Welcome to The PEAK!

The PEAK, or “Patient Education And Knowledge,” is the monthly newsletter for Free Range Direct Primary Care. This newsletter will hopefully provide you with evidence-based medical knowledge as well as updates regarding the practice.

Practice Updates

NEW PATIENTS: My office is accepting new patients! Currently, I can see them in 1-2 days for a new patient appointment. If you know of anyone in need of a primary care doctor, please send them my way!

APPOINTMENTS: If you are in need of an appointment, please schedule here. You may also call or email and I can get you on the schedule.

MEDICATION REFILLS: Please text/call (434-337-5934) or email (drjohnson@frdpc.com) with medication refill requests. I will get them to your pharmacy as soon as possible.

In this issue…

• Tick Bite Management
• Evidence on Fish Oil Supplements

How to Manage A Tick Bite…

Summertime brings out the pesky little arachnids, ticks. Management of a tick bite involves several key steps to minimize the risk of tick-borne diseases:

1. Prompt Removal: The tick should be removed as soon as possible using fine-tipped tweezers. Grasp the tick as close to the skin's surface as possible and pull upward with steady, even pressure. Avoid twisting or jerking the tick, which can cause mouthparts to break off and remain in the skin.

2. Post-Removal Care: After removal, clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water. Inspect the bite site for any retained mouthparts, which should be excised if present.

3. Avoid Harmful Methods: Do not use methods such as burning the tick with a match or applying petroleum jelly, as these can cause the tick to regurgitate its contents, increasing the risk of pathogen transmission.

4. Monitoring: Instruct the patient to monitor the bite site for signs of local infection or erythema migrans, and to be vigilant for systemic symptoms such as fever, fatigue, or joint pain, which could indicate a tick-borne illness.

5. Antibiotic Prophylaxis: Routine antibiotic prophylaxis is generally not recommended. However, the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) recommend considering a single dose of doxycycline (200 mg for adults, 4.4 mg/kg up to 200 mg for children) within 72 hours of tick removal if the tick is identified as Ixodes spp., the bite occurred in a highly endemic area, and the tick was attached for ≥36 hours.

6. Tick Identification: If possible, submit the removed tick for species identification to assess the risk of tick-borne diseases.

By following these steps, the risk of tick-borne diseases can be minimized effectively.

1.Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease PM, Rumbaugh J, Bockenstedt LK, et al.Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America. 2021;72(1):e1-e48. doi:10.1093/cid/ciaa1215.

2.Mosquitoes, Ticks & Other Arthropods.John-Paul Mutebi, John Gimnig. CDC Yellowbook

3.Tick Removal.Gammons M, Salam G. American Family Physician. 2002;66(4):643-5.

4.Clinical Practice Guidelines by the Infectious Diseases Society of America, American Academy of Neurology, and American College of Rheumatology: 2020 Guidelines for the Prevention, Diagnosis, and Treatment of Lyme Disease.Lantos PM, Rumbaugh J, Bockenstedt LK, et al.Neurology. 2021;96(6):262-273. doi:10.1212/WNL.0000000000011151.

5.Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis, and Treatment of Lyme Disease.Lantos PM, Rumbaugh J, Bockenstedt LK, et al.Arthritis Care & Research. 2021;73(1):1-9. doi:10.1002/acr.24495.

Can fish oil supplements increase the risk of stroke and heart problems?

Fish oil supplements, which are rich in omega-3 polyunsaturated fatty acids (PUFAs) such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been extensively studied for their cardiovascular effects. The evidence on whether fish oil supplements increase the risk of stroke and heart problems is mixed and context-dependent.

A study by Chen et al. published in BMJ Medicine found that regular fish oil use may increase the risks of atrial fibrillation and stroke in healthy individuals, with hazard ratios of 1.13 and 1.05, respectively.[1] However, in individuals with pre-existing cardiovascular disease, fish oil supplements were associated with beneficial effects, such as reduced transition rates from atrial fibrillation to major adverse cardiovascular events and from heart failure to death.[1]

Conversely, a meta-analysis by Chen et al. in the Asia Pacific Journal of Clinical Nutrition indicated that higher fish consumption and long-chain omega-3 PUFA intake were associated with a lower risk of stroke, particularly ischemic stroke, suggesting a protective effect.[2] This aligns with the American Heart Association's (AHA) advisory, which supports the consumption of marine omega-3s to potentially reduce risks of congestive heart failure, coronary heart disease, ischemic stroke, and sudden cardiac death.[3]

However, a systematic review and meta-analysis by Rizos et al. in JAMA found no significant association between omega-3 supplementation and a lower risk of major cardiovascular events, including stroke.[4] This highlights the variability in outcomes based on study design, population, and dosage.

In summary, while fish oil supplements may increase the risk of atrial fibrillation and stroke in healthy individuals, they appear to offer cardiovascular benefits in those with pre-existing cardiovascular conditions. The American Heart Association recommends marine omega-3s for cardiovascular health, particularly in high-risk populations.[3]

1.Study Links Fish Oil Use to an Increased Risk of Atrial Fibrillation and Stroke in Healthy Individuals, but Fish Oil Could Be Beneficial in Persons With Cardiovascular Disease. OpenEvidence TL;Dr. Summary of https://bmjmedicine.bmj.com/content/3/1/e000451

2.Fish Consumption, Long-Chain Omega-3 Fatty Acids Intake and Risk of Stroke: An Updated Systematic Review and Meta-Analysis. Chen C, Huang H, Dai QQ, et al. Asia Pacific Journal of Clinical Nutrition. 2021;30(1):140-152. doi:10.6133/apjcn.202103_30(1).0017.

3.Seafood Long-Chain N-3 Polyunsaturated Fatty Acids and Cardiovascular Disease: A Science Advisory From the American Heart Association. Rimm EB, Appel LJ, Chiuve SE, et al. Circulation. 2018;138(1):e35-e47. doi:10.1161/CIR.0000000000000574.

4.Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events: A Systematic Review and Meta-Analysis.Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Jama. 2012;308(10):1024-33. doi:10.1001/2012.jama.11374.

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