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Lyme Disease in the Age of COVID-19

As much of the world has been focusing on the COVID pandemic, many of us are sitting at home for many more hours than we are used to.  We’ve been given this unique opportunity to go outside and visit nature regularly. It’s a good way to combat cabin fever, remain physically active and care for our emotional needs during these times of worry and uncertainty.  

Every day I witness the streets around my home being filled with neighbors I rarely see, families on walks together, kids on skateboards and scooters.  It’s a busy scene for a usually quiet town, and as I try and look for the positive things during these times, this is a beautiful one to witness: that we are all walking more, being with our families and breathing in fresh air.  

Given all the fear and uncertainty around the coronavirus pandemic, as an Integrative Physician with a focus on Lyme Disease in my medical practice, I felt compelled to share critical information so that you don’t get Lyme.  This information is useful, even if you’ve had Lyme before, or have it now, you don’t want to get it again! (And if you are struggling with chronic Lyme, I have some ideas for you, too)

Deer ticks are transmitters of various diseases in our area including Lyme, Babesia, Bartonella, Anaplasmosis, Relapsing Fever and Powassan virus.  This is not just a cause for concern in the spring and summer as conventional thinking goes. Their activity is dependent on the weather. With climate change afoot I see cases all year round.  Most people think ticks are killed off by freezing temperature but in fact, they just go through a stasis period. When the right conditions come about, they reanimate and come to life again.  

Here are some simple things to keep in mind as we approach high season for tick-borne illnesses:

  1. Temperatures: Deer ticks can be active in temperatures above 32-35 degrees when the ground is thawed and not covered in snow.  This is now. Don’t let your guard down just because you still need a down coat.
  2. Location: It’s common knowledge that ticks are found in the woods or specifically in shrubs, leaf litter, rock walls.  However I’ve had many patients get lyme disease from just being on sunny lawn. We are ground zero for Lyme disease, expect the rules to bend and that it’s easier to transmit traditionally thought.
  3. Family Pets: I’ve had patients who have been outside only on concrete and had Lyme disease.  We forget that our animals can bring ticks into the home. They should be checked regularly.  I believe that pets that get treated with medications like Frontline may tend to protect the animal but they make it more likely for a tick not to attach to them but to someone at home. 

What You Can Do To Protect Yourself Against Ticks 

  1. Tick Checks: If you are out in nature make sure you make it a routine to check yourself over.  Oftentimes we are good at checking our children but we forgo ourselves in the interests of time.  I’ve been guilty of that, too.
  2. Deer Fencing: This is incredibly helpful if you are able to have one on your property but it’s not foolproof as smaller animals can bring in ticks. The transmission rates can be reduced by 83-97%.
  3. Clothing: I avoid the use of more toxic insect repellants like permethrin BUT I do like the manufacturers that have bound the permethrin into the clothing fiber.  I do not believe this is absorbed into the body and it can last up to 70 washings and still remain effective. Socks are some of the easiest ways to bring protection into your daily life but other garments such as a hat (since ticks are hard to find on the scalp) are great ideas as well.  Of course you can dress yourself head to toe in clothing and tuck your pants into your socks but who wants to do this when it’s hot. I need my tank top and some vitamin D! 

You’ve Been Bitten by a Tick – What Should You Do? 

While knowledge and prevention can go a long way, ticks are tiny and omnipresent.  Here’s what to do if you find you’ve been bitten by a tick.  

  1. Having the right tools at home or travel when you need them is imperative.  There are many companies that make a tiny portable collection kit complete with tweezers, magnifying glass, picture identification guides and a specimen container. 
    If you are concerned about transmission you should keep the tick and bring it to your doctor for testing.  Most doctors, however, test only for Borrelia Burgdorferi (Lyme) but they don’t look for the other tick-borne infections.  I advise patients to use a company in Pennsylvania called Tick Checks where you send it in directly and have your tick checked for a multitude of pathogens with results in less than 48 hours.
  2. While there are no clinical studies that support the use of topical essential oils after a tick bite, I would still recommend the topical application of clove, cinnamon bark or oregano oil based on in-vitro studies of their activity against Borrelia infections.  It certainly can’t hurt.
  3. Once you get bitten there is no great test to detect early Lyme disease.  Traditional methods become accurate 4-6 weeks after the bite. There are controversial tests that can be done but it’s a gray area where you have to make decisions on treatment based on the clinical scenario. 
  4. After a delay of 3-30 days, be on the lookout for Erythema migrans (EM) rash (Bullseye rash) which can begin at the site of a tick bite, although many people do not have a rash at all. Over the next 4-6 weeks look for symptoms of fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes may occur in the absence of rash. See your doctor should you experience any of these symptoms. 

You Have Chronic Lyme – Concerns about COVID

Dr Yee has been treating chronic Lyme for two decades using an Integrative approach that is especially critical during the COVID pandemic as people with Lyme often have a compromised immune system.  Each person with Lyme needs a personalized approach that includes:

  1. Supporting the immune system 
  2. Assessing the best antibiotic regimen
  3. Integrating or replacing antibiotics with herbal protocols
  4. Protecting the gut during antibiotic treatment
  5. Other options for testing and treatment that your conventional lyme doc might not  know about.
  6. Checking aggressively for other tick infections that might have been missed.

If you have Lyme Disease and would like to see Dr Yee, she is now accepting new patients via Telemedicine.  CLICK HERE to set up a call and learn more about how Dr. Yee can help.  

Pamela Yee, MD is an Integrative Physician at Blum Center for Health in Rye Brook, NY where she creates highly personalized treatment plans for each of her patients. Dr. Yee has a special interest in integrative cancer care, immune disorders, and lyme disease. She lives in Nyack NY where she and her husband manage their own organic micro-farm.

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{Recipe} Dr. Yee’s Fire Cider Brew

First, hand sanitizer became liquid gold. Then toilet paper, another commodity whose worth has skyrocketed all in an effort for people to feel safe and well-stocked.  Now, herbal and nutraceutical solutions for improved immunity have also flown off the shelves of health food stores. Finding them online has proven to be just as difficult.  Everything is BACKORDERED.  

In every single conversation I’ve had with patients these past few weeks, everyone wants to know what they can do to improve how well their immune system can prevent infection.   Recently, Dr Susan Blum had given her tips to boost immunity, and it’s a great start. If you are having a hard time procuring any of these products, read on for what I do personally to boost my immune system. 

For years, I have been taking a simple regimen of medicinal mushrooms at high doses. This year, long before coronavirus became the prevailing thought in each and everyone minds, I added a tablespoon of fire brewed apple cider vinegar to my regimen each evening and I have to say it has been extremely effective.  Granted, this is a “N-of-1” anecdotal report, but I feel quite strongly about it.  

Apple cider vinegar has been used as one of most common home remedies for a wide variety of health conditions from reflux to yeast infections to sunburns.  There is some pre-clinical data showing its efficacy as an anti-viral, anti-fungal and anti-bacterial agent but there is no hard clinical proof here. Typically I don’t recommend things without some level of evidence but here we are – empty shelves and backordered items.  It’s been working for me and its dirt cheap! 

You can find locally crafted concoctions of Fire Cider in health food stores and farmers markets but I like to make it at home.  Try this recipe while you are home social distancing and in a few short weeks you’ll have your own Fire Cider brew to boost your immunity as we get back to normalcy.  Wishing you good health! 

Recipe: Fire Cider Brew

(adapted from Rosemary Gladstar’s recipe)

Ingredients:

  • ½ cup grated fresh horseradish root
  • ½ cup or more fresh chopped onions
  • ¼ cup or more chopped garlic
  • ¼ cup or more grated ginger
  • 1 Tbs Turmeric 
  • 2-3 Tbs Honey
  • Chopped fresh or dried cayenne pepper ‘to taste’. Can be whole or powdered. 

Directions: 

  1. Place herbs in a half-gallon canning jar and cover with enough raw unpasteurized apple cider vinegar to cover the herbs by at least three to four inches. Cover tightly with a tight fitting lid.
  2. Place jar in a warm place and let it sit for three to four weeks. Best to shake every day.  
  3. After three to four weeks, strain out the herbs, and reserve the liquid.
  4. Add honey ‘to taste’. Warm the honey first so it mixes in well. 
  5. Rebottle and enjoy! Fire Cider will keep for several months unrefrigerated if stored in a cool pantry. 
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Intermittent Fasting and Autoimmunity

Many millennia before fasting became of interest for medical reasons, the practice of fasting — abstaining from all meals — was seen as a way to achieve a higher spiritual purpose.

The main religions often have annual fasts, and some have rites of passage, that include fasting so that one can undergo “purification.” The Hindus and Buddhists do, “atonement” through the Jewish tradition of Yom Kippur or the Catholic tradition of Lent, for clarity of religious purpose or become close to God as the Muslims do for Ramadan. And so on.

It is clear, through the passage of time and tradition, that there is a benefit – spiritual, emotional, and sometimes physical – to the practice of fasting.

Recently, fasting has become vogue but it is stemming from the resurgent scientific literature showing great promise in various fields including cancer therapy, metabolic diseases like diabetes and obesity, and an anti-aging and longevity practice, cardiovascular disease, neurodegenerative disease like Alzheimer’s and dementia and autoimmunity.

The definition of fasting is the abstinence of food, drink or both. The various fasting that science is starting to look at has much more nuance to it than just plain not eating.

The popular 5:2 intermittent fast for weight loss was popularized first in the UK. It features a normal eating schedule 5 days a week and 2 days of the week calories are restricted to about 500.  

The more specific intermittent fast, known as time-restricted feeding, has now been gaining more momentum. With intermittent fasting, you abstain from eating for anywhere from 13-16 hours of the day and keep food consumption during the other hours.

The weight loss that occurs with this approach is supported by studies stemming from Dr. Satchin Panda’s work at the Salk Institute. His research looks at the connection between the time you don’t eat and how it plays into the workings of the circadian rhythm, our internal clocks that can govern metabolism and sleep, for example. Recently, the University of Illinois at Chicago enlisted 23 obese volunteers and had them eat only between 10AM and 6PM. They lost weight and dropped their blood pressure significantly.¹

At the other extreme of fasting are those that abstain from anything aside from water sometimes for a day, but sometimes up to 7-10 days. Other variations include bone broth or vegetable broth fasts often diluted. And there are now low calorie versions of packaged fasts called “fasting mimicking diets” that are essentially 500 cal per day over five days.  

Promising Research on Fasting & Autoimmunity

The only study that looked at the role of fasting on autoimmunity in humans were on people who fasted for Ramadan, the ninth month of the Islamic calendar. Fasting periods are typically around 12-16 hours but there is variation set by the individual. A systemic review did find a mild effect on the immune system but that was transient and returned to baseline once they resumed their regular eating schedule. Lipids improved in some and there was a reduction of oxidative stress markers in others.²

The most persuasive evidence of the benefits of fasting on autoimmunity come from animal studies. Mice that were bred to mimic an autoimmune disease similar to Multiple Sclerosis were used in the study. Multiple sclerosis is a neurodegenerative disorder marked by the demyelination of neurons in the brain that affect nerve conduction. This is in part thought to be due to the body’s own immune system causing the damage.  

The mice were put into 2 groups, one a ketogenic diet (high-fat ultra low-carb) or a fasting mimicking diet (very low calorie and protein) for 3 days every 7 days for a month.

Researchers found was that mice on the fasting mimicking diet had reduced levels of inflammatory cytokines, increase in endogenous corticosteroids and improvements in T cell immunity. Aside from markers they saw that mice actually had REMYELINATION meaning the damaged components of the neurons regenerated what was damaged by the body’s autoimmune process. This was specifically though to happen during the re-feeding periods. Amazingly 20% of the mice had a complete recovery and all mice had a reduction in symptoms.³

This is certainly a very fascinating finding that will spur on further research to elucidate the utility of fasting in certain autoimmune conditions and we’ll hear more as time goes on.

I am big proponent of fasting in certain circumstances and I utilize the full spectrum of fasting methods in the right person. Would I have this discussion on fasting in an autoimmune patient, yes. But given the current data in autoimmunity it is not a methodology that I advocate early on.

Caution: Fasting is something that one can consider exploring on their own if they are not within the extremes of ages, healthy and without any active disease for which they are taking medication but if one does not fit in this category, it is advised that they seek the guidance of a knowledgeable  physician who can advise and monitor them through this process or to be able to assess if they are the right candidate to go through the process.

Do you have a health condition and wondering if fasting is right for you? If you live in our neighborhood, make an appointment with Dr. Yee. Or, if you live afar, consider a Tele-Education call. Send us an email for more information — > Email Now

 

References
  1. https://today.uic.edu/daily-fasting-works-for-weight-loss
  2. https://www.ncbi.nlm.nih.gov/pubmed/29230208
  3. https://www.ncbi.nlm.nih.gov/pubmed/29230208
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Protecting our Youth from Colorectal Cancers

cancer

By: Pamela Yee, M.D.

A photograph of a beautiful, vibrant, 22-year old woman with the following headline recently caught my eye: Colon and Rectal Cancers Rising in Young People (1). As reported by The New York TImes, the American Cancer Society cites an increase in the number of young adults developing colon cancer, a disease most associated with that of an aging population.

Interestingly, researchers are at a loss to explain this rise.

The connection is obvious to me.

I strongly believe our diet foremost, and plethora of toxic environmental exposures, cannot be ignored. These exposures, both food and environment, begin in the womb and continue throughout childhood.

The larger question is, how can we collectively get our children to develop good eating habits to set the stage for optimal health?

FOOD

What’s Changed? The MEDIA!

As a kid of the 70’s I witnessed the early blossoming of processed foods.  Doritos, Lucky Charms, Kool Aid and Twinkies were common kids’ staples and few spoke of organic food. But, coming from a family that immigrated from China, these foods were kept at bay since my Grandma home-cooked almost all meals. There was no need, or pressure, for convenience foods — they were seen as treats.

Also, the art of corporations marketing to children had just began taking off. The allure of characters beckoning children to sample their spaceship-shaped waffles or cookies bathed in food coloring could not readily reach children through TV and other media. I believe the kids I grew up with benefitted from this relative media innocence.

A crucial point in 1980 changed everything.  The Federal Trade Commission had been trying to set restrictions on advertising to children. Their argument was that young children could not discern commercials from entertainment programs and older children could not understand the long-term health consequences of eating lots of sugar.  But pressure from the sugar, toy, candy and cigarette industries and farmers growing wheat for sugared cereals, all swooped down to prevent this from happening.

In 1980, Congress passed an Act that “mandated that the FTC would no longer have any authority whatsoever to regulate advertising and marketing to children, leaving markets virtually free to target kids as they saw fit,” wrote Anna Lappe, author and food advocate.

This one act launched the onslaught of marketing to children, and morphed into the complex state it is today where movies create characters which then show up on cereal boxes, plastic toys and candy wrappers.  [To read more about this pivotal act in detail, you can read Anna Lappe’s take on it here.

It’s surprising there was no extended commentary on the New York Time’s report on why this increase in colorectal cancers are being seen in young adults, and that the reasons are “baffling.” To me it all boils down to the environmental change that has occurred over the last four decades. And if food is the “medicine” that we put in our bodies all day, processed by our gut and microbiome, it seems that there would be an association between diet and incidence of disease.  Of course we can wait and wait for further studies to elucidate or we can do something about it now.

HOW TO HELP OUR CHILDREN

ROLE MODELS

From a preventative sense, one of the most potent things we can do for ourselves, and for our children, is to set a behavior we want modeled.  The younger you start with children, obviously the better. But, discussions with older children about why and how food impacts how they feel are powerful. They may not take to them right away, but you are sending a verbal message that you then reinforce by walking the talk. If mom and dad are eating sugar or convenient processed foods on a regular basis how can you expect your children to take you seriously?

MEDIA

Another way we can help our children is to limit media.  Easier said than done, I know as tech is the easy babysitter we employ so that, as parents, we can do chores around the home or placate an angry toddler on an airplane.  But the more we rely on that easy solution the more detriment it imposes on our children, not only because of the advertising and marketing, but also on the very relationships parents have with their own children.

Catherine Steiner-Adair Ed.D, a clinical psychologist and expert in child development and education, wrote the book, The Big Disconnect: Protecting Child and Family Relationships in the Digital Age after extensive interviews with children and parents on how social media and technology change the way children learn, grow and make connections with others.  She also gives advice to parents and educators on how to deflect the detrimental effects of media on our children.

These suggestions can all translate to better eating — not only because of the reduction of media influences — but because it will force us to pause, parents included. When both parents and their children employ awareness and make conscious choices surrounding food, media and their relationships with one another, family health automatically comes to the forefront. Suddenly you will find that you’re at the dinner table, without your devices, and enjoying a meal together, conversation included.

Reference:

(1) https://www.nytimes.com/2017/02/28/well/live/colon-and-rectal-cancers-rising-in-young-people.html?smid=fb-share&_r=0]

Meet Dr. Yee:

Pamela Yee, MD is an Integrative Physician at Blum Center for Health in Rye Brook, NY.   Dr. Yee has a special interest in integrative cancer care and creates highly personalized treatment plans for each of her patients. She lives in Nyack NY where she and her husband manage their own organic micro-farm.

CLICK HERE  to learn more about Dr. Yee.

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How to Manage Cancer Treatment Side Effects with a “Whole-Person” Plan

By Pamela Yee, MD

Breast cancer patients often see me to reduce a variety of treatment side effects. Side effects during chemotherapy. Side effects from radiation. Side effects from being on long term estrogen suppression, such as Tamoxifen or Femara.

For some women, estrogen suppression, and the assumption that they are going to hit menopause like a wrecking ball, induces more fear than either chemotherapy or radiation. One day you’re living with a certain level of hormones and the next day the cord is cut. It’s easy to start imagining what it means to suddenly live without the hormones that define womanhood.

Some of the side effects of estrogen blockers are much like those in menopause: night sweats, hot flashes, vaginal dryness, insomnia, mood changes on the spectrum of irritability up to depression. Additionally, the Aromatase Inhibitors, like Femara, can cause muscle or joint pain and stiffness. In my practice, this is actually one of the most limiting side effects and a cause for some to stop their treatment.

Good News: There’s Another Way

Treatment of the muscle and join pain associated with Aromatase Inhibitors does not have to come in the form of more pharmaceuticals like non-steroidal anti-inflammatory agents (NSAIDS), such as ibuprofen and naproxen, which are very disruptive to the gastrointestinal system.

For years I’ve been advising my patients to employ techniques like acupuncture and exercise to treat side effects. Now there is research to back up my approach.

A study recently published in the Obesity Journal (1) demonstrates that exercise — both resistance training and aerobic — mitigates the side effects of Aromatase Inhibitors. How much training did it take? Weight training twice a week and 150 minutes of moderate aerobic exercise. Not only were side effects reduced but patients had a positive change in body composition. This is very exciting news and shows how even a small amount of exercise can have a big impact.

In many prior studies looking at the role of exercise in breast cancer patients, exercise has shown to increase survive and weight gain has been been associated with increased mortality.

Exercise has always been an important part of my treatment strategy with patients with breast cancer. The data clearly reinforces my approach as I continue to support my patients in helping them prioritize exercise in their treatment plan to increase their lifespan, improve their quality of life, and prevent recurrence.

About Dr. Yee

Pamela Yee, MD is an Integrative and Functional Medicine Physician at Blum Digital, LLC in Rye Brook, NY.   Dr. Yee has a special interest in integrative cancer care and creates highly personalized treatment plans for each of her patients. She lives in Nyack NY where she and her husband manage their own organic micro-farm.

CLICK HERE to learn more about Dr. Yee

Reference:

(1) Thomas, G. A., Cartmel, B., Harrigan, M., Fiellin, M., Capozza, S., Zhou, Y., Er-colano, E., Gross, C. P., Hershman, D., Ligibel, J., Schmitz, K., Li, F.-Y., Sanft, T. and Irwin, M. L. (2016), The effect of exercise on body composition and bone mineral den-sity in breast cancer survivors taking aromatase inhibitors. Obesity. doi:10.1002/oby.21729