Summer fun can be ruined by insect bites

The arrival of summer brings longer days, warmer temperatures and increased opportunity for outdoor activities. It also brings the opportunity for infections transmitted via insect bites. Among these infections are the arboviruses.

Arbovirus is a general term used to describe a variety of viral infections transmitted by infected arthropods. Among these are mosquitoes and ticks. The symptoms vary between the extremes of mild joint pain to life threatening brain infections.

Although Lyme disease presents with similar symptoms to arboviruses, it is the result of a bacterial infection that can be treated with antibiotics.

The frequency of encountering these viruses varies on geography. The most common arboviruses in the northeast include West Nile Virus, Eastern Equine Encephalitis and Powassan Virus Disease.

Initial symptoms of each of these infections include fever, rash, headache and joint pain. Fortunately, in most cases, these symptoms are self-limited. Treatment is primarily symptomatic with hydration, rest and anti-inflammatory medications.

More serious symptoms occur when the infection attacks the central nervous system resulting in encephalitis. These symptoms include persistent headache, confusion, seizures and loss of consciousness. Unfortunately, there is no specific treatment for viral encephalitis.

Golfers, hikers, trail runners and mountain bikers are most susceptible to infection based on their level of exposure. The best way to avoid infection is by wearing long-sleeved, light-colored clothing with pant legs tucked into socks. Frequently applying insect repellant with DEET to exposed surfaces is recommended.

As in most viral infections, elderly and very young patients are at highest risk.

“Insect repellant should never be applied to newborns and young children should not use products with more than 30 percent DEET,” reports Dr. Ashok Kottarathara, a local pediatrician in practice at United Community and Family Services. “Wristbands, smartphone apps and sonic repellents do not work against mosquitoes. Removal of all stagnant or standing water is another extremely effective way of preventing breeding of mosquitoes”.

Avoiding exposure to insect bites can be crucial to a more pleasant and safe summer.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Carpal tunnel injury is rare for pitchers

Last week, Boston Red Sox starting pitcher David Price was forced to miss at least one start due to symptoms of numbness in his dominant left hand. He was eventually diagnosed with carpal tunnel syndrome (CTS), a condition not commonly associated with major league pitchers. Subsequently, a controversy has ensued based on speculation that the condition is actually related to Price’s avid participation in computer games.

The carpal tunnel is a structure in the wrist formed by several bones at the base known as the carpal bones with a ligamentous roof called the flexor retinaculum. Within the tunnel a large nerve, known as the median nerve, brings sensation and movement to a discrete portion of the hand.

Narrowing of the carpal tunnel may be the result of direct trauma that produces acute swelling, arthritic changes in the carpal bones and enlargement of the flexor retinaculum due to repetitive use.

The presenting symptoms of CTS are usually neurological in nature as a result of compression of the median nerve. Typical complaints include changes in sensation in the thumb, index and middle digits of the affected hand. These include a tingling sensation that comes on during the night or when first awakening. Early symptoms oddly improve with movement such as shaking the hand. Later symptoms include weakness with fine movements involving the thumb and index finger.

The diagnosis is made by clinical examination and electrodiagnostic studies that can specifically isolate the area of injury to the median nerve and quantify the severity of the damage.

“Carpal tunnel syndrome is a very uncommon injury in baseball pitchers,” reports Dr. Joel Ferreira, an orthopedic hand surgeon at the UConn Musculoskeletal Institute. “It’s typically caused by constant repetitive use of the hands from lifting/typing or vibratory tool use as well as sewing and crocheting. In my practice, I rarely see patients develop CTS from video games.“

Conservative management includes the use of nocturnal wrist splints and steroid injections. Surgical decompression is reserved for more severe damage to the median nerve. Although the cause of Price’s CTS may be debated, the treatment options are clear.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at

Athletic genes are just one factor for success

Connor Svab, a local baseball standout at St. Bernard’s, is in many ways a baseball paradox. In addition to playing infield and pitching, he also plays varsity basketball. At 5-10, 140 pounds, he does not seem to possess the physical prowess valued by many professional teams.

Nevertheless, Svab has gotten the attention of scouts and will be heading to Castleton University to further his baseball career. Interestingly, both his father and great grandfather played professional baseball.

Scientists in the field of evolution have constantly raised the question of nature versus nurture. The arguments in favor of both approaches to development are most prominent in the field of sports. Are some athletes destined to reach great heights from birth or is greatness the product of hard work and opportunity?

Genes are the foundation of heredity. They contain the recipe for the production of proteins that make up the human body. Each person has two of each gene, one contributed by each parent. Those contributions produce our physical characteristics.

Brain growth also plays a prominent role in how a human develops. Specifically, the brain consists of a variety of networks that pass information to different areas within the brain. A brain cell is made up of a cell body and an elongated axon. The axon gradually becomes encased in an insulating material called myelin. Signals are transmitted along the myelin. Brain development is a dynamic process that spans through childhood and adolescence.

The maturation process includes making the brain operate more efficiently. It does this through a process of neuroplasticity. The brain eliminates some networks while making other regions of the brain operate faster and more precise. This can involve motor as well as sensory functions and result in rapid decision-making and reaction to a particular situation. This obviously can be a huge advantage in sports. It is believed that environment plays a big role in this phase of development. 

Lengthy discussions and analysis that center on baseball may have played a big role in the baseball development of Connor Svab.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at