Category: Preventative

how to avoid Lyme disease

How to avoid Lyme disease: what you need to know

Most folks have heard of Lyme disease. Some know people who have had it. But do you know enough about how to avoid Lyme disease?

I sometimes suspect Lyme when someone is achy in multiple joints or I see a suspicious bite site on my patient and suspect it. We’re in a time of the year when people enjoy walking in the woods, where ticks, the carriers of Lyme disease, live. Not every tick carries the disease but it’s important to know the basics of Lyme disease and importantly, how you can avoid getting it.


How Lyme disease happens

In the US, the two species of bacteria that cause Lyme disease are carried by black-legged or deer ticks. To contract the disease, the infected tick must bite you and remain attached for 36-48 hours. The bacteria from the tick enters the skin through the bite site and makes its way into the bloodstream.

The vast majority of ticks are not black-legged or deer ticks…and do not carry the disease. If you find an attached tick that looks swollen, it may have been attached long enough to transmit bacteria. Therefore, the best way to prevent infection is by removing ticks as soon as possible.


Signs that you may have Lyme disease

Image result for tick biteLyme disease symptoms can be categorized into early signs and later signs.

Early signs

In the first day or two after a tick bite, most people see a small, red bump similar to a mosquito bite. For the most part, the bump goes away in a few days. This is normal and doesn’t necessarily indicate Lyme disease.

If infected, you’ll see other early signs within three to 30 days after the bite. Some people get an expanding red rash that is often clear in the center, creating a bulls-eye pattern. It can grow quite large, expanding slowly over time, without being itchy or painful although it may be warm to the touch. Other early signs include fever, chills, fatigue, aches, swollen lymph nodes and neck stiffness.


Later signs

Additional signs or symptoms can show up if you have not received treatment during the early stage. A rash could appear on other areas of your body. You may find that you have severe bouts of joint pain, particularly in your knees.

Unfortunately, for a long time after infection – anywhere from weeks to year – new symptoms can show up, including meningitis, Bell’s palsy, numbness or weakness of limbs, fatigue, psychiatric symptoms and impaired muscle movement.

Less common, untreated Lyme disease can result in heart, eye and liver problems, as well as severe fatigue. It can even cause cognitive impairment, such as memory loss.


What to do if you’ve been bitten

First, don’t panic. Only a small percentage of tick bites lead to Lyme disease, with the greater risk occurring the longer the tick remains on your body. If you remove a tick in less than 36 hours, it’s much less likely that the tick could have infected you.

If you do start experiencing symptoms that you believe may be Lyme disease, get to a doctor right away. Early treatment can make an enormous difference. Even if your symptoms appear then go away, see your physician. The absence of symptoms doesn’t mean your Lyme disease is gone. And you don’t want to leave it untreated, as Lyme disease can spread to various parts of the body for years after infection.


Treatment for Lyme disease

The standard protocol for early-stage Lyme disease treatment is a regimen of oral antibiotics. Most individuals take a 14 to 21-day course.

If the disease is impacting your central nervous system, your physician may recommend intravenous antibiotics for 14 to 28 days. While this is often effective in eliminating infection, you may take longer to recover from your symptoms. It’s also important to know that there are side effects to intravenous antibiotics, including a lower white blood cell count, mild to severe diarrhea, or colonization or infection with other antibiotic-resistant organisms unrelated to Lyme.

For many people, this is it. They recover and move on. However, a small number of people will continue to have symptoms, such as muscle aches and fatigues. Physicians refer to this as post-Lyme disease and more antibiotics won’t help. This is likely one of the most frustrating parts of contracting this condition. While more research is needed, some experts believe that certain folks who contract Lyme disease are predisposed to developing autoimmune illnesses that contribute to ongoing symptoms.


Most importantly, how to avoid Lyme disease

Avoiding areas where deer ticks live, in particular, areas of woods or long grass, is the best way to prevent Lyme disease. But if you enjoy hiking or do outdoor work, you may not be able to steer clear of these spaces. Here are some ideas on how you can greatly decrease your risk:

  • Cover your body – wear shoes, long pants, long-sleeved shirt, hat, gloves. If you are walking a dog, keep them on a leash so you don’t have to chase them through any bushy or grassy areas.
  • Use insect repellent – a couple of months back, we wrote an article on the best insect repellents. Follow those guidelines.
  • Tick-proof your yard – clear out brush and leaves, mow your grass regularly and keep wood stacked in sunny areas to discourage rodents that can carry ticks.
  • Always check for ticks – be vigilant after spending time outdoors and check your clothing, your body and your scalp very carefully. Shower and use a washcloth. Remember, if you remove a tick quickly, you are much less likely to acquire Lyme disease.
  • Remove ticks quickly using tweezers – grasp the tick near its head or mouth without squeezing and pull carefully and steadily. Dispose of the tick by flushing it down the toilet and apply antiseptic to the bite area.

My favorite resource for Lyme disease information is the International Lyme and Associated Diseases Society. This is a great resource, particularly if you get a ​negative result from the basic Lyme disease test ​but suspect you have Lyme and require further testing (note: the basic test has a high false​ negative rate).


Dr. Sharman


safe insect repellent

Safe insect repellents that work

We’re at the peak of the tick and mosquito season, as our weather is at its warmest this month. And we are about to start the height of flea season. The warming climate is predicted to expand the habitat of ticks and mosquitos. So insect repellent is definitely needed. But which insect repellents are safe and effective?

Many of my patients who know of my caution in using products containing potentially harmful chemicals have asked me to suggest a safe insect repellent that will provide protection. It is important, for starters, to recognize that there is no perfect and completely safe way to prevent insect bites. However, all repellents are not created equal and you do have options for less toxic approaches.

This is what I usually share when I get asked about bug sprays.


Which ingredients are safe (and at what levels)

My go-to for any products containing chemical ingredients is the Environmental Working Group or EWG. A couple of months back, I shared my thoughts on sunscreen and much of my recommendations came from the research and advocacy of the EWG.

According to the EWG, DEET (at less than 30%), Picaridin (at 20%) and IR3535 (at less than 20%) are the safest, most effective ingredients. All three are found in insect repellents that live up to extensive EPA regulations with data to back up efficacy and safety claims. Here’s a quick primer on all three ingredients:



This is probably the ingredient you’ve heard of the most. It is rated as very effective in repelling a wide range of mosquitoes, ticks and other bugs. DEET has been used extensively and is a sensible choice for all-day protection. However, it often shows up in repellents at what are considered unsafe levels. DEET has a strong smell, can irritate the eyes and in rare cases can induce neurological damage. The incidents of nervous system damage most often occur after high exposures to DEET. And it’s even been known to melt plastic at these levels!

However, this is why less than 30% concentration is advisable. And really, you can be protected with just 10% for a couple of hours (then reapply). DEET isn’t perfect – but it has a long history of use and minimal safety concerns when used at appropriate levels. The EWG states that it’s a “reasonable choice” when weighed against the consequences of a life-changing disease, with few cases of toxicity in 60 years on the market. But it’s not the only choice you have.



Repellents containing picaridin have been shown to be effective against mosquitos and ticks from eight to 14 hours at a 20% concentration. It’s not an ingredient as widely used as DEET, so the number of studies is fewer…but it evaporates from the skin more slowly than both DEET or IR3535 and may repel bugs for longer periods. Other pros include very low inhalation toxicity, virtually no skin irritation and no stinky odor.

I wish Picaridin had more time on the market (it’s quite new) but it is promising. I also like that at very low concentration, this ingredient can provide minimum of five hours of protection. So you may get what you need with a product that has just 5-10%.



With a long presence on the European market, IR3535 provides similar or slightly less efficacy than DEET or Picaridin against mosquitoes. However, it is twice as effective against deer ticks. At the recommended 20% concentration, you’ll get eight hours of mosquito protection and at least six hours of tick protection. But IR3535 can be very irritating to the eyes.

Otherwise, this could be a good choice but I’d recommend against purchasing brands containing added sunscreen (products using IR3535 often have this). Sunscreens require more frequent application…and combo products would overexpose you to the insect repellent.


Do essential oils and botanicals work

In short, they can. However, there is no way to know how effective they are or for how long. In relying on them, you’re likely heading outdoors with a false sense of security that could put you at greater risk than if you were using nothing at all. Repellents that rely on essential oils or botanicals are classified technically as a minimum-risk pesticide – meaning they undergo no significant testing of efficacy. An essential oils/botanical label can say that the substance repels mosquitoes and ticks, but they can’t say it will protect you from Lyme, Zika or any other vector-borne disease.

safe-insect-repellentEssential oils and botanicals mixtures can be made at home or purchased ready-made. They do offer SOME protection to be sure. But they also evaporate more quickly from the skin. You’ll have to apply more frequently, and again, you’ll get zero protection from some specific illnesses.

They can irritate the skin – or you may find that you are allergic to a specific essential oil or botanical. They are never recommended for young children, due to lack of research. The EWG recommends avoiding all botanically-based repellents if you like in a high-risk area for disease or need long-lasting protection except one: Oil of Lemon Eucalyptus. Repel and Cutter brands have well-known products with Oil of Lemon Eucalyptus as the active ingredient. But again, the protection time is much shorter than DEET or the other chemicals mentioned earlier.

In light of diseases such as Zika and Lyme, the consequences of ineffective repellents can be severe. It’s important to use one that you know works well. Essential oils have no standardized oversight, such as EPA regulations. You may be taking a chance in using them.


How else to repel insects

Thankfully, there are many other tactics for keeping insects at bay aside from what you apply to your body.

For starters, avoid the dusk and dawn in the US, when mosquitoes are the worst. Clear your yard of places where mosquitoes like to breed (particularly any place with standing water). Mosquito netting works well for many spaces such as tents, strollers and on the porch. Always cover up exposed skin as much as possible with long sleeves/pants – and you can spray your clothing rather than your body for some protection. This site had some other ideas you may want to try.


I had a patient recently that wore a dog tick/flea collars around his boots. He said it helps prevent ticks and bugs from getting him when he is working outside. I thought this was brilliant! And it would avoid any risk of toxicity because it isn’t touching the skin.

The bottom line is that we all have to protect ourselves, particularly if we are outside for a long time and in an area prone to insect-born illnesses. The good news is that we have safe insect repellents that are effective. We’ve just got to know the facts and choose our protection wisely!

Dr. Sharman


Photo credit: ID 137875252 © Elizaveta Galitskaya |