Outdoor Safety

Transcription:

Melanie Cole, MS: The Santa Clarita Valley is home to a variety of insects and snakes. How can you avoid being bitten and what should you do if you are? Can mosquito or tick bites be harmful? What’s the best way to protect yourself? Well, here to answer all of those questions is Dr. Bud Lawrence. He’s the medical director of Henry Mayo New Hall Hospital’s emergency department. Dr. Lawrence let’s just start with your best advice on protection. Let’s just start there from snakes and bugs and ticks and mosquitos. What do you tell people about the best ways to protect yourself?

Bud Lawrence, ND: Well, I would say if you're going to be outdoors, which you probably should be. We live in southern California. It’s a beautiful area. It is a good idea to protect yourself against not only the elements but the insects and the little critters that can be out there. So certainly, when it comes to snakes, that’s fairly obvious. Snakes are definitely in our environment. They're running around. If you're out hiking in the wilderness or even in your backyard, you may run into a snake. Truly, we only have one poisonous snake in southern California and that’s going to be the rattlesnake. Usually that snakes going to be really kind and it’s going to let you know ahead of time if you're encroaching on its turf. It’s going to give you a little bit of a rattle. So, if you do hear a rattle, you probably want to back up. It’s usually a great idea to stay away from all snakes even though even if you do see a snake, the only poisonous one we have is a rattlesnake.

So, when it comes to snakes, just keep your eyes on the ground. It’s always a good idea to see where you’re stepping. You don’t want to step inadvertently and accidently step on a snake. That will potentially provoke them to bite you. You don’t want to go putting your hands into bushes or areas where you can’t see. Sometimes that’s where we see snake bites unintentionally when people are gardening or when they’re out in the wilderness. In general, I think that if you pay attention to your surroundings when it comes to snakes, most people do just fine. We tend to coexist with them quite nicely. They serve a good purpose in our environment. They usually give us a pretty good warning, the rattlesnakes do, when we’re encroaching on where they want to be.

Other things to look out for, things that you mentioned. You brought up mosquitos. That’s something that’s fairly common in southern California. I think it can be worse in other parts of the country. Mosquitos are definitely an issue, particularly in the summer. I think it’s a good idea to use mosquito repellant. That goes for all insects. I think the current recommendation would be to use a mosquito repellant tr an insect repellant that has DEET in it, D-E-E-T. I think that is something that’s going to work the best to keep those insects off of you. You want to stay covered if you're outside in the evening hours. There are some diseases that are transmissible by mosquitos and we kind of want to avoid our community or our patients or our family members getting exposed to those diseases.

Melanie: Now let’s back up to the snakes for just a minute Dr. Lawrence. You mentioned if you are gardening. What if one does bite you? Let’s first assume it’s not a rattler. So, if a normal snake, a garden snake, whatever bites you, what do you do about it? And if, god forbid, it is a rattlesnake, then what? What do you do?

Dr. Lawrence: So that’s a great question. So, again, the rattlesnake is the only poisonous snake. So, if a gopher or some other smaller snake bites you, you're going to have the issue of a puncture wound. So that is a wound. You're going to want to make sure that you're up to date with your tetanus immunization and you may want to go in and get seen for that. Certainly, a rattlesnake. That is an emergency. So, rattlesnakes can have what’s called a dry bite. So that’s a time when a rattlesnake will bite you and they're able to withhold their venom. So, they're just trying to tell you, “Hey, get away. Please don’t bother me. I don’t want anything to do with you and you shouldn’t want anything to do with me.” They just kind of nip at you. They’ll puncture you, but they won't necessarily envenomate you. These dry bites will look like any other snake bite. There will be puncture wounds.

What we’re really concerned about is the envenomation. So, if these rattlesnakes do envenomate you, you’ll start seeing some tingling and some swelling in that area. Sometimes some discomfort. Generally, some discomfort. The swelling is the first thing you probably will notice. It’s really important that you get to seek medical help as quickly as possible. Mostly because the medication we use to treat this envenomation, CroFab, takes quite a while for us to mix up once you get to the emergency department. We need to see you, evaluate you, which we do very quickly. We’ll take a very quick look at you and recognize right away that this is a rattlesnake bite, but that medication takes a little bit of time to mix up. We want to get that onboard as quickly as possible. Definitely a good idea that if you get bitten by a snake, even if you don’t know if it’s a rattlesnake or not. Or you're not sure even if it was a rattlesnake, even if you’ve been envenomated, I think it’s a great idea to head in the direction of your closest emergency department. Particularly if you’re out in the wilderness or up on a hike somewhere far away to start heading in the right direction to get towards medical help.

Melanie: What about ticks Dr. Lawrence? People hear about Lyme disease and how hard it is to treat once you do get it. People don’t know how to remove a tick and they're not quite sure about the head being left in. It’s the same for animals as it would be for people. So, what do you tell people about removing ticks and what they should do if they do find one in? Is this something you go to the doctor about to get checked for Lyme disease right away.

Dr. Lawrence: So, it’s a great question. So, in some parts of the country, Lyme disease is very prevalent. Particularly on the east coast area. Not quite such an issue for us in southern California, although there are some spotty cases of Lyme disease. So, it’s not as though we live in a community or a part of the country where Lyme disease does not exist. There are cases of Lyme disease, although they are very rare. So, the likelihood of you contracting Lyme disease from a tick bite is fairly low, but it’s out there. So, it’s something to be considered.

So, this is what I would tell you. If you’re in area where you could have a tick exposure, which we certainly do have ticks here. Those would be grassy areas, brushy areas, areas with branches. You’d want to definitely do a tick check when you get home. So, a tick check would be to check areas where the ticks might nestle up and start doing their thing where they’re going to start feeding, right? They're going to bury their head in and start sucking blood. Which sounds disgusting, but it’s just how they live. So, you want to check in and around the hair areas, in and around the ears, under your arms, bellybutton, waist, between your legs, and in the backs of the knees and around the ankles. Those kinds of places.

If you do find a tick, you definitely want to get it out as quickly as possible. So, you not want to let a tick stay in any longer than it needs to be. So, there are lots of kind of internet remedies of putting fire near it or covering it with oil. I would be resistant to try those things. I think the best idea to take with really fine tweezers and try to slowly, gradually remove the tick by placing the tweezers as close to the skin or as close to the head as possible. Ideally grabbing the head if you can, and without twisting, slowing and gently in the direction is into the skin just pull it backwards and try to remove that tick. Sometimes you may lose the head. Sometimes the head may come out, in which case you may want to seek medical attention to get that head removed. A lot of times, and I've removed a fair amount of ticks in the emergency department, the head comes out just fine. It’s just a matter of applying constant pressure.

Then the concern of Lyme disease, in the very early exposure stages, really this can be treated with a single dose of an antibiotic essentially. So, if there is a concern, or you're concerned about it as a parent or a patient, you can certainly talk to a medical professional about some advice of the overall risk of Lyme disease exposure versus the risk of the antibiotic. Sometimes that’s a reasonable conversation to have.

Melanie: What about bee stings? I mean if you're not allergic to bees, is there a problem if you get stung by one? There’s some old wives’ myths about things that you can do. Baking soda and water make that paste. Is there anything really that we can do if we get stung by a bee? How do you know, if it’s your child, and they get stung by a bee if they’ve never been stung before, what are you looking for to see if they happen to be allergic?

Dr. Lawrence: You know, bee stings are pretty uncomfortable obviously. A couple of things straight out of the gate regardless of if you're allergic or not, it would be a good idea to remove the stinger. You know that stinger with a bee usually has a little sack that has the venom in it where it envenomates you. You’d want to remove that. A really good way to remove that stinger: you don’t want to grab the sack with tweezers because that would just squeeze the rest of the venom in. So, what works really well I find is if you drag a credit card backwards as though against where the sting occurred, you can actually usually pull the stinger out using a credit card, just dragging it against the skin.

Then what you want to look out for, most everyone’s gonna get a localized reaction. You're gonna get some swelling, you're gonna get some redness. In someone who’s allergic, they're going to have more of a systemic reaction. Meaning a reaction throughout their entire body. So, you want to look for other areas of swelling or other areas of rash. Particularly swelling around the face, lips, and the mouth. Those kinds of things. Those would be concerning and maybe potentially a sign of a significant allergic reaction that would warrant further medical attention.

Most people who aren’t allergic to bees, when they get stung, they're going to have a localized reaction with some discomfort. You might want to treat that with some anti-inflammatory medication. Like some Motrin or Tylenol even. Then some ice on the affected area. Then you want to keep a close eye out for infection over the next three of four days, even up to two days. What happens is sometimes there is some bacteria that is on that stinger and it can be deposited underneath the skin. You can actually get a little bit of a skin infection in that area. So that’s something to look out for. If you did develop that or you were concerned about that developing, you can always talk to your physician about getting that looked at.

Melanie: Dr. Lawrence, wrap it up for us with your best advice about those little buggers that are everywhere: mosquitos, ticks, snakes, bees, all kinds and manner of crawling things. As an emergency room physician, what do you want listeners to take away from this segment today about protecting themselves and what to do if something does happen? If they're out hiking and something does happen to them.

Dr. Lawrence: I think you need to enjoy the outdoors. I think you need to be aware. I think you need to be prepared. So certainly, if you're someone who’s allergic to bees, you need to be carrying allergy medication with you if you're on a long hike or you're away from medical attention. For the general person who’s not allergic to these animals, or these insects rather, I would say that you should use insect repellent. You should wear clothing that’s going to protect you from ticks and those kinds of things, particularly if you're hiking. Try to hike in the middle of the trail. Don’t go walking near the sides of the trails where you're brushing up against the grass and the little trees and those kinds of structures where the ticks like to hang out and get on you. You want to be cognizant of mosquitos. Certainly, be aware of your environment when it comes to snakes. Be careful where you step. Keep an ear out for rattles.

I think that if you’re aware of your surroundings and use insect repellent, you dress appropriately. Certainly, after you go out on a hike in the outdoors or even in your backyard because there are ticks in your backyard if you have a very wooded backyard. Have someone like a family member or even yourself do a tick check. Try and do your best to make sure you don’t have a tick because they can be very challenging to find sometimes. Generally speaking, California, thankfully, we don’t have as many issues as some other areas of the country do. I think for the most part I would be very cautious about rattlesnakes. I think most of our community is pretty savvy to that. So, it’s just mostly about awareness.

Melanie: That’s great information. So important for people to hear as we do want people to get outside and enjoy the outdoors. Those are great things to be aware of and precautions to take. Thank you, Dr. Lawrence, for being with us today. You're listening to It’s Your Health Radio with Henry Mayo Newhall Hospital. For more information, please visit henrymayo.com. That’s henrymayo.com. This is Melanie Cole. Thanks so much for tuning in.