Adult Flu Clinics

Flu shots will be offered to the residents of Sandwich 19 years and older on the following dates:

Wednesday September 16, 2015    9AM-12Noon   1PM-4PM

Thursday     October 8, 2015    9AM-12Noon   1PM-4PM

Where:        The Human Services Building

270 Quaker Meetinghouse Road

East Sandwich, Ma.

Cost:           Most insurances will pay for the shot. (exceptions are United and Aetna). Please bring ALL insurance cards including  Medicare and Mass Health.  The cost for self pay is $15.00.

Appointments are necessary.  Please call (508) 833-8020 to schedule an appointment.

Those residents who will be having surgery, chemotherapy, or radiation prior to the clinics should call this office to discuss an earlier appointment.








Tick Season is Here Again-With More Diseases Than Ever!

Most people on the Cape are familiar with Lyme Disease, Anaplasmosis/Erlichiosis, and Babesiosis, but have you heard of Borrelia miyamotoi or Powassan virus?  The now well known black legged deer ticks can also carry these diseases.

Scapularis, Ixodes, Insect, Tick, Deer

In general, adult ticks are approximately the size of a sesame seed and nymphal ticks are approximately the size of a poppy seed.
Borrelia miyamotoi is a spiral shaped bacterium carried by deer ticks (which are active any time temperatures are above freezing).  Nymphs are most active from May to July and adults are more active in the fall and spring. Ticks carrying miyamotoi have been found in Sandwich.  Symptoms of a miyamotoi infection are fever, headache, and muscle aches.  Treatment is 2 weeks on the antibiotic doxycycline, which is also used to treat Lyme disease.

Powassan virus has been identified in patients in Massachusetts.  While it is generally accepted that a tick must be attached to a person for at least 24 hours to spread  infection, this virus seems to infect people in a shorter period of time.  Symptoms can occur from 1 week to 1 month after a tick bite.  As with other tick borne diseases, some people never become ill while others can have illness such as inflammation of the brain and spinal cord, fever, headache, vomiting, weakness, confusion, difficulty speaking and seizures.  Treatment is supportive.

How can you protect yourself?  Ticks live in wooded, brush filled, and grassy areas, so if you are in these areas here are some things you can do:

1.  Put deet on skin exposed areas (not on face or palms of hands).  The University of Rhode Island’s Tick Encounter website warns:

Repellents play an integral part in your personal protection strategy. Repellents containing DEET are not sufficient to protect against tick bites. DEET only repels ticks to areas where they could bite and even that little protection does not last long. PERMETHRIN kills ticks on contact. Clothing only repellents that contain Permethrin are very effective and provide long-lasting protection. The best protection you can achieve is by using a repellent that contains Permethrin on your clothes and one that contains DEET for your skin.

2.  Spray permethrin on clothes and boots/shoes

Watch videos about applying clothing-only repellent and how well Permethrin treated clothing repels and kills ticks.

3. Wear light colored long pants and long sleeves, tuck pants into socks or boots.

4.  Do a body check when you go indoors

5.  Treat pets with tick repellants

6.  Have a 3 foot tick free perimeter around your yard,

If you do find a tick on yourself, use tweezers to grasp it as close to the skin as possible and pull straight up.  After removal clean the skin with alcohol and put an antibiotic cream on the area.

clipart style image showing the proper removal of a tick using a pair of tweezers

Helpful Hint

icon of a tickAvoid folklore remedies such as “painting” the tick with nail polish or petroleum jelly, or using heat to make the tick detach from the skin. Your goal is to remove the tick as quickly as possible–do not wait for it to detach.

Go on if you want to send your tick to U. Mass. for testing


Shingles Shot

Zostavax, the “Shingles Shot”, is a vaccine produced by Merck Pharmaceutical Company and has been available since 2006.  The FDA has approved it for use in adults 50 years and older and the CDC recommends it for adults 60 years and older.  Many insurance companies will pay for their clients to receive the vaccine when they turn 60, but Medicare and Medex  plans will not pay for it.  In many cases, it is therefore best to receive the vaccine when you (or the subscriber) are still working, (optimally between the ages of 60-65).  Recent research has shown that immunity to the virus wanes 5-7 years after receiving the immunization.  The Centers for Disease Control and Prevention has not yet recommended a booster shot.

Glaxo Smith Kline pharmaceutical company is working on a vaccine which it believes will reduce the risk of shingles 97.2% in people age 50 and older.  More test results on this vaccine should be out this year.

Please call (508) 833-8020 if you would like more information on the Shingles vaccine.

Nuts Are A Healthy Snack

As little as 1 oz of salt free nuts a day can reduce your risk of heart disease.  Multiple large studies have consistently shown a 30% to 50% reduction in heart attacks or sudden death when  a handful of nuts was eaten several times a week.  Walnuts have omega 3 fatty acids which seem to prevent arrythmias from developing.  Almonds increase Vitamin E levels and lower cholesterol.  Vitamin E is an antioxidant which protects cells against damage.  There is some research out of U.C. Davis that almonds may reduce colon cancer as well as heart disease.  Cashews are also high in omega 3 fatty acids.

Instead of a sweet treat, grab a handful of nuts for a nutritious snack!

EBOLA Update

The Ebola Virus continues to ravage the 3 Western African countries of Liberia, Guinea, and Sierra Leone even as Americans seem to be losing interest.  The World Health Organization has published the following statistics:

Guinea            2793 cases                        1797 deaths

Liberia             8263 cases                         3515 deaths

Sierra Leone   10030 cases                        2977 deaths


21,086  cases                       8,289 deaths



CBS News

There are several vaccines being developed.  Three pharmaceutical companies with vaccines in the pipeline are:

Johnson and Johnson

This vaccine is in Phase I trials where it is being given to a few volunteers to check for safety and side effects.  Two shots must be given 1-2 months apart.

Glaxo Smith Kline

This vaccine is ready for Phase II clinical trials in February.  It will be given to a larger group of people, probably in Africa. It is made from a harmless cold virus and coated with proteins from 2 strains of the Ebola virus-Zaire and Sudan.  It seems to be well tolerated and induces antibodies against Ebola.


Mercks Phase I trial was stopped for a short period when volunteers experienced joint pain.  It has now resumed using a lower dose and seems to be well tolerated.


Tdap Vaccine for Pregnant Women

The Tdap shot (tetanus, diptheria, pertussis) is now recommended for pregnant women during the third trimester of every pregnancy (27th-36th week). The mother will produce antibodies within 2 weeks of receiving the vaccine which will offer her baby short term protection after birth. The infant can then be immunized starting at 2 months of age. An infant without protection can develop whooping cough and suffer severe complications such as respiratory distress, brain damage, and death.

In 80% of cases, infants catch whooping cough from someone in the home (30%-40% of the time from their mothers), so it’s a good idea to have all family members and caretakers vaccinated before the birth.

We offer the Tdap vaccine. Please call (508) 833-8020 for information or to schedule an appointment. Most insurances, including Mass.Health will pay.

Flu Shots

Yes, I am continuing to give flu shots. The normal flu season on the Cape does not usually get into full swing until Jan./Feb. so it is not too late to come in for your shot. Although it has been widely publicized that one of the A strains (H3N2) is only 50% protective the other 3 strains in the shot are still effective.

Prevnar 13

Update!  The first Prevnar 13 clinic was a success and I now have a new supply of vaccine available.  If you would like more information or would like to make an appointment for the newly recommended “pneumonia  shot” for folks 65 years and older, please call (508) 833-8020. 


The Ebola epidemic in West Africa continues and the call for more American health care workers to volunteer to go to West Africa is stronger, even as the issue of quarantining returning American citizens caring for (or even near) Ebola patients becomes front page news in the USA.   The Centers for Disease Control and Prevention (CDC) has it right in stating their new guidelines.  If we quarantine all health care workers who work here or abroad for 21 days (as some people want)  then staffs from Bellevue, NIH, Emory University and the University of Nebraska would be confined to their homes (and thus not available to care for these patients).  Remember, these are staff who have been trained specifically in the precautions needed to safely care for Ebola patients.   Medical staff might find it too difficult to work in Africa if they then had to be out of work for an additional 21 days after returning to the States. There is proof now that patients are not contagious until they have a fever and even then it takes blood and body fluids to transmit the virus.  Remember Mr. Duncan, the first Ebola patient to be cared for in the US?  His family was in an apartment with him for a couple of days when he had vomiting and diarrhea and they did not contract the virus.   We need to move past our fears and use scientific data and logic to formulate our policies, understanding that the policies could change with additional information.



A total of 13 703 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in six affected countries (Guinea, Liberia, Mali, Sierra Leone, Spain, and the United States of America) and two previously affected countries (Nigeria and Senegal) up to the end of 27 October. There  have been 4 922 deaths.
The outbreaks of EVD in Senegal and Nigeria were declared over on 17 October and 19 October 2014, respectively. EVD transmission remains persistent and widespread in Guinea, Liberia, and Sierra Leone. All administrative districts in Liberia and Sierra Leone have now reported at least one confirmed or probable case of EVD since the outbreak began.

Cases of EVD transmission remain lowest in Guinea, but case numbers are still very high in absolute terms.

Transmission remains intense in the capital cities of the three most affected countries. Cases and deaths continue to be under-reported in the outbreak.
Of the countries with localized transmission, Mali, Spain and the United States of America continue to monitor potential contacts. In Mali, a 2-year-old girl died of Ebola on 24 October, after travelling with her grandmother from Guinea. The case makes Mali the sixth West African nation to be affected in the current Ebola outbreak.
In Spain, the single patient with EVD tested negative for the disease for a second time on 21 October. Spain will be declared free of EVD 42 days after the date of the second negative test, unless a new case arises during that period. In the US, two health-care workers have tested negative for Ebola for the second time, and have been discharged from hospital. Another health-care worker remains in isolation and is receiving treatment.



Liberia has reported 6 535 confirmed, probable, and suspected cases, and remains the country worst affected by the outbreak (figure 2).

The most intense transmission continues to occur in the Montserrado area, where 30 new probable cases were reported in the last full week. This region takes in the Liberian capital, Monrovia. The weekly increase in  new cases in the area, however, appears to have halted since mid-September, with a reduction in numbers of confirmed and probable cases reported in the week ending 5 October. It is possible that this reflects a true reduction in incidence. However, further data are needed to resolve this question. Liberia continues to report few confirmed cases. Laboratory data on recent confirmed cases may provide scope for deeper analysis not currently provided by the incidence data. The capacity to capture a true picture of the situation in Liberia remains hamstrung by underreporting of cases.

Outside Monrovia, most newly reported cases have come from the districts of Bong, Margibi, and Bomi, which each reported 12 probable cases in the last full week. The district of Grand Gadeh, which was previously considered the only unaffected area in Liberia, now has 2 confirmed and 2 suspected cases. It is likely, however, that these cases did not occur in the past week, and the reporting of these cases has been delayed. Data for Liberia are missing for 19, 20, 21, 26 and 27 October.



A total of 521 health-care workers (HCWs) are known to have been infected with EVD up to the end of 27 October, 272 of whom have died (table 2). The large rise in the number of infections of HCWs in Liberia reflects changes in its method of reporting, and the inclusion of cases that had previously not been reported.

WHO is undertaking extensive investigations to determine the cause of infection in each case.

Early indications are that a substantial proportion of infections occurred outside the context of Ebola treatment and care. Infection prevention and control quality assurance checks are now underway at every Ebola treatment unit in the three intense-transmission countries. At the same time, exhaustive efforts are ongoing to ensure an ample supply of optimal personal protective equipment to all Ebola treatment facilities, along with the provision of training and relevant guidelines to ensure that all HCWs are exposed to the minimum possible level of risk.