The last snowpiles of winter were still melting in Grand Rapids, Minn., six years ago when Craig Engwall tackled some early spring yard work around his house.
Later, when he removed his wristwatch to clean dishes, he noticed a tiny blacklegged tick still in its nymph stage. No big deal, he thought. He removed the bug and was happy he didn't ignore it or mistake it for a freckle.
The first symptoms of Lyme disease hit him hard a few days later. His joints felt like glass, "like they were going to break," he said.
Engwall's physician prescribed Doxycycline and the antibiotic quickly made him feel normal. Two weeks later, the pain returned and he feared a relapse. He was diagnosed with babesiosis, a less prevalent tick-borne disease sometimes paired with Lyme. Doctors treated it with anti-malaria medication and Engwall recovered.
"I was lucky I had strong symptoms right away," said Engwall, a former state Department of Natural Resources official who heads the Minnesota Deer Hunters Association.
The self-proclaimed "tick missionary" retells his story at every chance. He says the joy of outdoor recreation in Minnesota is married to the obligation of guarding against tick bites and watching out for symptoms of tick-borne disease.
"I used to think it wasn't any big deal. I was almost nonchalant about it," said Engwall, who contracted Lyme disease a second time and once again was quick to detect it.
He knows fellow outdoorsmen who were slow to remove deer ticks or didn't receive timely treatment of symptoms. As a result, some of them suffer from chronic impairments, he said.
"I won't give up being in the woods," Engwall said. "It's just being smart and doing the right things."
Minnesota's peak season for tick-borne disease is June and early July. But the first cases for 2018 already have been recorded at the state Department of Health and tens of thousands of turkey hunters will be putting themselves at risk beginning April 18 in a spring season that runs through May 31.
Deer shed hunters, morel mushroom seekers, bird watchers, nature hikers and ATV riders also are in woods and fields when the state's blacklegged ticks are most active from mid-May to mid-July.
"All it takes sometimes is stepping off the ATV for a bit," said David Neitzel, supervisor of the Vectorborne Disease Unit at the Minnesota Department of Health.
Neitzel said turkey hunters are especially vulnerable because they often sit on the ground for long periods in woodland edge habitats where so-called deer ticks are abundant. Blacklegged ticks desire humid conditions and they gather in clumps of wet leaves, he said. And as the disease-carrying ticks have spread to more places such as Hubbard, Becker and Clearwater counties, they have spread throughout the entire turkey range, Neitzel said.
Rick Horton, regional biologist with the National Wild Turkey Federation, said he got religious about tick prevention in 2015. He was crawling around in Kansas prairie grass on a turkey hunt without taking any precautions. When he got home, his wife removed 10 embedded lone star ticks off his body using a tweezers.
He then went to a doctor and was prescribed a full regimen of Doxycycline before any symptoms could arise. In Minnesota, it's a good bet at least two of every ten blacklegged ticks can infect someone with a disease. They are known to carry seven different disease agents. Lyme disease is by far the most prevalent, with up to 1,400 cases a year reported to the Health Department.
Horton said his experience made him a believer in permethrin, an insecticide meant for application to outerwear. He covers the seams of his pants especially hard and also his rubber boots. DEET is a deterrent to ticks and can be applied to your skin, but permethrin kills ticks when they come in contact with it and can last on clothing for long periods. Horton said he hasn't had any tick problems since he started the new routine.
Neitzel said blacklegged ticks usually attach to people from their ankles to their knees, but turkey hunters also should apply an insecticide to their shirt or jacket if they plan to be lying down on the ground.
He said the Health Department is recording more cases of human anaplasmosis, a bacterial disease first recognized in Minnesota in the early 1990s. It was transmitted by blacklegged ticks to 733 people in the state in 2016, making it the second-most common tick-borne disease in Minnesota behind Lyme. Babesiosis ranked third in 2016 with 50 cases.
"Minnesota and Wisconsin are the hot spot for anaplasmosis in the United States," Neitzel said.
And where blacklegged ticks need to be attached for one to two days to transmit Lyme disease, it can take as little as a half-day for an embedded blacklegged tick to transmit anaplasmosis.
Here's more advice from the state Health Department on ticks. Again, early recognition and prompt medical attention are vital:
• Inspect your body for ticks and remove them. Even nymph-stage ticks smaller than a pencil tip can carry disease.
• For a month or so after a known tick bite, watch for symptoms including rash, muscle aches, excess fatigue or other changes in your health.
• Keep any removed tick in a bag marked with the date of the bite.
• Call your doctor if you are bitten by multiple ticks in a short time.
• More than a third of adult blacklegged ticks carry Lyme disease.