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June = Cancer From the Sun National Awareness Month

Today does not fit the bill for a hot and bright, sunny day, but rather a good one to put another fire log in the fireplace and snuggle up under a warm blanket with a hot cup of tea . . . yet, even on grey rainy days like today, there are some penetrating harmful UVA/UVB rays coming through the atmosphere to increase our risk of associated skin cancers.

I came across the below helpful patient handout from PEPID (open the link below) that helps anyone to assess the ABCDE’s that we utilize in medicine to help determine if a skin lesion could be portraying potential cancerous qualities, in addition to some simple protective awareness methods, so that when the sun is bright and hot, and we are more inclined to get out in it, we do not get burnt to a crisp and increase our skin cancer burden and risk. ¬†If you practice the Marshal Harpe, red-headed, pale skin, sun protection methodology, you try to always remember a long-sleeve shirt and brimmed hat, as well as some 15+ SPF block to help keep the pale skin protected and not scorched on the really hot and sunny days.

FYI, Shanea, if you ask her, will be glad to provide specific guidance from her extensive research on what are the best natural and non-harmful (least man-formulated and with minimal to no chemical pollutants and toxins) options of protective skin block available . . . as an example, she recently bought me a zinc oxide bar that will work great for nose and ears, providing that outdated style display of bright zinc marks to the exposed body; however, I still have not figured out how to easily get that all-over body application with a tiny, solid bar of zinc, should I go crazy and expose the sun-deprived, fish-belly white skin areas for a few minutes . . . I guess I could always wipe on some stylish zinc stripes or plaid checks, or even scribe some words to my body to show the effectiveness of a good sunblock covering on exposed skin to direct sun ūüôā

Some healthy sun exposure is good, to help our bodies generate the necessary vitamin D stores that support so many vital body functions, but be aware, as there is definitely a point of getting too much of a good thing.  Happy sunny days ahead! V/r, Marshal Harpe

Skin Cancer ABCDEs Link

Direct Primary Care Video

The Family Medicine Education Consortium, with funding provided solely by Direct Primary Care practices and physicians, recently released an informational video about the benefits and considerations you should entertain when considering if a Direct Primary Care (DPC) model of practice, such as Trout Lake Clinic, would be right for you and your family’s medical needs. ¬†Take the <5 minutes to watch the video attachment below, as it was well done and could positively influence your healthcare decisions for the future. ¬†Let me know what you think. ¬†V/r Marshal Harpe, D.O.


<p><a href=”https://vimeo.com/220896892″>Direct Primary Care (DPC): A Health Care Revolution</a> from <a href=”https://vimeo.com/daysedge”>Day's Edge Productions</a> on <a href=”https://vimeo.com”>Vimeo</a&gt;.</p>

Spring Tick Bites and Lymes

Spring appears to finally be here, and already I have encountered some tick bite concerns at the clinic, so I thought I would provide a summary of what I think you should know about tick bites and Lyme’s Disease.

Living near, and working and recreating in and around the forest and woodlands puts us at a much higher likelihood of crossing paths with the mighty, little, but highly bothersome tick. ¬†Typically, spring through early summer are the most active period for ticks and tick bites, but be aware of ticks during all seasons. ¬†Ticks are present even during cooler weather, but just not as fast moving. ¬†Preventing bites is step #1 to ensuring you don’t get Lyme’s. ¬†Consider suggestions of wearing long sleeves and long pants, along with hats when in the woodland areas, and try to avoid the brushy areas along frequented game trails. ¬†After your work or adventure consider a change of clothes and perform a head-to-toe skin check to look for unwanted guests. ¬†If you find a tick embedded in your skin, do not panic, but act swiftly to get it removed.

Spring/early summer ticks typically encompass more abundance of smaller, nymph stage ticks, that can run small, around 1mm size, similar to a poppyseed, making them more difficult to spot, and also more likely to bite and go unnoticed for a more extended period of time. ¬†Research by the University of Rhode Island has shown an estimated 20% of nymph stage deer ticks are infected with Borrelia Burgdorferi, the bacterial spirochete which causes Lyme’s. ¬†Another source estimated that up to 50% of female deer ticks (Ixodes ticks) can harbor Lyme’s. ¬†That being said, most tick bites are not harmful, even if a bite by a deer tick, provided it is identified and removed efficiently and effectively, particularly <24 hours after the bite occurred. ¬†Animal studies have shown that the spirochete lives in the gut of the tick, and during the blood engorgement phase after the bite, the spirochete migrates up to the salivary glands of the tick where it can potentially be transmitted to the host/human as the tick expels its saliva into the bite wound. ¬†Studies have shown that the salivary infestation of the spirochete is a time dependent event, with nearly no risk of transmission of Lyme’s spirochete in the first 24-48 hours after the tick has bitten, and progressive risk particularly after 72 hours from tick attachment.

Ticks latch on securely once they bite, utilizing a straw like tube and secreting a cement-like saliva into the bite wound. ¬†Your goal once you identify the embedded tick is to appropriately and effectively get it unattached in an expeditious manner, understanding that more time attached increases risk. ¬†Multiple home remedies and methods or approaches to removal have been tried and publicized, but research has shown that the best two options for removal are a small pair of tweezers or forceps, or gloved/protected fingers. ¬†Tweezer or finger removal methods have shown the best results of being able to remove the tick fully intact without leaving the mouth parts in the skin. ¬†Do not smother the tick with petroleum jelly, nail polish, gas or rubbing alcohol, as some suggest on the internet, as this can increase your risk for Lyme’s infection via increased salivary expulsion by the tick. ¬†Simply grasp the tick perpendicular to the body with tweezers, or with fingers, as close to the embedded head as possible, and using a steady upward pressure, gently but firmly pull the tick back out of his hole. ¬†Avoid jerking and twisting motions, and do your best to keep the insect fully intact, by avoiding excessive squeeze, crush or puncture of the tick body during the extraction process. ¬†Disinfect and wash the skin area of the bite immediately after removal. ¬†If small sections of mouthparts remain in the skin after removal, it is recommended to leave them alone, as they typically expel spontaneously. ¬†Place the removed tick in a ziplock bag or small jar, or take a close-up photo of the tick for identification, as the deer tick (Ixodes) most classically harbors the risk for the Lyme spirochete.

Ixodes (deer) ticks, which potentially can harbor Lyme spirochetes, have a characteristic appearance, with the adult female being orangish-red color, with a dark brown oval shaped “scutum” structure covering the upper back portion of the body. ¬†Males have a dark brown uniform “scutum” covering their whole back side. ¬†Unengorged adult ticks typically range ~3mm size, whereas the nymph stage is classically much smaller,¬†said to be around the size of a poppyseed. ¬†In addition to Lyme’s, deer ticks can also transmit human granulocytic anaplasmosis and babesiosis. ¬†Refer to the great close-up images of the deer tick at this site by the University of Rhode Island, for identification: ¬†Deer Tick Identification

After a tick bite, cleanse and observe the area of the bite for classic rash development in the ensuing days to weeks. ¬†The saliva of the tick has been known to cause a temporary localized red rash at the bite site after removal, which sometimes gets confused with Lyme’s, with the key factor being temporary or short duration or presence. ¬†The classic Lyme disease rash is known as Erythema Migrans, which presents as “Bullseye” shaped red rash rings on the skin. ¬†Picture Erythema Migrans ¬†Even if you have been bitten by a deer tick that was infected with Lyme’s, it does not mean you will get the disease or get sick. ¬†After bites, observe for symptoms of fever, muscle aches, new rashes, joint pain, headaches, vomiting, or other flu-like symptoms, or any signs of localized skin infection at the bite site. ¬†Seek medical attention if these symptoms develop. ¬†Cold compresses, Ice, anti-inflammatory pain medication, and anti-histamines can be considered if desired use after a bite, as possible home treatment, while monitoring for concerning signs or symptoms. Risk factors that can come into play for Lyme’s include: ¬†confirmed Ixodes (deer tick) particularly female, prolonged embedded tick >48-72h, improper removal, nymph stage, and engorged tick (enlarged globular tick size, with a typical adult being up to 3mm size).

Untreated Lyme’s can lead to chronic conditions, including possible cardiac arrhythmias or injury, neurological sequela including motor or sensory damage, paralysis, weakness, tremor or seizures, and joint arthritis. ¬†Therefore, prevention of tick bites, and close self monitor and observation of symptoms and bite areas after the encounter are prudent practices. ¬†If you have been bitten by a deer tick, don’t panic, as it will not help the situation, but rather just make you feel worse. ¬†Follow the steps listed above, and then closely observe for future symptoms and new skin rashes, and if concerning signs develop, seek medical evaluation, and your provider should be able to make a wise decision about the next step of treatment, should it be indicated.

Don’t miss out on the beautiful natural surroundings that we live in here in the Trout Lake valley. ¬†Don’t let the pesky little tick prevent your future adventures. ¬†Hike on!!!

Let me know if you have questions.

 

How Do I Make an Appointment at TLC?

We have a variety of options for you to generate an appointment with us at Trout Lake Clinic. ¬†You may have not yet noticed, but we recently added a “Booking” tab on the homepage of our website, which allows you the option to directly request an appointment with Dr. Harpe, even if not currently a TLC member, with slots open M-F currently between 8:30AM – Noon, and appointments booked around 30 minute increments. ¬†Also, feel free to email us at troutlakeclinic@gmail.com or call the office (509) 395-2134, to request an appointment time/date that will work for you, as we do see patients routinely in the clinic through 4PM, and will make special arrangements for other hours on a case-by-case scenario. Shanea’s Nutritional Therapy appointments will need to be booked through the office, as we do not have online booking available for her at this time. ¬†We offer free 15 minute consultations for anyone interested in learning more about the clinic and answers to enrollment and benefit options, during our daily hours. ¬†Since opening 20 FEB 2017, we are still assessing when routine appointment hours should occur, and the additional requirements we juggle as we operate and manage our new clinic with presently, just Shanea and I. ¬†Eventually, I dream of hiring a Medical Assistant to assist me in the clinic, although that will come after I have enough enrolled members to justify a part/full-time staff and finances to support. ¬†Presently, I try to be in the office from 8AM-4PM, as much as possible. ¬†At this time, I am still covering the occasional, rare ER shift in Goldendale, in order to support the clinic expenses financially. ¬†I have not yet posted specific business hours on our website and office, as we are still assessing hours, community needs, and additional business or other tasks we must juggle into the weekly schedule; however, as mentioned above, I am typically here M-F from 8AM-4PM, unless otherwise engaged. ¬†Individuals who elect to become TLC members can rest assured that if they need acute care even after I am not at the clinic, they can contact me directly and we will either get you an appointment in short order, or elect to see you in the clinic when you need. ¬†I hope this helps. ¬†Don’t be afraid to contact us and ask any questions that you might have, as we look forward to meeting you, and hopefully achieving your needs!

Respectfully, Dr. Harpe

TLC Opens Monday,20 FEB 2017

Monday, 20 FEB 2017, we will officially open Trout Lake Clinic! ¬†Finally, after an extended year of extensive remodeling the clinic will finally open its doors to medical care for Trout Lake and surrounding small communities. ¬†We are excited to be here and hope you will consider teaming up with us to work together towards a healthier you! ¬†We are here for both your chronic and acute care needs. ¬†If you have additional questions about enrollment or what Trout Lake Clinic has to offer, or how it might serve your medical needs, not clearly answered on the website, feel free to call us (509) 395-2134 and set up a free 15 minute appointment to discuss and/or answer your questions. ¬†Our mission is to serve the rural community of Trout Lake and nearby small towns. ¬†Dr. Harpe will be in the office from 8:30AM-4PM M-F, he is also available for TLC member’s acute care needs after hours and on the weekends. ¬†Soon, we will hopefully have created online appointment booking on our website. ¬†Thanks for considering your care with Trout Lake Clinic!