Currently, we are having an increase in the incidence of bed bugs.  I have seen many cases of bed bug bites in my office.   Oftentimes they appear as itchy red bumps on the skin in clusters and can be mistaken for hives or mosquito bites.  Here are some common questions people have about them.

What are they?  Bed bugs (Cimex lectularius) are insects about the size of a sesame seed that crawl and live in beds, box springs, mattresses, sofas, upholstery, rugs, luggage and sheets.  They feed on blood of humans and pets primarily at nighttime.  Unlike ticks, they do not cling to people after they feed.  Instead they prefer to hide in inanimate objects ready to feed again the following night.

How do they spread?  Bed bugs migrate by attaching themselves to clothing and luggage.  They can also crawl under the crevices of a baseboard and move from one room to the next.  Infestations often spread in apartment buildings where the bedrooms of two apartments are separated by a wall.  Bed bugs rarely attach to people after they feed, so person to person transmission is rare.

How do bed bug bites differ from mosquito bites?  Bed bugs are crawling creatures.  They bite, then they move on.  They classically feed 2-3 times each night and their bite marks look like three dots in a row or three dots in a triangle pattern.  Mosquitoes are flying insects and will feed on blood in one area and then fly off and find another area of your body far away.  For example, you may notice a bite on your neck and another behind your right leg.  Rarely will they stay in the same area and bite multiple times.  If you were bitten by a swarm of mosquitoes that could look like a very bad bed bug infestation.  Another distinguishing characteristic is that with bed bugs, you will see new lesions every morning.  Unless you leave the windows open at night and you don’t have a window screen, it is unlikely new itchy lesions in the morning could be anything but bed bugs.

If you are not sure, look around your bed, mattress, and box spring for small insects that look like flat sesame seeds with legs.  You may also find their droppings which look like poppy seeds or dark stains.  If you have light-colored sheets, you can look for maroon-ish red spots which are dried blood from the bed bugs feeding overnight.  They tend to be messy eaters and secrete an anticoagulant when they feed, which means you may bleed for a short time after they have finished feeding.  You can also visit your healthcare provider or dermatologist for an evaluation of the rash, or bring any bed bugs you may find in a plastic bag for identification.

I have never heard of bed bugs growing up as a child, why are they such a problem now?  We don’t have an exact answer for this, but some experts suggest that pesticides are much weaker now than before since many of the older pesticides were found to be toxic to the environment and to children and were banned in the 1980’s.  Others cite the increase in world travel and a population that is staying in hotels and traveling more than ever.

Does having a bed bug infestation mean the place is unclean?  Bed bugs have been found in all types of establishments including many big name five star hotels.  Bed bug infestations are not a marker for a dirty home or hotel.  It just means the bugs have found a way into the bed.  Would you be alarmed if you found a mosquito in your hotel room?  Certainly, there needs to be a thorough cleaning after an infestation is found and the establishment should make sure there are no remaining bed bugs before the room is used again.

What happens if I get bitten?  People have different reactions to bed bugs.  Some people have no reaction to them at all!  Others develop large itchy raised pink lesions that look like mosquito bites.

What can I do to stop the itching?  The reaction from a bed bug bite is primarily a histamine-mediated reaction similar to a mosquito bite or seasonal runny nose.  Antihistamines such as Claritin (loratadine) or Zyrtec (cetirizine) are helpful in preventing the itching.  If the itching is severe at nighttime, a dose of benadryl (diphenhydramine) can help reduce the itching and help you fall asleep as this medication can cause drowsiness.  Try not to scratch the areas.  The more you scratch, the more histamine is released.  If you feel the urge to scratch, apply a cool compress (an ice pack or a cool moist towel) to the area.  You can also apply over-the-counter hydrocortisone cream 1% to the areas twice a day.  If the itching is severe or the rash becomes painful, you may need to see your healthcare professional for other medications.

Can I get any diseases from bed bugs?  Bed bugs are not known to spread any serious diseases.  However, the bites can get infected if they are not kept clean.  Make sure to apply bacitracin or Neosporin to the areas and keep them clean.

How did I get them?  Bed bugs love upholstery, luggage and bedding.  Most people bring bed bugs home after staying in hotels or as a guest in someone’s house.  Almost every college has had infestations in their dorms.  During holiday season, some students unknowingly bring bed bugs to their homes.  I often will see a peak of bed bug cases amongst their parents following the winter holidays.  In recent years, bed bugs have also been found in movie theaters seats, clothing stores, and even the finest hotels.

How can I prevent myself from getting bed bugs?  Bed bugs like to travel from place to place in our luggage.  Don’t let them stow away in your roller board!  When you arrive at a hotel, do not place your luggage on the bed to pack or unpack.  Instead, place your luggage on the tile floor in the bathroom, remove the clothes and place them in the dresser or closet.  When you are ready to pack up, do the reverse.  After you arrive home, unpack your suitcase in your kitchen or bathroom where you have tile.  Immediately put all clothes into the washer machine to be cleaned.  Place your empty suitcase into a garbage bag and seal it shut.  Store your baggage in a hallway closet far away from the bedroom.  After you have guests stay with you, immediately throw all the sheets in the washer.  Advise your guests not to place luggage on the bed.

Why do my bites itch, but no one else has the same reaction?  Bed bug bites trigger an immune reaction which results in itching.  In certain people, they will not have as strong of an immune reaction to the bites and so they may not experience any itching after being bitten.

I have bed bugs in my bedroom, and I have no where else to go what can I do to prevent myself from getting bitten?  Bed bugs must be able to crawl on bare skin to be able to bite.  If you cover up exposed skin on your body, you lessen the chances of them biting you.  For example, you could wear pajama pants and tuck them into socks.  Instead of a tank top, you could wear a long sleeve t-shirt to bed.  You may also try spraying exposed areas with an insect repellant containing DEET (25% concentration or higher, sold under the name Deep Woods OFF), though I wouldn’t recommend this as a long term solution as this chemical has been known to cause cancer in high doses.

How can I get rid of bed bugs?  I would recommend thoroughly cleaning the sheets in hot soapy water and drying them out in a hot dryer.  Look for small black specks with a magnifying glass on the mattress, box spring, and bed.  Removed rugs and shampoo carpets in the room.  Move the bed away from the wall as bed bugs can sometimes live in the small crevice where the wall meets the floors.  Thoroughly clean your pet and don’t allow the pet to enter into the bedroom.  Sometimes, bed bugs may crawl from one apartment to another through these cracks or even between floors.  For small infestations (if you only just started to get bitten), you may want to try eliminating them yourself.  There are products such as bed bug traps (sticky traps), insecticides, and diatomaceous earth which you can use on those areas.  Try to avoid sleeping in that room for a while.  For larger infestations, you will need to hire an exterminator who specializes in bed bugs.  They may bring a dog to your house to sniff them out.  If you rent your apartment or house, these costs may be paid by your landlord depending on your local laws.

Bed bugs are becoming a common nuisance.  Protect yourself and your family.  Take precautions and learn how to spot an infestation before it gets out of hand.

Many of my patients say they have no time to exercise because they travel often for business.  Here are some tips I recommend for keeping fit during your layover.  Think of the layover as an opportunity to get in a good workout.  Exercise will also reduce your risk of blood clots in the leg called DVT’s and can reduce stress when your flight is delayed.

• Walk, walk, walk!  Most airports have long hallways that are great for distance walking.  If you have a pedometer, you can see how far you are walking.  Increase the pace so that you are barely able to speak a full sentence.
• Find a gym.  Many airports have gyms now or have arrangements with gyms a short taxi ride away.
• Bicep curls with your handbag.  Hold your purse, backpack, or duffle bag with you hand while seated in a chair. Pull the bag toward you as if you had a dumbbell in your hand.  If you need to add more weight, buy a large bottle of water and place it in the bag.  If you are a regular weightlifter, you can even try using your large luggage, but that can be quite heavy.
• Lunges.  These can be done while waiting at your gate.
• Calf stretches.  Waiting in lines for security can be turned into a simple workout.  Lift up your heels and “point” your toes like a ballerina and hold that for 2 seconds.
• “Chicken Stretch” for your upper back and shoulders.  This is absolutely essential for traveling especially sitting in cramped seats on the airplane.

Many patients bring in bottles of vitamins and supplements on their office visits and ask me for advice on whether they should take them.  Here are some tips to make sure you are getting what your body needs and nothing else.

• Make sure the vitamins or supplements are made by a reputable manufacturer.  I would trust vitamins that are made by a major pharmaceutical company that also makes medications that are FDA approved.
• Do not buy from a place or manufacturer that also sells “body building supplements” such as creatine.  Many of these tend to be made by small factories where the quality may be inconsistent.  Some studies have shown that the pills may contain too little or too much of the nutrient they claim on the label.
• For supplements made from plants or animals, such as fish oil, make sure they are from organic sources.  For example, some people with high cholesterol take fish oil supplements, but many of them are made from fish which may contain mercury.  By ingesting excess mercury, you could be doing more harm to your body as mercury is a known to be toxic to the nervous system.  Herbal supplements are like concentrated versions of the natural plants.  If any of them were grown with pesticides and fertilizers, you will have an exponential amount of those dangerous chemicals in your body as well.
• Check with your primary care provider or herbal medicine practitioner before you start any vitamins or supplement.  Your healthcare provider may be aware of drug interactions with the medications you’re taking.  They can also help you identify potential allergic reactions, or ingredients that may be dangerous.  I recall one time when a patient brought in a bottle of an herbal supplement that she had been taking and says she developed heartburn around the same time as when she started. I researched the supplement and found the main ingredient was derived from the poison ivy!  After she stopped the supplement, the heartburn went away immediately.

Try this.  The next time you are at a gym, walk around the gym with one 5 pound weight in each hand for about 5 minutes at a pace you normally would walk.  Next, put the weights down and walk for another 5 minutes.  Feel a difference?  I’m sure you will realize it’s much easier to walk without the weights!  But also your breathing is more labored when you are carrying more weight.  The muscles in your back, arms and legs may start to feel sore.  Now magnify that feeling for 24 hours/7 days a week!  That is what you it would feel like if you put on an extra 10 pounds.  Being overweight or obese can make you feel tired, and that can hurt your motivation for exercise, and cause more weight gain.  It is a vicious cycle, which is very difficult to break.

Now let’s say you are 10 pounds overweight.  If you lost that weight, you will be carrying that much less weight around in your day to day activities.  If you suffer from knee pains, that is 10 pounds less weight your knees will have to bear.  Think of how much more energetic you will feel!  We often don’t realize the impact of our weight on our energy level because we usually gain weight gradually.  One pound here and there, our body grows accustomed to the changes, but it is still affected by the excess weight in the long run.

The next time you step on the scale, calculate your BMI (Body Mass Index).  If you are overweight (BMI>25) or obese (BMI>30), think about how losing just a little bit of weight will make you feel.  Could you use more energy in your day?  Could your joint pains and body aches be improved?  Are you feeling more tired than you used to?  Losing weight may be the solution!

When I ask my patients if they are getting five servings of fruits or vegetables per day, many of them say “Yes, I drink plenty of fruit juice.”  I know many of us have been taught from an early age through TV commercials and the old “Food Pyramid” that drinking fruit juice is equivalent to eating a serving of fruit, but I disagree.  This may not be the healthiest option, and could be the reason why you can’t seem to lose weight.  While it is true that fruit juice does contain vitamins, you are getting way too many calories.  A typical 8 ounce glass of juice has about 180 calories, the same amount as your typical can of soda!  That means that if you normally drink 2 glasses of juice per day and replaced them with water, you could lose 1 pound every two weeks!

Still not convinced?  Think back to the last time you made orange juice by hand.  You would need about 8-10 oranges.  If I gave you 8 oranges, set them on a plate and told you to eat all of them, could you finish them all in 5 minutes?  Probably not. That’s exactly what you are doing when you drink juice.  In fact, we usually give orange juice to diabetics when their sugar is dangerously low because the body is able to absorb it quicker.  Liquids are digested much faster manner than solids.  When you eat a whole orange, the fiber (aka the stuff that gets stuck in your teeth) prevents you from extracting 100% of the calories from the orange.  Fiber also expands in our stomach and lets us know that we are full.  Our bodies are not able to break down most fiber in foods, which is why fiber is helpful to treat and prevent constipation.

The next time you have a craving for juice, think of it as drinking the same amount of soda.  As an alternative, eat the actual fruit.  You will get so much more fiber and less sugar.  Also, you will be guaranteed that the vitamins in whole fresh fruit will be much better for you than from a plastic bottle of processed juice that has been sitting on a store shelf for 6 months or more.  Many vitamins degrade rapidly when they are taken out of foods.  If you still must have juice, a good rule of thumb is make it yourself with fresh fruits (I’m sure you won’t be adding preservatives and coloring at home) and dilute it with equal amounts of water.  This way, you will drink half the amount of calories per serving.

Another option is to make fruit-infused water.  Take some cut fruit and put it in a pitcher, preferably one with a strainer at the spout.  Add water and a touch of lemon or a sprig of mint.  Leave it in the fridge overnight.  The flavors of the fruit will add subtle taste to the water without the calories.  This is a refreshing summer drink that won’t add to your waistline!