I wish this was about LIMES and not LYME….

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

We’re hearty New Englanders but we slipped, froze and just plain suffered this past winter. We’re now reaping the benefits of our new season with bright warm sunshine and trees in full bloom, but I’m afraid we’ll be paying a price. All the snow and ice combined with a wet and soggy spring has set up a perfect storm for a tick boom in New England, which is expected to peak in the next few weeks. Here’s some basic information and guidelines for preventing and identifying tick illness while you’re outside enjoying this glorious time of year.

Lyme disease occurs when people are bitten by blacklegged ticks (more commonly referred to as deer ticks here in the Northeast) infected by a bacterium called Borrelia burgdorferi. They can attach themselves to any exposed skin area, but really like skin folds and hard to easily see places in particular. Some areas ticks are fond of burrowing into include the groin, armpit, behind the knee, the waist, and folds of the neck. They also are frequently found in the scalp as hair hides them well. Ticks need to be attached for approximately 36-48 hours or more before the Lyme disease bacteria can be transmitted.

When you’re bitten by a tick, about three-quarters of the time a rash may occur. Sometimes it will look like a small bump and resemble a mosquito bite, lasting for a day or two and disappearing. This is not a rash consistent with Lyme disease. That rash, commonly referred to as a “bull’s-eye” rash, will appear at the sight of the bite within a few days to a few weeks later. The rash may expand over time, and as it gets bigger the center may become darker and firmer while the area between the borders and the center may become clearer (this is where the term “bull’s-eye” comes from). The area may be warm to the touch but it isn’t painful or itchy.

It’s important to have this rash evaluated by a health care provider. The appearance of symptoms such as fever, chills, muscle and joint pain, headache, swollen lymph nodes, and fatigue also require medical evaluation. Let your healthcare provider know if you have any changes in your blood sugar as unexplained elevations can signal infection. These symptoms along with the “bull’s-eye” rash require evaluation by your medical provider to see if any blood tests or other treatments are required.

The best approach to avoiding Lyme disease is prevention. Here are a few tips to try to incorporate into your daily habits:

  • Always do a thorough skin examination after being outside, especially if you’ve been in the woods or long grassed fields.
  • Ticks can be very small (as tiny as a poppy seed!) and look like a black speck. Wear white or light colored long sleeved shirts and pants tucked into socks so you can spot them easily.
  • Wear wide brimmed hats to protect your scalp and neck from a tick falling onto you when walking.
  • Wear gloves if you are doing any gardening.
  • Wear bug repellant with DEET. Apply to your clothes and to your skin and it will last for several hours. Avoid getting it in your eyes and mouth and wash your hands well after applying.
  • Stay on well-marked paths.
  • To avoid bringing ticks in the house, take off clothes and bag them before heading in to shower if possible.
  • Check your pets. Dogs and cats can’t spread the disease directly to you, but they can carry infected tick into the house.

Also note: every bug bite isn’t Lyme disease. It’s important to correctly diagnose Lyme but it is just as important to avoid misdiagnosing it. Summer in New England has so much to offer and I hope these few simple steps will help you and your family stay healthy and enjoy this season.

Announcements, Health

UPDATED: Survival Kit for Cold & Flu Season * 2013-2014 *

Just Announced: Due to high demand for flu vaccine, the Central Flu Clinic has been extended to Friday, November 8th.


Your primary care doctor and the Massachusetts General Hospital want to do everything possible to keep you healthy during the flu season. People with certain chronic health conditions, even if the conditions are well managed, have a higher risk of becoming dangerously sick from the flu.

Here is what you can do:

• Get a flu shot every year*.
• The best time to get a flu shot is in the fall. The MGH will have a Central Flu Clinic in the Main Lobby of the Wang Building, Monday, September 23 – Friday, November 1, 2013. Monday to Friday, 8:00 AM – 6:00 PM (9:00 AM — 3:00 PM on Columbus Day, Monday, October 14).  No Saturday dates are planned for this year.  Please call the Toll Free Flu Shot Hotline at 1-877-733-3737 before you come in to confirm that we have vaccine in stock and that the clinic is open.
• If you live outside of Boston, your health center or primary care practice may have flu shot clinics as well. You may also get a flu shot at many locations in your community including boards of health, senior centers, or local drug stores.
For further information go to the MGH FluShot website at:
*if you think you are allergic to eggs, please contact your doctor

To protect your family’s health:

Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. If you don’t have a tissue, cough or sneeze into your elbow, not your hands.
Wash your hands often with soap and water. You can also use alcohol-based hand cleaners.
Avoid touching your eyes, nose or mouth. Germs spread this way.
Keep your home and work spaces clean.
Try to avoid close contact with sick people.
If you are sick with flu-like illness, stay home for at least 24 hours after your fever is gone except to get medical care. Keep away from others as much as possible to keep from making them sick.
If you think you have the flu, call your primary care doctor’s office for advice. They are here to help!

Spread the word! Don’t spread the Flu!

Diabetes ABCs

Diabetes ABCs: K


Letter K

When the body is unable to get energy from glucose – often because there’s not enough insulin to move it out of the blood and into the cells – it starts to break down fat for fuel.  Ketones are substances created during this fat breakdown.  A buildup of ketones is harmful and can lead to a serious condition called ketoacidosis.  There are some at-home test kits you can use to check for ketones in the urine.  Test for ketones if you have high blood sugar (greater than 300 mg/dL); are sick, feel nauseous, or are vomiting; or if you are overly thirsty.  Contact your healthcare provider if results show moderate or large ketones present.

(Content reviewed by MGH Diabetes Center)

‘Tis the Season…Cold and Flu Season

By Eileen B. Wyner, NP
Bulfinch Medical Group

cough syrupWell, it is that time of year again.  And no, I am not talking about free shipping at or buy 1 get 1 free sales, but the less glamorous, always annual COLD AND FLU SEASON! All of us are vulnerable and need to take care of ourselves, but any illness can present a bigger challenge for those living with Diabetes. Each year there are many reports of serious complications from the flu, so it is important to be aware of the illnesses and the subtle differences between them.

Let’s start by understanding what cold and flu illnesses are and what makes them different from each other. Both are viral respiratory illnesses caused by two different viruses. Sometimes it is hard to tell which illness you have, so here are a few key points to be aware of.  A cold usually comes on gradually with symptoms such as a stuffy nose, sneezing, and sore throat.  It is unusual to have fever with a cold but you may have a hacking cough.  The flu is characterized by an abrupt onset of fever that may be as high as 101-103º, along with chills, significant body aches, and a dry cough.  The severity of flulike symptoms is usually so overwhelming it’s necessary to suspend your regular life until you feel better.

Treating these illnesses can be challenging because there is no magic cure. Since both are caused by a virus, antibiotics are not helpful (antibiotics are just indicated when there is a bacterial infection). It is important to treat your symptoms so you will feel more comfortable. Some measures you can take include drinking plenty of fluids, taking medicines to relieve your fever, achiness, and nasal congestion, and to get lots of rest. You should call your health care provider with any questions or concerns, especially if you have a lingering high fever or cough or if your symptoms continue for longer than 5 days without any improvement.

Any illness can make it difficult to keep your blood sugar values well controlled.  You may need to check your blood sugar more often than usual, and have a harder time keeping at goal. You may need to make adjustments in your diet and medications. You should always check with your health care provider or certified Diabetes educator to have an individual program for illness.

I wish all of you a holiday season of health and happiness, free of cold and flu!