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Bedbugs! (and a PS on Ticks)

I could sense anxiety in her e mail: These…things…on my skin. I don’t know what they are. Red itchy blistery things. They just appeared. Because they’re all in a line up my leg, a friend said she thought it might be shingles and to contact you.

Since the e-mail came with no photo, I couldn’t actually see what she was worried about. And because all crises seem to occur on Saturday evenings, I suggested she stop by on Monday. On Sunday, she wrote again that the lesions had spread to the other leg, with a few on her tummy. And the itching was driving her crazy.

This spreading completely eliminated shingles as a diagnosis.

When I finally saw her skin on Monday, I had to break the news that these were bedbug bites. She blanched. “Bedbugs?!” I knew without asking that she thought her tenth-floor apartment on Lake Shore Drive, already adequately protecting her from roving gangs of lumpenproletariat seeking to cross class barriers, should also be adequate against bedbugs.

Bedbugs, however, are astonishingly democratic. Manhattan hotels are filled with them. The four monolithic Presidential Towers west of Chicago’s Loop are packed with young attorneys, stockbrokers…and bedbugs.

“Any foreign travel?” I asked.

“No, though my husband does travel around Europe. Be he only stays at good hotels.”

“I think he may have inadvertently brought you some souvenirs.”

“But my husband doesn’t have any bites.”

This is definitely unfair. Some people simply aren’t allergic to the toxin bedbugs inject into the skin. They get bitten and nothing happens.

There’s an epidemic of bedbugs in the US these days, many of them likely brought home in the suitcases of people who have been traveling abroad. Here at home, one study traces bedbugs to workers in immense poultry processing plants carrying them in their clothes to urban areas.

Bedbug habits
Bedbugs gravitate to the warmth and smell of humans (fresh blood!), making their homes in mattresses, cushions, and stored clothing. They look like small beetles. Once, when I was on a boat somewhere in China, I awakened with a line of incredibly itchy bites–far itchier than mosquito bites–and, like my patient, thought I had shingles. “Boat beetles,” said the guide, his accent straight from “Terry and the Pirates”. “You’ve been attacked by boat beetles.” Weeks later, I realized these were bedbug bites. Fortunately, I didn’t bring home any souvenirs.

Bedbugs get hungry generally just before dawn when you’re still asleep, climb aboard, and travel to where you’re warmest. When ready to eat, they pierce your skin with two hollow tubes, one to inject a toxin that acts like a blood thinner, the second to suck enough blood to engorge themselves. Sometimes they’ll pause and bite two or three times, referred to as “breakfast-lunch-dinner” bites. The bites and the toxins don’t pose any health risks but (speaking from experience) lying in bed waiting for the march of the bedbugs can definitely interfere with sound sleep.

Here’s a short film about bedbugs. If you think you’re feeling a little itchy somewhere on your body just by reading this health tip, wait ‘til you see this.

Once you’re bitten, any good over-the-counter anti-itch cream (usually containing some cortisone, wintergreen, or Benadryl) will ease your discomfort.

Getting rid of bedbugs is another thing altogether. The only chemical that wipes them out (and which almost completely eliminated them altogether) is DDT, now banned. Most of the pesticides used by exterminators kill roaches and other pests, but bedbugs are immune. At least exterminators are good at finding bedbug nests, especially when they use specially trained dogs.

If you’ve got bedbugs, there are three basic steps to take:
1. Buy a mattress bag to encase your mattress.
2. Get out your vacuum cleaner and thoroughly clean your house.
3. Call an exterminator.

Oh, and if you happen to be one of these people who are attracted to great looking furniture that someone just happened to throw out, resist the temptation. It might be sitting at the curb because of…bedbugs.

P.S. on Lyme Disease
I’d very much like to thank one of my patients for correcting my naiveté about Chicago being relatively safe from deer ticks. Now that you’re feeling itchy about bedbugs, in actual fact deer ticks are quite prevalent in the Chicago area. I’ll let my patient speak to you directly here, and while privacy issues preclude me from identifying her, please know that I’ve thanked her. Also: click here for more on how to protect yourself from ticks.

Your health tip on Lyme disease might give people who live in the Chicago metro region a false sense of security. Both deer ticks and deer ticks carrying the Lyme disease-causing organism are very much present in the Chicago area, including the city itself. They’re a threat to anyone who ventures into tick habitat, including the urban parkway along the North Branch of the Chicago River, where ticks are routinely found, and the dunes in Lake County (Waukegan Beach and Illinois Beach State Park are major deer tick habitats).

Click here for a 2009 Illinois Natural History Survey report on deer ticks in the greater Chicago area and here for another report.

The solution is to be vigilant and use adequate tick prevention measures before hiking or working in these areas.

Since I do part-time contract work outdoors as a field botanist, I’m very aware of this myself. My preference for tick prevention, when I have to work in an area I know has a large deer tick population, is a product called Permanone (synthetic permethrin spray, used to treat clothing the night before—not the skin), which for me works far better than DEET. For your highly chemically sensitive patients, it and DEET probably aren’t options, however.

People should also know that juvenile deer ticks are extremely tiny and can be easily missed even with close inspection. Also, there are at least occasional cases of Lyme disease in dogs contracted in the immediate Chicago area.

  1. Deb says:

    I have read that Diatomaceous Earth (DE) can be effective against bedbugs. You sprinkle the DE, which is a fine powder like flour, on your mattress, under the sheet. DE is effective as an ant repellant which I recently learned on an internet site and found to be true.

  2. Anonymous says:

    After reading your note and just hearing on the national news tonight of New York’s assault on the critters, I had to share my story with you – about how extremely hard it is to get rid of them.
    It was probably 6 weeks between the time I think I brought them home with me (a motel in Miami, FL on a college visit with my daughter) and I realized what was causing the enormous of little red welts and horrible itching that had plagued me.  I actually saw one crawling across the sheets in the middle of the night.  I then tore off the sheets and lifted the mattress of my platform, wood-frame bed only to discover probably thousands and thousands of them – in the little folds and seams of the mattress, on the ledge of the bed that supported the mattress and in the spaces between the slats and parts of the frame.  Not only live ones,  but others that had already died and – much, much worse – their tar-like leavings encrusted on the wood.  Some were so bloated with my blood  they seemed to have doubled in size.  It was horrible.
    I called an exterminator and began some internet research.  The exterminator did his thing, but the more I read the more I realized it wouldn’t be enough.  In the meantime I found very useful advice on-line, and though I can’t remember all the sites I visited, Johns Hopkins’ info was the best.  Here’s what I had to do:
    First, I had to pick up every scrap of clothing in my bedroom and closet – where I found many bugs – and wash it or send to the cleaners.  I emptied every drawer and then kept the stuff in the dining room until the problem was solved.  I had to keep the covers off the floor because that’s how they can get on the bed from any hideouts they have in the floor molding.  Then I began to spray – just Raid Roach killer.  And I kept spraying and kept taking the bed frame apart and looking in the mattress creases, etc. – and kept finding bed bugs.  But each time I found fewer and fewer. 
    As I said I kept this up for about three week until they were gone.
    Ever since, I have been very careful when staying at hotels.  I keep no clothes near the bed and nothing – even suitcases – on the floor. 

  3. Anonymous says:

    Bedbug invasion must be due to suitcases being jammed into storage areas of two planes and two buses on recent trip to NYState (Manhattan, New Paltz, Geneva); various relatives visited and no one has bedbug problem. Dr. E: do you have any current info on solutions? Deepest thanx.

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Far and away, the commonest phone call/e mail I receive asks about COVID-19 diagnosis.
Just print this out, tape it on your refrigerator door, and stay calm.


• Runny nose
• Sneezing
• Red, swollen eyes
• Itchy eyes and nose
• Tickly throat
• No fever

• Runny nose
• Sneezing
• Sore throat
• Mild muscle aches
• Mild dry cough
• Rarely a low fever

• Painful sore throat
• Hurts to swallow
• Swollen glands in neck
• Fever

FLU (Standard seasonal flu)
• Fever
• Dry cough (no mucus)
• Sudden onset over few hours
• Headache
• Sore throat
• Fatigue, sometimes quite severe
• Muscle aches, sometimes quite severe
• Rarely, diarrhea

• Shortness of breath
• Fever (usually above 100 degrees)
• Dry cough (no mucus)
• Slow onset (2-14 days)
• Mild muscle aches
• Mild fatigue
• Mild sneezing

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