  It’s finally (almost) summer in Virginia and I’ve already started seeing patients come to the clinic with sunburn, poison ivy dermatitis, and the ever popular tick bite. I’m not sure about you, but growing up in the south, I had my share of tick bites and I can’t recall one instance when my parents took me to the clinic for it. When I started working in urgent care 5 years ago, I was surprised to see that so many people rush in to be seen for tick bites. I’ve noticed that my patients are generally unnerved by ticks and they are terrified of contracting a tick borne illness, particularly Lyme Disease. Most patients request blood tests and want to be prescribed antibiotics to prevent the onset of illness. So, you may ask yourself (or your healthcare provider), what should I do if I’m bitten by a tick?
First, remove the tick. Using tweezers or a tick removal tool, cautiously pinch as close to your skin as possible. Avoid squeezing the body of the tick, which could cause the tick to regurgitate and be more likely to spread disease. Pull in a steady upward motion & try to remove the entire tick with the mouth attached. If the mouth detaches, cleanse the tweezers with alcohol and gently try to remove the remaining tick from your skin. Cleanse your skin well with alcohol or other antibacterial skin cleanser. Avoid applying petroleum jelly or other home remedies to the bite site. Keep an eye on the bite site, but keep in mind that mild redness and itching are common symptoms of insect bites. Google Images When should I go to the clinic? You should seek medical attention if you experience flu like symptoms; including but not limited to, fatigue, rash, fever, body aches, nausea or vomiting. You may consider keeping the tick for lab testing. According to the Centers for Disease Control (CDC, 2018) "The Infectious Disease Society of America (IDSA) does not generally recommend antimicrobial prophylaxis for prevention of Lyme disease after a recognized tick bite. However, in areas that are highly endemic for Lyme disease, a single dose of doxycycline may be offered to adult patients who are not pregnant and to children older than 8 years of age when all of the following circumstances exist: a. Doxycycline is not contraindicated. b. The attached tick can be identified as an adult or nymphal I. scapularis tick. c. The estimated time of attachment is ≥36 h based on the degree of engorgement of the tick with blood or likely time of exposure to the tick. d. Prophylaxis can be started within 72 h of tick removal. e. Lyme disease is common in the county or state where the patient lives or has recently traveled, (i.e., CT, DE, MA, MD, ME, MN, NH, NJ, NY, PA, RI, VA, VT, WI). Antibiotic treatment following a tick bite is not recommended as a means to prevent anaplasmosis, babesiosis, ehrlichiosis, or Rocky Mountain spotted fever. There is no evidence this practice is effective, and it may simply delay onset of disease. Instead, persons who experience a tick bite should be alert for symptoms suggestive of tick borne illness and consult a physician if fever, rash, or other symptoms of concern develop." To read more about tick borne illnesses, please visit: https://www.cdc.gov/lyme/resources/TickborneDiseases.pdf Until next time, The Humerus NP Please note: This is intended to be information only and not intended to replace a medical evaluation and advice from your healthcare provider. Please seek medical attention if you suspect that you may have been exposed to a tick borne illness. Thank you.
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 Memorial day is a holiday that honors the men in women who have died while serving in the American armed forces. While many of us will enjoy a day off of work, BBQ, family and warm weather, let us pause to remember these heroes and the sacrifice that they made for our beautiful country. Let us pray for the families of those heroes, that they find peace among the grief that they feel.
As we enjoy the warm weather and the weekend off, it is important to note that in the medical field, we often refer to this time of year as the beginning of “trauma season.” Similar to flu season, we call it trauma season because we see an increase in injuries. Like PB&J, we have road trips & MVAs, boats & drownings, ATVs & compound fractures, biking, hiking & snake bites. Through the years in the ER, I have developed a few common sense tips for those of you who may spend time outside (instead of in the ER) this summer.
Have fun and be safe. Until next time, The Humerus NP  Over the past 16 years working in the medical field, I have cared for thousands of patients in a variety of roles and settings. I can never remember a face or name, but I often can remember a unique illness or quirky personality. I frequently get asked by my kids, “Did you see anything cool today?” Occasionally, I may have a funny or gory story to tell, but most of the time I tell them “No, just a whole bunch of coughs and colds.” But today, I was thinking, maybe I should write some of these funny stories down. So, here are a few of my most memorable…. Excuse me...What? Guy comes in to urgent care with complaints of cough and cold symptoms for the past couple days. He’s a business guy, dressed to the nines, has no time to be sick. Tells me he wants to “nip it in the bud.” So, I explain to him that colds are caused by a virus and that in a few days his immune system will do its job and kick it out of his body and he will be good as new. He demands a Zpack. I explain to him how antibiotics treat bacterial illnesses and not viral illnesses. (This is a very common conversation in the urgent care setting.) He is obviously not pleased because I am not accommodating his demand for the magic pills, so he stands up and says, “I’M NOT HERE FOR MY HEALTH!” A long pause ensues, I look at him, and he turns and walks out. Don’t put that there (warning: gross) Young women comes in with complaints of vaginal discharge. She states she is a bartender and borrowed her coworkers leotard. She thinks she may have contracted an infection from wearing the borrowed leotard without panties (insert eye roll). People, we’ve heard it all, just come clean with the true story. Anyway, I decided that she needed a pelvic exam and STI testing. While I was examining her I saw something brown in her vagina. I thought to myself, “That looks like feces… Oh no, I hope she doesn’t have a fistula.” Then it dawns on me, maybe its a retained tampon (not uncommon for women to forget to remove a tampon). So, I ask her, “Ma’am, did you leave a tampon in?” She gasps and says, “It’s a makeup sponge!” Wait…. What!!?? I was able to remove it with forceps and it looked and smelled like a dead mouse. Apparently, her friend recommended she use it because a sponge is more absorbent than a tampon. Her period had been over for 2 weeks. I do not get paid enough for that. Psych ward Early on in my nursing career I worked part time in a psychiatric facility. One day I was working in the stabilization unit, where the actively psychotic patients are admitted to the hospital. I had dozens of patients, and they were able to move freely about. A middle aged female patient comes to the nursing station and asks for a sanitary napkin. I agree and hand her a couple. She asks, “Where did you hide the bomb?” I recognized that she was paranoid, and would benefit from choosing her own pads. I hold the box out to her and she picks a few that look trustworthy. Several hours later, she asks for more pads and I oblige and let her pick from the box. Around 2 am, the fire alarm goes off. I look around and see my patient low crawling under invisible smoke from a fire. Now, if there is any way to make a stabilization unit more chaotic, try waking a dozen psychotic patients from a deep sleep at 2 am with a blaring fire alarm. Then lock all the doors so they think that they’re trapped and destined to burn alive. It was a nightmare! I contact the administrator who has the key to turn off the alarm and then go searching for my patient. I find her in the shower... with sanitary napkins stuck all over her body. I’ll try to think of some more, but in the meantime, tell me your most memorable funny patient encounter. Until next time, The Humerus NP |
