Tick Bites

Tick bites are common this time of year.  Some tick bites can be harmless, but some can infect you with serious, potentially deadly, diseases.  As the climate is getting warmer, the "tick season" is becoming more year-round across the United States.  Let's talk about what you need to know about ticks and their bites.

Just what is a tick?

Ticks are parasites that feed on warm-blooded hosts by biting them.  They are in the arthropod family, along with mites and spiders.  There are many kinds of ticks around the world, especially in warm, humid climates.  There are over 90 species of ticks found throughout the U.S., which can vary significantly in size and color.  The most common ticks in the U.S. include:

• Blacklegged tick (also called a deer tick)
• Lone star tick
• Dog ticks (American dog tick and brown dog tick)

How common are tick bites?

Tick bites are very common.  Most tick bites are not reported or treated by a medical provider, so we don't really know how many tick bites occur every year.  The Centers for Disease Control and Prevention (CDC) reported over 50,000 cases of diseases caused by tick bites in the U.S. in 2019.

What do you need to know about tick bites?

Ticks are often small and difficult to see until they have been attached for some time.  Most tick bites do not cause pain or itching, although some do.  A tick bite may not cause any symptoms initially.  You may not realize that you have a tick bite until the tick has been feeding on your blood long enough to become larger and easier to see. 

A tick will detach itself once it has had a complete blood meal, so a person can sometimes have a significant tick bite without even realizing it.  Some people develop a tick-borne infection without any recollection of a tick bite.

Ticks are more likely to spread disease the longer they are attached.  It is unusual to get a disease from a tick that was attached for less than 24 hours. 

For these reasons, it is very important to check for ticks after you have been in any area where you might find ticks and remove them as quickly as possible.

What parts of the body are more likely to have a tick bite?

Ticks can bite anywhere on the body, but they usually move to their preferred places.  This is usually a place with soft skin and plenty of blood.  For people, this includes:

• The scalp and neck
• Between the legs
• On the legs, particularly behind the knees
• In the belly button
• In or around the ears
• The arm pit or underside of the upper arms
• Around the waist

What should you do if you have a tick bite?

If you find a tick attached to your skin, take the following steps:

• Tug gently but firmly with blunt tweezers near the head of the tick at the level of your skin until it releases its hold on your skin.
• Do not squeeze the tick's body with your fingers or tweezers.
• Do not use kerosene, hot cigarette butts, hot match heads, or Vaseline to remove the tick.  These methods can cause the tick to release more infectious organisms while it is attached, increasing your chance of getting a tick-borne infection.
• After removal, avoid crushing the tick's body or handling the tick with bare fingers. 
• Wash the bite area and your hands thoroughly with soap and water.
• Save the tick in a zip top baggie or take good pictures of the tick for identification purposes.

When should you see your doctor for a tick bite?

• If you think the tick has been attached to you for more than a few hours.
• If you see a rash developing at the site of the tick bite or on other areas of your body.
• If you develop any flu-like symptoms after a tick bite, even a week or two later.
• If you have blistering or significant pain.

We will talk more about how to prevent tick bites as well as some of the diseases ticks can carry over the next couple of weeks.

If you have any questions about OTC hearing aids, please log into your account and send us your question. We are here to help. Dr. Anita Bennett MD - Health Tip Content Editor

Over-the-Counter Hearing Aids Soon to be Available

Thanks to a new regulation passed by the FDA, you will soon be able to purchase FDA-certified hearing aids from any major retailer that sells them. This could happen as early as mid-October. Let's talk about what this means for those who use or need hearing aids and how it could save you money.

Why is this important?

Hearing loss affects an estimated 30 million people in the U.S. and can have a significant impact on communication, social participation, and overall health and quality of life. Despite the high numbers of people with hearing loss, and the public health impact of that hearing loss, only about one-fifth of people who could benefit from a hearing aid currently seek help from a medical professional.

The use of hearing aids in people with hearing loss has been linked to the following benefits:

• Reduction in the incidence and severity of cognitive decline
• Reduction in the incidence and severity of depression
• Improved social participation
• Better quality of life

The FDA established the regulation rules with the following goals in mind:

• To protect the public health by providing reasonable assurance of safety and effectiveness of hearing aids
• To promote the hearing health of Americans by lowering barriers to access
• To foster innovation in hearing aid technology

What are the new regulations?

In 2017, Congress passes legislation requiring the FDA to come up with guidelines regarding the ability to sell hearing aids directly to consumers without the need for a prescription. That guidance was released in 2018 but the guidelines were not formalized until 8/16/22.

The new rules allow people with mild to moderate hearing loss to purchase a hearing aid over the counter (OTC), without the need for a medical exam, a prescription, or a fitting adjustment by an audiologist.

The new rules include:

• OTC hearing aids will be restricted to air conduction hearing aids, which can be either behind the ear or in the ear.
• The hearing aid volume level must be able to be adjusted by the user and the amplification level must be limited to prevent accidental ear damage.
• Labeling should be understandable for average hearing aid users (non-experts).
• OTC hearing aids can be made by manufacturers of any kind, but they will be subject to rigorous quality testing procedures before the FDA will license them to be sold.

How does this make hearing aids more affordable?

A large part of the cost of hearing aids comes from the components and the required research and development to pass quality testing. This is unlikely to change in the short term.

Here is where the cost savings comes from:

• You won't need to see a doctor to get a prescription.
• You won't need an audiologist to do hearing testing or hearing aid fittings.
• The hope is that with OTC hearing aids approved, more manufacturers and sellers will enter the market, encouraging more competition, and thus more competitive pricing over time.

Since many insurance companies set limits on coverage for costs related to hearing loss (some provide no coverage), getting rid of the doctor and audiology visits could add up to significant savings. In addition, travel costs can add up for those living in rural areas, or areas with limited medical providers. Eliminating the need for those medical visits, eliminates the travel costs as well.

When might an OTC hearing aid NOT be recommended?

OTC hearing aids are a good idea for those with long term hearing loss that has been previously diagnosed, or for adults with gradual hearing loss over time, particularly associated with aging.

There are times when a visit to the doctor to get an accurate diagnosis of the cause of your hearing loss is important, to see if the hearing loss may be reversible and to determine whether the hearing loss is caused by an underlying serious medical condition. You should see a doctor in these situations:

• Hearing loss in children
• Sudden or severe hearing loss
• Hearing loss that is not symmetrical in both ears
• Hearing loss that is associated with dizziness or vertigo
• You have significant ear pain, or ear drainage
• Headaches or other neurologic symptoms associated with the onset of hearing loss

How do you know if an OTC hearing aid has been through the FDA clearance process?

Don't rely on phrases such as "FDA-registered" or "FDA-approved". These words don't really mean anything as far as certified scientific testing is concerned.

The only way to know for certain that a device has been through the FDA clearance process is to check whether the device or manufacturer shows up in the official FDA database. To do that, use this link Establishment Registration & Device Listing (fda.gov). In the "Establishment or Trade Name" field, type the brand name. If no listing for the product comes up, you are not dealing with a brand that has been given proper FDA clearance.

If you have any questions about OTC hearing aids, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Can a 2-Minute Walk Help Lower Type 2 Diabetes Risk?

The answer is yes.  New research suggests that a light, 2-minute walk after eating can help lower blood sugar and reduce your risk of developing type 2 diabetes.

What does the research show?

• As little as 2-5 minutes of light-intensity slow walking was enough to cause a significant drop in blood sugar levels.
• Walking after eating was associated with a more gradual rise and fall in blood sugar levels compared to sitting or standing.
• This improvement in blood sugar levels was seen in people with and without diabetes or prediabetes.
• The improvement in blood sugar was evident across the weight spectrum. In fact, people with obesity even had significant reduction in blood sugar from standing compared to sitting.
• Walking for a longer period (more than 2-5 minutes) after a meal can provide additional benefits.
• The best time to walk is within 60-90 minutes after eating. This is the time window during which the blood sugar level typically peak.

How does the science of this work?

Glucose is the sugar that is produced and used by the body.It is an important fuel for muscles and other tissues.Under normal circumstances, the levels of glucose in the blood are tightly regulated by the metabolic processes of the body.  Diabetes happens when these metabolic processes go wrong for various reasons.

Glucose is released into the blood after meals and normally results in a small spike in blood sugar levels within 1-2 hours after that meal.  While small spikes in blood sugar after a meal are not abnormal, large spikes and longer elevations of blood sugar are not healthy.   

When muscles are engaged and used for walking, two things happen.  First, blood flow to those muscles increases, then those muscles will use glucose to power the activity of walking.  This results in the muscles essentially soaking up the excess glucose in the blood.

Are there other benefits to walking after eating?

There are many know benefits of walking after meals, including:

• The release of serotonin, and other beneficial hormones.  These hormones have many positive effects on the body, including improving sleep, increasing memory function, regulating your appetite, and boosting a positive mindset.
• Improved blood pressure
• Gut regulation
• Improved circulation to the extremities.
• Lower levels of stress hormones, which reduce inflammation in the body
• Increased fat metabolism.

How do you get started?

First, you should check with your doctor to be sure you are healthy enough to start an exercise routine.  Know your physical limitations and how far and how often you can walk without injury.

Start by walking a short amount (as little as 30 seconds) after each meal.  Gradually increase your distance/time as you tolerate it.If you can get up to 10-15 minutes after each meal, that would be great.

Walking with a family member or friend can help to make it more enjoyable.

Consider listening to music or an audio book while walking.

You could also walk on a treadmill, or maybe around the living room, while watching TV.

If you are not able to walk comfortably, try some arm exercises, maybe while standing if you can.

This study shows that small changes can make a big impact on your health.

If you have any questions about exercise and how it helps diabetes, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Lung Cancer Screening

Monday, August 1^st was World Lung Cancer Day, which reminded me that we haven't talked about the latest lung cancer screening guidelines.  Lung cancer is the leading cause of cancer deaths in the U.S, for both women and men, accounting for approximately 22% of cancer deaths.  I lost my father to lung cancer almost 30 years ago.  I certainly wish there had been a screening test for lung cancer back then.  Unfortunately, many people don't realize that there is a screening test for lung cancer available now.  Let's talk more about this.

How important is lung cancer screening?

In 2020, an estimated 228,820 people were diagnosed with lung cancer, and 135,720 people died from this cancer.

The most important risk factor for lung cancer is smoking.  Smoking is estimated to account for about 90% of all lung cancer cases.  The relative risk for lung cancer is approximately 20 times higher in smokers than in nonsmokers.  The risk for lung cancer also increases with age. 

Lung cancer in general has a poor prognosis, with an overall 5-year survival rate of 20.5%.  However, early-stage lung cancer responds to treatment much better, resulting in a better prognosis for improvement when the disease is diagnosed early.

Who should have lung cancer screening?

The 2021 guidelines from the U.S. Preventive Services Task Force (USPSTF) recommend lung cancer screening for people who meet these three criteria:

• People between age 50 and 80
• With a 20 pack-year smoking history
• Who are either current smokers, or have quit within the last 15 years

What exactly is a pack-year?

Take the number of packs of cigarettes smoked per day and multiply by how many years you smoked that much.  For instance, if you smoke 2 packs per day for 10 years (2x10=20), you have smoked 20 pack-years.  If you smoked 2 packs per day for 5 years, then cut down to 1 pack per day for the last 10 years, you have smoked 20 pack-years.

What test is recommended for lung cancer screening? How often should testing be done?

For people who meet the criteria, the USPSTF recommends yearly screening for lung cancer with low dose computed tomography (LD CT scan). This test has high sensitivity for detecting lung cancer, with a reasonable specificity. It also provides a lower dose of radiation than a traditional CT scan.

How effective is lung cancer screening?

Research shows that low dose CT screening among those at high risk for lung cancer reduces the lung cancer death rate by up to 20%.

Lung cancer screening is also highly cost effective.  Offering tobacco cessation interventions in combination with screening significantly increases the cost-effectiveness.

When should screening for lung cancer stop?

Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.

How are we currently doing with lung cancer screening?

Research indicates that only about 5 to 15% of Americans who are candidates for screening, are actually getting the screening done.  We need to improve this number!

What can you do?

If you meet the criteria for lung cancer screening, talk with your doctor about the test and consider having it done.

If you know someone who might meet the criteria, encourage them to talk with their doctor about screening.

Encourage your local community to publicize cancer screening guidelines.

If you have any questions about lung cancer screening, please log into your account and send us your question. We are here to help. Dr. Anita Bennett MD - Health Tip Content Editor