Avoiding Ticks: How to Stay Safe While Enjoying the Outdoors with Dr. Sorana Segal-Maurer

Summer is around the corner, and more of us are enjoying time outside. While there are many health benefits to being in nature, it’s important to be aware of the danger of outdoor pests like ticks. With tick numbers already reaching record highs, we wanted to re-air our conversation with Dr. Sorana Segal-Maurer, an infectious disease expert at NewYork-Presbyterian and Weill Cornell Medicine. 

Dr. Segal-Maurer shared ways we can protect ourselves and our loved ones from tick-borne diseases. She also explained the steps you should take if you do find a tick on yourself.

Faith: Dr. Segal-Maurer, thank you so much for joining us.

Dr. Segal-Maurer: Thank you so much for having me. Just love to debunk some things and really get people to be smart and to go outside.

Faith: There are a lot of misunderstandings out there about tick-borne illnesses. And one thing we can debunk right off the bat – I know we’re talking about ticks in summertime, but ticks are something we need to be aware of all year round, right?

Dr. Segal-Maurer: Big shock for everybody, ticks become active anytime the temperature’s above freezing. We all know we’ve had some very mild winters. We’ll have somebody come in with Lyme in February or March after we’ve had a number of days, or a week or so in the forties. and they have Lyme, and everyone is shocked and surprised, but we are not.

Faith: So if you find that someone in your household is bitten by a tick, what’s the first thing you need to do?

Dr. Segal-Maurer: So the first thing that you do is you need to keep a sharp tweezer around. Not a blunt tweezer. And actually, there are videos on the New York State website, on the CDC website, on YouTube, how to remove a tick. Do not squeeze the tick because squeezing the tick can push whatever infection, uh, through the mouth of the tick into the person’s body.

Try to get as close to the skin as possible where the mouth parts are and try to do steady pulling up of the tick. Dispose of it immediately is usually my advice. So I say flush it down the toilet. Um, definitely disinfect the area. Just a little bit of soap and water is more than enough. And call a provider, sort of talk ’em through what’s happened. So it’s less for the patient to ask about treatment, more for the patient to say, “This is what I found. What are my next steps?”

Faith: And what information is most helpful for healthcare providers?

Dr. Segal-Maurer: What we wanna hear is if the tick was engorged. So if the tick was sort of on the bigger end, the size of a sesame seed rather than a poppy seed, uh, I know those are super tiny. We wanna know that you went out maybe two, three days ago, and you found it today. That’s kind of helpful because we know it’s been latched on for a while. If the tick is just crawling and has not been feeding and super tiny, we do not recommend doing anything at that point.

Faith: We hear a lot about Lyme, but what are the most common diseases carried by ticks?

Dr. Segal-Maurer: So it depends on where you live, where you travel, where you work. So tick-borne illness in New York state for well over 10 years has focused on four major infections. And ticks can be infected with one or two or three or all four, or sometimes even more than four infections at the same time.

Faith: Oh my gosh.

Dr. Segal-Maurer: The infections are Lyme, anaplasmosis, babesiosis and Powassan virus.

Faith: Is there a way when someone has a tick bite, is there a way to draw blood or do some sort of test that can demonstrate how many of those illnesses they might have?

Dr. Segal-Maurer: We all want that blood test, right? That is not how we approach tick-borne illness, ah, because the test can be negative early on, even though the person may end up developing Lyme disease. So the way we go about it is we will make a decision based on risk.

We know from the work done at the state, they do something called tick drags. They analyze the ticks, and then they can tell us in this part of New York City, New York state, you have this. You have a lot of Lyme. You don’t have babesia.

The other thing that is wonderful, the cdc.gov has an interactive website that looks at tick-borne illness symptoms and actually you can put in the year, you can put in the month and you can see in your area in all of the United States, how many people presented with symptoms to their local emergency rooms or their local doctor. So we can put two and two together, we can look at the tick drags and tell you in your area you have this concentration of ticks that have Lyme.

If the tick has been attached for more than 36 hours, if it’s within 72 hours of removal, we may decide to give preventive treatment. If somebody comes down with one tick-borne illness, we educate them that they may need to come back to us if the symptoms don’t resolve or they have new symptoms that pop up.

Faith: What are the typical signs and symptoms of the most common tick-borne diseases?

Dr. Segal-Maurer: Yeah, so the most common is going to be Lyme, certainly for the Northeast. Fever, headache, muscle aches. And not everyone gets that distinct bullseye rash.

Faith: If it’s not a tick bite from a tick carrying Lyme, are the symptoms likely similar? Muscle aches, fatigue, headaches.

Dr. Segal-Maurer: The initial symptoms are exactly the same. So anaplasmosis, a different kind of infection that ticks carry, again, headaches, muscle aches, fevers, and there’s other blood test abnormalities that we see with anaplasmosis that we don’t usually see with Lyme.

Faith: And just to be clear for folks, ‘cause I feel like Lyme disease gets all the headlines. Is it as important and urgent to treat any kind of tick bite where you might have an illness that is not necessarily Lyme?

Dr. Segal-Maurer: So it’s a great question. The way we approach it is the following, Lyme being the most common, uh, the antibiotic that we use for Lyme actually happens to treat anaplasmosis as well, so you get a two for one, so to speak.

The problem comes with babesiosis. Babesiosis, the symptoms appear much later on. So we need to tell the patients, once we’ve treated Lyme, let us know how you are. If a month from now you get fatigued and you feel terrible, come on back because we need to do different tests to look for babesiosis, and the treatment is completely different.

Now, I bet you’re gonna ask me, well, why don’t we just treat everything at the same time? Nobody likes to take more medications than absolutely necessary. I’m among the many providers that really limit what we give patients. There’s side effects, please don’t take things you don’t need to take.

Faith: Can someone be immune to Lyme or other tick-borne diseases?

Dr. Segal-Maurer: I love that question because that’s a huge myth. There is zero immunity.

Faith: Oh wow.

Dr. Segal-Maurer: You can have Lyme once, twice, six times, and that’s where I hope, Faith, we’re gonna start talking about prevention. We’re all about prevention, all about education.

Faith: So prevention is the best cure, right? So what can people do to prevent tick bites?

Dr. Segal-Maurer: So prevention comes in a number of different modalities. Number one, let’s talk about, um, personal prevention. Let’s say you are going to a classic outdoor hike. Stay in the middle of the path. Wear light color clothing. If there’s a tick, you’ll be able to see it. Wear your socks over your pants. Wear a hat. There are ticks that attach to the scalp.

For the skin, use DEET, at least 30%. I most certainly do use DEET, and I have a little bottle at the front door. If somebody does not want to use DEET, they can potentially try oil of eucalyptus. It is not always as effective for a couple of reasons. Number one, depends how much you put on, it can evaporate. Number two, depending on what company you’re using, it may have different amounts of oil of eucalyptus.

The clothing can be sprayed with something called permethrin. That’s for the socks, uh, the shoes, uh, the pants, and all of that. Children, please check with a pediatrician always. Never get anything on children’s hands because obviously everything gets into their mouths. And pets? Uh, we may not be going outside, but the dogs are. They’re sticking their nose and snuffling in those leaf piles. And now you have to look at their face, their head, for ticks.

Faith: So that probably also involves a lot of assiduous brushing, checking your dogs probably more than you check yourself.

Dr. Segal-Maurer: Pretty much, yes. The environment, that’s our last piece. If you are in a high rise, maybe not as much to worry about, only when you go out to leafy green areas. But if maybe you live in a home that has a yard, get rid of leaf litter. Mow your lawn. The greatest risk for ticks are between the lawn and any kind of tree shrub areas. For the northeast, the most common place when you speak to people who have Lyme and all of these infections, they actually got them in their backyard.

Faith: I’ve even heard of people picking up a tick in a parking lot.

Dr. Segal-Maurer: Right.

Faith: So, but one doesn’t think of wearing, the kind of clothes you’d wear to go hiking just to stroll across your backyard or to a parking lot. So I would imagine that means, really kind of relentless checking, right? Where do we check? Are you gonna tell us absolutely everywhere?

Dr. Segal-Maurer: Absolutely everywhere is a good idea, but I think we need to stay focused. So the immature ticks, they don’t have the energy to really crawl and hide in a nice protected area. So frequently they’re found on legs, especially people going hiking, uh, without long pants and all of that.

The adults crawl to a protected spot, which could be behind the knees, in the groin, under the arms, uh, by the belt line, and in women under breasts, and in scalp, behind the ears. That evening, tick check is super important. Because you don’t know what’s happened all day long. And if you check in the morning and you say, well, I’m good. You don’t know what’s happening the rest of the day.

Faith: I think we both wanna end on a positive note here. We haven’t heard you warn against doing the things and we love in the outdoors. You want us to go on picnics, You want us to go on hikes, right?

Dr. Segal-Maurer: I absolutely do, and I, I’m so glad that we’re landing on this. As my husband has said to me, I’m a total Debbie Downer. But what I wanna emphasize. Yeah, I carry the suitcase of medications, but we’ve got on safaris, mountain climbing in exotic places because life is about enjoying.

I’m a huge supporter of the fresh air, the morning walks, the evening walks. Go, go golfing. But put on your DEET when you go golfing, please. Just be very smart about it. I personally don’t think there’s anything as regenerative as being in the outdoors.

Faith Dr. Segal-Maurer, this is a ton of helpful information. This will help us all stay a lot safer. Thank you so much for joining us.

Dr. Segal-Maurer: Thank you.

Our many thanks to Dr. Segal-Maurer.

Health Matters is a production of NewYork-Presbyterian.

For more stories of science, care, and wellness visit healthmatters.nyp.org.

The views shared on this podcast solely reflect the expertise and experience of our guests. 

NewYork-Presbyterian is here to help you stay amazing at every stage of your life.