The Only Time I've Wanted To Shave Someone's Head. Carefully.

In dealing with head lice, there is a quick - almost immediate - solution.  Shave your head. Lice hold on to the scalp by holding on to the hair.  Eggs are laid on the hair.  Nits and lice need the warmth of the hairy scalp to develop and grow.  No hair, no lice.

But I'm not really recommending this.  Not because you wouldn't look good with a shaved head (I think you would probably look great) but because shaving your head is a very drastic response to a problem that is usually easily remedied with a few combings over a couple of weeks.  The time put into a bit of lice combing is significantly shorter than the time needed to grow your hair back.

However, there was one time that I wish I could have shaved a head.

I was asked to do lice removal on a wonderful woman who had long beautiful hair.  Her hair was her crown, her glory - she was so proud of her hair.  She had a really bad case of head lice; the kind that makes you think she has had it for years. From far away her hair was lovely but as soon as you got close, you could see rows and rows of dark brown lice, bug upon bug. It wasn't the worst case of head lice I had seen but it was clear that her head lice would not be dealt with in just a couple of combings. And as I started, it was also clear that her problem was bigger than expected.

Her head was one big scab.  Months, maybe years,  of bites and scratching had left her head inflamed and infected.  Puss oozed from the sores and every time I touched her head, she flinched with pain.  I told her she needed to see a doctor.  She refused and demanded that I comb which I did. I tried to be as gentle as possible but it was clear that she was very uncomfortable. As I continued, I noticed that the glands in her neck were swollen.  I asked her if she had any other unusual symptoms besides itching and she told me she had regular chills and body aches. She wasn't sleeping well and had no energy.  I told her I felt she was having an allergic reaction to the lice and that her scalp looked infected. This concerned me because I knew she also had other conditions that compromised her health.  I explained my concerns but she wouldn't see a doctor.  Maybe she didn't want anyone else to know about her head lice. Maybe she was afraid that the doctor would tell her to cut her hair. Either way, she was adamant that she would be fine with a bit of lice combing.

Because her scalp was in pain, she could not handle the combing for very long.  I gave her my lice comb and told her that she needed to comb her hair daily, as much as she could handle, and reiterated her need for medical attention.  She refused to see the doctor and had me come to her home for one more short visit the following week which was not enough to complete the lice removal process. I asked her if she had used the lice comb.  She said she had been too tired to do the combing.  I told her she absolutely had to see a doctor. She again refused. I suggested she shave her head to get rid of the lice and allow her scalp to heal. She got upset. I did what I could that day but there were no more follow up visits.

Head lice are not normally a health issue.  They are an annoyance.  But the wounds caused by this woman's scratching became infected and her body started reacting to the infection and all the saliva and feces they left there by hundreds of lice.  As I have said before, there are things much worse than head lice.  Please, never let the stigma of head lice or the pride of your appearance keep you from getting the help you need. If your head lice has been going on for months or years, you should get support.  Talk to a friend or family member. Find a trusted professional.  And if you are having any symptoms besides a bit of itching, please talk to a doctor.

The best intentions, the most tragic consequences.

My heart goes out to the family in Springfield, Massachusetts whose daughter died earlier this year after trying a head lice home remedy. She was suffocated when the plastic bag that was placed over her mayonnaise drenched scalp slipped over her face.  You can read the details here. Mayonnaise on the scalp is a common home remedy for head lice that has no proven effectiveness and most people who try it then wrap the scalp in plastic to contain the mess. I am certain that this family was just trying to do the right thing and deal with this head lice.  In this family, a boy had head lice as well but they shaved his head instead.  This is common as the girls generally don't want to shave their heads but the boys are usually ok with it.

This was a tragic accident that demonstrates how we can sometimes lose perspective when we panic over head lice.  We can get so worked up about the bugs, which are rarely a health threat, and this can cause us to  take actions that are much more risky than the head lice themselves. Like putting a plastic bag over a child's head. Like the woman I met who slept in her car in the middle of winter thinking that the cold would kill the bugs when it could also have killed her.  Or the families I have met that have tried to treat their lice with their dog's flea treatment. Or Raid.  Or kerosene. Or gasoline. 

It is obviously that this family loved their little girl and they were trying to take care of her.  Many people turn to home remedies because they cannot afford the expensive lice "treatments", especially since these treatments require repeated use.   However, you don't need expensive products - head lice can be treated very inexpensively with tools that you can use again and again.   Lice combing on wet, conditioned hair is effective and safe.  You can get a good lice comb for the same price as any homemade concoction. If you are dealing with head lice, take the time to read the info in this blog and then proceed with good sense and perspective.  Take care in what you do - remember that there are things much worse than having head lice.

Lice Picking and Ergonomics (Spoiler Alert: Don't forget to stretch.)

If you read this blog, you know that I have taken a break from lice and nit picking.  First, it was for family reasons.  Now, it's because I have a neck problem that gives me arm pain.  The cause of this problem is unknown, but I'm sure that my bad posture in my work didn't help the situation.

What's worse than the itch? Burnout.

Recently, I spoke with two mothers who were dealing with head lice in their families (and dealing with it very well, I might add.)  In our conversations, it became very clear to me that these women were now experts on head lice.  They knew what they were looking for and were willing to put in the time and the right kind of effort to deal with this problem. I truly appreciate this kind of vigilance when it comes to head lice.  As I have said before, we must not underestimate these little guys - even with all of our modern weapons, we have more cases of head lice than ever before.  Head lice need to be taken seriously.

However, we must resist hyper-vigilance.Y'know, the kind of vigilance that makes us crazy.  Where we lose sleep over head lice, assume every itch is a new bite, start over combing or over treating our hair, restrict our regular activities,  keep everyone up late and wake them up early to do nit-picking, and clean our homes for hours every day.  I know we seem to feel better when we DO something, but the only thing this hyper-vigilance will do is make us sick. ( I'm speaking mostly to the mothers - sorry Dads, I have yet to find a two-parent home where the father is the main person who takes control over the family head lice.)

As I have said before, when feelings of lice anxiety are leading you down this path, get control of your feelings and look at the facts:

• Extra house cleaning has no proven effectiveness in the fight against head lice. Or, I should say it has evidence-based ineffectiveness.  Studies have shown that extra cleaning does nothing in this fight.
• Keeping children out of school, daycare, or other activities is not necessarily helpful; no-nit policies have been proven to be ineffective in keeping head lice out of these places.
• Head lice in most industrialized nations have developed a resistance to pesticidal treatments.
• Most alternative treatments  have little or no proven effectiveness.
• The over-washing, over-combing, and over-treating of hair can often be the cause of scalp irritation - it can be the cause of itching and/or skin reactions.

As I say again and again on this blog, the way you deal with head lice is to manually remove the bugs and eggs on the head.  To do this effectively, try to get the following things:

1. Time - Not the 10-hour marathon horror stories that I hear from some parents.  I mean, you need to know that you will be dealing with this for weeks and there is no getting around it, not even if you hire a lice professional.  We all can miss something, so some time should be put into combing/picking every 2 or 3 days until you have had 2 weeks with no sightings of bugs or eggs. The amount of time you need to spend in this endeavor will decrease as the weeks go on.
2. A good lice comb.  There have been effective nit-pickers throughout the years who never had the benefits of a good metal lice comb, but for the amount of time you save, I always recommend that you try to get one.  Not a necessity, but exceptionally helpful when used in wet combing.
3. Good light. Natural or artificial, light directed on the head really makes it easier to see what's going on.  For me, an inexpensive head lamp is a blessing.  It brings you directed light wherever you go and keeps your hands free for combing and picking.
3. Perspective. This is just head lice.  It is not the plague.  You are not unhygienic or unclean if you have it. Head lice are simply a reality in our world.  They have been around for ages and I expect we will still be dealing with them in the ages to come. They are a pain in the rear, but they don't have to be a tragedy if you don't let them. 

Trust that you have what it takes to deal with this problem.  Don't panic or start putting your family through a frenzy of frantic cleaning and unnecessary restrictions.  Never let head lice keep you from getting sleep, eating well, and engaging in enjoyable activities.  Never let head lice drain you financially or put your employment at risk.  Push through that initial feeling of panic.  Find a good friend to share your experience with.  Take a breath. Be gentle with yourself.  I know you can do this.

Imposters, Part 3 - Other Parasites

For all the press it gets, we often forget that pediculosis capitis (head lice) is pretty harmless. It's annoying. It's tiring. But, there are no real health risks directly related to this condition.

However, if you think you have head lice, answer some questions like these for yourself:

Do I have any itching/bites on ANY other parts of my body?

Do I feel ill or have any other symptoms (such as vomiting, diarrhea, muscle or joint aches, fatigue, flaky skin)?

If you are experiencing any other unusual symptoms besides the itchiness on your scalp, there may be something other than head lice going on. Especially if you haven't actually seen any bugs or eggs on your scalp. There are other illness, and other parasites, that can cause your scalp to be itchy. Some that can cause real health problems. If you call me, I will ask you questions. And while I can still come and check for head lice, I may recommend that you visit your family doctor.

Lice Lesson #11: Watch Out For Imposters, Part 2.

My friend phoned and asked about bugs. Bed bugs. Based on the bites she had, she wanted to make sure it wasn't head lice, or body lice, or scabies. Her bites were like mosquito bites on her torso. Head lice bite on or just around the head only, so it wasn't head lice. Body lice tend to bite in the warm places that are touched by the seams of your clothing, and you can see them on your clothes. Scabies also prefer the warm parts - armpits, wrists, under folds of skin - their bites are small and often in a line. We decided that her bites were caused by bed bugs and this was later confirmed. Ah, the pestilence that we have to face!

What You Can Do: Read about different parasites such as human lice, scabies, and bedbugs and investigate anything that looks like a bug bite.