The mild winter is not only going to cause worse allergies this spring/summer, but there will also be a bumper crop of ticks.  These arachnids are already out and ready to bite.  When you are walking through the woods or tall grass, make sure you are covered with long pants and long sleeve shirts.  Check yourself and your pets and have someone look over your body at the end of the day.  Use an insect repellant with Deet designed for ticks.

If you do find a tick, be sure to remove it carefully;  identifying the species of the tick is important. Only the deer tick (Ixodes scapularis) carries the bacteria that causes Lyme disease.  You can check this website from the University of Rhode Island for a detailed description and pictures of different ticks.  It is also important to note if the tick is engorged with blood.  The larger the tick has swollen, the longer it has probably been on your body, and the greater chance of becoming infected.  If you are not good with identification of ticks and do not plan to become an entomologist, you can bring the tick in a plastic bag to your doctor.

In your own yard make sure you cut areas of tall grasses as these are more likely to harbor ticks.  As the Boy Scouts’ motto goes, “Be Prepared!”

Pertussis, commonly known as “Whooping Cough” for the characteristic noisy deep inspiration between coughing, is making a comeback.  This condition is often characterized by severe coughing fits and lasts about 6 weeks.  The disease is highly contagious and spread by a bacteria in airborne droplets when an infected person coughs.  Many physicians across the U.S. have seen a rapid resurgence of cases.  In my practice I have seen several cases recently.  Typically, patients will complain of a severe “cold” that just won’t go away even after 2 weeks, and very bothersome coughing spells. Antibiotics are usually effective in the early phases of the illness.  In adults with normal immune systems, the infection is not life threatening.  However, if the disease is spread to young infants, people on chemotherapy, or the immunocompromised, the disease could be fatal.  The good news is that there is a vaccine.

Why is whooping cough more common now than before?  Almost all children in the U.S. are required to have pertussis vaccination prior to attending school.  However, the immunity for pertussis wanes after 20 years.  Most Americans have not gotten their booster shots.  The current recommendations from the CDC is that people between 19-64 should get a dose of the pertussis vaccine.  In my office I recommend getting the Tdap vaccine, as this also includes tetanus and diptheria in one shot.  If you had a tetanus booster within the last 10 years, it is still ok to get the Tdap.  If you are above 65, you should also get a booster.  This is especially important for grandparents who may be in contact with a newborn.  It is imperative that all people who work in healthcare, child care, and schools get the pertussis vaccine.  Protect yourself, see your doctor, get vaccinated!

In the business section of today’s New York Times, an article discusses how people are utilizing the smartphone for their health.  The article, titled “As Smartphones Become Health Aids, Ads May Follow”  mentions how apps can help users track their diet and exercise.  It is interesting to note that while people are becoming more sedentary because of technology, adopting certain apps can actually have a good impact on your health.

I personally use an app on my iphone called Runkeeper to log my runs outdoors.  The app is also able to draw your running path on a map showing exactly where you went, the total distance, average time per mile, and total calories burned.  There are also options to track cycling, hiking, skiing and walking.  I find this app very useful and a great motivating tool, and a huge advancement from pedometers.  You can even upload your runs to facebook and see how you compare to your friends.  In a way, it is making an individual sport more of a competitive one.  You can see the stats on your previous runs and try to beat your fastest mile times.  The best part is that the basic app is free to download.

For tracking your diet, there are a multitude of apps.  I recommend Calorie Tracker by LIVESTRONG.com.  You can set your calorie goal (ask your physician if you are not sure), and see how many calories you have consumed at any given day.  A unique feature of this app is that it also shows many calories you have left in the day.  While the process may seem tedious at first, over time you will learn how to manage calories and portion sizes on your own.

I generally don’t tell patients to spend more time on their phone, but in the case of health-related apps it can be a good thing.

After reading the article, “Surgery for Diabetes May Be Better Than Standard Treatment” I am concerned about the short-sighted view of bariatric surgery.  While the studies mentioned the death rate from the procedure is below 1%, I believe the lifetime risk for other health issues must factor into the decision and discussed.

Four examples of patients from my clinical experience who have had gastric bypass demonstrate this fact.  One patient was initially placed on a liquid diet post-operatively, as per protocol, but unfortunately even years after the procedure, she is still unable to eat solid foods.  She once enjoyed preparing food and eating with her family, but now is limited to shakes.  Another patient was found to have breast cancer on a screening mammogram after the surgery and is now struggling to keep on the weight with the nausea induced by chemotherapy.  Despite being given appetite stimulants, her stomach will not allow her to eat adequately.  A gentleman acquired HIV shortly after shedding the pounds and now is dealing with stomach issues from the medications he must take daily.  The fourth patient regained her pre-surgical weight over four years as she has received no further dietary advice since the six months after the surgery.　

While I do agree surgically reducing the size of the stomach can play an important role in preventing diabetes, physicians must address the possible long term complications fully with their patients.

The USPTF issued a revision in screening practices for cervical cancer for this year.  Some notable changes include:  recommending that women be screened no more than every 3 years, removing the requirement for screening pap smears before the age of 21 regardless of sexual history, and recommending against screening for HPV in women younger than 30 years old.

While these changes are based on evidence from medical literature, I am concerned that these recommendations may make women more complacent about regular gynecological exams.  Regular gynecological/pelvic visits are also helpful for screening/detecting sexually transmitted diseases, ovarian/uterine cancer, and pre-pregnancy counseling.  For many young women, the only time they see a physician is when they visit their gyn for their “annual pap smear”.  One of the reasons why many chronic diseases are better controlled in women is because women start routine medical care at a young age,  and are able to develop a familiarity with regular health check-ups and prevention.  Conversely, for many men even in their early 50’s, the last physician they saw was their pediatrician.  By that time many chronic illness such as hypertension have already done their damage on blood vessel walls and can be more difficult to treat.    

In addition, women with a history of previous gynecological cancers, HIV/AIDs, or strong family history of cancers should continue to be more vigilant about cervical cancer and discuss the issue with their physicians.  These groups are at higher risk for cervical cancer, and the USPTF’s changes in screening do not apply to these groups.