Habits for good sleep; avoiding ticks, their diseases; hearing aids: Upstate Medical University's HealthLink on Air for Sunday, Oct. 20, 2024

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a sleep specialist gives advice for getting good sleep.

Ioana Amzuta, MD: ... I recommend blinds or blackout curtains; especially if you are someone who is working shifts, and you have to achieve your sleep during the day. ...

Host Amber Smith: And a microbiologist sounds a warning against two ticks new to Central New York.

Saravanan Thangamani, PhD: ... They are good hitchhikers, though. They will try to find spaces that we normally wouldn't notice or normally would ignore. And, so we can bring them home. It's like the pets. Sometimes these ticks don't actually feed on the pets, but they are actually crawling on the pets. And then if we don't do the tick check on the pets, and they actually will crawl on the surface and they will find a perfect human to feed on. ...

Host Amber Smith: All that, tips for buying a hearing aid over the counter, and 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, we'll learn about dog ticks and lone star ticks and the dangerous diseases they can carry. Then, an audiologist gives advice about over-the-counter hearing aids. But first, getting a good night's sleep is sometimes a challenge, so we'll hear some tips and tricks from a sleep medicine specialist.

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

Do you have trouble falling asleep? Staying asleep? Feeling rested when you awaken?

My guest, Dr. Ioana Amzuta, is an associate professor of medicine specializing in sleep medicine, and she's here to help us get a good night's sleep.

Dr. Amzuta, welcome to "HealthLink on Air."

Ioana Amzuta, MD: Thank you for having me.

Host Amber Smith: I'd like to first ask you why sleep is important. Why do we need to sleep?

Ioana Amzuta, MD: The brain is a highly metabolic organ. In other words, it consumes a lot of our calories, about 20% of what we eat. Our calories are consumed by brain functioning while the brain is awake.

So you can imagine that (with) this very high metabolic rate, there are going to be some byproducts of this very intense metabolism. And one of them is adenosine, a substance that actually helps us fall asleep. So the sleep is necessary to get rid of all the byproducts of the brain metabolism.

But not only that, there are other, more complex functions of the sleep, and I may add that sleep is not a passive mechanism. It's not like the lights are out, and that's it, we fall asleep. The brain is, actually, actively shutting down some areas and opening up other areas of functioning in order to promote sleep.

And as I said, one of the main functions of sleep is to get rid of the byproducts of the metabolism, especially the adenosine, but also during sleep is when we consolidate memory that we accumulated during the day. We consolidate skills that we learned during the day, such as learning to play the piano or learning to ski or learning a new procedure, for us in the medical field.

Also, during sleep, there is a period of rest for the cardiovascular system, which is very important for the cardiovascular health.

A lack of sleep has a huge impact, not only on how you feel the next day, your ability to stay awake and focus on different tasks, but also on your cardiovascular health, on your immunity, which may be depressed by a lack of sleep. And, unfortunately, we are seeing an increase in the incidence of malignancies with chronic lack of sleep, suggesting that there is, again, something at the immune system level that is not working the way it's supposed to when we are sleep deprived.

Host Amber Smith: So how do we know how many hours of sleep our body needs to do all of that? Those are some important tasks that have to be done every night, it sounds like.

Ioana Amzuta, MD: So we know that for adults, seven to nine hours of sleep are necessary to ensure not only brain health, but cardiovascular health and a strong immune system.

And unfortunately, in the last 10, 15 years, we are dealing not only here in United States, but globally, with an increase in the lack of sleep, so much so that the World Health Organization declared an emergency regarding sleep disorders and especially lack of sleep. Worldwide, apparently 60% of the adults are not getting enough sleep. This is a huge number and with huge social and health implications.

Host Amber Smith: Well, I used the word "night" when I was talking about sleep, but I wonder, does it have to take place at night, or can you get your sleep between 10 p.m. and 6 a.m.?: Is that the same as between 1 a.m. and 9 a.m.?

Does it matter when you're sleeping?

Ioana Amzuta, MD: Well, it all depends on what your chronotype is. In other words, are you an early riser, or are you a night owl? And nowadays there are tools available on the internet where you can determine what type of chronotype you are. And this is very strongly determined geneticially, so not too much that you can do to change that. You are either an early riser or a night owl.

Unfortunately, because of the way the society is structured, the night owls are kind of being punished for their chronotype, because they are forced to go to sleep earlier and wake up earlier than they should. And this has a significant impact on their overall health, because the quality of their sleep is not going to be what it's supposed to be. As an example, if you are someone whose chronotype is such that you would sleep the best going (to bed) at midnight and waking up 8 o'clock in the morning, but you are forced to wake up at 6 o'clock because of your job, you can think that you lost only two hours of sleep, right?

But in fact, you are losing about 60% of your REM (rapid eye movement) sleep. This is the type of sleep where we consolidate most of the memories. And so you are going to be profoundly affected by that lack of sleep in the early morning hours.

So, to answer more concisely to your question, it does matter when you go to sleep, and that's determined by your chronotype.

Host Amber Smith: But the people that chronically are getting, say, six hours of sleep, they're not getting the recommended seven to nine, I guess they're the people that the World Health Organization is concerned about.

Ioana Amzuta, MD: Yes. Yes, and for good reasons, because there were multiple studies showing that sleeping less than seven hours a night is associated with 20% increase in cardiovascular disease, tripling your chance of developing metabolic syndrome, so gaining weight and having high glucose levels, hypertension, and again, there is an increase in the rate of malignancies, once you go below seven hours of sleep.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Ioana Amzuta, an associate professor of medicine specializing in sleep. medicine. So how do you take care of someone who comes to you saying that they're having trouble sleeping?

Ioana Amzuta, MD: First you want to get a very good history of what's happening with that person. Are they not sleeping well because their chronotype does not align with their work schedule? Is this a person who is working shifts and has a hard time going back to a regular sleep schedule in between the night shifts?

Is that someone who is traveling a lot and is affected by jet lag? Is this a person who is not sleeping well because they spent a lot of hours, just before going to bed, checking their mail, checking their social media, being exposed to the blue light from either the phone or a computer or a laptop?

Is this someone who has a drinking problem, and they drink alcohol heavily in the evening hours, and then they cannot have a good quality sleep because of their alcohol consumption? Is that someone who is drinking a lot of coffee until the late evening hours, and again, the sleep is affected by that?

And of course, we are always concerned about the possibility of obstructive sleep apnea, because with the obesity epidemic that we are seeing, obstructive sleep apnea is also a big concern.

Host Amber Smith: At what point would you ever consider a sleep study?

Ioana Amzuta, MD: We do a sleep study when we are concerned that someone may have obstructive sleep apnea.

And in that case, again, we are taking a very detailed history if that person has snoring, has apneic events, meaning that they stop breathing while they are asleep, and usually their bed partners are going to tell them that this is what is happening.

So then we are going to consider doing a sleep study to see if that person has obstructive sleep apnea. And we can do that as a sleep study in our sleep lab, or we can do it as a home sleep study.

Then we do sleep studies for people where we think that they may have a different type of sleep disorder, such as parasomnia, someone who is sleepwalking, for example, or someone who has a disorder related to the REM sleep, such as REM behavior disorder, where people are enacting their dreams. This is a very dramatic disorder.

Host Amber Smith: Let me ask you, is someone who has trouble falling asleep the same as someone who has trouble staying asleep?

Ioana Amzuta, MD: Not really. We used to categorize insomnia into sleep-onset insomnia and sleep-maintenance insomnia. In the last couple of years, the American Academy of Sleep Medicine kind of put everything under the umbrella of insomnia, and again, a very detailed history is necessary, and most of the time will tell you what is keeping awake that person.

I am seeing, at least in my practice, and I think this is pretty much everywhere, that people are excessively using their electronic devices. And that's the reason they cannot fall asleep.

And even if they fall asleep, with their phone in their hand or the laptop on their lap, they find themselves waking up in the middle of the night. And the reason for that is because they're exposed to this blue light that is resetting our circadian rhythm. In other words, our circadian center is fooled by the blue light into thinking that this is daytime. So it's stopping the production of melatonin, which is the trigger for starting sleep.

Host Amber Smith: Do you ever recommend sleeping pills to help someone get to sleep?

Ioana Amzuta, MD: No, and for good reasons. The FDA (Food and Drug Administration) actually approved the hypnotic medications only for short-term treatment, meaning under a month of acute insomnia, so something that has a duration of less than three months.

For the rest of the people, the treatment that is working is cognitive behavior therapy, and it takes time; it's basically retraining yourself to have better sleep hygiene: getting rid of all the distractions, getting rid of drinking coffee later in the evening, or any other caffeinated drinks, reducing the amount of alcohol and, even better, not having any alcoholic drinks in the evening hours, keeping the room at a low temperature, keeping the room quiet.

And again, a big, big part of this is allowing yourself enough sleep time, so don't just go to bed at midnight if you know that you have to wake up at 6 o'clock in the morning. Allow yourself a time in bed of eight hours. And not in bed watching movies or checking social media, but actually sleeping and resting.

Host Amber Smith: Now, what about supplements, or over-the-counter products like melatonin? Do you ever see a reason for people to take those? Do they work?

Ioana Amzuta, MD: First of all, here in United States, none of the melatonin products are FDA approved. As a result of that, they go under nutritional supplements, and so the dose of melatonin in this product is not checked, so you don't know for sure even if you are getting any melatonin in the supplement.

In Europe, the doses are standardized, and they are considered a medication, so they are checked. They ensure that you have a certain number of milligrams in the melatonin supplements.

The only reason to take melatonin would be for jet lag. Why is that? Because the melatonin is actually not helping you stay asleep. The melatonin is just a trigger for sleep. So, if you can imagine a race, the melatonin is the person who shoots the gun in the beginning of the race, that's all. It's giving a signal that the race has started, but it's not helping you stay asleep during the night.

Now, in order for people to have a healthy dose of melatonin before they go to bed, they have to be exposed to natural light in the early morning hours. And this is a signal for the brain that you have to start producing the substance, the melatonin, which will reach a peak around 9 to 10 p.m. for most of us. And again, if you travel somewhere and you have jet lag, melatonin is helpful, because it's kind of resetting this circadian rhythm along with other things, such as the light exposure, and the time of the meals, which is another very good timekeeper -- zeitgeber (time cue) -- for your circadian clock.

But other than this, melatonin is not really helpful to give you a good night's sleep.

Host Amber Smith: Upstate's "HealthLink on Air" has to take a short break, but please stick around for more about getting good sleep.

Welcome back to Upstate's "HealthLink on Air." I'm your host, Amber Smith, and my guest is Dr. Ioana Amzuta. She specializes in sleep medicine at Upstate.

Well, I wanted to ask you about some things people can do to optimize their chances of getting a good night's sleep. You've already talked about a lot of them, about avoiding the caffeine, avoiding alcohol. Does a bath or a shower before bed help your body realize that it's time to sleep?

Ioana Amzuta, MD: Yes, definitely. And the reason for that is because just before going to sleep, there is a drop in the internal body temperature, OK? And that's a signal for your brain that this is the time to go to sleep. This is something that is controlled by your circadian rhythm.

You can trick your body into thinking that this is the time to go to sleep by taking a hot bath. Now you are going to say, how come, because this is hot and you are telling me the body temperature has to drop.

But when you take a hot bath, what happens is that you have vessel dilation. So you are going to see how your skin is becoming red. That's because the vessels are dilating, and so when that happens, you are going to lose a lot of heat through all these dilated vessels, not during the bath itself, but immediately after that. And you can do that also with a prolonged shower, or you can use a sauna just before going to bed. It will create the same effect.

So this vessel dilation that will help your body get rid of some of the internal heat, that will drop your core body temperature, and it'll transition you very nicely to sleep.

Host Amber Smith: What about the temperature of the air in the room? What should that be set at?

Ioana Amzuta, MD: So there were studies looking into this, and it looks like the ideal temperature should be around 65 degrees.

Now, of course, different people have different levels of comfort. For me, 65 is far too cold. My level of comfort is probably around 75, not 65, but keep in mind that you have to keep your room on the colder side.

And again, 65 looks like it's the magic number.

Host Amber Smith: Is it better to sleep in the dark, or does that matter?

Ioana Amzuta, MD: That matters very much, and it matters, again, to create a more robust circadian rhythm. You need that darkness at nighttime and the light exposure in the morning to have robust production of melatonin.

And so I recommend blinds or blackout curtains; especially if you are someone who is working shifts, and you have to achieve your sleep during the day, that becomes extremely important.

Host Amber Smith: If you work out or exercise right before bed, will that help you tire yourself out so that you'll sleep better?

Ioana Amzuta, MD: You shouldn't exercise just before going to bed, and the reason for that is because the exercise is going to increase your internal body temperature. And this goes against what we were talking about before, that your body has to cool down before going to bed. But exercise is an extremely important way of getting a good night's sleep, so if you are exercising, try to stop exercising about two hours before going to sleep. And keep in mind that 30 minutes minimum of aerobic exercise daily will ensure a very good quality sleep.

Now there were people looking into what kind of aerobic exercise is better. Is running better than cycling, for example, and it looks like yes, there is a little bit better evidence for cycling, for spinning, for creating that good quality night's sleep.

Now, why that is, we don't know, and the difference is not huge, so whatever type of aerobic exercise, meaning that you have to increase your heart rate. And exercise for 30 minutes at the rate where you are sweating, and you are not able to utter more than two, three words at a time. It's extremely important to have a good night's sleep.

Host Amber Smith: Is reading a good way to wind down?

Ioana Amzuta, MD: Reading is a very good way of relaxing. But keep in mind that if you have a very bright light by your bed, so you can read, maybe that's not a good idea.

I truly encourage patients to keep the bed and the bedroom just for sleep. In other words, if you want to read in a different room, try to kind of wind down for the nighttime, definitely do it.

But then when you go to bed, try to keep the bed only for sleep.

Host Amber Smith: Now, some people like to read their books on a tablet that's backlit with that blue light ...

Ioana Amzuta, MD: Uh-huh.

Host Amber Smith: ... that you've already told us about. Is that not recommended in the evening?

Ioana Amzuta, MD: Fortunately, there are settings nowadays on the tablets, where you can adjust the light. You can put a black and gray scale on the tablet that will minimize the exposure to light, and a lot of them have specific nighttime settings.

Host Amber Smith: You're listening to Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Ioana Amzuta, an associate professor of medicine specializing in sleep medicine at Upstate.

Now, how do you feel about if someone is struggling to get a good night's sleep, and they're feeling tired during the day? How do you feel about naps?

Ioana Amzuta, MD: What will happen if you take a nap during the day? Remember we were talking about that byproduct, adenosine, that builds up in the brain as we are staying awake. If you take a nap, some of that byproduct, the adenosine, is going to be reduced. So by the time you go to bed in the night, you are not going to have such a powerful drive to fall asleep and stay asleep.

For most people, I would say avoid naps during the day. There are some professions where you kind of have to tell people to take a short nap. I'm talking about airplane pilots, long-distance drivers, physicians, nurses, where they don't have a choice, they have to work at different hours during the day, and they may become so sleepy that they cannot function. In that case, yes, you have to take a nap. I am telling everybody to try to limit the nap to about 30 minutes to avoid that post-nap drowsiness.

There was an interesting study done a couple of years ago, at UC (University of California)-Berkeley, where actually they did something called an "espresso nap." In other words, you have a shot of espresso, and then you take a nap, and when you wake up from that nap, you have enough time to absorb the caffeine, so you feel refreshed, both because of the caffeine and because you took that short nap. Again, not something that I would recommend for, usual circumstances. This is mostly for people who have to work shifts or have to work long hours, and they need to be awake and alert, for their job.

Host Amber Smith: Do you have any special advice for teenagers, who seem to need a lot more sleep during the teen years and are forced to get up early to go to school? Some of them are the night owls that wish they could stay up later and sleep later, but they can't because of school. Do you have any advice for them?

Ioana Amzuta, MD: I would have advice for the school system, not for the teenagers, because what is happening to them is very natural.

During the teenage years, there is a delay in your circadian rhythm. In other words, you are forced to fall asleep later during the night and sleep later during the day. This is physiological. It happens to all the teenagers. And this is extremely important for the brain to mature.

During this time, they have the highest concentration of REM sleep as well. And there were beautifully designed studies that showed that limiting the REM sleep during the teenage years by waking them up early in the morning is leading to depression, to personality disorders, to problems with attention during the day and concentration.

So, if anything, I would advocate for the schools to have later start times for the teenagers because it's really horrible what we are doing to them by waking them up so early in the morning, especially for the teenagers that are involved with sports.

Host Amber Smith: Any special advice for seniors who develop sleeping difficulties as they age?

Ioana Amzuta, MD: For seniors, it is very important to get light exposure during the day. This will ensure that you have a healthy melatonin a sleep-related hormone production. And again, exercise is the best cure for having problems sleeping, so maintaining a healthy level of exercise, 30 minutes of aerobic exercise five times a week, and in addition to that, some weight training, twice a week. That was proven to have amazing health benefits and improve the quality of sleep.

Host Amber Smith: Well, Dr. Amzuta, thank you so much for making time for this interview. I appreciate it.

Ioana Amzuta, MD: My pleasure.

Host Amber Smith: My guest has been Dr. Ioana Amzuta. She specializes in sleep medicine, and she's an associate professor of medicine at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Protecting yourself from two ticks that are new to Central New York -- next on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." New types of ticks have migrated to parts of Central New York, according to research from the lab of Upstate molecular biologist and tick expert, professor Saravanan Thangamani. He's here to tell us about these ticks and explain how they transmit viruses.

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

Saravanan Thangamani, PhD: I'm happy to return back and talk about the ticks that we are finding in our program.

Host Amber Smith: Well, you've told us so much about deer ticks, in the past, and Lyme disease, but now there are a couple other tick varieties to be concerned about. Which ones are you going to tell us about today?

Saravanan Thangamani, PhD: In addition to the deer ticks, there are four other takes that are emerging in the New York state. With specific reference to Central New York, I would like to focus on the dog tick, dermacentor variabilis, and the lone star tick, or amblyomma americanum. So the dog ticks, originally in the past few years, we were receiving the docs from I would say counties like Westchester and Albany, anywhere in the lower Hudson Valley. That's where the majority of the ticks were submitted to us. However, now this year we are actually seeing a lot of these dog ticks being encountered by humans in Central New York as well, in addition to the Western New York. So that is a change in pattern we were observing in the ticks that are submitted to us.

So dog ticks, unlike the deer ticks, they look different. Morphologically, they are a little bigger than the deer ticks. Dog ticks are bigger, and they're, I would say morphologically, the cuticle that we call the surface of the tick is a little bit more ornate and patterned than the deer tick. And also the dog ticks, they do have shorter mouthparts. So what I always tell that in the lab when we get the ticks, dog ticks are morphologically easy to differentiate from the deer ticks. There are key features that we look in the lab when we receive a tick. The first thing is the the cuticle of the tick. Cuticle is what the outer surface of the tick, they look different. And also the mouthpart of the tick. That is what that is inserted into this human skin. There are key anatomy that we look in the lab. I don't want to get into scientific terms in that, but dog tick mouthparts are smaller, and deer tick mouthparts are very long.

So what it means is that when a dog ticks attach on a human, they literally stay attached to the, barely attached to the top of the skin. However, the deer ticks, they actually pierce deeper, and then they stay inside the human skin a little stronger than the dog tick. So these dog ticks, or why we should be worried about these dog ticks? The dog tick actually carries an agent called Rickettsia rickettsii, a causative agent of Rocky Mountain spotted fever. It is a type of bacteria that can cause acute febrile illness. It can be treated with antibiotics, however, if it's not diagnosed early in humans, it actually can cause severe health consequences.

The second tick of human health importance that we are seeing more in the Central New York is the lone star tick ...

Host Amber Smith: Excuse me. Can I ask you about the dog ticks before we get into lone star?

They're called dog ticks. Is that because they, do you find them on dogs as well, or where do they get their name?

Saravanan Thangamani, PhD: I think in the older literature and it is believed that the adult stage of the ticks prefer to feed on dogs and larger mammals like dogs. Unlike the deer ticks, the adult stage of the ticks like to feed on the deer. That's why it's called deer ticks, right? Dog ticks preferentially feed on dogs. However, humans are accidental host. What I mean, "accidental host," is that the humans are not natural host for the these ticks. We happen to be next to the pet. We happen to be next to the dog. We happen to sleep next to the dog ticks in our bed; the dogs sleep in the bed with us, right? So basically accidentally these sticks are actually are attached to humans. So we are not a natural host for these ticks.

Host Amber Smith: When you were describing how they attach, and it sounds like the dog tick doesn't go as deep in, does that mean that it can jostle loose easier, or not?

Saravanan Thangamani, PhD: No. So they're very clever. So what they do is, in any tick, before they actually start feeding, the first thing they do is secrete gluelike proteins, what we call cement proteins. That allows the tick to stay anchored nicely on the human skin so that it doesn't drop off by itself. Since dog ticks don't have deeper mouthparts or longer mouth parts, what they do is actually they secrete huge amounts of these glue proteins first. So although they don't go deeper, they secrete more glue proteins in such a way that they actually stay attached to it. So equally, they are strongly attached to the skin, but it's about how deep they go into the skin makes a difference.

Host Amber Smith: Now, do these dog ticks get along with and coexist with the deer ticks and the lone star ticks? Or are they competing for food sources?

Saravanan Thangamani, PhD: They're competing for the resources. They're competing for the resources. So it's very rarely you would find dog ticks together with deer ticks. However, I know that we will be talking about the lone star tick later. Lone star tick adult stages, they like to feed on deer. So there, that is a direct competition between the deer tick and the lone star tick for this larger mammal, that's the deer.

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.

So, tell us about the lone star ticks. Are they from Texas?

Saravanan Thangamani, PhD: Not really, but they are from the Southern United States. They're from the Southern United States. Primarily, however, due to human behavior and climate change and the deer migration, we are seeing lone star ticks up all the way to the Canadian border, and we have traditionally seen this tick in the Suffolk County on Long Island in the state of New York. However, we are starting to see more of these ticks submitted to us from Central New York, and we are starting to see an increase in numbers as well from the Central New York region.

And morphologically, these are much bigger ticks. This is one of the largest tick I can tell. And also, the larger the tick means that it stays attached to the humans for a longer period of the time. Deer ticks on an average, they can stay attached to humans for five days, but lone star ticks because of its size, it needs to take more blood, so it has to stay attached to the human for seven to nine days, or even 10 days. To get that full complete blood feeding, however, humans will be able to find a big bump on our body, and we will try to remove it before the tick actually completes its feeding. However, in animals and deer, you can actually see these ticks, I would say, almost like a kidney bean size in a fully fed tick, you can imagine that.

And these ticks have larger, longer mouthparts than the deer ticks, which means that they can penetrate deep into the subcutaneous space of the skin. And also it can cause rashes. And this is the tick that also causes the meat allergy, or otherwise called as alpha-gal allergy, to these bites of this tick as well.

In addition to the alpha-gal allergy, this particular tick is of human health importance for the following reasons: it transmits agent that cause human ehrlichiosis. It transmits heartland virus, bourbon virus, and also it has the potential to transmit Powassan virus. So this tick is, in my opinion, the biggest, public health concern tick, that we have to be look out for in the, I would say, in the next couple of years.

Host Amber Smith: And when you mention that alpha-gal, that's the one that causes the meat allergy?

Saravanan Thangamani, PhD: Exactly. It is an allergic reaction to a carbohydrate called galactose-alpha-1,3-galactose, otherwise known as alpha-gal. Humans don't have this particular protein. So when a tick is feeding on a human, it actually injects this particular carbohydrate into our body. Our body, in response to any other foreign substances, it actually generates immune antibodies. In this case, it's IgE antibodies or immunoglobulin E antibodies.

So when we are already sensitized to this particular alpha-gal carbohydrate, when we take a meat or red meat that actually has this carbohydrate, our body responds to it. Some people respond much robust than the others. So in those cases where someone's body responds to it, they get an allergic reaction, typically between two to four hours after consuming a red meat.

Host Amber Smith: Well, I'm still surprised about the size difference, because didn't you tell us the deer ticks are about the size of a poppy seed?

Saravanan Thangamani, PhD: I must clarify here that there are three lifecycle stages of the tick, larvae, nymph and adult, right? Each stage has different lifecycle stages. The poppy seed-sized ones are the nymphal stage ticks, I would say. And even within in the nymphal stage ticks, the size difference is vastly different between these different ticks that we encountered in New York State. Of that, lone star ticks are the largest one. Even in a nymphal stage, you can clearly see the morphological differences of the tick in comparison to the deer ticks.

Host Amber Smith: So people, it sounds like, might have a little more luck at seeing or finding on their skin a lone star tick, just because it's going to be a little bit bigger. Is that right?

Saravanan Thangamani, PhD: You are absolutely right. You are absolutely right. So people can actually identify the tick on the human body much more easier than a deer tick.

Host Amber Smith: Now, does it have a star on it?

Saravanan Thangamani, PhD: OK, it does not have a star on it, but it has a small white, pale color dot that you have to assume that as a star. And that's why the tick is commonly referred as a lone star because it resembles the star in the Texas flag.

Host Amber Smith: Now you mentioned a bunch of the different diseases that these ticks can transmit. Are those also threats to dogs or other mammals that are out and about?

Saravanan Thangamani, PhD: Yes, of course. I think they do transmit ehrlichia that can cause disease in dogs and other specific, like tularemia that can actually cause disease in pets and veterinary animals and also humans as well.

But again, we are focusing primarily on the human, so that's why I kind of focused on this, but they do transmit agents that cause disease in dogs, pets, and wildlife as well.

Host Amber Smith: So all of these ticks that we've discussed, do you remove them the same way? Can you walk us through how best to remove them? Let's say you find one on your body after you've been in the woods.

Saravanan Thangamani, PhD: Absolutely. The mechanistic approach of removing a tick is the same. It doesn't matter what tick species. You just use a fine tip tweezer. Just go right underneath the mouth part, and pull it perpendicular to your body, in such a way that you don't try to angle it. Because sometimes when you're angling it -- as I said earlier, the ticks secrete large amount of glue proteins -- so you want to make sure that you are pulling the tick in such a way that you don't pull your skin as well. So that's why going perpendicular to your skin or perpendicular to the angle of the tick that is attached to it, it's always an easy way, with less damage to your skin. In the case of a lone star tick, as I said, the mouthparts are even longer than a deer tick. The chance of pulling a bit of your skin is there, so you have to be a little bit more careful when pulling. You know, don't yank it, don't swirl it. Just gently pull, with gentle pressure. It might take 10, 15 seconds to pull gently, so that you have the least injury to your skin, but you have to be patient, particularly with the lone star tick.

Host Amber Smith: Is this something where a person needs to let their primary care provider know that they've removed a tick? I mean, is there anything that can be done if the disease has already been transmitted? Is there anything you can do at this stage?

Saravanan Thangamani, PhD: Absolutely. It's very important for the health care provider to know that you are a bitten by a tick. That's one thing that our program is helping the public is that when they send the tick to us, within a couple of days, we send the results back to them to let the public know, the tick submitter know what agent that it carries. So by the time they go to the primary care provider, they have the tick results with them. So if they tell that information to the public health care provider, they will make informed decision because a lot of these agents, a lot of these diseases can be treated with antibiotics if diagnosed early. So that's the key point. If it's diagnosed early.

Like rickettsiosis. Like Lyme disease. If it is diagnosed early, you know the health care provider will prescribe the appropriate antibiotics to treat it. Even ehrlichiosis, you can actually get treated with the antibiotics if diagnosed early. So that's why it's very important to tell the health care provider that you got bitten by a tick.

And then if you, in some cases, people don't send the tick for tick testing. In those cases, the health care provider will have an epidemiological knowledge about this tick and also where they are coming from. For example, if it comes from Central New York, they can go to our tick dashboard and then find out what are the current agents that are transmitted by this tick, and then the health care provider can prescribe or even do a diagnosis on the human accordingly.

Host Amber Smith: Let's remind people of the website they can go to to learn more about tick submission or for the tick dashboard. What is your website?

Saravanan Thangamani, PhD: It's www.NYticks -- T I C K S -- .org So that is, again, www.nyticks.org.

Host Amber Smith: Very good. And before we wrap up, I want to ask you if you'll go over the steps people can take to minimize the chance of tick bites. What do they need to know before they head out?

Saravanan Thangamani, PhD: It is important to know the basic information about where ticks are living. Often they are living by the under brushes or, depending on the tick, there can be under brushes or on the top of the grass blades. But the most important thing is to actually know how to walk in the woods, know where to walk in the woods. I always tell people don't walk on the almost at the corner of the trekking tracks, because that's where the ticks are waiting because it's where the grasses are unmowed, and if you go closer to that will actually hop on. Basically, when you brush against the grass, ticks will actually easily move from the blade of the grass to your socks, and then they will crawl onto your body. And also you can do preventive measures like treat your clothes with permethrin, or have the insect repellent sprays that are good in protecting ticks and fleas, and also mosquitoes, because the current insect repellents that are being marketed, they can actually prevent people from getting mosquito bites, tick bites, flea bites, and also tick bites. And they can prevent it.

And once they come (in) from doing an outdoor activity, it's important to the tick check. And it's important to make sure that they put their outdoor clothing into in the dryer for 10 minutes at high temperature, because high temperature removes the humidity, and that essentially kills the ticks because ticks need high humidity for its survival. The moment you remove the humidity from the environment, they will die.

Host Amber Smith: Now they can't bite you through your jeans, but they could stay on your jeans and come home with you and then crawl onto your skin?

Saravanan Thangamani, PhD: Exactly. So they can come, they are good hitchhikers, though. They will try to find spaces that we normally wouldn't notice or normally would ignore. And, so we can bring them home. It's like the pets. Sometimes these ticks don't actually feed on the pets, but they are actually crawling on the pets. And then if we don't do the tick check on the pets, and they actually will crawl on the surface and they will find a perfect human to feed on.

Host Amber Smith: Well, Dr. Thangamani, I appreciate you making time for this interview.

Saravanan Thangamani, PhD: Thank you. It's always nice to share some information about the ticks and tick-borne diseases in Central New York.

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 Upstate's "HealthLink on Air."

Here's some expert advice from audiologist Erin Bagley from Upstate Medical University. What's important to know about over-the-counter hearing aids?

Erin Bagley: My biggest concerns are some of the marketing has been, "now available without needing a hearing test." I do think it's still really important if you have concerns about your hearing to get a hearing test. Hearing loss is one of those things that can come on very gradually over time. So, it's not always clear what degree of hearing loss you may have. Over-the-counter hearing aids are really intended for people with a mild to moderate hearing loss. But if you haven't had a hearing test, you may not know if you fall in that category.

Also, I think it's very important to make sure that we're ruling out other causes of hearing loss that might be treatable in another way. We want to make sure that it's not something like wax in their ears, or fluid, things like that that could be treated differently. So, I still think it's really important to at least get a baseline hearing test where you put on headphones, and let the audiologist know when you hear the beeps. We also measure word understanding as well, so some recordings of speech and have the patient repeat the words to see how clear speech is for them, too.

Ears come in all different shapes and sizes. And that's where, as a professional, it's important to make sure that our patients' hearing aids fit well. So that is a concern that we have with over-the-counter hearing aids, is just making sure people are able to get something that fits well for them. You know, I'm anticipating they're going to come with some different-size tips that go on the part that goes into the ear, and finding a size that is a good fit for the ear so that it stays in place well is going to be important.

Currently, we don't know exactly how the labeling is going to work on over-the-counter hearing aids. Our professional organizations, the American Speech Hearing Association and the American Academy of Audiology, have been working with the FDA (Food and Drug Administration) to give suggestions on labeling.

Hearing aids purchased through an audiologist in New York state have a 45-day trial period. So the patient can return the hearing aids within 45 days to get a refund. We don't know yet exactly how return policies will work with over-the-counter hearing aids, so one thing I would caution people about is to make sure anything you do buy over the counter does have some sort of clearly stated return policy in case it doesn't work out for you.

Also, I'm a big believer in things like online reviews. Get as much information as you can about the product you're buying because we don't know yet which manufacturers or which companies may be starting to produce their own devices and enter the market. So even audiologists, we're not sure yet what kind of devices we might be seeing in the stores.

You know, I'm anticipating some will look kind of more like a Bluetooth headset kind of device, and some are going to look more like a traditional hearing aid, so I think we're going to see a range of sizes and styles. A lot of prescription hearing aids have the ability to answer the phone, to stream music. Most of them have an app where you can make some adjustments to settings or volume.

Prescription hearing aids through an audiologist are fit, like a prescription. So they are fit to the person's hearing loss. There's measurements that can be taken with a small microphone in the ear while the patient's wearing the hearing aid to make sure that the output of the hearing aid is doing what we think it's doing and meeting their needs.

In my experience, the longer someone has been struggling with their hearing, sometimes the longer it takes for them to get used to hearing differently through the hearing aids and hearing sounds around them again, and kind of relearn what all those different little noises in their home environment are. But every person is different and has a different experience. I find people that are really motivated and wear their hearing aids consistently do adapt more quickly than people who are not quite ready to wear them all the time.

Host Amber Smith: You've been listening to audiologist Erin Bagley from 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.

​

Deirdre Neilen, PhD: Lauren Edwards is an internist and a PCP (primary care provider) at Stanford University. Her poem "Unsaid" gives a concrete form to an essential lesson we try to impart to our med students. Make room, a lot of room, for your patient to speak.

"Unsaid"

"There's one

more thing" --

you said, as I stood

to leave, my checkboxes

checked;

"I've been drinking

at night."

Drinking what?

"Fruit juice.

A lot.

Do you think that's it?

Why I can't lose weight?"

How much?

"About three full glasses.

It's gross, isn't it?"

Your voice transformed

to a childlike whisper.

Soft eyes look up

for judgment?

forgiveness?

understanding?

I sit

and let the silence

extend.

"After my mom

died it's been so hard,"

tears well.

I know, I said.

I did.

My dad's recent death

stings briefly.

"I mix vodka in

the juice."

It hung there

in the air

the Diagnosis

for hypokalemia

for hypomag

for the diarrhea

that these were blamed on.

It spiraled back

and back

to the bone marrow

biopsy years ago.

It's been here

all along.

And I wonder

how many times

was it your

"one more thing"

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," how concerned should you be about the mpox virus?

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.