Away for a bit due to a conference. First time sleeping in an airport. I think an experience that could have been made much better with the right preparations (i.e. a pillow and blanket). A long walk at LAX to the international terminal sets you up with a number of very safe and comfortable places to sleep… I hope to never have to put that to use again, however.

An interesting case from my final day of pediatrics. A young patient presenting with a recent tick bite. It sounds like a simple case of needing prophylaxis for Lyme disease – except this exposure happened in Arkansas where Lyme is not endemic, and the bite occurred from a Lonestar tick (Amblyomma americanum) as opposed to the Ixodes tick which most Wisconsinites are familiar with. The Lonestar tick does not carry the Borrelia bacteria which causes what is known as Lyme disease.

The Lonestar tick is instead the vector of several diseases including ehrlichiosis, tularemia, and southern tick-associated rash illness (STARI). The tick can also cause a person to develop alpha-gal meat allergy. This manifests as anaphylaxis when eating red meat products.

Thankfully treatment remains the same for most tick bites regardless of the specific family or species of tick. But this patient was 7 and a half years old… so another interesting clinical point. Doxycycline is the preferred treatment for all patients greater than 8 years of age due to the risk of teeth discoloration when used before this age. There is some evidence that doxycycline is fine, but that is a hard habit to shake for an older physician. So we settled on amoxicillin.