Don’t be Bugged by Bugs

2000, May/June Adirondac Adirondoc

Worldwide, insect – or tick-transmitted diseases are among the most common causes of death and disability. While the hiker in New York is unlikely to contract a fatal arthropod- borne illness, bugs are high on the misery index.

In honor of spring, we will consider three categories of critters with the potential to spoil one’s clay. I will refer to all by the untechnical term “bug” to reflect the fact that not all are true “insects” biologically. The three groups into which I have categorized these bugs are also not strictly biological; rather, they reflect the similarity of clinical disorders produced by members of each group.

Ticks. The list of disorders transmitted by ticks is lengthy, although most attention in the Northeast is directed at Lyme disease. The first line of defense against ticks is physical. Long-sleeved shirts and long pants with cuffs stuffed in socks (or with gaiters) are de rigeur in tick country.

Since most tick-borne diseases require an interval for the animal to attach and inoculate, a daily skin inspection while hiking can generally detect them in time. Everyone has a favorite trick for dislodging ticks; most of these are old spouse’s tales. The current practice guidelines of the Wilderness Medical Society call for gentle traction with small tweezers; this will usually remove the animal and (painlessly) a small chunk of skin. If a portion of the tick remains behind, gentle attempts to dissect it out with a needle or sharp scissors can be made, but do not go overboard with this. Be sure that the wound from your removal efforts is cleaned with soap, water and a topical antibiotic to prevent local infection.

In regions of heavy tick infestation, application of a permethrin product on clothes may provide additional protection, as will application of one of the DEET-based repellants on skin.

Painful stinging insects. Allergic reactions to wasps. bees, hornets and their relatives kill 50 to 100 Americans annually. In terms of likelihood of producing fatality. these are the most dangerous animals in the woods.

Bites from these insects are not preventable by repellants. They usually result from surprise contact, so minimizing the chance of such encounters is the best prevention. This entails such obvious strategies as checking potential campsites for nests. Some of these insects are ground-dwellers, and are discovered by barefoot campers walking in grass.

Most bites of stinging insects require little if any first aid. There are, however, two types of reactions of which we should be aware. Local reactions are defined as swelling, redness and tenderness that are continuous with the bite. Thus, swelling of the forearm and back of the hand after a bite on the finger is a local reaction. While these can be very dramatic and painful, they are harmless and do not represent true “allergy.” Although even experienced physicians may confuse these reactions with infection (“cellulitis”). insect stings rarely become infected. The only treatment for these local reactions is the use of cold and pain medication.

When a reaction occurs remote from the bite (a generalized rash or difficulty breathing, for example). the condition is virtually always caused by an allergic reaction to the venom. Such reactions can cause profound respiratory distress and shock. This condition is called anaphylaxis, and if untreated can be fatal. The emergency treatment of anaphylaxis is injected epinephrine. Fortunately, most individuals with venom anaphylaxis have milder reactions first. prompting physician evaluation and the prescription of an emergency epinephrine injector (EpiPen1 M). Hikers requiring such devices should carry them on their person, and inform everyone else in the party where they have it and how to use it.

Although there is debate about this, epinephrine is not currently available over the counter in the United States. Thus, the casual hiker may not legally obtain this medication to carry in a first aid kit.

Itchy stinging insects. Mosquitoes. black flies, punkies, no-see-ums: call them what you will, these bugs can be a real pain. Fortunately, while pesky. they rarely have any important health consequences in our area.

There is more nonsense written about these pests than all of those with much more important health consequences. For example, there are loads of ideas on what “attracts” mosquitoes and similar insects. Colors, sweat. oily skin, fragrances and a host of other factors are often implicated. In actuality, properly performed scientific studies have shown only one consistent attractant: carbon dioxide in exhaled breath. Thus. short of stopping breathing. there is little one can do to control the major personal attractant for these bugs!

Similarly, there is. an endless array of purported repellants. I know folks who swear by crushed bracken fern. fabric softener sheets, B-complex vitamin tablets and lotions such as Avon Skin-So- SoftTM.

The reason that there are so many “folk medicine” repellants for itchy insects. in my opinion, is easy to discern. There is a distinct psychological basis for how bothered one is by bugs, so there is a great potential for placebo effect. I am frequently struck by the differences within a group in how much bother is created by mosquitoes. Some folks seem to be attacked unmercifully. while others just go about their business with minimal disruption. Yet, if one tries to look at something objective, like numbers of bites or the size of the personal swarm, there is little to differentiate these two groups. Some people seem better able to accommodate these ubiquitous pests. Probably the best discussion of this topic is in one of my all-time favorite outdoor books, Davidson and Rugge’s The Complete Wilderness Paddler. Here you will find the ultimate placebo: a song to keep flying insects at bay!

If all prevention fails. and you are kept awake at night itching a day’s worth of bites, one of the over-the-counter antihistamines (such as BenadrylTM) will often relieve itching dramatically. Bugs are as much a part of the outdoor experience as mountains, rain and sunshine. Sure, they are sometimes a hassle. but they just come with the territory. If you find yourself bothered too much by them. maybe you should take up bowling.

~Thomas R. Welch, M.D.

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Topics: Insects & Spiders