Doxycycline

[LucyInColor]

Is doxycycline still the drug of choice for early tick bites? I'm planning a section hike & my doctor is pretty nice about giving me antibiotics to carry in case I'm bitten. Has anything changed in the world of tick bite drugs?

[gpburdelljr]

Why not ask your doctor?

[rickb]

Ask 10 doctors about the wisdom regarding a prophylactic course of Antibiotics after a tick bite (no symptoms) and you will likely get 10 answers.

Sort of like asking a financial advisor what the “best” investments are for your future.

Good idea to have a plan of action in place BEFORE you reach a decision point. In the not too distant past, one important factor on whether to take antibiotics (and if you decided to, just a couple or a full course) was how long the tick was embedded. Thinking on that may have changed. Another factor is what geographical location you got bit in. Easier to study up now and have a mental decision tree on what to do, than to try and figure e erythimg out in the woods.

You got a tick removal tool or good tweezers?

[becfoot]

Doxy is the drug of choice. I know too many NY'ers who have been recently bitten and that's what they're all getting and what you'd get if you went to urgent care here. One of my friends who got bitten is the wife of an ER doctor. She got the Doxy.

[foodbag]

I got Lyme in 2005 on the Trail in NJ - doxy for 30 days cleared it right up.

[chef4]

If you take it you need to be careful about sun exposure, it can lead to a severe sunburn or rash.

[TexasBob]

An once of prevention is worth a pound of cure. Consider treating your clothes with Sawyers or sending them off to Insect Shield because not getting ticks in the first place is the best way to deal with tick borne diseases.

https://sawyer.com/products/permethrin-insect-repellent-treatment/

https://www.insectshield.com/ISYOC.aspx

[Sarcasm the elf]

An once of prevention is worth a pound of cure. Consider treating your clothes with Sawyers or sending them off to Insect Shield because not getting ticks in the first place is the best way to deal with tick borne diseases.

https://sawyer.com/products/permethrin-insect-repellent-treatment/

https://www.insectshield.com/ISYOC.aspx

I highly recommend insectshield for tick prevention.

[Sarcasm the elf]

Since we’re discussing tick bite prophylaxis, I ran across these two articles recently that you may find relevant.

https://www.nejm.org/doi/full/10.1056/NEJM200107123450201

https://www.cdc.gov/ticks/tickbornediseases/tick-bite-prophylaxis.html

[Uncle Joe]

Why not ask your doctor?

Ask your doctor if Doxycycline is right for you!

[OCDave]

Ask 10 doctors about the wisdom regarding a prophylactic course of Antibiotics after a tick bite (no symptoms) and you will likely get 10 answers....




Yes, so much better to pose your medical questions here.

[Sarcasm the elf]

Yes, so much better to pose your medical questions here.

Agreed, however Rick is right insofar as Lyme recearch and recommendations have changed much over the years and not all medical professionals are up to date, particularly if they are not in an area where Lyme is endemic.

There is some merit to inquiring with a group like this to find what advice others have been given by their doctors. With the caveat that nothing should be relied upon until it has been separately verified and discussed with a medical professional.

[rickb]

Agreed, however Rick is right insofar as Lyme recearch and recommendations have changed much over the years and not all medical professionals are up to date, particularly if they are not in an area where Lyme is endemic.

There is some merit to inquiring with a group like this to find what advice others have been given by their doctors. With the caveat that nothing should be relied upon until it has been separately verified and discussed with a medical professional.
The tricky thing about antibiotics is what is best for society as a group, might not be best for any one individual.

Doctors come down differently on how to find a balance.

Do you want a Doctor who errs on the side of your health, or on the community’s health?

Or one that just follows the CDC’s latest recommendation?

Those who see their go-to Doctor as an all-knowing oracle of truth and wisdom, are likely folks who have never experienced serious health issues.

[TexasBob]

........Those who see their go-to Doctor as an all-knowing oracle of truth and wisdom, are likely folks who have never experienced serious health issues.

I hear you. A good doctor knows the limitations of their knowledge and experience and seeks more knowledgeable sources when they reach the edge of their experience and knowledge. To do otherwise is a disservice to their patient and themselves.

[OCDave]

...
Those who see their go-to Doctor as an all-knowing oracle of truth and wisdom, are likely folks who have never experienced serious health issues.

Those who come here, or any internet site, seeking medical advice from anonymous poster are folks who really have no clue.

Not happy with your doctor's advice, find another doctor. Asking the local grocer, mechanic, fish monger or tailor about health care rather than a healthcare proffessional is simply unwise.

[SWODaddy]

We're all going to die from pimples in 30yrs from over prescription of antibiotics.

[Five Tango]

I make it a point not to take antibiotics unless it's absolutely necessary.So far I have had two tick bites that required treatment.I now treat my clothes with permethrin and also take some supplements which I believe repel mosquitoes at least.

[rickb]

Those who come here, or any internet site, seeking medical advice from anonymous poster are folks who really have no clue.

Not happy with your doctor's advice, find another doctor. Asking the local grocer, mechanic, fish monger or tailor about health care rather than a healthcare proffessional is simply unwise.


Too bad this thread morphed in the way it did, rather than reveal specifics on what each of our Doctors have recommended to us.

Last year a close family member was prescribed about a two weeks course (not sure if Doxy or something else) of antibiotics for an embedded tick — even though there were no’s signs of infection.

A couple years ago my own/different physician gave me prescription for two pills for a tick that had been embedded on me for just under 3-days.

I know that others have been told to take a wait and see approach in similar situations.

There is no way I can say which Doctor was “ more right”, only that their approaches were very different.

[OCDave]

...
There is no way I can say which Doctor was “ more right”, only that their approaches were very different.

Exactly, my point.

[trailmercury]

If both patients had favorable outcomes, both doctor's treatments were "right".

[rickb]

If both patients had favorable outcomes, both doctor's treatments were "right".

True.

In the same way someone who decides not to buy insurance made the “right” choice if he never got sick.

[tdoczi]

If both patients had favorable outcomes, both doctor's treatments were "right".

bloodletting persisted as a viable medical treatment for as long as it did because, in part, if the process didnt kill the patient a good many of them, by sheer coincidence, survived and became healthy again.

does that mean the drs who performed bloodletting on them did the right thing?

[SWODaddy]

If both patients had favorable outcomes, both doctor's treatments were "right".

I have a rock that protects me from tigers. I know it works because I haven't been attacked by a tiger while carrying it.

[trailmercury]

bloodletting persisted as a viable medical treatment for as long as it did because, in part, if the process didnt kill the patient a good many of them, by sheer coincidence, survived and became healthy again.

does that mean the drs who performed bloodletting on them did the right thing?

Phlebotomy is still used in current medicine, look it up sir

[trailmercury]

I have a rock that protects me from tigers. I know it works because I haven't been attacked by a tiger while carrying it.

Not following you here

[trailmercury]

FWIW...

I am a family physician in Lyme-heavy Wisconsin, and I do indeed consider myself "Lyme-Literate"

I am very confident in handling tick prevention, tick bites, Lyme prophylaxis, Acute Lyme infection, Lyme sequelae etc etc

The decision to prescribe Doxy (or other antibiotics that kill borrelia) is made on a case by case basis.

folks can PM me with specific questions if desired.

[Sarcasm the elf]

I have a rock that protects me from tigers. I know it works because I haven't been attacked by a tiger while carrying it.

Sounds like something David Avocado Wolfe would sell.

[tdoczi]

Phlebotomy is still used in current medicine, look it up sir

there is no comparing modern phlebotomy to the ancient practice of bloodletting.

[tdoczi]

Not following you here
if someone gives you pills to take and you dont get sick that does not mean one can conclude the pills cured anything or that you would have gotten sick if you didnt.

and dont come back at me with "whats the harm of taking the pills just in case?"

[tdoczi]

The decision to prescribe Doxy (or other antibiotics that kill borrelia) is made on a case by case basis.


how do you feel about giving hikers antibiotics to carry around with them to take if they find a tick attached and afraid it might be carrying lyme?

[trailmercury]

how do you feel about giving hikers antibiotics to carry around with them to take if they find a tick attached and afraid it might be carrying lyme?


If a patient came to my clinic and made that request, I would most likely prescribe it after some patient education. Have you had the conversation with your doctor?

[trailmercury]

if someone gives you pills to take and you dont get sick that does not mean one can conclude the pills cured anything or that you would have gotten sick if you didnt.

and dont come back at me with "whats the harm of taking the pills just in case?"

My opinion that both patients were treated appropriately won't change.

I never tell patients to take these pills just in case, that's unwise and poor practice.

[Offshore]

I never tell patients to take these pills just in case, that's unwise and poor practice.

Here's an article from 17 years ago that addresses that: https://www.nejm.org/doi/full/10.1056/NEJM200107123450201 If you do a search on PubMed you'll find a lot more that are more recent and come to similar conclusions. So much for being "Lyme literate".

My own physician knows that I participate in a lot of outdoor recreation and suggested that I keep 200 mg of doxycycline in my FA kit in case of an embedded tick. He give me a new script at each annual physical.

[tdoczi]

If a patient came to my clinic and made that request, I would most likely prescribe it after some patient education. Have you had the conversation with your doctor?

nope. no interest in having it either. except perhaps as a way of vetting drs i might like to avoid

[tdoczi]

My opinion that both patients were treated appropriately won't change.

I never tell patients to take these pills just in case, that's unwise and poor practice.
yet youd also prescribe them pills that they were to take at their own discretion, as per your other post?

i fail to see the difference.

[trailmercury]

Here's an article from 17 years ago that addresses that: https://www.nejm.org/doi/full/10.1056/NEJM200107123450201 If you do a search on PubMed you'll find a lot more that are more recent and come to similar conclusions. So much for being "Lyme literate".

My own physician knows that I participate in a lot of outdoor recreation and suggested that I keep 200 mg of doxycycline in my FA kit in case of an embedded tick. He give me a new script at each annual physical.

would you take the doxy for any "embedded tick"?

[Offshore]

would you take the doxy for any "embedded tick"?

Given the relative risks and my location in the heart of the Lyme hot spot, yes, I would for a black-legged tick. That said, I've never had to use it as I don't consider it to be a first-line defense because you may never realize that you've been bitten. I take a proactive approach to tick safety by wearing permethrin-treated long pants, long sleeve shirt, hat, socks and shoes. The doxycycline is there for a worst-case scenario.

My internist takes a different approach - that of a partner in healthcare. Instead of taking the "I'm the expert here, so do as I say", we had an intelligent conversation re: the pros and cons, and I came to a decision with his input. That's my decision to make and may not be right for everyone, but a blanket refusal to even talk about it in light of decades of peer-reviewed medical literature showing a benefit really is a disservice to a patient.

[trailmercury]

yet youd also prescribe them pills that they were to take at their own discretion, as per your other post?

i fail to see the difference.



I am in agreement that a prophylactic dose of doxycycline is indicated in certain cases.

1. deer tick or tick not identified and
2. attachment time unknown or greater than 24-36 hours.

These folks are more likely to potentially benefit from the prophylaxis.

If a patient can assure me the deer tick was attached less than 36 hours or tick not engorged, (deer tick= ixodes scapularis), they are very unlikely to benefit from the 200 mg doxy.

let's not forget Babesia, Erlichia, Relapsing Fever and Rocky Mountain Spotted Fever as tick borne illness and disease to be aware of. Check the CDC website and talk to your private physician.

Offshore, I wish you the best of health and I'm glad that you are proactive about this important subject. I don't wish to further defend my training/experience/education on a public forum.

[trailmercury]

Given the relative risks and my location in the heart of the Lyme hot spot, yes, I would for a black-legged tick. That said, I've never had to use it as I don't consider it to be a first-line defense because you may never realize that you've been bitten. I take a proactive approach to tick safety by wearing permethrin-treated long pants, long sleeve shirt, hat, socks and shoes. The doxycycline is there for a worst-case scenario.

My internist takes a different approach - that of a partner in healthcare. Instead of taking the "I'm the expert here, so do as I say", we had an intelligent conversation re: the pros and cons, and I came to a decision with his input. That's my decision to make and may not be right for everyone, but a blanket refusal to even talk about it in light of decades of peer-reviewed medical literature showing a benefit really is a disservice to a patient.

the most important post of the thread

make a shared decision with your doctor

[tdoczi]

I am in agreement that a prophylactic dose of doxycycline is indicated in certain cases.

1. deer tick or tick not identified and
2. attachment time unknown or greater than 24-36 hours.

These folks are more likely to potentially benefit from the prophylaxis.

If a patient can assure me the deer tick was attached less than 36 hours or tick not engorged, (deer tick= ixodes scapularis), they are very unlikely to benefit from the 200 mg doxy.


they cant assure you of anything. theyre out in the woods carrying the drugs with them to use at their own discretion.

[trailmercury]

theyre out in the woods carrying the drugs with them to use at their own discretion.

And this can be quite empowering for them.

[tdoczi]

And this can be quite empowering for them.
thats a fascinating line of thinking re: medical care that i will not pursue further at this time.

with all due respect, you wouldn't be my doctor.

[trailmercury]

no harm done, I was certainly not recruiting you.

[rickb]

Instead of taking the "I'm the expert here, so do as I say", we had an intelligent conversation re: the pros and cons, and I came to a decision with his input. That's my decision to make and may not be right for everyone, but a blanket refusal to even talk about it in light of decades of peer-reviewed medical literature showing a benefit really is a disservice to a patient.

The last conversation I had with my Doctor regarding a tick bite included a discussion on the probability a Mount Desert Island tick (Acadia National Park) could be a vector (my info on that was superior to his), Bayes’ Theorem (I though myself about his equal but probably not given the context), the strategy suggested by Trail Mercury (virtually identical) and first hand experience dealing with this (hands down he had more).y

I think of him as a good doctor, but who could possible know? No red flags on the Internet, and I am alive and healthy. If I have a heart attack I will blame him, of course.

[chef4]

The tick/Lyme/other vector subject is so medically complex that it really doesn't lend itself to quick comments on WB; however, the idea that several have now suggested about having a conversation with a trusted medical professional who shares the decision making with you makes the most sense. Then you are informed and you make your own decision about what to do with an embedded tick, etc. If you get a red 'bullseye' rash after/while hiking an East Coast trail, see someone promptly.

[rickb]

The tick/Lyme/other vector subject is so medically complex that it really doesn't lend itself to quick comments on WB; however, the idea that several have now suggested about having a conversation with a trusted medical professional who shares the decision making with you makes the most sense.
I understand what you are saying, but a hiker needs to have a decision tree in place BEFORE going to see his trusted medical professional, and BEFORE hitting the Trail.

There are a number of good resources on line to help, and of course these can be followed up with a meaningful dialog with your doctor when you have your annual physical.

There is one school of thought that the time of tick attachement is important when considering a prophylactic (short) course of antibiotics— both with regard to the minimum time a tick needs to have been embedded to be of concern, and also the time beyond which a prophylactic course is not going to help anyway. Opinions on this differ.

The CDC speaks to this on-line, but their direction is less than crystal clear. Other resourses are out there to help — and of course a tick-litterate physician can be an important one.

When you are out hiking, the logistics of seeing a doctor quickly are not easy — much easier to just say “screw it” and hope for the best. If that is what one wants to do, fine. But far easier to think of things while reading WhiteBlaze than when out on the Trail.

I would think it wise to establish a means of contact with your doctor (email?), and discuss his willingness to help long-distance if you should discover a rash (it’s not always a bulls eye). Older folks like me know their Doctors and are probably not reluctant to ask about such things, but I expect many people might be. You ar their patient first, but also a customer.

If your Doctor prescribes a couple pills to take — under certain conditions — you might be able to take them at a time when they might have the greatest potential to be effective. Of course they could never be effective if you don’t have them.

There are plenty of details on all this — worthy of discussion I think.

My real message is stating what is probably obvious, but may not be:

A thru hiker should know exactly what to do if he gets a tick bite under various scenarios of time and place before taking his first step on the AT, and also make sure he has the ability to excersize that plan to the extent he thinks it important to do so.

Far better to have a plan worked out ahead of time, than to listen to a person like me at a shelter for help and direction.

[trailmercury]

I understand what you are saying, but a hiker needs to have a decision tree in place BEFORE going to see his trusted medical professional, and BEFORE hitting the Trail.










A thru hiker should know exactly what to do if he gets a tick bite under various scenarios of time and place before taking his first step on the AT, and also make sure he has the ability to excersize that plan to the extent he thinks it important to do so.

Far better to have a plan worked out ahead of time, than to listen to a person like me at a shelter for help and direction.


Agreed wholeheartedly.

If one of my regular patients or somebody new came in and said they were going on a long hike in a place where Tick disease is prevalent, a fairly long discussion would be had about tick bite prevention and tick borne illnesses. I would likely offer them a script for a 200mg doxycycline dose (or alternative) to be used out in the field later if certain criteria were met (attachment time, tick species etc.). I would let them share in the decision. I would want to get the impression from the dialogue that they reasonably understood when/if to use it (most likely the case for 95% or more adult humans, 100% of Whiteblaze members of course!!!).


Some folks incur preventable serious long term/permanent effects from Lyme disease. (Don't confuse this with "Chronic-Lyme", which is still highly debated and not an accepted diagnostic entity by the Infectious Disease Society of America and other highly esteemed peer-reviewed academic societies).



Post-Drift:
I thought about the other thread "AT in 100 years"...
In my fantasy, I see a pharmacy at Amicalola, stocked with doxycycline, Vitamin I, immodium, probiotics etc with providers there available to discuss with hikers if they should take them along on the hike, and when to use them.... again a shared decision.

[chef4]

Anyone who regularly hikes the east coast and particularly for distances like thru hikers should have a plan in place for tick bites (among other potential medical issues); few healthcare providers would welcome a phone call and/or cellphone image with a long distance request from a thru hiker whom they haven't seen in years. Most university hospitals have travel clinics staffed with infectious disease experts you can see to develop a plan, although depending on insurance these may be too costly for hikers, so I acknowledge the impracticality of this option (although it might be worth it if you also cover infectious diarrhea and skin infections). Among family docs/internists there is a full range of expertise on practical advice for tick bites and complications, from experts likely to offer your approach to novices, so hikers could be taking their chances when they see a healthcare provider. It would be good to have a list somewhere of docs who have a special interest in hiking medicine, perhaps there is one linked to the wilderness medicine society. Of course the majority of hikers do just fine with no advanced planning for this, you just never know who is going to have a problem.

[rickb]

Anyone who regularly hikes the east coast and particularly for distances like thru hikers should have a plan in place for tick bites (among other potential medical issues); few healthcare providers would welcome a phone call and/or cellphone image with a long distance request from a thru hiker whom they haven't seen in years. Most university hospitals have travel clinics staffed with infectious disease experts you can see to develop a plan, although depending on insurance these may be too costly for hikers, so I acknowledge the impracticality of this option (although it might be worth it if you also cover infectious diarrhea and skin infections). Among family docs/internists there is a full range of expertise on practical advice for tick bites and complications, from experts likely to offer your approach to novices, so hikers could be taking their chances when they see a healthcare provider. It would be good to have a list somewhere of docs who have a special interest in hiking medicine, perhaps there is one linked to the wilderness medicine society. Of course the majority of hikers do just fine with no advanced planning for this, you just never know who is going to have a problem.


Not so complicated.

Part A

Just research the short window of time when a single pill of Doxy has the potential to PREVENT serious health issues. There is a bit of disagreement on particulars, so read up.

Discuss with a tick literate physician.

Ponder how you would source and administer a single pill (if that is indicated) while you out in the woods. Rember the clock will be ticking (no pun intended).

Discuss that with your physician.

Thank your doctor for his advise,and for the single pill script he very well might have written.

Part B

Research, research and research, then discuss with your Doctor how to recognize actual Lyme Disease (or the possibility of it) at the earliest possible stage, and what to do if you find yourself in that position — including the potential impact of postponing treatment — because on the Trail it will never be convenient.

Ask you doctor for his advise on what to if you find yourself in a situation where it will take a few days (minimum) before you can present yourself to a Doc in a Box, or (last resort) an ER.

Thank him for considering your special situation as an AT Hiker.


Relax and handle things as the come.

[wordstew]

Some of the studies suggest that 3-4 days of doxy within 24 hours of the bite is just as effective as 30 days

[chef4]

Here are a couple of things that everyone should know:
1. Most Lyme disease comes from the tiny tick nymphs, about the size of a poppy seed, who transmit the disease in spring and until midsummer, they're easily missed on self exam. The larger ticks can transmit it, but they are easier to find, and they are more active later. They typically have to be on you for more than a day before the disease can be transmitted.
2. If you decide to take doxycycline try to limit sun exposure, as it can sensitize you to sunburn (similar to essential oils, see related posting)

[Sailing_Faith]

Just because it has not come up yet, do not take old Doxycycline! While many Rx meds are ok to take past their expiration date, doxy becomes liver toxic...... so that Rx you had filled years ago that you may be carrying ‘just in case’ needs to be replaced.

[rickb]

Just because it has not come up yet, do not take old Doxycycline! While many Rx meds are ok to take past their expiration date, doxy becomes liver toxic...... so that Rx you had filled years ago that you may be carrying ‘just in case’ needs to be replaced.

Settled science?

[chef4]

It's based on some old case reports of what happened to 3 people who took out of date tetracycline (precursor of doxycycline). The army tested doxycycline (since it's used for anthrax exposure) and found that it didn't deteriorate that way for a substantial time, and in fact sent 'expired' doxycycline out after testing it. Doxy is also expensive now (used to be dirt cheap, then a drug company pumped up the price) unless your insurance covers it. However, it's probably not a great idea to take it too long after the expire date, if you can afford a new supply, as no one is testing your batch.

[Offshore]

It's based on some old case reports of what happened to 3 people who took out of date tetracycline (precursor of doxycycline). The army tested doxycycline (since it's used for anthrax exposure) and found that it didn't deteriorate that way for a substantial time, and in fact sent 'expired' doxycycline out after testing it. Doxy is also expensive now (used to be dirt cheap, then a drug company pumped up the price) unless your insurance covers it. However, it's probably not a great idea to take it too long after the expire date, if you can afford a new supply, as no one is testing your batch.

Doxy is really not that expensive even if you have no prescription drug coverage. I get a prescription for 2-100 mg capsules from my doctor each year for my pack FA kit and it runs about $2.00. (Putting it through my insurance would actually make it higher due to the generic co-payment required.) Looking at prices for the normal course of 100 mg twice per day for 21 days (42 capsules), its running about $42 (Costco) - $95 (Walmart) and as low as $22 with a free coupon from goodrx.com.

Completely agree that given the long-term consequences of untreated or incompletely treated Lyme, its not worth using expired drugs of unknown efficacy - especially since doxy is so cheap.

[swjohnsey]

Doxycycline if the antibiotic of choice for Lyme and a bunch of other stuff. Other than sun sensitivity it doesn't have terrible side effects. I carry it. I would hesitate to use it if I got a suspicious tick bite or Lyme symptoms.

[Offshore]

Doxycycline if the antibiotic of choice for Lyme and a bunch of other stuff. Other than sun sensitivity it doesn't have terrible side effects. I carry it. I would hesitate to use it if I got a suspicious tick bite or Lyme symptoms.

Use the 200 mg prophylactic dose if you have gotten a suspicious tick bite, as it's been shown to prevent up to about 90% of expected Lyme infections. If you develop or already have symptoms of Lyme, then you need the full course of treatment. The 200 mg single dose doesn't apply to treating an infection, only preventing one.

[OCDave]

Use the 200 mg prophylactic dose if you have gotten a suspicious tick bite, as it's been shown to prevent up to about 90% of expected Lyme infections. If you develop or already have symptoms of Lyme, then you need the full course of treatment. The 200 mg single dose doesn't apply to treating an infection, only preventing one.

Or do 90% of tick bites not transmit Lyme? Could you provide a credible source for your statistic?

[Offshore]

Or do 90% of tick bites not transmit Lyme? Could you provide a credible source for your statistic?

Note my use of the word "expected" in my post. As far as sources, start with https://www.nejm.org/doi/full/10.1056/NEJM200107123450201 but there are many more articles on Pubmed. To be completely accurate, the reduction was not 90%, it was 87.5% - but still close enough to qualify as "about 90%".

[OCDave]

Note my use of the word "expected" in my post. As far as sources, start with https://www.nejm.org/doi/full/10.1056/NEJM200107123450201 but there are many more articles on Pubmed. To be completely accurate, the reduction was not 90%, it was 87.5% - but still close enough to qualify as "about 90%".


Thanks for the source.

[Fredt4]

If you have the bullseye you need to take Doxycycline. I've lived in Tennessee and have hiked, padded, hangglided, cave explored, camped, Backpacked, fished, hunted, explored and whatever since the 1970's and I never had a plan on dealing with Lyme. On my 2011 thru-hike I was bitten by an unseen tick. I got the bullseye and was diagnosed by a doctor and given the Doxycycline. I never developed or experienced any other issues. A friend in Nashville, a non-hiker, was also bitten. He also stated that he never saw the tick, only the bullseye. Same thing with another hiker on the AT. Lesson learned is that anyone is likely to be bitten whether they're hiking or not, and you don't need a plan to be bitten. It's totally an unfortunate bit of luck, but once you've been bitten and get the bullseye you need to be on Doxycycline. Most likely you'll never have and so called "contagious lymes" so be wary of anyone that talks about it. I will note that our former governor and current US Senate prospect was also bitten, but he apparently suffered some kind of chronic lyme disease issues. So whether you have a plan or not, you need to be aware of the disease and get proper care (Doxycycline) as soon as you see the bullseye and if so everything should be good.

[fiddlehead]

I read all this about going to your doctor.
What doctor?
If I'm from Pennsylvania, and I see a tick on me in, let's say Vermont, am I supposed to go to PA right away?
Or try to get an appointment with one in VT?
I know I tried to go to a dermatologist last year for a possible skin cancer and they told me they had an opening in 4 months time.
Who is your doctor?
Where is he?
Does he give advice over the phone?
Sometimes I don't understand American medical practice.
I would think it would be a better idea to have clinics and if there is a tick problem in VT, have doctors handy who are well educated in the type of ticks they have in VT.
(Or, just carry the doxy like my brother's and friends (deer hunters) do. )

[BillyGr]

I read all this about going to your doctor.
What doctor?
If I'm from Pennsylvania, and I see a tick on me in, let's say Vermont, am I supposed to go to PA right away?
Or try to get an appointment with one in VT?
I know I tried to go to a dermatologist last year for a possible skin cancer and they told me they had an opening in 4 months time.
Who is your doctor?
Where is he?
Does he give advice over the phone?
Sometimes I don't understand American medical practice.
I would think it would be a better idea to have clinics and if there is a tick problem in VT, have doctors handy who are well educated in the type of ticks they have in VT.
(Or, just carry the doxy like my brother's and friends (deer hunters) do. )

Many areas now have facilities (often called urgent care or similar) that are somewhere between a regular doctor's office and an emergency room.

They generally work on a walk in basis, and can treat anything a regular general practitioner would, plus some thing they wouldn't (like doing stiches, casts for broken bones and other similar treatments).

If one was on the trail, that would be the type of place to look for - might not be right along the trail, but certainly easier to get to than your regular doctor (potentially) several states away.

[Offshore]

I read all this about going to your doctor.
What doctor?
If I'm from Pennsylvania, and I see a tick on me in, let's say Vermont, am I supposed to go to PA right away?
Or try to get an appointment with one in VT?
I know I tried to go to a dermatologist last year for a possible skin cancer and they told me they had an opening in 4 months time.
Who is your doctor?
Where is he?
Does he give advice over the phone?
Sometimes I don't understand American medical practice.
I would think it would be a better idea to have clinics and if there is a tick problem in VT, have doctors handy who are well educated in the type of ticks they have in VT.
(Or, just carry the doxy like my brother's and friends (deer hunters) do. )

Urgent care center (in case you're not kidding).

[fiddlehead]

Urgent care center (in case you're not kidding).

Not kidding at all.
I don't have a so called "personal doctor"
I rely on my VA health care and local office for that when in my home in PA.

[Don H]

I carried Doxy all the way from GA until I got sick in MA. Called my Dr. and discussed my symptoms and he recommended I start taking the Doxy and called in a prescription for 28 days worth to the pharmacy in Dalton. When I got home I tested positive for Lyme.

For those that think Permethrin alone will prevent Lyme I treated all my clothes every month from VA in April until NH and still got Lyme. Never saw a tick, never saw a ring (erythema migrans).

[Traveler]

I read all this about going to your doctor.
Sometimes I don't understand American medical practice.
I would think it would be a better idea to have clinics and if there is a tick problem in VT, have doctors handy who are well educated in the type of ticks they have in VT.
(Or, just carry the doxy like my brother's and friends (deer hunters) do. )


VT has walk-in clinics. They also have indoor plumbing and doctors who are able to read in VT. What a wondrous time we live in!