Health

Summer 2016: The Tale of the Mosquito

By Eileen B. Wyner, NP
Bulfinch Medical Group

Eileen Wyner, NP

I have lots of fond summertime memories from my childhood. We could play outside really late, Hoodsie® Cups were allowed even if it wasn’t a birthday party, and mosquito bites made me scratch so much I got the evil eye from my mother because I was so annoying. That was the extent of thought anyone gave to bug bites. So what has changed? Playing tag until dark has been replaced with my commuter rail commute and Hoodsie® Cups are too hard to find in the supermarket these days. But the biggest change is that now if I get a mosquito bite it doesn’t itch so much as cause anxiety.

Mosquitos are more than annoying. They potentially carry serious and life threatening disease.  We all have to try harder to avoid being bitten. The best way to avoid bug bites and the possible illness (as well as the associated anxiety they may cause), is being informed about the recent facts concerning mosquitoes.  What you need to know about illnesses spread by mosquitoes:

  • West Nile Virus (WNV): This is a virus that often causes no symptoms. It is most common between the months of June and September, but people are at risk until the first frost.
  • Eastern Equine Encephalitis Virus (EEE):  EEE is a rare and severe mosquito transmitted virus that carries a 33% mortality rate. EEE may have no symptoms, but in some cases it can cause serious inflammation of the brain that can lead to coma. EEE is also present until the first frost.
  • Chikungunya: This is a virus caused by mosquito bites that always causes some sort of symptoms; usually fever, joint pain and sometimes a rash. Chikungunya can affect people of all ages but the symptoms can be greater in the very young, the elderly, or those with chronic diseases such as heart disease and diabetes. Treatment is possible and people usually feel better within a couple of weeks. This illness has not been found in mosquitoes in the United States BUT it has been seen in many other countries including the Caribbean. People who travel to infected areas can be bitten and develop illness when they return home.
  • Zika Virus: Zika has been front page news over the last few months, but it was first identified in 1947 in monkeys in Uganda. It is now frequently mentioned by the media as it has been accompanied by a rise in cases of microcephaly (a birth defect that affects the growth of the brain that is spread to the fetus during pregnancy and possibly at birth) and Guillain-Barré syndrome in South America. This past week CDC announced that infected mosquitoes have been located in parts of Miami, Florida and published guidelines for travelers to the area. Visit the CDC website for more information about Zika. The possible symptoms are very nonspecific, such as feeling tired, fever, rash, and conjunctivitis. People may be infected and not know it. There are tests available to see if Zika is the cause of the illness, but they are performed under very specialized circumstances. Ask your healthcare provider for more information. There is no treatment for Zika, but the symptoms can be treated as needed.

The best treatment for any of these viruses is PREVENTION:

  • Mosquitoes breed in moist spaces. It is important to remove standing water such as watering cans, wading pools, or rubbish cans.
  • Mosquitoes are known to be most active at dawn and dusk. However, Zika infected mosquitoes are mostly DAYTIME biters. It is still the best idea to make sure that window screens are intact. Close windows and use air conditioning if possible.
  • Wear protective clothing (e.g. long sleeves, pant legs tucked into socks) when outside during potential peak activity hours.
  • Use mosquito repellent. Products that include DEET, picaridin, oil of eucalyptus, or para-menthane-diol are appropriate to use. It is important to read the directions as many of these products are harmful to infants and children.
  • Zika presents another challenge as far as prevention. Zika can be spread through sexual activity, so it is necessary to observe safe sex practices if there is any chance of infection.

This is a beautiful time of year in the Northeast and sooner than I care to think about, I’ll be worrying about ice dams. I hope that you will all join me and go outside and play. Just don’t forget to add the right clothing and some bug spray in your backpack.

Announcements

Heart Month Chat Recap

Dr. Maria Vivaldi, a cardiologist at the Mass General Institute for Heart, Vascular and Stroke Care and director of education at the Corrigan Women’s Heart Health Program joined us for a bilingual chat about heart disease prevention.

Click below for the chat highlights. Keep an eye on our calendar for more upcoming chats and special events.

Guest Post, Health

Notes about Pneumonia

By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit

Aparna Mani, MD, PhD

Pneumonia is a disease that has been described since the time of Hippocrates.  Though the ancient Greeks accurately identified the symptoms that constitute pneumonia, it wasn’t until the mid-1800’s that a scientist named Edwin Klebs observed bacteria in the lungs of people who had died of pneumonia, pointing to infection as a major cause of this illness.  Simply put, pneumonia is an inflammation of the lungs most commonly caused by infection.  It affects more than five million people in the United States and an estimated 450 million people worldwide each year, thus the World Health Organization has designated November 12th as World Pneumonia Day.

The lungs are composed of airways that bring in oxygen and alveoli (microscopic air sacs) that help deliver it to the bloodstream. The lungs have several defenses to protect against invading bacteria, viruses and other types of microorganisms.  These include mucus producing goblet cells and tiny hair-like projections called cilia—not to mention the body’s own immune system.  Sometimes these defenses may be overwhelmed or breached, allowing a particular microorganism to take hold and fester in the alveoli. The result is a local pool of infection that fills and plugs up the alveolus, much like pus in a skin wound. The sheer volume of infection makes it hard for immune cells to get in and do their job of breaking it down and clearing it out.  A person suffering from pneumonia may experience fever, shaking chills, fatigue, productive cough, chest pain and shortness of breath.  Contact your healthcare provider if you are experiencing any of these symptoms.

To diagnose pneumonia, healthcare providers rely on history of symptoms and a lung exam which includes listening to breathing sounds through a stethoscope and percussing the lungs (a special technique of tapping the chest) with their hands.  A chest x-ray may also be done, though it is not always necessary. The main treatment for bacterial pneumonia is antibiotics.  Providers often base their treatment on the most commonly known microorganism given age, risk factors and living environment, though mucus or sputum samples may also be obtained to identify the specific bacteria causing the pneumonia. This allows providers to better pinpoint the appropriate drug to use in treatment. Depending on the severity of symptoms and other risk factors such as age and overall health, healthcare providers may choose to treat an individual as an outpatient or admit them to the hospital.  With treatment a patient may stabilize and begin to improve within a few days, but it may take a few weeks before symptoms resolve completely.

Risk factors such as smoking, excessive alcohol use, immunodeficiency, and chronic illnesses such as COPD, kidney disease and diabetes can increase an individual’s susceptibility for developing pneumonia. Seniors (people 65 and older) and young children are also at increased risk.  The pneumococcal vaccine developed against bacteria commonly known to cause pneumonia is recommended for seniors and anyone with the above risk factors. Talk to your healthcare provider about whether vaccination is indicated for you. In addition to vaccination, pneumonia can be prevented with everyday good hygiene practices such as hand washing, coughing or sneezing into an elbow or sleeve, and taking care of one’s overall health– including keeping blood sugar in good control.

Diabetes ABCs

Diabetes ABCs: U

Ulcer (foot)

U

A foot ulcer is a deep open wound, usually on the bottom of the foot that can be  slow or difficult to heal.  If you’ve lost feeling in your feet from neuropathy you might not feel it if you have a cut or blister.  Continuing to walk on even a minor injury can irritate the skin, causing it to break down and develop into an ulcer.  This is a serious condition and immediate medical care is required to prevent the spread of infection.  The good news is by taking good care of your feet you can prevent foot ulcers from developing in the first place.  Check your feet every day for blisters, cuts and sores and call your health care provider if you notice anything that isn’t healing right.  Always wear comfortable, well-fitting shoes and avoid going barefoot.

(Content reviewed by MGH Diabetes Center)
Guest Post, Health, Heart Health

About Stroke

By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit

Aparna Mani, MD, PhD

It’s thought that the medical term stroke comes from ancient Greek for ‘struck down’. This meaning makes sense when you think of what happens when someone suffers the symptoms of a stroke. They may experience sudden weakness, numbness or paralysis of the face, arms or legs, a sudden loss of vision, difficulty speaking or an inability to understand speech.  Our brains are responsible for all of these specialized, unique functions. Blood vessels carry oxygen-rich blood and glucose to the brain cells, powering them to do this work. With a stroke, there is a sudden block in the flow of blood through the arteries that supply blood to the brain. 

This sudden ‘block’ in flow most commonly happens due to a clot getting stuck in an artery, or bleeding of the artery itself. When this happens, the blood flow is interrupted, and the cells in the affected area of the brain don’t get the oxygen and glucose that they need to function. If the blockage clears and blood flow resumes within a very short period of time, the patient may have had a transient ischemic attack (TIA) or ‘mini-stroke. If, however, blood flow does not resume for a longer period of time, the brain cells will start to die. A person suffering a stroke will show symptoms based on the specific portion of the brain that has bad blood flow.  Emergency care is required for both strokes and TIAs.  Doctors may use a CT scan or MRI to get an image of the brain to assess someone who has symptoms of a stroke. Depending on the time that has elapsed since symptoms began, doctors may be able to intervene and restore good blood flow to the brain. 

Risk factors for stroke include high blood pressure, smoking, high cholesterol, family history of stroke, age, obesity and diabetes.  Stroke prevention begins with a discussion of your personal risk factors with your doctor. By recognizing these personal risk factors you and your doctor can come up with strategies for lifestyle changes and medications to reduce your risk for stroke. 

Strokes can have serious consequences and can lead to permanent brain damage, long-term disability and death. In fact, Strokes are one of the leading causes of death in the United States today.  Know the signs:  watch out for sudden weakness, numbness, paralysis, and difficulty with speech or vision.   If you or someone you know has any symptoms of a stroke, Call 9-1-1 immediately.  With fast treatment, it may be possible to avoid the long-term consequences of a stroke.  Remember, time is of the essence and every minute counts.

Aparna recently finished an internal medicine residency at Mass General and sees patients at the hospital’s Medical Walk-In Unit.
Health

Motivating Lifestyle Change

By Sandy O’Keefe
Program Manager, Chronic Disease Education

Rock climbing. Photo Credit: Bryan Wintersteen

Question: How many Diabetes educators does it take to change a light bulb?
Answer: One, but the light bulb really has to want to change.

How many times have you vowed to lose weight or start running only to have it fall to the wayside a few days later? You may blame it on lack of willpower, not having enough time, etc., but it’s time to give yourself a break; it happens to many of us! However, if you fine tune your action plan a bit, you can set yourself up for success.

First you need to figure out what motivates you to make changes in your life. This needs to be a powerful motivator— saying something like “I want to look better” isn’t strong enough to hold your attention. Instead, “I want to lose weight so I can walk my daughter down the aisle at her wedding next May” or “so I can spend time laughing and playing tag with my children outside this summer” are examples of motivators that will help you emotionally stay attached and focused on your goals. Equally important, this motivator must come from you personally.  It’s not enough to say, “I am doing this so my wife stops nagging me to lose weight.” Keep digging inside yourself until you find your own personal motivator, then write it down and keep it somewhere you can read it any time you need to remind yourself why you’re making this change.

In order to be successful at behavior change, the focus should be on immediate attainable goals rather than long term results. For example, when you say that you want to lose weight you are defining what you hope to experience in the future. Weight loss is the outcome you hope to achieve in the long run, but it’s not the goal. Think about the steps you will need to take before you experience the outcome. For example, maybe you need to invest in a pair of sneakers or join a gym. These are things that you can do in the immediate future to get started.

Goals should always be “S.M.A.R.T.” This is an acronym that stands for Specific, Measurable, Actionable, Reasonable and Time-based. A S.M.A.R.T. goal might be, “I will buy a new pair of running sneakers from Sally’s Sneakers on Sunday May 6, 2012.” Consider what might get in the way of this goal and adjust as needed. Again, I suggest writing your goal down and having it in a place where you can see it to remind yourself.

From time to time assess the success you’ve had with each goal. You might say to yourself:  “last week my goal was to buy a pair of sneakers— how successful was I with this goal?” Goals may seem small at first, but each one builds upon the success of the one before it.  As they link together, you’ll start to believe, “hey, maybe I can stick to my plan this time!” 

You may want to ask a friend or family member to be a support person for you to help you stay on track. Having a health coach is also a great way to set a clear S.M.A.R.T action plan. Coaches aid you in identifying those strengths you possess that can help you change your behavior. Once you begin to realize that you really do have the power to change, you will be well on your way to making a behavior change that will help you realize your long-term vision.

Photo Credit: Bryan Wintersteen