D: So I understand you removed insects from your leg earlier today?

P: Yes I did, it was uh it was behind my left uh knee kind of in like the joint behind where it bends. Um it was stuck pretty good, it's still kind of red and tender there. I noticed it because the back of my knee was starting to just feel a bit sore, um not the joint itself, but just kind of the skin, the whole area back there. Um and I found this tick, I brought I brought it in with me if you wanted to have a look at it, um it's in like this little plastic container, uh and I don't really know when I got it. I was hiking on Friday um and then Saturday I was out in my garden, I hope they're not around my house, I hope that it was from hiking um and not gardening, but uh I did spend a lot of time outside on Saturday as well.

D: OK, so sounds like it's been a little bit of time since you were last outdoors to when you first noticed it?

P: Yeah.

D: OK, so when you picked it off the tick, obviously you have it for me, is it quite swollen or engorged?

P: It's not too bad, um I I have actually had a tick in the past and this is a long time ago and um maybe like 10 years and I actually had that kind of target rash thing that they talk about. And, uh at that time I remember I had to take antibiotics for a bit. Um this um didn't look like that, it was more, it was just kind of sore in one spot, I don't think it um it was as bad as that time and the tick that time, sorry I've kind of gotten off track, that time it was quite swollen, this one was maybe a little bit, but not as much.

D: OK, so just in terms of the tick's size, it doesn't look like it's been feeding for too long, so when ticks uh are feeding they tend to engorge, they tend to swell up, so this looks more like a tiny little bug or does it kind of look like a little grape, almost like it's been swollen up with blood?

P: No, this one, this one's pretty small.

D: This one's pretty small, OK. And I should mention that, well obviously you've had a tick bite in the past, the big concern for us is a disease called Lyme disease, which is spread by bacteria, but in fact only one type of tick predominantly is a transmission transmitory agent for it. It's called a deer tick, and its coloration, it's got a little bit of a brown butt and there's some black legs. Does it look like that at all?

P: I don't think so, uhm, I uh I was looking at the pictures online, I think it looks like the other kind of tick, um but I heard that, yeah, but I heard that lately now they've been considering all ticks in this area as possibly carriers of Lyme um because I think it's kind of become more more of a problem sm so that was making me a bit nervous.

D: OK, absolutely, what we can do is we can send this tick off to the lab and they'll be able to identify the species for it, but for tick bites in general, one of the key considerations is for how long it's been on your body for. So unfortunately, if you're out on Friday and Saturday, that'd mean that this tick has been on you for longer than at least 72 hours. So I think one way or another, we're likely going to have to put you on antibiotics just as kind of a prophylactic at the very least, just want to make sure that um you're not at risk of developing Lyme disease. I'm sure you've heard from the news that Lyme disease can present in a variety of ways, but it's a disease that we try our best to avoid. And just in terms of your symptoms, so you say you've had a bite in the past and you you've got that rash before, that kind of bullseye rash, do you have that rash now?

P: No, I don't uh as far as I know, I mean, you can have a look too. It's behind my knee, so it's not the easiest place to see, but it's uh it looks a little red, it's like tender where the tick was, but I don't see that like larger circle rash.

D: OK, that's reassuring. Now any, it'd be pretty unlikely for you to have other symptoms, but just in case, do you have any other joint pain? 

P: No.

D: Have you been feeling ill or have been feverish in the last little while?

P: No, no, I've been fine.

D: OK, and you removed that twit tick once you found it, you presented to me, have you checked your body for any other possible bites?

P: Oh yeah, I looked around and I looked at my husband too 'cause we we were just a little bit, you know, gave us a little bit of a scare, but no, there's been nothing else.

D: That's good. And did you bring a pet with you at all when you were hiking and gardening?

P: Uh no, I didn't, no.

D: OK, good. Any other family members you think might have been exposed?

P: Uh no it was just uh me and my husband.

D: OK, and what geographic area were you in um when you were hiking?

P: We were uh in Strathroy along the creek.

D: OK. I can do, if I remember there's a Lyme disease distribution map for Ontario and we can see exactly how that lines up to see if we should be a little bit concerned or not. Looks like Strathroy is close enough to be considered a little bit of a concerning point, so I think that we will be moving forward with antibiotics, but of course we'll be talking to the physician who'll be having a look at you as well. So it sounds like you haven't been having too much symptoms aside from you've noticed this tick, the skin around it is fairly sore and you've had this in the past, but you were treated with antibiotics in the past and since then you haven't had too many health problems after that?

P: No, no. I've been pretty healthy.

D: OK, and just about your health right now, is there anything that you see the family physician or doctor for in general and regarding your health?

P: Uh just for my cholesterol.

D: OK, are you taking and medications for that?

P: Uh Yeah, I take a uh statin, can't remember which one. 

D: OK, got it. And do you have any allergies?

P: Uh no.

D: So no drug allergies?

P: No.

D: OK, now we've already talked about other exposures, so it doesn't sound like anyone else in your family or any pets are around, so it's unlikely that you have ticks coming in and you said you might have gotten this from gardening, but um you're hoping that your area doesn't have ticks. Maybe just take a look, ticks like to live in long grass, kind of on the intersection between woods and fields to see if there's any hovering around that kind of make a waving motion with their legs and they're sometimes easy to spot, you might wanna get some insecticide out there. But it sounds like this is fairly recent, unfortunately just for the length of time this tick might be on you for, it's probably safer than not to start you on some medications, but I'm going to go talk to the doctor after we do a quick physical exam, and we might also send the tick off to a local laboratory so they can identify the species for it definitively, as well as might just send some blood work just to see if there's any titres or any serology that would make us a little bit more concerned for Lyme disease. But aside from that you've been feeling well otherwise?

P: Yeah, totally fine. It was just a little tender there and that's the only reason I looked.

D: OK. So no headaches?

P: No.

D: Nothing like that?

P: Nothing like that. 

D: OK, excellent, alright. I'm fairly happy with what we talked about today. Do you have any questions for me Jean? 

P: No, this is pretty well what I expected today, so thanks for helping me out.

D: No problem. OK, I'll go talk to the doctor, we'll come back and talk to you, OK? 

P: Great, thanks.

D: Thanks Jean.