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Last fall, U.S. Attorney Thomas Delahanty, Attorney General Janet Mills and Commissioner John Morris formed the Maine Opiate Collaborative following Senator King’s roundtable forums on opiate abuse and the governor’s forum on the same topic.

The Collaborative consisted of three task forces:  Prevention and Harm Reduction, Law Enforcement and Treatment.  Each of these task forces, which consisted of content experts, people with broad experience, people in the medical field and people in recovery, developed a set of goals, objectives and strategies which were presented on May 6th.  Over my next three blogs I will do my best to summarize these recommendations.  Though some require formal government action, many can be undertaken by caring and motivated medical personnel, community leaders, community members, friends and family.  So let’s start with Prevention and Harm Reduction:

  • Goal 1 – Promote good public health and safety and reduce the harmful effects of opiate use.  Objectives include:
    • Increase the understanding of the harms associated with opiate use and to address the stigma associated with the disease of addiction and its treatment through education of the public at large.
    • Decrease the use of opiates by our youth.  This will require a concerted and ongoing effort on the part of parents and family, government institutions like CDC and the Maine Office of Substance Abuse and Mental Health Services, the Department of Education and others.  Healthcare providers, schools and communities need to address adverse childhood experiences and the impact they can have on wellbeing.
    • Work to address and prevent child abuse and neglect.
    • Reduce access to opiates, through more effective use of the Prescription Monitoring Program and increase efforts aimed at the safe storage and disposal of prescription opiates.
    • Decrease the number of drug affected babies born in Maine each year through pilots of the already established Snuggle ME project, screening for substance abuse in pregnancy and guidelines for best care of substance use disorder in pregnancy, and improved support for families with infants exposed to substances.
    • Decrease overdose deaths in Maine by increasing the availability of naloxone.
    • Increase opportunities for treatment and recovery for people with substance use disorder with recovery centers in each public health district and establishing collegiate recovery communities at all Maine colleges, through reducing barriers to housing, education and employment for people in recovery, providing broader access to recovery coaches and increasing access to treatment.
  • Goal 2 – Strengthen Maine’s public health infrastructure to reduce opioid use disorder and overdose deaths.  Objectives include:
    • Improving Maine’s ability to take a comprehensive approach to the problem by creating a high level position to coordinate efforts across the state and empowering the Substance Abuse Services Commission to work to implement the recommendations of the Opiate Collaborative, and develop the existing “2-1-1” program into an information and resource hub for people seeking services for opioid use disorder.
    • Increase local capacity to work on prevention strategies by supporting Maine’s public health districts in collaborating with schools, recovery and wellness coalitions, healthcare organizations, faith communities, law enforcement and others to promote healthy communities and address public health challenges.

It’s a lot of information and I have condensed it!  Yet all of this, and the recommendations of the other two task forces (to be summarized in future blogs) can help us to address the most important public health challenge for Maine today.  As Senator King says, there is usually no silver bullet for solving big problems, but there often is silver birdshot.

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Naloxone (Narcan) is a life-saving antidote for opioid (heroin, oxycodone, fentanyl and others) and PCHC is committed to making it as widely available as possible.

With 272 opioid overdose deaths in 2015, a 31% increase from 2014, we are faced with our most significant public health challenge in decades and we must respond at all levels; with life-saving measures like this, with law enforcement, with treatment and with education and prevention. And we must commit to doing all of this work with compassion and understanding. On May 6 the Opiate Collaborative Task Force will release a comprehensive set of recommendations for Maine. The easy availability of naloxone to reverse an overdose and to safe a life is a simple, common sense and compassionate piece of that puzzle. Dr. Karilynn Dowling, one of PCHC’s second year pharmacy residents, has done extensive work to help us prepare for this.  She is committed to this work and her summary follows:

Images from MICIS naloxone detailing materials.

28,000 Americans died from an opioid overdose in 2014. Nearly 19,000 of these deaths involved prescription opioid medications. The majority of deaths were unintentional.

Naloxone is an opioid reversal agent that rapidly reverses an overdose on opioids (prescription and/or street drugs). Naloxone is not just for substance abusers. It is for anyone who takes an opioid or knows someone who does. Naloxone is prescribed on account of risky medications, not risky patients. The concept is similar to EpiPens for people with allergies.

  • Naloxone is an emergency medication that acts within several minutes and wears off in 30-90 minutes.
  • The potential harm in giving someone naloxone is low, especially in comparison to its potential benefit as a life-saving medication.
  • If someone who is not overdosing on opioids is given naloxone, it will have no effect and will not harm them.

A person who is overdosing on opioids is heavily sedated or unresponsive, so naloxone is given by a family member, friend, or bystander. Naloxone can be given by an injection or through the nose (intranasally).

Intranasal naloxone is preferred because:

  • Studies have shown it is as effective as the traditional injection method for reversing an overdose
  • Time to draw up a syringe is removed and risk of needle stick is removed
  • It is easy for the general public to learn how to use

Images from MICIS naloxone detailing materials.Currently, naloxone is a prescription-only medication in the state of Maine. Naloxone may be prescribed to an individual at risk of experiencing an opioid overdose, a family member or friend of such an individual, or any other person in a position to assist someone who has overdosed. Naloxone can also be distributed through a community-based overdose prevention program under a doctor’s standing orders.

Intranasal naloxone is available in two forms. When someone has overdosed on an opioid, a bystander should call 911, administer rescue breaths, give naloxone (see below), and remain with the person until help arrives.

Naloxone for Opiod Overdose
KariLynn Dowling, PharmD
April 17, 2016

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It seems like every time I am asked to talk or write about a disease or healthcare challenge, when I look into disease management and maximizing health, good sleep is among the top recommendations.  Whether it’s an inflammatory disease, heart disease lung disease, diabetes, anxiety, depression, stress or chronic pain, adequate, restful restorative sleep improves health, supports a sense of wellbeing and contributes to better health outcomes.

But what are the effects if inadequate sleep?  Even if you don’t have a chronic disease or other health challenge, poor sleep can have a negative impact.  A recent post on the Cleveland Clinic’s website outlined some of these concerns.

  • Alertness – this is common sense but missing even 1 ½ hours of sleep decreases alertness and a number of brain functions like creativity, innovation and attention.
  • Memory – a lack of sleep decreases your ability to retain and to process information.
  • Relationships – not getting enough sleep can make you moody and impatient and that is not good for your interactions with others, at work and at home.
  • Quality of life – being tired makes you less likely to engage in enjoyable activities and you’re also less likely to exercise regularly.
  • Car accidents – drowsy driving leads to thousands of accidents, injuries and deaths every year.
  • Serious health complications – complications of long term sleep deprivation include heart failure, heart attack, stroke, diabetes and high blood pressure.  This is serious business.

So how much sleep should you get each night?  Updated research indicates that for most people the following guidelines apply:

  • Older adults, 65+ years: 7-8 hours
  • Adults, 26-64 years: 7-9 hours
  • Young adults, 18-25 years: 7-9 hours
  • Teenagers, 14-17 years: 8-10 hours
  • School-age children, 6-13 years: 9-11 hours
  • Preschool children, 3-5 years: 10-13 hours
  • Toddlers, 1-2 years: 11-14 hours
  • Infants, 4-11 months: 12-15 hours
  • Newborns, 0-3 months: 14-17 hours

There are a number of behaviors that make it more difficult to sleep, like too much screen time during the day and evening, alcohol use, tobacco use, lack of regular exercise and unhealthy eating.  There are also a number of things that can be done to improve sleep time and quality like “sleep hygiene” (see past blogs or google it), healthy eating, regular exercise and cognitive behavioral therapy for sleep.

So get some Zs and live a healthier and happier life!

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In addition to movie discounts and joke fodder for my children, my AARP membership sometimes also provides some interesting medical information.

It’s usually pretty reliable and often useful but a recent Facebook posting by AARP caught my eye.  It was entitled “10 Surprising Heart Attack Triggers” and it’s a very interesting list, but before we launch into it it’s important to be clear about the difference between and “association” and “cause and effect”.  Cause and effect means that we know that some factor causes a particular outcome:  smoking and lung cancer or influenza virus and the flu, as examples.  Associations, on the other hand, are observed patterns of relationship between a factor and an outcome and can lead to studies that prove or disprove cause and effect.  Some associations can be misleading (for instance measles vaccine does not cause autism but because it is administered at about the age when autism begins to become apparent many people and some unscrupulous physicians claim cause and effect).

So with that in mind, let’s look at some of these interesting “triggers of heart attack” from the AARP.

  1. Asthma that requires daily medication  Having asthma that is severe enough to require the use of daily medication is associated with a 60% higher risk of a heart attack.  No cause and effect here.  It could be that asthmatics are more likely to ignore symptoms of heart disease, thinking that chest tightness is part of their asthma.  Asthma is also a disease of inflammation, which can also contribute to heart disease.  And perhaps the medications themselves carry some risk.
  2. Taking certain drugs for heartburn  These drugs, called protein pump inhibitors (PPI) include drugs like  Nexium, Prilosec, Prevacid and Protonix, are associated with a 16% to 21% increased risk of heart attack.  Again, no cause and effect has been proven, but PPIs ma reduce blood levels of nitric oxide, which is a chemical which may protect the lining of our arteries.  There are other reasons that it may not be good to stay on PPIs for a long period of time (the subject for another blog) and it is recommended that people regularly try to substitute safer drugs, like ranitidine (Zantac) or cimetidine (Tagamet).
  3. Having migraines with visual changes  This is called a “classic migraine” headache and is typically preceded by visual changes like wavy lines or seeing spots.  Women of middle age and older with this problem in the prior year have a 91% increased risk of heart attack and a 108% increased risk of stroke.  Migraines are not well understood so this association is hard to explain.  But 18% of women fall into this category so it is important.
  4. Skipping the flu shot  Separate from the reduced risk of developing influenza, the flu shot appears to confer protection from heart attack in the ear following administration, a 50% reduction in fact.  Apparently some of the antibodies produced by the bod in response to the vaccine help to protect our blood vessels.  This is compelling and getting a flu shot seems like a “no-brainer” to me.  I know that anti-vaccine types will shudder to read this but really, it is safe and pretty effective.
  5. Weak grip strength  A recent study has found that for every decrease of 11 lb. decrease in grip strength there is an associated 17% increase in risk for heart disease.  This may be due to circulation problems to our muscles in the same group who have coronary artery disease.  This may be a useful tool to screen for risk of heart disease in people who are not having symptoms.  It’s being studied.

If you or a loved one have some of these “risks” it is not cause for panic.  But it might be a good reason to have a discussion with your primary care provider and to limit your risk for heart disease through healthy eating, exercise, blood pressure control and avoiding tobacco use.

Next month we’ll take a look at the other 5 “surprising triggers of heart disease”.

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Although I made it through another Black Friday without spending a penny (due more to an aversion to shopping than any principled stand against the degradation of holidays with naked consumerism) I have not been immune to the relentless marketing of “goodies” via email and social media.  Electronics are always pushed especially hard and have great appeal. Cell phones, tablets, computers and game consoles can be functional (tools for communication, resources for information) and fun (games, social media, movies, on demand TV). But it comes at a price that goes beyond their substantial dollar costs.

Our overuse of “devices” is impacting our health.  Studies have shown that with increasing screen time comes higher rates of depression, obesity, poor sleep quality, decreased physical activity and decreased socialization.  And our children mimic our behaviors.  Children do not have a natural ability to manipulate digital devices or any inherent interest in them, but they do have a powerful drive to emulate the behavior of the adults in their lives, and when they see parents and others spending much of their time staring at one screen or another they are quick to pick up on the behavior.  Children who spend more time with TV, electronic games, smart phones and other screens are less physically active and have a higher risk of obesity, behavior problems, ADHD, poor sleep, and poor school performance.  And the average child spends 7 hours a day focused on one screen or another.

It is alarming to note that studies have shown that heavy use of the internet is associated with:

  • shrinkage (called atrophy) of the gray matter of the brain in the areas involved with organizing, planning and impulse control
  • degradation of white matter, which allows for communication between different parts of our brain and helps us to balance emotional responses with reason
  • thinning of the cortex of the brain and decreased ability to perform cognitive tasks and a heightened sensitivity to rewards and an insensitivity to losses
  • changes in dopamine systems that mimic addiction so that heavy users may crave access to  screen time when they cannot have it

For adults these dynamics can be annoying to others but also substantial impairments to personal, social and work success.  Their impact on children can be profound as the changes in a developing brain (and brain development continues into our early 20s) may be permanent.

So here are a few straightforward strategies to balance the value and fun of screen time with the need for real human engagement and physical activity:

  • Put your own devices away and spend quality time with the children in your life.  This time should include physical activity, conversation, shared experiences and lots and lots of eye contact (one study has shown that the more time parents spend on devices the more risky their child’s behavior came – an attention gaining strategy!).  You’ll feel better too.
  • Limit your screen time and your children’s screen time.  1 hour a day for all screens, including TV, is the recommendation for children.
  • Remove TVs from the bedroom.  TV at bedtime impairs sleep and leads to behavioral problems in children.
  • Ban electronics from the dinner table and have a conversation!
  • Set aside time dedicated to physical activity, for you and for your children.

It feels good to unplug and it is unlikely that you’ll regret foregoing screen time in favor of time spent with family, friends, your children or even a good book.

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With all of the justifiable attention to the challenge of opioid (heroin and prescription narcotic) addiction in our state it is easy to lose sight of the harm that results from the unsafe use of alcohol. Here are some facts about alcohol use in our society:

  • 1 in 4 high school students in Maine reports drinking alcohol in the last month and 1 in 6 reports binge drinking.
  • 4 in 10 people aged 18 to 25 report binge drinking in the prior month.
  • In 2013 there were 1203 alcohol related car crashes in Maine.
  • 41% of EMS responses for overdose are related to alcohol.
  • 50% of Americans age 12 and over report being current drinkers (that’s 135,000,000 people using alcohol).
  • There are 60,000,000 Americans who are binge drinkers and there are 17,000,000 heavy drinkers.
  • Only 1 in 6 people with problem drinking talk to their doctor or health care provider about it.

Most people are familiar with many of the complications of heavy alcohol use – intoxication, impaired judgment and accidents from binge drinking. Most of us are aware of the harm to work, family, and social ties that can arise from the chronic regular use of alcohol. Fewer people understand all of the potential health consequences of problem drinking. These include damage to the liver and liver failure (cirrhosis), pancreatitis, gall stones, osteoporosis, high blood pressure, vitamin deficiency, anemia, atrial fibrillation, birth defects, and an increased risk of heart disease, stroke, dementia, kidney disease, depression, suicide and diabetes. Few people realize that alcohol is a carcinogen. Women who drink even modest amounts of alcohol have a higher risk of breast cancer than those who do not drink, and regular use of alcohol increases the risk of cancer of the mouth, esophagus, stomach and colon, cancer of the liver, pancreatic cancer and lung cancer.

Alcoholism (also called Alcohol Use Disorder ) is diagnosed by meeting 2 or more of a list of symptoms or behaviors, which can be found here: The more of these a person has, the more severe the alcohol use disorder, and about 7% of our adult citizens (17 million people) have Alcohol Use Disorder. Alcohol Use Disorder runs in families and there are people who are genetically more at risk. It is also more common in people with other mental health problems.

A much larger number of people (as many as 30% of adults) have what is called “At Risk” use of alcohol – that is they may not have yet experienced social or medical complications of their alcohol use but are at risk for developing those complications. More importantly, with education and support they have a chance to reduce their alcohol use to safer levels. Thus, it becomes important that we find ways of identifying people with “at risk” or problem drinking and offer them the information and resources they need to be safer and healthier. Fortunately there are tools we can use to help in that work. It is likely that primary care providers will be doing more routine screening for “at risk” use of alcohol as part of normal history taking with patients, and each of us can also do our own test, for ourselves, our friends and our family. In adults a very helpful screen is the Alcohol Use Disorders Identification Test (AUDIT). An easy to use version which calculates and helps you to interpret your score can be found here: This questionnaire asks about your frequency of drinking, the amounts you drink, binge drinking and potential serious consequences of your drinking. It’s quick and easy and if you score greater than 8, your drinking is putting you at risk and by reducing the amount you drink you can reduce those risks. If you score over 20 you are likely already suffering harm from alcohol and should do all that you can to cut back, including talking to your primary care provider. Education, counseling and peer support can help and there are medications which can improve your chances of reducing your alcohol use.

For more information and to learn what is being done here in Maine I suggest the following links:

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Earlier this year I suffered a fairly significant episode of low back pain due to a herniated disc.  Yes, I overdid it and I did not lift that air conditioner as carefully as I might have, so I accept full blame.  That didn’t make it any better when the spasms set in in the middle of the night! This was my most severe episode of back pain, but like almost all adults, I’ve had other episodes during my life, so this is a subject on which I write with true empathy.

So some important things you should know about low back pain:

  • It is very common. In fact it is the second most common reason people seek care with a doctor or other healthcare provider.
  • It is almost never serious, although serious conditions, like significant illness or cancer, can cause back pain. The vast majority of cases are straightforward and are related to muscle strain or spasm, or as in my recent case, a herniated disc.
  • Acute low back pain usually gets better on its own. Although the pain can be severe and debilitating, it is usually temporary and more than 90% of cases resolve by 6 weeks. When back pain becomes chronic (lasting more than 12 weeks) it can be more complicated to treat and can interfere with important functions of daily living. It is critical to understand that narcotic pain medicines have no role in treating chronic back pain, and if you have been started on them for acute low back pain, after a few weeks it is time to look at other therapies (a topic for another blog).
  • Treatment for acute low back pain is pretty straightforward. Stretching, physical therapy, chiropractic therapy, cold and heat therapy, massage and acupuncture can all help. Improving your posture, strengthening your core (especially your abdominal muscles), a healthy diet, weight loss, stress management, smoking cessation and good sleep habits can all contribute to a more speedy recovery.
  • Most of the time X Rays are not necessary. It’s even less frequent to need a CT scan or MRI. These tests are typically reserved for pain that lasts more than 6 weeks or in instances when symptoms or physical findings indicate a more serious cause of the pain.
  • There are warning signs of more serious disease. Fever, weight loss, other persistent symptoms, worsening pain after a few days, weakness in your legs or a loss of sensation should be evaluated by your primary care provider. If you have other serious medical conditions like diabetes or osteoporosis, or if you take prednisone or other medicines that suppress your immune system you should seek attention early on.
  • Surgery is seldom the answer. I wish I had a dollar for every patient I have seen who has had back surgery and continues to have pain. This isn’t because of poor surgeons or poor techniques. Rather, abnormal findings on a test like an MRI are very common as we age and may or not be the cause of a person’s back pain. Even most herniated discs will get better without surgery (mine did).
  • Most importantly, staying active, maintaining a healthy weight and a healthy lifestyle, using good back mechanics and exercising good judgment can help prevent back problems in the first place.

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Summer is here and after the winter of 2015 we rightly expect to take advantage of as many opportunities as possible to enjoy the warm weather and the beauty of our lakes, rivers, seashore and woods.  Most of the time in summertime in Maine, we are blessed with comfortably warm days and comfortably cool nights.  But there are days when the heat can become a risk and that risk can be elevated for susceptible people.

Children can get a heat rash (called Miliaria) which can cause itching or a burning sensation.  It usually resolves once the skin is cooled, either by moving to a cooler room or applying cool compresses or taking a cool bath.  Young children are especially susceptible to the very high temperatures that occur very quickly in a car left in the sun.  This is a very unsafe environment for children and they simply should never be left in a car in the heat.

Older people can develop edema, or swelling, in their hands and feet as a result of heat exposure, and exposure to heat can also cause fainting in susceptible people (called heat syncope).  The elderly, those with chronic illness, or people on certain fluid medicines or blood pressure medicines can be more prone to this problem.  This can occur while the body temperature remains normal, and treatment consists of moving to a cooler area, lying down and elevating the legs.

Heat cramps can occur in the legs, arms and abdomen and can be very painful.  Again some people are more susceptible than others, and stretching and moving to a cooler environment can help.  I experienced this phenomenon one time on a long bike rife in high heat and humidity and it is very unpleasant!  Less commonly a syndrome called heat tetany can occur.  It results from hyperventilation due to heat, a change in acid/base balance in the body and resulting symptoms like spasms of the hands and feet and tingling around the mouth.  A quiet, calm and cool environment can help, but the temperature should be checked and if it is elevated medical attention should be sought immediately.

Heat exhaustion occurs in people with heat exposure and an elevated temperature (up to 104 F) and includes symptoms like a rapid heart rate, sweating, nausea, vomiting, headache, weakness, fainting, profound thirst and confusion.  This is a potential emergency and medical evaluation should be an immediate priority.  Often the body’s electrolytes (sodium, potassium, etc.) are normal but they can be abnormally low.  Treatment can consist of cooling and drinking fluids like sports drinks, or IV fluids may be necessary.  Children, the elderly and people with chronic diseases are particularly susceptible.

Heat stroke occurs with heat exposure when the body core temperature exceeds 104 F and there is confusion or altered mental status.  In some instances the person affected by heat stroke will stop sweating  When heat stroke does not involve exertion it is most common in children who are either unable to exit  a very hot environment (for example, the parked car) or who have illnesses or are on medications (some meds for ADHD) which make them susceptible.  When heat stroke is related to exertion it tends to occur in young adults involved in heavy exertion (work or athletic events or military training) in conditions of high heat and humidity.  When relative humidity exceeds 75% our body’s self-regulation fails to adapt fully in most circumstances (because our perspiration won’t evaporate rapidly enough).  Heat stroke is a life threatening medical emergency and aggressive treatment with cooling, fluids, some medications and other interventions require hospitalization.

All of these problems are best approached by a a carefully planned approach to prevent the problems in the first place.

  • If you are not used to hot temperatures allow yourself to gradually adjust to them through limited exposure and exertion at first.
  • Restrict your activity in high heat or in high heat and humidity to that which you can comfortably accomplish.
  • Sporting events should be curtailed in high risk situations.
  • Hydration breaks during active times are important.  Rest and fluids can be very effective.  Interestingly, sport drinks are more likely to lead to adequate hydration than water, simply because people are more likely to drink more of them.
  • Light, loose fitting, lightly colored, absorbent clothing is very helpful.

Here’s wishing you all a safe, enjoyable and comfortably warm summer!



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Summer is here and in addition to all that we enjoy about this time of year, it is also the season when insects reappear. Some are nuisances (black flies!), some help control nuisances (dragon flies!) and still others carry disease which can profoundly impact our wellbeing. The common deer tick (ixodes scapularis) carries the bacterium (borrelia burgdorferi) which causes Lyme Disease in humans. Here is a link to images of the Lyme tick and some other common ticks (which do not transmit Lyme Disease):

There are some simple steps you can take to reduce your risk of contracting Lyme Disease.

  1. Know when you are at risk. These ticks reside in wooded areas, leaf piles and tall grass. When you are in these areas wear long pants, long sleeves, and socks. It’s even better if you tuck your pants into your socks.
  2. Reduce the risk in your own back yard. Create a barrier to the ticks by keeping your lawn mowed, remove leaf piles and build a border of gravel or mulch between your yard and woods or long grass.
  3. Use insect repellent. The chemical diethylytoulamide, or DEET, is an effective tick repellent and is found in many commercial insect repellents. It does not have to be 100% DEET, and can be sprayed on clothing and skin. Permethrin powder can also be applied to clothing to ward off ticks.
  4. Better check yourself. When you have been in an area where ticks may live, check yourself and your children carefully for ticks. Have someone else look at your scalp and back to make sure that you haven’t missed any. Bathing after spending time in tick prone areas can also help to reduce risk.       Ticks need to stay on your skin for at least 24 hours to transmit Lyme Disease so early detection and removal can be crucial. Most disease is transmitted when ticks have been on your skin for more than 48 hours.
  5. Properly remove any ticks that you find. This is best accomplished by using tweezers to grasp the tick as close to your skin surface as possible and gently but steadily pull straight up. If bits of the tick remain do not try to “dig them out”. Your immune system will extrude them with time. Once the tick is removed wash the bite area thoroughly with soap and water.
  6. If you have had a tick on you talk to your primary care provider. If the tick was on you for more than 36 hours you may choose to take antibiotics to prevent Lyme Disease, but you can also choose watchful waiting, and treatment if a rash or other symptoms appear. Both options are reasonable and relatively safe. The use of antibiotics to prevent disease does not have to be a long course (in fact , a single dose is recommended). If the classic “bulls eye” rash or other early symptoms appear, treatment may last for 10 days to 3 weeks. Here is a link to view the classic rash of Lyme Disease, called erythema migrans, but it does not occur in every case:
  7. If it is possible save the tick in a zip lock bag for your primary care provider to see. It is uncommon now to have to send a tick for identification since most providers are adept at distinguishing between Lyme ticks and the common wood tick. However, it may be necessary in some instances.

There is a great deal of controversy about Lyme Disease and much of the discussion has led to unnecessary fear. The simple steps I’ve outlined are not controversial and can help us all enjoy a happy and safe summer.

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For better or worse I normally I like to fill this blog with my own thoughts on health care related topics.  However, once in a while I see something that is so well done that I think it is important to share it here – this month is one of those instances.  What follows is largely summarized from a Cleveland Clinic patient information page, which I highly recommend.  You can most easily access it by “liking” the Cleveland Clinic on Facebook, or go to First, let’s remember that over 100 million people in the US suffer with chronic pain.  Second, you should know that the National Institute of Health (NIH) estimates that over 70% of people with chronic pain receive improper treatment.  And finally, it’s critical that we all understand that there is no evidence that narcotic pain medications are effective in treating chronic pain and there is very significant evidence of the harm these medicines inflict on individuals, on their families and on our communities.

Here are some home based treatments which actually do work in helping people cope better with chronic pain and achieve a higher level of functioning:

  • Deep breathing – slowing your breathing intentionally while taking deep cleansing breaths can help you relax and allow you to lessen your discomfort.
  • Get some sleep – restful sleep is critical to our body’s restorative process and allows us to cope with all kinds of stress, including pain, during the day.  Sleep medicines cause sedation but do not induce restful sleep, so they are not the answer.  A concept called sleep hygiene (ordering your exercise, nutrition, evening habits and sleep environment to maximize sleep) is effective, free and not that difficult, yet few people commit to it.
  • Exercise – Even though you have pain there is almost always a way to make regular exercise part of your life.  Stretching, strengthening and aerobics all help and the better your muscle tone the better your body can protect itself from painful movement.  Exercise also releases natural chemicals which reduce pain and increase our sense of wellness.
  • Work on your smoking habit – tobacco products increase sensitivity to pain and reduce circulation, along with the myriad other deleterious health effects you already know about.
  • Practice “mindfulness” – rather than ignoring or cursing your pain, acknowledging it, observing it and being conscious of how it effects your movement, your breathing, and your attitude and emotions actually helps you to tolerate it better.  There are many mindfulness coaches who can help with this, and there also on line resources.
  • Eat a whole-food, plant based diet – whole grains, vegetables, legumes and fruits have anti-inflammatory effects and can reduce pain in joints and muscles (including your back!), while processed meat, red meat, sugar, white bread and pasta have the opposite impact.
  • Yoga – it works.  Period.  Really.  And beginner poses are easily found online.  Try it!
  • Enjoy your hobbies – make a point of doing the things that bring you pleasure.  It reduces stress and improves health.  For me it’s visiting with my granddaughter and biking, and I can’t wait to combine the two!
  • Engage in social activities – people with chronic pain can lean toward isolation, and many of the medications commonly used to treat pain also cause social withdrawal.  Regular activity with other people helps to reduce anxiety and pain.

I hope you’ll consider these simple, safe and effective strategies for yourself or a loved one suffering with chronic pain.  It can be better!