What to tell your patients

A midsummer night's itch

There's a lot more in Canada's wilderness than just bears

By Anna Byk

Every summer weekend the McIntyres venture out to cottage country to bask in the surrounding nature. With those treks into Canada's wild come a variety of bug bites, rashes and even the occasional earache. This year, Mrs McIntyre is determined not to get caught unprepared by nature's assault.

It's likely that a good number of your patients will also want to gear up before their summer vacations. So, here are some tips on how they can deal with those summer aches and itches.

WHAT TO TELL YOUR PATIENTS ABOUT THE SIDE EFFECTS OF SUMMER
Poison Ivy/Oak It's something many of those outdoor types can spot from a mile away, but for many city slickers poison ivy is just another five-leafed plant. Other than an obvious rash, patients should look out for blisters and pimple-like red bumps. If they wash the area within 10 minutes of first contact they might be able to prevent the rash and some of the other symptoms. In the event that the patient does break out, there are a few options to help cut down on the scratching. "The zinc in calamine lotion isn't the greatest way of controlling the itch," says Dr Gordon Searles, an Edmonton dermatologist. "Short-acting antihistamines do a good job and the average 1% hydrocortisone cream may help." For more violent reactions Dr Searles suggests that you instruct patients to get to the closest MD for prescription-strength steroid cream or an oral steroid, like prednisone.

Bee stings Unlike other insects, bees actually leave their venomous stinger behind when they go in for the kill. Patients should try to remove the stinger ? either by using a fingernail or credit card edge to scrape it off. "If they leave the stinger in it can get infected," warns Dr Searles. Tweezers are a no-no, and actually causes the release of more venom. If the stinger is embedded below the surface, patients should stop by a doctor's office to have it taken out. As for pain and itching, regular acetaminophens and antihistamines do the trick. The one thing that could be a cause for concern is anaphylactic shock. About 1% of children and 3% of adults are allergic to bee stings. Those who've never been stung may not know the severity of their allergy. Anaphylaxis usually kicks in 20 minutes to two hours after a bite. If symptoms develop patients should call 9-1-1.

Swimmer's ear Kids are naturally drawn to water and it's sometimes near impossible to get them out of the local pool or lake. So it's no surprise that some of them turn up at the local clinic with otitis externa. Parents should be forewarned that this type of earache rarely needs antibiotic treatment. The local doc may remove any drainage or pus but a prescription for antifungal eardrops is usually the standard.

Swimmer's itch Another side effect of those lazy days in the water is swimmer's itch. Like poison ivy this rash is a reaction to a skin irritant, in this case, flatworm larvae. The parasites tend to thrive in warmer, shallower waters. Dr Searles explains that it takes the parasites about 20 minutes to get under the skin. He adds, "If the skin is wet they won't penetrate and get in." The larvae sit on the skin's wet surface so a good rub down with a towel once out of the water can get rid of them. Antihistamines, like diphenhydramine (Benadryl), will ease the itch and so will over-the-counter hydrocortisone creams.

Lyme disease Probably one of the most discernible signs of Lyme disease is its bull's eye-like rash, which can appear anywhere between three and 30 days after a tick bite. Lyme disease is rare but patients should know what to look for, especially if their vacation plans have them delving deep in the bush. If patients are heading into the backwoods, they should regularly check their skin for ticks. Should they find one, it needs to be removed carefully with tweezers. Aside from the rash, which is the first sign, people with Lyme disease have flu-like symptoms ? fever, chills, headaches, stiff neck and fatigue. If patients are experiencing these symptoms they need to see a doctor.