Summer Health With the DIY Doctor

Back by popular demand, here is another installment of “Ask the DIY Doctor” (also known as The Partner).  This time around we focused on common questions and concerns regarding Summer.   Find out the basics of what to do if you do get sunburned, what the skinny is on the new FDA guidelines about sunscreen, eating after swimming and if you really are playing Russian Roulette when you eat that potato chip you  dropped at the office picnic…..

It’s summertime and I’m sure that many of you have plans for bbq’s, beach trips and lots of outdoor DIY home projects. Courtney asked me to do a little piece on some common health questions that people run across in the summer.  The first question goes into a lot of depth because it’s a huge public health issue.

1)      What do I do when I get a sunburn?

Well, the easy answer is, don’t get one! Once you get a sunburn, there really aren’t a lot of things you can do to make the burn go away faster. Most burns are superficial and will heal over the course of several days to a week.  For mild burns, placing ice packs and keeping the skin cool by avoiding further sun exposure and taking cool showers often help. A lot of people also swear by the use of aloe vera, although studies haven’t shown it to be particularly helpful.

For burns that really sting or itch, using over-the-counter NSAIDs such as Ibuprofen or Naproxen can help reduce some of the inflammation of the burn. I’ve also found that using a topical anesthetic gel, such as Solarcaine can be helpful too.

If the sunburn causing blistering, then that indicates that the burn has reached some of the deeper layers of skin. This poses three problems. The first is that there is a potential for scars to develop. The second is that blistering wounds can often become infected. The third is that deep sunburns are the most likely to lead to the development of skin cancers. If you do develop a blistering sunburn, I would seek medical attention, particularly if it starts to become infected. Make sure that you get out of the sun and make sure to use an antibiotic ointment such as Neosporin or Bacitracin to keep the area clean.

Now, obviously, the best way to treat sunburn is to never get one! Ways to avoid excessive sun exposure include wearing wide-brimmed hats as well as long-sleeved loose-fitting clothing. That said, I’m totally vain and you’ll probably catch me on the beach with only my swimming trunks on! So, the best way to protect yourself in that scenario is to use sunscreen liberally, but I’ve found that there is a lot of misinformation about sunscreens out there.

UV radiation essentially comes in two forms, UVA and UVB. UVA accounts for about 90% of UV radiation that hits our skin and UVB accounts for the rest. UVA penetrates into the deeper layers of the skin and causes most of the tanning changes we get. Unfortunately, it is also responsible for causing premature skin aging and wrinkling, and increasing the risk of skin cancer. UVB penetrates into the more shallow layers of the skin and is most responsible for actual reddening of the skin and sunburns. Interestingly, tanning beds usually use a very high percentage of UVA, so that you tan, but don’t burn as easily (that said, it also does more skin damage).

Many people buy sunscreen based on SPF, but what exactly does it mean? Well, the number represents the increased proportion of time it would take for someone to get a sunburn. So, for instance, if you would get red after being in the sun for 10 minutes at midday, a SPF 15 sunscreen would theoretically increase that by 15 times, or 150 minutes.

There are two fundamental problems with SPF. First, most sunscreens have to be reapplied every 2-3 hours because you sweat it off, rub it off, etc (there’s no such thing as sweatproof or waterproof sunscreen). So, there’s really no point in applying sunscreens with SPF greater than about 30 unless you’re exceptionally fair-skinned and burn quickly. Second, SPF only refers to UVB protection. As I mentioned earlier, it’s UVA rays that are associated with most of the long-term damage associated with sun exposure. Currently, there are no FDA guidelines regarding rating UVA protection, although they are being developed.  For the moment, make sure you buy a product that specifically states that it has both UVA/UVB protection and make sure to apply the sunscreen liberally at least every 2 hours and anytime you come out of the water. Here’s to healthy skin this summer!

2)      Is it true that I shouldn’t swim right after I eat?

Well, I get asked this question a lot. We’ve all been told by someone that if we swim after eating, we could get a stitch in our side and then drown. Now, this is something that’s not taught in medical school so I had to dig around for some more information on this. It turns out that, probably, there’s no increased risk of cramping with physical exertion after eating, so there’s no absolute reason not to go swimming after eating.

With that said, I do have two thoughts about this. First of all, exercising on a full stomach can cause feelings of indigestion or nausea and I can’t imagine that it would be fun to be swimming (or running) on a full stomach. More importantly, cramps are possible at any time, so make sure that you never go swimming alone. Make sure that you go with at least one responsible person or, better yet, go to a pool or beach where there are lifeguards. I can’t tell you how many tragic drowning I’ve had to see over the years because someone went swimming by themselves and something happened.

3)      Damn it! I’ve dropped my hot dog on the floor! If I pick it up within five seconds, can I still eat it?

Ick! There’s no clear answer to this question. The moment food contacts a surface, it has the potential to pick up bacteria. The longer the contact time, the more contaminants food will pick up, but there’s really no “safe” time. Certain bacteria, such as salmonella and E. coli don’t require a large exposure to get sick; in fact, it may take only 10-100 individual bacteria to get a nasty gastroenteritis. While the majority of dropped food can probably be picked up and eaten safely, I personally wouldn’t recommend it. This is particularly true in areas where there is a lot of foot traffic (shoes pick up lots of fecal remnants on sidewalks) and in food prep areas where uncooked meats and their drippings may come into contact with surfaces.  So, unless you’re down to the last hot dog and you’re going to pass out if you don’t eat it, I would recommend throwing it away.

Here’s to a healthy and happy summer! Cheers, The Partner!

Got some health questions that you want to ask?  Shoot the DIY Doctor an email at lifeoutloudmail@gmail.com.

Images in order: (1) thehonch.net, (2) blogrocketsport.co.uk, (3) Plunge47.wordpress.com

Disclaimer: Advice given under the column “Ask The DIY Doctor” is written by a board certified physician but he is no substitute for your physician!  The advice addresses general concerns regarding medial issues and is not intended to replace one-on-one conversations with your family-care physician. 

Holiday First Aid: I Spy With My Injured Eye ……

Surprisingly, us DIYers are a bit of an accident prone bunch. I guess between the glue guns, drills, electric saws, knitting needles, paint brushes and countless other tools we all use throughout our DIY adventures, we are bound to hurt ourselves at some point. Fortunately, for me (and for you), we have our resident “DIY Doctor” on call to answer all of our first aid questions.

After the amount of feedback we got from his first posting (plus all the positive accolades y’all heaped on him), The Partner got a big head was excited to dive into writing a second posting answering all the questions you sent in. In this posting, our DIY Doctor will be addressing how to handle eye injuries and protecting your back…….

Who would have thought that cooking and crafting could be so hazardous to your health? Thanks for your follow-up questions from my last post. Based on that, I’ll answer a few more health-related dilemmas you might run across getting ready for that perfect holiday party.

I’ve gotten a little too glitter-happy when I was making my holiday centerpiece and a piece has flown in my eye and now it’s painful and red…

When a foreign object enters the eye, it can cause quite a bit of irritation. If there is significant trauma, it can also cause injury to the cornea, also known as a corneal abrasion. Now, glitter is one thing, but if something hard hits your eye at high velocity, make sure to seek medical attention immediately to be evaluated for a penetrating eye injury. One can’t always tell if an object has penetrated into the eyeball, so if something hard has hit the eyeball quickly, don’t wait and go to the ER. This is an emergency.

For all other injuries, check to see if the foreign object may be still in the eye. You can inspect the eye in a mirror, or better yet, have someone else take a look. Many objects can get caught underneath the eyelid, which can be difficult to see. You can actually take a cotton tip swap and roll the eyelid over (invert the eyelid). I know it sounds gross, but it’s totally safe to do and allows you to take a good look.

If there is an object in the eye, rinse it out with lukewarm water. DON’T rub the eye – it’ll only cause more irritation and might damage the cornea. If there isn’t an object that you can see, rinse anyway…there still might be something there and you should make sure you get it all.

If there’s only irritation, removing the foreign body should do the trick and the irritation should pass within minutes to a few hours. If there is a corneal abrasion, the pain will persist, and typically last for 3-5 days. Generally, no therapy is needed and the abrasion will heal itself over that time. There has been a great deal of controversy about different therapies for corneal abrasions, including patching, antibiotic drops, etc. None has really been shown to improve healing. In addition, steroid drops should NEVER be used, as they can slow healing. Also, rubbing the eye can make things worse and slow healing, so don’t touch the injury.

Two last things…first, if an eye injury occurs with a soiled substance (i.e.dirt) or an organic substance (i.e. a vegetable), there is a higher risk of infection of the corneal abrasion becoming infected or ulcerating. If you see an ulcer in the eye, or the pain doesn’t get better, see an ophthalmologist immediately. These infections are rare, but if they do occur, can spread rapidly and compromise your eyesight.

Second, if your eye comes into a contact with a noxious chemical, please verify what went into your eye before you rinse. If you come into contact with lime (the chemical, not the fruit), hydrochloric acid or sulfuric acid, DO NOT expose the eye to water! It will cause a heat reaction and make things worse. Go to the ER immediately then. For all other contact, rinse your eye thoroughly for a good 15 minutes and if pain persists, see a MD.

I’ve gotten that splinter out of the Douglas Fir that I was carrying, but man, it was heavy and I think I threw out my back.

Oh my neck....oh my back....oh my...err if you know the song, you can finish it. This is a family related blog......

The best way to treat a back injury is to avoid them altogether. Many back injuries occur because of improper lifting technique. First, never try to lift something that you don’t think you can handle…you can always look for that hunky dude down the street to help you out. Second, a little planning before you lift something heavy can go a long way. First, make sure that you can get a decent grip on the object and that you can keep your hands close to the core of your body. That way, you’ll be able to use as much leverage as possible. Second, do a good squat and lift with your legs; they’re far stronger than your back. Bending from your waist is a recipe for an injury. Also, it’s helpful to tighten your abs right before you lift – a tight core will help to stabilize your back muscles.

Unfortunately, back injuries still occur commonly. If this happens to you, here are a few tips. First, to reassure you, over 90% of all back injuries will heal themselves over time, even those that may involve the sciatic nerve (aka sciatica, which is back pain, coupled with shooting nerve pain to the buttocks and down the legs).

Second, stay modestly active. Bed rest actually impedes healing and can lead to worsening muscle spasm and rigidity. You should focus on doing gentle stretching exercises (emphasize gentle…none of those Jane Fonda bouncing stretches) and walking daily. Avoid lifting heavy objects (duh) and also avoid high-impact exercises.

Third, heat is your friend, as it helps to loosen muscles. A warm shower or bath, coupled with intermittent warm compresses, can be helpful. I’m not a huge fan of medication use, but if you need more help with pain, a NSAID (such as Ibuprofen or Naproxen) has both pain relief and anti-inflammatory properties. I think they are superior to Tylenol, which has no anti-inflammatory properties and Aspirin, which is fraught with bleeding/ulcer complications at doses needed to provide pain relief. If the pain is really severe, seek medical attention, as short bursts of stronger narcotic pain medications and/or muscle relaxants may be helpful, although they tend to be quite sedating and can interfere with work and driving.

If you back pain lasts for greater than 6 weeks or they are associated with neurologic signs other than sciatica, such as numbness in the groin or bowel/bladder incontinence/retention, please don’t tough it out and go see an MD.

The one good thing about a back injury during the holidays is that you can get sympathy points from your friends and make them do stuff for you, so all is not lost. Happy Holidays!

Big thanks to the resident DIY Doctor for his medical expertise! If you like this section, keep the questions rolling in at lifeoutloudmail@gmail.com or leave a comment.

Holiday First Aid: A Primer in Three Acts…..

Now that the blog is gaining traction, The Partner couldn’t stand to sit on the sidelines.  He practically begged to write a post for the blog and who am I to deny the guy?  Honestly, I asked The Partner, who is also a licensed doctor, to give some helpful tips on some common first aid scenarios that arise during the holiday season.  In case you were wondering, yes The Partner is a real doctor -  medical degree from a fancy school and gainfully employed at a hospital in San Francisco.   So without further waiting, here are some helpful tips from Courtney Out Loud’s resident physician:

Happy Holidays to everyone. This is CourtneyOutLoud’s partner (AKA “The Partner”) writing to you today. Unlike Courtney, I have not an iota of talent with cooking or with home décor. In fact, I’m more liable to injure myself trying to do a home project than anything else! That’s why I’ve decided to contribute to this blog by providing some handy advice about what to do if you suffer a little physical indignity while attempting to make your home a special place for the holidays.  Here are three scenarios that you might run across…

1)      While I’m carrying my gorgeous 7 foot Douglas Fir into the house, it slipped from my hands and now I’ve got a splinter!

Photo: eHow.com

Splinters are generally harmless and many will work their way out on their own over time, but those that consist of organic matter are more likely to lead to skin infections, so it’s best to try to remove them. I recommend that they be removed immediately, as there won’t be as much inflammation around the splinter and it’ll be easier to get out. To remove a splinter, first wash the affected area well with soap and water. Then, try to squeeze the sides of the splinter or squeeze the base of the splinter to see if you can remove it.

If this doesn’t work, usually because the splinter is nearly entirely embedded in the skin, you’ll need some tools.  I use both a needle and a set of tweezers. In order to prevent infections, the needle and tweezers should be sterilized. Povidone iodine is best, but if you’re in a pinch, isopropyl (rubbing) alcohol is generally okay.

Use the needle to create a little crater in the skin around the site where the splinter has inserted into the skin. Don’t stab yourself with the needle, rather, angle it and slowly push  the very top layer of skin away from the splinter circumferentially. When you have about 1-2 millimeters of exposed splinter, take your tweezers and grab the end of the splinter with the corner of the tweezer, grip firmly and pull. This may take a few attempts and it’s important to use the sharp corner of the tweezer. If unsuccessful, dig a little more with the needle.

Once you’ve removed the splinter, don’t forget to wash the affected area again with soap and water and then place a band-aid over the wound. Superficial splinters will heal in 2-3 days, but if it becomes inflamed, more painful, or starts to drain pus, seek medical attention as this could be the signs of a developing cellulitis or abscess.

2)      Ouch! I’ve burned myself…a) taking my Christmas ham out of the oven, b) accidentally touching the end of my glue gun trying to replicate Courtney’s coffee filter wreath, c) lighting the Menorah.

Graphic: http://www.purdue.edu

Burns are classified by the thickness of skin that’s injured. Generally, with household exposures, burns are mild and involve only the surface of the skin. The degree of injury is related both to the temperature of the contact and the time of contact. So, the first and foremost thing to do if you get a burn is to get the offending agent off your skin! This means wiping hot glue off your hands, rinsing off hot oil ASAP.  The longer the contact, the greater the damage!

Before I go on, if the burn happens in any of these areas – your face, eyes, groin (don’t ask, but I’ve seen it happen) – stop reading and go to the nearest ER. Burns on these areas can cause permanent scarring and affect bodily functions, so go get checked out right away.

Continuing on, after you’ve gotten the offending agent off, it’s best to rinse the burned area under cold water for 5 minutes or so. This will decrease the temperature of the skin and further limit the amount of thermal damage.  The key thing after rinsing is to see if the area is painful or not. Feeling pain is a good thing, as it signals only a superficial or partial thickness burn that will likely heal without scarring. If you don’t feel any pain or discomfort in the area and the area looks burned, you should be concerned about a full-thickness burn and should seek medical attention urgently. Fortunately, full thickness burns are uncommon with household activities.

It’s best to put on an antimicrobial agent on the wound, as it will help to accelerate healing of the wound. Common over the counter agents like Neosporin or Bacitracin work well.  Also, in a pinch, honey or aloe vera have natural antimicrobial properties and have been used as homeopathic remedies too.

Finally, for cosmetic reasons, I try to keep burns, scrapes or cuts out of direct sunlight exposure because all wounds will become hyperpigmented (darker) than the surrounding skin when exposed to sunlight. For the first 5 days or so after these injuries, cover them up with a band-aid. After the wounds have healed, put some sunscreen on those areas before you go out for a few weeks to keep them from darkening.

3) I’ve just had the best meal making some of Courtney’s treats, but now I’ve got an upset stomach. What’s the best remedy?

First, some foods are notorious triggers for an upset stomach. These include highly acidic foods such as tomatoes and citrus fruits. Caffeine, alcohol and strawberries are also common triggers. If you know these cause you problems, try to limit your intake of these foods.

An upset stomach can be caused by a variety of things, but probably the most common is gastroesophageal reflux disease (GERD), where acid that’s produced in the stomach refluxes, or regurgitates in the esophagus, causing irritation and discomfort. I generally find calcium containing medicines, such as Tums, which are supposed to neutralize the acid, mildly helpful, but not particularly effective.  Far more effective are medications that actually suppress acid production in the stomach. The first class of medication are the H2 blockers  (Pepcid, Zantac, Tagamet). These are all over the counter and provide quick relief. However, if GERD is a chronic problem for you, these medications are generally not potent enough and wane in effectiveness over time. If you do have chronic upset stomach or GERD symptoms, then a proton pump inhibitor (Prilosec, Nexium, Aciphex, Prevacid, Protonix) is much more potent and doesn’t lose effectiveness over time. Prilosec is the only one available over the counter and it’s pricey, so I would only use this class of medication if your symptoms are more chronic.

Hope this helps with those unfortunate accidents!  The Partner had a hoot writing this posting and is eagerly awaiting your feedback and follow-up questions.  Don’t disappoint him – leave a comment or shoot him an email at LifeOutLoudMail@gmail.com.  Until then, be careful, avoid spicy food and force your significant others to do the heavy lifting!  Check back next week for another set of holiday medical scenarios and answers from The Partner.