Health Thursday, April 20th, 2000
	Safety issues stressed in warmer weather By Dr. Anthony Policastro Nanticoke Memorial Hospital When I was in the military, we emphasized the fact that you could never tell people about safety too many times. For that reason, I have resurrected an old article about safety at this time of year. It may be worthwhile to read it again. Spring is here. Some mornings are still cold. But it is getting warmer. Warm weather means outdoor activities. It is certainly fun to be outdoors. It can also be dangerous. Mother Nature is good to behold. However, she also offers potential problems for us. Sun injury is common at this time of year. It is not summer yet. Therefore, we figure the sun is not too bad. We go out in the sun for long hours. We do not use sunscreen. The result is the first sunburn of the season. Sun exposure can be just as bad at this time of year as in the summer. You may not need as much sun block as you do in July. You may not need as high a number of protection in the sun block. However, you still need to take care of exposed skin. The change to short sleeve shirts and short pants can cause problems. The back of your neck is often exposed. Think about what you will be doing. Think about how long you will be exposed to sun. Then take proper precautions. Outside activity leads to sweating and fluid loss. We need to replace those lost fluids. An active adult on a hot day can lose as much as a quart per hour. When I was in the Air Force, I sent over 160 people to Desert Shield. They arrived in August. They set up a field hospital in the 110 degree heat. Forced drinking of fluid was necessary. You need to have that same "water discipline" when you are active in summer sun. Heat injury can be mild, moderate or severe. The worst case is often called sunstroke. It results in high body temperatures which can be dangerous. Taking fluids is the best preventive medicine. Spending time outdoors means sharing that space with other creatures. Some of those creatures are not always kind to humans. Some of the more annoying creatures are stinging insects. Honeybees, yellow jackets, wasps, and hornets fall fall into this category. A sting from any one of them can be very painful. There are two kinds of reactions. The most common reaction is the local reaction to the sting. It consists of swelling, pain and redness. They may cover a small area or they may cover a larger area. The size of the area is related to how much venom is injected. The amount of venom is related to how long the stinger remains in the skin. At one time the recommendation was to only remove the stinger by scraping it out. The feeling was that if you squeezed it with your finger, you would push more venom into the wound. However, we now know that the problem is how long the stinger is in the skin. Therefore, it should be removed as quickly as possible. Once the stinger is removed, the treatment is aimed at the swelling and pain. Ice can be very effective to prevent swelling. This is true for 24 hours. The cold ice decreases the blood flow to the region. Thus, less fluid leaks into the area. After 24 hours, warm soaks can help the swelling go down. By this time all the fluid has leaked out of the area. The warmth increases the blood flow so fluid can go back into the blood stream. Elevation of the swollen area above the heart can help reduce swelling. Pain is treated with Acetaminophen (Tylenol) or Ibuprofen (Motrin). These are two of the items I suggested for your home medicine cabinet. Sometimes Diphenhydramine (Benadryl) can help the swelling a little. The more serious reactions to stinging insects are the allergic reactions. They are rare. However, they can be deadly. They can result in breathing problems. They can cause your blood pressure to drop. They can cause hives all over the body. Sometimes people think they have a severe reaction because they have a lot of swelling. This is not true. Severe reactions cause symptoms in a different part of the body than where they sting occurred. Patients who have one of these reactions need to be seen as an emergency. After that, they need a physician to direct how to handle things in the future. Mosquitoes are biting insects. They are not usually as deadly. Some mosquitoes carry diseases like malaria and yellow fever. That is not a concern in this area. Mosquito bites are annoying. They itch a lot. The best thing for the itching is Diphenhydramine (Benadryl). Ticks are common in this area. We see both the dog tick and the deer tick. The dog tick can carry Rocky Mountain Spotted Fever. This disease consists of a high fever, headache and rash. It occurs in the summer months. It is treated with antibiotics. The deer tick is smaller. It carries Lyme disease. The symptoms of Lyme disease are many. It frequently affects the joints and skin. Ticks can also cause a local infection in the skin. This sometimes results in swollen glands. When a child gets swollen glands in the back of their neck in the summer, check their scalp for a tick. There are multiple ways suggested of removing ticks. However, the one recommended by most experts is use of a tweezers. The tick is grabbed as close to the head as possible. Then, gentle pulling of the tick with the tweezers will usually result in removal. You might want to add a tweezers to your medicine cabinet if you do not yet have one. Tick repellents only work when used frequently. If you use them that frequently, you can have side effects from the repellent. Therefore, looking carefully at the skin after going through a wooded area is the best advice. Plants can sometimes be annoying as well. poison ivy, poison oak and poison sumac fall into this category. They contain oils which can get on the skin. If you are allergic to the oil, you will break out. it is a form of contact dermatitis. You can develop a contact dermatitis from other things too. These plants are the most famous for doing it. Since the oil causes the rash, it should be removed. Make sure you remember to remove it from clothing and under fingernails. Unless someone else touches the oil on your skin, they cannot get the contact dermatitis. If you wash the oil off, the rash is not going to be passed on to someone else. The itching that they cause can also be treated with diphenhydramine (Benadryl).