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The Challenge of Diagnosing Lyme Disease

July 29, 2019

From The New York Times:

Lyme disease is on the rise. The 30,000 cases reported annually to the Centers for Disease Control and Prevention by state health departments represent only a fraction of the cases diagnosed and treated around the country. About half the cases occur in people under the age of 21, and boys from 5 to 9 years old are the most commonly affected group, possibly because they spend a good deal of time outdoors.

A recent article in The New York Times about a child who was treated for Lyme disease and did well, offering a reassuring message about relatively straightforward cases of the infection, drew more than 700 reader comments, many of them angrily denouncing the author and predicting medical complications to come for her son. Some responses reflect the frustrations of people who feel they have struggled for years with persistent and recalcitrant symptoms from the infection.

The condition can be challenging to treat, in part because it is not always easy to get the diagnosis right the first time around. The biggest problem is that there is no reliable biomarker for Lyme, no way to test, unequivocally, for the presence of the bacteria, Borrelia burgdorferi, which are transmitted by tick bite and cause the disease.

You can make a diagnosis of acute Lyme disease by seeing the characteristic rash, erythema migrans, which at its most classic looks like a target. But it doesn't always look like that, and it can be hidden in the hair, and it doesn't show up nearly as clearly on darker-skinned people. "A large number of affected patients don't have the rash," said Dr. Lise Nigrovic, a pediatric emergency physician at Boston Children's Hospital.

The blood tests we have don't test directly for the bacteria, but instead test for the body's antibody response. When you hear people talk about sending a "Lyme test" or a "Lyme titer," what they are sending is a two-tiered test, looking to see whether the body is making antibodies to that bacteria. For that reason, the test will be negative early on during the infection, because it takes time for the immune system to mount this defense.

So the Lyme test is not helpful in the earliest stages of infection -- which is when you would ideally like to start treatment. Not only that, it takes a while to get the results.

"For me as an emergency room physician, none of the tests come back in rapid enough time to make a decision," Dr. Nigrovic said. She makes treatment decisions on the basis of symptoms, such as meningitis or swollen joints, she said, and that also means deciding how aggressively to pursue alternative diagnoses -- for example, deciding whether a swollen knee needs to be surgically drained or looking for other possible infections: "In my world, it's like, O.K., do I tap the knee, let the orthopedist take the kid to the O.R. when it's probably just Lyme?"

And the increase in Lyme should remind us that ticks can carry other infections as well.

Click here to read more.

Sun Safety and Protection Tips

July 16, 2019

From the American Academy of Pediatrics:

Spending time outdoors is a common activity on spring breaks or summer vacations, but remember to protect against the sun's rays. Everyone is at risk for sunburn. Children especially need to be protected from the sun's burning rays, since most sun damage occurs in childhood. Like other burns, sunburn will leave the skin red, warm, and painful. In severe cases, it may cause blistering, fever, chills, headache, and a general feeling of illness. The American Academy of Pediatrics offers tips to keep children safe in the sun.

Sun Safety for Babies Under 6 Months

- Babies under 6 months of age should be kept out of direct sunlight. Move your baby to the shade under a tree, umbrella or stroller canopy. Dress babies in lightweight clothing that covers the arms and legs and use brimmed hats that shade the neck to prevent sunburn.
- When adequate clothing and shade are not available, parents can apply a minimal amount of sunscreen with at least 15 SPF (sun protection factor) on infants under 6 months to small areas, such as the infant's face and the back of the hands. Remember it takes 30 minutes to be effective.
- If an infant gets sunburn, apply cool compresses to the affected area.

Sun Safety for Kids

- The first, and best, line of defense against harmful ultraviolet radiation (UVR) exposure is covering up. Stay in the shade whenever possible, and limit sun exposure during the peak intensity hours - between 10 a.m. and 4 p.m.
- Select clothes made of tightly woven fabrics. Cotton clothing is both cool and protective.
- Try to find a wide-brimmed hat that can shade the cheeks, chin, ears and back of the neck. Sunglasses with ultraviolet (UV) protection are also a good idea for protecting your child's eyes.
- Apply sunscreen with an SPF 15 or greater to areas of your child's skin that aren't covered by clothing. Before applying, test the sunscreen on your child's back for an allergic reaction. Apply carefully around the eyes, avoiding eyelids. If a rash develops, talk with your pediatrician.
- Be sure to apply enough sunscreen -- about one ounce per sitting for a young adult.
- Reapply sunscreen every two hours, or after swimming or sweating.
- If your child gets sunburn that results in blistering, pain or fever, contact your pediatrician.


Sun Safety for the Family

- The sun's rays are the strongest between 10 a.m. and 4 p.m. Try to keep out of the sun during those hours.
- The sun's damaging UV rays can bounce back from sand, water, snow or concrete; so be particularly careful of these areas.
- Wear commercially available sun-protective clothing, like swim shirts.
- Most of the sun's rays can come through the clouds on an overcast day; so use sun protection even on cloudy days.
- When choosing a sunscreen, look for the words "broad-spectrum" on the label - it means that the sunscreen will protect against both ultraviolet B (UVB) and ultraviolet A (UVA) rays. Choose a water-resistant sunscreen and reapply every two hours or after swimming, sweating or towel drying. You may want to select a sunscreen that does not contain the ingredient oxybenzone, a sunscreen chemical that may have hormonal properties.
- Zinc oxide, a very effective sunscreen, can be used as extra protection on the nose, cheeks, top of the ears and on the shoulders.
- Use a sun protection factor (SPF) of at least 15. The additional benefits of using sunscreen with SPF 50+ are limited.
- Rub sunscreen in well, making sure to cover all exposed areas, especially the face, nose, ears, feet and hands, and even the backs of the knees.
- Put on sunscreen 30 minutes before going outdoors - it needs time to work on the skin.
- Sunscreens should be used for sun protection and not as a reason to stay in the sun longer.

Medical groups warn climate change is a 'health emergency'

June 26, 2019

From the Associated Press:

WASHINGTON (AP) -- As Democratic presidential hopefuls prepare for their first 2020 primary debate this week, 74 medical and public health groups aligned on Monday to push for a series of consensus commitments to combat climate change, bluntly defined by the organizations as "a health emergency."

The new climate change agenda released by the groups, including the American Medical Association and the American Heart Association, comes amid early jostling among Democratic candidates over whose environmental platform is more progressive. The health organizations' policy recommendations, while a stark departure from President Donald Trump's approach, represent a back-to-basics approach for an internal Democratic climate debate that has so far revolved around the liberal precepts of the Green New Deal .

"The health, safety and well-being of millions of people in the U.S. have already been harmed by human-caused climate change, and health risks in the future are dire without urgent action to fight climate change," the medical and public health groups wrote in their climate agenda, shared with The Associated Press in advance of its release.

Among other things, the groups are pressing elected officials and presidential candidates to "meet and strengthen U.S. commitments" under the 2015 United Nations climate agreement from which Trump has vowed to withdraw. They're also pushing for some form of carbon pricing, although without any reference to potential taxation of emissions, and "a plan and timeline for reduction of fossil fuel extraction in the U.S."

Former Vice President Joe Biden's climate change plan, released earlier this month, tracks broadly with several of the medical and public health groups' priorities. While the groups call for a reduction in petroleum and natural gas use in transportation, they do not go as far as several of Biden's rivals in supporting an outright ban on the oil and gas extraction technique known as hydraulic fracturing, or fracking, which involves injecting high-pressure mixtures of water, sand or gravel and chemicals into rock.

Other groups signing onto the list of climate policy priorities include the American Lung Association, the American College of Physicians and multiple state-level and academic public health organizations. That the agenda's endorsing groups do not operate with "a political axe to grind" could help them draw more attention to climate change, said Ed Maibach, director of the Center for Climate Change Communication at George Mason University.

To read more, click here.

A Retreat To Nature Can Boost Immunity And Mood

June 17, 2019

From NPR.org:

When my editors asked me to report on forest bathing, I packed a swimsuit. I assumed it must involve a dip in the water.

It turns out, my interpretation was too literal.

I met certified Forest Therapy guide Melanie Choukas-Bradley and several other women who'd come along for the adventure at the footbridge to Theodore Roosevelt Island, a dense jungle of an urban forest along the Potomac River in Washington, D.C.

Here, I began to get it. Forest bathing isn't a bath. We sat on the banks of the river, but we did not get in the water.

It's not a hike, either. We did walk the forest trails, but we meandered with no particular destination in mind.

The aim of forest bathing, Choukas-Bradley explained, is to slow down and become immersed in the natural environment. She helped us tune in to the smells, textures, tastes and sights of the forest. We took in our surroundings by using all our senses.

As we passed through a stand of pawpaw trees, we touched the bark. We smelled the black walnuts, which give off a lovely citrus fragrance. We got a little shower of ripe mulberries, too.

"Close your eyes and just breathe, just breathe," Choukas-Bradley intoned. It felt a bit like a meditation retreat.

It took me a few minutes to clear out the clutter in my brain, and tune in to the natural world.

"When you open your eyes, imagine you're seeing the world for the very first time," Choukas-Bradley told us.

After I opened my eyes, the green looked a lot greener. And I began to see things I hadn't noticed before: the flutter of birds, the ripple of the water, the swaying of trees.

A forest guide "helps you be here, not there," says Amos Clifford, a former wilderness guide with a master's degree in counseling, and the founder of the Association of Nature & Forest Therapy, the organization that certifies the guides.

Clifford's goal is to encourage health care providers to incorporate forest therapy as a stress-reduction strategy. There's no question that stress takes a terrible toll in the United States; a 2015 study found work-related stress accounts for up to $190 billion in health care costs each.

"It's my hope that the health care system will include [forest therapy] into the range of services they reimburse for," Clifford says.

The practice began in Japan. Back in the early 1990s the Japanese Ministry of Agriculture, Forestry and Fisheries coined the term Shinrin-yoku -- which translates roughly as forest bathing.

For more from NPR.org, click here.