A Primer on Summer Safety
When it comes to summer, Olivia Kane, 36,
mostly remembers the happy times: eating crabs on the beach,
chasing flickering fireflies at night, and playing softball
with friends. But there are other memories the Arlington,
Va., resident wishes she could forget. Like the rash from
poison ivy that broke out on her face, neck, and arms two
days before she had to walk down the aisle in her sister's
wedding. Or the time she went to the beach to get a tan
before high school graduation. "What I got was a bright
red sunburn," she says. "I had blistered cheeks,
a blistered chest, and I was the graduation speaker."
But her worst summer memory was when she
took a sip from a can of soda and gulped down a bee that
had crawled into the can when she wasn't looking. "I
knew I swallowed something," Kane says. "I got
so hysterical that I threw up." Out came the bee, and
she went straight to the emergency room where she was treated
for difficulty breathing.
Experts say there's a lot people can do to
minimize the risks of health problems related to summertime
activities. "While treatment with FDA-approved products
is good, prevention is even better," says Jonathan
Wilkin, M.D., director of the Food and Drug Administration's
Division of Dermatologic and Dental Drug Products. So before
you pack your swimsuit or hit the hiking trail this year,
brush up on these summer hazards.
As a child in Pratt, Kan., Linda Talbott
got frequent, blistering sunburns while playing outside
all day. Then in her college years, it was cool to be tanned.
"Everyone wanted a tan, and I thought tanned skin looked
beautiful," Talbott says. "But it's not beautiful
when you're 65 and you've had melanoma."
In 1997, Talbott noticed a dark spot under
her left eye. "I thought it was mascara, but it grew
to the size of a raisin and started to bleed" after
about six weeks. Her doctor said it was melanoma, a serious
form of skin cancer. Another lesion on her cheek, previously
misdiagnosed as an age spot, also turned out to be malignant.
She needed immediate surgery on her face to remove the cancerous
tissue and save her life.
Everyone is at risk for skin cancer, but
especially people with light skin color, light hair or eye
color, a family history of skin cancer, chronic sun exposure,
a history of sunburns early in life, or freckles, according
to the American Cancer Society. Rays from artificial sources
of light such as tanning booths also increase the risk of
What you can do: Remember
to limit sun exposure, wear protective clothing, and use
sunscreen. Sunscreen should be applied 30 minutes before
going outdoors and reapplied at least every two hours. Use
water-resistant sunscreen with a sun protection factor (SPF)
of 15 or higher. The FDA regulates sunscreen as an over-the-counter
(OTC) drug and is working on a proposed rule that will specify
testing procedures for determining levels of UVA protection
in sunscreen products. It will also include labeling for
UVA protection to complement existing SPF labeling for UVB.
So in the future, consumers will be able to choose a sunscreen
based on both UVB and UVA protection levels. Sunscreen is
formulated to protect the skin against the sun's ultraviolet
light (UV), not to help the skin tan.
Some medications can increase sensitivity
to the sun. Examples are tetracycline antibiotics, sulfonamides
such as Bactrim, non-steroidal anti-inflammatory drugs such
as ibuprofen, and some fluoroquinolones. Cosmetics that
contain alpha hydroxy acids (AHAs) may also increase sun
sensitivity and the possibility of sunburn. Examples are
glycolic acid and lactic acid. It is important to protect
your skin from the sun while using AHA-containing products
and for a week after discontinuing their use.
According to the American Academy of Dermatology
(AAD), along with regularly using sunscreen, it's smart
to wear wide-brimmed hats and seek shade under a beach umbrella
or a tree. Sunscreens alone may not always protect you.
And don't forget sunglasses, which protect the sensitive
skin around the eyes and may reduce the long-term risk of
developing cataracts. People who wear UV-absorbing contact
lenses still should wear UV-absorbing sunglasses since contact
lenses don't completely cover the eye.
If you do get a sunburn, don't put ice or
butter on it, says Bruce Bonanno, M.D., an emergency physician
at Bayshore Community Hospital in Holmdel, N.J. "Use
a cold compress, and if you don't have that, a pack of frozen
vegetables will work." OTC pain relievers may also
be helpful. Mild and moderate cases may be helped by topical
corticosteroids such as hydrocortisone. Severe cases may
require oral steroids such as prednisone.
Be on the lookout for moles that change color
or size, bleed, or have an irregular, spreading edge--all
potential signs of skin cancer.
Bites From Mosquitoes and Ticks
Rob Baxley, 32, of Savage, Md., never saw
the tick, but thinks he came into contact with one when
he helped his brother build a deck in June 2003. "Soon
after that, I noticed a little red spot on my thigh,"
Baxley says. "But then it grew." He estimates
the rash was about the size of a grapefruit when he went
to the emergency room in mid-July.
About 80 percent of people who get Lyme disease
develop a large rash that looks like a bull's-eye. Baxley
experienced other classic Lyme disease symptoms, such as
muscle aches and stiff joints. His doctor also found a similar
rash on Baxley's calf.
After a blood test confirmed Lyme disease,
Baxley took the oral antibiotic doxycycline, followed by
intravenous treatment with a second antibiotic called Rocephin
(ceftriaxone). In addition to the physical symptoms, he
is also experiencing depression for the first time. "The
whole thing is frustrating," says Baxley. "It's
taken a toll on the whole family."
Ticks are usually harmless. The biggest disease
threat from tick bites is Lyme disease, which is caused
by the bacterium Borrelia burgdorferi. The bacteria
are transmitted to humans by the black-legged deer tick,
which is about the size of a pinhead and usually lives on
deer. According to the Centers for Disease Control and Prevention
(CDC), there were 23,763 cases of Lyme disease reported
nationwide in 2002.
Another insect-borne illness, West Nile virus,
is transmitted by infected mosquitoes and usually produces
mild symptoms in healthy people. But the illness can be
serious for older people and those with compromised immune
systems. In 2002, there were 4,156 cases of West Nile virus
in humans reported to the CDC. Less than 1 percent of people
infected with West Nile virus develop severe illness. The
symptoms are flu-like and can include fever, headache, body
aches, and skin rash.
What you can do: There are
no vaccines on the market for West Nile virus or Lyme disease.
If you're spending time in tall grass or woody areas, use
insect repellent with DEET to ward off mosquitoes and ticks.
But insect repellent should not be used on babies, and repellent
used on children should contain no more than 10 percent DEET.
Check yourself and your children for ticks
before bedtime. If you find a tick, remove it with tweezers,
drop it in a plastic bag and throw it away. You don't have
to save the tick to show it to doctors. People who want
to get a tick tested for diseases or other information could
check with their local health departments, but not all of
them offer tick testing. The CDC recommends cleansing the
area of the tick bite with antiseptic. Early removal is
important because a tick generally has to be on the skin
for 36 hours or more to transmit Lyme disease.
OTC antihistamines, such as Benadryl or Claritin,
can bring itch relief. Topical anti-itch cream on the affected
area also may help, especially for children, says Edward
Lamay, M.D., a physician in the emergency department at
Durham Regional Hospital in Durham, N.C. You may also want
to keep their nails short. "Some kids scratch bites,
break the skin, and then get a bacterial infection,"
In the summer of 2003, the Nebraska Poison
Center in Omaha received a call about a 4-year-old girl
who was stung on the tongue by a bee while sipping from
a soda can. She was treated in the emergency room for swelling
not only to the tongue, but to her lips and up to her eyes.
"It's a concern anytime there is swelling
in the face or an area other than where the sting occurred,"
says Charles Pattavina, M.D., an emergency physician at
The Miriam Hospital in Providence, R.I. Other symptoms of
an allergic reaction are hives, itching, rash, difficulty
breathing, and shock. Most reactions to bees are mild, but
severe allergic reactions lead to between 40 and 50 deaths
each year. An allergic reaction can occur even if a person
has been stung before with no complications.
What you can do: To keep
bees away, wear light-colored clothing and avoid scented
soaps and perfumes. Don't leave food, drinks, and garbage
out uncovered. Treat a bee sting by scraping the stinger
away in a side-to-side motion with a credit card or fingernail,
and then washing the area with soap and water. Pulling the
stinger or using tweezers may push more venom into the skin.
For any bug bite or sting, ice or a cold compress and OTC
pain-relieving creams or oral medications can help.
Because bees puncture the skin with their
stingers, there is a risk of tetanus infection. After getting
the regular series of childhood tetanus shots, adults should
have a tetanus booster shot every 10 years.
Watch for signs of allergic reaction to stings,
which typically happen within the first few hours. If you
or your child has ever had an allergic reaction to a sting,
experts recommend carrying epinephrine, a prescription hormone
given by injection to support blood pressure, increase heart
rate, and relax airways.
In August 2001, Tracey Jaurena, an athletic
trainer in Coalinga, Calif., was working on a football field
when a friend called her cell phone number. The caller said
Jaurena's son Abe, 12, had collapsed during practice nearby
with his youth football league.
"When I got there, Abe's face was blotchy
and I kept calling his name, but he couldn't answer me,"
she says. Jaurena cooled Abe down until emergency workers
arrived and he was treated for dehydration at the hospital.
Jaurena believes Abe got sick because it was at least 95
F that day, the players were inappropriately dressed in
full uniform, and Abe hadn't had a water break in close
to an hour. "It was also the third day of football
practice and it's important to acclimate athletes to the
weather," she says.
During heat illness, the body's cooling system
shuts down. Body temperature goes up, which inhibits the
ability to sweat. Mild symptoms of heat exhaustion include
thirst, fatigue, and cramps in the legs or abdomen. Left
untreated, heat exhaustion can progress to heat stroke.
Serious heat-related symptoms include dizziness, headaches,
nausea, rapid heartbeat, vomiting, decreased alertness,
and a temperature as high as 105 F or more. In severe cases,
the liver, kidneys, and brain may be damaged. About 400
people die each year from heat exposure, according to the CDC.
The risk of heat illness goes up during exertion
and sports and with certain health conditions such as diabetes,
obesity, and heart disease. Alcohol use also increases the
risk. So do medications that slow sweat production such
as antihistamines, tricyclic antidepressants, and diuretics
used to treat water retention, high blood pressure, and
some liver and kidney conditions.
People ages 65 and older and young children
are especially vulnerable to heat illness. During the summer
of 2003, at least 42 children in the United States died
after being left in hot cars, according to Jan Null, a meteorologist
in San Francisco who tracks heat-related deaths. What some
people don't realize is that the temperature inside a car
can climb much higher than temperatures outside during a
sunny day. Heat stroke in children can occur within minutes,
even if a car window is opened slightly.
What you can do: Air conditioning
is the No. 1 protective factor against heat illness. If
you don't have air conditioning, spend time in public facilities,
such as libraries and malls that have air conditioning.
Reduce strenuous activities or do them during early mornings
and evenings when it's cooler. If you're outside for long
stretches of time, carry a water bottle, drink fluids regularly,
and don't push your limits. People who play sports should
wear light, loose-fitting clothes and drink water or sports
drinks before, during, and after activity. If you see someone
experiencing heat illness, have the person lie down in a
cool place and elevate the legs. Use water, wet towels,
and fanning to help cool the person down until emergency
Burns From Fireworks and Grills
Sia Karpinski, 10, of Akron, Ohio, hasn't
been interested in playing with sparklers since July 4,
2002, when she stepped on a discarded sparkler while in
bare feet. She was treated for serious burns at the Burn
Center at Akron Children's Hospital as an outpatient for
about six weeks.
The U.S. Consumer Product Safety Commission
estimates that about 8,800 people were treated in emergency
rooms in 2002 for injuries associated with fireworks. Most
injuries involved the hands, head, and eyes. Lee Duffner,
M.D., an ophthalmologist in Hollywood, Fla., says, "Unfortunately,
I've treated burns of the cornea and eyelids and hemorrhages
inside the eye caused by hand-held sparklers and other fireworks."
Mary Mondozzi, a nurse at the Akron Children's
Hospital Burn Center, says she also sees burns from grills
and campfires. "Children get hurt playing around grills
or they get burned when they throw objects into campfires,"
What you can do: Stick with
public firework displays handled by professionals. Children
should always be closely supervised when food is being cooked
indoors or outdoors. Be aware that gas leaks, blocked tubes,
and overfilled propane tanks cause most gas grill fires
and explosions. "Teach children to cover their faces,
stop, drop, and roll if their clothes catch fire,"
Generally, minor burns smaller than a person's
palm can be treated at home. But burns bigger than that,
and burns on the hands, feet, face, genitals, and major
joints usually require emergency treatment. "For a
minor injury, run cool water over it and cover it with a
clean, dry cloth," says Mondozzi. Don't apply ice,
which can worsen a burn. Don't apply petroleum jelly or
butter, which can hold heat in the tissue. Consult your
family doctor if a minor burn does not heal in a couple
of days or if there are signs of infection, such as redness
Summer is prime time for weddings, picnics,
graduation parties, and family cookouts. And feeding the
large groups involved can make food safety especially challenging.
Last June, at least 81 students from E.C. Drury High School
in Milton, Ontario, reported signs of food poisoning after
a graduation celebration. Many had bloody diarrhea. In July,
stool samples confirmed E. coli as the cause of
illness, though the exact food source of the bacterium was
not confirmed. Known sources of E. coli include
undercooked beef, sausage, and contaminated produce.
Typical signs of foodborne illness include
nausea, vomiting, cramps, and diarrhea. In serious cases,
high fever, bloody stool, and prolonged vomiting may occur.
Young children, pregnant women, older people, and those
with compromised immune systems are hit hardest.
Bacteria, whether in food or in the air,
grow faster in warmer weather. Don't just worry about the
potato salad or egg dishes, says Marlene Clark, a registered
dietician at Cedars-Sinai Medical Center. "You have
to be careful with any food, including melons and lettuce,"
she says. Since 1996, the FDA has responded to 14 outbreaks
of foodborne illness for which fresh lettuce or fresh tomatoes
were the confirmed or suspected source. The causes included
E. coli, salmonella, cyclospora, and hepatitis
What you can do: It seems
so basic, but not everyone does it. Wash hands well and
often with soap and water, especially after using the bathroom
and before cooking or eating. Also wash surfaces when cooking,
keep raw food separate from cooked food, marinate food in
the refrigerator, cook food thoroughly, and refrigerate
or freeze food promptly. The FDA suggests never leaving
food out for more than one hour when the temperature is
above 90 F. Any other time, don't leave food out for more
than two hours. "Keep hot food hot and cold food cold,"
Clark adds. "Wash off fruits and vegetables with cool
running water." Also, scrub fruits with rough surfaces
like cantaloupe with a soft brush.
When you are packing food for a picnic, place
cold food in a cooler with plenty of ice or commercial freezing
gels. Cold food should be held at or below 40 F and the
cooler should be stored in shade. Hot food should be wrapped
well, placed in an insulated container, and kept at or above
Those hit by a foodborne illness must stay
hydrated so they could try chewing on ice chips or sipping
clear fluid after vomiting has stopped. In the next day
or so, eat only light foods such as bananas, rice, applesauce,
toast, crackers, and soup. Seek emergency treatment if severe
pain accompanies the illness, if vomiting doesn't stop in
a couple of hours, or if bloody diarrhea is experienced.
Poison Ivy, Poison Oak, and Poison Sumac
Betsy Dunphy, 44, enjoys living in a woody
area in Herndon, Va. But she could do without the poison
ivy. She once missed a week of work when a rash from the
vine spread all over her face and chest. In the summer of
2002, she developed a poison ivy rash on her wrist after
moving azalea plants, and was careful to keep it from spreading.
Rashes from poison ivy, oak, or sumac are
all caused by urushiol, a substance in the sap of the plants.
Poison plant rashes can't be spread from person to person,
but it's possible to pick up a rash from urushiol that sticks
to clothing, tools, balls, and pets.
What you can do: Dunphy says
she's been able to avoid an outbreak in the last two years
mainly by learning what poison ivy looks like and avoiding
it. According to the American Academy of Dermatology, while
"leaves of three, beware of me," is the old saying,
"leaflets of three, beware of me" is even better
because each leaf has three smaller leaflets.
"I also wash my garden tools regularly,
especially if there is the slightest chance that they've
come into contact with poison ivy," Dunphy says. If
you know you will be working around poison ivy, wear long
pants, long sleeves, boots, and gloves.
Hikers, emergency workers, and others who
have a difficult time avoiding poison ivy may benefit from
a product called Ivy Block, made by EnviroDerm Pharmaceuticals
Inc., of Louisville, Ky. It's the only FDA-approved product
for preventing or reducing the severity of rashes from poison
ivy, oak, or sumac. The OTC lotion contains bentoquatam,
a substance that forms a clay-like coating on the skin.
If you come into contact with poison ivy,
oak, or sumac, wash the skin in cool water as soon as possible
to prevent the spread of urushiol. If you get a rash, oatmeal
baths and calamine lotion can dry up blisters and bring
relief from itching. Treatment may include OTC or prescription
corticosteroids and antihistamines.
Poisoning in Children
The parents of a 2-year-old boy called the
Nebraska Regional Poison Center in Omaha last summer when
he accidentally sprayed cleaning disinfectant into his eye.
He developed a burn in the cornea. Another 2-year-old boy
spent several days in the hospital and survived after drinking
charcoal lighter fluid that had been left by the barbecue
pit. In another case, a 3-year-old girl got into a bottle
containing insecticide and died several days later.
"We see the calls go up every spring
and summer," says Joan McVoy, a nurse at the poison
center. Children may accidentally ingest sunscreens, berries,
cleaning solvents, insect repellents, pesticides, plants
and mushrooms, and hydrocarbons in the form of gasoline,
kerosene, and charcoal fluid.
The American Academy of Pediatrics (AAP)
no longer recommends that syrup of ipecac be used routinely
to induce vomiting in poisoning cases. The main reason that
the AAP changed its recommendation in 2003 was that, although
it seems to make sense to induce vomiting to empty the stomach
contents after a poisoning, research hasn't shown that ipecac-induced
vomiting is beneficial in improving the clinical outcome
of accidental poisoning cases.
Other concerns are that the continued vomiting
caused by ingesting ipecac could prevent children from keeping
down the activated charcoal they may be given in the emergency
room. Charcoal binds to poison and keeps it out of the bloodstream.
"There are also some substances that you don't want
coming back up because they do more damage, such as drain
cleaner and other corrosives," says Arlene Solbeck,
an FDA scientist.
The FDA is considering various positions
on the safety and effectiveness of ipecac syrup and whether
it should still be made available over-the-counter or switched
to prescription status.
What you can do: Dangerous
substances, including medication, should be kept out of
reach of children. In addition, substances should be kept
in their original containers to avoid confusion or mistakes.
Children who have ingested poisonous substances may experience
difficulty breathing, throat pain, or burns to the lips
If you suspect that a child has ingested
a poison, call the poison center immediately to relay the
type of poison ingested and get advice on what to do. If
you dial the nationwide poison help line--(800) 222-1222--you'll
be connected to your regional poison center. Convulsions,
loss of breathing, or loss of consciousness require calling
911 immediately. Take the poison with you to the emergency
room, whether it's a part of a plant or the chemical's container.
Henna tattoos: The Food
and Drug Administration has received complaints from people
who have received products marketed as henna temporary tattoos,
especially so-called "black henna," at places
such as salons and kiosks at beaches and fairs. There have
been reports of allergic reactions, skin irritations, infections,
and even scarring. "Black henna" may contain the
added "coal tar" color, p-phenylenediamine, also
known as PPD, which can cause allergic reactions in some
people. Henna itself is made from a plant and typically
produces a brown, orange-brown, or reddish-brown tint. Other
ingredients must be added to produce other colors. Even
brown shades of products marketed as henna may contain other
ingredients intended to make them darker or make the stain
last longer. While the FDA has approved henna for coloring
hair, and PPD is used in cosmetics as a hair dye, neither
of these color additives is approved for direct application
to the skin.
Depilatories: The FDA also
has received complaints about skin burns and scarring from
some chemical hair removal products. If you use this type
of product, always do a patch test in accordance with the
directions, don't use it on broken or irritated skin, and
keep the product away from eyes. Cosmetics don't go through
FDA approval before they are marketed, though the agency
can take action to get unsafe products off the market.