Woods Hole Doctor Shares Tick Removal Tips

Dr. Alan Steinbach of Woods Hole with his dog, Fuji. Dr. Steinbach said he and his wife are vigilant to examine themselves and each other regularly for ticks, in part because Fuji sleeps in bed with them, which increases their likelihood of being bitten by one.ELIZABETH W. SAITO/ENTERPRISE - Dr. Alan Steinbach of Woods Hole with his dog, Fuji. Dr. Steinbach said he and his wife are vigilant to examine themselves and each other regularly for ticks, in part because Fuji sleeps in bed with them, which increases their likelihood of being bitten by one.

The best way to remove an embedded tick is to grip the tick close to the skin with a pair of tweezers and pull gently but firmly. All other methods—burning the tick off, applying alcohol to get it to retract, and twisting—are not only a waste of time but potentially harmful, according to Dr. Alan B. Steinbach of Woods Hole.

“Fingernails are not appropriate,” Dr. Steinbach said, because it is harder to grip the tick close to the skin, and sharp nails may actually puncture the tick’s body. “Conceivably you could get some tick goo on your finger and then that could be a vector” for spreading tick borne bacterial diseases such as Lyme disease, babesiosis, and anaplasmosis, he said.

The reason burning, twisting, and applying chemicals are not ideal, Dr. Steinbach said, is that such methods agitate the tick, which “in theory” could cause the tick to reflux, increasing the risk of bacterial transmission. Dr. Steinbach said solid scientific studies on this point are lacking, but most doctors agree there is no benefit to manipulating the tick prior to removal.

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An article on tick removal published in American Family Physician states that “although there is conflicting evidence as to whether the removal technique influences infection rates, these methods [applying a hot match, alcohol, or nail polish remover] may induce the tick to salivate and regurgitate into the attachment site, theoretically increasing the risk of infection.”

It is important to get the tick off as soon as possible, because the risk of contracting Lyme disease increases significantly after 24 hours. Ticks do not get a blood meal the same way mosquitos do. Instead of piercing through the skin to access a capillary, a tick cements itself into the skin and dispatches chemicals that cause cell death; after it causes enough damage, a pool of blood will form at the wound, which the tick then drinks from, Dr. Steinbach said.

Lyme disease is spread exclusively by deer ticks, also called blacklegged ticks. According to the Center for Disease Control, “Typical symptoms include fever, headache, fatigue, and a characteristic [bull’s eye] skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system.”

A good pair of tweezers, good lighting, and steady focus are all important for effective tick removal, Dr. Steinbach said. In other words, do not try to pinch a tick off a child as he wiggles about in a dimly lit bedroom. Having an appropriate “death chamber” close at hand is also important, Dr. Steinbach said. Dropping the tick into a jar of alcohol, or sealing it in a piece of clear tape are both effective methods of disposal. Cutting the tick is “not a good idea” because it exposes the cutter to the tick’s potentially infectious body fluids. Carrying the tick from one room to another is also a bad idea because the tiny arachnids can easily slip loose, Dr. Steinbach said. Best to have a disposal plan worked out before removal, he said.

After the tick is removed, apply alcohol or another antiseptic to the attachment site. If any part of the tick remains in the bite site, there is a greater risk of the wound becoming infected, Dr. Steinbach said. If a tick is highly engorged and difficult to remove, seek medical assistance. A tick that has recently bitten its host will be easier to remove.

Dr. Steinbach said that when he talks with infectious disease colleagues, they all rate Lyme disease high on the list of diseases to be concerned about. “Many of them put Lyme in the top 10” if not in the top five, up there with HIV, he said. Chronic Lyme can be highly debilitating. “It’s our own little private hell, since it isn’t very prevalent anywhere else,” he said. The Cape and islands has the highest incidence of Lyme disease in the state.

Dr. Steinbach, 73, is a part-time family practitioner. He works in the office of Dr. Natalie L. Chambers in North Falmouth, and also in regional urgent care centers. After being “bi-coastal” between Woods Hole and Muir Beach, California, he and his wife, Sala Steinbach, recently made Woods Hole their permanent home. 

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See more tips from Dr. Steinbach.

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