As we turn the bend during the second semester of the school year we begin to face challenges. For many of us the material seems insurmountable….maybe we perceive it as such, or maybe teachers realize they are falling short and rush to get all the information in before the school year ends.
Either way, students feel stressed, overwhelmed and many times unable to catch up. So what do you do when you find the material to be TMTH (too much to handle)?
Firstly, realize that you don’t have to learn everything. Remember, the professor can’t test on EVERYTHING. So don’t go at a packet, slide deck or book with the attitude that you have to know everything. Find the Titles, the main point in the paragraph that follows, and any supporting info that seems to buttress the main point. Careful with your use of highlighting if you’re tired and burning out because you’ll start to highlight everything. Which brings us to….
Two heads are better than one. Sometimes three…but more than that may be distracting. What you thought was important in class or on a sheet of information can be confirmed or denied by another student. Moreover everyone has strengths and weaknesses so find one who can compliment you and help you discern what’s important to know.
Rather than guessing, take 15 minutes to meet with the teacher to get an idea of what they find imperative to learn/know for the test. But don’t go into their office asking “will this be on the test?” I would be direct, honest, but humble by asking:
Now, many times the professor will oblige. But if not, you need to indirectly determine what he/she is going to test. This brings us to…..
How was the material given?
If your professor brushed over it quickly in class, it could mean they don’t find it crucial enough to test or ….they don’t completely understand the material themselves. Most likely this will not be tested. However, if he/she brushed over it because it was given in a previous lecture, then its open game.
Demonstrations of the brush over include:
Are they big on testing if you paid attention in class or knowing the information that’s necessary to succeed? Are they a jerk and will pick the most esoteric piece of content from a 1000 word slide or will they focus on main points? Get an idea on what makes them tick.
For some institutions the exam is to test competency. These are the most clear-cut, fair tests and to me, make the most sense. If, for example, in medical school one is studying poor lung function and what a spirometer discerns, the inventor and history of the tool will most likely not be tested. Keep in mind, your professor has bosses and they have bosses, so your competency reflects on them.
For other institutions it may be at the professor’s discretion. So you need to feel out each teacher and see what they’re all about. If they are big on class attendance and will weight the test towards those who showed up, expect questions on content that was highlighted in class. And if they are big on seeing if you paid attention, you will be tested on something they impressed upon you sometime during lecture. So during the lecture watch for the following:
So after you’ve done your “homework,” how do you tackle your studies?
Your time is divisible so grab a calculator and aliquot into equal periods. Make sure you have extra sessions included for breaks and catch up sessions. Or you can use a calendar that is already compartmentalized on which to create your timetable.
Clean your desk!
A nice clean, crisp desk with plenty of pens and highlighters helps energize one more than cluttered paper. Moreover have a second work space you can go to when you get sick of working at your desk.
Now this is easier said than done. Some will put their hardest classes on their study calendar first, some the easiest. There are pros and cons to both. What I suggest is alternating difficult and easy subjects. You need the start of your day and initial power hours knocking out the difficult material, but then the easier classes will boost your confidence and sometimes energy. So one option could be:
Take real breaks!
You should design two types of breaks: Short and Long.
Your short break should be no shorter than 10 minutes. During the break you must do the following:
Your long break should be no shorter than 45 minutes. During these breaks you can:
If you’re “going through the motions” of studying and feel “burnt” you won’t be absorbing the material and subsequently you’ll be wasting precious hours. You must identify burnout by looking for the following:
When studying you’re classwork it’s difficult to avoid the boredom and stress, but the following may help:
Remember, we’ve all been there and school is supposed to be challenging. Stay on course and get help if you need such as a tutor. We all make it to the finish line….even if we’re a little bruised up when we get there.
It’s tax season and most of us are hoping to shave a few bucks off our tax bill. Well, many are not aware of the deductions that are available when it comes to medical expenses.
If you spent over 7.5% of your adjusted gross income on unreimbursed medical expenses during 2018, you may be able to deduct what you spent over this 7.5%, according to the IRS.
So, for example, if you make $100,000 a year, 7.5% would equal $7,500. So let's say you spent $10,000 on medical expenses, subtract the 7.5 % ($7,500) from $10,000, and the remaining $2,500 is tax-deductible.
But the expenses made can also include those of your spouse, children and dependents. Combined, these could qualify you for descent deductions.
Publication 502 breaks down what services or items you purchased in 2018 that are tax-deductible and which are not. Here’s a brief summary:
Tax Deductible Items:
Unfortunately the following cannot be written off:
So review the list and see what you can apply to your 2018 itemized deduction worksheet. But make sure you have your receipts and logging of car mileage…. and start keeping track this year as well!
Mexican researchers had a major breakthrough in treating HPV (Human Papillomavirus), the most common sexually transmitted disease. In fact, the CDC states that almost 80 million Americans are infected with HPV with approximately 14 million people becoming newly infected per year. Those are just the numbers in the U.S. alone.
What exactly is HPV?
HPV is a group of more than 150 related viruses, named for the warts (papillomas) some HPV types can cause. Some other HPV types can lead to cancer. According to the CDC website:
“In most cases, HPV goes away on its own and does not cause any health problems. But when HPV does not go away, it can cause health problems like genital warts and cancer.
Genital warts usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. A healthcare provider can usually diagnose warts by looking at the genital area.
HPV can cause cervical and other cancers including cancer of the vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat, including the base of the tongue and tonsils (called oropharyngeal cancer). Cancer often takes years, even decades, to develop after a person gets HPV. The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers.”
According to, El Universal, a popular Mexican newsite, a research team at Mexico’s National Polytechnic Institute led by Eva Ramon Gallegos, was able to eliminate HPV in dozens of patients using a non-invasive photodynamic therapy. Which makes us all ask, what is photodynamic therapy? Well, according to cancer.gov:
“Photodynamic therapy (PDT) is a treatment that uses a drug, called a photosensitizer or photosensitizing agent, and a particular type of light. When photosensitizers are exposed to a specific wavelength of light, they produce a form of oxygen that kills nearby cells.”
Sounds like science fiction to me but whatever works! Anyway, according to Ramon’s study, the team was able to eliminate HPV in 100 percent of patients that had no premalignant lesions and in 64.3 percent of subjects with lesions.
Now, I know that viral headlines all across the internet screamed the HPV has been cured but, um - not so fast. There are over 100 different kinds of HPV. Some cause health problems, some do not. Some, but not many, cause cancer. One of the reasons cancer is so hard to cure is because each type of cancer will require a completely different cure. Something that cures cervical cancer, for example, will probably not cure breast cancer. And something that cures type 6,11,16 and 18 (most of the problematic HPV types) types of HPV might not work on other types of HPV.
As pointed out by Liz Highleyman, the editor in chief at www.cancerhealth.com in her A Cure for HPV, not so fast…, there are too many forms of HPV to claim they have all been cured. Highleyman notes the Mexican research only focused on two types of HPV. So, while the research is good news, it’s not exactly a full cure. From her article:
“It’s not clear how photodynamic treatment might eliminate HPV infection, which would seem to require some type of antiviral therapy. But there’s clearly something going on.
Despite the unanswered questions raised by the recent reports, the findings from the Mexican study are good news for people with HPV-associated dysplasia. Photodynamic therapy is well tolerated and noninvasive. Using PDT instead of surgery to remove precancerous tissue could help preserve function in people with anal lesions and the ability to carry a pregnancy in women with cervical lesions.
The news also presents an opportunity to promote HPV vaccination. The new Gardasil 9 vaccine protects against several of the most common cancer-causing HPV types (16, 18, 31, 33, 45, 52 and 58) and two wart-causing types (6 and 11). It is recommended for girls and boys around age 11 or 12, before they become sexually active. However, the FDA recently approved the vaccine for women and men up to age 45, meaning people who were not vaccinated as teens or young adults may still be able to benefit.”
Okay. So perhaps “cures HPV” is too strong a statement. But things seem to be heading in the right direction!
Multiple states are bracing for “early” allergy seasons.
We still have a month left of winter yet grass is sprouting, leaves are growing and flowers are blooming. Add just having a wetter winter and warmer-than-normal temperatures to the mix and this is the perfect recipe for an early allergy season.
Allergy season usually begins with the start of Spring in March. Yet many may start their symptoms as early as February if they are allergic to what’s blooming.
Tree pollens start first in January and then taper off in April. Grass pollen starts to rise in February and March. Finally weed pollens join the party by the Spring and extend through the Summer and Fall.
Here are your questions answered:
Allergies are the result of the immune response to a foreign particulate that our body senses. One could be allergic to pollen, dust, dander, food, insects, mold, metals, transfused blood, grafts, medicine and anything the body senses as a foreign intruder. Even though these may be individually harmless, a hypersensitivity reaction occurs as a result of their intrusion into the body. IgE antibodies find the allergen (intruder) and activate mast cells in the tissue and basophils in the blood. When these cells get activated, they release substances to help protect the body, including histamines, leukotrienes, and cytokines. These help the body attempt to sneeze and cough the allergen out, wall off the antigen, signal more antibodies, or produce tears and nasal secretions to flush it out.
Symptoms of allergies could include any or a combination of the following:
Colds may have very similar symptoms to allergies. However they are different.
The common cold is caused by a virus. When one gets infected by the virus they may feel malaise, fever, and achy. This does not occur with allergies.
Moreover, nasal secretions from allergies are usually clear. In a cold, the mucous could be thicker and with color.
The same holds true with sputum. During an allergy the cough may have little to no mucous and if so, be light-colored. Thick mucus could be a sign of an infection.
An allergic sore throat will seem more dry and scratchy. A sore throat from a cold is more uncomfortable and less easy to soothe.
Allergies may persist or be cyclical. Cold symptoms will usually subside after a few days and rarely persist longer than 10 days.
Yes and no. Allergies should not in and of themselves cause an infection. However they may make one more vulnerable for a virus or bacteria to take over. Hence a bronchitis, sinus infection, or pneumonia could uncommonly follow an asthma attack.
As stated previously, if one is susceptible to colds, an allergic attack could make them vulnerable. Moreover if one suffers from asthma, an allergy attack could incite an asthma attack. Very rarely would we see a life threatening anaphylaxis to an allergen such as pollen.
Avoiding, or decreasing exposure to the allergen is key. We suggest the following:
Local tree, ragweed and grass pollen counts can be obtained here.
Valentine’s Day is one of the biggest holidays of the year, with consumers spending more than $20 billion a year buying cards, chocolates, flowers, and teddy bears. But what no one admits to is it is one of the most anxiety producing and miserable holidays of the year.
When you’re single the last thing you need to be reminded of is just that….you’re single. Valentine’s Day inundates us with the “normalcy” of being in a relationship such that anyone who’s single feels there’s something wrong with them. Single people feel forced to shut off the TV, avoid shopping, avoid others and remain indoors for the week surrounding Feb. 14th.
If you’re married, and have been so for some time, Valentine’s Day reminds you of how much you are lacking in sex and romance. But worse yet, you are now compelled to do something for Valentine’s Day. No credit for spontaneity. No credit for being romantic, since the whole world seems to be celebrating Valentines. And… it’s all pain, no gain. If you mess up, and your gift or celebration is not very romantic, you’re in the dog house. And if you forget about the holiday all together…Whoa Nelly…..
When one thinks of candy they think of chocolate, lollipops, vibrant colors…..Valentine’s heart candy is the worst candy out there. They’re pale, hard, practically crack your teeth, not very tasty and force you to read them before you eat.
Don’t give me anymore work to do. You could be pretty high maintenance. And what if I’m not ready to commit?
Valentine’s Day gifts are made to be publicized. And even if you gave your sweetheart the gift in private, it will be posted on social media or broadcast at work the next day. In fact, not sending the gift to their work could be a major faux pas.
If you’re single, use this holiday to celebrate the friendships you have. Make it a singles night out and celebrate your freedom. Or make a friend feel special by sending a “friend” valentine. These could include:
Since the gift of spontaneity has already been hijacked by this holiday, do something creative and unpredictable. Candlelight dinner, a poem, luxury bath, weekend trip, something sappy…..but do it right and you’ll get bonus points.
Here’s the silver lining. Most Valentine’s Day gifts/gestures do not have to cost a lot. Valentine’s Day is about the heart and showing one how much you care. So a note, poem, song, personalized song list, or even a cute little doodle can go along way.
We make the mistake of thinking men want what we want. Let’s take cologne for that matter….men don’t want to smell like perfume or “parfume”y….they like smelling like men. Forcing them to use toilet water is not cool.
Another common gift given to men is a shaving set. Does the average man like shaving, let alone every day? Top that off with wasting an opportunity for them to get a cool gift with one that includes shaving products??? Cruel, just cruel.
For men, many prefer steak for dinner, time alone in their man cave, or sex. I think that’s about it. Pretty easy.
So hope this helps you get through Valentine’s Day anxiety free and worry free.
And remember…. its only one day…just one day…. and will all be over Feb. 15th.
A report published in the American Heart Association’s Heart and Stroke Statistics annual report cite 48% of US adults have some type of cardiovascular disease.
The uptick could be due to rising obesity, and lowering thresholds for diagnosing guidelines such as high blood pressure (now considered high if over 130/80).
Although smoking rates have declined over the years, many still use tobacco and recent research has found E-cigs to increase risk of heart attack and stroke by 70%.
A stroke occurs when an area of the brain does not get the proper oxygen and blood flow it needs. There are two major types of stroke: ischemic and hemorrhagic.
Ischemic strokes are more common than the latter and occur when a clot prevents blood flow to part of the brain. 80% of all strokes fall under ischemic. It is a likened to a heart attack, except the brain tissue is being deprived of blood and nutrients. Plaques commonly arise from arteriosclerosis that break off travel to the smaller vessels of the brain.
Hemorrhagic strokes are less common and occur when there is a bleed of one of the brain vessels. The bleed prevents blood flow into the brain since it is seeping outside the brain tissue, causing damage to nearby cells. The bleeds could occur from high blood pressure or aneurysms that rupture.
Since a clot or bleed usually affect one area of the brain, we see symptoms on one side of the body, many times its contralateral (opposite) side. We can also see central effects. The symptoms of stroke include the following:
If the stroke was caused by a clot (ischemic) immediate treatment includes dissolving/removing the clot. Aspirin is used initially and if within the proper time frame, tissue plasminogen activator (TPA). These clots can also be surgically removed and arteries widened to bring blood flow to the brain.
With a hemorrhagic stroke, we need to stop the bleed and improve flow to the brain. Controlling the bleed, bypassing the vessel, “clogging” the aneurysm with techniques such as “coiling” (endovascular embolization) are sometimes utilized.
Time is of the essence, so it's crucial to identify the warning signs and call 911 immediately. The American Stroke Association uses the acronym “FAST” (Facial drooping, Arm weakness, Speech difficulty, and Time to call 911). The sooner a stroke victim receives medical attention the better the prognosis.
What are the risk factors for stroke?
The following put us at risk of having a stroke.
Avoid the following:
Firstly, we must know our risk factors. These include:
Family history of heart disease
Personal history of heart disease
High Blood Pressure
Males over 40
Females who are postmenopausal
and even short stature has been cited as a potential risk factor.
As you can see, many of us can be at risk for heart disease. Therefore secondly, we should be evaluated with an EKG, echocardiogram and any other exams our medical provider and/or cardiologist deem necessary.
Thirdly, reduce your risk by the following:
Maintain a normal blood pressure
Maintain normal blood sugar
Maintain normal cholesterol and lipid levels
Maintain a balanced diet, rich in potassium-rich foods such as fruits and vegetables
Maintain a healthy weight.
A recent study published in the Lancet finds Millennials to be at much higher risk for cancer than their parents and grandparents ever were.
Those born between 1981 and 1997 appear to be at increased risk of cancer of the:
Study authors cite obesity as the main culprit.
The CDC reports the prevalence of obesity was 35.7% among young adults aged 20 to 39 years.
In 2016 the International Agency for Research and Cancer listed multiple cancers in which obesity plays a role. They include the above as well as breast, ovarian, and esophageal cancer.
Studies have found obesity to alter hormone levels which could incite cells to rapidly divide. Fat acts as if it's another organ, inducing signals that can affect insulin, sugar and fat metabolism and can induce inflammation when it accumulates around other organs.
Moreover it could be an associative relationship in which those who are obese may have poor diets and exercise habits which are linked to cancer as well.
In the above study, non-obesity related cancer, such as lung, appears to be at less risk for millennials as many are saying no to tobacco products.
However, other causes could be at play such as radiation exposure. The verdict is not yet out on vaping either.
Study authors state:
A Harvard study finds popcorn and caramel flavor electronic cigarette liquid may damage the cilia of one’s respiratory system.
Diacetyl and 2,3- pentanedione have been found in multiple products to aid in flavoring and considered safe for human consumption. But that’s the key….consumption by eating, not necessarily inhalation.
In this recent study from Harvard TH Chan School of Public Health, the cilia, small projections that line the respiratory tree allowing for a brush and propelling of contaminants coming down the pipe, appeared impaired in function when exposed to the chemicals.
Changes in gene expression of the cilia’s production and function were witnessed and could put one at risk for lung disease and lung cancer.
Diacetyl has been linked to “popcorn lung,” in which inhaling the yummy smelling chemical lined vapor could cause scarring of the lungs and loss of function.
Last summer a study published by the American Heart Association found nine different E-cig flavors to impair blood vessel function, which can impair heart health.
Endothelial cells, which delicately line blood and lymph vessels, were found to become inflamed at low concentrations of some vapor flavors. And at high concentrations of others, exhibited cell death. Nitric oxide production, necessary for vessel dilation to improve blood flow, was impaired as well. These are often the same changes seen in early heart disease.
The 9 flavors (and the chemicals within) cited in the report to cause the endothelial inflammation and/or damage were:
Strawberry flavoring appeared to have the most adverse effect on the cells.
Now, many other flavors were not included in this study, so it's unknown how safe they may be.
For more on the study, read here.
An alternate study published last November looked at vaping flavors and their effects on heart muscle cells.
For more on this study, read here.
The moral? Just because we love the taste of something, doesn’t mean it’s safe to inhale.
A study from New York University found the nicotine in electronic cigarettes to cause DNA damage similar to cigarette smoking.
Dr. Moon-shong Tang and his colleagues exposed mice to e-cig smoke during a three-month period, 5 days a week for three hours a day. They found these mice, compared to those breathing filtered air, to have DNA damage to cells in their bladders, lungs and hearts. The amount of nicotine inhaled was approximately 10 mg/ml. That dose would be commonly consumed by many humans who vape.
They then looked at human bladder and lung cells and found tumor cells were able to grow more easily once exposed to nicotine and vaping chemicals.
In a previous study, researchers from Vanderbilt-Ingram Cancer Center in Nashville found e-cig smoke to increase one’s risk of bladder cancer.
In 2015, the University of Minnesota identified chemicals commonly found in e-cig vapor to include:
Although electronic cigarette “juice” may appear safe, it could produce harmful chemicals once heated to become a vapor.
A lethal dose of nicotine for an adult ranges from 30-60 mg and varied for children (0.5-1.0 mg/kg can be a lethal dosage for adults, and 0.1 mg/kg for children). E-cigs, depending on their strengths (0 – 5.4%) could contain up to 54 mg of nicotine per cartridge (a 1.8% e -cig would contain 18mg/ml).
The topic of nicotine increasing one’s vulnerability to cancer is nothing new as decades ago researchers found nicotine to affect the cilia (brush border) along the respiratory tree, preventing mucus production and a sweeping out of carcinogens trying to make their way down to the lungs.
More research needs to be performed but this recent report reminds us that exposing our delicate lung tissue and immune system to vaping chemicals may not be as safe as we think.
For more on the study read here.
In February, one study reported that toxic levels of lead and other metals may leak from the heating coil element into the vapor inhaled during e-cig use.
Researchers at Johns Hopkins Bloomberg School of Public Health found these metals to include:
We’ve known for some time that vaping fluid could contain chemicals that turn toxic once heated, but this study shed light on e-cig metal components causing metal leakage to the vapor making contact with delicate respiratory epithelium (lining).
Reported by Forbes, Rich Able, a medical device marketing consultant, stated the following, “the FDA does not currently test any of the most popular vaping and e-cigarette instruments being manufactured at unregulated factories in Asia that source low-grade parts, batteries, and materials for the production of these devices,” suggesting that “the metal and parts composition of these devices must be stringently tested for toxic analytes and corrosive compounds.”
These chemicals may act as neurotoxins, affecting our nervous system, cause tissue necrosis (cell death) and even multi-organ failure. Moreover they can affect how our immune system reacts to other chemicals as well as foreign pathogens, affecting our ability to fight other diseases.
Although studies have suggested e-cig vapor to be safer than tobacco smoke, not enough research has been done, in the relatively few years vaping has been around, looking at how heat-transformed chemicals and leaked metals affect our breathing, lungs and other organs once absorbed into the body.
The ex-CIA officer credited for rescuing six US diplomats from Iran in 1980 has passed from complications of Parkinson’s.
Antonio “Tony” Mendez had joined the CIA in 1965 and became master at disguises and rescues.
During the Iranian Revolution in the late 70’s, protestors stormed the US Embassy holding 66 embassy staffers hostage. 6 had escaped to the homes of two Canadian diplomats but were unable to leave the country. Mendez was able to disguise them as a film crew and smuggle them out in 1980, portrayed in Argo, the Academy Award winning film starring (and directed by) Ben Affleck.
After 444 days the other hostages were released on President Ronald Reagan’s inauguration.
He retired from the CIA in 1990 and wrote memoirs of his experiences. He was diagnosed with Parkinson’s ten years ago. A statement from his agent and family reported he passed this week in an assisted-living facility in Maryland.
The Hollywood Reporter reports:
Ben Affleck, in response to the news, tweeted the following:
"Tony Mendez was a true American hero. He was a man of extraordinary grace, decency, humility and kindness. He never sought the spotlight for his actions, he merely sought to serve his country. I'm so proud to have worked with him and told one of his stories."
Parkinson’s disease is the second most common neurodegenerative disorder, next to Alzheimer’s, and the most common movement disorder that affects 1% of the world’s population over 60 years old. In the US, 60,000 new cases are diagnosed each year. It affects several areas of the brain, primarily the substantia nigra, altering balance and movement by affecting dopamine producing cells.
It was first described in 1817 by James Parkinson as a “shaking palsy.”
Common symptoms of Parkinson’s include:
and patients may later develop…
Most cases are idiopathic, meaning the disease arises with no specific cause. However some cases are genetic and multiple genes have been identified that are associated with the disease.
The average age of onset is 60, but some cases may occur as “early onset”, before the age of 50, and if before the age of 20, it is known as juvenile-onset Parkinson’s.
Men appear to be more affected than women at twice the rate.
Risk may be enhanced with a history of head trauma.
Exposure to herbicides and pesticides has been linked to an increase risk of Parkinson’s as well.
Average progression rates can last years to decades, however, earlier onset disease may manifest much quicker.
Although there is no cure for Parkinson’s, symptoms can be treated by a variety of measures.
Daliah Wachs is a guest contributor to GCN news, her views and opinions, medical or otherwise, if expressed, are her own. Doctor Wachs is an MD, FAAFP and a Board Certified Family Physician. The Dr. Daliah Show , is nationally syndicated M-F from 11:00 am - 2:00 pm and Saturday from Noon-1:00 pm (all central times) at GCN.
In the last 6 months, three cats in Wyoming have tested positive for the plague.
Currently there are no known humans affected, however, under 10 human cases on average occur each year in the United States.
The type of plague the cats tested positive for was bubonic. So here’s the breakdown.
The plague as we know it is most commonly caused by a bacteria called, Yersinia pestis.
The victim usually acquires the plague from being bit by a flea who fed on infected animals such as rodents, or by contact with one who has the plague. Cat scratches from domesticated cats who are infected have been documented as a form of transmission.
Direct contact with infected bodily fluids could spread the plague as well. Pneumonic plague can be spread through a cough or sneeze.
There are three types of plague:
Bubonic – the most common, at first affects the lymph nodes, but may spread to throughout the body
Pneumonic – infects the lungs and may be spread from person to person by respiratory droplet.
Septicemic – infects the blood stream and can be the result of untreated bubonic and pneumonic plague
For all three types of the plague one can have:
But with bubonic plague, one may have large “bubos” or swollen glands in the neck, underarm, or pelvic/groin region.
With pneumonic plague, one may additionally have cough, shortness of breath and blood in their sputum.
Due to the disease spreading quickly, in some cases causing death within 24 hours, antibiotics need to be instituted immediately.
Moreover supportive measures such as IV fluids and oxygen may be needed as well depending on the severity of symptoms.
Flea control is paramount. So insect repellent for humans, and flea control products will help limit bites from the infected insects.
Moreover avoid rodents and clean out areas in and around your house to avoid them from scurrying around.