How To Protect Against Tick Bites with Christopher Bazzoli, MD

Podcast Transcript

John Horton:

Hello, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

Thirty years ago, tick-borne illnesses weren't exactly a big worry for most of the United States. It's safe to say that things have changed. Tick-borne diseases have experienced an epidemic-level rise in the past few decades, as tick populations surged and those pesky buggers moved into new regions.

So where are the hotspots and what can you do to protect yourself? We're going to chat about that today with Chris Bazzoli, an ER doc and wilderness medicine specialist. Dr. Bazzoli is one of the many experts at Cleveland Clinic who hop into our weekly podcast to discuss health trends.

Now, let's dig into this growing tick problem before one of them digs into you.

Welcome to the podcast, Dr. Bazzoli. I know we talked a while back about getting you on the guest list, so I'm glad we were finally able to make it happen.

Dr. Chris Bazzoli:

Thank you so much for having me. Really, really appreciate the opportunity to share some of my passion and spending the afternoon with you.

John Horton:

Now, you're here today to talk about ticks, and I got to tell you, growing up, I never remember ever thinking about ticks and Lyme disease when I went out to go play in the woods. But today, with case counts rising, it seems like something that needs to be on our minds. What changed?

Dr. Chris Bazzoli:

Well, one, you grew up a little bit. Your parents were certainly worried about the ticks for you.

John Horton:

I don't know, it was way back. Trust me, I'm a little older than you think so.

Dr. Chris Bazzoli:

No, but to your point, we certainly have had an increase in tick longevity, increase in the range due to climate change. And so we are seeing more ticks, and we're seeing more overlap between the different species of ticks that we historically didn't see as much. We're also much more aware of the diseases that they carry and then, unfortunately, transmit to us. So both kinds of factors are playing into raising the consciousness and raising the awareness of the vector ticks and the illnesses that they can transmit to us.

John Horton:

Yeah, I saw a map, I think it was by the CDC, that kind of showed where ticks used to be concentrated and where they used to have these issues, and you go back 30 years, and it was really just kind of a sliver of the East Coast. Now, it's like the entire northeast part of the country is covered. A good chunk of the Upper Midwest has … it really has expanded, and then it's also speckled all over the rest of the country, too. I mean, there's really kind of no hiding from it anymore.

Dr. Chris Bazzoli:

Right. And to an amount, to a degree, those ticks were regional and there. Many of those diseases have been around for many decades, hundreds of years, most likely. But we're just getting to the point in the last 50, 100 years, where we're starting to have higher levels of population, so we can start to notice patterns and then, especially with technology, able to record a lot of that data and at a much finer level, notice those patterns. I mean, we're talking about the discovery of Lyme disease in Connecticut in the 70s. Lyme disease was certainly around before then.

John Horton:

Didn't get invented then, huh?

Dr. Chris Bazzoli:

Yeah. Yeah. We just didn't have the systems and the wherewithal to be able to pick up, like, “Huh, why is this kid over here getting this knee pain?” And like, “Oh, geez, there's a lot of cases of this and what's the common factor?” And a lot of this goes back to, I mean, the history of epidemiology, the classic typhoid cases of Europe and New York, etc. Really, the last 100 years really has seen an increase in our ability to detect these, and now, with technology able to actually test and see what these pathogens are at a very fine level.

John Horton:

Dr. Bazzoli, you had mentioned that there are kinds of seasons where maybe ticks are a little more active and you might need to pay attention a little bit more. What are those?

Dr. Chris Bazzoli:

Yeah, so by far the peak in the U.S. is June and July. That's where we have peak tick activity, reproduction. It's the easiest time of the year for them to find a blood meal and then reproduce. And so during the wintertime, the colder months, ticks go dormant. They may still be active during a warmer period. And overall, with climates warming, you got to be mindful where you're at in the country. A Texas winter is different than a Maine winter. And so being-

John Horton:

…a little bit.

Dr. Chris Bazzoli:

…of the temperature and where you're going. As the temperature warms in spring, that's when we start to see activity increasing and then again, that peak June, July, of the year before, tapering off again in the fall. But remember, this is going to be different where you're traveling internationally, and there are different ticks internationally carrying different diseases. So you got to know before you go.

John Horton:

But let's talk a little bit about some of those diseases because that's the big worry. Ticks, I know, they kind of gross people out, but you're more worried about what they might give to you. You mentioned Lyme disease. Let's talk a little bit about that. And then, some of the other dangers that we kind of see or kind of connect to getting chomped on by one of those creepy crawlies.

Dr. Chris Bazzoli:

And so, we, on ticks and Lyme disease gets the lion's share of the attention because it is the number one vector-borne illness in the United States. The CDC estimates over 450,000 cases a year in the U.S. And so a significant portion there, and deserves our attention.

So there's a number of things with ticks that are interesting. So ticks live two to three years, and with milder winters, you have more of those ticks making it another year and, therefore, reproducing, et cetera. So we're seeing that higher tick burden. There are obviously a number of ticks throughout the U.S. and spread around, or more or less predominant in different geographical areas of the country.

The Lyme disease is carried by the black-legged tick, the Ixodes tick. We have, like in Ohio, we frequently have dog ticks as well. Those don't carry Lyme disease. They carry some of their own viruses and potentially bacteria. But there's a number of things we can do to still safely enjoy the outdoors and reduce the potential for transmission of a disease from a tick to us, causing illness.

John Horton:

Yeah. Now you mentioned Lyme disease, obviously, being the big one. What are some of the other illnesses that are less common but you still hear about and are being associated with ticks?

Dr. Chris Bazzoli:

Yeah, so we have things like babesiosis, ehrlichiosis. There's a really interesting actual illness that you've maybe heard about in the news the last several years, an illness caused by the dog tick, and it's not even a virus or a bacteria. It's actually a reaction to the tick's saliva, and that syndrome is called alpha-gal syndrome.

John Horton:

Wow, the meat allergy.

Dr. Chris Bazzoli:

Yeah. Yeah, the meat allergy. So you're familiar. And this one's actually interesting. It's not caused by a virus or a bacterium. It's actually your own body reacting inappropriately to the saliva of a tick, of the Lone Star tick here in the U.S. And what happens is your immune system essentially recognizes something in that saliva, inappropriately programs it and then in the future, recognizes this protein, this alpha-gal protein in red meat, as a foreign body. And so your body reacts to it like an allergic reaction, and so really not fun. Can't eat red meat anymore.

John Horton:

Wow. That'll ruin your barbecue.

Dr. Chris Bazzoli:

Exactly, exactly.

John Horton:

What about the one, it sounds like it was a good name, the Rocky Mountain Spotted Fever. Is that something that's just kind of concentrated, I'm guessing out in kind of the Rocky Mountain area?

Dr. Chris Bazzoli:

No. So it's not just the Rocky Mountain area.

John Horton:

It's got the name, huh?

Dr. Chris Bazzoli:

Exactly. It's got the name, and perhaps we can link to some of these maps, but you frequently kind of see it actually more in the Southeast. And commonly with tick-borne illnesses and really to a lot of insect-borne illnesses just beyond ticks, things we're looking for early on in an illness is rash of some amount, fevers and chills, and then kind of aches and pains — and there's a lot of different variation there. So like Lyme disease causing that, in a majority of cases, but not all cases, that very recognizable bullseye rash. Rocky Mountain Spotted Fever, a much more spotted rash that sometimes can include even the hands and the soles there. And then, even in Rocky Mountain Spotted Fever, they have it in the name: fever.

Same thing with Lyme disease, getting fevers, chills like you're coming down with a cold because your body is trying to fight something off. And then, those aches and pains or other signs of illness. So you start noticing some of those and you've been spending a lot of time outdoors. Certainly, if you noticed that you had a tick attached to you recently, that's the point you should go talk to your doctor.

John Horton:

Now, since Lyme disease is by far the most common, let's focus on that one for a bit or just a little bit more. How serious is Lyme disease? I've heard, sometimes, it can cause lifelong issues.

Dr. Chris Bazzoli:

So it's a very difficult illness. Luckily, it doesn't cause, the term we use in the medical field, a “high degree of mortality.” So it doesn't outright kill people, which is-

John Horton:

…good news

Dr. Chris Bazzoli:

…so very low numbers there. But the burden of morbidity … so the burden and the chances of ongoing and chronic illness and pain and discomfort is pretty high. And especially, we take that in the context of how difficult Lyme can be to detect. So we have tests, but the way that your body's immune system reacts, it is not always easy to tell, especially early on in an infection stage, whether the symptoms that a patient a person is feeling is really from a Lyme infection or some other cause, and a lot of those tests can't tell us very well if you are currently having a Lyme, you know, the Borrelia burgdorferi spirochete, trying to infect your body, or if just at some other point you were exposed to it and your body was able to fight it off at that point, or you got a course of antibiotics for some other reason and that was sufficient to kill the spirochete.

John Horton:

What are some of the main symptoms of that? I always thought it was kind of like a lot of aches and pains and things along those lines.

Dr. Chris Bazzoli:

So kind of the early phase for all these illnesses — but then, especially for Lyme disease — we talk about the rashes. So typically, again, that's a bullseye rash, fever and chills in that early phase as well. And then, aches and pains, again, coming down with a cold. Now, Lyme disease is interesting. It's actually caused by a spirochete bacterium, and another, unfortunately, common spirochete that we may know about is syphilis. These are actual modal bacteria, and so they can travel, and so you actually get different phases of infection. So you have this initial phase of infection with Lyme, and that's where we want to catch.

John Horton:

Well, it sounds like once you get that initial one, if it goes away and it fades, then you probably think, "OK, I'm good."

Dr. Chris Bazzoli:

Exactly, and that's the same, you read the history textbooks. That was always the difficulty and the fear with syphilis in trying to recognize and treat that.

And so with Lyme disease, we want to catch in that initial phase. If we treat it with antibiotics, we can cure patients and never have further problems. If we don't catch it in that initial phase, it goes on to then the more dangerous secondary and tertiary phases. And at those points, we're starting to introduce risks such as meningitis, heart blocks and rhythm dysfunction of the cardiac system. That's when we're starting to talk about arthritis developing in otherwise totally healthy 10-year-olds. And a lot of those effects, once we get to the secondary and tertiary phases, we can certainly help, but sometimes, we cannot completely undo those by any stretch.

John Horton:

So it sounds like if you catch it right away and you do go in, the treatments that we have can knock it out and you're not going to have those issues, as opposed to if you wait, it settles in and then it sounds like you're in for the long haul of this kind of disease, just kind of hanging out in your body and appearing from time to time.

Dr. Chris Bazzoli:

The disease, in that secondary and tertiary phase, we can treat and kill the bacteria still at that point, but by then, a lot of times, the damage to your immune system or those tissues is already done and there's no great and easy way to undo that damage. Whereas, in the primary phase of infection, we're talking system tissue, and antibiotics are very effective at eradicating the disease at that point and preventing those long-term changes and effects on your tissues and immune system, et cetera.

John Horton:

Well, you already told me enough, where to me, I just want to avoid this altogether. So Dr. Bazzoli, help us stay safe here. What can we do to limit our risk when we are out in the woods or in nature?

Dr. Chris Bazzoli:

There's definitely a number of things we can do to substantially mitigate our risk here. And so we absolutely still encourage folks to go enjoy the outdoors and spend time recreating, but we do this safely. And so that really starts with preparation. The CDC has a lot of really great information, as do state health departments. And so, we talk about this from the park service, know before you go. You've got to know the area that you're headed to. When we're traveling to the Northeast, if we're not from that area, we need to learn more about it and what we need to be cautious of and mindful of.

When we're talking about ticks in particular, wearing long-sleeve shirts and pants, tucking in socks, things like that. Basically denying ticks points of entry to your skin level, that goes a long way, kind of a simple measure.

Repellents are very effective. The same repellents that we use for mosquitoes, DEET at the 20% concentration, safe for pregnant mothers and children, applied, is an effective repellent. If we don't like the texture of DEET, there are alternatives. So repellents like Picaridin, which is a derivative of the black pepper, that is very effective, again at the 20% concentration. We also have a newer product kind of initially developed in Europe and making its way over. You may see it in formulations IR3535, that is effective. You can even treat your clothing. Some clothing you can purchase has been pretreated, but you can also purchase washes to wash into some of your outdoor clothing called Permethrin. That's a derivative of the chrysanthemum flower actually, a plant, and that is toxic to insects. So when the tick then crawls on your clothing, tries to get too personal, the toxin actually disables and kills them, but it is not harmful or toxic to humans.

John Horton:

Maybe … seeing some tips when they talk about the color of your clothes, maybe making a difference or is that just so you can kind of see them if they're on you?

Dr. Chris Bazzoli:

Yeah, we talk about color of clothing perhaps a little bit more with mosquitoes, and the data there is a little bit mixed. In general, lighter clothes do allow for more visibility, but some of the really bright colors actually end up attracting insects. So generally, best to stick to your substantial clothing and kind of what you've got that you can tuck in well.

John Horton:

Go with safari beige. Would that be the right one?

Dr. Chris Bazzoli:

There you go.

John Horton:

The right color.

Dr. Chris Bazzoli:

That's perfect.

John Horton:

Yeah. What about as far as when you're, you're tromping around out there. Are there certain areas where you're more prone to maybe come in contact with a tick?

Dr. Chris Bazzoli:

Right, so ticks love generally wooded areas, long grasses. And so when we're off trail or in the grass — and we need to be mindful of this, too, even just yard work depending on the situation of our property and our home. And so any place where we have those transitions from a more managed lawn to longer grass. And then the wooded areas, that's where those ticks love to live and then try to hop a ride.

It's also important to think about our four-legged friends. They love to go play. And our children, right? Not always at the top of the mind for them, and they can bring ticks back to us.

And so really important if we're in an area with ticks and during tick season, which we'll talk about, really important to perform tick checks.

John Horton:

So how do you do that? Is that something where every time you come in, you should give yourself a little once-over to see if you picked up a hitchhiker.

Dr. Chris Bazzoli:

If you're going to be spending an extended period of time in the wilderness and potentially exposed to ticks, say, like a backpacking trip, you should be performing tick checks morning and night, twice a day.

If you are returning home from work and you're going to go outside and do some yard work for two hours before sundown, OK. Then, when you come in, do your tick check then.

And why that's important is some of these diseases, notably, most notably Lyme disease, takes quite a bit of time to actually transmit that pathogen to you to infect you. So a tick has to be attached for a period of time, actually ingest a meal in the case of Lyme disease, ingest a meal. Ingesting that meal, starts to basically revive that spirochete bacterium in the gut of the tick. That spirochete then starts reproducing in the tick, and then the tick has to regurgitate some amount of that back into you to infect you and that.

John Horton:

It all sounds so gross.

Dr. Chris Bazzoli:

It's so gross.

John Horton:

This is happening to you.

Dr. Chris Bazzoli:

I know, right? But that, luckily, takes time somewhere on the order of about 24 or 36 hours at a minimum. Now, if a tick has already had a meal on a deer in the last day or two, obviously, that's going to be accelerated if they then attach to you. So that's why we really recommend twice-a-day tick checks or as soon as you come in from the outdoors because if we can pluck that tick off of you early, we can really reduce the chances that any pathogen was ever transmitted to you.

John Horton:

Do they usually chomp right in immediately or do they kind of hang out for a while and roam around if they get in your hair? I know I found them on my dog where they come in and all of a sudden you're petting and you see something, a little bug moving around and it was a tick. So do they not just, like I said, just chomp right in.

Dr. Chris Bazzoli:

So I'm not a total expert in tick behavior and psychology.

John Horton:

Appetite, yeah.

Dr. Chris Bazzoli:

But to the best of my understanding and experience, depends on the season. And then, it also depends on really how quickly that tick is finding a suitable location. It's much more difficult for them to latch into our tougher, thicker areas of skin. So they're really looking for the nooks and crannies where we have thinner skin and more vasculature, so it's not as tough of work for them to get in and they're able to get more blood faster in those areas.

John Horton:

Where would that be? Some of those spots, and it sounds like when you're looking then you should be the kind of hotspots to even check out.

Dr. Chris Bazzoli:

So the head is very vascular, the scalp is, and so checking through the hair. But then, things like armpits, groin, down around your ankles as well, tucking in kind of underneath the sock line. Those are all really kind of thin-skinned, more vascular areas that ticks really like. And depending on the season and how hungry they are and how desperate they are, you'll notice the same thing with mosquitoes, too. Lazier portions of the season, maybe they're flying around. You get to a little bit later, hungrier portion of the season or coming right in and trying to bite whatever they, you get a hold of.

John Horton:

The whole thing just makes me squeamish. You hate this idea that this thing is kind of just feeding on you. But I guess that's kind of what happens.

Now, if you do find one of them and they've burrowed in and that head's in there and their butts sticking up and they're eating, obviously, you want to get it out. So what's the best way to do that? I know my first instinct would be to freak out and probably just try to yank it and I'm guessing that's not the way to go about it.

Dr. Chris Bazzoli:

Not the best way to go about it. Certainly may work, but we've got better ways that'll keep you safer and make sure we get the whole tick out kind of in one go. And so-

John Horton:

…walk us through it.

Dr. Chris Bazzoli:

…exactly. Definitely not fun.

And so first thing, take a deep breath. The matter of a couple of minutes is not going to be life or death here. And so as best we can, try to wash the area first because this tick has created an entry point into your skin. And so, one of the things we think about is secondary infection from just the bacteria that's living on your skin and in the environment. So try to wash the area up really good. Don't do anything drastic like trying to burn this tick off or try to suffocate a tick really doesn't work. Just wash and then go find a good pair of tweezers. You want to grasp as close to the skin as possible so that you're getting the head and all of its essential mouth parts that are embedded into the skin as you can. And then, we're just going to pull straight up, 90 degrees to the skin.

We don't want to jerk to the side or try to scrape because then we can remove the body but leave portions of the head and the mouth embedded in the skin and then again, more difficult to remove at that point and an infection risk.

So best thing is wash the area, tweezers right at the head as close you can to the skin and then pulling straight up, nice gentle pressure, 90 degrees to that area of the skin.

And then, once we have the tick out — we don't need to save ticks and we don't recommend sending ticks off for testing, but it is helpful to put the tick in a container so that you can take a photo so you can help identify what type of tick it is. That narrows down any potential disease if you do start to get sick. And then, really being mindful to wash again. Warm soapy water, really scrub that area and make sure that, again, all those small mouth parts are out of the skin and you've helped to reduce any chance of secondary infection. You can put a little bit of antibiotic ointment on the area or really just a Band-Aid® to protect that open wound in the skin from other bugs getting in there.

John Horton:

Yeah. Is there a point you should see a doctor? Is that only if you have some symptoms that develop or if you get one and it bites in, should you go and just get checked out?

Dr. Chris Bazzoli:

So in the majority of cases, a tick bite alone is ... having a tick attached to you is in and of itself not an emergency. Depending on where you are and, therefore, what kind of ticks could have attached to you and what tick did attach to you, there is some amount of potential urgency. So needing to address this in a matter of days.

So there's a really helpful tool that the CDC created called, actually, the Tick Bite Bot, and it's a little AI chatbot that you can ask. It'll ask you a series of questions and help guide you based on where you're at and the timing of things on what your next best steps are. The first step, again, is always removing this tick early and then getting a good photo of it so that you can identify it. If you identify it as a black-legged tick, Ixodes tick, that potentially could be carrying Lyme disease, and you're in a highly endemic area, there's some consideration the CDC publishes that, depending on how long that tick has been attached to you. We may give you a one-time dose of antibiotics as like a preventative.

John Horton:

Yeah.

Dr. Chris Bazzoli:

If you know that you just headed outside for an hour or two and you're coming back inside and the tick is attached then, and so the attachment time is very short, you do not need that prophylactic dose of antibiotic, just remove that tick. And then, we're in the watch-and-wait period over the next two weeks. If you develop, again, those signs and symptoms — rash, fever and chills, aches and pains — that's the point to talk to your doctor and say, "Hey, maybe this is just a run-of-the-mill virus, but I did pull a tick off of me six days ago. I took a picture of it." And either, "Here's the picture of the tick." Or, "Yes, I even went through and identified what type of tick." There's a couple of apps that can actually help you identify what tick was attached to you. And the Michigan State Health Department even runs a program, I believe it's Found A Tick, Take A Pic, and you can send them a picture of a tick and they'll get back to you in a day or so with an identification.

John Horton:

Now, people are going to worry that you're going to be infected. And I think we want to emphasize that, like you said, just getting bit doesn't mean you're going to be infected. Not every tick is carrying that. So it is a matter of kind of being patient, waiting it out, and just taking those precautions that you mentioned.

Dr. Chris Bazzoli:

The vast majority of ticks are not carrying disease. So again, this is why we emphasize good prevention. But then, even if you are bitten by a tick and they are attached, that's why we do those tick checks twice a day, to minimize the contact time. And it's worth noting, too, if a tick is just crawling on you, it's totally fine. That means they haven't attached, there's no chance that they've transmitted a disease to you. Just properly dispose of that little bugger.

John Horton:

Get rid of it. Make sure you get out of the house and probably squish it to be honest.

Dr. Chris Bazzoli:

Yes, please do.

John Horton:

So after hearing all this, Dr. Bazzoli, I can see where folks might just decide it's safer to stay inside. That's not the goal here, right?

Dr. Chris Bazzoli:

Definitely not the goal. Spending time in the outdoors is personally a great joy. But we know, because we've studied it, it has really great impacts to physical health, mental health. That connection to the environment is really important as we have developed as humanity. We're one of the few creatures that can see green. We have a particular response to the blue of water that is calming. So it's actually physiologically really important for us to spend time in nature. And so we don't want to discourage that. What we want to do is encourage doing that safely and in a mindful manner so that you can continue to do it with full health with your family for many years to come.

John Horton:

That's great advice.

So appreciate you stopping by. You gave us a ton of information, and I think everybody can feel a little better and a little safer when they head on outside.

Dr. Chris Bazzoli:

Thanks so much, John. I appreciate you.

John Horton:

If you wander the great outdoors, odds are, you're going to ramble through some areas with ticks. But by taking the proper precautions, you can limit your risk of getting bit and dealing with a tick-borne illness. So go and explore. Just do it smartly.

If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.