Summertime and the livin’ is sneezy

Solutions to summer maladies

Through the looking glass

You can feel the change right when it hits. The sky is high and bright, a soothing blue lit by early sunlight. The air is filled with the aroma of young blossoms and fresh grass. Children don’t ask to come inside, and adults seek ways to sneak out to the golf course, coastline, bike trail, or pool.

You know it’s here as you witness spring blossoming into summer through the glint of freshly washed windows. You try to suppress a sneeze but you can’t, and then you’re overtaken by another sneeze and another … and your eyes are running and you’re out of tissues and you really don’t care any more. It’s allergy season, and you’re relegated to witnessing the splendor of spring through the glass.

“If you can figure out what bothers you and avoid it, that’s your best medicine,” says Dr. Deborah Biller, chairperson of the Family Practice Division at Community Hospital, who divides her family practice between Monterey and Big Sur. “But we don’t always know what it is, or it’s too pervasive, like pollen. Once you are exposed to what you’re allergic to, your immune system sets up a reaction to the chemical or antigen, creating a histamine response of running eyes and nose, sneezing, and coughing, which is why you want the help of an antihistamine medication.”

Biller suggests some effective over-the-counter oral medicines, such as Claritin^® or Benadryl^®, as well as nasal sprays like Flonase^® or Nasalchrom^®.

“Pollens, that great summer goody,” says allergist Dr. Jeffrey Lehr, “affect about 20 percent of our population, who respond sometimes with a tickle cough and sometimes with more severe upper respiratory problems such as wheezing, sneezing, coughing, and even asthma. It helps if you can take an allergy medication before you get out into it for prevention. However, if you still have problems or feel sick, allergy shots, which take six months to become effective, can be helpful.”

The sting of summer

He was lucky. Depending on how you look at it. He didn’t feel lucky having to mow the lawn on a perfectly good Saturday. He didn’t feel lucky having to prune the roses instead of hitting balls at the driving range. And he didn’t feel lucky having to clean out the attic instead of cruising the bay in his kayak. But when he uncovered a hornet’s nest in the attic and got away with no more than one sting and a mild swelling, he felt very lucky.

He was lucky. This time.

“If you have any history of bee stings, each subsequent sting can be progressively worse,” says Monterey family practice doctor Scott Schneiderman, vice chairperson of the Family Practice Division at Community Hospital. “You may have experienced a rash or mild swelling the first time, but the next time could result in a full anaphylactic (severe and sometimes fatal allergic) reaction. You just don’t know. It’s important, if you know you’re allergic or you’ve been stung before, to get a bee sting kit and keep it handy.”

Keep a bee sting kit in your motor home and your house, your beach bag and your purse, your briefcase and your car. Take it hiking, camping, sailing, wherever you go outside.

“The bee sting kit contains an injectable form of epinephrine,” says Biller, “which blocks the allergic response. It is a different type of allergy than poison oak, which is slower acting. A bee sting allergy can manifest immediately as a swollen bump, or within minutes the person can start wheezing, experience trouble breathing, have their face swell up, or go into shock. Make sure your kit hasn’t expired. Most important, avoid the bees.”

Ticked off

She wasn’t much of a hiker, but she’d try anything once. Besides, the higher she’d climb among the wildflower meadows of the Santa Lucias, the better the view of the endless blue ocean off the coast of Big Sur. And that was a sight worth reaching for.

She knew enough to break in a pair of sturdy hiking boots high enough to protect her ankles and softened by a pair of comfortable socks. She put on a pair of khaki shorts and threw on a couple of layers up top. Halfway up the hill, she felt a slight tickle at the back of her right knee. Seeing nothing, she hoped she hadn’t brushed against poison oak and continued to the top. Checking her leg once again, she saw nothing but a little dirt and a couple of scratches.

She checked her leg again in the shower, when she turned to scrub off the dirt. What had once seemed a speck of mud looked more like a kernel of corn. Recognizing the tick feasting behind her knee, she screamed and went in search of a match. She should have grabbed a pair of tweezers, gripped the tick as close to the skin as possible, and pulled it straight out, being careful to avoid squeezing the tick, which can emit bacteria into the skin.

“We get ticks in Big Sur, where my practice is, year round,” says Biller. “April, May, and into summer, a lot of tourists have problems. One of the problems is that the ticks are so small. Deer ticks start out the size of a comma on the printed page, and wood ticks aren’t much bigger, about the size of a capital ‘O,’ so they’re hard to spot until they balloon up. This can be partially avoided or discouraged by wearing long clothing in light colors, because most ticks will show up better and you can brush them off before they ever have a chance to burrow into the skin.”

Ticks are often found on the thigh, groin, underarms, and backs of knees, behind the ears, and on the neck at the hairline. Once the tick has been removed with tweezers, the area should be cleansed with soap and water.

“The biggest concern,” Biller says, “is the potential for contracting Lyme disease, which is carried by the deer tick in some regions. The good news is that it’s very treatable if diagnosed early.”

Lyme disease is rare on the Monterey Peninsula, but if you develop a telltale bull’s-eye rash, pain, fever, headache, or muscle ache after a tick bite, see your doctor.

No such thing as a healthy suntan

During the 1940s and early ’50s, young coeds used to lie perfectly still on a sandy beach, while their friends carefully set tiny pebbles around their necks in a floral pattern. If they lay there long enough, the sun’s rays would tan or burn the skin around the pebbles and they were left with a reverse tattoo of a necklace once they removed the pebbles.

Obviously, those necklaces have long since faded. And the young women are now in the winter of their lives, many of them sporting scarves to conceal the deep creases of sun- and time-weathered skin.

Did we ever really think it was good for us? No one welcomes an iron burn, and we recoil when we touch a hot stove, yet we lie for hours under the rays of a natural oven, stopping to check the progress or turning like a rotisserie to keep the burn even.

“The key to sunburns is don’t,” says Schneiderman. “While a sunburn can make your skin appear old and wrinkled, of greatest concern is the susceptibility to skin cancer. We have learned that it’s not the chronic mild exposure to the sun but the burns, even early in life, which can be a precursor to cancer years and years later. Especially the blistering second-degree burns.”

Now that you’ve spent decades tanning your skin, fashion has taken another fickle turn. What’s in vogue today is the skin you were born in, whatever tone it may be. The bad news is, just like that lip liner you had tattooed last spring, you can’t go back.

Nevertheless, do what you can. Invest in the new line of UVprotection garments, so lightweight you’ll still feel the freedom of summer, but woven to protect you from the sun. Wear a hat, sit in the shade, and apply sunblock liberally and often.

“The important thing to know about sun is sunblock,” Schneiderman says. “Never use a sunblock less than SPF 15. On the other hand, anything above 30 is not going to provide additional coverage. It doesn’t mean anything in terms of clinical usage; we can’t be out there long enough to benefit from anything higher.”

If you do get sunburned, cool it down. As with any burn, apply ice, cold compresses, and most effectively, aloe vera gel. Most important, get out of the sun.

What’s your poison?

It started out looking like a small bug bite on his arm, hardly worth noticing. Until about 3 a.m. three days later, when he awoke to find that the irritation had consumed his body like an alien invasion, rampaging up his arm, across his chest, and down the other arm, leaving mass hysteria in its wake. It was red, it was rough, it was itchy and oozing. It was poison oak.

How could this have happened? Where had he been? It couldn’t have been Garland Park, where he’d been hiking on Saturday. He’d been so careful to stay on the path and, even when he’d strayed, he’d laid a blanket on the ground before spreading out the lunch.

The blanket. He had also folded that blanket into his arms and carried it down the hill at the end of the hike. Now what?

The poison oak plant has a distinct appearance, but you have to be on the lookout for it. Its characteristic three leaves are green in the summer, enabling it to hide among other leaves in the woods. By the fall, the leaves turn a beautiful red color, which can attract unsuspecting children and adults to gather it for autumn leaf collections. Once the leaves fall off the vine, people often unwittingly collect the wood for kindling.

“During any stage of the plant’s life, it is the sap that serves as the antigen,” explains Biller. “The body sees the sap as a foreign substance and reacts against it. Most common is that the skin breaks open with a rash as long as three days after exposure.”

The rash begins as a rough, red, itchy patch, which can become more puffy and bumpy and can progress to blisters, which emit a clear fluid.

“Prednisone or cortisone will turn off that key that started the body’s reaction and stop the spread or development of the rash,” says Biller. “The steroids are the only medicines that will do that. If the rash is merely red and itching but not blistering or weeping, you want the antihistamine benefits of Benadryl^® or Claritin^®, or hydrocortisone cream or calamine lotion. These creams have a topical effect where you put them but don’t work internally.”

Poison oak is a member of the Rhus family, which includes poison sumac in the Midwest, poison ivy on the East Coast, and the mango in the tropics.

According to Lehr, more than 70 percent of the population will develop sensitivity to the plant after touching it. “And once you do, you’re stuck with it. Hopefully, you won’t touch it again. Avoidance is the key. While you can’t contract it from touching the rash, you can get it from your pets, clothing, the plant — anything that carries the sap.”

“To get the sap off before it has a chance to penetrate the skin,” says Biller, “I recommend Technu^®, a widely used over-the-counter cleanser. The real trick is to avoid exposure to the skin in the first place. Wear long sleeves and shoes when in the vicinity of poison oak, and tuck your pants into your socks. Wash your hands, your clothes, and yourself as soon as you can after possible exposure.”

And whatever you do, don’t scratch.