#1: I've read that if you pull the tick out within 24 hours your chance of
getting lyme is down to almost 0%. Does that apply if any of the head was
left in you?

#2: From my indications (below) should I see a doctor / start treatment?

Thanks,
Gary

Four days ago my dog came inside and about 30 minutes leter I found a tick
attached to my abdomin. I'm sure he wasnt' there before.

I have pulled ticks from the dog and know to try to pull them straight out
and not leave any parts. But when I pulled on this tick I'm pretty certain I
didn't get it all.

It hurts just a little, even now 4 days later. Doesn't hurt in general, but
if I touch that spot I can feel a light "pain".

Two days after pulling the tick the spot looked like:
* A black spot about the size of if I've pressed a "sharpie" pen there.
Maybe 2 mm.

* A small band of white/normal skin around the black spot

* A small red circle/line around that. This circle was about 5 mm in
diameter.

I do not believe the circle is the "rash". It was not like that. It was just
a very thin red line.

  Table 1.          Infectious Diseases Society of America-

      For prevention of Lyme disease after a recognized tick bite,
 routine use of antimicrobial prophylaxis or serologic testing is not
 recommended (E-III). A single dose of doxycycline may be offered to
 {*filter*} patients (200 mg dose) and to children 8 years of age (4 mg/kg
 up to a maximum dose of 200 mg) (B-I) when all of the following
ircumstances exist: (a) the attached tick can be reliably identified
 as an {*filter*} or nymphal I. scapularis tick that is estimated to have
 been attached for 36 h on the basis of the degree of engorgement of
 the tick with {*filter*} or of certainty about the time of exposure to the
tick; (b) prophylaxis can be started within 72 h of the time that the
 tick was removed; (c) ecologic information indicates that the local
 rate of infection of these ticks with B. burgdorferi is 20%; and (d)
 doxycycline treatment is not contraindicated. The time limit of 72 h
 is suggested because of the absence of data on the efficacy of
 chemoprophylaxis for tick bites following tick removal after longer
 time intervals. Infection of 20% of ticks with B. burgdorferi
 generally occurs in parts of New England, in parts of the mid-
Atlantic
 States, and in parts of Minnesota and Wisconsin, but not in most
other
 locations in the United States. Whether use of antibiotic prophylaxis
 after a tick bite will reduce the incidence of HGA or babesiosis is
 unknown.

      Doxycycline is relatively contraindicated in pregnant women and
 children <8 years old. The panel does not believe that amoxicillin
 should be substituted for doxycycline in persons for whom doxycycline
 prophylaxis is contraindicated because of the absence of data on an
 effective short-course regimen for prophylaxis, the likely need for a
 multiday regimen (and its associated adverse effects), the excellent
 efficacy of antibiotic treatment of Lyme disease if infection were to
 develop, and the extremely low risk that a person with a recognized
 bite will develop a serious complication of Lyme disease (D-III).

      Prophylaxis after I. pacificus bites is generally not necessary,
 because rates of infection with B. burgdorferi in these ticks are low
 in almost the entire region in which the tick is endemic. However, if
 a higher infection rate were documented in specific local areas
(20%),
 prophylaxis with single-dose doxycycline would be justified if the
 other criteria mentioned above are met.-

If you are seriously concerned about this, and want to take
preventative measures, if it were me, I would not feel comfortable
with this this single dosage...but would opt for a full14-21 day
course of antibiotics. There are competing guidelines from
ILADS...they simply allow preventative use.

Also...whether to take preventative antibiotics or not necessarily
involves some sense of the potential of any given tick within your
area of carrying the bacterium.

Risk depends upon prevalence within the area.

And...it is generally believed (and I think agreed upon) that the
disease is highly treatable within the first three months after
exposure. So, there is something of a "grace" period within which to
wait and see if symptoms develop. I suppose, most would suggest that
the earlier treatment is commenced, the better the chances of complete
recovery, however.

An ELISA IgM may not be responsive or acccurate within the first 4-6
weeks after exposure.

After a tick bite, Bb undergoes rapid hematogenous dissemination, and for
example, can be found within the central nervous system as soon as twelve
hours after entering the {*filter*}stream. This is why even early infections
require full dose antibiotic therapy with an agent able to penetrate all
tissues in concentrations known to be bactericidal to the organism.

It has been shown that the longer a patient had been ill with Bb prior to
first definitive therapy, the longer the duration of treatment must be, and
the need for more aggressive treatment increases.

Bb contains beta lactamases, which, with some strains, may confer resistance
to cephalosporins and penicillins. This is apparently a slowly acting enzyme
system, and may be overcome by higher or more continuous drug levels
especially when maintained by continuous infusions (cefotaxime) and by depot
preparations (benzathine penicillin). Nevertheless, some penicillin and
cephalosporin treatment failures do occur and have responded to
sulbactam/ampicillin, imipenim, and vancomycin, which act through different
cell wall mechanisms than penicillin and the cephalosporins.

There is evidence that B. burgdorferi can remain viable within cells, such
as macrophages, lymphocytes, endothelial cells, neurons, and fibroblasts. Bb
has been shown to evade the effects of antibiotics in vitro by sequestering
in these intracellular niches. In addition, Bb can coat itself with host
cell membranes, and it secretes a glycoprotein that can encapsulate the
organism (an "S-layer"). Because this glycoprotein binds host IgM, it is
possible that host protein as well as cell membrane hide Borrelial antigens.
In theory at least, these coatings interfere with immune recognition, thus
affecting the clearing of Bb, and also cause seronegativity.

There are multiple strains of Borrelia burgdorferi and they vary in their
antigen profile and antibiotic susceptibilities. In addition, L-forms and
cystic forms exist which do not contain cell walls, and thus cell wall
antibiotics will not affect them. Apparently, Bb can shift among the three
forms during the course of the infection and cause the varying serologic
responses seen over time, including seronegativity. Because of this, it may
be necessary to change antibiotic or even prescribe a combination of agents.

Vegetative endocarditis has been associated with Borrelia burgdorferi, but
the vegetations may be too small to detect with echocardiography. Keep this
in mind when evaluating patients with murmurs, as this may explain why some
patients seem to continually relapse after even long courses of antibiotics.

Just changing the subject back in case the guy wants to find the
responses to his question...are you trying to confuse him?...what's
the source, here, please?

Do you want to wait that long?

He is giving you bad advice!

Get at least two weeks of Doxy.

 #1: I've read that if you pull the tick out within 24 hours your
chance of
 getting lyme is down to almost 0%. Does that apply if any of the head
was
left in you?

 Not necessarily...if the tick was improperly removed...especially by
 grasping the midgut...the tick can disgorge its midgut contents in to
 your {*filter*}stream.

 Mainstream doctors insist the tick must remain attached, feeding for
 36 hours.

 Other doctors and Lyme patient activists dispute that. It's a point
of
 disagreement and contention.

 If it were me...with that alone...no, I wouldn't, personally.

 I would monitor the site for any indications of an expanding
 rash...watch for flulike symptoms...joint pain or
 stiffness...recurrent headaches...any unusual fatigue and or shaking
 or twitching.

 Keep in mind that {*filter*}-testing, screening for the disease will not
be
 effective until the body has had time to develop an appropriate
 antibody response.

 Best advice is to find a KNOWLEDGEABLE physician who has treated the
 disease several times previously.

 Still, there is the "better safe than sorry" route...and if your
 physician is willing to prescribe preventative antibiotics...then
 maybe you would feel more comfortable going that route?

That business about the twitching was merely, along with the business
about joint stiffness, headaches and fatigue, to indicate possible
signs of trouble.

If you bothered to read what I said...I am NOT giving 'advice'.

Personally, however, I think it is a bit extreme to insit that EVERY
tickbite be treated with two weeks of antibiotics.

Thank you all for your answers.

I've had tick bites before and didn't worry about them and usually dont'
worry about every little thing that happens to me. But this time I feel that
something is amis. I know this isn't a very (at all) scientific way to think
of it...but there it is.

I'm starting to take Doxy. It seems to me the side effects (for me) aren't
particularly risky.

Again, thanks for your replys.