Summer Health Update 2010

When planning a trip to NYC, if you are traveling by airplane and you have any medical conditions, please check with your doctor to find out if you have any special needs or require additional medications prior to your flight. Make sure to have only light meals, leave adequate time to get to your destination to avoid stress, and use a luggage cart or use the services of a porter to avoid muscle strains. Remember if you take medication regularly, be sure to pack adequate amounts before your trip and remember to pack an additional amount in a separate suitcase or carry-on, as luggage can get delayed or misplaced and cause undue stress if the medication needs to be replaced.

In addition, be sure to wear loose, comfortable clothing for your flight. If you have any alcohol or caffeine (coffee, tea or soda), drink limited amounts and have plenty of water. Be sure to get up and walk around the cabin a few times during the flight, use restroom facilities when needed and do some light exercises. This will help prevent fatigue, strain, urinary tract infections, jet lag and possibly travelers thromboses (blood clots) in the pelvis and legs. Also, try to take regular naps and listen to relaxing music or other relaxing in-flight entertainment. If you plan to travel from NYC, make sure that you are fully immunized and counseled about country-specific precautions (see Emporiatric Medicine section).

With New York City being a temperate climate; summertime, with all its flowers, trees and grass in full bloom, can account for an increase in allergies and asthma. The most effective way to combat these problems is to avoid allergy triggers. Unfortunately, this means avoiding many of New York City's beautiful parks, gardens and countryside. However, there are ways of combating these allergy symptoms. There are hosts of over the counter treatments and preventive medications that will still allow you to enjoy our beautiful parks and gardens. Some of these medications are sedating, but others like loratadine are not. Many people only suffer from the congestive aspect of allergies like nose, ear and sinus congestion. For these symptoms, an over the counter non-sedating decongestant like oral pseudoephedrine (Sudafed) or nasal decongestantswill usually help. Please remember that this medication will only work for congestion and stuffiness but not for sneezing and runny nose; only an antihistamine will help those symptoms. You can also ask your doctor about the various non-sedating prescription medications available for the treatment and prevention of seasonal allergies. If you are prone to develop asthma symptoms this time of year, again, avoidance is the best prevention of symptoms. If you plan a trip to New York City this season, again, please remember to take adequate amounts of your medications and inhalers with you and bring along spare medication in case yours is lost or you run out.

While running along Jones Beach or riding the waves at Coney Island, you must be careful of sun exposure. Before heading out, make sure to wear clothing that covers your body and shades your face. Use a sunscreen with at least an SPF-15 or higher on all areas of the body exposed to the sun and be sure to apply it before going outside for maximum effectiveness. Sunburns cannot only ruin a vacation but can damage your skin and can lead to skin cancer. Re-apply sunscreen every two hours, even on cloudy days. Be sure to wear sunglasses, as long-term eye exposure to the sun can lead to cataracts.

Water safety is also important this time of year. Remember, avoid going into the water if you cannot swim; if you can, remember to never swim alone and to swim near a lifeguard. Again, do not drink or use substances and swim or participate in boating or other water sports. Always enter the water feet first and do not dive into unfamiliar waters. Again, always remember to supervise children closely, even when a lifeguard is present whether in a hotel pool or at the beach. Always follow all pool regulations and lifeguard directions. Additionally, always wear a properly fitted, Coast Guard-approved life jacket when boating and fishing.

In addition, the sun and heat during the summer also predisposes one to dehydration and heat-related illnesses like heat cramps, heat exhaustion and heat stroke. Being active and exercising makes heat-related illness happen more quickly. Be sure to drink plenty of fluids (non-alcoholic, non-caffeinated) while walking around as to avoid these illnesses. Also, wear lightweight, light-colored, loose-fitting clothing, try to limit your outdoor activity to morning and evening hours, and try to rest often in shady areas. Small children and the elderly are most at risk. Heat cramps are forceful and painful muscle contractions that occur usually in the legs and occur directly as a result of heat, dehydration and poor conditioning rather than lack of salt or electrolyte imbalance. Fluids, rest and a cool environment help alleviate this condition quickly. Heat exhaustion is a bit more severe with heavy sweating, paleness, muscle cramps, tiredness or weakness, thirst, increased breathing rate, dizziness or headache, irritability, and nausea or vomiting. Treatment includes drinking cool, non-alcoholic beverages such as water or WHO Oral Rehydration Solution, rest, taking a cool sponge bath (or if the person can stand safely or be moved to a tub, help him/her take a cool shower or bath), changing to lightweight clothing, and most importantly, moving to an air-conditioned place such a shopping mall, or local heat-relief shelter (these often include the public libraries, senior centers, or recreational buildings). Get medical help if symptoms get worse or last more than 1 hour. If untreated, heat exhaustion can develop into heat stroke, the most severe form of heat-related illness. Up to 40% of people with heat stroke may die due to brain damage, even when they get appropriate medical help. Signs of heat stroke include a body temperature of 103 degrees or higher, red, hot and dry skin (although some victims may sweat), a rapid pulse, throbbing headache or dizziness, seizure, nausea or vomiting, and confusion, agitation or unconsciousness. If you think someone may have heat stroke, activate the emergency medical service by calling 911 right away. Don�t wait! Heat stroke is a life threatening medical emergency! There are a few things you can do until EMS arrives; move the person to a shady area and use water to cool the person (for example, put the person in a tub of cool water, spray him with water from a garden hose, or sponge him off with cool water). Keep up your cooling efforts until the person�s body temperature stays at 101-102 degrees. If the person can safely drink, give him non-alcoholic fluids. These simple efforts, performed quickly save lives.

Also, if taking a bicycle out for a spin in Battery Park or a skateboard or scooter out in Prospect Park, make sure your equipment is in good working order and that you have the correct protective gear. Remember, New York State law requires all persons under age 14 to wear approved bicycle helmets when riding or as passengers on bicycles. Make sure the helmet is approved by the USCPSC. Also when skateboarding, riding a scooter or in-line skating remember to wear knee pads, wrist guards, helmets, elbow pads and gloves to prevent injuries. Also, take it easy and don't try maneuvers that are beyond your abilities. Use only smooth, paved surfaces without any traffic and avoid streets or surfaces with water, sand, gravel or dirt.

When it comes to safety, the most dangerous activity during this summer is driving. The easiest way to stay safe is to stay off the roads when possible. However, if you plan to drive to or in NYC, please be prepared. Make sure the car is in good working order and that you do regular, scheduled maintenance (this is less of an issue with rental cars). Make sure your car is supplied with jumper cables, a spare tire and a jack, reflective triangles, a help sign and a first aid kit for minor emergencies. Your car should have enough oil, coolant and windshield washer fluid for the trip. You may also want to consider joining one of the automobile clubs like the Automobile Club of America. They are a very good resource for travelers. Pay full attention to the road while driving. If your child demands your attention, if you�re tired or if you need to talk on your cellular phone, please pull over to a safe place so there is no danger of an accident. Also, be aware that the law in New York State is that you must wear a hands-free device if talking on a cellular telephone when driving. In addition, take note of any medications that may interfere with your driving ability. Whether driving yourself, or if you are a passenger in a car or taxi, please be sure to wear your seatbelt and strap your children in their safety seats every time. Remember please never drink alcohol and drive. Rely on public transportation as much as possible. New York has one of the finest public transportation systems in the world. Besides, this time of year, New York is beautiful to walk around, so go out and enjoy its many sights, museums, theatre and events.

In addition, as in any large city (NYC being one the safest), personal security is also an issue and there are a few prudent, common sense personal safety tips to take note of. A very nice brochure outlining these safety tips is published by The American Hotel & Motel Association and is available from the security office in most NYC hotels.

Women's health issues are also important during this time of the year. Urinary tract infections are common this time of the year as the warm weather predisposes to dehydration and many outdoor activities and inconvenient bathroom facilities can make some women not void when they need to. Long trips, whether traveling by air or by car, bus or train can increase the chance of a UTI by sitting in one position for a long time and again by not going to the restroom when needed. Voiding when cued and taking in adequate fluids will greatly reduce the chance of getting a urinary tract infection.

This is also the time of year that many people turn to more amorous activity. While nobody likes to think about it, another issue is sexually transmitted infection (STI) prevention. In our practice, we unfortunately treat a fair amount of STI�s this time of year. Vacation and business travel statistically are associated with an increased risk of STI transmission. Letting one's guard down when not being home, combined with alcohol intake make travelers more at risk of acquiring STI's. STI's can lead to major health problems, such as infertility, blindness, brain damage, heart disease and even death if left untreated. Prudent STI prevention including abstinence and use of barrier devices will also make for a healthier and safe trip.

Planning a summer picnic or barbecue? Please be sure that the food is stored and packed safely. Keep raw and cooked foods separated, so they do not contaminate each other. Remember to wash hands often when handling raw food or use a hand sanitizer to avoid food related infection. Please be sure that all of your raw foods are cooked thoroughly and please make sure your cooking location is away from any flammable objects, including shrubs, trees, picnic tables, etc. to avoid a fire. Be sure also while outdoors to beware of lightning hazards. Look for a shelter equipped with a lightning protection system like those found at golf courses, public parks and pools. If you're caught outside and unprotected; get in a hard topped car, never use a tree as a shelter, avoid areas that are higher than the surrounding landscape, keep away from metal objects including bikes, golf carts, fencing, machinery, etc. and avoid standing near tall objects. Immediately get out and away from pools, lakes, and other bodies of water. Spread out - don't stand in a crowd of people. If you feel a tingling sensation or your hair stands on end, lightning may be about to strike! Immediately crouch down and cover your ears, do not lie down or place your hands on the ground. If indoors, stand clear from windows, doors and electrical appliances, unplug appliances well before a storm nears - never during, avoid contact with piping; including sinks, baths and faucets, and do not use the telephone except for emergencies. Remember, victims of lightning shock should be administered CPR if necessary, and seek medical attention immediately.

Additionally, while having a picnic in the Hamptons or Fire Island is a fun way to spend the day, you need to be careful of various hazards you may encounter. In our practice, this is the time of year we see patients who come in contact with poison ivy, poison oak or poison sumac that they touched while on a picnic or trekking. Knowing what these plants look like and avoidance are the best prevention. Calamine lotion, cool baths, baking soda paste and over the counter hydrocortisone cremes will help with the itching. Occasionally, the symptoms may be so severe they require medical attention. Remember, when in wooded areas, fields, or areas with a lot of brush, wearing long pants, long sleeves and gloves will protect you against poison plants and protect against tick bites. Some ticks carry Lyme disease (Borreliosis), which is an infection that can cause skin, heart, joint and nervous system problems. If you find a tick on you, use tweezers to grasp the tick as close to the skin as possible and pull steadily and firmly. Apply antiseptic and save the tick by placing it in alcohol for possible identification purposes. Remember, not all ticks carry Lyme disease and if bitten by a tick there currently is no evidence for a need for a preventive antibiotic. Please contact a physician if the area of the tick bite turns red or swollen.

This brings us to another recently noted insect borne illness; West Nile encephalitis. While the chances of a person getting encephalitis are small, especially among travelers to New York City, West Nile virus continues to require our attention during the summer and early fall. Men and women over 50 and infants who live in areas of higher incidence are at the greatest risk from the disease. Mosquitoes are small flying insects that feed on human and animal blood or plant juices. Only female mosquitoes bite to get a blood meal for their growing eggs. They are usually considered only a nuisance but occasionally can transmit disease like West Nile encephalitis. There are about 65 species of mosquito in New York State, yet only a handful of them can transmit the disease. They usually bite between dusk and dawn when the air is calm. Female mosquitoes are most likely to bite at this time as they expend less energy. Again, most mosquitoes do not transmit disease, however you can help reduce your risk of being bitten by mosquitoes. You may wish to minimize your outdoor activities between dusk and dawn and go to a Broadway show, have dinner in one of New York's fine restaurants, take in a movie or visit one of our fine museums instead. Wear shoes and socks, long pants and a long sleeved shirt, jacket or light sweater when outdoors for extended periods of time, or when mosquitoes are more active. Also, you may want to consider the use of mosquito repellant, according to directions, when you wish to remain outdoors. Don't be alarmed by what some papers may say about the West Nile epidemic. New York City government and New Yorkers alike have done a great job these last few years of greatly reducing the amount of West Nile carrying mosquitoes in New York by eliminating many of the mosquito breeding grounds. We anticipate an even greater reduction in West Nile carrying mosquitoes this summer.

While this article may appear to be disheartening, it is meant to prevent the most common of the situations that we see in our travel medicine practice during the summer. Prudent precaution will stave off illness, discomfort and injury, allay fears and allow everyone to have a truly safe and enjoyable summer in New York City.

Page Last Updated On 7/25/10