Crozet Annals of Medicine: A Lousy Time


By Guest Columnist Amita Sudhir, MD

The beginning of the school year—such a happy time, full of new friends, new school supplies, new clothes, new teachers, new classrooms, new beginnings—and new parasites.

As a parent, it is never fun to see the school’s caller ID on the phone. Hearing the voice of the school nurse provokes all kinds of anxieties. That’s why I didn’t know whether to be relieved or horrified when she asked me to pick up my daughter because she had lice, one year ago when she began kindergarten. We were scarcely two weeks into the school year. (More accurately, she called my emergency contact because my phone did not pick up the call. This is frequently a problem at the hospital. I now, unlike most emergency physicians, carry my pager everywhere. That was only one way in which the lice changed my life. My emergency contact, an experienced lice-fighting mom herself, met her at the school and kept her entertained, and at arm’s length from herself, while she waited for me).

I knew that lice were a possibility because of a letter the school had sent home. I had even checked for them. But I had somehow missed the tiny, whitish eggs clinging to the roots of her hairs, waiting to erupt into a full-scale infestation. Horror of horrors! My daughter was now the host to a common, and most difficult to subdue, parasite.

As parasites go, lice are not really that bad. They don’t carry disease. They don’t make the host sick by stealing nutrients.  Why do they generate such revulsion in us? I think it is because they are the only parasites we regularly encounter that are visible on our bodies. They are insects after all. The same creatures that we swat away, repel, and crush when they are not on us, and when we are encountered by only one, let alone hundreds.

They are sneaky little creatures. When you try to pick them out, they run and hide under a new, unturned clump of hair. The lice I had seen on patients were whitish, unlike ones I had seen in India as a child, which were darker. It turns out they can pigment their eggs, at least, and maybe their whole bodies, to match the hair color of the host. When my daughter’s infestation first began, the eggs were white and stood out against her dark hair. As time went on, they got darker and harder to find.

Of course, where there is a parental fear, there is a solution that proves to be profitable for someone! While you are still in the throes of initial shock and revulsion, you may be tempted to call a 1-800 number and a person at the other end promises to come promptly to your home and physically remove all lice and nits from all infested persons in a single sitting without using any medication. (This is no mean feat considering that removing the nits involves pulling impossibly tiny little eggs down the entire length of a hair. When I had lice as a child, I was nine, and my hair was long enough to sit on. Not fun.) I can’t attest to the efficacy of any of these services. Although I booked an appointment, the astronomical cost persuaded me to call and cancel.

I decided that I would arm myself with knowledge, and the American Association of Pediatrics is an excellent place to do just that. An article in their journal told me everything I needed to know. Pyrethrins and permethrin are over the counter insecticides, available at your local drug store, that kill the lice…but not all the nits. So you have to re-treat the head after 7 to 10 days to kill any nits that hatched in the meantime. Resistance is rumored, but no one knows how common that really is, so I decided to take my chances instead of asking for a (incredibly expensive, brand-name) prescription treatment that promised to kill more of the eggs. In fact, the AAP suggests that even if resistance is suspected, it is reasonable to consider treating with the previously mentioned agents rather than something more toxic. I suspect many cases of resistance are in fact due to not following the instructions.

I also armed myself with a headlamp. I remembered from my childhood that the quickest way to get rid of an infestation is to manually remove all the nits, although the AAP says this is not necessary.  Every night for 3 weeks, I went through my daughter’s hair, literally, with a fine toothed comb and a bright light. I also pulled any nits I saw off each hair with my fingers. She was allowed to watch an iPad during this process, which she took to calling her “lice TV.” I can only imagine the torture for her; it was excruciating for me. Many of them were already dead (hatched or killed by the medication). The live ones emit a juicy sounding pop when crushed with a fingernail.

After  three weeks, they were all gone. I imagine this won’t be the last time we see our fine six-legged friends. Next time, I won’t hide away all her stuffed animals in the basement. Lice can survive only for 48 hours off a human head, so anything she hasn’t played with recently is unlikely to be infested.

The other way in which the lice changed my life is that I fought a tiny, formidable adversary who could outbreed me in a miniscule fraction of my lifespan, and won! I wish you all a happy, and, against all odds, parasite-free school year!


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