here.
6. Be more diligent about your diet and sleep quality. In the very least, restrict sugar for 30 days, stay hydrated, and address insomnia.
Tick Bite Kit:
- Tick Twister (which gets behind the ears better than a Tick Key or fine-tipped tweezers)
- Antiseptic or Andrographis tincture (for topical use)
- Bentonite clay (for topical use)
- Astragalus capsules or tincture (or other recommendation from your ND or healthcare provider)
- In areas where Public Health still tests ticks: Clear tape, recipe cards or cardstock, and a marker (to tape the tick to and record details)
- A means of identifying the type of tick and a reminder of some sort to take a photo of the tick bite site and any rash that subsequently develops
Q: When should I see my doctor for antibiotics?
Pharmaceutical antibiotics may be recommended after an engorged (full of blood) black-legged tick was attached for more than 24 hours, and fewer than 72 hours have since passed. A longer course of antibiotics is also indicated in the weeks immediately following a tick bite if you develop a rash near the bite site (generally expanding, not itchy and larger than 5 cm), regardless of what Lyme disease test results might indicate. Also consider antibiotics if you’re the only one in your social circle who develops a summer flu despite no known tick bite. (Diagnosis of Lyme Disease is clinical, meaning that a health professional can prescribe antibiotics without a test if your symptoms clearly match Lyme Disease.) Note that you might still need to seek support for possible infection even if Public Health guidelines suggest no antibiotic is needed in your case.
Q: What should I do when I’m done the antibiotics?
Some clinicians speculate that, given best available evidence, a single preventative antibiotic dose might suppress the Lyme-associated rash but not Lyme disease itself. Many patients are also concerned about the risk of relapse following a longer course of antibiotics for Lyme disease symptoms.2 The evidence is not clear, which is why addressing your immune system in some form is so important! Depending on your symptoms and state of health, your Naturopathic Doctor may recommend following your antibiotic course immediately with a course of anti-microbial and/or immune-supportive botanicals, such as Astragalus, Eleutherococcus, Andrographis, and probiotics.
Q: What if my doctor says that I don’t need antibiotics?
Our public health guidelines are designed to address acute Lyme disease symptoms. However, ticks carry multiple infections, some of which are not sensitive to doxycycline and which may be transmitted in fewer than 24 hours. (You can read a bit more about tick infection transmission time, here.) Treat every tick bite regardless of how long the tick was attached. Pharmaceuticals aren’t always necessary, but immune-supportive approaches are always indicated. This could be as simple as avoiding dietary sugar and ensuring plenty of high quality sleep, or it could mean a more targeted treatment plan from your healthcare provider.
Q: When should I get tested for Lyme Disease?
Get tested 6 weeks after a known engorged tick bite, or if you have persistent symptoms months after a summer flu regardless of whether you noticed a tick bite. Be aware that false negatives are common if you complete the test less than 4 weeks after the tick bite or if you took antibiotics. False positives are also possible! Additional international testing is available through your Naturopath, but even this can be inaccurate. A diagnosis must be made clinically (i.e. based on symptoms) and alternate testing may be useful to guide appropriate treatment.
Additional Resources:
Online:
Lyme Disease Symptom Questionnaire
Lyme disease news and articles
Canadian Lyme Disease Foundation
Books:
Healing Lyme, by Stephen Buhner
Lyme: The First Epidemic of Climate Change, by Mary Beth Pfeiffer
Toxic: Heal Your Body from Mold Toxicity, Lyme Disease, Multiple Chemical Sensitivities, and Chronic Environmental Illness, by Neil Nathan, MD
References:
1. Ontario Agency for Health Protection and Promotion (Public Health Ontario). Vector-borne diseases 2017 summary report. Toronto, ON: Queen’s Printer for Ontario; 2018.
2. Cameron DJ, Johnson LB, Maloney EL. Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Review of Anti-infective Therapy. 2014;12(9):1103-1135. doi.org/10.1586/14787210.2014.940900.
