Podcast: WHAT DOES YOUR DOCTOR SAY?

Episode: Ticks, mosquitoes, wasps. How to react?

Leading: Dariusz Litera

Guest: Dr. Marcin Roszkowski, family medicine specialist

Duration: 15 minutes

Ticks, mosquitoes, wasps, and bees are a common topic of conversation among patients, especially during vacations, trips, and nature walks. While many such situations result in only local discomfort, some require careful observation, and some symptoms should prompt immediate medical attention or emergency medical assistance.

In this podcast episode WHAT DOES YOUR DOCTOR SAY? Dariusz Litera talks with Dr. Marcin Roszkowski, a family medicine specialist, about how to safely remove a tick, what not to do if you find one in your skin, when to observe the bite site, and the importance of erythema migrans.

The conversation also covers mosquitoes, repellents, and wasp and bee stings. The expert explains which symptoms after a sting may indicate a serious reaction, when it's worth calling for help, and why allergic individuals should inform others about their risk.

Full podcast transcript

[00:00:00] Introduction: Ticks, Mosquitoes, and Holiday Anxiety

Dariusz Litera:

Nothing ruins the holiday spirit like blisters and annoying itching. While mosquitoes are the most common nuisance, ticks keep many parents awake at night, especially if the whole family is spending their vacation outdoors.

Today, your doctor is Dr. Marcin Roszkowski, a specialist in family medicine. Good morning, doctor.

Dr. Marcin Roszkowski:

Good morning, Mr. Editor.

[00:00:22] What are the risks of a tick bite?

Dariusz Litera:

What can be the danger of such a tick bite?

Dr. Marcin Roszkowski:

Like.

Dariusz Litera:

Really?

Dr. Marcin Roszkowski:

Statistically, we are in very little danger from a tick bite.

Dariusz Litera:

Well, the doctor calmed me down a bit, because when I go for a walk with my dog, I mainly remove these ticks from the dog, but I'm afraid that some of them will end up under my pant leg somewhere.

Dr. Marcin Roszkowski:

Can the editor identify what species of tick this is? Because not all ticks are created equal.

Dariusz Litera:

I can't.

Dr. Marcin Roszkowski:

Ixodes ticks are the kind of ticks that transmit things like Lyme disease, which we all fear so much. So if your dog had a tick from another species, you have to worry about Lyme disease, Mr. Editor.

Dariusz Litera:

But how do you tell them apart?

Dr. Marcin Roszkowski:

They are easy to distinguish, but difficult to describe in front of a microphone.

Dariusz Litera:

So we look on the internet and type Ixodes.

Dr. Marcin Roszkowski:

And we do distinguish. It's truly possible to distinguish one from the other.

Dariusz Litera:

There is some geographical variation.

Dr. Marcin Roszkowski:

Poland is a region entirely endemic to the Borrelia burgdorferi bacteria, which causes Lyme disease, also known as Lyme disease.

Dariusz Litera:

Okay, so we don't want to get Lyme disease, but statistically, as the doctor said, the probability is not high.

Dr. Marcin Roszkowski:

It's not a big deal, but it poses a risk of several diseases. Ticks bite our skin, drink blood, and after drinking this blood, they become hydrated and release the excess water back into their bodies in the form of saliva. And unfortunately, it happens that these very germs, whether bacteria, viruses, or other organisms, can re-enter their bodies. That's why they transmit these diseases.

[00:01:47] How to safely remove a tick from your skin?

Dariusz Litera:

Let's say a tick like this is implanted, and I look, pull up my pant leg, and there it is. How do I safely remove it?

Dr. Marcin Roszkowski:

It's very simple, provided you know the rules. Don't twist, strangle, burn, or soak it in anything. You should use a simple tool that allows you to grasp it either near the mouth or pry it open near the mouth and simply pull it out of the skin with a gentle but firm, continuous motion.

Dariusz Litera:

So that nothing is left inside.

Dr. Marcin Roszkowski:

It can stay inside. Don't worry. These are just fragments of the tick, chitinous fragments that pose no threat and don't increase the risk of infection, unlike with other insects.

Dariusz Litera:

Does this one decisive move count?

Dr. Marcin Roszkowski:

No, it's not so important that it's a decisive movement. We just pull it out all at once. Neither too suddenly nor too slowly. The most important thing is not to strangle it. We catch it near the mouth.

We can use various tools. We can use fine-tipped tweezers or a card available at the pharmacy that has a notch. We insert this notch until the tick becomes trapped in the notch. Then, we pull it out with an upward motion and pry it out.

The loops are also very convenient. They look like a pen with a small loop at the end. You place the loop on the tick, tighten it around its mouth, and then pull it out easily without any suffocation. Very safe.

[00:03:01] What not to do with a tick and how to deal with it without a tool?

Dariusz Litera:

Well, veterinarians advise completely different things, because the veterinarian to whom I took my dog with numerous ticks says to twist them out.

Dr. Marcin Roszkowski:

I know they say that. However, literature clearly states: don't twist, don't stifle, don't treat anything differently.

I'll recommend a very simple method if you're on vacation or in a meadow and don't have any tools to remove a tick. Take a PET bottle, cut out a piece of plastic, make a narrow V-shaped incision in the plastic from the edge, and proceed the same way as with the card. Slowly insert the tick to pry it up and pull it out.

Dariusz Litera:

Then the tick flies away.

Dr. Marcin Roszkowski:

Yes, yes.

Dariusz Litera:

Maybe it would be better, now that we have it on our skin, to take a photo of it so that we can determine what species it was?

Dr. Marcin Roszkowski:

This can make things a lot easier.

[00:03:43] What to observe after a tick bite?

Dariusz Litera:

Later we observe this place.

Dr. Marcin Roszkowski:

This is the case when it comes to Lyme disease. We monitor the injection site. We want to ensure that a red circle at least five centimeters in size doesn't appear there after at least seven days. So, at least seven days and at least five centimeters allow us to diagnose erythema migrans, or Lyme disease.

Dariusz Litera:

So if this redness appears, then?

Dr. Marcin Roszkowski:

To the doctor.

Dariusz Litera:

And what does the doctor do?

Dr. Marcin Roszkowski:

The doctor prescribes a course of antibiotics. Depending on the scientific association, this is a longer or shorter course. Americans are the most daring in this regard. They provide the shortest course. In Poland, however, infectious disease doctors prefer 14 to 21 days of antibiotic treatment. We use simple, narrow-spectrum antibiotics, so the impact on the human body is minimal.

Dariusz Litera:

And that concludes the matter?

Dr. Marcin Roszkowski:

In 99.9 percent of cases, yes.

[00:04:27] What if we miss a tick bite?

Dariusz Litera:

What if we miss the flush?

Dr. Marcin Roszkowski:

This won't always result in the next stage of the disease. Most often, the body will cope with it. However, we don't want to risk the more complicated stages of Lyme disease. For example, the joint stage, where large joints become inflamed, or, heaven forbid, neuroborreliosis, which can be detected years later and has very nonspecific symptoms.

Dariusz Litera:

That's why we observe the skin. If a tick has been present, we look closely. If redness appears, we go to the doctor, who will prescribe treatment.

Dr. Marcin Roszkowski:

And we're healthy. No tests, no exams. We don't need to test the tick or ourselves.

The length of time the tick is embedded in the skin is crucial. The tick harbors the Lyme disease in its digestive tract. It drinks this blood, the Lyme disease uses the blood to transform into its life cycle, and is then released. Therefore, it must be 24 to 36 hours before the tick can infect a human.

Dariusz Litera:

So what if we remove it relatively quickly?

Dr. Marcin Roszkowski:

There is a very good chance that no redness will appear.

Dariusz Litera:

And this is also information that can calm everyone down.

[00:05:23] How to prevent tick and mosquito bites?

Dariusz Litera:

Is there anything we can use to prevent insect and arachnid bites?

Dr. Marcin Roszkowski:

First, a common-sense measure. Avoid ticks during the periods when ticks are most active, i.e., in the mornings and afternoons, in the appropriate months, say April to October, when temperatures are above 5 to 7 degrees Celsius.

We avoid bushes and tall grasses. Contrary to popular belief, ticks don't jump from trees. The only time a tick falls from a tree is when it falls off a bird or, for example, a squirrel and lands on the ground. However, ticks usually live at heights of one to one and a half meters. And we avoid such places, or rather, we exercise caution after being in such places.

Dariusz Litera:

And we observe ourselves to see if anything wanders off somewhere.

Dr. Marcin Roszkowski:

After each such walk, it's worth checking your child and yourself. Longer sleeves and longer pant legs also protect us from this. And repellents. The most popular ingredient is probably DEET.

Dariusz Litera:

However, it causes insects and arachnids to avoid us.

I also have one home remedy: If a dog is walking in front of us, its body temperature is higher than that of a human, and ticks have thermoreceptors and usually attack animals that are warmer. That's why dogs detect ticks. This is scientifically unexplored, but it has been observed many times.

Dr. Marcin Roszkowski:

I don't know about ticks, but with mosquitoes, there are many factors. It's not just temperature, not just heat, but also carbon dioxide and several substances secreted by our skin.

[00:06:54] Mosquitoes, Vitamin B, and Itch Relief

Dariusz Litera:

Doctor, mosquitoes are a very common problem because they're either there or they're not. There are either a lot of mosquitoes or very few. We discuss this topic often. There's a lot of talk in Poland about mosquitoes when they appear.

Are there ways to say, for example, "We need to take vitamin B to stop mosquitoes from biting us?" That's what I read online.

Dr. Marcin Roszkowski:

I have not found any scientific publications that would encourage this.

Dariusz Litera:

So the doctor denies it?

Dr. Marcin Roszkowski:

I do not confirm.

Dariusz Litera:

I see. So we also use traditional repellents to deter them. We apply something locally to help alleviate the itching.

Dr. Marcin Roszkowski:

We can also take these preparations in tablet form. We can take creams or gels, but sometimes tablet form also helps.

Dariusz Litera:

To avoid this unpleasant feeling.

Fortunately, we do not have malaria in Poland, so we are not in an area where it is a threat to us.

Dr. Marcin Roszkowski:

We don't have it yet.

Dariusz Litera:

Is something coming?

Dr. Marcin Roszkowski:

Climate change could lead to the emergence of several diseases. Zika, malaria, and others could emerge here.

Dariusz Litera:

Can this malaria parasite get to us here?

Dr. Marcin Roszkowski:

If the weather changes accordingly, then yes, because it depends on it.

[00:07:54] Wasp and Bee Stings. When Can a Situation Be Dangerous?

Dariusz Litera:

And when it comes to insects that sting us, the situation is more complicated because we react to these stings differently.

Dr. Marcin Roszkowski:

Fortunately, they do not transmit diseases to us, but they can also cause a lot of trouble.

Dariusz Litera:

And here the consequences can be very serious, even life-threatening.

So how do we identify typical sting symptoms and distinguish them from symptoms that can escalate and become life-threatening? This is always a stressful situation.

I remember several such cases. A child, or an adult, was stung because some sugary drinks were sitting in the garden, someone grabbed them, or there was some fruit. Suddenly, somewhere on that fruit, there was a wasp. A crack, and we had a problem.

In what time intervals does this occur so that we can control the situation?

Dr. Marcin Roszkowski:

Good. The child is running around without shoes. There's a lot of clover in the grass, and somewhere on a limb, a bee or a wasp is perched. The child starts crying and comes running to us. We quickly pull out the stinger and see what's happening.

The child has never previously experienced anaphylaxis or any serious complications after a bee or wasp sting. Don't panic. Most often, it ends with a few hours of swelling, pain, and redness, which subsides over time.

Dariusz Litera:

Do we apply compresses to prevent pain?

Dr. Marcin Roszkowski:

First of all, we calm ourselves and the child. We can also administer oral painkillers. They will work within half an hour to an hour. If the pain persists for 2 to 3 hours, there's a chance it will overlap. A cold compress and everything will be fine.

[00:09:25] Swelling, Allergy, and Anaphylaxis Symptoms

Dariusz Litera:

Okay, when does the situation go in the wrong direction?

Dr. Marcin Roszkowski:

It escalates. We're talking about a 10 percent increase. Children are generally less likely to be allergic to bee venom than adults. We're talking about a 10 percent increase in people who will experience swelling that's a bit more severe than the typical swelling, lasting a few hours. Sometimes it can last up to 10 days.

Generally, this applies to, for example, a hand or leg that swells. This doesn't necessarily result in medical intervention. It happens. We usually know about it. This person is mildly allergic to Hymenoptera, and their hand swells.

Of these 10 percent, perhaps one in a hundred people, an anaphylactic reaction may occur. This means the body will experience a violent reaction leading to shock: deterioration of well-being, loss of consciousness, and even cardiac arrest.

Dariusz Litera:

And then?

Dr. Marcin Roszkowski:

Let's not wait until then. We need to identify the symptoms that could potentially lead to shock.

These are respiratory symptoms. Hoarseness may appear, there may be some wheezing in the lungs, and there may even be obvious difficulty breathing. There may be—God forbid—swelling of the face, ears, lips, and eyelids, and there may even be gastrointestinal symptoms.

Dariusz Litera:

Let us add that the wasp or bee did not necessarily have to sting in the head and neck area.

Dr. Marcin Roszkowski:

Yes, it is. Abdominal cramps, diarrhea, nausea, and vomiting may occur. Later, you may experience an increased heart rate, low blood pressure, and some dizziness, including loss of consciousness.

If these symptoms begin, it's worth seeking professional advice. This usually results in a call to 999 or 112, but it's better to call 999.

Dariusz Litera:

To call the emergency services, to save.

Dr. Marcin Roszkowski:

To seek advice. Alternatively, the dispatcher will decide whether the situation is risky and whether to send a team. But it's better to call, seek advice, hang up, and thank them than to fear that we might be calling the team in vain.

Dariusz Litera:

So, yes, there must be awareness. And in such a situation, we really need to separate ourselves from these emotions a bit. That is, we must act consciously, saving the person if the symptoms worsen.

Dr. Marcin Roszkowski:

I think even paramedics aren't completely detached from their emotions during their work. We have to act consciously. If we suspect they might be experiencing shock, it's better to call, ask, be reassured, and thank them than not to do so.

[00:11:53] Stings around the face, mouth and neck

Dariusz Litera:

And is a sting in the head and neck area an indication to seek immediate help?

Dr. Marcin Roszkowski:

This is a big risk because there may be no allergy, but the swelling can make breathing difficult.

Dariusz Litera:

That is, if it is the face, or possibly the area around the mouth.

Dr. Marcin Roszkowski:

This poses a risk of swelling, difficulty breathing or cardiac arrest.

Dariusz Litera:

So then we just go for help or call for help.

Dr. Marcin Roszkowski:

We're not going, we're not going. We'll call or go if we're nearby.

I was just thinking about this yesterday. It seems reasonable to offer this advice: even if you're near a dental office, dentists use various anesthetics and must also be prepared for shock reactions. They also have medications available.

So we don't go first. We either get supplies locally or call for help.

Dariusz Litera:

It's important to seek help and get professional guidance on what to do next. Or direct help, meaning a team will arrive and rescue the person.

Do any long-term effects of these kinds of situations remain in our bodies?

Dr. Marcin Roszkowski:

They're unlikely to stay. Each subsequent anaphylactic reaction may be worse, but it usually resolves without a trace.

[00:13:04] Emergency adrenaline and informing the surroundings

Dariusz Litera:

But there should remain a trace in our consciousness that we must absolutely protect ourselves from such situations.

Dr. Marcin Roszkowski:

And inform those around us. A wristband, for example: allergic to bee venom. If someone is so severely allergic, an anaphylactic reaction may occur.

A 50-year-old man lies unconscious in a strange position on the street. People pass by, and their first thought is: Drunk. Especially since he's wheezing, as he's barely breathing.

Dariusz Litera:

And such a wristband can save lives. Let's remember such situations and should probably all consider whether we have such people in our immediate circle.

Dr. Marcin Roszkowski:

And do these people carry adrenaline with them? Adrenaline is a lifesaving, primary, first-line drug in such situations. So if we have a child, wife, husband, or grandmother, we also need to know how to use it.

Dariusz Litera:

Adrenaline in a syringe, which resembles a pen or insulin pen, is administered simply, even through clothing.

Dr. Marcin Roszkowski:

Yes, in the thigh. The important thing is to hit a large muscle and not think twice.

Dariusz Litera:

A decisive movement and then injection. Besides, everything is described on the applicator. If someone has something like this on them, they're allergic and have been stung.

Dr. Marcin Roszkowski:

Regardless, we still call 999 for advice or go to a doctor if there's one nearby, as I mentioned. This is because some people still have a delayed reaction. After an initial improvement, the condition can rapidly worsen within a few hours.

Dariusz Litera:

Dr. Marcin Roszkowski, a family medicine specialist, said in the podcast "What Does Your Doctor Say?" Thank you very much, doctor.

Dr. Marcin Roszkowski:

Thank you very much, Mr. Editor.

Key takeaways for patients

• Statistically, after a tick bite, the risk of serious consequences is small, but it is worth observing the site of the injection.

• The tick should not be twisted, strangled, burned or doused with anything.

• It is best to remove a tick with a tool that allows you to grab it or pry it off near the mouth.

• If a fragment of the tick remains in the skin, according to the expert, it does not increase the risk of infection.

• After a tick bite, observe whether a red circle with a diameter of at least five centimeters appears after at least seven days.

• The appearance of erythema migrans is an indication to contact a doctor.

• According to the expert, after a tick bite, there is no need to routinely examine the tick or perform tests on yourself.

• Prompt tick removal is important because the interview highlighted the 24 to 36 hour period as being important for the risk of Lyme disease infection.

• Common sense, avoiding tall grasses and bushes, checking your skin after a walk, wearing longer clothing and using repellents are important in preventing contact with ticks.

• The effectiveness of vitamin B as a mosquito repellent was not confirmed in the interview.

• After a wasp or bee sting, local pain, swelling and redness most often occur, which disappear over time.

• Symptoms such as hoarseness, wheezing, difficulty breathing, swelling of the face, lips, eyelids or gastrointestinal symptoms may require urgent medical attention.

• If you suspect an anaphylactic reaction, it is better to call 999 or 112 and consult the situation with the dispatcher.

• A sting around the head, neck, mouth or oral cavity can be dangerous due to the risk of swelling and difficulty breathing.

• People at risk of a severe allergic reaction should inform others about the allergy and carry emergency adrenaline with them.

Information about participants:

Guest: Dr. Marcin Roszkowski, A family medicine specialist with many years of experience in primary care. He also works with patients in the treatment of obesity and in the broadest sense of preventive healthcare.

Presenter: Dariusz Litera, medical editor, health communications specialist, and creator of the podcast CO NA TO TWÓJ ELEKARZ. He has been involved in patient education for years, conducting interviews with specialists in various fields of medicine.

ATTENTION!

This material is for educational purposes only. It does not replace a medical consultation. If you experience any disturbing symptoms, consult a doctor.

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