By Eileen B. Wyner, NP
Bulfinch Medical Group
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.
Instead of being fried, these shrimp are baked and served with homemade
honey mustard dipping sauce. Compared to similar restaurant appetizers, you’ll save over 50% of the calories of both the shrimp and sauce by making them yourself.
Small amount of olive or canola oil to grease baking sheet
½ cup panko breadcrumbs
¼ tsp garlic powder
½ tsp onion powder
Pinch of salt
1 large egg white, beaten
12 shrimp, peeled and deveined
1 tbsp grainy Dijon mustard
1 tbsp honey
1 tsp orange juice
Pinch red pepper flakes
Lightly coat a baking sheet with canola or olive oil. Place pan in 400 degree oven while you
prepare the shrimp (this will shorten the cooking time). Meanwhile, combine breadcrumbs,
garlic and onion powder, and salt in a small bowl and stir to combine. Place egg whites in another small bowl. Dip shrimp in egg whites and then in breadcrumb mixture. Place on preheated baking sheet and bake for about 5-8 minutes, until shrimp is opaque if cut with a knife. While shrimp is baking, combine mustard, honey, orange juice and red pepper flakes. Serve honey mustard as a dipping sauce, alongside of shrimp.
Yield: About 2 servings (serving size: about 6 shrimp and 1 tbsp sauce)
NUTRITION INFORMATION PER SERVING:
CALORIES: 160 calories • PROTEIN: 8 g • SODIUM: 305 mg • CARBOHYDRATE: 26 g FIBER: 1 g • FAT: 3 g • Sat Fat: 0 g
(Recipe adapted from Cooking Light)
By Chrisanne Sikora
Project Manager – Social Media
“It’s like skateboarding-plus-surfing-plus-canoeing.” That’s how I tried describing stand-up paddleboarding to a friend as we talked about what we were looking forward to doing this summer. I’d been curious about trying stand-up paddleboarding (or SUP as it’s often called) after watching people paddling around a harbor near Chatham last year. I did a little research to see if there were any places closer to home where I could try SUP. As it turns out, my local sporting goods store offers outdoor “adventure” classes, so last month I signed up for one of their Intro to SUP classes.
We began the class by meeting our instructor, Tom, and introducing ourselves to our classmates. After a little explanation of what we were going to learn in the class, Tom helped us get fitted for life vests and set up our paddles. Next, he went over the different parts of the SUP board and taught us the basic paddling strokes we’d be using: forward, sweep (turning) and stopping. We practiced our paddling strokes on the grass for a little bit, and then trooped down the hill to the river where Tom helped us get onto our boards and explained how to fall correctly if we should lose our balance.
We paddled around near the shore a little bit to get used maneuvering the board, and then headed off upriver. I’ll be honest I was a little nervous about paddling against the current at first, but it turned out to be pretty easy once we got going. Being out on the water, falling into a rhythm with paddling, was really peaceful. I watched a duckling swimming near the riverbank; a couple of dragonflies hitched a ride on my board; fish jumped out of the water trying to catch the little insects buzzing around the surface. We spent almost two hours on the water but it didn’t feel that long at all.
I’m happy to report that I didn’t fall off my board once. I did, however, have to duck under some low-hanging branches several times once or twice and got tangled up in some weeds by the shoreline for a bit. Guess I need to practice that sweep stroke. It was definitely a good workout and fun way to spend a Saturday afternoon. Looking forward to doing it again sometime!
A big thanks to everyone who tuned-in to our fitness chat this week – our best one yet! We’ve put a transcript up on Storify, so if you missed it you can still catch up. Lots of good info on starting a fitness routine in there, so definitely worth a read.
Join us Wednesday, May 22nd at 2pm EST for a chat on starting a fitness routine for spring and summer. Mike Bento, Personal Trainer at The Clubs at Charles River Park, will lead the discussion and answer your fitness-related questions.
Discussion topics will include:
- Is cardio or weight training better for diabetes?
- Are machines or free weights better for strength training?
- Is there a best time of day to exercise?
Follow #MGHDSME for more details. If you’d like to submit a question for our chat, e-mail email@example.com.
Find us on Twitter: @MGHDiabetesEd
By Paula Cerqueira, Dietetic Intern
From barbecues to picnics at the beach, food is a big part of celebrating the season. To ensure both pleasurable and safe eating experiences throughout the summer, it’s important to follow food safety guidelines that help prevent food borne illness. The following tips should help serve as some basic strategies:
- Purchase last, refrigerate first – When purchasing groceries, buy meat, fish and poultry last and drive straight home to refrigerate or freeze so they’ll stay in the safe temperature range.
- Thaw in the refrigerator or microwave – Use the refrigerator to thaw overnight or use the microwave to defrost if you’re in a rush. Never thaw (or marinate) at room temperature.
- Make good use of your cooler – When transporting food, use an insulated cooler and ice/ice packs to keep food below 41°F to minimize bacterial growth. Pack raw foods that you intend to cook at your destination in a separate cooler from food that is ready-to-eat.
- Cold food should be kept cold – Food should only be taken out of the refrigerator when it’s ready to be immediately cooked or eaten.
- Clean hands, separate tools – Before handling food, wash your hands thoroughly with soap and water. Prevent cross-contamination by using different plates and utensils for raw and cooked meat, poultry and fish.
- Cook to safe temperatures – Raw meat, poultry, and fish may contain bacteria that can lead to illness if not cooked thoroughly. Be sure to cook hamburgers, poultry, and hot dogs to an internal temperature of 165°F. Fish, beef, pork, lamb, and veal (whole pieces, not ground) are safe at 145°F. Always use a meat thermometer and measure temperature in the middle of the thickest part of the food.
- Once hot, keep it hot – After cooking, keep food hot (>140°F) until served. Store any leftovers in shallow containers and refrigerate within 2 hours (1 hour if it’s over > 90°F outside).
For more information regarding food safety, visit the USDA Food Safety and Inspection Service website.
(Reviewed by Melanie Pearsall, RD, CDE, Nutritionist at MGH Revere)
By Eileen B. Wyner, NP
Bulfinch Medical Group
Summer has arrived in a fashion that will be hard to forget. That’s what life in New England is all about: blink and the weather will change. I really love summer, weather and all. It’s a time where I slow down the daily pace, enjoy the long hours of daylight, and remember being a kid where my only responsibility was reading the 7 books required from the Boston Latin School Summer Reading List. Well, adulthood has a few more responsibilities and I want to give you some pointers that will hopefully keep this summer healthy and happy for you and yours.
Managing your Diabetes can get a little tricky with the advent of heat and humidity, so a little pre-planning can help ensure you’re able to enjoy this magical season completely. Remember, extreme heat can lead to heat exhaustion and heat stroke, both of which can be serious medical conditions requiring urgent medical attention. Symptoms of heat exhaustion include dizziness, extreme sweating, muscle cramps, and clammy skin. This is best treated with cool fluids in a cool location and close monitoring of your glucose levels. Heat stroke is much more serious and characterized by a dangerous rise in your body temperature along with decreased ability to perspire. This potentially life threatening condition always requires urgent medical attention.
- It’s so important to stay well hydrated. The best choices are water and sugar free liquids. Caffeinated beverages can actually cause dehydration so drink those sparingly. It’s also a good idea to use caution when drinking alcohol. Small amounts of diluted sports drink may be necessary if you’re exercising in the heat. It’s best to develop a plan with your health care provider to determine if you need additional fluids.
- Exercise is important to maintain all year round, but extra caution is required with the heat, humidity, and bright sun. Outdoor exercise is best done before and after the high sun and heat of the day. However, with very hot temperatures and elevated heat indexes, outdoor exercise may need to be postponed. Indoor activity should be done in air conditioned facilities. If you don’t have access to a gym you can try walking around the mall, or up and down all of the aisles of the store while doing your food shopping.
- The sun isn’t always your friend. ALWAYS wear sunscreen during any outside activity, not just when you’re at the beach. The sun’s rays are strong and present, even when the sky is hazy, and you have to protect your skin. It’s also important to use the sunscreen correctly. Dermatologists recommend using a shot glass worth of lotion for the whole body. Reapplication is needed every 3 hours or so, especially after swimming or sweating. Another way to help to protect you from the sun and heat is to wear a wide brimmed hat and light colored, light weight loose clothes that will help to deflect the sun.
- Your blood sugar control may be affected by the heat. Your appetite may fall off or you may be eating those special treats of summer: corn on the cob, potato salad, and lots of berries. All these things are fine in moderation, but may make your blood sugars a little erratic. You also have to be really careful about your supplies and medications. Your glucometer, test strips, oral medications, and insulin are all extremely heat and sunlight sensitive. Prolonged exposure to extremes of weather will cause malfunction and possible inactivation of your medications. This could be life threatening. Always store these things in moderate temperatures and use a well insulated gel pack for travel or any weather related storage. NEVER use a freeze pack for your insulin: it will freeze, not cool, your insulin and it will be deactivated.
- NO bare feet. EVER. Good foot care is always in season. Always wear socks when doing heavy exercise, walking, and hiking as they will help to absorb moisture and protect the skin from breaking down. Change your socks frequently if they get too sweaty and always make sure your shoes fit well. Wear closed toe shoes with outdoor work like lawn mowing or painting to provide extra protection in the event of an accident. I ask all my patients, regardless of their medical conditions, to always wear water shoes or beach shoes when at the beach, in the ocean, and even poolside. It is very common to get a cut or abrasion from debris in the water or on the shoreline and this could be very serious for anyone, and especially so for people with Diabetes. Avoid flip flops as the rubber piece that separates the toes can cause friction and lead to skin breakdown.
I hope that this list will help you and your families have a wonderful summer. Now if you’ll excuse me, I have to go and start working on my self-appointed summer reading list. Happy summer to all!
Need a side dish to bring to this weekend’s cookout? This quick and easy recipe combines some of summer’s freshest ingredients for a refreshing salad packed with nutrients. Just top it with some grilled chicken for a fast, tasty summertime meal!
1 pound fresh spinach, washed and dried
1 pint strawberries, sliced, stems trimmed
½ cup sliced almonds
1 tbsp poppy seeds
2 tbsp sesame seeds
¼ cup olive oil
1/3 cup sugar
¼ tsp paprika
1/3 cup apple cider vinegar
1/3 cup red wine vinegar
Lightly brown almonds in a small frying pan on the stovetop on medium heat until golden: about 3 minutes; let almonds cool. In the meantime, combine spinach and strawberries in a large salad bowl; whisk dressing ingredients together in a separate bowl. Add poppy and sesame seeds to cooled almonds and sprinkle mixture over spinach and strawberries. Drizzle with dressing and enjoy!
Yield: About 7 servings
(2 cups salad mixture and 2 Tbsp dressing per serving)
NUTRITION INFORMATION PER SERVING:
PROTEIN: 4 g
SODIUM: 52 mg
CARBOHYDRATE: 18 g
FIBER: 4 g
FAT: 13 g
Sat Fat: 2 g
(Recipe adapted by Ashley Reynolds, Dietetic Intern. Photo Credit: Levi Szekeres)
Summer is almost here, bringing an abundance of colorful fruits and veggies to your local grocery store and farmer’s market. The USDA recommends eating a variety of fruits and vegetables; variety usually refers to the types of fruits and veggies you eat, but you can also think of it as different colors. Fruits and vegetables are good sources of a number of vitamins and minerals, as well as compounds called “phytochemicals” that can help protect against things like heart disease, high blood pressure and some cancers. Filling your plate with a variety of colors is the best way to get a wide range of range of these nutrients in your diet. Here’s a quick snapshot of the phytochemicals and health benefits of each color group:
Red—The tomato’s bright red color comes from lycopene, an antioxidant that may help promote heart health and protect against some cancers (watermelon and grapefruit also good sources of lycopene). Red fruits and veggies like raspberries, cranberries, red peppers and beets are good sources of anthocyanins, an antioxidant that may also help protect against cancer as well as maintain healthy vision.
Orange/Yellow— Vitamin A is an important nutrient for maintaining healthy skin and eyes, and fighting infection. Fruits and vegetables in this group get their bright color from beta-carotene, a nutrient the body uses to make Vitamin A. Carrots are great sources of beta-carotene, as are apricots, sweet potatoes, mangos and squash.
Green—These fruits and veggies are good sources of lutein, an antioxidant that promotes healthy vision and may help protect against cardiovascular disease. Broccoli, kiwi, avocados and dark leafy greens like spinach and kale are good choices from this group.
Blue/Purple—Also good sources of anthocyanins, fruits and veggies in this group may help with memory and protect against cancer. Look for blueberries, blackberries, raisins and eggplant.
White/Brown—Members of this color group, especially onions and garlic, contain properties that may help lower blood pressure and protect against cancer. Some other good choices from this group include cauliflower, mushrooms and bananas.
(Post content reviewed by MGH Nutrition Department. Photo Credit: Gabriel Del castillo)
The grill has been pulled out of hibernation and pressed into service for the first of many backyard BBQs. Kids, reveling in their freedom from books and classrooms, chase after the ice cream truck as it makes its afternoon rounds through the neighborhood. Yup, summer has arrived; time to hit the beach, drive with the windows open and spend time with friends and family on vacation or weekend getaway. The start of summer is brimming with anticipation and potential for fun outdoor activities, but there are a few things to consider as you enjoy these fun and carefree days.
The first and most important thing to remember is it can get HOT! This may sound like stating the obvious but it’s very easy to underestimate the effect hot weather has on our bodies. High heat and humidity make it difficult for the body to cool itself properly, a risk factor for developing a heat-related illness like heat exhaustion. Warmer weather can also affect blood glucose levels, so you may find you need to test more often as the weather heats up. You’ll also want to protect your testing supplies and medications (including insulin) from extreme temperatures—never leave them in a hot car or trunk when traveling—and out of direct sunlight.
Dehydration also becomes a concern when the temperature rises. We lose a lot of fluid through sweating, so stay hydrated by drinking plenty of water throughout the day (stay away from caffeinated beverages and alcohol, though). Also, try to limit outdoor activities during the hottest part of the day. Exercising somewhere with air conditioning is best on hot days, but if you prefer exercising outdoors go out either in the early morning or in the evening when it’s a bit cooler.
Beaches and pools are popular summertime destinations. But while you’re cooling off by the water, it’s still important to keep your feet protected from sharp rocks, shells and other debris. Wear a comfortable pair of beach shoes while walking and avoid crossing hot sand or pavement with bare feet. And always, whether you’re at the beach or in your own back yard, wear sunscreen! Sunburns can raise blood sugar, and blistered or peeling skin can potentially become infected. Keep your skin protected from sunburn (as well as other harmful effects of sun) by applying sunscreen that has an SPF of 30 to any exposed skin before going outside (including face, neck and tops of feet) and reapply throughout the day, especially after spending time in the water.
Hope everyone has a safe and happy summer!