Regulator rules against CVD warnings on NSAIDs
Thank you for the interesting article in your clinical section by Dr Philip Welsby of the Western General Hospital in Edinburgh about treating tick bites and Lyme disease (July 23).
It is possible to buy tick removers from pet shops and I have found, having removed a few ticks from people, that it is best to unwind them one and three quarter turns anticlockwise (clockwise in the southern hemisphere).
They then come out very easily with the little feelers still twitching enough to frighten the patient.
In the old days, before we knew about unwinding ticks, I had some patients who were tracking insects on an island in the Gulf of Carpentaria off northern Australia.
One had a lot of ticks in his nether regions and, remembering my advice, poured some industrial alcohol on the area and a few ticks dropped off.
His colleague, then remembering the other advice, held a lighted cigarette to the area and there was a large whoosh which certainly treated the ticks but was not ideal. If people want to use these methods it should be either/or, not both.
However, it is best to stick to unwinding them. As regards treatment, either give the doxycycline within 72 hours, as Dr Welsby suggests, or, if it is later than this and somebody has developed the erythema chronica migrans (ECM) rash, then I have found if you give a long-acting tetracycline 300mg twice a day, for 60 days, patients will not develop neurological symptoms.
The Borrelia burgdorfer titre often takes a while to rise. We have had a few cases in Malvern already; I presented two cases back in 1988, and recently somebody developed Lyme arthritis in her knee after riding a horse across one of our local commons.
It is worth considering B. burgdorfer titres in neuropathies, including optic neuritis.
Winnie the Pooh said 'the more you look, the more it isn't there' but for
GPs, the more you look the more you
A L McCracken