Why I still say wet combing is a clear choice even when the research is murky.

When I was doing head lice consultations, I never recommended any commercial "shampoos" or pesticidal treatments to deal with the infestation.  I always recommended wet combing.

But does using only wet combing really work?

Earlier this year, I read a literature review that can be found on  the Canadian Paediatric Society website, among other places. It reviews the research on different methods and products for eliminating head lice infestations.  It mentions wet combing and says that "There is little evidence to support wet combing as a primary treatment for head lice."

In this report, there are two studies mentioned, both from 2002.  In one study, wet combing got rid of the lice in only 38% of the people treated.  In the other study, adding wet combing to those treated with permethrin seemed to offer no benefit.  I couldn't find the studies mentioned in the article.

This would be discouraging to me if I didn't also know of other studies where wet combing shows effectiveness:

Hill N, Moor G, Cameron M, Butlin A, Williamson M, Bass, C. Single blind, randomised, comparative study of the Bug Buster kit and over the counter pediculicide treatments against head lice in the United Kingdom. BMJ 2005;331:84 (Bug busting is just a commercial wet combing kit.)

Tebruegge M, Runnacles J. Is wet combing effective in children with pediculosis capitis infestation? Arch Dis Child 2007;92:818–20.

Of course, in my own experience time and time again with head lice, wet combing works. Period.

But wet combing is not a chemical solution that you dose out. It is a technique and no two people are going to do it exactly the same way or use the same lice combs.  We should expect to get different results between studies.

What makes wet combing the most effective for me though is that you can do it again and again.  This alone increases its effectiveness in my book. If you buy a good comb, it is there for you to use whenever you need it.  No running out in the middle of the night to find a open drugstore to buy a "shampoo".  You just grab your comb and start combing.  I can do a combing whenever I want and as often as I want (unlike with pesticides which can have side effects and where there is a limit to how much and often you can use them.)

And wet combing is just so much cheaper.  A good comb costs less than the "shampoo" needed for one treatment. I used to feel so bad for families who thought they were finally rid of their head lice only to get it months later when it started going around their child's classroom again. They would always be stressed out about the anticipated costs of buying all those products.  I was always happy to tell them that they didn't have to spend oodles of money if they did wet combing.  (The comb in the picture is a good one at Walmart.  It's $10.47 CAD.)

Wet combing does take some time but that time will decrease each time you do it.  And again, most commercial 'shampoos' still recommend combing and multiple treatments so you aren't really saving time by using them. (Another great reusable tool in the fight against head lice is your hair dryer.)

Check out other posts for how to wet comb.  Worry less about perfecting a technique and just get combing.

Hair Conditioner - fights more than split ends!

If you have ever had head lice, and I am assuming that you are acquainted with it since your reading this blog, then you know that nits are a pain to remove.  Lice eggs and egg shells are cemented to the hair so well that they can be stuck on the hair long after the lice are gone.  This is one reason why I dislike no-nit policies - they don't take this into account. I am sure that many a child has been sent home from school because a nit was seen when no actual lice were present.  The only way to be sure you have head lice is to actually find one on the head.  I have gone into homes where parents found some nits but no lice - and I didn't find any lice either.  The nits were usually a few inches away from the hair shaft, indicating that they had been laid long ago,  and I then had the good fortune to tell the parents the child had lice at one point but for some reason doesn't any more.

This problem of cemented nits has spawned an small industry of products claiming to dissolve the substance that glues the nits to the hair shaft.  Sprays, rinses, creams - you can find many that claim to loosen or remove nits.  Probably the most common home remedy that I have seen people use for nit removal is vinegar.  Have you ever had vinegar in your eyes?  The kids whose parents gave them a vinegar rinse are not usually appreciative of this technique. 

As you may know, I feel the best way to remove lice, eggs, and shells is manually.  I recommend using a good metal lice comb (with very rigid teeth, such as the Licemeister or the Nit Free Terminator).  But I also recommend wetting the hair and slathering it in cheap hair conditioner.  This process of wet combing is proven to greatly increase your chances of lice detection and it is a non-pesticidal and effective way to remove lice and nits.  The conditioner helps the hair remain wet (slowing down the lice), makes it easier for the hair to stay detangled, and allows the comb to glide through the hair more smoothly.  I always recommend the cheapest conditioner because you may need a lot of conditioner and beating head lice should never break your budget.

Interestingly, hair conditioner was part of a head lice study that came out this past spring.  The study was called "Efficacy of Products to Remove Eggs of Pediculus humanus capitis (Phthiraptera: Pediculidae) from the Human Hair". You can read the study's abstract here. In other words, it compared different products that made claims that they removed lice eggs from the hair shaft. The conclusion? Egg removal was significantly helped with just water and hair conditioner.  Specialty products were no more effective than these simple tools and some substances had no effect at all. 

So, join me in buying that vat of generic conditioner from your local dollar store. This is just one more example of how effective does not have to mean expensive.

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.

Comment of the Day: Lice in African-American Hair

Here's a comment I just received:

"Hello, I am African American and my 5year old got head lice from school. I have found it very difficult to use the combing method because of her natural hair is very kinky and curly when wet. It just seems to pull out the hair and it is painful for her. Myself and my 2 year old also have lice now. I used the shampoo I used lots of hair grease I see a few nits but they fall off easily. There is not much info on lice and African American hair. What do you recommend? I do not see live lice just a few tiny nits. How often should I wash bedding? What color are live lice?"

Hmm. There's not much info about lice in African-American hair because it is not commonly seen in African-American hair due to the shape of the hair shaft. (See an earlier post about this here.)There are those that say that African-American people don't get lice, which is not true. Cases are uncommon, but lice are very good at adapting and I am sure that we will just see more and more cases of lice in this population.

In your case, are you sure you actually have head lice? You say you haven't seen any live lice and the what you think have been nits have fallen off easily, which doesn't really happen. Nits are glued to the hair and have to be scraped off the hair shaft with a good lice comb or with your fingernails, so if something is coming off with just a flick or a light rub, I would guess that it is just dandruff. Also, you really need to see a louse before you can be certain you have an active case of head lice. Lice are small but not microscopic (though I really enjoy putting them under a microscope!) They are usually a mousy brown colour but can look darker in light hair and lighter in dark hair but are also sort of translucent and can blend in with many hair colours (which is a pain).

But let's assume you are dealing with head lice. So what to do? It truly is more difficult to get a good lice comb through very curly and coarse hair. However, I have done it by wetting the hair and using almost an entire bottle of the cheapest hair conditioner on one head when combing - you may not need to do this, just use as much as you need. You don't rinse this out, you comb through it. This can help to make the hair straighter and detangled for combing. (You first need to detangle with a brush or a wide-toothed comb before you start with a lice comb.) Unfortunately, combing through tight curly hair is more time consuming, quite messy (I recommend you climb in the bathtub with your own kids for lice combing when you need loads of conditioner - the water and bath toys help keep them occupied). It becomes more difficult to see what you have combed off the scalp when you are combing off globs of hair conditioner, but it can be done.  After combing, wipe your comb on some toilet paper and look through the conditioner for signs of eggs or bugs.You may need to try out different metal lice combs to find one that works for you that doesn't pull out your hair. Do not comb the hair unless it is wet and coated with conditioner. Hair conditioner is better to use than other greasy products like olive oil because the grease can actually grab at the comb, where the hair conditioner will allow for a smoother and more continuous stroke from root to tip.

Even if the combing is tough, keep trying. If you have tried different metal combs and have been doing wet combing with conditioner and you still find it too hard, then you can try wet combing with a plastic fine toothed comb. Plastic combs generally do nothing in the way of removing nits and very little to remove nymphs, but they can still remove many larger bugs through wet combing with conditioner. And if you can't comb out everything, it is still better to comb out something. If you keep combing thoroughly and regularly (every couple of days), the idea is that you will be able to comb out the bugs as they hatch but hopefully before they can lay new eggs allowing you to outrun the problem. As for nits, if the metal lice comb is too painful, get yourself in good light (I recommend using a cheap head lamp for nit-picking) and pick out anything you can see.  Focus mostly on anything you see right next to the scalp. And, if you are not sure about what you are seeing, when in doubt, pick it out.

Lastly, read about the use of an ordinary hair dryer as a lice-fighting tool in other posts on this blog. There is research to show that fast-blowing warm (not hot) directed air blown on sections of the hair and scalp can dry out most of the nits and about half of the bugs. Use the blow dryer on dry hair on the highest speed, but don't burn your children with the highest heat. I like the use of a blow dryer because, like a good lice comb, it is a tool you can use again and again. Read the posts for more info and check out the research.

As for lice shampoos, I personally don't recommend them but only because of their limited (or non-existent) effectiveness, the false sense of security that they give,  and their extra cost. As for house cleaning and laundering, I DO NOT RECOMMEND that you do any extra cleaning. There is no research to show that this helps in any way and research to show that it has no effect (again, check out the research links on the blog).  I have much experience to show that parents who focus on the surroundings more than on the scalps burn themselves out and make themselves nuts over these ineffective, busy, and costly tasks.  Keep your focus on the head. You've got enough to do with the combing, picking, and blowing. Try to maintain some balance, keep things in perspective, get some sleep, and stick with it  until you have had 2 weeks with no new sightings.

Good luck!

Hire a professional or don't. Either way, you still gotta put in some time.

Here's a question I just received:

"My friend said she had lice but she got treated two weeks ago. She said that the first time you get treated at places like (insert lice removal salon here), you cannot give lice to someone else. You can't spread. Is this true?"

Here's my answer:

The answer to this is not so cut and dry. If someone is known to have had head lice, I generally assume that they still have it until there have been no sightings of new lice or nits for two weeks. However, just because a person may still have head lice, it doesn't mean that they are necessarily able to spread it. A lice professional will usually be able to remove all adult bugs in the first sitting. It is the adult bug that can leave the head - newly hatched nymphs will not venture off the head for at least a week. So, a person with head lice may be of no immediate threat to others (which is one reason I'm against no-nit policies in schools and day care centres). But let's say that a tiny nymph was missed by the lice professional.  In 7-10 days, if no further combing had been done, there would be a new adult louse on the head that would be able to transfer to someone else through head-to-head contact.

While I generally trust experienced lice professionals (as long as they focus on lice removal over pushing lice "shampoos"), I never underestimate head lice.  I challenge lice professionals who claim to deal completely with your head lice problem in one visit. If they get the bugs out, the chances that they've missed an egg or even a tiny louse,  are still high. When I do home visits, I always offer a free follow up. This is because I believe that everyone should have a second visit with the professional - all of this and I still instruct families to still keep up with their own lice combing. I respect head lice and their resiliency. No matter what "treatment", no matter which professional is utilized, the affected head should still be thoroughly wet combed every couple of days with a good metal lice comb until at least 2 weeks have passed with no new sightings of lice or nits.

Now remember, you don't NEED a lice professional and I really have a problem with professionals that tell people that you must use an expensive product or service in order to deal with lice effectively. I've seen too many hard-working, low-income families who put themselves at risk by throwing away hundreds of dollars and buckets of sanity over their lice problem because of some "expert advice". I've seen people who give up because they feel they will never be able to afford the cost of "treatments" or services.  You know, head lice was dealt with effectively before the invention of salons and chemicals and paid services and fancy tools.  Back in the day, if someone had head lice, you just got in some good light, buckled down, and nitpicked for hours, everyday, until the lice were gone.  Yes, that actually works.

Lice removal professionals are more like housekeepers than health care workers. Everyone can vacuum, but some people don't want to so they hire a cleaner.  Everyone can deal with their own head lice problem, but some people don't want to and that's OK as long as they can truly afford it.  There are times you might want to use the services of a lice professional. (Read my post about this here.) but it isn't a necessity AND using their services won't let you off the hook - you will still have to do lice checking and combing at home.

Loose ends...

Here are two quick tips that I've been meaning to share.  They don't come from me, but they are very good to know...

1. If you or someone you know has head lice AND a problem with dandruff, deal with the dandruff first. Use a good dandruff shampoo and try to get out all the flakes. This will save you from trying to determine if what you are seeing is lice or dandruff. (Thanks to the mother - I'm sorry I lost your name - who gave me this tip a few months ago.  Great idea.)

2. Here's a tip that is important to know if you are using the inexpensive purple lice comb that I recommend on this blog.  I have had 3 calls in the last two months where people have told me that on their purple combs, the side with the short teeth pulls through the hair and tears some of it out.  This is surprising to me as I have purchased many of these combs over the years and have never experienced this.  Still, when I hear this news from 3 different sources, I tend to believe it. Maybe it's a bad batch?  These callers still used the purple comb and found that it worked well - they just stopped using the side with the short teeth. 

Got any more tips?

Don't wait. Do something.

With head lice, as with most things, knowledge is better than ignorance. However, sometimes, we are reluctant to act on a problem because we don't feel that we have the right tools or expertise. Don't feel that way with head lice. If your loved one has head lice, there are only a handful of things you can do to make this problem worse:

1. Rub your head on their head. Share the love and the bugs.
2. Use toxic or unsafe treatments or methods to deal with head lice.
3. Scratch the bites until infection develops.
4. Do nothing.

Most people can easily avoid the first three actions. But it is surprising how many people do the fourth action - or should I say, inaction. They do nothing about head lice because they feel ill equipped to deal with it. Read this blog post about how even doing the little you can do with what you have can go a long way in dealing with head lice.

Lice Advice via Classic Sitcoms: If it's "All in the Family" take it "One Day at a Time"

It was a dark and stormy night. Well, it has been a dark and stormy night; we even had tornado warnings today. It is 10:30 pm. I just put my son and middle daughter to bed. Why so late? Because I found head lice on my daughter's head. Yes, no one is immune from head lice, not even the children of The Nice Lice Lady. But I wasn't freaked out or upset(though I wish I had noticed it at 7:00 pm instead of 9:00 pm.) I was quite happy - random lice checks work!

My daughter had been scratching the back of her head earlier this evening. She noticed that I saw her scratching and said, "C'mon, Mom, you don't need to check - it's just a mosquito bite." I may have replied by saying, "But, my darling daughter, you must understand that regular assessment for the condition of pediculosis capitis, or head lice, is the most effective way of detecting the condition before a more serious problem arises." Hmm. I don't think I said that. I think I said something more along the lines of, "Get over here; you know the drill."

I looked in the itchy spot but found nothing. Because we were going to start supper, I reminded myself to do a more thorough check later. Which I did. At bedtime. Yawn.

I found one egg on her bangs. So, I knew we had to do the whole big lice thing, the crazy production, the...just kidding. Head lice are a treatable problem that you have to take seriously, but it doesn't mean that you have to go crazy. You may be surprised at what a non-issue this is in our house. Here's what we did...

Video Link - How to use your lice comb.

As I have said many times before on this blog, the most helpful tool to have in your fight against head lice is a proper, metal lice comb. I have also said that not all combs are created equal. This includes metal combs. There are a lot of combs on the market with metal teeth that are positively useless. If the teeth can easily bend or separate, then they will still comb around the nits instead of scraping them out. The three combs I recommend are the Licemeister, the Nit-Free Terminator, and the lovely inexpensive generic purple duel-sided comb found at Walmart. For information about these combs, click here.

There is a video on YouTube about the Licemeister comb and how to use it. The techniques apply to any proper lice comb. I will provide the link to the video in a moment, but if you go to watch it, promise you will come back and read my comments about the video. Will you read the rest of this blog post? You will? Ok, then click here for the link.

I like this video because

How to deal with your own head lice.

So, you are the one who has head lice. What if you don't have a buddy to help look through your head? If you are on your own, here's what you can do:

Even if you don't know what to do, do something!

A CPR instructor once told me that a high percentage of serious emergency situations where a first aider is on the scene, the injured or ill person still dies. I found this to be surprising. Then he continued by saying that the deaths didn't occur because the first aider did not adminsiter CPR correctly, but rather because the first aider didn't do anything at all. Many first aiders are so afraid of making mistakes; afraid of getting the ratio of breaths to compressions incorrect, or of doing things in the wrong order, that they remain inactive. The CPR instructor said, "But if the person's heart has stopped, they are technically DEAD. Your imperfect or rusty technique isn't going to make the person more dead. You have nothing to lose by taking some action.

It is the same with head lice.

So it's late and you can't get to the store to get a good lice comb? Use the comb you have and comb the hair that is detangled, wet, and conditioned. You will still be able to get out quite a number of adult bugs this way.

Or grab your blowdryer - warm, fast blowing air kills bugs and eggs.

Or, get in some good light and simply go through the hair, strand by strand. Just like the monkeys do. Look at the root of the hair and the scalp and pick out what you see. Is it eggs or dandruff? Well, dandruff will usually move when flicked, but eggs won't. When in doubt, pick it out. Even with no other tools, your nimble fingers can pick out bugs and eggs faster then they can lay them. If you spend time considerable on this problem and focus your energies on the scalp (and not on housecleaning) you can out run those bugs.

Head lice has been around longer than our tools. We have dealt with them for a long time. You have the ability to get rid of them, or at the very least, get the head lice under control. Get started and do something.

Why I don't like lice "shampoos" or "treatments".

In the fight against head lice, so many professionals state that permethrin based products are your first line of defense. They are touted as being necessary treatments when in fact they are not needed at all. Here is why I have a big problem with lice "shampoos":

1. These "treatments"are costly.
My heart always breaks when I hear yet another story of a family that spend hundreds of dollars on "shampoos" and "treatments" only to find that they didn't work. Most "shampoos" require a second treatment in a week. Bring out the credit card - cha-ching! But wait a minute - I charge for my lice checking/removal services - am I hypocritical?

Don't believe the Nix package. The hair dryer is your friend.

Here's some info I've mentioned before, but it is worth mentioning again. Researchers at the University of Utah created a contraption called "The Lousebuster"(Update: This device is now called the AirAlle). It is a souped-up blow dryer that kills 80% of lice and 98% of nits. Sounds great, huh? It is, but read on...

In creating this specialized tool, they did quite a bit of research about blowing air and head lice. Here's what they discovered the effectiveness of using a regular blow dryer as a weapon against head lice:

How to remove head lice from someone else.

If you are dealing with head lice on your own head, and you do not have someone to help you, click here.

So, you've checked and you are certain you have found head lice in someone. Don't worry. You can beat this. People have been fighting head lice effectively for years without any special tools.  If you have nothing but your hands, just get the person with lice in some good light and start picking out the bugs and eggs.  You can pick lice and nits out faster than they can reproduce and so you can always get ahead of their cycle if you just put in the time.   However there are some tools that can be of help in the fight:

Do You Really Have Head Lice? How To Check It Out.

If you suspect that someone you know has head lice, check it out.
If you think you might have head lice, find a buddy to check for you.

1. Comb through the hair to remove all the tangles.

2. Ensuring that are looking under good light, go through the hair section by section, and hair by hair looking for any lice eggs or bugs. You can use your fingers to do this, or you can use a regular comb to gently pull away a few hairs at a time for examining. You only really need to look for any lice activity from the scalp to approximately 3 inches off of the scalp, though be extra diligent in your search if find older lice activity farther away from the scalp. It may help to use hair clips to keep the hair in sections. Look through the hair from different angles, looking over the hair and under the hair.

3. Check for nits (live eggs or hatched eggs). Don’t waste time wondering if eggs are live or hatched – if you have them, you have a problem. Their eggs are like tiny oval drops that are yellowish-white and are completely glued to the hair. On dark hair, they can look white and on light hair, they look dark. If you see something on the hair, flick it with your finger or try to brush it away. If it moves, it is NOT a nit. Also, look at its shape – is it a completely uniform oval shape? If not, it is not a nit. Now, having nits DOES NOT guarantee that you will have an active case of head lice. It does mean that you should investigate further.

4. Watch for live bugs. The baby louse starts out as small as a tiny speck of pepper. After hatching, it is completely clear in colour, but it turns red after its first meal, and it then turns a translucent brownish colour as it grows. Its colour is enhanced by the colour of the hair it is in – head lice look darker in lighter hair and can easily blend in with darker hair. A louse is as big as a sesame seed when it is fully grown. If you see a bug, remove it immediately. Note, in dry hair, bugs run from the light and can move very quickly through the hair. In wet hair, bugs stay still so after checking for eggs, you should comb through wet hair with a fine tooth comb to see if you comb out any bugs. You can add some hair conditioner to the hair to make combing easier.

5. Start wet combing. Here's where the real checking begins. It's great if you have a metal lice comb but this can even be done with a plastic fine toothed comb. Wet your already detangled hair and coat it with some cheap hair conditioner. Comb through the hair from scalp to tip and check the comb after each stroke for lice (this probably won't remove any eggs or tiny bugs, but adult lice can still be caught this way). Keep on combing until you have counted to at least 100 (or found a bug, whichever comes first).

At the first sign of bugs, switch from doing lice checking to doing lice removal. If you have any questions, give me a call. Good Luck!

Study says wet combing is more effective than "treatments".

Here is a link to an article that reported on a study about wet combing. In this study, wet combing was proven to be more effective than over-the-counter treatments:

http://news.bbc.co.uk/2/hi/health/4744929.stm

Isn't that just what I've been saying, my dears? Adult lice go into survival mode when wet - they "freeze", staying still long enough for you to comb many of them out. (Note that I'm talking about ADULT bugs - baby bugs, or nymphs, are often too tiny, so keep combing regularly until you are sure the problem is gone.) When you wet comb, add a little bit of conditioner to the hair to keep it from drying too quickly. Also, don't forget to remove the eggs as well (the combs, even the excellent combs, won't remove all the nits). One thing I find interesting though - this article mentions a product called "The Bug Buster Kit". Do you know what this kit is? A box of fine-tooth combs. Even a regular comb can take out a quite a few adult bugs when the hair is wet. Why do we have to make combing into a "program" or "product"? Yet another gimmick to buy. But there is no product that will completely get rid of head lice.

But there is a person that can get rid of head lice - YOU. (And if you want some help, just call me.)

Everyone wants the magic pill.

The Edmonton Journal ran an article in today's paper from the Los Angeles Times. This article was about a drug that could be taken in pill form that would get rid of head lice.

This pill is nothing new under the lice-fighting sun. The drug is an anti-parasitic drug called Ivermectin. It has been used for years with livestock, but is not approved for human use in North America. When I saw the Journal's headline, "Pill may be a better parasite killer", I was saddened. How long are we going to look for the magic pill in getting rid of head lice? As with any oral medication, ivermectin can have side effects, some of which are worse than the itching of head lice. The study presented in this article was not just a study on ivermectin alone - it showed that malathion lotion (another topical pesticide) was more effective in killing head lice when paired with ivermectin pills. However, let me highlight a few parts of this article:

In the article, Dr. Olivier Chosidow says that, as with the over-the-counter products, "lice can become resistant to ivermectin". He also is quoted as saying that the medicine can cause problems for some people. The article then lists the side effects experienced by some people in the study.

My favourite quote from the article is from Dr. Barbara Frankowski from the University of Vermont College of Medicine. She says, "In the grand scheme of what kids get, head lice is minimal. It get blown out of proportion. For me to want to use something on a patient, it has to be 100% safe. You never want the cure to be worse than the problem you're trying to get rid of." Very true, and the only thing that is both effective and completely safe is picking/combing.

Time is on your side.

Nit-picking is the most effective way to get rid of your head-lice problem. So, why are people so reluctant to do it? You might think that a lot of people are really grossed out by the bugs. But, for most people, that's not the issue. They don't want to get down to the business of nit-picking because they feel "they just don't have the time".

Yes, nitpicking takes time. It can an hour or two, or even longer if you do it all at once. But if you think that there is any treatment that can speed up the process for you, then you are very mistaken. The "shampoos" will not kill all the bugs and will not kill the eggs. You will have to use more time and more money dealing with the problem again in a matter of days. And, as you know if you have ever used the so-called treatments, their instructions state that you still have to pick out all eggs and bugs. So, you see, absolutely no time is saved by using a commercial treatment.

The good news is, you don't have to have a 5 hour marathon nit-picking session that causes your hands to cramp up and your eyes to blur. An adult louse only lays 3-10 eggs in a day - that may seem like a lot, but you can pick faster than that. So, if you can't deal with your family member's head lice problem in one or two longer sittings, here's what I suggest. Pick for as long as you can over a number of days. Even 15 minutes here and 20 minutes there every day will get you ahead of the game. Your priority is to pick out any bugs that you see. Then grab the eggs as you can. A real lice comb will speed things up even more. Be sure to keep things relatively clean , take basic precautions so that other people in the house don't also get head lice, and do regular quick head checks on everybody and you will be fine. If you keep doing this, then there will come a day very soon when you will no longer see any bugs or eggs.

You can call me for more free info. And if you want to have me come over to pick, I will gladly take your money. But it probably isn't necessary. You can always find the time to deal with this. Just do it.

To Cut Or Not To Cut...

Does having long hair increase your chances of getting head lice and more difficult to get rid of it? Increase your chances? Maybe, as longer hair has a longer reach and can brush the hair of others more easily. More difficult to detect and get rid of? Another maybe, but don't reach for the scissors. You just need to take more time to deal with the problem. There are things you can do to reduce your chance of infestation and increase your chances of removal.

First, putting the hair up in a braid, a bun, or a ponytail is a good idea. This will help to keep the hair from going all over the place and brushing against others who have head lice. If the hair already has little "guests" crawling around it, putting the hair up will help keep the lice from travelling.

Second, if the person with long hair already has head lice, the purchase of a good lice comb is a worthwhile investment (and the combs that come with the lice treatments don't count!). Read about my favourite comb, the LiceMeister, here. With lice combs, you have to comb from root to tip in one continuous motion. If you stop, you give the bugs that you have scooped up a chance to crawl off of the comb. So separate the long hair into small, manageable sections, remove all the tangles with a normal brush or comb, and then use the lice comb on wet hair one small section at a time. Wet hair helps immobilize the bugs; you can add a bit of hair conditioner throughout the hair to prevent it from drying while you are combing.

After you have combed through every strand of hair, you NEED to go through the hair again, strand by strand and manually pick out any bugs or eggs that the comb has missed. Read my blog post about nit picking right here. If you are still not sure what you are looking for, look at some pictures here.

Something you should know. It is unlikely that any nit (egg) that is more than a few inches from the scalp will hatch as newly laid eggs are right near the scalp. You may want to remove them all for cosmetic reasons, but you really just need to direct your energies to activity near the scalp.

With long hair, this whole process can take hours, so take lots of breaks, and don't be afraid to do it over a couple of days. Lice can only lay up to 10 eggs a day, and even with multiple bugs, you can pick faster than they can lay. Just keep combing/picking everyday until you get to the point where you see no bugs or nits. Then, keep checking thoroughly for another 7 days, just in case you missed something.

Once the person with long hair is lice free, make sure you do regular lice checks. These checks can be done quickly, but you must be sure to really lift up all the hair and peek in all different areas of the scalp. Do the quick check every day and a thorough check once a week. If you see new lice activity, do thorough combing, picking, and checking everyday until you have removed the problem.

So think twice before you cut the long hair - you may be in for a longer battle but it still takes longer to grow out the hair again than it does to just deal with your lice problem.

I have a small problem with Alberta Health Services...

My daughter got another notice from school that someone in her class has head lice (no, it wasn't her). We get these green information sheets sent home fairly frequently. Maybe you've seen these information sheets before. These handouts have been created by someone at Alberta Health Services (formerly Capital Health in Edmonton). I think it is great that notices are sent home. I don't like all of the information given:

The pamphlet says: "You will need...Shampoo, 1% Permethrin lice treatment, and a regular comb or brush."
Oh please. I fight head lice all the time. I do not use ANY lice topical treatments. None. Zippo. This is not a "need". Even if you did use the lice treatment, the directions on the pamphlet are different than the ones given in the box. Whose advice should you follow? I would think you should follow the advice of the maker of the product. If you use the product, that is. Which I don't.

"Nits that are more than 1/2 inch from the scalp will not hatch."
Not necessarily so, though anything past a few inches is certainly not viable.

"In fact, lice really like clean hair"
Lots of people say this and you can read one of my old posts about this idea here.

"Wash hats, scarves, combs, brushes, hair barrettes, bed sheets and pillow cases in hot soapy water."
I used to recommend this too.  But don't do it.  It is a waste of your energy and not proven to have any effectiveness.  Lice don't want to be on things.  They want to be on people.  Put all your attention on the head.

If after 48 hours, live lice are still seen, and "if steps were missed or hair products with conditioner were used...repeat the treatment with the same product immediately..."
Permethrin is a pesticide.  And there are many studies to show it is no longer effective.  It just doesn't work.

This pamphlet implies that if you do a proper second treatment in a week, then you will have solved your problem. The steps end with the phrase, "That's it - you're done!"
Are you kidding me? The huge majority of my business comes from people who have tried these "shampoos" 2, 3, 4, or more times! They've followed every direction, cleaned every surface, and gone mad because the lice remained a problem.

"Hair dryers, hair conditioners, vinegar rinses and chlorinated swimming pools should be avoided for 7-10 days..."
Hair dryers and hair conditioners can actually have a place in the fight against head lice. I discuss the topic of hair dryers in this post. For my post on hair conditioners, click here.

This pamphlet has a some good advice, but its emphasis on the use of lice "shampoos" is part of what I believe is causing so many cases of head lice in our schools. In step #4 of "How to Treat", it tells you to remove the eggs, but it doesn't really explain just how time consuming or how absolutely essential this step is. It doesn't tell you that you will have to manually remove the bugs as well. In my mind, you could get rid of almost every step in this pamphlet except step #4, and then you should have it repeated again and again.

One more note. If a doctor or a health nurse tells you that you have head lice, but then a lice removal professional comes over and says that you don't, trust the lice removal professional. I was once called in to see a woman to offer a third opinion. This woman had seen her doctor who told her that she definitely had head lice (even though he barely looked at her head). Then she had called another lice removal professional to remove the lice, and was told that she didn't have head lice. Then the woman called me and I told her that she could probably trust the other lice removal professional, but she wanted me to come in anyway. I went to see her and found that she didn't have head lice. Unfortunately, she still believed her doctor and called me a week later to check again. She still didn't have head lice, but she did have an itchy scalp from the useless half-dozen treatments she had given herself in the meantime.