Summertime is a great time to get out and enjoy the great outdoors.  This year in the Northeast region, we are seeing a higher than usual number of ticks and tick-borne diseases (Lyme, Babesiosis, Erlichiosis, Powassan, just to name a few).  Be sure to protect yourself and your loved ones with these tips:

• Cover up when you are hiking, tuck your pants into your boots or socks.
• Check for ticks after being outdoors, even if it’s just your backyard.  Have a loved one look at your back and the back of your legs.  Ticks prefer armpits, the belt line, groin areas, and the areas around the hairline and the area behind the ears.
• Check your pets regularly for ticks after coming indoors.
• Use an insect repellent containing at least 30% DEET on exposed skin/clothing.  (If you applying sunblock, the sunblock should be applied BEFORE the DEET)
• Plunge into a pool/ocean, take a vigorous shower after being outdoors.  The water can dislodge ticks that are not yet attached.
• Unlike mosquitos, ticks do not typically start feeding until 24 hours after crawling around your body for a nice safe place.  This means you should continually check your body for at least 2 days after being in a tick infested area.  Removing of a tick as soon as possible can dramatically reduce your chance for infection.
• Protect your yard from ticks, trim down any tall grasses, try to prevent animals from getting into your yard.  Most people think deer carry the most deer ticks, but mice and chipmunks are more likely to bring the bugs into your backyard.  If you have an infestation of mice, get an exterminator.  Remove bird feeders that may spill grains onto the ground that rodents can feed on.
• If you do find a tick, remove it very gently with a small pair of tweezers or a specialized tick remover.  I recommend anyone who lives in an area purchase one of these tick removers as they are inexpensive and do not require as much skill.  If you do use tweezers (the ones usually used for plucking eyebrows), you want to be careful to lift it gently by the mouth parts.  Do NOT squeeze the body of the tick, or the blood stored in the abdomen will get “injected” into your body.
• Do not burn the tick, apply vaseline, sesame oil, alcohol or do anything to the tick.  I have heard many of these far fetched “home remedies” in my practice.  None of these are effective and could cause more harm (e.g. burning your skin with a lit match)
• Save the tick and try to identify it by comparing to these pictures on the CDC website.  Deer ticks are the only ones known to spread Lyme disease.  If you do find an engorged deer tick (looks like a white jellybean with legs) on your body, you will need to see a healthcare professional for medication that will prevent you from getting Lyme disease. If you are not sure what type of tick it is, bring the tick with you and your healthcare professional can identify it for you.
• If you develop a rash that looks like the logo for Target stores develop anywhere on the body, see your healthcare provider immediately.  This is the classic rash of Lyme disease that usually appears 1-2 weeks after being infected by a deer tick.  The rash is generally not itchy or painful, and enlarges slowly over days.  Even if you don’t recall being bitten by a tick, you should still see your medical provider.  At this stage, Lyme disease is curable with oral antibiotics.  Later stages of Lyme disease can cause flu-like symptoms, fatigue, nerve issues and joint pain.

A classmate of mine from residency training recently made an amazing series of videos on YouTube.  Dr. Jamie Malcolm is a board-certified gastroenterologist and internist and he did an excellent job describing the causes and treatments of acid reflux.

Please click on the links below to access Dr. Malcom’s videos.  I’m sure you’ll find them very informative!

• What is GERD or acid reflux?
• What are the triggers of acid reflux?
• 3 ways to improve acid reflux without taking a pill
• Natural and homemade remedies for acid reflux
• Which antacid do I buy at the pharmacy?
• Acid reflux and PPI’s (Proton Pump Inhibitors)
• Are Proton Pump Inhibitors safe?

Earth day is a time we acknowledge the state of our environment and what we can do to improve it, but it should also be a time that we think about our own health and well being.  These are mutually concepts as pollution in our environment has a direct impact on our health.  Here are some ways I recommend to mark this day.

1. Plant herbs.  This is so simple, buy some pots, soil and seeds.  I like planting basil or cilantro.  Any windowsill provides adequate sunlight.  By growing your own herbs without pesticides and fertilizer, you are helping the environment.  Fresh herbs are also great additions to your diet as they contain many nutrients and add a amazing flavors to your food.  If you have high blood pressure, herbs can be a replacement for excess salt.
2. Buy sustainable and locally grown produce.  Think this is expensive?  They are actually usually just as expensive, but often tastier since they do not need to be shipped from other countries and are picked from the fields when they are ripe.  Know what fruits and vegetables are in season.  Out of season fruits are almost always grown abroad.
3. Compost your waste.  Find out where you can drop off your coffee grounds, fruit peels, and other organic matter.  A simple Google search can help you.  Better yet, if you have the space, create a compost pile in your yard which will turn into free fertilizer for you garden!
4. Take mass transit or ride a bike.  Mass transit is often less expensive and has a smaller carbon footprint than driving a car.  As an added health benefit, you often will have to climb stairs and take more steps walking to the station.  You burn more calories!  It’s a win-win situation for you and the earth.
5. Avoid packaged or processed foods.  A box of cookies or a microwave dinner require a lot of plastic and paper which lead to destruction of the environment.  These food items also contain a lot of preservatives, processed sugars and chemicals that can be toxic to your body.  Make these items yourself or go to a local small business which makes food fresh and without carcinogens.  Trust me, a freshly baked cookie always tastes better than anything that comes out of a box that has been sitting on the grocery store shelf for six months!
6. Avoid wasting food.  Buy only what you need and freeze any leftovers.  Food wasted is not only costly for you, but also the environment.
7. Do not discard medications down the toilet.  There have been some studies that have found trace amounts of antidepressants and antibiotics in lakes and streams.  If you have any leftover pills, bring them to your pharmacist or your doctor’s office for safe disposal.
8. Use cleaning supplies that do not contain harmful chemicals.  Vinegar, baking soda, glycerin soap and plain water are often just as effective as the harsh chemicals we often use to clean, which can often cause chemical irritation to our noses and skin.  Don’t pollute your home!

I love reading medical mysteries in the New York Times Magazine on Sunday.  Each of them usually starts off with a person with some vague symptoms; they visit several doctors usually a primary care physician and multiple specialists.  They get a battery of blood tests, imaging such as CT scans or MRI’s.  Then at some point, they may be given a diagnosis and treated, but the initial treatment doesn’t work.  Other treatments are tried, but they also fail.  Ultimately, they get cured by some physician who thought out of the box and found the “zebra” (medical jargon for an extremely rare disease that eludes most other doctors, in contrast to the “horse” which is commonplace).  It’s like a Sherlock Holmes mystery or episode of “House” and utterly fascinating to me.

What I find even more amazing about these stories is that the protagonist is often a patient who feels like something is wrong, yet all tests come back negative for any definitive diagnosis.  This persistent and inquisitive person is unwilling to accept that their condition does not have a name and does not have a treatment, despite multiple medical professionals who tell them it may all be just “in their head”, yet they persist and are brave to say that something is definitely not right.

I believe we all have an ability to detect subtle changes in our body, but many times we ignore these signals or discount them.  These may not be classic “symptoms” found in a medical school textbook, as every person is unique, but they are just as valuable for diagnosis and proper treatment.  For example, before I develop a full blown cold, my ears start to get red and warm. When this happens, I immediately take steps to build up my immune system and may do a sinus rinse or drink ginger tea.  I think it’s very important to get to know and understand your body’s unique way of speaking to you.  It’s kind of like when you play poker and the other player has a weird habit or tic (called a “tell”) that they do when they’re bluffing.  You can use this knowledge to your advantage…

I tell my patients all the time to listen to their bodies.  Get to know the subtleties.  Are you feeling slightly dizzy or off balance, could your blood sugar low?  Are your eyes burning, could your blood pressure high?  Is your appetite suddenly gone, maybe you are getting a viral intestinal infection (stomach flu)?  Learn to trust these messages.  These are unique to you and can be helpful to leading you to wellness.  I can’t tell you how many times I’ve worked with patients who come in week after week with a new medical issue often times completely separated by organ system or body part (e.g. arm pain one week and toe pain the next week).  Sometimes this can drag on for over a few months, but I tell them their body is telling them something isn’t all right and we need to continue finding the solution.  Ultimately, we often do find an answer or the problems resolve themselves.

If you do find yourself in one of these situations, I would recommend keeping a journal.  Input your symptoms and any related aspects.  For example, people with celiac disease (inability to digest gluten properly) can be diagnosed earlier if they keep a food and symptom journal.  Oftentimes, it’s difficult to recall these associations during your appointment with your medical provider.  A journal helps to visualize recurring trends and patterns over long periods of time.  One time, I had a patient who developed two weeks of allergic skin reactions (hives) but during our intake and discussion, we couldn’t identify any particular trigger. After keeping a diary for two months, she identified that the reactions occurred only after drinking a certain brand of soy milk and exercising afterwards.  Interestingly enough, she didn’t have the reaction if she exercised only or drank a different brand of soy milk!  After avoiding this brand of soy milk or just not exercising after the brand that caused the reaction previously, she noticed she was fine.   Journals that include lab tests are also helpful if you need to see another provider or specialist so they can pick up where the other left off.

Listen to your body, learn to understand it’s language, and trust your instincts!  No one knows your body better than you!

I see people with colds, flus, sore throats, and sinus infection on a daily basis all year round.  People have all sorts of home remedies and trust certain over the counter medications to make them feel better.  However, some of these can actually make you sicker and impede your body’s ability to fight off infections.

Here is a list of some remedies you didn’t know could be making you sicker:

• Tea with lemon-  Lemon can be very acidic and exacerbate conditions such as acid reflux.  Many studies have shown that asthma-sufferers can actually see improvement if they adopt a low acid diet or take medications to reduce acid in their stomach.  The pH of lemon is low enough to even “burn” your throat if you consume too much and can even cause a sore throat or cough.  I recommend ginger tea with honey instead.  Honey can actually help your immune system.
• Apple cider vinegar- Just as with the lemon, vinegar is extremely acidic and can cause more trouble with digestion.
• Cold medications to help you “sleep”- There is one very popular brand that starts with an “N” and rhymes with “quill” which I find is the overwhelming choice among patients.  However, this medication contains an antihistamine (like benadryl), and cause fatigue, sleepiness and drowsiness the next morning.  So you may think these symptoms are due to the cold or flu virus, but you are actually experiencing a side effect of the cough suppressant!  If you must take this type of medication to fall asleep, I would recommend drinking something with caffeine the next morning to reverse the effect.
• Excessive Vitamin C-  This is one of the most common errors I see in my practice.  People take excess vitamin C in pills, lozenges, or packets that they mix with water and drink.  The are also sold as supplements that you take before you get on an airplane flight supposedly to prevent yourself from getting sick.  Sometimes the dosages can be 600% more than the recommended daily dosage!  Vitamin C is essentially Citric Acid.  Yet again, another acid!  It can easily cause reflux and sore throat.  Even worse, high doses can cause an attack of gout (a joint disease caused by excess uric acid) and formation of kidney stones!  Can you imagine taking vitamin C for a simple cold and ending up having to go to the ER for a kidney stone!  These medications may be sold over the counter, but they should still be used with caution.  Sadly, there has been no scientific study that shows Vitamin C has any benefit in preventing or mitigating cold or flu symptoms.
• Ginger Ale-  Many people think ginger ale is equivalent to ginger tea.  It is not.  Most commercially marketed “ginger ale” contains no or minimal ginger extract.  Ginger ale is often carbonated, which means there is carbonic acid, also not good for acid reflux sufferers and the gas can create uncomfortable bloating.  In addition, ginger ale contains excessive amounts of sugar with over 140 calories per can.  Sure you want to feel better, but if you have issues with high blood sugar this can certainly make you feel sicker.
• Decongestants- These are effective medications if you have sinus congestion.  They can cause your heart to race and blood pressure to increase.  Accordingly, people with heart conditions and/or high blood pressure should avoid decongestants.  In some people, they can even precipitate insomnia and panic attacks!
• “Starving a Cold”-  This is part of the old saying “Starve a cold, feed a fever.”  You should never starve when you are ill.  To fight off an infection, you need a healthy immune system.  Hydrating with liquids and eating a healthy diet rich in antioxidants and protein is a necessity!
• Don’t exercise when you’re sick-  This is partly true.  If you have a fever, chills, shortness of breath, or a pneumonia, exercising is not advisable.  However, after a few days of rest some light exercise can help you get better quicker.  Jumping up and down during exercise can jostle the phlegm or secretions in your nasal passages an airways so you can clear them out quicker.  Increased circulation to the body also improves your immune system.  I recommend going at a slower pace than you usually go (about 50% slower) and for half the usual duration.  It’s important to stay hydrated during the workout.
• “Toughing it out”- Many people feel the need to go to work even when they are very sick.  I think this is unwise for several reasons:  1. You will get your coworkers sick as you are likely to be highly infectious (you never want to be known as THAT person who spreads the cold to the whole office).  2. You will wear your immune system down when you need to be recuperating, 3. You will likely stress your body out and expose yourself to other potentially deadly bacteria (this is how colds turn into pneumonias) during your commute to work.  4. You will not likely be productive at work when you are not feeling well.  If you got better sooner, you could be back at work earlier and much more productive.  5. If you get sicker at work (due to being dehydrated or pass out), you will likely be taken to the hospital or unable to get home safely.  This could mean you have to lie in a chaotic emergency room for many hours.  Wouldn’t it be nicer to be at home in your own bed with chicken soup and your favorite Netflix movies?  Here are some movie suggestions!