How to Avoid Getting “Ticked Off” With Nurse Practitioner Expert Vanessa Pomarico-Denino
This tick season, be prepared with facts about these tiny parasites and the diseases they carry.
Vanessa Pomarico-Denino, EdD, APRN, FNP-BC, FAANP, has worked to educate herself, students and mentees on a variety of different topics. This includes her teaching and speaking on burnout; serving as co-chair of the American Association of Nurse Practitioners® (AANP) Health Equity, Diversity and Inclusion Community; and exploring for a wider audience how nurse practitioners (NPs) care for the LGBTQIA+ community on episode 21 of NP Pulse: The Voice of the Nurse Practitioner®. Her expertise on tick-borne diseases, however, was borne out of something personal, accidental and unfortunate.
“When you become a consumer of an infection, you then become an expert,” Pomarico-Denino explains to host Sophia Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FAANP, FNAP, FAAN, on her return to the podcast for episode 121. Approximately eight years ago, Pomarico-Denino’s mother was stricken ill with a tick infection. When she also noticed a rash on her own neck, she went to see a dermatologist. Told that she had contracted Babesia, the same disease her mother had been diagnosed with, Pomarico-Denino was initially skeptical — in part because she hadn’t been spending much time outside.
“We narrowed it down to 30 minutes in my mother's backyard,” she remembers, pinpointing the only time when she could have been bitten. “That was the only time I had been outside in the two weeks proceeding, and that was the only place that I could have gotten the same infection that my mother did. I often say that there was a tick family that was looking for the Pomarico family to get us both sick.”
It just so happens that Pomarico-Denino and her mother were bitten by ticks in Connecticut, with that state’s City of Lyme holding the dubious honor of hosting the discovery of (what is now called) Lyme disease (LD). But ticks can be found all over the place, she says: “It's not just in Connecticut. It's everywhere. It's all throughout the United States. Every state has some form of tick disease, not just Lyme. We also see it in Asia, Australia and other parts of Europe. It's everywhere.” The “big four” of tick-borne diseases include Lyme disease, as well as several less well-known varieties. “Lyme is the most common tick-borne disease in the country right now, but there's also Babesia, Ehrlichiosis and Anaplasmosis,” Pomarico Denino explains.
Twice (Or Just Once) Bitten
In a 2022 article entitled “Unexplained Rash in the Summertime” in the Journal for Nurse Practitioners (JNP), the authors note that, “According to the Centers for Disease Control and Prevention (CDC), ∼476,000 persons were diagnosed with LD from 2010 to 2018, giving insight into the magnitude of transmissibility.” Furthermore, “a 9% increase in cases [was] reported between 2016 and 2017,” with the authors pointing out that “this increase can be attributed to climate change and a notable increase in average daily temperatures, both of which facilitate tick activity and longevity.” Ticks, unfortunately, are only getting more comfortable as the world gets warmer.
What can NPs do to protect themselves and their patients from these tiny bloodsuckers? First, Pomarico-Denino believes prevention is key, and she recommends everyone use “some kind of tick repellent” as a line of defense. Helpfully, the Environmental Protection Agency (EPA) has a website dedicated to different repellents, including a search tool to zero in on the right kind of chemical needed to thwart this unfortunate arachnid (ticks are not insects, but instead belong to the same family that brought us spiders and scorpions). She notes that the chemical permethrin, specially, can be applied to clothing and “stays through five to six washings.”
After an outdoor adventure, Pomarico-Denino drives home the importance of “just being mindful of the fact that you do a really good skin check on yourself when you come in — or have somebody in the house do that skin check — looking through your hair, looking in the different crevices of the body. Because I've picked ticks out of a lot of different places on the body.” Ticks enjoy biting and burrowing into warm, moist areas of the body — places where you’re least likely to enjoy finding them.
Ticks: Everyone’s Least-Favorite, Disease-Carrying Butt-Breathers
What if, during a skin care check, a tick is discovered half-buried into the skin? “The old thing used to be to light a match, blow it out and put the hot match on there,” reminiscences Pomarico-Denino of previous “solutions” to destroying ticks found on the body. “Well, the only thing that that did was fry the end of the tick. The ticks breathe out their butt...so they have their pincers, and their head is embedded.” Leaving a dead, half-fried tick in the body is less than ideal, and instead Pomarico-Denino recommends taking a pair of tweezers, and then “press the skin down as much as you can around it, and you pull [the tick] straight up. If you pull on an angle, it's going to detach from the head. You have to actually go straight up.”
Unfortunately, “many times you can't get it out. The head just detaches. And usually, if [the patient is] in the office, I'll put a little bit of topical anesthetic spray on them and take it out with a scalpel.” The Center for Disease Control (CDC) has a visual guide for tick removal and has also created a Tick Bite Bot “to assist people in removing attached ticks and seeking health care, if appropriate, after a tick bite.”
Whether the tick is seen, removed or otherwise, you’re not going to want to dismiss that mysterious bite you or your patient received while gardening, “leaf-peeping” or even just spending some time outdoors. Instead, it’s a good reminder to stay covered, vigilant of bites and aware of how to remove ticks and treat infections — because our warming world is becoming a more comfortable place for our least favorite arachnids.
No Ticky-Tacky Presentations at the 2024 AANP Fall Conference
While Pomarico-Denino will not be presenting at the 2024 AANP Fall Conference on Sept. 19-22 in Reno, Nevada, several other co-chairs of AANP Communities will be. Both co-chairs of the Cardiology Community will be presenting on three topics related to their specialties at the conference, as will Shannon Idzik, DNP, CRNP, FAANP, FAAN, co-chair of the Endocrinology Community; Randee Masciola, DNP, WHNP-BC, FAANP, FNAP, co-chair of the Women’s Health Community; and many more!