Xylocaine and Lyme disease: A deer tick story

It was a small deer tick, hidden by the crus helix, embedded in the cymba conchae, the crevice just above the ear canal of my seven-year-old patient halfway through my Saturday clinic.

He was worried that it would hurt. His parents hadn’t wanted to try removing it on their own. I had a hard time even seeing the small tick as it was sitting at an angle where I saw it from straight behind.

“Let me get some stuff,” I said.

I drew up a couple of milliliters of Xylocaine with epinephrine and discarded the needle, grabbed some 2″ by 2″ gauze pads and rummaged among my autoclaved instruments for the finest foreign body forceps we have.

Back in the exam room, I explained my strategy:

“This syringe doesn’t have a needle on it. I’m just going to pour some Novocaine over the tick; then we’ll wait a few minutes before I gently pull him out with this instrument.”

The boy looked worried.

“Piece of cake,” I said. “It won’t hurt a bit.”

I asked the boy to lie on his side with his tick-ear facing upward. Holding his head at just the right angle, I expressed enough Xylocaine from the syringe to completely fill the cone-shaped crevice in his ear where the tick was submerged. I then held his head firmly but gently to make sure the tick stayed under the surface of the anesthetic.

“I’ve seen a lot of tick bites already the last two weeks,” I said as we waited. “I haven’t seen any new cases of Lyme disease yet, though.”

“You know the rash of Lyme disease was actually first described in Sweden, way back in 1909, by a doctor named Arvid Afzelius. And it was discovered a long time ago that penicillin could be used to stop it. I remember hearing that was routine when I started medical school in 1974. But it wasn’t until the early 1980’s that doctors in Lyme, Connecticut saw the connection with all the other symptoms we now call Lyme disease.”

As I prepared to finally remove the tick, I added: “We vaccinate dogs for Lyme disease here, but not people, but in Sweden, all my relatives have been vaccinated.”

I grabbed the handles of the forceps, pointed the tip away from me, reached into the cymba conchae while still holding the boy’s head in place. Then I closed the tip of the forceps gently, without locking the instrument, and pulled. The tick offered no resistance. It was intact.

“See, here he is, legs, jaw and all, out of where he doesn’t belong.”

The boy and his parents squinted as they looked at the tiny deer tick.

“And he didn’t feel a thing,” I added. The boy finally smiled.

“People use all kinds of different oils and things to suffocate the tick,” I said. “I prefer Xylocaine, which by the way was in developed in Sweden in 1943.”

To myself, I reflected that I don’t even remember when I first decided to try Xylocaine. I know people have had good luck with oils, but we don’t keep any of them in the office. But we always have Xylocaine. And that does add more of an air of medical magic than just plain olive oil.

“A Country Doctor” is a family physician who blogs at A Country Doctor Writes:.

Image credit: Shutterstock.com

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