Questions can be submitted to ASK DR KEN and selected questions will be posted on the site.

Tick Bites, What should I do?

Question from KP

 live in an area where there are a lot of deer ticks and Lyme Disease. What should I do if I remove a deer tick from myself?  Do I need to take antibiotics?


Deer ticks infected with the bacteria, Borelia Bourdorferi, that attach to one’s skin, can cause Lyme Disease. Stage 1 Lyme Disease consists of the development of an expanding red flat, round rash around the site of the tick attachment. If untreated, the rash increases in size for up to several weeks, before Stage 2, occurs, which is characterized by a flu-like illness, corresponding to the bacteria spreading from the skin to the blood. Treatment of Stage 1 Lyme Disease consists of oral antibiotics for at least 2 weeks.

Treatment with a single dose of an antibiotic at the time of the tick bite is recommended by some sources, including the CDC, for at risk individuals to prevent the development of Stage 1 Lyme Disease, A tick bite is at risk of causing Lyme Disease if the following conditions are meet:

  1. The Tick is identified as an adult deer tick, usually engorged (fat). This can require some expertise in tick identification.
  2. The tick has been attached for more than 36 hours. In situations where one can be certain that the tick was removed relatively quickly, antibiotic prophylaxis is not recommended.
  3. Less than three days has passed since the tick was removed. This is preventative treatment only and not meant to treat Stage 1 Lyme Disease.

Based on a consideration of a variety of factors, a health care provider may prescribe a single dose of Doxycycline at the time a tick is removed from the skin, with the aim of preventing the development of Lyme Disease.

Do I Need a COVID test every time I get a cold?

Question from JA:  

Do I need to get a Covid test everytime I get a cold or flu?


That is a good question. The only way to accurately distinguish cold or flu symptoms caused by COVID virus from other viruses, or even allergy symptoms, is by laboratory testing. If it is important to know this information then the answer is yes. For individuals at risk for severe illness or hospitalization, the best practice is to test at onset of all symptoms or for known exposures.  Early diagnosis of Covid infection for higher risk individuals is important in order to identify those patients most likely to benifit from treatment with antivirals or monoclonal antibobies. Similarly, for individuals such as healthcare workers that are in contact with high risk individuals, testing is necessary in order to prevent spread. Keep in mind that testing, particularly using rapid tests, is not completely accurate, with many false negative results. Even testing may not identify infection. For low risk individuals including children, the current practice is to test for all acute viral or respiratory synmptoms. As the pandemic transitions to endemic, the indications for testing should become better defined. So the answer to your question is that we don’t know the optimal amount of testing we should be doing for minor respiratory or viral symptoms in children and adults. 

Should I Get Get Another Booster Shot?

Question from JA:

I received the initial 2 shot series of the Pfizer vaccine and a booster shot after 6 months. Should I get another booster?


Currently, the CDC is recommending a second booster for all adults over 50 years old and younger people with moderate or severe immune suppression. Israel is offering it to anyone over 18. Data from Israel shows it provides some additional benefit in preventing severe disease (which is already very unlikely after 3 vaccines) and only little benefit in preventing infection. We know that immunity, after vaccination decreases to some extent after 3-6 months, It is likely we will be getting additional Covid vaccines in the future. The vaccine makers are working on sprain-specific vaccines. If you have been infected with Covid that should also boost your immunity, perhaps more than another booster vaccine. Consider your risk of exposure,  your risk of becoming very ill if infected and how long since your last booster or infection when deciding whether to get a second booster. Most of all keep up with the latest information. The answer to your question will become clearer as we observe what is happening in the real population and more data is analyzed. Remember, we are reading the medical textbook at the same time that we are writing it.

I received my second booster as soon as it was available



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