Lyme disease (named for Lyme, Connecticut where it was first described) is an infection carried by Deer Ticks that can cause a skin rash, as well as serious nerve, heart and brain problems. The infection is most common in late spring or summer and in most people the first sign is a flat or raised skin bump that slowly gets bigger, often with clearing of the rash in the middle, resembling a target. It is diagnosed by recognizing the rash, and/or blood tests. It is not spread from human to human.

According to State of Wisconsin public health officials, a warmer spring can increase tick activity and therefore Lyme disease. If you think you might have Lyme disease you should see your health care provider, but it is sometimes tricky to diagnose and difficult to treat. Therefore, it is important to reduce the chance of tick bites that cause Lyme disease in the first place.

Here is how to prevent Lyme disease (or other infections spread by ticks):

• Avoid areas where there are a lot of ticks if possible
• If you do get a tick on you, remove it as soon as possible by grabbing it with a tweezers as close to the skin as possible and slowly pulling it off (other techniques such as a smoldering match or kerosene might cause the tick to pass along the infection earlier by irritating it)
• Wear light-colored clothing so that ticks can be more easily seen and removed (the ticks don’t usually pass along the infection until they have been attached for a day or more)
• When in a tick-infested area, use tick repellent and examine yourself daily to look for and remove ticks
• There used to be a vaccine for Lyme, but it was discontinued due to some reports of joint reactions and a low demand

One of the most frequent questions I get in the Ask a Question section of Proven Health Ways is:  How do I stay healthy when traveling abroad?

Strategies to protect your health while traveling include vaccinations, avoiding times of political unrest or violence, protection from infection from insect bites, and food/water cautions. Some vaccines need at least 4-6 weeks to work well, so it is important to plan ahead.

One excellent resource for information about travelling anywhere in the world is the Centers for Disease Control (CDC) website. Go to www.cdc.gov, click on “Travelers’ Health” and then “Destinations” to see what is recommended for your planned destination.  Then call your primary care provider or travel clinic to see how you can get the vaccines you need.

As to the reader’s specific question: Yes, TWINRIX (a combined vaccine for Hepatitis A and Hepatitis B) would be a good idea before travelling to Jamaica, either in the usual schedule of 0, 1 and 6 months, or an an accelerated schedule of 0, 7 and 21 days (and a booster at 1 year).

Because she was a new patient to me, I asked for more information. I found out from her and her reliable caretakers that she had never actually been sexually active. You can imagine her relief when I told her that she did not need Pap tests because research indicates that only women who have had sexual intercourse are at significant risk for developing cancer of the cervix.

So who needs to have Pap tests done, and who doesn’t? The US Preventive Services Taskforce sums it up well:

Pap tests are strongly recommended for all women who have been sexually active and have a cervix (the part of the uterus that is tested with a Pap) .

· When should you start having Paps? Start at age 21, or three years after starting sexual activity, which ever comes first.

· How often should you have Paps? Every 3 years appears to be just as beneficial as having them every year.

· When can you stop? Since cervical cancer is less likely after middle age, stopping Pap tests at age 65 makes sense if recent tests have been done and were normal.

Check with your doctor or nurse practitioner to see if Pap tests are right for you. Visit Proven Health Ways for more information about Pap tests and other prevention activities.

Whoever submitted this question is wise to question the advertised claims. Remember that what happens in a research lab with plants or animals does not necessarily predict what will happen in people.

I just did a review of the literature and found absolutely no conclusive research that the Acai Berry leads to any positive health outcomes in people. If anyone knows of any studies (actual research, not just reports of someone experiencing benefits), please submit a reference, and I’d be happy to evaluate the study and comment on what if any evidence it provides.

Salted water to cover
2 large russet potatoes, peeled, cut into six or eight same-size pieces

2 tablespoons butter
1 teaspoon fennel seed, crushed (or fennel powder, I used a mixture)
Salt & pepper
1 large fennel bulb, outside layer trimmed if needed, cored, chopped roughly in fairly big pieces (save some of the frond for garnish)
1/2 cup half ‘n’ half (or fat free half ‘n’ half, the inspiring recipe called for at least 1 cup, how much is used may depend on the relative moisture in the cooked potatoes as much as taste preferences)
More salt & pepper to taste (if needed)

Bring the water to a boil. Add the potatoes as they’re prepped. (If you do the prep work in advance, peel the potatoes and so they don’t brown, cover with cold UNSALTED water. Replace the water before beginning to cook.) Cover and cook til tender, about 15 minutes. Drain. (Here, the inspiring recipe called for returning the potatoes to the hot pan and cooking for a few minutes more to dry a bit. I liked this step but not sure it made a pile of difference so you might want to try it yourself to see.)

While the potatoes cook (or 2-3 hours in advance if you like), melt the butter and fennel seed on MEDIUM in a skillet til shimmery, let bubble a minute. Add the fennel, sprinkle with salt and pepper, stir well to coat with fat and disperse the salt. Cook softly for 15-20 minutes, til soft but not brown. (If you’re prepping ahead, stop here.) Add the half ‘n’ half until just beginning to bubble.

Mash the potatoes with a masher or a hand mixer (NOT a food processor which creates gum). Stir in the fennel-cream mixture. Season to taste and serve.

Ingredients (use vegan versions):

1 can French cut green beans
1 1/2 canisters vegan French fried onions
1 1/2 cups soy milk
1 cube veggie bouillon
2-3 tablespoons corn starch (or potato starch) mixed with 2-3 tablespoons cold water to use as a thickener
1/2 medium onion, diced
1 carrot, diced
3/4 cup chopped mushrooms (button, crimini, portabella, whatever)
1-2 tablespoons vegetable oil
1/2 teaspoon each of garlic, salt, pepper, basil, oregano, sage, marjoram, thyme,
whatever other hearty herbs make you happy

Directions:

This is meant to be a vegan version of the traditional green bean casserole served at holidays, etc., for those of you who loved it and were sad to not have it at the holidays once you went vegan. Many of my non-veggie friends like this better than traditional green bean casserole because it has more veggies and more herbs and spices.

Heat soy milk and veggie bouillon in a saucepan, stirring until bouillon cube disintegrates. Do not boil or scald the soy milk. Just heat it.

Sauté onions, carrots, and mushrooms in the veggie oil in a skillet. Add salt, pepper, and herbs and spices.

Mix the starch and water well, and pour into the soymilk/bouillon. Stir well, because this will coagulate pretty quickly. Quickly add the can of green beans, the sautéed veggies, and about half of your French fried onions, and stir well.

Pour that mixture into a casserole dish or pan and top with remaining French fried onions. Bake in oven at about 350 degrees for 10-15 minutes, until the onions begin to brown. Remove. Eat. Enjoy.

Makes: 4-6 servings, Preparation time: 10 minutes, Cooking time: 20 minutes

• Prior recommendation: Routine mammograms every 1-2 years for women 40 years and older
• New recommendation: Age 40-49: Consider mammograms every 2 years on an individual basis, taking into account patient values and risk factors, but don’t just do it routinely for everyone. Age 50-74: Routine mammograms every 2 years.  Age 75 and over: Whether or not mammograms are helpful is unknown

These new recommendations have made quite a stir, and led to more than a little confusion among patients as well as health care providers. So how do we make sense out of a group like the USPSTF, which I have found to be more objective and thorough than most, making such recommendations like these that not everyone agrees with?

First, it is important to understand that there is no absolute right or wrong here; it is a matter of balancing the possible benefits and harms, and making a judgment. For example, I do not think anyone reading this would recommend that all women have mammograms every month starting at age 21. But why not? Wouldn’t it save more lives from breast cancer, compared to screening less often or waiting until age 40 or 50? Of course it would. But the cost of doing monthly mammograms at these young ages would be relatively high in terms of radiation exposure, biopsies for false positive tests, and money, and the benefit would be relatively small because breast cancer is very rare at younger ages.

So where do you draw the line? When should we health care providers start recommending that women have mammograms? Again, there is no right or wrong answer to this, and professional organizations have different ways of deciding what they are going to recommend. I would say that talking about it with our female patients age 40-49, rather than routinely recommending it, is a rational approach based on good research. It also involves some degree of judgment, and therefore is a position that reasonable people could reasonably disagree on.

Finally, this guideline, like all guidelines, can and should be used thoughtfully and skillfully by primary care providers in consideration of their patients’ needs and preferences. Remember, guidelines are written for populations, but applied to individuals.

Baked Cauliflower with Garlic and Spices

Ingredients:

1 head cauliflower
1/2 cup vegetable broth
1 clove garlic
1/4 tsp thyme
pepper to taste, about 1/2 tsp

Directions:

Preheat oven to 400 degrees. Break cauliflower into desirable sized pieces and place into baking dish. Mince garlic and add to remaining ingredients. Then mix all ingredients together with cauliflower, until there is an even coat of broth and seasoning on each piece of cauliflower. Bake at 400 degrees for about 40-45 minutes, stirring half way through.

Number of Servings: 6

Serving size, 1/2 cup

Nutritional Info per serving
Fat: 0.2g
Carbohydrates: 5.7g
Calories: 27.2
Protein: 2.0g

Avocado and Orange Spinach Salad with Sweet Mustard Dressing

Ingredients:

1 orange
1 avocado
1/2 small shallot
1 large bunch de-stemmed spinach, or 1 bag fresh

Sweet Mustard Dressing:
1/2 cup red wine vinegar
1 tsp. mustard powder (to taste)
2 tbsp. olive oil
1 tsp sugar

salt and pepper to taste

Directions
Place spinach, shallot, and orange into a salad bowl and toss until ingredients are evenly dispersed. Place sliced avocado on the top of the salad before serving.

Serve with Sweet Mustard Dressing

Nutritional Information:

Serving size: 1/2 cup. Makes 8 servings.
Fat: 6.9g
Carbohydrates: 7.9g
Calories: 92.5
Protein: 1.9g

As a practicing family physician, I have often heard from women that mammography, in which the breasts are compressed in order to x-ray, is uncomfortable. Occasionally, women have actually declined to get this life-saving measure due to this discomfort. This experience is not universal, however, and many women have told me that while not a pleasant experience, mammography is not painful, and the benefit is clearly worth it.

Many strong research studies have shown that mammography saves lives in women 40 and over; about a third fewer deaths from breast cancer over seven years on average. In some of these studies, mammograms were done along with breast exams by healthcare providers, called “clinical breast exams,” and these studies showed a benefit as well. I have to qualify this next statement by saying that I am not a woman and have never had a clinical breast exam or a mammogram, but I would guess that in most if not all cases, clinical breast exams would be more comfortable than mammograms.

So an obvious question would be “Are clinical breast exams effective by themselves in reducing deaths from breast cancer?” Unfortunately, the research on this question does not provide strong evidence one way or the other, so we just don’t know. Similarly, we do not know one way or the other if breast self exams by women are effective in reducing deaths from breast cancer.

Another possible screening test for breast cancer is magnetic resonance imaging, or MRI. The MRI is more comfortable than a mammogram because the breast is not sandwiched in between two plates, but it is also more expensive (about 20 times more) and produces more tests that are positive when there is no cancer present (false positives) than mammograms do. MRI’s are therefore not recommended routinely for screening, although some recommend them in addition to mammograms as being worth the cost in women at very high risk.

In summary, mammograms, while uncomfortable for many and very uncomfortable for some, are still the best way to screen for breast cancer. If they are very uncomfortable for you, you will just need to decide if they are worth the decreased risk of this potentially deadly disease.

One final note that may be good news is that getting mammograms done every two years seems to be as effective as doing them every year in most women.