Family Webicine

By Rod Moser, PA, PhD

The rains have finally stopped in Northern California. The trees have finished blooming and are now fruiting. There are bees, butterflies, hummingbirds, and other pollinators everywhere. It looks like it is going to be a good fruit year, unlike those years where an unseasonal snow or torrential rain destroyed the blossoms. Everything would be ideal outside except for the mosquitoes and ticks and the potential diseases they can carry, like Lyme disease or West Nile Encephalitis, both of which are becoming more common in our area.

Not long ago, we were blessed with a rare event – a solar eclipse, the first one in decades. We were able to view it, until the mosquitoes drove us off. At one point, before I doused myself in DEET, I had at least a dozen honing in on me. Even my wife, who claims to “not be bothered” by mosquitoes was driven into the house. I don’t like smelling like insect repellant, but I would have died from blood loss had I not used it.

I have tried just about every home remedy as an effective insect repellant, and I even wore an electronic device that was supposed to drive them away. Nothing has worked as well as DEET, and even DEET has its critics. It has been used and extensively studied for over five decades, and complications are extremely rare. DEET is safe for adults but should not be used on babies under two months old.

Mosquitoes always seem to bite you in a place you cannot easily reach. I have gone through four tubes of hydrocortisone cream and taken some antihistamines, but I still have some itchy bites. One time, while vacationing in Minnesota, the Land of Giant Mosquitoes, I was so terrorized that I completely covered my naked body with the strongest DEET I could find. I then put on a long sleeved shirt, long pants, and a hat in order to sleep. In the morning, both of my eyes were swollen shut from mosquito bites on my eyelids!

I put up a bat house several years ago, and I believe I have at least two or three residents now, with room for about two dozen more. Bats eat mosquitoes, but I am concerned that our mosquitoes will eat the bats. Ecologically, we also have a lot of frogs (Spring Peepers) and lizards this year. Frogs, when they are not busy attracting a mate, will eat mosquitoes and mosquito larva in any standing water. Birds are good mosquito-eaters too, and I do my best to attract birds using feeders. Of course, the feeders attract squirrels and the squirrels attract coyotes. I am not about to get dingo dogs to run off the coyotes.

Some people are more prone to getting bitten than others. Unfortunately, I am one of those people who are attractive to bugs. Researchers have found that certain kairomones – the odors our body produces – can be detected over 50 meters away by hungry mosquitoes. Lactic acid, sweat, heat from our skin, and exhaled carbon dioxide all send signals that you are a desirable meal.

I am still recovering from shoulder surgery, so outside tasks are limited to what I can lift with my good arm and by a narrow window of time around mid-day. The early morning hours and about 4 PM when it starts to cool down are mosquito time.

After a few hours collecting downed tree limbs, I found a big tick happily burrowed into the top of my foot. It didn’t appear to be a deer tick – a potential carrier of Lyme disease – so I was not overly concerned, other than the yuck factor. I will watch for the signs of Lyme disease anyway. An expanding, bull’s eye-like, round rash at the site of a tick bite, accompanied by flu-like symptoms (headache, fever, joint pain, chills, etc.) is highly-suspicious of Lyme disease, requiring prompt medical intervention. I had my wife do a thorough tick inspection, but the one on my foot was the only one.

I try to keep the undergrowth clean for fire protection, but if I am going get ticks every time I go into the woods, forget it. I have already hired one of my adolescent patients to come up for some yard work. At least if he gets Lyme disease, I can diagnose and treat him.

I always get questions about the best way to remove a tick. As a child, my uncle used a lit cigarette or match to burn the tick, enticing it to come out. I was always puzzled about this. If someone burned my butt, I sure would not be backing into the flame. In the office, I will often freeze the tick with liquid nitrogen and pull it out with sterile forceps. If the head is retained, I will inject a small amount of lidocaine under the skin and remove the core using a punch skin biopsy tool. Others have used a gob of Vaseline to smoother the tick or rubbing alcohol to kill it. Either way, the goal is to get it out intact if you can. Deer ticks in an area that has known cases of Lyme disease can be tested by the health department, so save the tick in a container.

Did you know that mosquito-eating lizards can carry a tiny mite that is also capable of carrying Lyme disease?

Maybe I should just move.