Your Health | Mount Sinai Today

What You Need to Know About Lyme Disease Before Taking That Hike

Updated on Jun 30, 2022 | Your Health

Lyme disease can cause swollen joints, chronic fatigue, and a host of ailments that make diagnosis difficult. Erna M. Kojic, MD, Chief of Infectious Diseases at Mount Sinai Morningside and Mount Sinai West, explains the condition and whether you should worry if you feel lethargic a few days after a trek through the woods.

Is there a typical Lyme disease patient?

Each year, 30,000 people in the United States contract Lyme disease caused when a blacklegged tick—also known as a deer tick—carrying the Borrelia burgdorferi bacterium has fed on a person for at least 48 hours. The typical patient is someone who has been hiking, biking, or otherwise been active in a grassy, woody area, like those throughout upstate New York, Long Island, and other parts of the New York metropolitan area. Within a week of contracting a tick bite, they often develop a bullseye rash and experience flu-like symptoms, joint swelling, fever, and fatigue. After visiting an urgent or primary care physician, these patients will receive antibiotic treatment that will cure the disease.

That being said, I often tell people that Lyme disease can be anything, and anything can be Lyme disease. Depending on how long the bacteria has been untreated, it can affect almost any part of the body, including the nervous system and the heart.

According to the Centers for Disease Control and Prevention (CDC), 20 to 30 percent of those infected with Lyme do not get the bullseye rash. Are there other warning signs?

Unfortunately, there are no foolproof warning signs. But there is a blood test for Lyme disease that you can receive if you experience flu-like symptoms after being active in a tick-infested area.

People who are infected can go untreated for a long time if they don’t see a rash and therefore don’t connect their fatigue with Lyme disease. Fortunately, patients with years-long, unmanaged Lyme disease can be treated with intravenous antibiotics.

I thought my chronic fatigue was Lyme, but test results were negative. Should I get tested again?

When we test for Lyme disease, we look for specific antibodies that the body produces in response to infection. However, these antibodies cannot be detected until the bacteria has been present in the body for weeks. If you tested negative for Lyme disease but are still concerned that you have the condition, visit an infectious disease specialist.

I was treated for Lyme, but I still feel fatigued. What should I do?

Although Lyme disease is curable with antibiotic treatment, some people develop something called Post-Treatment Lyme Disease Syndrome, in which joint pain and fatigue linger. This condition is manageable with physical therapy. I advise patients with these lingering symptoms to listen to their body, stay active, and trust that they will get back to their baseline in time.

There is a common misconception that antibiotic treatment does not work, or that Lyme disease patients should remain on antibiotics indefinitely. This is incorrect.

Any advice for people who are at risk of contracting Lyme disease?

I often tell hikers, bikers, or anyone at risk for tick exposure to apply tick-repelling bug spray to bare skin and to treat their clothing with permethrin, an insect repellent. Permethrin is particularly useful as it kills ticks on contact, and it can last on clothing for several washes.

I also tell patients that having had Lyme disease once does not prevent you from getting it again, so tick prevention remains important.

Finally, do not blame everything that is bothering you on Lyme disease. Because the disease is so multi-symptomatic, I have had patients miss serious conditions, like multiple sclerosis, because they believe they have Lyme disease. If you have had symptoms for quite a long time, and you test negative for Lyme disease, you should be looking for something else.

Erna M. Kojic, MD, is the Chief of the Division of Infectious Diseases at Mount Sinai Morningside and Mount Sinai West. She is board certified in Internal Medicine and Infectious Disease as well as a prolific researcher in the area of Human Papillomavirus (HPV) and HIV.

Make an appointment with Dr. Kojic

Learn more about Mount Sinai's Infectious Disease Services

I Feel Sick. Should I Stay Home or Go to Work?

Updated on Jun 30, 2022 | Cold and Flu, Your Health

You wake up in the morning and you know you don’t feel right, but you can’t afford to be sick. Meetings to attend, deadlines to meet, kids to get to school—it’s not going to go away because you don’t feel good. Matthew Weissman, MD, MBA, a primary care doctor with the Mount Sinai Health System, offers some common-sense advice about when to stay home, and when to keep your kids home.

As New Yorkers, we feel this drive to keep going all the time. So many of us feel compelled to go to work even when they don’t feel well. When should people stay home from work?

Lots of us feel this pressure to show up to work, be tough, and work through it. But we’re doing a disservice to our colleagues and ourselves by doing that. Helping each other as good New Yorkers means that if you have symptoms such as fever, sneezing, runny nose, muscle aches, or fatigue, you should stay home. You should give your body—and your colleagues—a break and stay home.

How long should you stay home?

If you have a fever, you should stay home at least 24 hours after the fever goes away. And when flu symptoms are present, you should probably stay home for a week from the time the symptoms start. Maybe you can find an alternative way to work, like working from home, but that’s not an option for everyone. Perhaps you can find time to work when others aren’t around, or find a space that’s a bit secluded. But pushing yourself is never a good idea. It will just take that much longer to recover.

The other thing is that people are contagious 24 hours before they start showing signs of the flu. So that’s even more reason to practice good hand hygiene all the time, get your flu shot, and don’t share drinks, food, or toothbrushes with other people. You really have to be on alert all the time—not just when someone near you is coughing or sneezing.

What about keeping my kids home from school?

I know it’s tough on kids to miss school, so perhaps checking with your pediatrician is a good idea. If it’s just the sniffles and no fever, it may be okay for them to go. Or perhaps they can find a way to video chat into some classes. You certainly want to help prevent spreading colds and flu around the class. That’s why it’s important to teach kids about good hand hygiene, and to cover their cough with their elbow instead of their hands.

Sometimes when you’re sick, you are a bit torn. You wonder if it’s in your head, and you think about all the stuff you have to do.

It’s a balancing act. But think about it as an investment in the future. If you get some rest now, you’ll be more productive at work in the future. It may not be in our nature to slow down, and it may not seem like it’s what everyone else is doing. But it’s really important to protect our ability to function down the line. Because the flu will wipe you out for a week, at least, and then you’re really playing catch up.

The flu isn’t always just a few days of being under the weather. People forget that it’s a deadly disease, and can lead to other complications like pneumonia. So if you’re going to err, it might as well be on the side of safety.

Another thing that people wrestle with is, “Is this just a cold or is it the flu?”

That’s true. Many people confuse the flu with a cold, so it’s important to know the difference and to get checked out when appropriate, since the flu can be deadly. Colds tend to come with just runny noses, sneezing, and head symptoms, while influenza tends to have more bodily symptoms like muscle aches and fever. If it is the flu, treatment like Tamiflu is most effective in the first few days of symptoms. If it’s a bacterial infection, you may need antibiotics. If it’s a cold, the best thing you can do is rest and get plenty of fluids. Many times people come to us and feel they should have antibiotics. It’s important that doctors only prescribe antibiotics when needed; otherwise, patients may experience unnecessary side effects, or the antibiotics may not be as effective when you really need them.

And of course, you have New Yorkers who don’t want to give up their workout. Is it a bad idea to work out when you don’t feel well?

If you really have the flu, you’re going to feel debilitated and not feel like working out anyway. But if you just have the sniffles, you might feel better after a little exercise. Certainly you don’t want to contaminate people. But if you have a slight cold, it might feel better to get the blood pumping and your airways opened up. And you definitely want to wipe down the treadmill with an antiseptic wipe, and wash your hands before and after your workout. The gym is one of those places where you can come into contact with all kinds of germs.

Always listen to your body and let that (and your doctor) be your guide.

Matthew A. Weissman, MD, MBA, is Chair of Medicine at Mount Sinai Downtown and Associate Professor of Medicine (General Internal Medicine), and Pediatrics, at Icahn School of Medicine at Mount Sinai

Renowned Microbiologists Explain the Coronavirus

Updated on Jun 30, 2022 | COVID-19, Featured, Your Health

The novel coronavirus is transmitted through the air and replicates in the respiratory system and in blood.

The novel coronavirus that began in Wuhan, China, has been labeled a Public Health Emergency by the U.S. government. As confirmed cases of the coronavirus now known as COVID-19 continue to increase in this country and around the world, and additional information unfolds, two renowned microbiologists at the Icahn School of Medicine at Mount Sinai, Peter Palese, PhD, and Adolfo García-Sastre, PhD, recently provided insights into the disease. Dr. Palese is the Horace W. Goldsmith Professor and Chair of the Department of Microbiology, and Professor of Medicine (Infectious Diseases); and Dr. García-Sastre is the Irene and Dr. Arthur M. Fishberg Professor of Medicine (Microbiology, and Infectious Diseases), and Director of the Global Health and Emerging Pathogens Institute.

What is COVID-19?
Dr. Palese: It belongs to a group of viruses known as coronaviruses, to which the SARS (severe acute respiratory syndrome) virus and MERS virus (Middle East respiratory syndrome) belong. It is transmitted through the air and replicates in the respiratory system and in blood.
Dr. García-Sastre: The COVID-19 and the SARS-CoV are closely related and they originated from bats. In the case of the COVID-19, we are not yet sure of its precise origin—whether the virus went directly from bats to humans or whether it went from bats to a host animal and then to humans, which is what happened with SARS. But we believe it originated from bats.

The SARs outbreak in 2003 is different from the novel coronavirus in that it was traced to civet cats and raccoon dogs, which were eaten as a delicacy in some parts of China. The animals were originally infected by bats—either through bites or by breathing in bat urine and feces. MERS, a respiratory illness relatively new to humans and traced to the Arabian Peninsula, is believed to have been spread by camels that were also infected by bats.

How did this novel coronavirus start?
Dr. Palese: Samples of the virus were found in a large fish market in Wuhan where other live animals are kept in cages and sold as food.

Dr. García-Sastre: People went to the market to buy food and were exposed to the virus, which infects through the respiratory tract. Like the flu, it is spread by aerosols.

What are the most important factors to consider as the disease unfolds?
Dr. Palese: The reproduction number, or “R” number, appears to be around 2.5. That means every person who is infected will pass the disease on to 2.5 other people. The influenza virus is a little lower. Measles has a much higher R number of about 18. These are averages. But we have to be vigilant. There are reports that the disease can be transmitted for about 24 hours before symptoms develop. If that is confirmed, it would make it more difficult to contain. The disease caused by the novel coronavirus is accompanied by flu-like symptoms, including very high fever. Fatalities stem from pneumonia and comorbidities, such as old age, asthma, or chronic obstructive pulmonary disease.
Dr. García-Sastre: Don’t panic. The virus does not seem to be associated with very high mortality. It is progressing more quickly than the SARs virus did, but it also appears to be less deadly. The rate of transmission appears to be similar to that of the seasonal flu. That is an estimate because we don’t know for sure whether all of the people who have the disease have been diagnosed. Some may have very mild cases. Another consideration is at what moment does an infected person begin to transmit the virus? With flu, people can transmit the disease before there are symptoms. With SARS, most transmissions happen after there are symptoms.

Are vaccines available?
Dr. Palese: Our government is rapidly developing vaccines and they are in the pipeline, but nothing has been approved as of today.
Dr. García-Sastre: Vaccines may be first available only on an experimental basis.

A New Yorker’s Survival Guide to the Cold and Flu

Updated on Jun 30, 2022 | Cold and Flu, Your Health

You’re on the bus or subway during your morning commute. A fellow passenger near you starts sneezing and coughing. You eye them suspiciously. Are you at risk for catching something?

Matthew A. Weissman, MD, MBA, of the Mount Sinai Health System offers some street-wise strategies for beating the cold and flu in New York City.

As New Yorkers, we ride subways, buses, and elevators—does that increase our risk or build immunity?

I think it does both those things. There’s data that says being exposed to a lot of germs over time increases your immunity to disease. So in general, people who live in New York are more immune to stuff than people who live by themselves on a farm somewhere.

We’re tough here in New York!

Absolutely. The problem is, there are lots of different types of colds and viruses. And the flu virus mutates and changes every year, so even if you have immunity built up, it doesn’t mean you’re not going to catch something. So yes, we’ve got tough exteriors and a tough immune system, but we’re still at risk of catching diseases.

Should people worry about riding crowded subways and buses? If one person coughs in a subway car, are we all going to get sick?

I don’t think so. A lot of fresh air gets into the subway. Doors open all the time. You’re not in an airtight capsule. You might want to give yourself as much space as possible. And if possible, you might want to alter your commute during cold and flu season to a time or a line that’s not as crowded. It’s also a great time of year to bundle up and walk part of the way to work or school. Enjoy the fresh air! But I ride the subway all the time.

What’s the best way to cover your cough?

People should cover their cough with their elbow, not their hands. Because if you cough into your hand, and then grab onto the subway pole that’s not helping anybody. And part of being a good New Yorker is helping each other by not riding the subway or going to work when you’re contagious, which can last 24 hours after your symptoms and fever go away. On the subway, I’m thinking about airborne germs and picking something up with your hands from the subway pole. So keep your hands away from your face while you’re on public transit, and when you get to work, it’s a good idea to wash your hands (and maybe even to carry some hand sanitizer with you).

Why is handwashing so important?

Handwashing is key. It’s one of the most important things you can do, other than get the flu shot. We come into contact with so many contaminated things in the city. And when you touch your face or rub your eyes, that’s a problem. Of course, you should wash your hands before you eat and after using the restroom. But after your commute, or any time you come into contact with dirty things is a good idea. Frequent handwashing throughout the day is smart. We don’t think about all the things we touch that are frequently handled, like computer keyboards, phones, door knobs, or office kitchen appliances like microwaves or refrigerators. When you go to the gym, you should wash your hands after using the treadmill or using weights. At the salad bar, no matter how clean, the utensils are used by a lot of people. In public restrooms, I try to always use paper towels to dry my hands instead of the air blowers, which tend to just spray germs around.

Use soap and warm water to wash your hands. Twenty seconds of scrubbing vigorously on all surfaces is key. Keeping Purell or another alcohol-based hand sanitizer is good, too. That would be convenient after your commute even though it doesn’t kill all kinds of germs.

Is wearing a mask on the subway effective against germs?

It may reduce your exposure but I think masks are actually more useful in preventing your own germs from spreading, since they’re not really air-tight around the sides. A lot of people don’t use them correctly and keep taking them off or reaching underneath with their hands. Is it worth the trouble? Maybe, but I’m not convinced that it’s as effective or useful as the other things we’ve talked about.

How about cabs and car services like Uber? How risky are they?

You’re probably better off in a cab or ride-sharing service than a subway in terms of avoiding germs. I try to keep the windows open as much as possible. And seatbelt buckles and door handles are more things that are frequently handled that we don’t think about. So minimize touching them and wash your hands after.

What about public restrooms? Are they safe during cold and flu season?

Sure, public restrooms are safe. I use them all the time. I think it’s very hard to get anything from a toilet seat, so laying down toilet paper or sanitary guards isn’t really that helpful. Hand dryers are another story. The evidence is that they just spray germs around. I’d much rather use paper towels, given a choice. And once you wash your hands, opening the door with a paper towel is a good idea.

What about salad bars?

While studies show that salad bars may have bacteria, it is not clear how often they actually cause disease. My suggestions are that you want to have a sense that the salad bar is well maintained. The cold food should be kept cold and the warm food kept warm. Is it being replenished regularly, or has it been sitting there for a long time? Does it have a sneeze guard on top? Of course, you can’t avoid using the serving utensils that lots of other people have touched. So especially during cold and flu season, I make sure that washing my hands is the last thing I do before I eat.

Any other advice for New Yorkers?

Living in New York is stressful, and that’s not good for your immune system. We’ve got emotional stress, we’re rushing, we’re busy, we don’t sleep enough—and all of it takes its toll on our immune system. And then you have our exposure to airborne pollutants. It’s always important to get exercise, to eat healthy including lots of fruits and vegetables, to sleep well at night, and to reduce stress as much as you can.

Matthew A. Weissman, MD, MBA, is Chair of the Department of Medicine at Mount Sinai Beth Israel and Senior Faculty in Internal Medicine and Pediatrics at Icahn School of Medicine at Mount Sinai

Beyond Weight Loss: The Benefits of Intermittent Fasting

Updated on Jun 30, 2022 | Diet and Nutrition, Your Health

New Yorkers are born tough, but not Stone-age tough. Our ancestors were hunter-gatherers who often went periods of time without food while foraging. Humans had adapted to the unpredictability of getting their next meal.

But now we have “evolved” to expect three square meals a day, not to mention snacks.

“Weight loss has become a cultural obsession,” says Jennifer Cholewka, RD, CNSC, CDN, Clinical Nutrition Coordinator at The Mount Sinai Hospital. “And intermittent fasting is a trending topic. But it has roots in how we have evolved as human beings.”

Scientists are discovering that our bodies adapt to intermittent fasting in ways that our ancestors did. And according to a recent article in The New England Journal of Medicine, fasting has health benefits that extend far beyond weight loss. It seems that “when” we eat can be just as important as “what” we eat.

What is intermittent fasting?

With intermittent fasting, there are scheduled times when you eat and times when you don’t. Medical researchers have studied three approaches and shown them to be effective.

Daily time-restricted feeding means narrowing the time you eat to a shorter period of time during the day, usually eight hours. The time that you’re fasting is 16 hours each day. So you might stop eating at 8 at night, and not eat again until noon the next day. After 10-12 hours, your body throws a “metabolic switch” and you start burning through the glucose stored in your body. Your liver stores about 700 calories of glucose, and once gone, your body starts burning away that hard-to-get-rid-of belly fat.

5:2 intermittent fasting means that you eat as you normally do, five days a week. On the other two days, you only eat one moderately-sized meal. The two days that you’re fasting should not be consecutive. And your goal should be one 500-calorie meal on those days. You could work up to this gradually, by starting with one day a week. Your meal on that day could be 1,000 calories. Try that for a month, and then extend it during the second month to two days a week. The next month, reduce your meals to 750 calories. And then the next month, shoot for 500 calories.

Alternate day fasting is the most extreme version. On the days that you eat, keep it to a 12-hour window. Then you will fast that night and not eat anything the next day. It’s important to note that you can drink as much water as you want, and also tea and coffee if you don’t add any calories like milk, half-and-half, or sugar. You can also take vitamins, supplements, and of course, your normal meds. Talk to your doctor though, because certain meds and supplements need to be taken with food. So your plan might be to eat Sunday, Tuesday, Thursday, and Saturday. And then the next week, it would be Monday, Wednesday, and Friday.

What’s the payoff?

As if being svelte wasn’t enough, the benefits of intermittent fasting cited in The New England Journal of Medicine include:
• Cancer prevention
• Cellular and DNA repair
• Diabetes prevention and improvement
• Prevention of heart disease and stroke
• Greater mental acuity and brain health
• Greater muscle endurance

Some of these benefits are related to weight loss. Intermittent fasting increases your metabolism so you burn more calories, and it tends to target fat around the central organs. Belly fat is worse for the heart and causes inflammation. And less cholesterol means less heart disease and risk of stroke.

But once your “metabolic switch” kicks in, there are a host of other benefits. Once your body runs out of glucose, it starts converting ketone bodies from the liver for fuel. And this causes a wave of other changes throughout the body, because ketone bodies aren’t just fuel, they give orders to a variety of other cells and molecules that can affect health.

Scientists have been looking at the relationship between intermittent fasting and cancer in animals for quite a while. Calorie restriction or alternate day fasting has been shown to slow the growth of many tumors and increase their response to chemotherapy and radiation. Studies on humans are promising, but care must be taken to avoid malnutrition. Consultation with your doctor is key.

Another process triggered by the ketone bodies is called autophagy, which repairs the normal cells in the body. It’s like cellular house-cleaning, where the cells get rid of old proteins. Studies on both humans and animals demonstrate physical benefits. In one study, young men who fasted for 16 hours lost fat while maintaining muscle mass over a period of two months of resistance training. Balance, coordination, and endurance all improved in animals during fasting studies.

Brain power gets a boost, too. Verbal memory, spatial cognition, short-term and associative memory are all improved with humans in fasting studies. This is powerful news for the prevention of Alzheimer’s and Parkinson’s diseases. Neurological benefits have also been documented for multiple sclerosis and rheumatoid arthritis.

What’s the downside?

To gain the benefits, intermittent fasting isn’t a quick fix; it’s a lifestyle. Maintaining periods of not eating can be hard to stick to. But starting with a gradual program and working up to longer periods of fasting can help. In the beginning, you can expect to feel hungry, but science tells us that this is as much psychological as physiological. Drinking water when you feel hunger pangs can trick your body into feeling full. You might feel a bit foggy—but good news, black coffee and tea are your friend. And of course, if you’re under any type of medical treatment such as chemotherapy, consult your doctor first.

Throughout history, spiritual literature is full of examples of people who fasted for purification. On the basis of the latest research, it seems that the glow of health is here for modern-day fasters.

Are Natural Remedies Safe to Treat the Cold and Flu?

Oct 25, 2019 | Cold and Flu, Your Health

This year, millions of Americans will develop a cold and 5-20 percent of people will develop the flu. While these viral illnesses differ in severity—the flu can lead to hospitalization whereas a cold generally does not cause serious health complications—the best method of prevention is identical for both. To avoid getting sick, wash your hands diligently and—if you happen to get sick—cover your mouth with a sleeve instead of a hand when coughing to prevent your illness. In addition, everyone six months and older should receive a flu shot.

Once you have contracted a cold or flu, are over-the-counter or prescription medications always the best treatment method? Natural remedies—non-medicinal treatments that include vitamins, herbs and herbal supplements, and alternative treatments like acupuncture—may be adequate. Lee Coleman Hinnant, MD, a family medicine physician at Mount Sinai Doctors-Stuyvesant Town, explains when natural remedies are acceptable alternatives and when conventional medicine is the best bet.

What natural remedies can I use to treat a cold?

Zinc lozenges taken within 24 hours of cold symptoms may reduce the duration of a cold in adults. The effectiveness has not been proven in children. While effective for colds, zinc should not be taken long-term due to potential drug interactions and gastrointestinal side effects. Intranasal zinc should not be used as there is a risk of a permanent loss of smell.

Honey may be helpful in reducing nighttime cough in children and adults. It should never be used in children under one due to a risk for botulism.

Keep in mind that while these remedies may be effective in treating your illness, most colds are minor and will resolve within a week.

Since the flu can cause more severe symptoms, is it ever appropriate to treat naturally?

No. No natural or herbal remedies have been proven effective for the flu. The flu can land you in bed for a week or more with fevers, aches, and a severe cough. Within the first 48 hours of these symptoms, you should be seen by a doctor, as you may be a candidate for an antiviral medicine such as Tamiflu which can lessen the duration and severity of the illness.

What other natural remedies have been proven effective?

Studies show that meditation as a daily practice reduces the number of colds and their duration. This is mainly because meditation reduces stress which suppresses the immune system, making you more susceptible to illness. Exercise is also effective in this manner, but less so than meditation.

In healthy people, several studies showed that probiotics may reduce the number of colds a person contracts per year. Patients with health conditions should consult a physician before taking probiotics as there is a potential risk for infections.

Are there natural remedies that have been proven ineffective or harmful?

Yes. Vitamin C has not been proven helpful in the general population for cold prevention or treatment; however, it has been proven to reduce colds in half for those who pursue strenuous exercise like marathons or skiing.

Echinacea, which has commonly been used for cold prevention, is likely safe, but has not been proven effective.

American ginseng may reduce the duration of colds, but it needs to be taken daily over long periods of time and may cause side effects like interfering with blood thinners, so it is generally not recommended.