5 Ways to Keep Mosquitoes and Ticks from Bugging You! (Gear Guide+)

Black flies, ticks, mosquitoes, and other biting insects can turn the most peaceful outdoor paradise into a stressful tormenting nightmare. In this post I’ll discuss the bug repellent strategies and gear that have worked for me as well as those that are recommended by the CDC, and that are registered with the EPA (after being shown to be both safe and effective for human use in repelling ticks and mosquitoes).

1. Cover up

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Wearing long-sleeves, long pants, and gaiters in an attempt to keep the mosquitoes at bay hiking through the high sierra during my PCT thru hike.

The first step in keeping the insects at bay is to minimize the amount of skin the buggers have access to by wearing long-sleeved shirts, long pants, socks, gaiters, and closed-toe shoes. This is fairly effective at keeping ticks from biting you, but as many of us have discovered, mosquitoes have an impressive ability to bite through clothing. Constantly wearing head-to-toe rain gear is an effective way to keep the biting insects at bay, but when the weather is hot and humid wearing rain gear as bug repellent is just a different kind of misery. Instead, I move on to option #2…

My thoughts: wearing long-sleeved shirts, socks, long-pants, ultralight gaiters, and closed-toe shoes is just a start. For repelling ticks I highly recommend using permethrin-treated clothes as described in section 2. For black flies, be sure to include a head/bug net. For mosquitoes, add a an EPA-registered and CDC-approved skin-applied bug repellent as described in section 3.

2. Wear Permethrin-Treated Clothing

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Permethrin is based on the naturally occurring insecticides found in chrysanthemums.

Permethrin is a man-made synthetic insecticide based on the naturally occurring insecticides (pyrethroids) found in chrysanthemums. It kills insects and anthropods (eg ticks) that come in contact with it by affecting their nervous systems (neurotoxin). According to the centers for disease control and prevention (CDC), “permethrin-treated clothing repels and kills ticks, chiggers, mosquitoes, and other biting and nuisance arthropods.”

The environmental protection agency (EPA) has evaluated permethrin for treating garments and has approved it as both safe and effective for human use for this purpose. The EPA in their “2009 revised exposure and risk assessment evaluated multiple exposure scenarios for permethrin factory-treated clothing, including toddlers wearing or mouthing the clothing, and military personnel who wear permethrin-treated uniforms on a daily basis. All exposure scenarios showed that permethrin factory-treated clothing is unlikely to pose any significant immediate or long-term hazard to people wearing the clothing.” The EPA also states that, “there is no evidence of reproductive or developmental effects to mother or child following exposure to permethrin.” If you have concerns about the safety of premethrin you can also check out this FAQ, which goes into more detail. One of the major reasons that permethrin is considered safe is that it is poorly absorbed through the skin.

When applied to clothing, permethrin binds tightly to the fibers of the clothing (especially cotton clothing). Since permethrin is not water soluble, it remains bound to clothing through repeated washing cycles and is not readily transferred to your skin if/when the garment gets wet. Note that permethrin kills ticks/mosquitoes on contact, so does not prevent bugs from landing on you. As a result, permethrin-treated clothing works best when it is loosely fitting.

The two CDC-recommended and EPA-registered methods approved for permethrin-treated clothing are factory-permethrin treatment and self-permethrin treatment.

Clothing Treatments (CDC Recommended and EPA registered) Manufacturer Claimed Maximum Effectiveness
Permethrin

  • Factory-permethrin treatment
    • Clothing: 70 launderings.
  • Self-permethrin treatment (0.5% permethrin):
    • Gear: 40 days of direct exposure to sunlight.
    • Clothing: 6 weeks and/or 6 launderings
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Wearing my factory-permethrin treated pants and shirt at Choquequirao, Peru.

Factory-Permethrin Treatment 

According to the CDC, factory-treated clothing, ie “clothing that is treated before purchase, is labeled for efficacy through 70 launderings.” My experience and the research I’ve done suggests that factory-permethrin clothing is effective through 25-50 washings. The military finds effectiveness against ticks last for about 50 washings and the EPA suggests that repellency beyond 25 washes when wear and tear is included is more likely to be true. Gear list/review of my factory-permethrin treated clothing:

  • Ex Officio BugsAway Damselfly Jacket (15/15)
    • Weight (5/5): 6 oz, 100% Nylon
    • Effectiveness (5/5): I carry/wear this mesh jacket for all of my hot weather backpacking and kayaking adventures. It protects me from both mosquitoes and excess exposure to sun. I give this jacket my highest recommendation. It remained effective against mosquitoes for about 1 year of heavy use (I didn’t count the # of laundering cycles). I used it on the PCT, kayaking in Maine during black fly season, hiking all over New England during mosquito season, and trekking through Peru in temperatures up to 112F.
    • Durability (5/5): The mesh has held up well under brutal thru-hiker treatment and ongoing use. After the factory-permethrin treatment wore off, I have self-permethrin treated the jacket and continue to use it for all my desert/hot climate adventures.
  •  Ex Officio BugsAway Damselfly Pants (11/15)
    • Weight (5/5): need to find scale, but light weight, 100% Nylon
    • Effectiveness (5/5): Both in the US and abroad I’ve found these pants to be effective at preventing bug-bites. For example, while my cohort in Peru ended up getting eaten alive with red welts all over their legs I remained bug-bite free.
    • Durability (1/5): These are great travel pants for hot weather, but not so good for brutal backpacking use: the butt of the pants shredded after less than a month of use during my PCT thru-hike.
  • UV InsectShield Buff (10/10)
    • Effectiveness (5/5): Keeps the bugs from biting my neck, which is awesome.
    • Durability (5/5): I’ve had good luck with the Buffs lasting forever
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Wearing my self-permethrin treated leggings, gaiters, and hat at Machu Picchu, Peru.

Self-Permethrin Treatment

If you apply permethrin yourself you have the option of either spraying it on to you clothing/gear or soaking your cloths in it. The CDC recommends treating “clothing and gear, such as boots, pants, socks and tents with products containing 0.5% permethrin,” and treating items “at least 24–48 hours in advance of travel to allow them to dry.” Note: According to the EPA: “Permethrin repellent products used for factory-treatment of clothing or as spray-ons for clothing are not to be applied to certain clothing such as underwear.”

  • Sawyer 0.5% Permethrin Premium Clothing Insect Repellent
    • Spray-on application method (~4/5): I use it on gear items for tick protection. I don’t have a good metric for effectiveness of my treated gear, but it seems to work. The gear I treat with spray-on premerthin, with the amount of premethrin I used to treat it in parentheses, includes:
      • hiking boots & camp shoes (~ 3 oz for both)
      • sleeping bag (~6 oz)
      • backpack (~ 3 oz)
      • tent body (~ 6 oz)
    • Soaking application method (5/5): I use it for clothing items for both tick and mosquito protection. I soak my clothing items in 0.5% permethrin (using the method described in the section-hiker post linked here) to treat my cloths because I am skeptical about getting complete coverage of my clothing using the spray-on method. My self-permethrin treated clothing seems to keep its protective properties through 6-10  washes. The clothing I treat by soaking it in permethrin, with the amount of premethrin I used to treat it in parentheses, includes:
      • OR Sparkplug gaiters (~2 oz)
      • MontBel Stainless Mesh Desert hat and midweight hat (~1 oz)
      • Sleep clothes (~12 oz): sleep shirt, leggings, and camp socks
      • Montane Featherweight Wind Pants (~3 oz)
      • Wrightsock Coolmesh 2 socks (~4 oz/pair)
      • Techwick (T1) long-sleeve hoodie (~4 oz)
      • Lightweight fleece hoodie (~5 oz)
      • Hiking leggings (~4 oz)

My Thoughts About Permethrin: Factory-permethrin treated clothing keeps its repellence 5-10 times longer than self-permethrin treated clothing and is worth it to me for my super-lightweight summer clothing. As far as I can tell, permethrin-treated clothing is the best product out there for preventing tick bites. For mosquito repellency the situation is less clear. Permethrin kills mosquitoes on contact, and does not actually act as a repellent, which means that the mosquitoes land on you (and may bite you) before they die. For loose-fitting clothing permethrin works fairly well against mosquitoes, but it is much less effective when used on tight-fitting clothing made from thin fabrics. As a result, I recommend purchasing 1 size larger than normal to maximize effectiveness of permethrin-treated clothing for preventing mosquito bites. Also, according to the CDC mosquitoes in some areas (such as Puerto Rico) have developed resistance to permethrin!

Other repellent treatments for clothing: DEET (EPA-registered) and picaridin (EPA-registered) may be applied to clothing, but they provide shorter duration of protection (same duration as on skin) when compared to permethrin, and must be reapplied after laundering. Both DEET and picaridin are repellents that can be applied to clothing that has been treated with permethrin to provide added protection. Note that DEET may damage plastics and some types of fabrics. I recently experienced this when the small bottle of 100% DEET in my pack leaked, melted through its cap, and fused itself to my bug net in a scary mess.

3. Use Bug Spray (Skin-Applied Repellents)

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The bug repellent picaridin is based on piperidine, a compound found in black peppercorns.

The CDC and EPA recommend using skin-applied bug repellents (wearing bug spray) in addition to using permethrin-treated clothing. The question then becomes, which bug repellent should I use? Since bug repellents are classified as pesticides, the EPA is in change of regulating them. Skin-applied bug repellents whose safety and efficacy data meet EPA standards are given an EPA-registered status. EPA-registered repellents can be classified as either conventional repellents, biopesticide repellents, or natural repellents.

Conventional repellents

Conventional repellents are synthetic repellents that directly kill or inactivate pests. The two conventional repellents that are both EPA-registered and CDC-recommended are DEET and picaridin. DEET and picaridin have the longest-lasting repellent effects of all of the skin-applied bug repellents evaluated and registered by the EPA.

DEET in concentrations of 5% to 99% is EPA-registered and approved for direct application to human skin. Unlike permethrin, DEET doesn’t kill mosquitoes or ticks, it just makes it hard for them to smell/detect us, and therefore less likely to bite us. Although the court of public opinion is convinced that DEET is horribly toxic, the EPA believes that it is safe for use as instructed at all concentrations, and for children and adults of all ages. Note that DEET may decrease the SPF of sunscreen and it may dissolve plastics and some fabrics.

Picaridin is a synthetic compound resembling piperine, which is found in black pepper. Picaridin is EPA-registered for human application in concentrations of 5% to 96.8%. It is commercially available as Sawyer Picaridin Insect Repellent as well as under other brand names.

Conventional Repellents (CDC Recommended and EPA registered)
Maximum Repellent Efficacy/Duration
Picaridin (aka icaridin)

DEET (N, N-diethyl-m-toluamide)

  • Mosquitoes:
    • 2 hrs (5% DEET)
    • 8 hrs (25% DEET)
    • 12 hours (100% DEET)
  • Ticks:
    • 2 hrs (5% DEET)
    • 4 hrs (25% DEET)
    • 10 hours (100% DEET)

My Thoughts About Conventional Repellents: I hate having to apply bug repellent directly to my skin, but on my thru-hikes (and other adventures) I carry a small bottle of 100% DEET for emergency bug-repellent use. DEET has worked well when I needed it, except for one stretch of the PCT where the mosquitoes were impressively aggressive and to my surprise seemed to be DEET-resistant; I applied 100% DEET and they bit me anyway. Although I didn’t know it at the time, it is scientifically possible that the mosquitoes in question were in fact DEET-resistant. After doing the research for this post, I’m going to give picaridin a try.

Biopesticide Repellents

Biopesticide repellents are naturally derived repellents, which are generally considered less toxic than conventional pesticides. It is also important to note that biopesticide repellents don’t need to stand up to the same degree of rigor as conventional pesticides to gain EPA-registered status. There are two EPA-registered and CDC-recommended biopesticide repellents: oil of lemon eucalyptus, aka PMD (p-Menthane-3,8-diol) and IR3535 (the active ingredient in Skin-So-Soft).

Oil of lemon eucalyptus is an EPA-approved way to market PMD (p-Menthane-3,8-diol), a synthetic version of the compound found in the oil of the lemon eucalyptus plant. The essential oil of lemon eucalyptus (pure lemon eucalyptus oil) is NOT EPA-registered and repellency of the essential oil only lasts for ~1hr.  According to the FDA, commercially available bug repellents listing Oil of Lemon Eucalyptus as their active ingredient are using the man-made synthetic version of the compound: p-Menthand-3,8-diol. Oil of lemon eucalyptus (PMD) at high concentrations has an efficacy similar to DEET over shorter period of time, but if you can find the information about it’s toxicity you profile you’ll be surprised to learn that the EPA considers oil of lemon eucalyptus to be more toxic than DEET at least in terms of potential for eye irritation. Having accidentally gotten DEET (Toxicity Category III) in my eye, I shudder in horror at the thought of accidentally getting oil of lemon eucalyptus (Toxicity Category I) in my eye. To me, the labeling practices for oil of lemon eucalyptus seem to be deceptive at best. It is commercially available as: Repel Plant-Based Lemon Eucalyptus Repellent and Cutter Lemon Eucalyptus Insect Repellent.

IR3535 is the EPA-registered bug repellent in modern Skin-So-Soft bug repellents. It is important to note that the Skin-So-Soft bath oil that was used as bug repellent in the ’90s does not contain IR3535. I remember the Skin-So-Soft bath oil as bug repellent as being woefully inadequate to the task, but have not tried the Skin-So-Soft containing IR3535. Although IR3535 is EPA-registered, the only commercially available forms I was able to find are combined with sunscreen, and the CDC does not recommend the use of combined sunscreen/bug spray products because sunscreens typically need to be applied more often than bug sprays alone. It’s also important to note that the toxicity profile for IR3535 is similar to that of conventional bug sprays. IR3535 is commercially available as: Skin So Soft Bug Guard Plus IR3535 Expedition SPF 30.

Biopesticide Repellents (CDC Recommended and EPA registered)
Maximum Repellent Efficacy
 Oil of Lemon Eucalyptus aka PMD (p-Menthane-3,8-diol)

IR 3535

  • Mosquitoes:
    • 10 hours (20% IR3535)
  • Ticks:
    • 12 hours (20% IR3535)
  • Black flies:
    • 3 hours (20% IR3535)

Although the following natural repellents (classified as biopesticides) require frequent re-application, and are not recommended by the CDC, they are registered with the EPA as being safe and effective:

Natural Repellents (EPA Registered)
Maximum Repellent Efficacy
Refined oil of Nepeta cataria aka Hydrogenated Catnip Oil (HCO)

  • Mosquitoes:
    • 7 hrs (15% HCO)
Oil of citronella

  • Mosquitoes
    • 2-3 hrs (~5%)
  • Ticks
    • ~1 hr (~5%)
 Essential oil of wild tomato (lycopersicon hirsutum) aka 2-undercanone or methyl nonyl ketone

  • Mosquitoes
    • 5 hrs (7.75%)
  • Ticks
    • 2 hrs (7.75%)

NOTE: The CDC does not recommend the use of products that combine sunscreen and repellent “because sunscreen may need to be reapplied more often and in larger amounts than needed for the repellent component to provide protection from biting insects.” Instead they recommend the use of separate products where sunscreen is applied first and is followed by the use of insect repellent.

My Thoughts About Skin-Applied Pesticides: After looking at all of the repellent options currently EPA-registered and CDC-approved I’m going to switch from 100% DEET to 20% Picaridin. The improved safety profile of picaridin compared to DEET as well as the promise of greater efficacy against black flies and longer duration of protection have convinced me to give it a try. At first glance the biopesticides, especially the Oil of Lemon Eucalyptus sounded promising, but on closer review the fact that they can claim a connection to naturally occurring pesticides isn’t enough to convince me that they are safer than the conventional repellents and the need to reapply them more frequently makes them a poor choice for me. If you’re looking for a second opinion, the EWG guide to repellents list the pros and cons associated with the different repellent options. Whichever bug repellent you choose, be sure to check the concentration of the active ingredient and to read/follow the application directions carefully. Which bug repellents have your tried? Comment and let me know which ones have worked (or failed to work) for you.

4. Know your enemy!

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Avoid the biting bugs by learning to love winter!

Know when and where the biting bugs are most active, and try to avoid them. Let’s start with when. The biting insects tend to be most active during the same seasons that people are most active: the spring in summer months. Below is some general information about the when and where for some of the most pesky biting bugs.

Black flies

Mosquitoes

  • Season: whenever temperatures are consistently above 50F
  • Most active time of day: depends on species.
    • A. aegypti & A. albopictus: typically bite from dawn ’til dusk, but may bite at night
    • Culex species: typically bite from dusk ’til dawn
  • What attracts them? Carbon dioxide from your breath, heat, and and other compounds secreted in our sweat and found on our breath.
  • Areas to avoid: swampy areas and areas with standing water; mosquitoes lay their eggs in standing water

Ticks

  • Season: whenever temperatures are above freezing (32F), although they tend to be most active April to September. Ticks are least active when temperatures are below 32F and during droughts
  • Most active time of day:  during the most humid part of the day; ticks need moisture to survive, especially the tiny and troublesome nymphs. As a result, nymphs are most active at night and during the mornings on hot days.
  • Areas to avoid: tall grasses and leaf litter and elevations below ~3500 feet
  • Added advice: shower as soon as you return from your outdoor adventure, do a tick check, wash your clothing in hot water, and remove ticks promptly

Additional Thoughts: In addition to avoiding the buggiest areas in the buggiest times (e.g. hiking in the snow), I’ve found that hiking faster (>2 miles/hr) prevents the majority of black flies and mosquitoes from landing on me and biting me. It turns out that mosquitoes typically fly at 1-1.5 miles/hour (1.5 miles/hr), so the little data I was able to find supports the anecdotal evidence that I can outrun most mosquitoes!

5. Dealing with the Itch


When I was a kid loved playing  in the swamp down by the river, which meant that I’d frequently come home covered in both mud and bug bites. The itchiness would drive me nuts, so I started experimenting with things in the first-aid cabinet that might take the itch away: “after bite”-didn’t work, benadryl cream-didn’t work, calamine lotion-didn’t work, toothpaste-didn’t work, and then I tried IcyHot. It worked!! IcyHot completely masked the itch. I then discovered that if I hadn’t scratched the bite before applying the IcyHot, the bug bite would disappear by the time that the IcyHot wore off… I’d found a bug bite cure!

My Thoughts on IcyHot: As an adult I’ve realized that bug bite prevention works better than carrying IcyHot with me everywhere I go (and constantly coating myself in it), but when my bug bite prevention methods fail and I have a bug bite that’s driving me nuts I still head to the medicine cabinet and treat it with IcyHot.

Summary

When it comes to avoiding ticks and Lyme disease my basic strategy is to:

  • Cover up with long-sleeves, long-pants, and gaiters
  • Use permethrin treated clothing
  • Avoid tall grassy areas
  • (while backpacking) Do a ticks checks and change into dedicated sleep clothes (long-sleeved lightweight shirt, camp socks, leggings) before getting into my sleeping bag at night.
  • (while in civilization) Do tick checks and shower after returning from each hike/outdoor activity in tick-infested areas
  • Avoid unleashed dogs (they run through the tall grasses and bring the ticks back to me)

For mosquitoes, I try to avoid the skin-applied repellents, but when the mosquitoes/black flies are particularly irritating I end up including them. My mesh Bugs Away jacket is a godsend in hot, humid weather. For mosquitoes my basic strategy is to:

  • Cover up with long-sleeves, long-pants, and gaiters
  • Use permethrin treated clothing
  • Hike faster! I’ve found that mosquitoes and black flies don’t tend to bite me when I’m hiking at >2 miles/hr
  • Use EPA-registered and CDC-approved repellent on exposed areas (hands, ankles, neck/face) sparingly as needed; I typically carry/use DEET, but will be trying out 20% picaridin.
  • Use a head/bug net in extreme circumstances, especially when the gnats dive-bomb my eyes, fly up my nose, and start swarming so thickly that I inhale the dang things… For gnats I also use the thru-hiker trick of poking a tall blade of grass/wheat out of my hat since they seem to be attracted to the highest moving point; it seems to help a little, but is much less effective than a properly positioned high quality bug net.

Combining these strategies seems to work for me with most biting insects most of the time. The one glaring exception is horse flies. Horse flies are relatively undeterred by repellents, and will bite any exposed flesh they can find. When I’m in an area horribly overrun with horseflies my strategy is to either to dive into the closest body of water and go for a swim (staying under water as much as possible) or to dive into the safety and security of my tent for a nap.

Links

Previous posts I’ve written about ticks:

Previous posts I’ve written about mosquitoes:

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Ticks & Lyme Disease at home and on the trail…

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2012 Master’s Project by Victoria Shelus

When a fellow 2013 thru-hiker was hospitalized with severe Lyme meningitis (inflammation of the membranes surrounding the brain) earlier this month, I decided to do some research and try to help raise awareness about Lyme.

“How many of my friends have had Lyme disease?” I wondered… I assumed that most of my friends with Lyme experience were hikers since I’d estimated that almost 30% of the northbound 2013 thru-hikers I met in New England had had it,  but I wasn’t really sure… so I turned to my Facebook friends looking for answers…

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What I discovered came as a surprise! 5% of my friends (22 of the people that viewed the post, n=440) have had confirmed cases of Lyme! And most of them, (68%, n=15) weren’t hikers at all! They’d gotten Lyme in their yards or in nearby parks… The youngest had been bitten before she even turned a year old! I guess with 5,665 reported cases of Lyme in Massachusetts in 2013 (a 12% increase from 2012) I shouldn’t have been surprised… but I definitely was! (Also, check out this link: How did 2014-2015s harsh winter effect tick populations?)

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RI Tick encounter risk: Red=high, blue= low (Link Risk of tick encounters in Rhode Island by year)

2014

RI Tick encounter risk: Red=high, blue=low.

Where were my non-hiker friends getting Lyme? Lyme disease is named after a town in Connecticut and is endemic in New England so I wasn’t surprised that 93% (14/15) of my non-hiking friends with Lyme live in New England… but they weren’t getting it from backpacking trips to the wildnerness; they were getting it from ticks lurking in their yards and suburban parks. Since there are more white-footed mice and deer (the two biggest vectors for ticks and Lyme disease in New England) in the suburban areas of Massachusetts, New Hampshire, Connecticut, and Rhode Island than in the wild areas it makes sense that those are the places where people are getting infected with Lyme… Clearly I need to start eying the tall grass, brush, and leaf litter in suburban parks and backyards with much more suspicion…

QDMA data from 2001-2006

It seemed strange, however, that  0% (0/7) of my hiking friends with Lyme were from New England… Another surprise was that 100% of my hiker friends that got Lyme got it during their during their thru-hikes (revision: 1 was on a 500 mile section-hike)! Maybe it’s partly because thru-hikers from other parts of the country don’t have the same level of tick awareness that people in the Northeast have? I remember being absolutely horrified the first time I saw someone drop their pack and lie down in the middle of a field of tall grass while I was hiking through North Carolina… Why? Ticks!!!! I had the same trouble on the PCT, even though people assured me that the PCT doesn’t have the same issues with Lyme… It was just engrained behavior for me…

A white-tailed dear I saw while hiking through Pennsylvania on the AT

A white-tailed dear I saw while hiking through Pennsylvania on the AT

Though a part of me loved the bucolic moments when deer wandered towards me on the trail… a bigger part of me was hungry and wished that I was going to be having have a nice venison steak for dinner instead of a boring dehydrated meal (Note: the CDC has this assurance, “You will not get Lyme disease from eating venison or squirrel meat”)… the biggest part of me, however, would start to feel imaginary ticks crawling on my arms and legs, so I would stop and do a tick check… “Is that a speck of dirt, or a deer tick?” I would wonder again, and again, and again…. On the trail I couldn’t shower as often as the CDC recommends for tick prevention, but I carried wet wipes with me and wiped down my legs with them every night as part of my tick check (~50% of tick bites in adults are on their legs).

It wasn’t until I hiked into Virginia on the AT in June that I really started seeing tons and tons of deer… I swear they were waiting around every corner of the trail. In the Shenendoah’s I saw tourists intentionally feeding the deer! I was horrified… Almost as horrified as I’d been watching people inside the AT shelters pick dozens of ticks off of their dogs and drop them just outside where they could re-attach to the dog or the next unsuspecting hiker that went by! Since dogs carry ticks, and can get sick from Lyme, tick checks are important, but disposing of the ticks appropriately is too!

DeerTicks

Later on in Virgina, I watched a fellow thru-hiker, Fingers, count as he plucked 48 ticks from his arms and legs after finishing a night hike… I hadn’t ever thought about it, but ticks don’t just quest (hunt for food) during the day, they also quest at night! In cool, humid climates adult ticks quest both day and night… When it’s hot during the day, the young ticks that cause 98% of Lyme cases quest at night (when their local humidity drops below 80% they dry out, dessicate, and die)... I had no idea that ticks came out at night… (I blindly asked 5 of the 7 thrus that had had Lyme if they’d done any night-hiking… all 5 had gone nighthiking in Virginia (or further north) prior to coming down with Lyme symptoms!)

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On the AT in Virginia with my parents .

It was July when I first discovered a tick on my person, “Ewwww, a tick!” I exclaimed looking at the lyme carrying Ixodes scapularis tick crawling on my hand! I was at a campground in the in the Shenendoah’s of Northern Virginia with my parents, “what kind is it?” my mom asked from the camper. I looked down at it, “A deer tick… it looks like a tiny poppyseed, but it has legs and is moving….”

Sizes of Ticks

“Wait, don’t brush it off, I want to see it!” cried my mom from the camper. “Really MOM!!” I replied incredulously! I have to admit that I was eying it curiously, but I was also in a hurry to get the damn thing off of me before it decided to bite. I watched it very carefully for the 3 seconds it took for my mom to come over and check it out (here are some tick pictures just for you mom!) As soon as she looked at it, I breathed a sigh of relief, flicked it into the fire, and headed for the showers. Mom was right to insist that we, the filthy stinky hikers, shower as often as possible… (Ticks usually take a couple of hours to attach so showering is recommended by the CDC as effective prevention). reportedcasesoflymedisease_2013

It wasn’t until I got to Pennsylvania that the first thru-hikers I knew started having symptoms of Lyme… I was sitting around hanging out with my friend Sir Stooge in Boiling Springs, Pennsylvania when I noticed that he had a rash on the back of his calf (50% adult bites on legs, 22% on torso, 18% arms, 6% genitalia, 4%head/neck whereas 49% of bites on children were on head & neck). It was 4 or 5 inches across, with a partially cleared center… Bull’s eye (the classic erythema migrans rash)… A tick had found it’s target (a picture of his rash from his blog is below)…

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Sir Stooge’s rash from a picture on his blog

“I’m not sure if it’s Lyme,” he told me. “I think I’m going to wait until we get to the next town to get it checked out,” he continued (One study suggests that only 54% of thru-hikers know how to identify the erythema migrans rash of Lyme Disease). “Why?” I asked with disbelief.  “Well, it’s only 3 or 4 days to the next town… I’ll go then,” he said still procrastinating… I looked at him skeptically. Lots of thru-hikers don’t get prompt medical treatment because they don’t have health insurance and transportation to hospitals and clinics can be a challenge, but he was insured and his parents lived nearby, “You have health insurance, you’ve got a ride, go! The speed at which you treat Lyme matters,” I insisted!

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He ended up going to the ER, being diagnosed with Lyme, and was put on antibiotics (Lyme is usually treated with b-lactam or tetracycline antibiotics: penicillin or doxycycline). While he was at the hospital they tested him for Lyme, but he said on his blog, “I called the hospital to get the results of my blood titer (to see if I had antibodies against the Lyme). And much to my surprise, I tested negative for any Lyme.” Luckily for him, he took the antibiotics and his flu-like symptoms and rash went away… Unfortunately Lyme tests done when the rash first appears are rarely diagnostic because it takes the body a few weeks to generate Lyme antibodies, which is why the CDC recommends a 2-tiered approach to testing for Lyme: begin with Lyme ELISA tests (false negatives are common in the 1st 2 weeks of infection and positive results just suggest that you’ve been infected sometime within the last 5 yrs), and follow up with IgG and IgM Western blots only if ELISA is positive (Positve ELISA + Positive Western Blot ~100% certainty of Lyme Diagnosis).

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CDC report on the number of Lyme cases per month

As I continued to hike North I ran into my friend Bud, who’d left me in the dust as blazed ahead of me during the southern part of the trail… He was standing dazed and confused in the middle of the trail, clearly struggling… “Well well well, look who it is,” he said with a weak smile. “You don’t look so good,” I said, “Are you ok?” I asked, split between shear joy at seeing a hiker I knew, and concern over his obvious ill health…. “Well, I was hoping to hike, but I just can’t right now,” he confessed before continuing, “I ummmmm, well… I got Lyme… real bad, it really messed up my head…. my memory…. I started repeating myself all the time… and… I don’t think I’m going to be able to get to town today… I can’t hike that far,” he lamented.

He’d gone to the hospital and tested positive for Lyme and had already been on antibiotics for a week, but it was taking longer to recover than he’d hoped. It was a story that I would hear over and over and over again that August and September as I continued towards Katahdin… People without the characteristic rash, but with flu-like symptoms and a brain fog that just wouldn’t lift… Everything causes flu-like symptoms… With the rash, or a known tick-bite followed by flu-like symptoms Lyme is obvious, but without those two things? I wasn’t sure… actually, I’m still not… Thinking back on it, I had an awful lot of the symptoms while I was on the trail…

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Light-sensitive headaches… well, it’s probably just a migraine… fatigue and muscle aches, well, I’m a thru-hiker! Swollen knees… once again, thru-hiker… Nausea, double vision, trouble standing? Must be heat exhaustion… Having trouble breathing and exhausted? Must be my asthma… Would I even know if I had Lyme? I never thought that I had Lyme on the trail and I was never diagnosed with it… but I was treated with Doxycycline (for 10+ days, the preferred treatment for Lyme) during my thru-hike, and at least once afterwards… If I ever did have Lyme, I am relatively confident that it’s gone now!

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A dog tick (Dermacentor variabilis) I found attached to my leg on the AT in Pennsylvania. Dog tick’s don’t carry Lyme!

Lyme is certainly a scary thing, but a  life without playing outside is an even scarier thing for me. The fact that mice are also carriers for Lyme, that ticks hang out in the leaf litter, that most people get Lyme from nymphs in June and July, and that the nymphs are at least as likely to bite at night as during the day were some of the things that were new information for me. Check out my previous post: “Deer are the scariest things in the woods…” for more information about prevention, and stay tuned for one more post where I’ll go into the tick’s life cycle and what that means for Lyme disease transmission and prevention.

Have you been bitten by a tick? Did you get Lyme? Do you know someone that has? Did you get the rash (I’m curious about how similiar most people’s rashes are to the text book rashes)? Do you know where you got it? I’d be interested to hear you Lyme stories… either in comments below, or email me: patchesthru at gmail dot com.

 

Finally som tick advice for backpackers/thru-hikers based on my experience:

  • Shower as often as you can!
    • carry wet wipes to clean off and check target areas
  • Ticks bite at night!
    • Don’t hike thru tick-prone areas at night especially if the days have been really hot and humid!!! The ticks are out, and it’ll take you longer to see them and remove them
    • Don’t camp (especially if you are using a tarp without and bug prevention) in areas with dense brush, high grass, or leaf litter… Ticks quest at night!!! They don’t jump, or fly, but they do crawl.
  • Be especially attentive at lower elevations!
    • If you’re hiking at elelevations lower than 2000 feet to extra tick checks… Ticks are less common above 2000
  • Check dogs regularly for ticks (and use preventative measures)
    • Don’t forget to dispose of the ticks appropriately
    • Consider keeping your dogs out of the AT shelters when people are sleeping in them… The only way ticks have been shown to enter the shelters is if we bring them there!
  • Check your pack for ticks!!! If you set your pack down in the tall grass or leaf litter, ticks can grab a free ride directly back to you… besides, you don’t want to carry anything extra :-P
  • Walk in the center of trails where possible… It’s better for you and its better for the trail!
  • Use repellents: permethrin kills ticks on contact or 20% Deet
    • Permethrin comes in a wash or spray that you can apply to your favorite clothing and is good for dozens of washes
    • 20% Deet is just as effective as 100% deet for prevention…
  • Know the symptoms of Lyme and seek medical attention as soon as possible if you experience any of them

The beautiful balds in TN.

Deer are the scariest things in the woods… Here’s why!

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What’s the scariest thing that I’ve encountered in the woods? Most people guess that it’s the bears, or the rattlesnakes, or the people. It’s not. It’s the deer

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Bambi (deer), Thumper (rabbit), and his fellow terrorists (skunks, squirrels, birds etc.) are loveable and cute, but they’re also masters of biological warfare! While we fawn all over them, they deliver their payloads of disease-laden ticks to our backyards, parks, trails, and campgrounds.

Borrelia burgdorferi

Corkscrew shaped Lyme bacteria.

Ticks have been roaming the earth since the time of the dinosaurs, and infecting humans with the corkscrew-shaped bacteria (spirochetes) responsible for Lyme disease for the last 5300 years…

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Autopsy of the 5300 year old mummy “Otzi-the iceman” revealed borrelia spirochete DNA!

In the US alone, ticks infect an estimated 300,000 people with the bacteria that cause Lyme disease (Borrelia burgdorferi) each year. Lyme disease is currently on the rise (up 12% between 2012 and 2013 in Massachusetts)… and the worst thing about it? It’s targeting our poor, defenseless children!

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Distribution of Lyme cases by age: 5-15 year olds (playing in their yard), followed by 40-60 year olds (gardening) are the most likely to get Lyme disease.

Since June and July are the months that most people get infected with Lyme disease we need to learn how to protect ourselves, and our children, from this menace right now!

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Number of cases of Lyme disease in the US per month.

Let’s start with some simple guidelines from the CDC:

  • Wear Repellent!

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  • Check for ticks daily!
    • A tick typically is attached for 36-48 hrs before it transmits Lyme to it’s host… get them off before they infect you!!
    • Although ticks can bite anywhere, their favorite spots are: the head and neck (~50% of bites in children and 4% in adults), legs (50% in adults), torso (22% in adults), arms (18% in adults), and genitalia (6% in adults, but even higher in men… check your junk for the funk!).

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    The size of the Lyme carrying deer tick at different stages of development.

  • Shower after outdoor activities!
    • Shower within 2 hrs of outdoor activities: ticks usually roam around for a couple of hours before settling in and attaching to a tasty bit of thin skin… Wash them off before they even attach!
    • Wash & tumble dry clothes on high for ~1hr when you get home to kill remaining ticks.
    • medical illustration of Erythema migrans

      Bull’s eye rash (Erythema migrans)

  • Call your doctor if you get a fever or rash!
    • ~3-30 days after being bitten by infected ticks 80% of adults and 60% of children develop a rash. The Lyme rash (erythema migrans) is typically red and expands to >2 inches in diameter (5 cm), frequently clearing in the center giving it the Bull’s eye appearance.
    • Arthritic knee

      Lyme Arthritis

    • ~4-60 days later: the Lyme spirochetes invade systemically and cause flu-like symptoms. They may also cause: multiple bull’s eye rashes in remote locations, arthritis in the large joints (Lyme arthritis), cardiac issues (Lyme carditis, which is 3x more likely in men than women), and brain issues (Neuroborreliosis, Lyme meningitis, Lyme encephalitis, and Lyme palsy).
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CDC’s report of Lyme disease symptoms in US patient

Remember that Bambi and his terrorist friends don’t just hang out in the woods, they also hang out in your backyard! Ticks love moist areas, leaf litter, tall grasses, and brush…

  • Have you done your yard-work? Reduce your chances of Lyme infection by 50-90% by removing leaf litter, tall grasses, and brush from around the edges of your lawn! Create a tick-free zone around your yard and suburban parks:
    • Mow your lawn regularly and remove tall weeds… I hate the idea, but another option is to apply pesticides to your yard 2x a year, which reduces Lyme infection by 68-100%
    • Lay down a three foot wide barrier of wood chips/gravel between your lawn and the woods to restrict tick migration. Consider fencing in your yard to keep out deer, raccoons, and other Lyme disease carriers.
    • Keep activities away from lawn edges and overhanging trees
  • Is your garbage covered and inaccessible? The critters that get into your gargbage (Mice, squirrels, skunks, rabbits, and raccoons) carry Lyme disease! Mice are an especially big problem: the white-footed mouse is one of the biggest carriers of Lyme disease (common in small patches of woods, 5 acres or less) !
  • Do you have pets? Dogs love to romp in the woods and tall grasses where they fetch ticks and bring them right back to you! Check your dogs for ticks before letting them into your house, your tent, or the shelters on the AT… Talk to your vet about tick prevention treatments like Frontline. Note: Dispose of ticks properly! If you toss them onto the ground they’ll just grab onto you the next time you walk by… I see this all of the time and it makes me very grumpy!
  • Are you hiking in the middle of the trail? Hike in the middle of the trail and avoid tall grass, leaf litter, and brushy areas whenever possible… No matter how beautiful the wild meadow looks, don’t drop yourself, your pack, or your tent in the middle of it… Ticks love wild meadows and will happily catch a free ride from your pack to you! Know before you go: the Appalachian Trail goes through 12 of the 14 states responsible for 96% of all Lyme cases in the US!
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CDC Map of reported Lyme cases in the US in 2013

Please join me in raising awareness about ticks and Lyme disease by sharing this post and your comments about Lyme disease below. Stay tuned for my next post, which will also be about ticks and Lyme disease!

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~90 Million year old tick fossil from New Jersey

Disclaimer: I am not an MD or public health official. I am a scientist and an outdoor enthusiast with a passion for research… After discovering that ~5% of my friends (see my upcoming post) have had Lyme, I decided to do some research about it and share my findings here. Talk to your doctor if you have health related questions!

Tick Time (Days 90-91)

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On the trail we have to get used to, and try to make peace with the creepy crawly things. Sometimes that peace comes easier than others.

The ticks are definitely the bugs that I like the least. A week or so ago my friend Sir Stooge developed a giant bulls eye rash on the back of his calf. There was absolutely no mistaking it… Lyme disease. He never saw the deer tick that bit and infected him (Probably because the deer ticks are smaller than the flecks of mud and leaves that cling to all of our exposed flesh).

Lyme disease on the trail was no longer an abstract thing, it was there, with us amongst the rocks and rattlers in Pennsylvania. Before I reached Pennsylvania I’d only found two ticks on me… One deer tick (which I showed to my mom) and one dog tick, but neither of them had actually bitten and attached to me…

I stopped for lunch and took my shoes and then socks off because my feet were, as usual, feeling sore. As I peeled my dirty, sweaty socks off I noticed something stuck to my ankle just at the sockline. I absentmindedly tried to brush it off, something that I do dozens of times a day to brush random bugs, dirt, and mud off of me.

It didn’t move. I bent my head down to inspect this resilient piece of mud and discovered that it wasn’t mud at all… It was a tick. Ewwww… I wanted it off of me… Now!

It reminded me of one of the less pleasant experiences of my childhood…. Going swimming in the cove and discovering when I took a shower afterwards that I was covered in leeches instead of being covered in mud. For me it is a very strong, visceral feeling that tries to replace all of my rational thoughts with, “Get it off of me, get it off of me, Get!.. It!… Off!… Of!… Me!…

I took a deep breath, swallowed my visceral emotions, and tried to determine the best (and fastest) way to get the tick off of me. I wasn’t sure where my patented tick remover was in my pack, but something like a credit card would work just as well. My friend Lotus had her license handy, so I used her license like razor, bringing it down underneath and below the mouth and body of the tick and then quickly scraping it off of my leg and flicking it onto my waterproof stuff sack with one smooth motion.

Though I’d looked at it on my leg and decided that it was a dog tick and not a deer tick, I took a picture of it so I could double check later. Knowing what kind of tick it was mattered because some ticks carry Lyme disease and others don’t. The next time I had Internet access I looked at the pictures of the different kind of ticks and compared them to the tick that I had taken off of my ankle. It was definitely a female dog tick… I breathed a sigh of relief. At least *that* tick bite wasn’t going to give me Lyme disease.

P.S. If you’re curious about where Lyme disease is the most prevalent, the CDC has some startling maps of confirmed cases of Lyme disease.

Caught… (Days 59-61)

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At least the rain isn’t lasting all day, everyday now, though I still seem to be getting caught by intermittent deluges where the sky opens up and dumps 1-2 inches of rain in an hour, and then sunnier skies return. It’s definitely an improvement over the last week, so I appreciate that.

Yesterday, for the first time, I found a tick on my leg. It didn’t seem to care that I’d coated myself in deet, or maybe the rain and sweat had just rinsed all of the insecticide away.

Ticks and Lyme Disease are constantly on people’s minds out here. I check myself for ticks everyday, and have been glad not to find them. Some of the other hikers have found as many as 29 ticks on themselves in one day! The hikers with dogs seem especially prone to collecting lots of ticks.

Hopefully that will be the first and last tick to try to feast on me, but I will remain ever vigilant in my battle against the bugs.

It looks like I might actually get a break in the weather so I’m going to get back out on the trail and soak up some sun while it lasts!