Ask Dr. Mike: How Scared Should We Be of Ticks and Lyme Disease?

Mike Cirigliano, aka Penn’s Dr. Mike, who tells us all about deer ticks and Lyme disease

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Meet internal medicine physician Michael Cirigliano, affectionately known as “Dr. Mike” to not only his 2,000 patients, who love his unfussy brilliance, tenacity, humor, and warmth (he’s a hugger!), but also to viewers of FOX 29’s Good Day Philadelphia, where he’s been a long-time contributor. For 32 years, he’s been on the faculty at Penn, where he trained. And he’s been named a Philadelphia magazine Top Doc every year since 2008. Now, he’s our in-house doc for the questions you’ve been itching (perhaps literally) to ask a medical expert who’ll answer in words you actually understand. Got a doozy for him? Ask Dr. Mike at victor@phillymag.com.

Dr. Mike, ticks and Lyme disease are always a problem this time of year, but reports suggest that the ticks are really, really bad right now. How worried should I be?
Oh, Lyme disease is a nightmare from Hell. Lyme disease scares me.

A friend of mine told me that her son got bit by [a tick] the other day, and she was really freaked out.
Well, she should be — Lyme disease is a major issue. It’s already endemic to the Philadelphia area. I can’t even tell you how many people I treat every year for Lyme.

How do you diagnose it? It’s just a simple blood test, right?
Many times, the blood test can be negative, even though the patient is sick. So it needs a clinical diagnosis. One of the most common things we look for with Lyme is a rash called erythema — the classic bullseye. Although 70 to 80 percent of people who have Lyme will present the rash, the ones who don’t — 20 to 30 percent — often get misdiagnosed.

An example of a bullseye rash that is a symptom of Lyme disease caused by a deer tick. / Photograph courtesy of Centers for Disease Control and Prevention

Will sprays like Off! help prevent me from getting bit in the first place?
Yes, yes, yes! That’s one of the critical measures you need to take. I know it’s 100 degrees out, and you don’t want to wear long sleeves and long pants. But if there’s brush — whether you’re in a field or your own backyard — at least use DEET, okay? The best way to prevent Lyme is to not get bitten.

I know that Lyme comes from a deer-tick bite, but what actually causes it?
Lyme is caused by a bacteria called Borrelia burgdorferi, which is a spirochete [spiral-shaped bacteria, some of which are serious pathogens, that can burrow deeply into tissue]. Spirochete can present in many, many, many different ways. So if you get Lyme disease but no diagnosis, and nobody treats you, the delay can then lead to more serious conditions.

Like what?
You can develop heart problems. You can have neurological problems. You can get Bell’s palsy. You can get arthritis. When someone comes into my office and says they have a tick bite, I take it very seriously. Some data shows that if the tick just crawling on you, or if it was on for less than 24 hours or so, you can treat the bite with one dose.

One dose of what, exactly?
Usually doxycycline — unless the patient is young, then you use amoxycillin. In people with the rash, you’re talking about a 10- to 14-day treatment. I had a woman — you ready for this? — she was going to have hand surgery [for arthritis-like symptoms]. And I said, “you know, just because I’m a nightmare crazy guy, let’s just check for Lyme.” She had Lyme arthritis! I treated her for 28 days, and she got better.

What other symptoms might make you test me for Lyme?
Well, you can have fatigue, fever, joint pain, enlarged lymph nodes. You listen to your body, okay? If you listen to your body, it will tell you, “Hey, something’s not right.” I like quoting Sir William Osler, the father of modern American medicine, who one said about syphilis, “It’s a great masquerader.” Well, Lyme is also a great masquerader. And both syphilis and Lyme are spirochetes!

If you find a tick on yourself or someone else, what should you do?
You generally try to remove it. There’s a lot of old wives’ tales about how to do it.

When I was a kid, I remember my mom would light a match, then blow the match out and touch the hot match head to the tick, and the tick would release. Or it was supposed to.
That was back in the day when ticks were large. But deer ticks, the ones spread Lyme disease, are tiny.

Like a pinhead?
Yes. You can use tweezers, and you grab the tick as close to the skin surface as possible, and then you pull upward. Some people use gasoline or rubbing alcohol and petroleum jelly, but believe it or not, it’s been studied: Tweezers are the best way to go. Then you clean the area right away with alcohol, soap, and whatever.

I also have heard that you should Scotch-tape it to an index card so your doctor can examine it.
Well, that always helps.

Back to the bullseye: How big are we talking for this rash?
It starts off small and then gets bigger. It can be almost the size of your armpit. The rash can then show up all different kinds of areas, even in the little nooks and crannies of your groin or armpit.

So you’re saying I should ask my wife to inspect my groin whenever I come in from the field?
Well, that wouldn’t be a bad idea — for a number of reasons.

Is the rash itchy?
Generally not.

But again, if you have a rash, you might not even know it’s there?
You may not know. Now, some people will call me and say “I think I have poison ivy. I have this round thing on my back.” I ask: Does it itch? “Not really.” Well, I think you have Lyme disease. I’m telling you right now, Victor: I napalm first and then ask questions.

Between this conversation about tick bites and Lyme disease and the one we had recently about skin cancer and sun exposure, I feel like you’re telling me I should just never go outside.
Well, I’m not saying to live in fear. But we have to talk about alpha-gal.

Oh, great. Something else I probably don’t want to get.
Sometimes, a person can get bitten by a tick and then develop an allergy to something in red meat. And then they eat a hamburger and they can die. So, ticks are bad. I don’t like them. I don’t like them one bit!