Tick-Borne Powassan Virus Infections Are Increasing

As we begin the summer months, and people spend more time outside, we experience more tick-borne illnesses. Mention tick-borne illnesses and you immediately think of Lyme Disease which is the most common tick-borne disease in the United States.

A new tick-borne illness is emerging in the same geographic area that Lyme Disease is seen.   Powassan Virus (POWV) has increased from two cases reported in 2008 to well over 30 reported in 2017.  Two cases have been reported recently in New Jersey, including one fatality.

In Lyme Disease the tick attaches to the human body for 36-48 hours prior to the bacterium being transmitted to humans. In Powassan Virus this occurs within the first 15 minutes that the tick latches on. The incubation period can range from one week to one month with patients experiencing fever, vomiting, headache, weakness, loss of coordination, confusion, difficulty speaking and or seizures. The virus affects the central nervous system and can cause encephalitis and meningitis. One in 10 cases is fatal.  Recovery with permanent neurological damage can occur.

There are no medications or vaccines available to prevent or treat POWV infections. Treatment is supportive. Scientists believe the increase in ticks and POWV is a direct result of climate change.

Prevention is the key especially if you are going to be in an area known to have ticks. Experts suggest:

  1. Wear long sleeves and pants with socks pulled up over the bottom of the leg pants.
  2. Wear light colored clothes so ticks can be spotted on your clothing
  3. Use insect repellant with at least 20% DEET. Spray it on the exterior of your clothing and apparel
  4. Upon returning inside perform a thorough tick check.

This is an infection and virus most practicing physicians know very little about. There are no telltale warning rashes as in Lyme Disease.  Until more is known, prevention is the best option.

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Tidbits on Dementia and Alzheimer’s Disease

A few years back I attended a lecture given by the director of geriatrics and memory / wellness program at the Massachusetts General Hospital. She began the program by asking the audience for a show of hands as to how many doctors and health care providers were suggesting that their older patients try brain teasers and brain games and puzzles to keep their geriatric patients mentally sharp and stave off dementia.  Everyone’s hand shot up indicating that we all were trying this method to stave off memory loss. She responded with, “Your patient’s will all be great problem solvers when we diagnose their dementia.”   She delivered a message of the importance of older patients maintaining a social network of friends and family that provided the stimulation rather than relying on computer games and brain teasers.  Like everything else in medicine, time and research modify your approach as to what works.

Two studies published in the Journal of Geriatric Psychiatry promoted the use of regular puzzle attempts by seniors. The first by Helen Brooker, Ph.D. from Exeter in the United Kingdom showing that older adults who regularly use word and number puzzles have higher cognitive functioning than those who do not.  She looked at 19,000 plus cognitively healthy individuals aged 50-93 years.  Participants self-reported their frequency of playing word puzzles.  Their frequency of performing word puzzles correlated positively with 14 measures of cognitive function.  They then compared individuals who used number puzzles against those who did not and found similar positive results for the puzzle participants.

Clearly being able to enjoy solving puzzles is correlated with beneficial cognitive performance. It is probably one piece of a larger puzzle including socialization, healthy lifestyle choices, genetics and human interaction that contributes to overall health.

Sunscreen Ingredients are Absorbed says FDA

For years public health officials, dermatologists and primary care physicians have been encouraging people to apply sunscreen before going out into the outdoors to reduce the risk of sunburn and skin cancers.  We are taught to apply it in advance of exposure by about 30 minutes and to reapply it every few hours especially if we are sweating and swimming.   Living in South Florida, sun exposure is a constant problem so we tend to wear long sleeve clothing with tight woven fabrics to reduce sun exposure.  My 15-month old grandson, visiting last weekend was smeared with sunscreen by his well-meaning parents before we went out to the children’s playground nearby.

These precautions seemed reasonable and sensible until an article appeared in JAMA Dermatology recently.  An article authored by M. Mata, PhD. evaluated the absorption of the chemical constituents of sunscreen after applying it as directed four times per day.  The article was accompanied by a supporting editorial from Robert M. Cliff M.D., a former commissioner in the FDA and now with Duke University School of Medicine and K. Shanika, M.D., PhD.

The study applied sunscreen four times a day to 24 subjects. Blood levels were drawn to assess absorption of the sunscreen products avobenzene, oxybenzone and octocrylene.  The results of the blood testing showed that the levels of these chemicals far exceeded the recommended dosages by multiples. The problem is that no one has evaluated these chemicals to see if at those doses it is safe or toxic causing illness?

The editorial accompanying the findings encourages the public to keep using sunscreen but cautions that the FDA and researchers must quickly find out if exposure to these levels is safe for us?  We do know that the chemical oxybenzone causes permanent bleaching and damage to coral reefs in the ocean from small amounts deposited by swimmers coated with sunscreen. The state of Hawaii has actually banned sunscreens containing oxybenzone to protect their coral reefs.

The fact that these chemicals have been approved and are strongly absorbed with no idea of the consequences is solely the result of elected officials wanting “small government” and reducing funding to the oversight organizations responsible for making sure what we use is not toxic.  It is a classic example of greed and profit over public safety.  The research on the safety of these chemicals must be funded and addressed soon. The American Academy of Pediatrics and Dermatology need to advise parents of youngsters whose minds and bodies are in the development and growth stages what is best to do for their children – sooner rather than later.

Fever Blisters or Herpes Simplex Labialis Treatment with Honey versus Acyclovir

Herpes Simplex lesions cause mouth and gum ulcers and fever blisters. In order for the virus to be activated it requires exposure to sunlight. As these ulcerations appear they are painful, unsightly and the virus can be transmitted person to person.  Modern day treatment has consisted of taking an antiviral medicine such as Acyclovir in topical form applied four to six times per day for seven days. The medication reduces the healing time and pain in this infection.

Researchers in New Zealand decided to test their home grown Kanuka Honey versus Acyclovir in the treatment of herpes labialis. They randomized 952 adults who presented to community pharmacies with herpes labialis over a two year period to two groups.  One group received a traditional acyclovir 5% cream, the other kanuka honey (90%), and glycerin cream (10%). They applied their medication five times daily.

They then observed how long it took for the infected and involved skin to return to normal and pain resolution.  It took 8-9 days for the acyclovir to work and 8-9 days for the kanuka honey to return skin to normal appearance. There were no differences in pain observations or time for the open wound to close.

A large jar of Kanuka honey costs $60 by ordering online. A 15-gram tube of 5% acyclovir topical ointment sells for $379.99 locally.

Summer Insects, Ticks & Insect Repellant

As our climate warms, and we enter the summer season, the pathogens we face taking a walk outside have changed as well.  Recently in the northeastern US an individual walking through a well-manicured lawn in the mid-day sun was bitten by a type of disease spreading tick called the worrying long-horned tick never before seen in that region. Ticks primarily attacked in shaded areas with long uncut grass and shrubs. This is a new distribution of tick locations and behavior.

Mosquito borne diseases such as Zika (no reported cases in Broward, Dade or Palm Beach Counties in 2019), Chickengunya fever and even Yellow Fever are common in the Caribbean and parts of Central and South America. For this reason, the release of Consumer Reports’ recommended insect repellants prior to us spending more time outside in the summer weather is always of interest.

Consumer Reports emphasized that its top-rated products all contained either DEET, Picardin or Oil of Lemon Eucalyptus. DEET should have a concentration of 25-30% to be most effective and is considered safe at that strength.  Picardin is a synthetic relative of the black pepper plant and is suggested in the 20% range.  Oil of Lemon Eucalyptus should be in the 30% range.

Interestingly, Oil of Lemon Eucalyptus, a natural occurring product, is the only chemical not yet tested for safety in young children.  It consequently should not be used in children three years of age or younger. Sprays were felt to be more effective than creams or lotions.  In all cases they recommend spraying it on exposed skin and the outside of clothing – never on the skin under areas covered by clothing.  Don’t use the product near food and wash your hands after applying.

Their top two rated products were Total Home (CVS) Woodland Scent Insect Repellent, an aerosol spray containing 30% DEET and selling for $6.50 and Off Deep Woods Insect Repellent VIII Dry for $8.50 containing 25% DEET.   Rated right below these two was Repel and Oil of Lemon Eucalyptus pump spray for $7 a bottle.

Consumer Reports has stopped testing products for Tick effectiveness because in the past they found that DEET and Picardin products which protected against mosquitoes also protected against tick bites. They emphasized wearing shoes and socks, long pants and sleeves and spraying insecticide externally on the clothing helped protect against tick bites.  They advised seeing a physician quickly if you contract a tick bite. They additionally discussed the fact that many of these recommended insect products stained the very clothing you applied it to as protection.  These warnings are listed in their product ratings.

Consumer Reports Releases Sunscreen Ratings

Periodically, Consumer Reports aggressively reviews and tests sunscreens for effectiveness. Last month they posted their 2019 ratings.

The report was divided into creams and lotions versus sprays.   To test each sunscreen, they applied it to human skin then soaked the skin in water to duplicate the effects of swimming and sweat. They then exposed the volunteers to sunlight.  To cover the skin adequately they used about a shot glass worth of sunscreen on bodies wearing a bathing suit. They said this approximated using one teaspoon per body part area such as one teaspoon for your face, one teaspoon for your head and neck, one teaspoon for each arm and leg etc.

Their top-rated lotion was La Roche-Posay Anthelios 60 Melt In Sunscreen giving it a rating of 100.  A tube costs $36.  The next highest rated was BullFrog Land Sort Quik Gel SPF 50.  It was given a rating of 95 and only costs $13 for a bottle.

Consumer Reports also rated spray sunscreens. To properly apply the spray they suggested holding the nozzle close to the skin and then spraying until the skin glistens. At that point they advise rubbing it in even if the product is advertised as a “no rub“ product.  Once this is done, they suggest repeating the process. They emphasize to never spray directly into the face or eyes. They suggest trying to refrain from inhaling the spray which is why spray sunscreen is not recommended for children.  Their favorite spray choice is Trader Joe’s Spray SPF 50+.  It gets a rating of 100 and sells for $6.  They describe it as having a beach aroma in a combination of floral and citrus scents.   Banana Boat SunComfort Clear UltraMIst Spray SPF 50+ received a score of 96 and is priced at $13.

This past year research has shown that several sunscreen ingredients including oxybenzone are absorbed and achieve blood serum levels at much higher numbers than anticipated.  Oxybenzone is now forbidden in sunscreens used in the state of Hawaii because small amounts of bleach which can kill their coral reefs. There are now sunscreens without Oxybenzone.  Walgreens Hydrating Lotion SPF 50 achieved a score of 74 and has none of the offending ingredient.  It sells for $3. Hawaiian Tropic Sheer Touch Ultra Radiance Lotion SPF 50 achieved a score of 70 and cost only $8.

Mineral or barrier sunscreens composed of titanium dioxide and zinc oxide are known to be safe in major studies.  Consumer Reports believes these products do not provide as much protection as the products containing oxybenzone and similar active absorbable chemical.  “Some provide adequate SPF protection but not enough UVA protection and vice versa.”  The mineral sunscreens that performed admirably in their tests include California Kids # Supersensitive Lotion SPF 30+ for $20 and BadgerActive Natural Mineral Cream SPF 30 for $16.