Blog Posts

PAD Can Be B.A.D.!

April 27th, 2016
Stable atherosclerotic plaque PAD

iStock Photo

If you haven’t already heard about it, PAD is peripheral artery disease, and it’s not uncommon, especially when people get older. According statistics from the US Centers for Disease Control and Prevention (CDC), more than eight million American have PAD, including 12 percent to 20 percent of people 60 and over.

PAD is disease that affects the blood vessels located outside of the heart, most often those in the legs; and like coronary artery disease, PAD is generally caused by the build-up of fatty plaque in the arteries. This condition is called atherosclerosis.

Smoking – current or a history of smoking – high blood pressure, high cholesterol and a sedentary lifestyle are all factors that can lead to atherosclerosis and, thus, PAD. People with diabetes have a higher risk for PAD as well.

The thing people with PAD generally notice the most is pain, aching or cramping in the legs, hips or butt when walking or climbing stairs. This pain usually goes away once the person sits down and rests. This on-off pain is called claudication. Some other symptoms a person might have include wounds that won’t heal, cold legs or feet, shiny skin on the legs with a loss of hair and difficulty finding a pulse in the legs or feet.2

Blood flow in the lower legs is the big concern with PAD, and one of the main tests used to measure it is called the ankle-brachial index or ABI. It’s a simple, noninvasive, painless test that takes only a few minutes to perform. It compares the blood pressure reading in the ankle with the reading in the arm. A lower BP and pain in the ankle is an indication of PAD in the leg.

Once the doctor has the results of the ABI, he or she might use other tests to confirm blocked blood flow in the leg arteries. Other tests that might be used include ultrasound or angiography, during which a contrast agent is injected into the artery or arteries to be studied, and then images are taken that display blood flow and show the blockages clearly.

Undiagnosed and untreated, PAD can lead to some nasty problems. Legs with blocked arteries and wounds that won’t heal are prone to infections that are difficult to treat. This can lead to gangrene and possible limb amputation. Also, people with PAD are at increased risk for coronary artery disease, heart attack and stroke.

Don’t fret if any of this sounds like you. There are things you can do to treat PAD or lower your risk of developing it. The best treatment for PAD is regular physical activity, which might sound counter-productive for a person who can’t walk without pain. Actually, gradually increasing periods of activity alternating with rest is effective in reducing symptoms. That’s because exercise increases the formation of collateral blood vessels that can compensate for the arteries that are blocked, improving overall blood flow.

Making some other lifestyle changes is also helpful, like stopping smoking and adopting a diet low in saturated and trans fats and cholesterol, with plenty of fruits and vegetables. Your doctor might also prescribe a medication to help control your blood pressure or lower your cholesterol. In severe cases of PAD, surgery might be necessary to unclog or bypass blocked arteries.

Don’t just chalk up the cramps when you walk to the aches and pains of getting older. If you have any symptoms of PAD, be on the safe side. Have them checked out.

Stable atherosclerotic plaque PAD

iStock Photo

Healthy or Not?

April 20th, 2016
Benefits of standing up while you work

iStock Photo

Excitement was building in our office as we talked about getting adjustable desks so we could get out of our chairs and spend some time standing at our keyboards instead of sitting. After all, sitting all day is not good for your health. As one article I read put it, people who sit too much are at an increased risk for diabetes, heart disease and early death.1 The article went on to discuss a number of benefits of spending part of your day on your feet.

First of all, if you’re on your butt, you’re not burning many calories. According to the article, you burn more than 170 more calories standing at your desk than sitting and, over time, that adds up. It’s a small, but positive step toward fighting weight gain and obesity.

In addition, studies have found that standing lowers blood sugar levels and prevents those after-lunch spikes. It also decreases the risk of heart disease and appears to reduce low back pain.

If that’s not enough, the article suggests, standing at your desk for part of the day can help improve mood and energy levels and may even boost productivity as a result. Bottom line, studies have found, according to the article, a strong link between increased sitting time and early death.

Standing at work is a no-brainer, right? Wrong.

An NPR article from March reported the results of an analysis of the best research done so far on the benefits of standing at work, and the analysts say, “Hold on!” According to them, there’s no real evidence of these health benefits. They claim the studies done so far were either too small to be significant or poorly designed, so their results are not scientifically meaningful. They even suggest that standing can be harmful by leading to enlarged, varicose veins.

That’s always possible, but the fact remains. Extended sitting is a killer.

I think a professor quoted in the NPR article summed up the situation perfectly. He suggested that as long as a person stands in moderation, he or she will reap some health benefits. I think that’s all we’re really looking for.

Get with the Beat!

April 6th, 2016
iStock photo

iStock photo

It happens every now and then. My heartbeat runs amok. It’s likely due to too much caffeine or one of my medications, but I’ll get palpitations. The feeling is truly weird. My heart’s been checked out and everything’s OK, but there are a lot of non-heart-related reasons your heart can skip a beat.

Of course, if you get palpitations, you’ve got to get your heart checked out, especially if you have other symptoms such as shortness of breath, dizziness, chest pain or pressure, or trouble breathing. Palpitations could signal an arrhythmia, a problem with your heart’s electrical system that controls the rhythm of its beating.

The good news is less than half of those with palpitations actually have arrhythmias. In most cases, palpitations are harmless and go away without any treatment needed. In some cases, the cause of the irregular heartbeats is never determined, but there are a few factors that have been found to trigger the flutters or the skipped, hard or speedy beats.

In addition to caffeine, nicotine, alcohol and street drugs such as cocaine, marijuana and amphetamines can stir the pot. So can certain medications, including asthma inhalers, decongestants and drugs to treat an underactive thyroid. Some over-the-counter cold medicines that contain pseudoephedrine can do it, too. For palpitations, there are problem supplements and herbal preparations as well, such as ma huang.

Certain things going on inside the body can affect the heartbeat, also. The body needs the appropriate levels of electrolytes, such as potassium, magnesium and calcium, for optimal function. When these levels are out of balance, it can affect the smooth coordination of the heart’s electrical system and cause changes in the heartbeat.

We all know how awful stress can be for you. Well, add another black mark, because stress, fear and anxiety can increase the adrenalin level in your body and cause a rapid heartbeat. A good workout or other vigorous activity can get it going as well. No surprises there.

I know we blame hormones for just about everything, but the hormonal changes that occur during pregnancy, menopause and perimenopause can sometimes create palpitations or increase their frequency. Stupid hormones! I know we need them, but they can sure mess up a lot of functions when they’re out of whack.

If your palpitations are related to an arrhythmia, another heart issue or other medical problem, such as an overactive thyroid or anemia, obviously you need to be treated for that underlying condition. But what do you do when the cause is not so clear-cut? Many experts tell you that you should keep a log of what you’re doing when they occur and any other symptoms you may be having at the same time.

If you do this for a while, you might be able to identify substances or situations that trigger your palpitations, and then you can take steps to avoid those triggers in the future. If too much caffeine is the culprit, cut back. If stress is the problem, try some stress-reducing techniques like relaxation exercises. Lifestyle changes can often take care of the problem, but if not, your doctor might prescribe a medication as a last resort.

iStock photo

iStock photo

Palpitations can freak you out, but as long as your heart gets the A-OK from your doctor, they’re pretty harmless. Don’t be foolish, though. If you get them and it’s unusual for you, or you have any of those other symptoms with them, GET YOUR HEART CHECKED OUT. Palpitations are weird, but they can also be a warning!

Beyond Nervous

March 31st, 2016
iStock Image

iStock Image

Do you get a little worked up when there’s a problem at work, before giving a speech or when you have to make a big decision? It’s pretty typical to feel a little anxious at times like these. But imagine feeling so anxious that you can barely function. That’s what it’s like to have an anxiety disorder.

Anxiety disorders are a group of true mental illnesses with which worry and fear are severe and constant. Types of anxiety disorders include panic disorder, social anxiety disorder, specific phobias and generalized anxiety disorder. Each type has its own set of symptoms, but there are some general anxiety symptoms the disorders have in common such as:

  • Feelings of alarm and uneasiness
  • Heart palpitations
  • Nausea
  • Dizziness
  • Muscle tension
  • Trembling
  • Headache
  • Sweating/flushing

It’s not unusual if you’re experiencing symptoms like these to think you’re physically ill, maybe even having a heart attack, and to seek medical treatment. If these symptoms continue and your doctor can’t find a physical reason for them, he or she will likely refer you to a psychiatrist or other mental health professional such as a psychologist, social worker or counselor.

Mental health professionals use specialized interview and assessment tools, as well as their own observations of your behavior, to determine if you have an anxiety disorder and which type. Once they know this, an appropriate treatment plan can be developed.

Anxiety disorders are generally treated with medication, psychotherapy or both.3 The medicines most often used are antidepressants and anti-anxiety drugs. You and your doctor might have to try more than one drug to find one that works for you.

Psychotherapy or “talk therapy” with a trained professional can help change how you think about things or situations that cause you to become anxious. Then, you can learn new ways to react when confronted with them. This type of therapy can be done in an individual or group setting.

There are some other steps you can take that can help you feel better when your anxiety level is high; but remember, these suggestions are complements to your doctor’s treatment plan, not replacements. Always follow your doctor’s recommendations for your care. Try these tips as part of your overall approach to battling anxiety:

  • Do what you can to manage the stress in your life. Give yourself time on the job or when doing schoolwork to take a break.
  • Try some relaxation techniques, including meditation. Deep abdominal breathing helps relax and calm you as well.
  • Take care of yourself physically. That includes eating healthy, exercising regularly and getting a good night’s sleep.
  • Replace “negative self talk” with “coping self talk.” Instead of telling yourself, “I can’t do this,” say, “This is difficult, but I can make it.

Anxiety disorders can be treated successfully, but it takes a little effort on your part. Believe me, it’s worth it!

Be Aware, Get Screened: Colon Cancer Awareness

March 24th, 2016
Colon Cancer Ribbon - iStock image

Colon Cancer Ribbon – iStock image

I’ve put it off for far too long. I can’t ignore it any longer.

March is National Colorectal Cancer Awareness Month and I’ve made a commitment to undergo a colonoscopy.

Yes, I say “commitment” because I’ve been putting it off for a few years now. Even though I have far too much at risk.

My niece died of colon cancer at the age of 42, leaving behind a husband, four kids and a bright future. My paternal grandmother also succumbed to the disease. My father was diagnosed at one point in his life, had surgery to remove a portion of his colon and, thankfully, survived. Lung cancer took his life years later.

Among cancers that affect both men and women, colorectal cancer is the second leading cause of cancer deaths in the United States.

Colon cancer is preventable, treatable, and beatable, especially if detected in its early stages. It can be prevented by finding and removing polyps before they become cancerous. Begin screening at age 50, and before, if there is a strong family history of risk factors.

In February 2000, President Clinton officially dedicated March as National Colon Cancer Awareness Month. Since then, it has grown to be a rallying point for the colon cancer community when patients, survivors, caregivers and advocates throughout the country join together to spread colon cancer awareness by wearing blue, holding fundraisers and education events, and talking to friends and family about screening and so much more.

Given my family history, I can’t delay a colon screening any longer. For myself and my family.

Live Well, Feel Great!

March 9th, 2016
national nutrition month, eating healthy

Public Domain Image

We’re well into 2016, so how are you doing with your resolutions? Fear not! National Nutrition Month is here to give you a boost. All March long, we celebrate healthy eating, not just to lose weight, but to live well and reduce the risk of many chronic diseases.


The theme for 2016 is “Savor the Flavor of Eating Right.” The Academy of Nutrition and Dietetics, which created the annual celebration, chose this theme to encourage everyone to take time to enjoy food traditions and appreciate the pleasures, great flavors and social experiences food can add to our lives. We can do this while making informed decisions about what and how much we eat.


The word “diet” makes most people cringe because it is often associated with a way of eating that includes eliminating your favorite foods. But “diet” is a more general term, including everything you eat, when you eat it, how much you eat and how you prepare it. So when your doctor recommends a healthy diet, don’t freak out. It’s easier than you think. A few different food choices can make a big impact.


The President’s Council on Fitness, Sports & Nutrition agrees. The Council says small changes can make a big difference to your health. They offer eight healthy eating goals and suggest you try incorporating at least six of them into your diet.1 These tips can help rejuvenate your New Year’s resolution to eat better – and maybe you’ll lose some weight in the process.


  1. Make half your plate fruits and vegetables – Choose a variety of colorful fruits and vegetables. The more color on your plate, the better.
  2. Make half the grains you eat whole grains – Choose whole-wheat bread and pasta, quinoa, oats and brown rice for the best nutrition. Check the food label. The first ingredient should be “whole grain” or “whole wheat.”
  3. Switch to fat-free or low-fat (1%) milk – If you can’t hack lactose, try calcium-fortified soy beverages.
  4. Choose healthy protein sources such as lean meats and poultry, beans and peas, eggs, nuts and seeds.
  5. Compare sodium in foods and choose the lower sodium versions.
  6. Drink water instead of sugary drinks such as sweetened soda, energy drinks and sports drinks.
  7. Try adding some seafood to the menu – Seafood has protein, minerals and heart-healthy omega-3 fatty acids.
  8. Cut back on solid fats such as cakes, cookies and other desserts that contains butter, margarine or shortening, and processed fatty meats such as sausages and bacon.


Eating healthier is a good first step, but you can go even further if you add physical activity to your improved meal plan. We’ve all heard the recommendations: 30 minutes of moderate physical activity every day. With the combination of a healthy diet and regular activity, you can not only lose or maintain weight, you also can reduce your risk of chronic diseases such as diabetes, heart disease, stroke and some types of cancer. Good deal!


Eating healthy doesn’t mean you have to give up everything you love to eat. If you make a few changes to your food choices, you can still do as the theme of National Nutrition Month 2016 suggests, “Savor the Flavor of Eating Right.”

Confused about Mammograms? Join the Club!

February 23rd, 2016
breast cancer prevention is with common screenings

Public Domain Image

When should you get a mammogram? If you’re a woman past 40, that question isn’t as easy as it used to be. Health organizations are no longer in agreement about when, or how often, women should be screened for breast cancer through mammography.

Since the 1980s, women have been encouraged to get routine annual mammograms, certainly by age 50 and possibly even younger. Groups like the American Cancer Society said yearly mammograms should start at 40. The thinking was that breast cancer caught early is the most curable.

Now some groups have changed those recommendations, but not uniformly.

Let’s start with the U.S. Preventive Services Task Force. In January, the federal advisory panel of health experts issued guidelines that not only altered recommended ages for mammography but also how often women need mammograms.

The advisory group now recommends routine mammograms for women between the ages of 50 and 74. Not every year, mind you, but every other year. This is for women at average risk. For instance, they don’t have a sibling, mother or child with breast cancer, or the breast cancer gene mutation known as BRCA1 or BRCA2.

The more conservative guidelines are meant to provide a balance between screening for breast cancer to save lives through early detection and lessening the risk of false positive findings and overtreatment.

The task force panel’s recommendations basically say women between 40 and 49 need to make their own decisions while weighing the possibility of good versus harm. In other words, what is the likelihood that the harm from mammograms such as false positives outweighs the likelihood of catching an aggressive cancer?

Sometimes, what looks like it might be cancer on a mammogram really isn’t. But to find out, women must go through the anxiety of being called back for another look and possibly undergo biopsies that weren’t really needed.

Or the mammogram might detect a very small, localized lesion called Stage 0. It may or may not progress. Unfortunately, there aren’t any tests to say for sure, but some studies are questioning whether treatment is really necessary in lieu of careful monitoring.

According to the task force, the scientific evidence isn’t strong enough to indicate whether women older than 75 significantly benefit from mammograms compared to the potential harm of false positives and overtreatment.

This age group isn’t included in studies about screening mammograms. Information on the task force website, however, says there may be some indicators that the older a woman becomes, the less she may benefit.

Meanwhile, other health groups aren’t in agreement with the Preventive Services Task Force panel and want women to know it.

The American Cancer Society now has new guidelines and recommends annual mammograms start at age 45. After age 55, women can adopt every-other-year screening, according to the ACS.

On the other hand, the American College of Obstetrics and Gynecology recommends that routine mammograms begin at 40. So does the Society of Breast Imaging, which has started a web campaign called End the Confusion. The campaign is aimed toward advising women why getting fewer screening mammograms isn’t wise.

So now we’re in the gray zone of “shared decision making.” In consultation with their doctors, women will have to figure out what is best for them as individuals.

When even experts can’t agree, this might seem difficult.

One factor women should consider is family history, although there’s a wrinkle here, too. Women who have sisters, mothers or daughters with breast cancer do have higher risk and it’s likely their doctors would recommend more frequent screening. However, not having a family history is no guarantee. More than 85 percent of new cases are diagnosed in women without a family history of the disease.

In the end, a woman will have to determine how comfortable she is with uncertainty. Would she rather lessen her chances of having an unnecessary biopsy or being faced with the decision of treating a very early cancer that might never be harmful? Or is she the type who never wants to risk the possibility of breast cancer going undetected because she had less frequent mammograms?

Taking care of her self is something every woman needs to do. How often that includes routine mammograms is a personal decision she will have to make.

Put Your Heart Into It

February 16th, 2016
iStock Image: 60992736

iStock Photo

I think we’ve all heard the statistics about cardiovascular disease, which includes heart disease, stroke and high blood pressure. By now, we know it is the number one killer of men and women in the United States. Heart disease alone kills one in four Americans each year.

What you might not know is that heart disease is preventable in many cases if you make healthy choices and manage your health conditions. Topics such as a healthy diet and exercise get a lot of the press time, but managing stress in your life is just as important. Stress is more than an emotional upheaval. Too much of it not handled properly can affect you physically as well.

The American Heart Association has an entire stress management section on its webpage with lots of good information and tips. Here, I’ll focus on what stress can do to you and mention a few things you can do to combat those effects. The website has many more.

Think about what causes you to feel stress. For many of us, work is a big contributor, but many things can leave a person feeling stressed. It could be an illness, either personal or that of a loved one, relationship problems, financial concerns or just the hassles of everyday life.

When we’re stressed, we often feel anxious, irritated and out of control. You might not connect them, but those little (or big) aches and pains you get – like headaches, backaches or stomachaches – could also be related to stress, as well. So could those feelings of depression and helplessness, tenseness and anger. If you’re having trouble sleeping or you’re feeling tired all the time, that could be stress, too.

The AHA admits the link between chronic stress and heart disease is not clear, but we do know that the body reacts to stress by releasing adrenaline, igniting the “fight or flight” response, which includes increasing the heart rate and blood pressure. Chronic stress causes a person to be on “high alert” for long periods of time. That’s got to take a toll on the ticker after a while.

Let’s switch gears and talk about how we can cope with the stress that is pretty much inevitable in our lives. The AHA has some good ideas. Besides the basics of eating better and getting physical activity, they suggest you fight stress with healthy habits. Here are a few they recommend (see their website for the whole list):

  • Remember to laugh – It’s the “best medicine,” and it works for stress, too.
  • Slow down – Plan ahead and give yourself plenty of time to get each task done. This way, you’re not rushing around trying to do everything at once.
  • Practice giving back – Helping others helps you as well.
  • Try not to worry – The world won’t end if you don’t mow your lawn or clean your kitchen today. It will still get done if you do it another time.

The AHA also offers some other stress management tools including positive self-talk and daily relaxation tips. If you want more, many community health centers and even some hospitals offer classes on stress management. Certain forms of exercise, such as yoga and Tai Chi, are also good at relaxing the mind and body and relieving stress.

While we don’t fully understand the link between stress and heart disease, we do know that stress, especially chronic stress, takes a terrible toll on our bodies, leading to emotional and physical responses. Often, we deal with chronic stress by engaging in negative behaviors: We eat too much, we drink too much, and we rush around in a panic and ignore the gym.

Determining the cause of our stress, recognizing our responding behaviors and making some healthy adjustments are essential to managing stress in our lives. Pay attention, and give your heart a lucky break!

Will You Live to be 100?

February 11th, 2016

Public domain image

I was browsing through the greeting card aisle at a local store the other day and noticed a new category for milestone birthdays. Happy 100th! My first thought was that the greeting card industry is catching up with population trends.

Population experts say that centenarians are among the fastest-growing age groups in the United States. They’re still a tiny percentage in a population of 321 million but look at these figures from the White House Conference on Aging: In 1980, just over 32,000 Americans were 100 or older. By 2013, the number of people past the century mark had more than doubled to 67,347.

Just this year, parents of three friends of mine surpassed age 100. One mother celebrated her 101st, another mom turned 102, and a father is now 101. I don’t think this is so unusual. I’m continually hearing about someone who has lived for a century or more.

So what’s going on here? It’s a question that is attracting a lot of attention from researchers in the United States and other parts of the world where the number of 100-year-olds is growing, such as in Europe.

One of the longest running projects is The New England Centenarian Study that started at Boston University in 1995. The study has some good news for my friends with centenarian parents. A strong genetic component seems to help for joining the 100th birthday club. At least 50 percent of the centenarians in the New England study had a parent or grandparent who reached very old age.

The study’s website lists these highlights from findings:

  • Obesity in centenarians is rare. However, their diets varied widely. They ranged from vegetarians to those who ate a lot of saturated fat.
  • Centenarians weren’t smokers.
  • They have a tendency to be resilient and can handle stress a little better than most.
  • Many centenarians are lucky enough to enjoy both long life and good health. Some in the study, less than 15 percent, didn’t have any age-related illnesses at age 100. About 43 percent didn’t develop a chronic disease until after age 80.

There is also a theory that centenarians may simply age more slowly than the rest of us. For instance, many of the women centenarians were able to have children after their mid-30s. Researchers speculate that being able to naturally conceive and bear a child past 35 or 40 could be an indicator the women’s bodies were aging slowly.

So maybe your parents or grandparents didn’t live to be 100 or come very close. The researchers at the New England Centenarian study point out that genetics aren’t everything for living a long and healthy life. They say the average American can still live into his or her late 80s through good lifestyle habits. In other words, eat right and exercise, especially if your family history includes diseases like diabetes.

Or are you a future centenarian who will be getting a 100th birthday card? Assess your odds with The Living to 100 Life Expectancy Calculator. The calculator is on the New England Centenarian Study website and gives recommendations for improving your lifestyle, too.












Reviewing the Zika Virus

February 4th, 2016
Courtesy of iStock

Courtesy of iStock

Sharing media coverage with the election lately is ongoing news about a rapidly spreading virus called the zika virus. While only 36 people (as of this posting) in the United States have contracted this virus, other areas of the continent and the world have been more brutally hit. So much so that the World Health Organization (WHO) has declared it a global public health emergency(1).

Don’t let that scare you too much. Keep in mind, the people in the US who have the zika virus did not get it here. In most cases, they were infected while traveling in countries where the virus is more prevalent and returned with it. The virus is not transmitted from person to person, so the infection does not spread if an infected person touches or breathes on you.

It is spread to people through the bite of an infected mosquito, specifically an Aedes mosquito; and, yes, we have that type of mosquito in the US. This mosquito, which is known to transmit other weird diseases, gets the zika virus by biting an infected person. So, the more infected people, the more infected mosquitoes. The more infected mosquitoes, the more infected people.

According to the WHO, it’s not certain how long after exposure that symptoms will appear, but it’s likely a few days. Symptoms include a fever, skin rashes, conjunctivitis (red eyes), muscle and joint pain, malaise and headache. These symptoms are usually mild and last for several days to a week(2). Some people might not even know they’ve been infected.

For most people, zika virus disease will pass with little concern. Treatment is geared to relief of symptoms and should include getting plenty of rest, drinking fluids to prevent dehydration and taking medication such as acetaminophen to reduce fever and pain (3). There is no specific treatment for the virus itself and no vaccine to prevent infection.

There are potential complications of the zika virus, however, and pregnant women and their newborns appear to be at highest risk. In addition to the bite of a mosquito, the virus can be transmitted by a mother to her baby during pregnancy or around the time of birth. The WHO’s emergency declaration comes in the wake of a “strongly suspected” link between the virus and the neurological birth defect called microcephaly.

Statistics have shown that in Brazil, which has seen an explosion of the virus, there are higher than normal cases of microcephaly in populations with evidence of zika infection. Microcephaly is a rather rare condition present at birth in which the infant’s head is abnormally small, which is generally associated with incomplete brain development and intellectual disability.

A potential link between the zika virus and the neurological/autoimmune condition Guillain-Barré syndrome is also suspected. With Guillain-Barré, the individual’s immune system attacks the nerve cells, which causes muscle weakness and sometimes paralysis that can last a few weeks or several months. Most people recover from Guillain-Barré syndrome, but some are left with permanent damage.

Tom Frieden, director of the Centers for Disease Control and Prevention, affirms the CDC’s commitment to dedicating resources to discovering better testing for diagnosing zika virus, as well as ways to treat it, contain it and prevent it in this country(4). He notes that for non-pregnant people, the virus poses no significant health risk. He also believes that from the information known at this time, a widespread transmission in the contiguous United States appears to be unlikely.

Still, wear your insect repellant and long-sleeved shirts and long pants when outdoors. Stay in places with air conditioning or screens on the windows and doors to keep mosquitoes out. Avoid being outdoors when mosquitoes are most active, and help children and the elderly with mosquito prevention. Take steps and be safe from all mosquito-borne illnesses, as well as the discomfort of their bites!

Page 22 of 26