Richard P. Holm, MD
When we say “tick” in the clinic, we’re not talking about unusual twitches or the recurring beat of a clock. Usually tick-talk is about a group of small bloodsucking and disease-spreading bugs. Ticks are cousins to spiders, mites, and scorpions, and these buggers are NOT insects. Insects have three segments to their bodies and six legs, while ticks have fused bodies with two segments and eight legs. Ticks are distinguished by how they grab onto passing animals and climb upwards to find a dark quiet spot to suck their victim’s blood. Common carriers of ticks are mice, squirrels, cats, dogs, and deer.
Entomologists estimate that ticks evolved into blood-feeding parasites about 120 million years ago; 3500 years ago, tick fever was described by Egyptians, and 2500 years ago, Homer wrote about ticks on Ulysses’ dog. These they are found throughout the world, especially in warm and humid climates. Ticks require a blood meal, and, be warned, most illnesses are spread by these tiny, smaller than a sesame seed, bugs.
Ticks carry various infectious diseases[i] which they inject into animals and humans. Every year, more than 40,000 cases of tick-borne illness is reported in people in the U.S., but the CDC estimates that ten times that number of cases go unreported. The worse news is that ticks are expanding their territories and the number of diseases they spread are increasing. In our part of the country, we have the American dog tick (often incorrectly called the wood tick) which carries Rocky Mountain spotted fever and Tularemia. In Minnesota and Wisconsin the blacklegged tick carries Lyme disease, ehrlichiosis, and babesiosis. In the Black Hills, Colorado, and Montana the Rocky Mountain wood tick carries Colorado tick fever.
We encourage outside activity, but preventative measures should be taken whenever going outside into grass, weeds, garden, or woods. In the spring and summer, tuck pants into socks so the buggers can’t climb up into private areas; apply tick repellant on lower clothing; and check for ticks at the end of the day. Remove these suckers with tweezers, pinching as closely to the point of attachment as possible and gently pulling until she lets go, while avoiding squeezing the body of the tick. Antibiotics should be started if any rash, fever, or illness follows a tick bite.
Spring is coming soon, so be prepared for a tick attack.
It was a gift from a patient who decided, after nearly 20 years of my encouraging, cajoling, and quite frankly nagging, that it was finally time to give them up. That’s the thing about changing habits. Sometimes it takes a long time.
We have different ways of understanding how people approach change. One of the most universally used is something we call “the stages of change.” People move from not being willing to even consider the downsides of their current habits, to seeing those downsides and weighing the advantages of a change, to making plans to develop new behaviors, and then to actively practicing these new habits. From my perspective, “practice” is the often under emphasized concept there. Developing new habits, and breaking old ones, takes lots and lots of practice.
Whatever your goal is— becoming a non-smoker, losing weight, completing your first marathon, or even cleaning out your garage— it helps to have a concrete plan of action. Expect setbacks. I like to tell my patients that babies don’t learn to walk overnight. First, they roll, then they sit, then they crawl, then they cruise along the furniture, and finally they take those first unsteady steps. It takes them about a year to get to that point. Along the way, they fall, a lot. But they keep getting back up to try it again, and in what seems like the blink of an eye, they start running away from you at bedtime.
There are some take home lessons in that story. First, change is a process. A daunting challenge is more approachable if you break it down into smaller, incremental steps. “Getting healthy” is hard. Getting to bed half an hour earlier is easier. Second, consider yourself a learner. I love to encourage smokers not to think of it as quitting smoking, but as learning to be a non-smoker. If you are quitting, and you have a cigarette with your coffee, it’s tempting to decide you’ve failed and throw in the towel. If you view it instead as learning not to smoke, it’s easier to finish that cigarette, and try again.
Learners aren’t failures when they haven’t mastered their topic. If you smoke that cigarette, ask yourself “why?” And then ask yourself, “what can I do instead, next time?” Keep asking yourself those questions. Keep getting back up. Keep trying again.
Tenacity pays off. I have a pack of cigarettes to prove it.
by Jill Kruse DO
When I was in my third year of medical school, I learned one of my most important lessons. It did not come from a textbook or from a teacher, but from a brief conversation with a patient on hospital rounds.
“How long have you had diabetes?” I asked. It was a simple enough question. Diabetes often progressed with time and the longer it was present, the longer the cumulative damage. I wanted to gauge if his foot infection was a new issue or part of a larger battle that had been going on for months to years. “Thank you,” he said. I was confused. “Thank you for what?” I asked. That was not the expected answer. “For asking me how long I had diabetes and not calling me a diabetic,” he said. For all intents and purposes, for me as a third-year medical student, the questions were identical. I did not realize there would be any significance to the phrase I chose.
My patient continued, “Diabetes is something that I have, not who I am. It does not define me. I am so much more than this disease.” This gentleman’s, my patient’s, comment made me pause. When I walked into his room I had a lot of data about him, but no knowledge of him.
He went on to tell me about his life, his family, his prior job. He spoke of all the things that changed after his diagnosis and all the things that stayed the same. He no longer was the “diabetic in room 26”, a task that I must complete, he was a person who needed my help. He had a name and a rich history that the medical chart did not record. This quick conversation completely changed how I interacted with him for the rest of his stay in the hospital and every patient I have encountered since.
I have a gentle reminder for you and me, like my gentleman gave me all those years ago: you are not a disease or a chronic illness; you are a person who is looking for help to improve your health. It is easy to let a chronic illness become one’s identity and become the only subject discussed at a clinic visit. Remind us that there is so much more to your story, because sometimes we get busy and forget; we are human too.
Throughout my years of caring for people, many seem caught in the deep-seated joy-starving depression. I have seen the devastation from that awful diagnosis involve not only those sad and melancholy, but greatly affect those around them. For those who are 18 to 45 years of age, depression is the number one cause for disability, resulting in an estimated 200-plus billion dollars of lost earnings per year. I have looked on aghast when depression caused such helplessness that the patient chose to escape life with suicide. There are about 40,000 deaths per year to suicide, which accounts for about the same number of deaths resulting from breast cancer. Despite a similar death rate, the money invested in depression research is about one percent of that spent studying breast cancer.
Science has not yet defined why depression occurs, but theoretical causes for this malady include a genetic predisposition, a learned process, a troubled childhood and adolescence, a stressful environment, sad or traumatic situations, addiction, or even not enough sun. Most of us periodically have what is called “situational depression,” such as the appropriate sadness that follows severe loss or death of a loved one. What is more typical of harmful depression is when there is no “situation,” no reason for it to happen, no sad story to explain why one is filled with sadness. When the patient says, “there is no reason for my being so sad,” then the clinician knows there is a problem.
The diagnosis is not always that easy. We physicians often suspect depression when people experience chronic pain, find it hard to concentrate, are without energy, have flares of temper, sleep too much or too little, have a loss of appetite or have over-eating binges, have unexplained crying spells, or become filled with anxiety for minimal reasons. People often make things worse by covering-up depression with alcohol, sleeping pills, anti-anxiety medications, or substance abuse, and these meds all make the diagnosis even more difficult.
Two-thirds of people with depression do not seek or receive help. But when the one-third that do get help follow-through with treatment, 80% are better in four to six weeks. There is help and hope for those with this miserable condition, but people need to be open to the possibility of such a problem (and men are usually the worst deniers). Treatment typically includes a half-hour of exercise or walking daily, someone to talk to, and often a medication with minimal side-effects.
If you are possibly struggling with depression, please get help. At least do it for those around you.