A common anxiety; labor and delivery; mosquito precautions: Upstate Medical University's HealthLink on Air for Sunday, Oct. 13, 2024

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," some ways to deal with test anxiety.

John Ringhisen, NP: ... What we see is the anxiety starts to bleed over into other areas of life. They start becoming increasingly socially anxious, and they become avoidant of social situations where they're feeling judged and evaluated. ...

Host Amber Smith: What to expect at the Family Birth Center.

Nurse Julie Moore: ... They can help with positioning, help the patient relax. They're basically there to guide them and support them, and they can even help them in the postpartum period with initial newborn care. ...

Host Amber Smith: And mosquito-borne diseases to guard against.

Saravanan Thangamani, PhD: ... It primarily infects equine or horses, but humans are an accidental host. And if we get that virus infection, it can lead to fatal consequences. ...

Host Amber Smith: All that, plus a visit from The Healing Muse, right after the news.

This is Upstate Medical University's "HealthLink on Air," Your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.

On this week's show, a pair of nurses tell about deliveries at the Family Birth Center. Then we'll learn about protecting ourselves from mosquito-borne diseases, including West Nile virus. But first, what to do about test anxiety.

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Host Amber Smith: From Upstate Medical University in Syracuse, New York. I'm Amber Smith. This is "HealthLink on Air."

If you're heading back to the classroom, you may also be facing a type of anxiety that arises when it's test time. Lots of kids and adults face test anxiety, but there are some strategies that can help.

We'll hear about them from my guest, Mr. John Ringhisen He's a nurse practitioner of psychiatry and behavioral sciences at Upstate.

Welcome back to "HealthLink on Air," Mr. Ringhisen.

John Ringhisen, NP: It's good to be back, Amber. I appreciate you having me.

Host Amber Smith: So how common is test anxiety?

John Ringhisen, NP: It's amazingly common, particularly in my practice, where I handle a lot of the medication management and psychiatry services for Upstate Medical University.

So a great deal of my patients deal with test anxiety, but it's also very common in the community, and not just with people that are going to school or in academic settings.

Host Amber Smith: Is some degree of anxiety about a very important test considered normal?

John Ringhisen, NP: It is. Some level of anxiety is a natural response to going into a situation where you're going to be evaluated.

Whether you have test anxiety really speaks to how impaired or how much being anxious interferes with your ability to successfully perform to your satisfaction on an exam, assuming that you've done the proper studying, and you've prepared yourself for the exam.

Host Amber Smith: So what is the youngest age that it might become apparent?

John Ringhisen, NP: I've heard of cases in the pediatric providers that I work with, that they see kids as young as when they first start going to school all day, kindergartners, first graders, where you don't think of them being tested, but think of it more as performance anxiety. The idea that they need to have the right answer or the idea that they need to behave a certain way starts becoming a very anxious situation for the child.

Host Amber Smith: For someone as young as, like, a kindergartner, what would be the signs and symptoms that would clue a teacher or a parent that something's up?

John Ringhisen, NP: Usually what you start to see is where the child starts to become more and more avoidant of participating in class because they're trying to avoid the anxiety of having to have the right answer right on the spot at home. Parents will find that their children just don't want to go to school, or they're very anxious around school, and school becomes a real burden for them.

Host Amber Smith: Are there physical symptoms? Even as kids get older and

they start recognizing that tests stress them out, do they experience physical symptoms?

John Ringhisen, NP: Some of them can. They'll describe kind of the symptoms that you associate with anxiety that you feel on your body, where your chest might get very tight, you might get short of breath, you might break out into a sweat. Some people's sleep can be really disturbed because they're so worried about being in a testing situation or having to perform at school that they ruminated about things at night and don't sleep very well.

Host Amber Smith: Is there a personality type that is more or less likely to have test anxiety?

John Ringhisen, NP: No, not really. We do see performance anxiety and specifically, test anxiety, across all kinds of personality types. I've even seen some professionals that you would think wouldn't have any trouble speaking in front of a large group or being evaluated for, say, like, a raise or a performance enhancement at work suddenly get very nervous in those situations.

Host Amber Smith: What type of tests are we talking about? Because there's a wide variety, from pop quizzes to these short, little, maybe even daily, tests that some teachers may give, versus, like, a semester exam. Do you see anxiety across the board?

John Ringhisen, NP: I do. I see it more often on what are considered high-value examinations, where there's a large percentage of the grade that's associated with the exam, those midterm semester exams or the final exams for a course, or sometimes, even large papers or large assignments that have a large weight in the class, can become more anxiety provoking than say, a pop quiz or a regular daily test over the knowledge of what they had to read the night before.

Those don't have as much of an impact over their overall evaluation. So with being less valuable, they don't get as anxious about those events.

Host Amber Smith: So do we know what causes anxiety like this?

John Ringhisen, NP: It's really an anxious response to any other stressor that somebody might experience. It just happens to be more acute and more focused in the academic setting, or it comes to people's increased notice in an academic setting because we don't really test ourselves outside of school. When we start working on the job, the idea that you have to sit down and take a written exam where you have to get the right answer, that's not something you typically do with your work. So it's really in the academic setting that we see this kind of performance anxiety where being in an exam situation really manifests itself.

Host Amber Smith: So someone who really struggles with this in school, they can look forward to it ending once they graduate, or are they likely to see other types of anxieties crop up?

John Ringhisen, NP: They could see other types of anxieties crop up, where if they're not addressing the underlying thought or the underlying belief of being evaluated, that causes that really big spike in their anxiety that makes performing on a test very difficult for them, if they run into a similar situation.

Some of the ones that I listed before were like, say, an employer wants to evaluate you for a raise, or you're going into an interview situation where you feel like you're going to be judged and evaluated as to whether you're appropriate for a position or not.

I've seen people that struggled with test anxiety during childhood struggle in similar ways in those situations where they're being judged and evaluated.

Host Amber Smith: So test anxiety can crop up later in life in stressful situations.

John Ringhisen, NP: Yeah, that's what I was kind of talking about where sometimes you see it crop up in people once they get out of school. Where I see it the most is job interviews. They go into an interview where they don't interview very well because they're so anxious about being just the focus of the conversation and the focus of being judged or evaluated as to whether you're going to be appropriate for a job.

That's probably the most common area where I see a carryover later into life, where people who struggle and come to me as adults saying, "I can never interview," or "I can never stand up in front of people, and I'm very bad at public speaking, and that's becoming more part of my job as you move up in management, you're expected to talk to and communicate with your coworkers. I'm very bad at that."

When I have a discussion with them, one of the questions I ask is, is this something that's persisted or is this something that you struggled with a lot as a kid? Did you have a lot of test anxiety or did you struggle on group projects or speaking in front of the class or anything like that?

And a lot of times those individuals say, "Yeah, I had a really hard time testing as a kid."

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with nurse practitioner John Ringhisen from psychiatry and behavioral sciences about test anxiety.

I'm curious if this is something that should be diagnosed and treated.

John Ringhisen, NP: It should be diagnosed and treated as part of an overall anxiety disorder. We don't have a specific diagnosis for test anxiety. It's usually more contained with the idea of being socially anxious and a social anxiety disorder, or being generally anxious and as part of a generalized anxiety disorder.

Host Amber Smith: So you would assess somebody overall. Might there be medications involved?

John Ringhisen, NP: There could be. We typically try to start with behavioral interventions, where test-taking skills, studying skills, things that will make somebody more confident in their academic performance and their academic capabilities so that the idea of being evaluated on those skills is not as much of a stressful situation for them.

I have prescribed as-needed medication so that that way you're not taking something every day. Just a few minutes before you go into a really difficult exam or a situation where you know you're going to be anxious, you take something, like an antihistamine. One I use, very common, is called Vistaril, or hydroxyzine. It's kind of like a non-drowsy Benadryl. And the idea is that that calms your body enough so that by you not having such a strong response in how you feel, you're not sweating, your heart rate hasn't really kicked up, you're not feeling really anxious, hopefully, because you're more comfortable going through the exam experience.

And it's important with those as-needed medications to kind of pre-medicate. It's kind of like chasing pain in the hospital. You'll hear about people having surgery, and the physical therapist comes in, and before the physical therapist comes in to do any kind of range-of-motion exercises, your nurse gives you something for your pain so that you can be a better participant in your physical therapy.

It's the same idea of anxiety. It's much easier and much more successful with an as-needed medication to get ahead of the anxiety rather than try to chase it after you're already starting to really freak out in an exam situation.

Host Amber Smith: What happens if somebody has severe test anxiety, but they don't get treatment?

They go unrecognized, they fall through the cracks or whatever. Does it tend to get worse?

John Ringhisen, NP: The test anxiety itself usually doesn't get worse, but what we see is the anxiety starts to bleed over into other areas of life. They start becoming increasingly socially anxious, and they become avoidant of social situations where they're feeling judged and evaluated.

They might become more critical of themselves. And when that starts to happen, you start to see people get really down on themselves, and you might see symptoms of depression and sadness start to crop up because the anxiety is limiting or making them more critical of themselves because they're not performing well in those testing situations.

Host Amber Smith: So it sounds like it is important to recognize this.

John Ringhisen, NP: It is. It's important that if you feel like you are putting extra effort, extra time and extra energy into just being able to sit comfortably through an exam or evaluation, consider the idea that there might be something going on outside of school. Or inside the context of what you're trying to accomplish with your academics that you need to speak with somebody about.

Because I've also seen situations where, there's a very stressful situation at home. I have a lot of adult learners, and if there's upset in the home or just the idea of going back to school, the test anxiety doesn't have to be directly related to you doing poorly or being worried about your academics. It could be anxiety from outside of the classroom following you into the testing room.

Host Amber Smith: People might be aware of test anxiety from a common but unpleasant dream called the examination dream. People can have one of these years after they've left school. They dream that they're in a classroom again, a test is being passed out, and they're totally unprepared for it, and they panic.

John Ringhisen, NP: It's interesting that you bring up dreams because the thought and the idea behind how we dream and why we dream is something that I look at a lot in my work because I look more at the emotional context of what's happening in the dream, less so than the narrative context of what's happening.

So in what you talked about there where somebody's feeling very anxious at work, maybe it's not even related to being tested or anything like that, just they're stressed right now. The brain is going to cast a wide net over your entire life experience, and it's kind of like doing a Google search for "afraid." you get a couple trillion hits on "afraid," but your brain kind of pulls the top ones that kind of relate to how you're feeling in the moment and decides to play the best virtual reality scene for you to try to keep you asleep. because that's what dreams really are. They're the guardians and protectors of sleep. That's a very Freudian thing.

So what your brain's trying to do is keep you asleep while you're anxious to preserve and protect your sleep and also give you an opportunity to try to come to resolution with the idea of feeling and being anxious. I'll use myself as an example. When I start to get really anxious, or I know I'm really worried about something, my dreams start to take on the West Point context because four years of West Point was a very anxious experience for me. But I made it through. I successfully graduated. I did fine, but that's what my brain does to me, and I think that's the experience that my brain is trying to give me. Here's a situation where you felt a lot like what you do right now, but you got through it, you were able to navigate it. So it's trying to normalize or kind of remodel the experience that I'm having right now, subconsciously while I'm dreaming, so that that way when I wake up, maybe I feel a little better.

Host Amber Smith: Well, let's talk about if there are some preventive strategies. You mentioned sitting comfortably. Does that have an impact?

John Ringhisen, NP: Sitting comfortably does. And what I mean by sitting comfortably, one of the behavioral interventions that I recommend often to people that struggle with test anxiety is really around the test-taking skills that a lot of the learning centers teach our students here at Upstate and how they approach an exam. Making sure that you've used the restroom before you go into the room, making sure if you are going to use a medication that you've taken it before you go into the room, making sure that all the other stressors, of what am I going to wear? Do I need to pack a lunch? Do I have enough water? Try to take care of much of that stuff ahead of time. So it's less to worry about as you walk into the exam. And then make sure that your environment is comfortable. And some people, I even recommend practicing in a similar environment to the test taking environment that you're going to be in.

Sometimes they give tests here at Upstate that are in some of the larger lecture halls. So just being in such a big open space makes people feel very anxious while they're sitting during their exam, so I encourage them to try to study in places like that. So it's like a level of exposure therapy where as you get used to being in large spaces like that, doing your academic work, maybe that translates over to feeling less anxious in the testing environment.

Host Amber Smith: Is there anything that loved ones can do, parents or teachers, or not do that would help kids who have test anxiety?

John Ringhisen, NP: I think I would rather focus on what I would encourage people to do in this situation because each individual situation is going to be so unique to the individual and the relationship that they have with the person that's trying to be supportive in this case.

The biggest and most important thing that I think teachers and parents and loved ones can do to support somebody who's struggling with this is to try to be validating in the language that you use when you're talking with them. What I mean by that is recognizing that it's a real thing, that it's not just something that is wrong with the individual or something that they just need to suck it up or be more resilient about it. Recognize that this struggle is real to the person that's experiencing it, and that it is a real problem that needs to be addressed and that seeking help is something that is worthwhile and going to help them be better in what they're trying to achieve.

Host Amber Smith: Well, thank you. I appreciate you making time for this interview, Mr. Ringhisen.

John Ringhisen, NP: I greatly appreciate you having me back. Amber.

Host Amber Smith: My guest has been Mr. John Ringhisen. He's a nurse practitioner of psychiatry and behavioral sciences at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air

What to expect at the Family Birth Center, next, on Upstate's "HealthLink on Air."

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Host Amber Smith: From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

The Family Birth Center at Upstate Community Hospital has a baby-friendly designation. We'll learn what that means and what birthing a baby is like from nurses Julie Moore and Lindsay Miner.

Welcome to "HealthLink on Air," Ms. Moore and Ms. Miner.

Nurse Lindsay Miner: Thank you.

Nurse Julie Moore: Thank you, Amber.

Host Amber Smith: It's called the Family Birth Center. Does that mean more than just the mom-to-be is involved in the birth?

Nurse Julie Moore: Yes, it does. At the Family Birth Center, we try to include the significant other and one other support person to attend the birth with the patient. Sometimes that extra support person is a doula that is there to support the patient. But yes, we want them to feel welcomed and supported while they're here in the Family Birth Center.

Host Amber Smith: Now, Ms. Moore, some people may not be familiar with the term "doula." What is a doula?

Nurse Julie Moore: So a doula is somebody that is either provided by Onondaga County or somebody that the patient can hire that is basically a birth assistant. They will come to the hospital with them. Generally they'll wait until the patient is closer to delivery.

They can help with positioning, help the patient relax. They're basically there to guide them and support them, and they can even help them in the postpartum period with initial newborn care and teaching the patient how to take care of their baby.

Host Amber Smith: How does that differ from a midwife?

Nurse Julie Moore: A midwife is somebody who is board certified and educated to attend the delivery. So they are making the medical decisions and taking care of the patient basically from the time of conception through delivery.

They, I guess, are similar to a doula because they provide that individual support, but they're different in the respect that they are the ones that are making the medical decisions. Doulas are not allowed to make any medical decisions.

Host Amber Smith: I see. Now, there was a renovation not too long ago that created 21 private postpartum rooms. What can you tell us about them? Ms. Miner?

Nurse Lindsay Miner: These rooms actually are wonderful rooms. They're very, very nice. We have actually 20 rooms; one of our rooms was converted to a lactation room. And these rooms are designed for "rooming in," so what that means is that mom and baby would be together unless there's a medical reason that baby could not be with mom, in which case baby would be in the nursery.

Host Amber Smith: So the mom has her own bed, the baby has a bassinet next to the bed? Is that how that works?

Nurse Lindsay Miner: That's correct.

Host Amber Smith: I've heard of the term "couplet care," and I wasn't sure what that meant. Can you explain that?

Nurse Lindsay Miner: The way that I would describe couplet care is basically where my nurses are focused on the mom and the baby together, and making sure that mom has all the tools and resources she needs to take care of the baby, that we are observing interactions between mom and the baby, that mom has everything essentially that she needs, as well as making sure that the baby is getting their needs met. Julie, I don't know if you want to add anything to that, but that's the way I would describe it.

Nurse Julie Moore: So I would also add to that that couplet care means that the baby is rooming in with mom for the entire stay. Baby only comes out of the room if there's a procedure that needs to be done, or if the patient requests a couple hours of rest or whatever. Then baby might come out of the room at that point, but couplet care really means that baby stays in the room 24/7 with mom and dad, and they are treated as one.

Host Amber Smith: With the baby in the room there, in the postpartum room, is the mom allowed to have other friends come up and visit?

Nurse Lindsay Miner: Yes, mom is allowed to have friends come up and visit. We try to limit it to three on postpartum, but we do have sibling visitation, and there's no age limit on that, because baby could be a sibling of an 18-month-old or a sibling of a 15-year-old. It really could go either way, or they could have many siblings.

Host Amber Smith: What happens if the mom is ready to go home and gets discharged from the hospital, but the baby needs to remain hospitalized? Where does the baby go for that?

Nurse Lindsay Miner: Typically, if the baby is hospitalized, often in that scenario, the baby's in our nursery. but mom can very frequently stay as what we call boarding, which means that mom is discharged from the hospital and is no longer a patient but is allowed to stay on the unit, so they can be close to their child.

Host Amber Smith: And is there room in the postpartum rooms for the support person to stay around the clock?

Nurse Lindsay Miner: There is, and we actually have furniture that would convert to a bed for the support person to be able to stay overnight with the mom, as they desire to do so.

Host Amber Smith: Ms. Moore, can you tell us about the birthing rooms?

Because when the mom comes to the hospital, she doesn't go straight to postpartum. That's for after the birth, right? So what room does she have the baby in?

Nurse Julie Moore: Correct. So when they come to labor and delivery, we have six labor rooms, and we have three triage rooms. So if they're coming for induction, or we know they're in labor, they will go into one of our labor rooms.

They're all private. They all have a tub, which the patients can use throughout the birth process. And there's definitely plenty of room for her support person to stay in the room with her.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Julie Moore and Lindsay Miner, two of the nurses at the Family Birth Center at Upstate Community Hospital.

In addition to the labor and delivery nurses, like the two of you, who are the other professionals that are part of the Family Birth Center team? And we've already talked about doulas and the role of midwives. Are there other people that may be involved?

Nurse Julie Moore: We have our providers. We have in-house providers, we have other providers -- if one provider's not available, they're our backup. We have anesthesia in-house. So all we have to do is call, and they're right on the unit to assist with epidurals (an anesthetic injection) or if we have to go to the OR (operating room). We have nurse practitioners, APPs (advance practice providers), which take care of the infants at delivery and after if needed. And we have a pediatrician who's in-house for part of the day; they will come round (check on) on the infants after delivery.

Nurse Lindsay Miner: In addition to that, we also have a neonatal "SWAT" team of nurses, and they do critical care, if needed, on a newborn that might need additional support from the nursing staff.

Host Amber Smith: Well, let's talk about pain management. I know some women may choose to experience natural childbirth, but some may seek an epidural for pain relief or some alternatives.

What are the alternatives that you offer?

Nurse Julie Moore: As you stated, we have the epidural. They can do pain medications through their IV, which are generally helpful in early labor. And then we also have nitrous (nitrous oxide, or laughing gas) here, which is available for patients to use, which kind of helps take the edge off. I wouldn't say that we use it nearly as often as the IV medications or the epidural, but it is a good alternative for somebody who's not looking for medications like that.

Host Amber Smith: Do you know roughly what percent choose pain relief of some sort?

Nurse Julie Moore: Pain relief? I would say in general probably about 50% of patients. We do have a fair amount that come here with a birth plan that are looking for a natural delivery, as you stated, so they try to avoid pain medications if they can.

I will say that we try to educate patients when they come in with a birth plan to remain flexible, because things do change, and to let us know if they get to the point where they decide they really need help with their pain, to make sure that they let us know so that we can help them with that.

Host Amber Smith: So, Ms. Miner, what does the baby-friendly (from the accrediting body Baby-Friendly USA, for upholding high standards) designation mean?

Nurse Lindsay Miner: That covers a lot of things, however, if I could best summarize it, it really is keeping mom and baby together as much as humanly possible, skin-to-skin contact, optimal care for feeding -- basically policies that support that mom-baby relationship.

If I had to summarize it in a sentence, I would say that it really encourages and focuses on that really critical bonding between the mom and baby during the time that they're with us.

Host Amber Smith: Do you find that that helps encourage women to breastfeed? I'm curious about how many women are choosing to breastfeed these days?

Nurse Lindsay Miner: I would say a fair amount actually choose to breastfeed as much as possible. We do try to facilitate whatever mom decides they want to do. But I'd say a fair amount actually do decide to breastfeed.

Host Amber Smith: Now, what do moms-to-be need to know about the Upstate Cord Blood Bank?

Nurse Julie Moore: The Cord Blood Bank: Our hope is that eventually, word will get out about this, and that more providers will be telling their patients about it ahead of time.

But the Cord Blood Bank is a great option for parents that want to donate their baby's (umbilical) cord blood. There is a process that they have to go through before they come to the hospital, or, if they are here for induction, they can complete it here. There's a survey that they have to complete that basically fills out their entire history, which basically allows the Cord Blood Bank to know if they are a suitable donor or not.

There's, like, private cord blood banks that use that blood specifically for that baby if it's needed in the future.

This cord blood is donated for any other person, cancer patients or whoever, that they are in need of that cord blood to help with their treatment, so it's donated for those purposes instead of for that individual.

Host Amber Smith: Can moms who deliver at other hospitals use the cord blood bank, or do they need to deliver at Community?

Nurse Julie Moore: All of the hospitals in the area participate in the Cord Blood Bank. I will say, and it's probably because they're right next door, that I think we do a lot more cord blood banking than any of the other area hospitals.

Host Amber Smith: I'm curious, on average, how early moms arrive at the hospital. In other words, from the time they get to the hospital until the baby's born, how long is that, typically?

Nurse Julie Moore: It's really dependent. I always tell people I wish I had a magic ball to tell you, like, when they're going to deliver, because that's always the magic question when they come in: How long is it going to take?

It really is dependent on what number baby it is. I would say if it's a first-time mom, this is her first delivery, to expect it to take, if they're coming in in natural labor, it could take up to 24 hours. If they're coming in for an induction, it could take a few days.

So it really depends. After baby No. 1, it tends to go a lot quicker; then we're half a day, maybe, but first-time babies like to take their time.

Host Amber Smith: I know labor and delivery nurses like yourselves have years of experience helping moms prepare for their babies. I wanted to ask each of you, what is the advice you find yourself repeating time and again to the new moms? Ms. Moore?

Nurse Julie Moore: Before they deliver or after?

Host Amber Smith: Oh, let's do both.

Nurse Julie Moore: For me, when a patient first comes in, like I was saying earlier, I really try to explain everything that they may expect while they're in the hospital with us before delivery. I think really the best thing I can tell them is to relax and just kind of go with the flow, because when you fight it, sometimes it takes a little bit longer to get through that labor process.

And then after delivery, enjoy every single minute of it. There's nothing like having a baby, first time, second time, 10th time. It doesn't matter. It's really, truly, a miracle.

And my advice is: Just enjoy every minute of it.

Host Amber Smith: Ms. Miner?

Nurse Lindsay Miner: I would say, kind of jumping on what Julie was saying: Go with the flow. There's a lot of folks, I think even myself included, that had a birthing plan down to a T, and it absolutely did not go the way I planned.

And you know what? At the end of the day, as long as you have a happy, healthy baby, that's really what matters.

So things will change, in all likelihood. So be prepared for that. And it's OK. Things are going to change. We're going to get through it. At the end of the day, you're going to have a little one you've got to take care of. And afterwards, I would say there's a reason for the saying "It takes a village." It's OK.

Whether it's your first baby, fifth, 10th, being a parent is hard work, and it's OK to need help. It's OK to ask for that help. It's OK. There are resources if you need it. If you don't, that's OK, too. But I would really encourage anybody who needs help to definitely reach out and ask for it, because it's out there for you, available in the community.

Host Amber Smith: Well, thank you to both of you for making time for this interview.

Nurse Lindsay Miner: Thank you.

Nurse Julie Moore: Thank you, Amber

Host Amber Smith: My guests have been nurses Julie Moore and Lindsay Miner from the Family Birth Center at Upstate Community Hospital. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air," protecting ourselves from West Nile virus and eastern equine encephalitis.

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Host Amber Smith: From Upstate Medical University in Syracuse, New York. I'm Amber Smith. This is "HealthLink on Air."

A pair of mosquito-borne diseases have been in the news lately. So I'm turning to Upstate molecular biologist, professor Saravanan Thangamani, to tell us about these mosquitoes and explain how they transmit West Nile virus and eastern equine encephalitis.

Welcome back to "HealthLink on Air," Dr. Thangamani.

Saravanan Thangamani, PhD: I'm happy to return back.

Host Amber Smith: People have died from diseases transmitted by these mosquitoes, so it's pretty serious. What do we need to know about Triple E and West Nile virus?

Saravanan Thangamani, PhD: Well, mosquito-borne diseases are actually a major problem for the Northeastern United States, specifically the West Nile virus, and we call it Triple EV, or eastern equine encephalitis Virus. As the name suggests, it primarily infects equine or horses but humans are an accidental host. And if we get that virus infection, it can lead to fatal consequences.

West Nile virus was originally introduced to the United States in 1999. It was originally discovered in the New York Bronx Zoo, then eventually exploded throughout the United States. Now it is in the news because lately more and more infections of West Nile virus are being reported in the United States, and we are seeing mosquito positives. Pools of mosquitoes are positive for West Nile virus.

Largely it causes asymptomatic infection in humans. I would say 80% of the humans who get mosquito bites that carries the West Nile virus do not develop any symptoms. However, one in five will develop acute febrile illnesses, and one in 150 people actually get into serious symptoms of neurological infection, such as the infection of the central nervous system, such as encephalitis or meningitis. So that's where it becomes really problematic, particularly in a population greater than 50 years old, because that's where your immune system starts to slow down. Immune systems start to respond slowly. And that's when the virus actually causes heavy damage to public health, is that people who are over 60 years of age or at the greater risk of West Nile virus infection.

So this is a mild disease, as I said, is asymptomatic in majority of the cases. However, if it infects the central nervous system, it can lead to fatal, or severe health consequences, primarily infecting the spinal cord and brain.

Host Amber Smith: Now are we talking about, is it the same mosquito that carries EEE and West Nile virus, or are they different?

Saravanan Thangamani, PhD: No. So those are two different mosquitoes. So West Nile virus is primarily transmitted by a mosquito, in the genre Culex mosquitoes. There can be Culex quinquefasciatus, or Culex pipiens, and Culex tarsalis. They all can actually transmit West Nile virus. Those are primarily bird feeding mosquitoes. Again, I'm telling that humans are accidental hosts. This particular mosquito, they prefer to feed on birds. And then humans become accidental hosts because we try to -- human behavior, right? -- we try to live closer to the woods, we try to venture into the woods, trekking and other things. So that puts us closer proximity to these mosquitoes that prefer to feed on birds.

The triple E virus, on the other hand, is transmitted by another mosquito species called Culiseta melanura, so it's a completely different mosquito than the one that transmits West Nile virus.

Host Amber Smith: Are both of these mosquitoes potentially in Central New York?

Saravanan Thangamani, PhD: Yes, we do have both in our area. And Culex mosquitoes are present throughout the United States, and Culiseta mosquitoes are especially present in the Northeastern and the South, I would say some parts of Florida, but definitely in higher densities in Northeastern United States.

Host Amber Smith: It seems like we're hearing about this more. Are there more mosquitoes, and are they more of a threat to us now than they were in the past?

Saravanan Thangamani, PhD: I would say yes. And it's primarily due to human behavior and climate change. And, you know, these are the dominant mosquitoes that are of human health importance in the northeast United States.

However, we know there are other mosquitoes like Aedes aegypti and Aedes albopictus that transmit viruses that cause diseases such as dengue virus, Zika virus and chikungunya. But they are not present in Central New York, at least to our knowledge. As of today, they are not present in Central New York, but if you go to Tri-State Area, or New Jersey and other places, you will see those mosquitoes.

Host Amber Smith: Well, I want to ask you a little more specifically about both West Nile and Triple E, but once a person is infected with either of those, are they infectious to other people?

Saravanan Thangamani, PhD: No. So these viruses are transmitted to humans only through mosquito bites, not through any other means. So there is no human-to-human transmission in this case. So it is purely through mosquito bites. So you have to have a mosquito bite, provided the mosquito carries a good amount of virus in it, that it injects to the human to cause a disease.

Host Amber Smith: This is Upstate's "HealthLink on Air" with your host Amber Smith. I'm talking with professor Saravanan Thangamani. He's a microbiologist and immunologist, and his laboratory focuses on the biology and ecology of virus transmission.

Dr. Anthony Fauci disclosed that he was hospitalized with West Nile virus for a week recently, and he said he'd never felt sicker in his life. Does this mean he was bitten by an infected mosquito that was carrying West Nile. Is that the only way he could have gotten it?

Yes. I've been reading in the news -- however, these days I don't know how much I can trust the news media -- apparently there was a report that he got bitten by mosquitoes in his backyard. So it's obviously he got bitten by a West Nile virus-positive mosquito. And he's in the higher risk group, which means that, as I said earlier, people over 60 years of age are at the greater risk of getting infected or getting a productive infection, right? So I think, in my opinion, he's one of those very few human cases where he got probably inflammation to the central nervous system or infection to the central nervous system. Is there a test to determine that he was bitten by West Nile, or how is West Nile diagnosed?

Saravanan Thangamani, PhD: So, laboratory testing, like any other disease condition is through either the blood or the spinal fluid. And most of the virus infection to the central nervous system are diagnosed through spinal tap fluid. So basically they take their spinal fluid, and then they look for either the antibodies or the viral nucleic acids. You go to the doctor, only when you are acutely ill, right? You don't go at the early stage. So these viruses, they actually move away from the blood very quickly, and they infect the target organs. Which means that if you are not going within the first five, six days after a mosquito bite, your blood is of no value. I mean, you can't detect the virus in it. But if you want to look for the actual viral signatures, like actual virus or viral nucle acid, spinal taps are the good samples to do because the virus infects the central nervous system, which means that we will be able to isolate the virus or identify the virus in the spinal fluids.

Host Amber Smith: How is it treated?

Saravanan Thangamani, PhD: At this time we don't have a vaccine, so it's more of a supportive therapy and antiviral therapy, depending on different clinicians, you know, they might use different antiviral therapies. But there is no FDA-approved treatment for West Nile virus, at least as of today.

Host Amber Smith: And at least one community where EEE has been found has been asking residents to stay indoors at dusk to reduce the risk of mosquito bites. Is this a smart strategy?

Saravanan Thangamani, PhD: I don't think so. I mean, it's my personal opinion. So this doesn't represent Upstate's opinion. This is my personal opinion.

You know, people need to be aware of mosquito bite prevention as well. So wear long sleeves, wear light color clothes and applying certain repellent before you get out in the outdoor activity. And then, if we store stagnant water, like a water in a pan, we should actually flip them upside down. If you have a stagnant water lying in our garden somewhere, or flower pots or bird feeders, those are the places the mosquitoes will come and lay eggs. So if we can try to avoid those kind of mosquito habitats, we can actually go out and have a good lifestyle without us getting worried and locked us in.

And I think that I do not agree with the strategy, because there are many ways how we can prevent getting tick bites.

Host Amber Smith: What about swimming pools? Now that's chlorinated water. Does that attract mosquitoes like plain water would?

Saravanan Thangamani, PhD: No, they wouldn't because it's, as you said, it's chlorinated. You know, it essentially kills the... Even if the mosquito come and lay the eggs, the larvae will die. Even if the larva hatches, the larva will die. So basically there is no way those water will actually aid larva growth.

That's why even if you got bird feeders, you can actually buy bricks that you can put in your bird feeder that can actually kill the larvae, but it's not harmful to the birds. So you can buy those things. You can still have bird feeders, like water for the birds in your backyard, at the same time, not aid mosquito growth and perpetuation as well. So there are different ways how we can control your backyard for mosquito growth. Educating the public is very important because we can't scare from every single pathogen or a disease, then we cannot enjoy our life.

Host Amber Smith: You mentioned wearing light-colored clothing. What difference does that make?

Saravanan Thangamani, PhD: Dark-colored clothing tends to attract mosquitoes. So wearing light color, you don't have, mosquitoes doesn't land on you. And again, there are research that people are doing that why someone is more attractive to mosquito bites than others. There's a lot of theory going on. It is our body microbiome and, you know, every person's body emits different odors that attracts the mosquitoes to different levels. And also the body heat is also an attractant for the mosquitoes as well. So there are different reasons why a mosquito is attracted to a particular human, but wearing light-color clothing, it actually, you are not attracted to the mosquitoes, generally.

Host Amber Smith: Now, you mentioned that most people who contract West Nile virus don't have any symptoms. Is that the case with triple E, or do you have symptoms when you develop that?

Saravanan Thangamani, PhD: Well, triple E is almost the same. You know, during the acute phase you don't actually get any symptoms. So most of these arbovirus, or the viruses transmitted mosquitoes or the ticks, in the early stage, you don't see any symptoms.

But, similar to the West Nile, triple E also cause similar symptoms because these are encephalitic viruses. They cause encephalitis in humans, but triple E is very rare.But it's fatal. So 30% of the people who shows productive infection can actually succumb to the disease.

When we talk about the West Nile virus, one in 150 people are actually showing productive central nervous system infection.

But here, 30% of the people who actually are exposed to the virus can develop severe encephalitis. So its case fatality is very high here.

But in terms of symptoms, they're all the same. The behavioral changes will happen, drowsiness will happen, seizures will happen, severe headaches will be noticed. But if you connect those symptoms together with, "Hey, I'm living in an endemic area that are known to have this particular mosquitoes," then the clinician will put these puzzles together: "OK, now I need to look for this person. Let's take this final tap and I'll look for it." So this epidemiological information is very, very important for the clinicians.

So the constant surveillance, like our county, Onondaga County, is doing constant surveillance for these mosquitoes. So that actually helps the clinicians to know what is happening in our own back yard.

Host Amber Smith: So if you know that you've been bitten by a mosquito, is there any way to tell from the bite whether something was transmitted?

Saravanan Thangamani, PhD: Yes, you can tell. You can actually take a punch biopsy from the site of mosquito bite, and then you can look for some viral signatures there. But it depends on how quickly after a mosquito bite they come. Because the virus are pretty good in actually establishing infection in the skin and then disseminates to the target organs. Within a day or two, they will disseminate.

But you know, I don't think that our medical practice will allow us to take a punch biopsy and then look for the virus. They would rather take a blood or spinal tap. Yes, they are a little invasive, but it's better than having a (punch biopsy) scar for your life.

Host Amber Smith: So if someone gets bitten by a mosquito, they need to wait for a few days to see if they become ill?

Saravanan Thangamani, PhD: Yes. Mosquitoes feed on humans just for a few minutes, right? So you can't actually capture them and send it to a lab for testing. So if you feel like you got exposed to mosquito bites, a good number of mosquito bites, I would be advising them to look out for any symptoms of acute febrile illness. Are you getting fever? Are you getting tired? Are you getting headache? Are you getting lethargic? Those are the symptoms that you are sick.

That sickness could be directly related to a mosquito bite, whether it is West Nile or EEE V (virus), you are now getting sick post-tick bite. So it is always important to go to the health care provider as early as possible. As early as you actually notice those acute febrile illness. And then the healthcare provider, based on the epidemiological information, can decide what to do for it.

Because the good thing is that the blood and the spinal type are required for both West Nile and EEE V. So they can actually look for both the virus signatures in these samples and then find out is it West Nile or Triple E V? But one thing I must tell is that there is no treatment, right? Only supportive therapies available at this time, antiviral therapy, depending on the healthcare provider might give, but again, only supportive therapy is available at this time.

Host Amber Smith: Well, this has been very informative. Thank you for making time for this, Dr. Thangamani.

Saravanan Thangamani, PhD: Thank you for having me.

Host Amber Smith: My guest has been Dr. Saravanan Thangamani. He's a professor of microbiology and immunology at Upstate. And the Thangamani Lab focuses on biology and ecology of virus transmission. I'm Amber Smith for "HealthLink on Air."

​

Host Amber Smith: Here's some expert advice from Tamara Roberts from the Clark Burn Center at Upstate Medical University. What is the standard first aid for someone who has suffered a burn?

Tamara Roberts: Immediately stop that burning process. If they're on fire, they need to stop, drop, and roll to get that fire out. And then they need to cool it with lukewarm water. So if they have that ability, they need to, for at least five minutes, be cooling it with lukewarm water. Never use ice, because ice actually can cause further injury to the tissues of the skin and make your burn worse. So we strongly discourage that. Then depending on how severe it is, they may need to go get treatment. If they have open tissue, or blistering, and it's a pretty big area, I would say if it's covering their entire forearm or even a hand that may be like a whitish color, it could be very severe. It's better to go get checked out than to not get checked out. We have a number that they can call right here at Upstate. It's 315-464-1800, and push the button for burn clinic. And they can call and get an appointment scheduled right into the clinic. We have clinics four days a week. If they were to go to the emergency department, they would be assessed by our burn team right there in the emergency department, or one of the physicians trained in burns, and they would assess if they need to be admitted into the hospital, if they need further treatment, or if they can just follow up in the burn clinic. And they'll help them make that appointment.

Host Amber Smith: You've been listening to Tamara Roberts from the Clark Burn Center at Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

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Deirdre Neilen, PhD: Shiwei Zhou is an infectious diseases physician from Michigan. Her poem, "Sort by Date of Death," reveals that a caring physician can't stop questioning if there was something else she could have done for her patient.

"Sort by Date of Death"

There is a place in the medical record, a tab

labeled Date of death. Click and you'll find

autopsy results; final discharge summary

or last documented phone call.

Why do this? Simple curiosity; professional

reflection and practice. Doesn't everyone?

Certainly nothing to do with the ceaseless interlocutor

asking of each name with an end date if

they died because of something you missed

that should not have been missed

or because of something you did

that should not have been done

or maybe because there was one more question

you should have asked -- the right question --

a question someone else would have asked

someone not you. Someone better.

Sometimes it is clear: a massive stroke. Or aspiration event,

PEA arrest, 45 minutes of CPR, anoxic brain injury.

Sometimes it is not: the autopsy is declined,

the last call is about a refill or a new mole.

It doesn't matter which names

on this list find you blameless,

because there will always be the other names, to which these

are added (clear water cannot clear an ink-stained glass):

the wife to whom you said, go home tonight, he'll be fine,

the young woman dead before her second anniversary.

Those are numbered in a different list, maintained

on a different server, the one in your head.

Stories are judged on how they end. Perhaps physicians are

judged on how their patients end.

Yes, there is a place you can go in the medical record

seeking revelation -- or is it absolution?

Though by now it can only be hoped

that you have come to realize

you will find neither.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.

Next week on "HealthLink on Air," advice for getting good sleep.

If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org.

Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel.

This is your host, Amber Smith, thanking you for listening.