Trombiculidae (pronounced /trɒmbɨˈkjuːlɨdiː/) is a family of mites called trombiculid mites (also called berry bugs; harvest mites; red bugs; scrub-itch mites; and aoutas.^[3]   In their larval stage, those species which bite their host and "causes intense irritation"^[4] or "a wheal, usually with severe itching and dermatitis,"^[5][6] are called chiggers.^[7]   Trombiculidae live in the forests and grasslands and are also found in low, damp areas where vegetation is rank such as woodlands, berry bushes, orchards, along lakes and streams, and even in drier places where vegetation is low such as lawns, golf courses, and parks.^[8]

They are most numerous in early summer when grass, weeds and other vegetation are heaviest. In their larval stage they attach to various animals, including humans, and feed on skin, often causing itching. These relatives of ticks are nearly microscopic measuring 0.4 mm (1/60 of an inch) and have a chrome-orange hue.^[9][10] The (best known) species of chigger in Northern America^[11] is the hard-biting Trombicula alfreddugesi of the south-eastern United States and humid mid-west^[12] and Mexico…

It’s that time of year again, friends, when you’re minding your own beeswax in the great outdoors, & then you suddenly have a burning itch in your leg, you look down and there is a tiny red dot…  Darn, chiggers! 

I used to think that these bugs would actually drill down into your skin, then you put nail polish over the site and they suffocate, then the burning would stop.  Well, that’s not quite it.  It turns out that the chiggers are actually only interested in eating your skin cells.  They attach to you, and inject enzymes that break down your skin cells, then suck up that tissue through a tube.  This tube is created by your body trying to protect itself by hardening the skin cells around the bite area.

It is difficult to treat chigger bites due to the number of factors involved in a chigger wound:

• Mechanical damage
• Allergy response
• Immune response
• Possible bacterial infection / subject to local influences

Each person will respond with a different combination of these things in their reaction to the chigger bite.  So some treatments will work better for some than for others.  The toxic enzymes and the tube (stylostome) can remain in your skin for 7 days or more. 

Here are some ideas to help treat chigger bites:

See your doctor if there are signs of infection (redness in skin around wound, heat, swelling) or severe dermatitis.

Reducing itching:

• Over the counter topical corticosteroids / antihistamines
• Hot shower / bath
• Topical anesthetic

Getting rid of the chiggers:

• Soaking the bite site in Epsom Salt water
• Wiping the area with isopropyl alchohol

Two over-the-counter meds:

• Chigarid, forms a protective barrier over the wound
• Chiggerex, a soothing cream

Covering the wound with clear nail polish is a home remedy that I have actually found to work at times.  While I now know that it isn’t due to suffocating a burrowing chigger, it is possible that sealing the bite from the air might be effective – or it might be removing or neutralizing the stylostome / tube & toxic enzymes present in the bite. 

Insurance – it is something you pay for every month, or every paycheck, and it is supposed to be there when you need it.  What happens when it seems that the system is working against you more than for you?

There are hundreds of insurance companies, each with hundreds of plans available.  They use coded phrases, words and numbers to make their processes easier for them, but more confusing for you.  It can be hard to find one person to speak with regarding your claim among the various voice-mail directories and the army of individuals in various departments in major insurance companies. 

Yet, insurance companies are regulated by each state.  Every state government monitors the actions of insurance companies and how they work with us, the consumer.  These agencies are your advocate in making sure insurance companies deal with you fairly. 

When an insurance company does not cover your medical expenses according to the contract that you have with them, they are guilty of fraud. 

If an insurance company is reported a certain number of times in a year to their state board, they will be put up for an inspection by the state regulating agency.  Insurance companies do not like to be inspected, and they tend to put whoever is complaining on the “quick pay” list…just to get you out of their hair. 

To file a complaint in Tennessee, you can go to this link:

http://www.tn.gov/commerce/insurance/complaint.shtml

In Georgia, go to this link:

http://www.gainsurance.org/Fraud/Home.aspx

I have had to report insurance companies in Georgia in the past, and I did get paid as a result.  You do not have to allow them to use their large employee base, coded mail messages, and confusing processes to keep you from getting back the money you are due.

One frequent request I receive while providing medical assistance at events is for aspirin.  With the array of supplies under the Archer PT tent which are at the ready, most athletes who ask are rather taken back when I reply that I don’t have any.  There are two reasons for this.

First, as a licensed Physical Therapist it is actually against my practice act to issue medications – EVEN over the counter medications.  And second, taking aspirin is not recommended, and studies show that it is not actually effective, in relieving pain for endurance athletes.

Why NSAID’s Are Not A Good Choice

At one event two years ago I witnessed one of the ways in which taking aspirin, which comes under the category of NSAID’s – Non-steroidal-anti-inflammatories – can backfire.  It was a charity cycling event where a group of massage therapists were working to relieve muscle spasms for the riders after their long day on their bikes.  I was called over by one of the massage therapists who seemed rather alarmed.  When I got to the table, I saw that the woman she had been working on had a large wound on the side of her leg where her skin had just peeled back like a water-logged nectarine.  And it would not stop bleeding.

The wound occurred during the massage itself, but it was obviously not due to the massage therapists’ technique.  I quizzed the cyclist on the table regarding any prior incidents, medical conditions, etc., with nothing she mentioned giving a clue as to why that happened.  Until I asked what medications she might be on – and she mentioned that she had taken quite a bit of aspirin that day in order to relieve knee pain so she could complete the ride.

Now I won’t spell out how many she had taken, because I would like to dissuade the clever among you who are reading this from subtracting from that amount and figuring that for YOU it would be OK to just take so many less...  No dice.

What had happened to this particular cyclist was that she had taken enough aspirin while participating in an endurance event that it made her blood super-thin, and even left her skin vulnerable to what would normally be a fine amount of friction during her massage.  So if she had been so unfortunate to have been in a crash during the event, she could have been in big trouble from what would normally have been an insignificant wound.  I don’t want to think of what would have happened if she had cut a blood vessel or had a head injury.

Other medications under the NSAID category are ibuprofen (Advil and Motrin), naproxen sodium (Aleve), and ketoprofen (Orudis KT).  The following was excerpted from an article on About.com and gives other reasons why taking these drugs is not a good investment:

NSAIDs and Athletic Performance

So, does taking an NSAID really improve athletic performance? Does it prevent or reduce muscle soreness? So far, the research doesn’t support the use of NSAIDs for athletes. Here’s what they have found so far:

1. Several studies have found little actual performance benefit of taking ibuprofen and warn that it may mask pain, which can lead to increased risk of injury.
2. One study concluded that taking 400 mg ibuprofen four hours before exercise reduced the perception of muscle soreness but didn’t actually prevent muscle cell injury as which indicated by creatine kinase, a protein found inside muscle cells that is released when they are injured.
3. Further studies have cautioned that the use of NSAIDs during ultra distance exercise, such as an Ironman Triathlon, is associated with an increased risk of exertional hyponatremia . [Low sodium concentration in the blood.]  Researchers believe that this effect is likely due to altered renal (kidney) function. The issues related to altered kidney function in athletes are not hard to imagine. Poor fluid transport and restriction can lead to dehydration, hyponatremia and at the extreme, kidney failure.
4. The most convincing real-life study may have been the one conducted during the running of the 100-mile Western States trail running race. Researcher David Neiman measured the influence of ibuprofen use during the grueling race by studying runners in three groups: a control group, a group taking 600 mg of ibuprofen one day before and on race day and a group taking 1200 mg of ibuprofen one day before and on race day.

The Study Findings

·      Both groups taking ibuprofen had higher plasma levels of markers (serum C-reactive protein, plasma cytokine and macrophage inflammatory protein) for muscle damage.

·      Reported delayed onset-muscle soreness was the same across all groups.

·      Serum creatine kinase levels was the same across all groups.

·      Race times did not differ among the groups.

·      Ratings of perceived exertion did not differ among the groups.

 “The bottom line was ibuprofen use by endurance athletes did not affect performance, muscle damage or perceived soreness but it was associated with elevated indicators of inflammation and cell damage.  …using NSAIDs…may, in fact, cause a serious health risk in some endurance athletes..”

by Elizabeth Quinn

http://sportsmedicine.about.com/od/medicationanddrugs/a/NSAID_endurance

One Exception

If you have been advised by your doctor to take a baby aspirin, or any other medication(s) prior to or during your endurance event, please do so.  There are some cases where this can help reduce the risk of a stroke or heart attack in those who are at higher risk for cardiovascular disease.  Please check w/ your doctor if you have any questions regarding this!

Rather Than Using Aspirin…

Instead of using aspirin as a means to avoid soreness, consider the following:

1. Train

Prepare before your event.  If the course will be hilly, train on hills.  Make an effort to strengthen your muscles before you ask them to work for hours on end.

1. Be realistic about the consequences of participating in an endurance event. 

If you are running a marathon or an ultra marathon, biking 100 miles, etc. you are going to feel it.  A certain amount of soreness is part of the endurance experience.

1. Be realistic about your body.

An actual conversation at a recent endurance event:

“Hey – I had broken my toe last week, and I was wondering if you could check it.”

The orthopedic surgeon who was present and I looked at one another…

“I’m pretty sure it’s still broken after you just ran 26 miles on it.”

Seriously people – you are going to hurt anyway during an endurance event.  But please do not go into it knowing that you already have an injury and will only further injure yourself by participating in the event.  Fractures and torn tendons will not miraculously heal after you’ve pounded on them for hours.  It is terrible to have put so much time and effort into your training only to be set back by an injury.  But you can use the time and effort in your recovery to learn how to be a better athlete than you were before the injury occurred.  Learn to race better again another day, and for many years to come.

1. Learn your nutritional and hydration needs

Practice and keep notes on what does and does not work for you in various temperatures and conditions.  Track what clothing, food, and fluids are the best and which are the worst for your body on a given training day.  Your body does not like to operate while dehydrated!  Proper food and fluid intake will go a long way in decreasing soreness.

1. RICE

I’ve said it thousands of times, “Ice is your friend.”  And so is rest, compression and elevation.  Simple, organic, effective.

1. A good support crew

Having good friends and family members around at the finish line or to pace alongside you at an event is a wonderful bonus to the entire experience.  Remember to be the support that other athletes will need too – volunteer!

1. Massage

A good therapeutic massage allows you to feel looser and encourages you to move

around more quickly after your event, speeding your recovery.

1. Walk / Stretch / Yoga / Sleep

            I don’t advise that you try these all at once, but these things do help.

Kinesiotape is made of a breathable rebounding cotton base with a gel adhesive arranged in a swirl pattern on the other side.  The tape is made to mimic the elasticity that we carry in our skin and muscles, in contrast to the relative rigidity found with the use of athletic tape.

Re-educate the neuromuscular system

Reduce pain

Enhance performance

Prevent Injury 

                                                 Promote improved circulation and healing

As a Physical Therapist, I have really enjoyed using this tape to assist patients in learning new muscle movements to correct a muscle imbalance, support weak areas, and improve circulation.  I have found when used correctly, it will act like a dynamic brace, and will promote the correct movement(s) of a joint long after you’ve been to your PT appointment.

I have often been asked about pre-cut Kinesiotape – sold under the brand name “Spider Tech,” among others.  I understand the concept – having a pattern of tape pre-cut can make application easy for the average person.  However, there are a few things you’ll want to keep in mind:

1.     Your body might not conform to the “average person” they had in mind when they pre-cut the tape.  A piece that is meant to be used over the lateral quad might actually fit over on your IT band unless you are just the right size. 

2.    It might seem that all you need to do is peel off the back of the tape and lay it down just as you see it on a picture or video.  But this tape is made to be applied with a certain amount of stretch in one area, and none at all in another.  The amount of stretch you use varies depending on your body structure and the reason you’re applying it in the first place.

3.    You might not be able to apply the tape to the area you’d like to reach – your back, shoulder blade, etc.

Having a Physical Therapist who has evaluated your areas of strength & weakness, noted any swelling or loss of range of motion, and who understands what the ideal planes of movement are for you in a given situation is key to getting the most out of using Kinesiotape.  Finding a PT who is familiar with the material and who won’t stretch the tape too far or too little will also help you to benefit from it’s use.  You do not want to waste your time or money by applying the tape in a way that promotes the wrong movement. 

One of my favorite things about Kinseiotape is that it allows me to create an organic, customized extension of my hand, if you will, in order to correct any “cheating” that clients often do to get around an area of weakness or pain.  The vast majority of people that I see are unaware that they are substituting healthy muscles to take over the job of injured ones.  I have found that using the tape as a “minder” throughout the day speeds the healing process.

One of the promoted uses of Kinesiotape is to aid in the reduction of lymphedema / swelling.  This is one of the areas in which I specialize, through the use of Complete Decongestive Therapy, which combines a manual massage technique with skin care instructions, compression, and exercises to significantly reduce swelling quickly.  When I have applied the Kinesiotape in these cases, to be honest I’ve not been impressed with the results.  Although I think a certain type of application pattern will help reduce local acute swelling, I don’t find that it speeds the reduction of larger areas of chronic swelling to a significant degree.

Physical Therapists are knowledgable in muscles, tendons, ligaments, bones, other soft tissue and the way they are supposed to work together with proper innervation and circulation.  It makes sense to put our years of experience to use in helping you get back to an active life!  Contact Archer PT today to make an appointment and learn more about how Kinesiotape can work for you.

Epi-pen ready to go...

Regardless of the weather, everyone is capable of having a off day in the midst of a race.  Trying a new pre-race meal, or pushing yourself to the edge of injury, etc. can throw you for a loop.  If you are out there and something goes wrong, it pays to be prepared.

First – if you have allergic reactions to bee stings, or asthma, or are supposed to be carrying other emergency-level medications with you, please be responsible enough to do so.  I don’t quite understand the reasoning behind people not carrying these things with them, especially in a trail race situation.  There are no magic medical buses hiding behind the trees with everything you need at a moment’s notice.  The few ounces of prevention are worth it. 

Second – use a ROAD ID or some other type of medical identification when you are training or racing.  It’s just common sense.  Especially as a single person traveling out of town to an event, I make sure that someone will be able to know my medical info and will be able to call my friends and family if needed.  The Road ID is a great way to take care of that.

Third – ever jump in on a race at the last min. in the place of someone who had to drop out? Especially if the race is full and this was the only way you can get in – whew, you made the cut!  You have their race number and all is well, right?  Unless they happened to be allergic to every life-saving medication known to man, and during the day you are somehow in need of medical attention, and your race number is still attached to Joe Runner’s ID rather than to who you actually are….ooops.  If you want to trade places with someone to enter a race, please have the decency to let the race director know, and follow their guidelines.  

Training and racing are wonderful experiences.  Event directors and medical support personnel have put hours (and in some cases years of training) into making your day the best it could possibly be.  As part of your preparation for the event, please set aside a few moments and take responsibility for your own health and for making others aware of your identity and medical needs.  We hope you never need it, but it will be so much better to have the right information and medication on hand if you do.