Davis Square Family Practice Newsletter
In This Issue
Bob Love, NP
Lyme Disease is Here
Join Our List
Join Our Mailing List
Lyme- bull's eye rash
Lyme Disease Season is Upon Us
Preventive Medicine
Dr. Bershel's Top Preventive Suggestions
Deborah Bershel, MD 
Marie Botte, NP
Robert Love, NP
Paula Mahoney, Office Mgr
Qianna Price, M.A.
O'Callaghan, M. A.
Randi Baxter, M.A.
Monica Pereira, Sec.
Jason Joyce, Sec.
Dorothy Anderson, Phlebot.
Important Info
Office Phone 
Appts.-  Same day appts. should always be available  for emergencies
Call Backs- Should be completed by your clinician by the end of day.
Refills- Allow 24 hrs. for handwritten refills
After hours- Call office for name and phone number of covering physician. If you prefer to confer with Dr. Bershel her cell is (617) 230-7988
(sometimes phone is shut off so Dr. Bershel can sleep)
 Issue #7
Our Latest Addition- Bob Love,NP
Lyme Disease
Preventive Med Ideas
Sneezing boy
It is the hope of this practice to provide timely and reliable information on topics of interest to our patients. As this is a relatively new addition to Davis Square Family Practice, please send us your thoughts and comments. if you have any questions about the content of this newsletter please feel free to email me at dbershel@gmail.com
Deborah Bershel, MD
Bob Love , Nurse  Practitioner
We are pleased to announce that Bob Love, NP has begun working in our office parttime. Currently he is working parttime on Wed nesdays and Fridays so that we will always have 2 medical clinicians available every day. He is the perfect fit for our practice - he's both bright and exceptionally caring.
Lyme Disease Ticks Are Already Out

This article was written by me in 4/10. If you want a complete and detailed summary by UpToDate please click on the following link :

UpToDate Lyme Article 

You will be able to see picture of ticks and the skin rash imbedded in the article.


While I've seen patients come in with acute Lyme disease in the winter, April through all of October are peak time to contract it. The ticks are found anywhere there is grass and bushes. Even backyards are not safe areas to roll around unless you do a tick check at night. While walking in the woods/bushes, it is advisable to wear long pants with the socks over the bottom of the pant leg -( ignore any outcries from children who don't want to appear nerdy).

Here is more bad news that is not well-disseminated --- even the dog tick, and not just the much smaller dear tick, can transmit Lyme disease. And while animals don't transmit the disease to humans your pet's ticks can travel over to you.
Lyme Tick 
What is Lyme disease-
 It is a tick borne illness caused by borrelia burgdorfi bacterium. It is a spirochete bacterium that behave in ways similar to syphilus. It can infect multiple organs such as the heart and brain many years after the initial symptoms have passed - if the initial attack was not treated
Symptoms of Lyme disease -Appear within a day to a week after contact. There is often a bull's eye rash but honestly any sort of rash can appear (and sometimes no rash at all). There can be a high fever, muscle ache, joint aches, mental confusion.
50% of the time there is no recollection of a tick bite. If you think you have the flu but there is no respiratory illness (like a prominent cough) think of lyme disease. In general, I would recommend a call to our office or the covering physician if you have these symptoms. It may just be a virus but place the burden on us.
Diagnosis -It's made by history and physical exam. I tend to always do the more expensive Western Blot test as it is more senstive the the standard Lyme screen.
Treatment - 14 to 21 day course of doxycline for those over 9 years of age or amoxicillin or a cephalosporin for children under that age. This
regimen is usually effective but fatigue and joint aches may persist beyond the treatment period - this usually doesn't necessitate additional antibiotics. Ibuprofen can help fever and joint pain. If the story and exam are suggestive
f Lyme I do not wait for the test results to come back - the sooner you treat it the more likely a quick and complete recovery will occur.
What should you do if you have a tick bite and no symptoms?  My approach is different than the official recommendations of the CDC. The evidence says that it takes 24 hours for the tick to imbed and have a blood meal and thus get the borrelia bacteria into your bloodstream. I have heard too many anecdotal stories of symptoms occuring within 24 hours of a tick bite. The consequences of untreated Lyme are so extreme (potentially) that I recommend prophylactic antibiotics for all tick bites (deer and dog). The prophylactic treatment is one dose of doxycline 200 mg or amoxicillin (adjusted according to weight) for those under 9 years old. BTW, of course remove the tick.
My Top Preventive Medicine Idea's

In general most people are well aware of what can be done to promote wellness but few of us are ever perfect. As with everything in medicine, sometimes today's wisdom is proven to be wrong but I'm confident that most of the following recommendations will stand the test of time.

  1. Don't smoke or quit smoking - Smoking shortens life expectancy by about 7 years. It doubles the risk of impotence before 40 years of age. It increases the risk of heart disease, is the main cause of emphysema and markedly increases the risk of lung cancer (90% of lung cancer is caused by cigs), throat cancer, mouth cancer, stomach and colon cancer,  and bladder cancer.
  2. Stop substance abuse - Drinking more than 1-2 drinks/day (if female) and 2-3 (if male) is associated with poorer health outcomes. Street drugs and prescription drug abuse likewise leads to health problems. While I will not equate abuse of cocaine, amphetamine, PCP, opiods (such as heroin, Percocet, Oxycontin, etc.), benzodiapines (valium-like drugs) with marijuana, there is little doubt that daily use of 'pot' is bad for your health. The devastation caused by substance abuse on the person's ability to function healthfully with family, friends and employer is often more immediate than the short-term physical effects on health.
  3. Mental Health - If you are not content with your life - be it depression, anxiety, job dissatisfaction, relationship/family issues - then you are not leading a truly healthy life. Sometimes there are bumps in the road and they will smooth out with time but often years upon years go by and we end up far from happy. We are interested in helping you in coming up with an approach ( directing you to a therapist or providing medication or offering you with a empathetic ear) that you will be comfortable with.
  4. Regular exercise - The more you do the better. In 2008 a large study showed that in every decade of life those who exercised the most died at half the rate of those at the bottom. I consider exercise as 'sacred' as a medicine that you might take daily to lower your cholesterol or blood pressure.
  5. Eat a healthy diet - I'm uncertain about precisely what this means except it has become quite clear that Americans eat too much. Eating lots of fresh fruits and vegetables will provide you with a wide array of cancer-preventive isoflavones that you just can't get from eating a hotdog on a bun. Research has confirmed that all mammals (though not yet proven in humans) live longer, essentially do not develop diabetes and have as much as a 50% reduction in cancer if they are deprived of calories. I will elaborate more on this subject under a separate obesity article that has yet to be completed.
  6. Fish Oil - Fish oil has many positive effects on the body and unless you are a strict vegetarian or fish allergic (in which case you can get a similar 0mega-3 oil from flax seed) most everyone should be on 1000mg of it. It has an anti-inflammatory effect on the body and may be a part of a program to reduce levels of pain. In a 2009 study of British women there was a 50% reduction in the death from heart attacks in those on 1000mg fish oil or more. Sometimes we can successfully lower a person's triglycerides with it.
  7. Vitamin D - We don't get enough of it in Boston (certainly not in the winter). Higher vitamin D levels are associated with a lower incidence of multiple sclerosis, heart disease and diabetes as well as many cancers (colon, breast, pancreatic, prostate). All adolescents and adults need to take at least 1000 i.u. (international units) daily and infants (who don't get it in formula) and children through 9 years old need 400 i.u.
  8. Multivitamins - This may be controversial as many studies have yielded varying results. To my knowledge no study of multivits has shown a worse longterm from taking them. Around the year 2000, the Women's Cooperative Health Study showed that multivits lowered the risk of colon cancer by about 75% if taken for 15 or more years. In non-smokers colon cancer is the second most common cancer, so this is big news in my opinion.
  9. Resveratrol - A substance found in abundance in red wine, grape skin, pomegranate and blueberries. It appears to prevent the aging of our cells by slowing down the shorting of the telomeres of our chromosomes. (Regular exercise also slows down the shortening of telomeres). In addition it appears to prevent the development of diabetes. I recommend taking 150 mg of grape seed extract per day.
  10. Coenzyme Q 10 - It appears to have an anti-inflammatory effect on the body and may lower levels of pain. It also appears to have a good effect on the heart. All patients on statin drugs (a type of cholesterol-lowering agent) should be on it as it those drugs block Coenzyme Q 10 in our cells (I apologize if I have failed to inform you of this previously). I'd recommend 50-100 mg per day.

       11.Aspirin - Taking a daily baby aspirin (for men over 40 and women over 50) is  controversial, in my opinion. If you have low risk for heart disease (no family or personal history of heart disease or stroke, no hypertension, no cholesterol elevation, no cigarette use) then perhaps you will gain little from the aspirin andyou may increase your risk of hemorrhage. Ask your clinician before you decide on your own to begin an aspirin regimen.

       12. Alcohol in Moderation - This is a tough one to recommend as alcohol hasdestroyed many lives and families. Nonetheless, the evidence is irrefutable, alcohol when taken in small amounts (1-2 drinks per day for women and 2-3 for men) dramatically lowers the risk for heart disease. Red wine is best, then white,followed by beer and then hard liquor. In 2009 a longterm study showed that the risk  reduction was over 50% for lifetime drinkers and 33% for those who began moderate drinking in midlife. Make no mistake, if you are at risk for alcohol abuse then don't even remotely contemplate drinking.

I hope you found the information in this newsletter useful. Again, please let us know your thoughts on the newsletter and if you have any suggestions for other topics. 
Deborah Bershel, MD