One of the most devastating chronic conditions I treat in my practice is something we all need to be aware of – because it’s literally right in our own backyards: Lyme disease!

Lyme disease is no longer a rare condition affecting people who live out in rural Connecticut (Lyme disease originated in Lyme, CT); it’s something we all need to think about if we spend anytime outdoors, have pets, or even if you and your kids just play in your suburban front yard.

By all measures, Lyme disease cases are growing in numbers in affected regions that are used to the disease, and it’s geographic reach is expanding. The northeastern states, saw a more than 320% jump in counties with a high incidence in the past few years, from 43 counties to 182 most recently. A 250% increase was seen in the north-central states. Amongst eight doctors, nurses, and nutritionists I recently had dinner with, 3 had been diagnosed and treated for Lyme disease in the past couple of years – 2 successfully and one, sadly, with lingering symptoms after too short a course of antibiotics (only 2 weeks) was administered after Lyme disease symptoms started.

Prevent Disease & Do “Tick Checks”

The best way to treat Lyme disease is prevention – keep the grass short around your house, appropriately treat your pets for ticks, tuck your pants into your socks when you go for hikes, and do a thorough tick check each evening on all family members if you live in an area with Lyme disease — even if you’ve just be outdoors causally. Essential oils on your clothes may help a bit, too, though I’m not sure how much.

I can’t tell you how many Lyme ticks are found on someone simply after they took the dog for a walk in a grassy area. Ticks like to hang out in warm places, but can be anywhere on the body. My husband found one just inside his belly button once! So check the common places – groin, hair, behind the ears, but also do a full body “once over.” Deer tick nymphs are tiny.

Here’s a picture from the Centers for Disease Control and Prevention.


If You Find a Tick

If you do find a tick on yourself or a family member, here’s what you should do:

  • If it has not bitten into the skin at all (meaning you can easily and simply lift if off of the skin, or it’s still crawling around), simply remove it with your fingers and destroy it (I recommend flushing it down the toilet). There is no need for medical treatment if the tick has not bitten you (is not attached), but if there’s one tick, there could be more, so do a tick check that day, and again the next.
  • If the tick has latched on, remove it promptly as follows:
    • If available, use tweezers or small forceps to grasp the tick as close to the skin surface as possible. In the absence of tweezers, use paper or cloth to protect the fingers during tick extraction.

Pull straight up gently but firmly, using steady pressure. Do not jerk or twist.
    • Do not squeeze, crush, or puncture the body of the tick, since its fluids may contain infectious agents.

Disinfect the skin thoroughly after removing the tick and wash hands with soap and water.

If sections of the mouthparts of the tick remain in the skin, they should be left alone as they will normally be expelled spontaneously.

After the tick removal and the skin cleansing, the person bitten (or the parents) should observe the area for the development of EM for up to 30 days following exposure. Components of tick saliva can cause redness that should not be confused with erythema migrans (EM) or the classic bulls-eye rash.

Since the tick usually needs to be attached for two to three days before transmission of Lyme disease occurs, removing the tick within this time frame often prevents infection.

When to Take an Antibiotic

If the tick has been bitten in, and you suspect it’s been more than 24 hrs, or you’re just not sure, then I recommend a single dose of doxycycline for anyone over 8 years old and not pregnant or breastfeeding, and a longer course if the tick has been on longer than 24 hrs.

For younger children, pregnant and nursing mommas, see your doctor for the appropriate antibiotic recommendations.

Remain alert for Lyme disease symptoms in the ensuing weeks. Only about 50% of people who get Lyme disease ever had a bulls-eye rash, and most never saw the tick that bit them! What you want to look out for are flu-like symptoms — fever, headache, generalized aching and painful joints are the most common early symptoms.

If there are any suspected Lyme disease symptoms, I recommend full course of 1 month of antibiotics, particularly if there was tick bite, rash, or not, or simply if it is tick season (spring thru early autumn) and you are in a region with Lyme bearing ticks (which is a pretty wide range of places!).

This is not the time to be worrying about antibiotic overuse – and you know that if I’m saying that, given how ardent I am about avoiding unnecessary antibiotics, it’s fo’ real, momma!

For younger children, pregnant and nursing mommas, antibiotics are also needed – but see your doctor for the appropriate antibiotic treatment.

Protecting Your Gut and Mitochondria from Antibiotic Damage

A probiotic can be given along with and for a few months post antibiotic treatment, and if long term antibiotics are required, the probiotic continued and mitochondral support added in (l-carnitine, B6, d-ribose, co-Q10) because some antibiotics can have an effect on these little powerhouse organelles that live in our cells.

Stay safe, be smart, and have fun!




  1. As someone who had Lyme Disease (and treated it successfully after a course of one month of doxy), I appreciate how straightforward and direct this post is, without any major fear-mongering or doomsday scenarios about how awful Lyme Disease is. It can be terrible, but most people (I have heard 95%) are successfully treated by antibiotics if caught early, and this is important for people to know. When I was first diagnosed (very early), I was surrounded by lots of (mis)information that made me lose a ton of sleep, and caused me to worry that the antiobiotics wouldn’t work. For most people, they do! So if you do get Lyme Disease, get treated, and expect that you are probably doing to be okay.

    So Aviva, I appreciate that you did not include lots of scary (and incorrect) info telling people that their life would be over if they got Lyme Disease.

  2. Dear Aviva,

    Thank you for your podcast. I see that you mentioned your husband is a tick magnet and often brings ticks into the house and your bed. I would encourage to him to simply change his clothes (ideally putting them in the dryer at high heat), have a shower, do a quick tick check and then get into bed. Its great that this tick was merely crawling on you (rare to feel that before it attaches as they are in some cases only the size of poppy seed this time of year) but a tick bite as you say is no joke. Lyme can become a debilitating chronic disease and as you say some ticks that bite you are so small you do not realise you have been bitten so that you could easily get past the 24 hour mark without knowing you have been infected. I suggest everybody do a daily tick check between the months of May and September because it takes about five minutes and it can save you a lot of hardship as you say to get the tick off of you within 24 hours. Waiting until the flu like symptoms to show up or the bull’s eye rash means its often too late to prevent the spread of the disease throughout the body making it much harder to eradicate especially if you get more than one disease. Lyme is not the only one ticks spread. There is Bartonella, Ehrlichiosis and Babesia to consider as also being possibly transmitted at this time though almost nobody has heard of these and the media seldom include them in their discussion of Lyme disease. These co-infectons is what causes many people to not recover from the small doses of antibiotics traditionally given they don’t have the strength to attack these co-infections that are quite common in Lyme transmission. I think everybody ought to have a 24 dose of antibiotics in their first aid kit in you live in a Lyme area and doctors should be in a position to provide these to people in Lyme infested areas. This whole thing about too many antibiotics comes often from our consumption of meat and dairy, not too many medical doses although this does happen as well sometimes. I hope that this has been useful to you and your readers. As you say Lyme is exploding in the US and has surpassed infections rates of HIV so we need to take our fun outdoors seriously with regard to this health issue.

  3. I live in eastern Massachusetts where ticks are rampant. Many of the doctors here no longer recommend the “one dose” approach to antibiotics as they have found it drives the ticks into cyst form and they re-emerge later and start colonizing leading to chronic lyme. This is exactly what happened to me and luckily I saw a doctor who recognized my symptoms as lyme. That was 7 years later, and before I saw him I was diagnosed as “pre-lupus” (no such diagnosis exists.) I was treated with herbs and I got better, but the damage to my adrenals, my gut, and the emergence of autoimmune issues are all things that I am still dealing with. Visitors think I am nuts when I tell them they must check religiously for ticks. It’s essential, especially if one has pets.

  4. Great article! So Glad you’re bringing Attention to Lyme! Here on Cape Cod it’s a BIG problem and Sadly Not Much attention is given to it here especially during tourist season. I had Lyme & didn’t know until my knee swelled to the size of a large grapefruit, i thought i had some how hey my knee? Thankfully my Doctor knew better & took blood right then & there.
    Be vigilant about it!

  5. Thanks, Dr. Romm! This is one of the best videos/articles I’ve seen so far on Lyme Disease! Will share it everywhere. Do you have any recommendations for repelling ticks? I.e. essential oils, etc. Here’s to a tick-free summer! 🙂

  6. Stephen Buhner, the herbalist who wrote Healing Lyme uses astragalus effectively for prevention and early treatment. Below are his recommendations:

    The primary herb for prevention is astragalus. Stephen recommends a minimum of 1,000 mg daily if you live in a lyme endemic area. This will keep the immune markers high that need to be high to prevent infection or, if you are infected, to keep the disease symptoms as minimal as possible.

    For new tick bites, Stephen typically recommends taking astragalus – 3,000 mg daily for 30 days, 1,000 mg daily thereafter, indefinitely.

  7. I am a full convert to tick removal by spinning them! Have you seen this? I’ve always been worried about tweezers- trying to find the balance between enough pressure to get them out, but not so much to crush them. I’ve used the spinning technique twice now- so easy and works amazingly well. Here’s an example:

  8. My granddaughter just went through this in Utah. I had no idea they had migrated this far west..Thank you for your information!

  9. I have just been diagnosed with Lyme but a tick bit my 4 years ago! 🙁
    I live in the UK and I’m breastfeeding my 3yo and my 11mo.
    I’m so gutted I will have to stop breastfeeding when we decide to start the antibiotic treatment… and even more gutted that my husband and kids might have it too 🙁

  10. Deer ticks carry not only Lyme but often a range of other diseases including anaplasmosis and Powassan disease, both of which can be transmitted within minutes of a bite. Three weeks ago my fiancé died after a year in care following anaplasmosis infection. If Bruce had been properly diagnosed, 10 days on Doxycycline would have saved him. Lyme disease occurs in many different strains; current testing recognizes fewer than a handful of these. As far as I can tell, no known antibiotic works for Powassan disease kills an extraordinary number of those it infects and leaves many others compromised for life. These diseases do not produce a bulls-eye rash, and neither does Lyme much of the time. Whole body checks, showering after hiking, immediately washing or whirling clothes in the dryer, cleaning shoes and jackets — these are our best defenses until these diseases and the creepie-crawlies that carry them are better understood by the medical establishment and the general public.

  11. If past tick bites have happened in a lyme endemic area, and some occasional, mild symptoms are present like fevers, headaches, or occasional mild aches and pains, but nothing clearly lyme, what testing would you recommend for lyme as well as coinfections such as babesia? My whole family, including 11 and 14 year old, are in this boat in upstate NY. I had acute lyme with bullseye rash and other acute symptoms, and took 4+ weeks of antibiotics, which apparently cleared it, but have had tick bites since. So I am clear on acute lyme, but less clear on possible subclinical or chronic cases. I would like to get the whole family accurate and useful testing, and want to know the best tests to request. Thanks!

    • Hi Meg,

      This is Megan from Dr. Aviva’s team. Klair labs is a probiotic that Dr. Romm uses regularly in her practice and for mitochondrial support, a good quality CoQ10 is great for mitochondrial support. I hope this helps!

      Megan- Dr. Aviva Romm Nutritionist

  12. My daughter just got off of one month of antibiotics and we are continuing to treat with the homeopathic, herbs, probiotics and transfer factors our Dr. recommended. This is the scariest thing that has ever happened to me as a mom, since I know the risks of lyme disease (watching my herbal teacher suffer for years here in Chicago). I’m hoping that all the care we are giving my daughter will keep her system strong. I had no idea how many strans of lyme there are. My daughter tested positive for only one stran p41 with only one band on it instead of two. Any insight Aviva? We are continuing homeopathic argentum quatrz, astragalus, probiotics, tranfer factor and transfer factor lymeplus for six months. I guess I want to be in the know about coinfections coinfections as well.

  13. Thanks so much for this video! I am absolutely freaked out by ticks. I already deal with a disease that has kicked my butt from time to time. I love to hike and never used to think twice about it until a 4-5 years ago. I had only heard about ticks until then. And all of a sudden all my favorite places to hike (including our family cabin up north) have ticks! A few years ago we ended our vacation early because the ticks were so bad.

    I love getting this information from someone like you because your philosophy is how i treat my disease and live my life. I had been freaking out for so long over getting lyme disease on top of it that I have not enjoyed hiking much at all in the last 4 years. I go, but, ticks are on my mind. Terrified of antibiotic use as well. This makes me feel more comfortable about treating if need be.

    Thank you!


  14. Thank you for this post! What do you suggest for folks like myself, who are dealing with chronic Lyme? Best guess, I have had it since childhood, I am now 34. Last year I was in a wheel chair. I have seen much improvement with use of Teasel, Silver Shield, Protandim, & Axio, along with other supplements. I would greatly appreciate your prospective on how you deal with situations similar to mine.

  15. Hi Aviva,

    I really appreciate the comforting clarity and balanced perspective of this article. I did have a few clarifying questions I would love to hear your perspective on:

    -What do you suggest doing if you find a bite that could potentially be from a tick, but you are not sure and have not seen a tick on you (but you do live in an in endemic area)?
    -One study (Nadelman et al. abstract available a t looked at the efficacy of a single dose of doxy within 72 hours of a tick bite. If it is after a 72 hour period, do you think a single prophylactic doxy dose is still worth it?
    -What do you think of Stepehn Buhner’s suggestion that (potentially in addition to antibiotics–he does seem to advocate simultaneous use of herbs and antibiotics for Lyme) 3,000mg of astragalus be taken for 30 days after a tick bite followed by 1,000mg indefinitely?

    Thank you for this and all of the good work you do!

  16. Hi ,
    As an RN, BSN and 40 years of knowledge and research in holistic health, I only recently saw a reference for the first time ever of antibiotics impairing mitochondria function; and now I’ve read it here again!

    I am 61 and had a tooth extracted five months ago after a year long subtle but
    insidious infection, with no pain until the very end; at which time due to delay of it’s extraction, and to prevent any remote possibility of incurring osteomyelitis, I stayed on Amoxicillin for nearly three weeks. Whether it was due to the duration of the infection or the longer course of antibiotics,
    it took me two months to regain my energy.
    Given my new, yet very recent exposure to the above as mentioned, I can only NOW wonder if perhaps the antibiotics impaired
    my mitochondrial function ??

    I would be very interested if you could either shed some light on this, or provide any links or references to antibiotics and mitochondrial function? Is it only certain antibiotics or what? Thank you in advance and keep up your stellar work and contribution! Kudos and THANK YOU!

    • Hi Trisha,

      This is Megan from Aviva’s team. Keep an eye out for an email from me with the links.

      Warm wishes,
      Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

  17. Hi Aviva,

    I had the bullseye rash about ten years ago. Never saw the tick but went to emergency room and doc gave me 7 to 10 days of antibiotics. It’s been so long that I don’t remember exactly. I have not seen any symptoms over the years. Can the disease be dormant for this long or should I assume I’m in the clear. After readiing this post I became a little concerned.

    Thank you for all of your wonderful info.


    • Hi Gaby, Conventional Lyme specialists and infectious disease docs say no; Lyme integrative and functional docs often say yes. I’m not sure which is true, quite honestly! But we do know that spirochetes in general, can go dormant and reactivate… If you haven’t got symptoms, then I wouldn’t think about it at all….

  18. I appreciate this article…very informative. I had Lyme back in 1991. I was fresh out of highschool working at a hospital in Athens, Ga as a CNA. We had a staff meeting one evening during my shift and the nurses and CNAs were given a sheet talking about Lyme and what to look for in our patients. I had been at the hospital for about a month and noticed every evening that I would suddenly get very tired and always ended up with a headache. As a CNA working on an orthopaedic floor, you stay pretty busy and I didnt have time to be tired. Long story short, as I was reading the different stages and the symptoms of each stage, it suddenly became very clear that I had all of stage 1 symptoms. I found myself rudely interrupting the meeting, saying, “I have THIS.” I showed my fellow nurses and CNAs the bulls eye rash on the top of my hand, which I had been treating as a ring worm, and told them that it was not the only place I had the rash…interestingly I devolped many rashes along my upper legs and my torso and some along the inside of my upper inner arm…never heard anyone else talk about having more rashes but did read it was not uncommon. Nurses encouraged me to go down to the lab and have blood work done and have it sent to my GP. Sure enough I tested positive for Lyme and my doctor was completely fascinated being as I was his very first case. About ten years later, I had to go to the doctor and went to a doctor that I had never been to. I was concerned because I had symptoms at the time that reminded me of when I had Lymes disease…I told him I had Lyme and he proceeded to ask questions, what test they performed etc. etc and then proceeded to tell me that there was no way that I could have had Lymes disease because we lived in the South and Lyme was only in the North East region of the country of Vermont and Conn. I left his office thinking he was a quack. Needless to say, I still get really freaked out when I see a tick or find one on my children. My mother was diagnosed about 12 years ago as well. I always wondered if you develop antibodies and possibly become immune?

  19. Please forgive me if you’ve addressed this. I keep reading the article and I’m not certain if I’m reading it correctly. If you have a tick bite and you’re in a lyme infected area, do you automatically recommend a full course of antibiotics. I have a 3 year old that was bitten one week ago. No symptoms, but tick tested positive for lyme. Pedi recommends that we do not treat with antibiotics, but will do so if I insist. (amoxicillin since she is 3). Pedi says that amox probably not effective anyway. Trying to decide what to do…quickly. Thanks!

    • Hi Christine, Sorry to see this so late – I’m sure you’ve sorted out the situation but now. I know this had to be stressful. For kids, it’s a little more complex as the antibiotics that work best for Lyme aren’t appropriate for kids under 7. So we often don’t treat. But if there are symptoms – I absolutely do- and I recommend rechecking labs ever few months for 6-12 months to trend what’s going on. I also recommend checking for co-infections that can also happen with LYme. Best, Aviva

      • Hi Dr. Romm –

        We just discovered two bulls eye rashes on our 4 1/2 year old daughter while camping in a high Lyme area. The red circles are now faintly pink after 2 days, and circles are not expanding. Had been regularly checking for tics, none were discovered. She has no symptoms. Saw her doc yesterday, who said we should monitor for symptoms and then tx if symptoms arise. Do you think that the presence of bulls eye rash in and of itself is sufficient reason to move forward with full course anti-biotic tx?

        Thank you so very much,

        • The presence of a Bull’s eye rash is indicative of a bite and infection. PLEASE SEE YOUR CHILD’S DOCTOR for appropriate assessment and treatment. Antibiotics are tricky at that age – the typical doxycycline can’t be given and other antibiotics are less effective, but treatment may still be advisable. ALSO MAKE SURE true Bullseye vs another skin rash…

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