Recent graduations, Liberty Park band concerts and summer days remind us that the wonderful time of summer with its activities and vacations is here. This season does present us with many opportunities for fun and relaxation, but we must use caution with regard to our activities, especially sun exposures. However, it isn't just the bright sun's effects which present health problems to us. As Dr. Sally Dorfman (Medscape) has remarked: "There is a dark side. Skin cancer, insect bites, poison ivy, foodborne illnesses, drowning, burns, and injuries lurk in the shadows. Take this opportunity to remind patients - and ourselves - of the importance of prevention to avert, or at least minimize, the risk of summertime discomfort, illness, injury and death."
During past summers, this "For Your Review" column has included information about summertime ills and their prevention and treatment. I hope you remember many of the topics and ideas which were discussed and continue to implement them in your summer activities. However, some of those previous comments bear repeating and appropriate elaboration today.
Former years' epidemiological experience reported by the Minnesota Department of Health was notable by the increasing incidence of tick-borne diseases found in Minnesota. In 2000, about 550 cases were reported; in 2008, more than 1,400 cases were documented, and the numbers are increasing. Although most of us are aware of the much-discussed Lyme disease transmitted by the deer tick, other similar illnesses have been found in our state (Human Anaplasmosis, Babesiosis, and rarely, Rocky Mountain Spotted Fever). It should be noted that as this time (June 2013), the deer tick involved with Lyme disease has not been found in southwest Minnesota. However, patients with Lyme disease have been treated here in Lyon County, but they were infected in another part of the U.S. There are many ticks in our geographic area, especially in woods and recreational areas, e.g. parks, trails, etc., which presence requires careful post-activity inspection of adults and children to remove these ticks before they cause infections. The optimal method of removing a tick is to use a fine tweezers to grasp the tick's mouth parts and withdraw the mouth parts and the body. Cleanse the wound and apply alcohol to the tick to preserve it for identification if necessary.
Prevention of insect bites is of great importance. Ticks, mosquitoes, and other insects can to be avoided by the use of proper clothing, DEET sprays, and education about insect habits. Insects are entitled to protect their environment! All patients with significant allergy to insect stings should be aware of the allergy and carry appropriate medication and an EpiPen. Ask your physician for specific information and direction in its usage.
Raising little excitement but carrying the possibility of very serious illness is the bacterial infection tetanus. One injection every 10 years or as needed usually prevents illness. Check with your physician as to the date of your last tetanus immunization. In the case of some wounds, a modified approach to treatment may be necessary.
Medications used for blood pressure control such as diuretics (hydrochlorthiazide, furosamide) lower blood pressure by causing the kidneys to excrete more fluid and decrease the blood volume. This action, beneficial for blood pressure control, aggravates the attempts to cool the body by vasodilation. Compounding this effect are blood pressure medications called beta-blockers which slow the pulse and thus decrease the heart's pumping action, helping the blood pressure but again compromising the cooling effect of the pulse. These agents, often used together, can virtually block adequate body cooling in times of heat-related disease, often resulting in a fainting spell, especially in the older population. Alcohol use can be an aggravating factor. Alcohol tends to dilate the blood vessels, effectively decreasing the effective blood pressure. Its use also may increase the pulse rate and adversely affect brain function and other normal body functions. Appropriate knowledge of one's medications and the avoidance or careful use of alcohol will minimize adverse reactions.
Eating may also cause syncope (fainting) by pooling blood in the stomach as the food is digested. The blood pressure drops, and blood is shunted to the stomach and away from the muscles. Thus the admonition by your mother (or grandmother) that you should wait an hour to swim after eating your picnic lunch is physiologically valid and true. In addition, those important fruits and vegetables in your diet should be prepared by appropriate washing and scrubbing before use.
In short, eat carefully, exercise reasonably on an empty stomach, be cautious about your medication usage and the sun, and use alcohol carefully if at all while in the sun, especially if medications such as discussed above are present.
Enjoy the summer and the sun, but with caution! Avoid prolonged sun exposure, certain drugs, insects, and alcohol. Don't forget your hat, sunscreen, and most importantly, your COMMON SENSE!