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Tick Bite FAQs

By Jamie Harms, M.D.

Warmer weather is here, and with it, ticks are back.  Here are some frequently asked questions about ticks and tick bites.

What should I do if I am bitten by a tick?

Use tweezers to grasp the tick as close to your skin as possible, then pull the tick off with steady pressure. Then wash your hands and the area of the bite with soap and water. Sometimes, the mouthparts of the tick will break off and stay in the skin. If you can remove them easily, use the tweezers to pull them out. If you can’t remove them easily, just let the skin heal. Your body will break down the remaining mouthparts over time.

What kind of tick bit me?

Lyme disease is carried by the deer tick, also known as the blacklegged tick. It is not carried by dog ticks, so you should try to identify the type of tick that bit you. The CDC has excellent illustrations of the ticks found in Maryland. The ticks that are out in the spring are nymphs. They are very small, about the size of a poppy seed.

What is my risk of getting Lyme disease from a tick bite?

Ticks need to be attached at least 36 hours to transmit Lyme disease. If you pull off a tick which is crawling on your skin or which is not engorged with blood, you will not get Lyme disease.

Should I take an antibiotic after a tick bite to prevent Lyme disease?

Researchers still don’t have a clear answer about this. There have been some small studies suggesting that a single dose of  doxycycline may  reduce your risk of getting Lyme disease after a tick bite, but only under these conditions:

  • You are not allergic to doxycycline. No other antibiotics have been studied for preventing Lyme disease. Children must be at least 8 years old to take doxycycline. Pregnant women should not take doxycycline.
  • The tick can be identified as a deer tick.
  • The tick has been attached for more than 36 hours based on the time of exposure or the observation that the tick is engorged with blood.
  • You can take the dose of doxycycline within 72 hours of removing the tick.

Experts do not recommend that people take antibiotics to try to prevent other tick-borne diseases, such as anaplasmosis, babesiosis, ehrlichosis or Rocky Mountain Spotted fever.

Do I have Lyme disease?

Most people with Lyme disease will get a rash around the site of the tick bite one to four weeks after the bite. The rash is often described as  “bullseye” rash, because it is often red on the outside and clear on the inside. Lyme disease rashes can also come in other patterns, though. A Lyme disease rash gets bigger each day, and it usually over two inches wide. Check out these photos from the researchers at Johns Hopkins Hospital.

When should I see my doctor?

If you were bitten by a tick and have an expanding red rash around the bite or have “summer flu” symptoms, you should see your primary care provider.

Well-Child Visits: Foundation for a Healthy Life

A Q&A with Dr. Jamie Harms

Dr. Harms explains why children, like adults, should see their doctor for annual checkups.

Q: My child isn’t sick. Why should they get a checkup?

A: A yearly checkup – known as a “well-child visit” ─ helps monitor your child’s development and can spot potential health problems. The visits also help your child develop a positive relationship with their doctor, a relationship that will become the foundation of good health care throughout your child’s life.

Most parents are good about bringing babies and preschoolers in for regular appointments, but after children start school, visits tend to drop off. When that happens, we miss a lot of opportunities to help kids grow up healthy.

Q: What happens during a well-child visit?

A: We track your child’s growth and development, including their vision. It’s surprising how many kids start school with vision problems, which can impact their ability to learn. We can help detect issues so kids can do well in school.

Children change a lot in 12 months, and we can tell you what to expect in the coming year. If you have questions or concerns about your child’s health, we can answer your questions and direct you to health resources.

We can help teach your child good health habits, like eating healthy, getting enough sleep, and balancing screen time with active play time. The annual visit is also a good place for kids to learn how to deal with social pressures they will encounter at various ages, including relationships, drinking and drugs.

Q: What else happens in the appointment?

A: We will make sure your child receives any needed immunizations, including measles, polio, tetanus, diphtheria, pertussis and influenza (flu). Kids who don’t see their doctor regularly miss these vaccines and are at higher risk for serious illness. In fact, many college-age kids have missed important immunizations, even though some diseases are most likely to occur in the teenage years, such as human papillomavirus (HPV) and meningitis.

Q: What problems do you typically see?

A: There’s a big problem with children not getting enough physical activity. With too much time spent watching TV, playing video games or being on their phones, many kids don’t build bone strength or develop good cardiovascular health. Inactivity during childhood can lead to serious problems later, including obesity, heart disease and diabetes.

Also, some of the kids we see don’t get enough sleep. We live a crazy 24-hour society, and children get drawn into that. Kids ages 6-13 need 9-11 hours of sleep each night, and teens need 8-10 hours. Lack of sleep can cause emotional and behavioral problems and poor performance in school.

Q: When should my child get a checkup?

A. It’s a helpful reminder to schedule the visit near your child’s birthday each year. And many MPCP offices have extended hours, so you don’t have to pull your child out of school.

Setting good health habits early makes a real difference. The whole idea of staying healthy starts with seeing the doctor once a year. It’s never too early to start building a healthy life.

What To Do? Emergency Department vs. Urgent Care vs. Your Doctor’s Office

By: Jamie Harms, M.D.

Having an illness or injury often results in a good deal of anxiety and worry. You want medical attention and relief from your symptoms as quickly as possible. But where should you go to get the best, most appropriate and cost-effective care? The following are the most widely used treatment options and suggestions about when each might be best suited to meet your particular medical needs.

The emergency department:  Most emergency departments are part of hospitals, although there are free-standing emergency departments in Bowie and Queenstown. The ED is designed and equipped to handle serious or life-threatening emergencies.  It is always open, including nights, weekends and holidays. Patients are seen according to how sick or injured they are.   The most serious cases jump to the front of the line, even if they arrive later than everyone else.  Physicians in the ED are trained to look for life-threatening conditions, and the tests you will receive in the ED will help them decide if you have any of these.

The Emergency Department is the right place to go if you have a serious or potentially life-threatening illness or injury:  chest pain, sudden weakness on one side of your body, a new seizure, severe headache, persistent heavy bleeding, poisoning, or a large broken bone.

The Emergency Department is probably not the right place to go if you have a milder illness or a longstanding issue.  You are likely to wait longer for treatment. The Emergency Department doctors do not have access to your medical records.  Your visit will be much more expensive-as much as 4-6 times as expensive! Remember, they have to keep all that life-saving equipment available all the time. That’s great if you need it, but it’s just an extra charge if you don’t.

Urgent care centers:  There are lots of these in our area.  They often have extended hours, including evenings and some weekend hours.  They are designed and equipped to handle medical problems that need attention the same day, but are not life-threatening.  Patients are usually seen in the order they arrive, so your wait will depend on how many other people go to the Urgent Care Center at the same time you do.  Many Urgent Care Centers have X-ray and blood testing equipment.

An Urgent Care Center is the right place to go if you have a new illness or injury that occurs when your doctor’s office is closed: sprains and strains, painful urination, ear pain, severe cough or wheezing.

An Urgent Care Center is probably not the right place to go if your doctor’s office is open or if you have a serious or life-threatening condition. A visit to an Urgent Care Center is more expensive than a visit for the same condition at your doctor’s office. The provider in the Urgent Care Center does not know you and will not have access to your medical records. Urgent Care Centers are not equipped with life-saving equipment or providers trained to treat life-threatening illnesses or injuries.

Your doctor’s office:  No one knows you like your own doctor. Your doctor is equipped to treat many illnesses and injuries, and can arrange any testing you may need. Your primary care doctor has your medical records and knows your medical history. Patients are seen by appointment. Maryland Primary Care Physician offices reserve appointments for patients who need same-day treatment. Many MPCP offices have evening and/or Saturday hours for your convenience.  Call or check our website, www.mpcp.com, for a list of hours at your doctor’s office.

Your doctor’s is the right place to go if you have a new problem, such as sinus pain, ear pain or flu, cuts or other wounds, sprains or strains, cough, or a flare up of an old problem, such as back pain or migraine headache, or an ongoing problem that may require more testing or treatment, such as persistent stomach problems or joint issues.  You will pay the lowest copay at your primary care doctor’s office, and most times, you will be able to get an appointment the same day you call.

Your doctor’s office is the wrong place to go if you have a serious or life-threatening condition. If you need care in the next hour, go to the Emergency Department.

Don’t forget: Good communication is important to make sure you get good care. If you’re not sure what to do, call your primary care provider. Even when the office is closed, there is always someone on call who can direct you to the care you need. If you ever need to go to the Emergency Department or an Urgent Care center, take a list of all your medications and allergies with you. Let the staff know who your primary care provider is, and schedule a follow up appointment if needed.

Primary care quicker, less costly than the ER

A study by a New York health insurer claims 90% of conditions commonly seen in emergency rooms ─ like sinus infections, sprains and sore throats  – could be treated faster and at a lower cost elsewhere. Excellus BlueCross BlueShield reports that in 2013 emergency room visits in the state for these conditions were nearly 8 times more expensive than a primary care office, 3.5 times higher than an urgent care center, and 15 times costlier than telemedicine. Patients in ERs also had the longest wait times for treatment. The report concludes: “the best method of care for nearly all of these cases is for patients to see their primary care doctors.”

Easing Back-to-School Anxiety

By: Jamie Harms, M.D.

It’s hard for most of us to see the more relaxed days of summer come to an end. For our children and teens, back-to-school time can be exciting, but it can also create anxiety and stress. Here are a few tips to make this transition easier for the whole family:

  1. Map out the morning routine. Discuss how the mornings will work, from wake-up times to setting out clothes the night before to whether your child will be making lunch or buying it at school, etc. Do a practice run—show them how long it takes to walk to the bus stop, or drive to school so they are prepared the first day.
  2. Early to bed. Kids need 9-11 hours of sleep every night, depending on age. Once you know how early they need to be up, plan a regular bedtime and start sticking to now so the first week of school is easier.
  3. Healthy food fuels the body and mind. Let your kids help you shop for healthy foods they enjoy and encourage them to start the day with a good breakfast, especially one containing some healthy protein.
  4. Prepare a “homework space.” Clear out a designated area, complete with supplies of pencils, markers, tape, etc. so your child has space to work. Depending on his or her age, you may want to make this space in a common area of the house so you can be available to help with homework.
  5. Be a bit empathetic. Adjusting to a new school, trying to make friends, dealing with a heavier work load—all of this can be very stressful for kids. Try to be a support during these first few weeks of transition back to school.