Have you heard about the latest medical breakthrough? It’s a miracle cure that reduces the risk of brain cancer by 52.737%! Brain Shield was recently unveiled at the Meeting of those Concerned with Brain Cancer with stunning success. But don’t take my word for it. Annie from Lodi says “What a godsend. This treatment changed my life.” Annie has been using Brain Shield for 13 months and guess what, no brain cancer. Brain (CT) scans have confirmed that Annie is cancer-free. Interested in reducing your risk of cancer? Call 1-878-4-SHIELD.
Sound suspicious? Well, it should, because it’s completely bogus. I’m certain most of you weren’t fooled. But, did you pick up on the specific clues that Brain Shield story is full of bull#$%*? There are a number of them. By discussing each red flag, I hope to provide some tips for cutting through the hype in the medical media. Your health is of the ultimate importance and the quality of the medical news you heed (or ignore) is critical. So, here’s how to discern the valid from the bull #$&*. I thank the Association of Health Care Journalists (AHCJ) for providing the basic principles to work from.
Red Flag #1: Language. Be wary of health reporting that utilizes sensationalistic language. I am not sure that “miracle cures” actually exist, but if they do, they are rare. Antibiotics might qualify. A (hypothetical) treatment to reduce the risk of brain cancer by 53% certainly does not. The vast majority of “breakthrough” treatments and “dramatic” findings are nothing of the sort. Similarly, phrases like “deadly diseases” and “sweeping epidemics” are used to sell media, not to properly inform.
Red Flag #2: The anecdote. Testimonials may be useful in painting a vivid and personal picture of a disease or treatment but anyone who extrapolates the experiences of a handful of people to larger groups is taking a leap of faith. The AHCJ cautions health journalists to avoid the “tyranny of the anecdote,” particularly when the anecdote contradicts the sum of available evidence. An excellent example is the long hyped (and many times disproven) link between vaccines and autism. Causality is difficult to establish and a series of heart-breaking stories about children who developed autism not long after receiving immunizations does not establish a link and absolutely contradicts the vast evidence exonerating vaccines as a causal agent. Similarly, absent more information, readers should not be impressed by the “remarkable story” of Annie from Lodi.
Red Flag #3: Lack of peer review. The peer-review process in the scientific community is far from perfect, and plenty of junk slips through its cracks and into the medical literature. Andrew Wakefield’s seminal publication about the MMR vaccine and autism has become a classic example. But nonetheless, peer-review is a rigorous process – and one that (mostly) discourages researchers from publishing poorly conceived or managed research. Thus, you should put far more trust in medical evidence presented in a peer-reviewed journal (such as the New England Journal of Medicine) than preliminary results that appear in the mass media or at a scientific conference. Research presentations at conferences have not been vetted in the same manner as studies that make it to print in journals. The Meeting of those Concerned with Brain Cancer sounds like a worthwhile gathering, but should not be taken as the definitive source for information about preventing brain tumors.
Red Flag #4: Lack of perspective. There is a lot of nuance involved in interpreting the numerical significance of medical research. A 52.737% reduction in the risk of brain cancer sounds fantastic until you consider that brain cancer is an extremely rare condition (about 6 cases per 100,000 people). Think about it in terms of the value of your home – a 53% reduction in value is profound if the starting value is high. But what if your house isn’t worth squat (let’s say $100) to begin with? Then a 53% difference is no longer a big deal. Similarly, a 53% reduction in the number of cases of a common medical condition is big news, but a 53% reduction in cases of a rare condition is less newsworthy. Journalists can put this into perspective by giving data about statistical significance (the benchmark as to whether an observation is likely to have occurred randomly or is likely related to an exposure) or – for medical therapies – the number-needed-to-treat. For example, our hypothetical Brain Shield would need to be used in nearly 200,000 people in order to prevent a single brain cancer. When you consider this, you also realize the use of extra decimal points (52.737%) is another red flag. Those extra decimal points are purely for show – a means of making the results seem more robust than they actually are. Genuine data does not require three decimal places – none or one is usually sufficient. Watch out for numbers with drawn out decimals.
Red Flag #5: Too good to be true. No medical treatment is without risk. This is even true of treatments involving basic life substrates such as oxygen, water and salt. Too much of any of these things can be harmful. Thus, any discussion of a medical treatment must mention its risks. The very rough estimate of lifetime risk of cancer caused by a CT scan of the head is one in 2000 – thus Annie from Lodi has actually increased her brain cancer risk by attempting to confirm that her anti-brain cancer treatment is working. Silly Annie.
So, next time you read “stunning” health headlines or stay up for the 11 o’clock news to learn about the latest epidemic sweeping the area, keep these red flags in mind. If you encounter any, tune out, go to bed, and find a different (better) source in the morning. Or if you’re not sure, you can follow the advice of my buddy (and frequent contributor) Dr. Clark Hinderleider and “investigate the reliability of the outlet from which the content is received by using a 'fact-check' source such as HealthNewsReview.org." Whatever you do, I wouldn’t rely on Annie’s advice.
Saturday, August 7, 2010
Can you handle the hype? (Marin IJ)
Flesh-eating bacteria, super-viruses, killer E-coli...Bird flu, swine flu, equine flu… Toxic mold, toxic shock, toxic toys, toxic Tylenol…Salmonella in your peanut butter, heavy metals in your salmon…Cancer from phthalates, tumors from your phone…Autism and vaccines, pertussis and vaccines (lack thereof). The media spits out an endless series of scary health stories, many sensationalized for effect. You’re all familiar with these pieces. I feel downright accosted by some of the headlines: “The toxic mold and the hidden room: a homeowner's nightmare,” (abcnews.go.com), or “The deadly ‘superbug’ that's spreading fast across the country,” (Ophrah.com) and “Talk & die syndrome more common that you think” (cnn.com).
With the frenetic heat of media hyperbole, it’s hard to know which health hazards to be concerned about and which to put on the back burner of the worry stove. Not surprisingly, the public is often confused about health matters, and I really believe the media bears a heavy burden of responsibility for this. Medical reporting suffers from a number of ailments, including outbreaks of misinformation, deficits in understanding and context, and, often, a rush to pronounce conclusions.
Take, for example, two stories that sparked a substantial panic this past year. One was the unfortunate death of Natasha Richardson from a seemingly minor head injury and the other was the Food and Drug Administration’s (FDA’s) warning about liver damage due to excessive doses of acetaminophen (Tylenol).
Richardson’s tragic death from an epidural hematoma (bleeding on and around the brain) after falling on a beginner ski slope received widespread media attention, including in this column. The scope of the reporting was varied and from a public health perspective had some beneficial impact. The story reinforced the importance of wearing a helmet during high-risk sports such as biking, skateboarding, and (at least for beginners) skiing. On the flip side, some reports were alarmist and others were dangerously inaccurate. For example, I read an on-line article claiming that clot-busting drugs could have successfully treated Richardson’s brain injury. In actual fact, giving clot-busters to Richardson would almost certainly have hastened her death. Another report recommended that people with head injuries visit their nearest trauma center – which is a good idea for someone who has taken a header off the roof – but not necessary for most minor head impacts. And finally, a rather hysterical blog advised that all patients with head trauma be screened with a CT scan of the head. These and other alarmist stories, such as a Good Morning America feature on a young girl who sustained an epidural hematoma after she was struck with a softball, sent thousands of people to EDs to be checked out for trivial head injuries.
Dr. Brian Walsh from Morristown, New Jersey and colleagues quantified this effect by comparing the number of ED visits for head injury related complaints before and after Natasha Richardson’s death. They discovered that the total number of visits in the ten days after the actress’ death was 73% higher than the number of visits in the ten days prior, while the sum of serious injuries was unchanged. In other words, there was a huge surge in patients with minor head bonks who visited the ED to get checked out. This, of course, is what emergency departments are for, but nonetheless the media let these people down by failing to adequately stress the (well-established) warning signs of serious head injury (such as severe headache and repeated vomiting) and the potential risk of obtaining an unnecessary CT (radiation exposure that is thought to increase lifetime risks for cancer, especially in children). This failure to paint an accurate picture of risks and benefits is one of the five health media deficiencies identified by the American Council on Science and Health (ACSH), an advocacy group dedicated to providing sound health information to consumers.
A second deficiency, recognized by the ACSH and others, is the media’s tendency to gloss over the importance of dose, often altogether ignoring the maxim "the dose makes the poison." An excellent example of this is the media coverage after an FDA advisory panel warned that excessive doses of acetaminophen (Tylenol) could cause liver damage and failure. This statement was intended to raise awareness of the danger of cumulative doses of Tylenol. Truly, it can be hard to keep track of the amount of acetaminophen you’re taking, as it is commonly used as a cocktail ingredient in over-the-counter cold and flu preparations as well as in prescription painkillers such as Vicodin and Percocet. Hence the warning: people taking large doses of these medications, with or without additional Tylenol, are at risk for liver damage. Increased awareness of this risk, as well as changes in physician prescribing patterns (e.g., away from combination medications like Vicodin and towards single drug prescriptions) is desirable. Unfortunately, the message that many patients received, and I heard this many times in the ED, was that Tylenol is a dangerous medication. This could not be farther from the truth – Tylenol is one of the safest pain medications at our disposal and, if used at recommended doses, has far fewer harmful side effects than alternatives such as ibuprofen or naproxen. So please remember – the dose makes the poison. Remember this in regards to Tylenol, lead in children’s toys, mercury in fish, and phthalates in milk. With most environmental or dietary exposures, “everything in moderation” should keep you healthy.
There’s more to write about on the topic of the media and health, and three more ACSH identified deficiencies to cover. But since this column is running out of space and I do not want to violate any principles of responsible health reporting, I will pick up the topic in a couple weeks. In that column, I’ll give tips on how you can become a discerning reader of health news so you can decide for yourself which “scares” to freak out about and which to just forget.
With the frenetic heat of media hyperbole, it’s hard to know which health hazards to be concerned about and which to put on the back burner of the worry stove. Not surprisingly, the public is often confused about health matters, and I really believe the media bears a heavy burden of responsibility for this. Medical reporting suffers from a number of ailments, including outbreaks of misinformation, deficits in understanding and context, and, often, a rush to pronounce conclusions.
Take, for example, two stories that sparked a substantial panic this past year. One was the unfortunate death of Natasha Richardson from a seemingly minor head injury and the other was the Food and Drug Administration’s (FDA’s) warning about liver damage due to excessive doses of acetaminophen (Tylenol).
Richardson’s tragic death from an epidural hematoma (bleeding on and around the brain) after falling on a beginner ski slope received widespread media attention, including in this column. The scope of the reporting was varied and from a public health perspective had some beneficial impact. The story reinforced the importance of wearing a helmet during high-risk sports such as biking, skateboarding, and (at least for beginners) skiing. On the flip side, some reports were alarmist and others were dangerously inaccurate. For example, I read an on-line article claiming that clot-busting drugs could have successfully treated Richardson’s brain injury. In actual fact, giving clot-busters to Richardson would almost certainly have hastened her death. Another report recommended that people with head injuries visit their nearest trauma center – which is a good idea for someone who has taken a header off the roof – but not necessary for most minor head impacts. And finally, a rather hysterical blog advised that all patients with head trauma be screened with a CT scan of the head. These and other alarmist stories, such as a Good Morning America feature on a young girl who sustained an epidural hematoma after she was struck with a softball, sent thousands of people to EDs to be checked out for trivial head injuries.
Dr. Brian Walsh from Morristown, New Jersey and colleagues quantified this effect by comparing the number of ED visits for head injury related complaints before and after Natasha Richardson’s death. They discovered that the total number of visits in the ten days after the actress’ death was 73% higher than the number of visits in the ten days prior, while the sum of serious injuries was unchanged. In other words, there was a huge surge in patients with minor head bonks who visited the ED to get checked out. This, of course, is what emergency departments are for, but nonetheless the media let these people down by failing to adequately stress the (well-established) warning signs of serious head injury (such as severe headache and repeated vomiting) and the potential risk of obtaining an unnecessary CT (radiation exposure that is thought to increase lifetime risks for cancer, especially in children). This failure to paint an accurate picture of risks and benefits is one of the five health media deficiencies identified by the American Council on Science and Health (ACSH), an advocacy group dedicated to providing sound health information to consumers.
A second deficiency, recognized by the ACSH and others, is the media’s tendency to gloss over the importance of dose, often altogether ignoring the maxim "the dose makes the poison." An excellent example of this is the media coverage after an FDA advisory panel warned that excessive doses of acetaminophen (Tylenol) could cause liver damage and failure. This statement was intended to raise awareness of the danger of cumulative doses of Tylenol. Truly, it can be hard to keep track of the amount of acetaminophen you’re taking, as it is commonly used as a cocktail ingredient in over-the-counter cold and flu preparations as well as in prescription painkillers such as Vicodin and Percocet. Hence the warning: people taking large doses of these medications, with or without additional Tylenol, are at risk for liver damage. Increased awareness of this risk, as well as changes in physician prescribing patterns (e.g., away from combination medications like Vicodin and towards single drug prescriptions) is desirable. Unfortunately, the message that many patients received, and I heard this many times in the ED, was that Tylenol is a dangerous medication. This could not be farther from the truth – Tylenol is one of the safest pain medications at our disposal and, if used at recommended doses, has far fewer harmful side effects than alternatives such as ibuprofen or naproxen. So please remember – the dose makes the poison. Remember this in regards to Tylenol, lead in children’s toys, mercury in fish, and phthalates in milk. With most environmental or dietary exposures, “everything in moderation” should keep you healthy.
There’s more to write about on the topic of the media and health, and three more ACSH identified deficiencies to cover. But since this column is running out of space and I do not want to violate any principles of responsible health reporting, I will pick up the topic in a couple weeks. In that column, I’ll give tips on how you can become a discerning reader of health news so you can decide for yourself which “scares” to freak out about and which to just forget.
Have you done your neurobics today? (Marin IJ)
There’s a woman at my gym who walks on the treadmill. Backwards. Why the heck does she do that? Not because the view is better and not in protest of the television that sits atop the machinery. Not to keep the wear on her sneakers even or to draw attention to herself (although she accomplishes both.) No, she walks backwards for the neurobic benefit. That’s right, neurobics – aerobics for the brain. And while walking backwards on a treadmill may not be a particularly safe exercise, the basic concept behind it is interesting.
The term “neurobics” was first introduced by neurobiologist Lawrence C. Katz about ten years ago along with the hypothesis that mental exercises, especially those that tax the brain in novel ways, can stimulate the growth of new dendrites and neurons. The theory is that most people perform many actions by routine – the processes are hard-wired by repetition into the brain’s mainframe. Routines like how you tie your shoes or answer the phone or walk on the treadmill are performed with little conscious thought. By switching things up and challenging your brain to orchestrate tasks or thoughts in different ways, you may be able to improve the cognitive (aka thinking) function of your brain.
Intrigued? You’re in luck. Dr. Katz, in collaboration with Manning Rubin, has written Keep Your Brain Alive – a book describing 83 neurobic maneuvers (“cross-training for the brain”) for people over the age of forty. The drills, which are designed to fit into your daily routine, include writing or brushing your teeth with your non-dominant hand and starting the ignition of your car with eyes closed (please remember to open them before you start driving). These are simple changes, not the New York Times crossword or advanced Sudoku, but Katz and others are convinced there is a benefit. But you probably don’t need a new book to teach you neurobics – how about using nothing but facial expressions to communicate during dinner, typing an e-mail without looking at the keyboard, or walking backwards on the treadmill?
Is there any solid evidence that neurobics help cognition? When I recently perused the medical literature I didn’t find much evidence supporting the specific practice of neurobics. This doesn’t mean, of course, that neurobics aren’t valuable; it just means that they haven’t been adequately studied.
Research has shown, however, that “cognitive engagement,” such as regular reading, learning a musical instrument or playing card games, is associated with decreased risk of cognitive decline and Alzheimer’s dementia. (This from an exhaustive NIH review prepared by scientists at the Duke Evidence-based Practice Center.) Physical activity also seems to have a benefit. A recent article in Clinics in Geriatric Medicine reviewed dozens of studies on the topic, many of which enrolled thousands of participants. The bottom line, according to the authors: “Increasing evidence suggests than an active life has a protective effect on brain functioning in the elderly population,” however no quality study to date “has shown that regular physical activity prevents dementia.”
With the U.S. population aging – over 70 million Americans will turn 65 in the next two decades – brain health is sure to become a major priority for physician and scientists. If we can keep this population active and productive well past the age of Social Security, there will be major benefits for individuals and society.
I asked a neurologist friend what he thought about improving brain health. Neurobics – well, he’d never heard of them. Physical activity and plenty of Vitamin D – good ideas for anyone of any age. Antioxidants in the diet to neutralize free radicals? Absolutely. “Tell your readers,” he told me “to eat blueberries.” A tasty thought, but I wouldn’t suggest eating them while walking backwards on a treadmill.
The term “neurobics” was first introduced by neurobiologist Lawrence C. Katz about ten years ago along with the hypothesis that mental exercises, especially those that tax the brain in novel ways, can stimulate the growth of new dendrites and neurons. The theory is that most people perform many actions by routine – the processes are hard-wired by repetition into the brain’s mainframe. Routines like how you tie your shoes or answer the phone or walk on the treadmill are performed with little conscious thought. By switching things up and challenging your brain to orchestrate tasks or thoughts in different ways, you may be able to improve the cognitive (aka thinking) function of your brain.
Intrigued? You’re in luck. Dr. Katz, in collaboration with Manning Rubin, has written Keep Your Brain Alive – a book describing 83 neurobic maneuvers (“cross-training for the brain”) for people over the age of forty. The drills, which are designed to fit into your daily routine, include writing or brushing your teeth with your non-dominant hand and starting the ignition of your car with eyes closed (please remember to open them before you start driving). These are simple changes, not the New York Times crossword or advanced Sudoku, but Katz and others are convinced there is a benefit. But you probably don’t need a new book to teach you neurobics – how about using nothing but facial expressions to communicate during dinner, typing an e-mail without looking at the keyboard, or walking backwards on the treadmill?
Is there any solid evidence that neurobics help cognition? When I recently perused the medical literature I didn’t find much evidence supporting the specific practice of neurobics. This doesn’t mean, of course, that neurobics aren’t valuable; it just means that they haven’t been adequately studied.
Research has shown, however, that “cognitive engagement,” such as regular reading, learning a musical instrument or playing card games, is associated with decreased risk of cognitive decline and Alzheimer’s dementia. (This from an exhaustive NIH review prepared by scientists at the Duke Evidence-based Practice Center.) Physical activity also seems to have a benefit. A recent article in Clinics in Geriatric Medicine reviewed dozens of studies on the topic, many of which enrolled thousands of participants. The bottom line, according to the authors: “Increasing evidence suggests than an active life has a protective effect on brain functioning in the elderly population,” however no quality study to date “has shown that regular physical activity prevents dementia.”
With the U.S. population aging – over 70 million Americans will turn 65 in the next two decades – brain health is sure to become a major priority for physician and scientists. If we can keep this population active and productive well past the age of Social Security, there will be major benefits for individuals and society.
I asked a neurologist friend what he thought about improving brain health. Neurobics – well, he’d never heard of them. Physical activity and plenty of Vitamin D – good ideas for anyone of any age. Antioxidants in the diet to neutralize free radicals? Absolutely. “Tell your readers,” he told me “to eat blueberries.” A tasty thought, but I wouldn’t suggest eating them while walking backwards on a treadmill.
Flop-Roll-and-Face-itis (Marin IJ)
For the last few weeks, each dawn has awakened with the planet’s greatest team competition on television with vuvuzela horns as a brain-buzzing soundtrack.
As a fan, this World Cup has been thrilling to watch. As a physician, however, I’ve found it puzzling. Each morning, I witness an epidemic of a peculiar type of injury. Soccer players, some of the fittest of all athletes, fall to the ground after the slightest hint of contact – and proceed to roll around, hands clamped to their faces as is they’re mourning the death of a loved one. These men are stricken, horribly, for seconds to minutes at a time, and then bounce back to their feet as if nothing has happened. It’s odd actually, and I must admit that my Emergency Department (ED) experience hasn’t given me a clue as to what this mysterious soccer affliction (shall we call it “flop-roll-and-face-itis”) might be.
People with kidney stones will often rock back and forth in misery, unable to find a comfortable position. Patients with migraines frequently hold their hands to their faces, to shield their eyes from the light. Narcotic abusers may shift dramatically from a pose of comfort to one of excruciating distress when they realize they are being watched. But, in terms of traumatic injury, these soccer-induced spells are original. Take the Brazil-Portugal game, a defensive struggle that ended in a 0-0 tie. In this game, between two elite teams, there were more stricken players then quality shots on goal. For example… a Portuguese player feels a soft hand to his back and is launched onto the ground, arms splayed, emulating Dicaprio in The Titanic. His head rests on the ground for a moment and then he rolls to his back, his hands go to his face, he flexes his knees and rotates back and forth on the turf. What is hurt? Is it his head? Is it his Achilles tendon? The referee runs in with a yellow card for the Brazilian who touched him, and suddenly the Portuguese player is cured. He pops up, ready for another run on goal. Later, a Brazilian takes cleats to the heel and falls to the ground, clenching both ankles with his hands, and rolls, 1, 2, 3, 4, 5 times! What an odd injury this is! The announcer, a Brit, dryly takes note; “If you roll around a lot you are not as hurt as if you are lying still, in real pain.”
Could it be that these players are faking their injuries? I asked Dr. Joseph Centeno, an orthopedic surgeon and sports medicine specialist at Kaiser-Permanente. "Let's put it this way,” he replied, “I've never had to operate on a flopper." Next, I talked to my brother, Chris Ballard, a writer for Sports Illustrated who covers the NBA. Had he ever seen this type of injury in the sport of basketball? “Only on rare occasions,” he said, “and strangely enough it seems to only afflict European or South American players such as Vlade Divac or Manu Ginobili.”
But, all ridiculous theater aside, I should note that serious injuries do occur in the game of soccer. Many stars, including Ballack of Germany, Essien of Ghana, and Beckham of England, are sitting out the World Cup with physical ailments. And here in the U.S., as soccer gains greater popularity as a youth sport, thousands of kids are suffering knee, ankle, face, and head injuries. Each year, approximately 75,000 children ages five to 14 are treated in EDs for soccer-related injuries – more than the number of visits due to gymnastics, ice hockey and skiing injuries combined. Of these, many are knee injuries, particularly anterior cruciate ligament (ACL) tears. The ACL tear is a serious impairment that usually requires surgery and extended rehab, so it is worth taking note that the risk of this injury can be minimized by reducing the yearly load of play (in other words, taking some time off) and employing structured warm-up before play.
Of greater concern, however, are soccer-related head injuries – as even minor ones can have cumulative consequences. Head trauma, of course, is a problem in many sports, but soccer players are exposed in a rather unique manner because they are trained to repeatedly strike a rapidly moving ball with their unhelmeted craniums. A Canadian study, recently published in the journal Injury, found that 15% of soccer-related ED visits were for head injuries, of which 11% (of these) were concussions. Another Canadian study found that a disturbingly high number of youngsters (age 12-17) playing team soccer had evidence of concussion (over 50%) and that this percentage was significantly lower in those wearing protective headgear. A third study, published in the journal Neurosurgery, found decreased neuropsychological scores and reaction times in professional soccer players who had suffered a head injury the day before – even when these players claimed they did not feel any ill effects.
So, does any of this help explain the puzzling frequency of dramatic injuries at this year’s World Cup? I think it does. Some of these players, it seems, are damaged by years of forceful headers and contested corners. And thus, they have developed the deluded judgment that turf flopping is an acceptable strategic play (and one that the referee and the public won’t notice). From a purely clinical standpoint, they are wrong. The intent of flop-roll-and-face-itis may be difficult for a referee to recognize in real time, but with a remote control and a little clinical perspective, it’s a remarkably easy diagnosis.
As a fan, this World Cup has been thrilling to watch. As a physician, however, I’ve found it puzzling. Each morning, I witness an epidemic of a peculiar type of injury. Soccer players, some of the fittest of all athletes, fall to the ground after the slightest hint of contact – and proceed to roll around, hands clamped to their faces as is they’re mourning the death of a loved one. These men are stricken, horribly, for seconds to minutes at a time, and then bounce back to their feet as if nothing has happened. It’s odd actually, and I must admit that my Emergency Department (ED) experience hasn’t given me a clue as to what this mysterious soccer affliction (shall we call it “flop-roll-and-face-itis”) might be.
People with kidney stones will often rock back and forth in misery, unable to find a comfortable position. Patients with migraines frequently hold their hands to their faces, to shield their eyes from the light. Narcotic abusers may shift dramatically from a pose of comfort to one of excruciating distress when they realize they are being watched. But, in terms of traumatic injury, these soccer-induced spells are original. Take the Brazil-Portugal game, a defensive struggle that ended in a 0-0 tie. In this game, between two elite teams, there were more stricken players then quality shots on goal. For example… a Portuguese player feels a soft hand to his back and is launched onto the ground, arms splayed, emulating Dicaprio in The Titanic. His head rests on the ground for a moment and then he rolls to his back, his hands go to his face, he flexes his knees and rotates back and forth on the turf. What is hurt? Is it his head? Is it his Achilles tendon? The referee runs in with a yellow card for the Brazilian who touched him, and suddenly the Portuguese player is cured. He pops up, ready for another run on goal. Later, a Brazilian takes cleats to the heel and falls to the ground, clenching both ankles with his hands, and rolls, 1, 2, 3, 4, 5 times! What an odd injury this is! The announcer, a Brit, dryly takes note; “If you roll around a lot you are not as hurt as if you are lying still, in real pain.”
Could it be that these players are faking their injuries? I asked Dr. Joseph Centeno, an orthopedic surgeon and sports medicine specialist at Kaiser-Permanente. "Let's put it this way,” he replied, “I've never had to operate on a flopper." Next, I talked to my brother, Chris Ballard, a writer for Sports Illustrated who covers the NBA. Had he ever seen this type of injury in the sport of basketball? “Only on rare occasions,” he said, “and strangely enough it seems to only afflict European or South American players such as Vlade Divac or Manu Ginobili.”
But, all ridiculous theater aside, I should note that serious injuries do occur in the game of soccer. Many stars, including Ballack of Germany, Essien of Ghana, and Beckham of England, are sitting out the World Cup with physical ailments. And here in the U.S., as soccer gains greater popularity as a youth sport, thousands of kids are suffering knee, ankle, face, and head injuries. Each year, approximately 75,000 children ages five to 14 are treated in EDs for soccer-related injuries – more than the number of visits due to gymnastics, ice hockey and skiing injuries combined. Of these, many are knee injuries, particularly anterior cruciate ligament (ACL) tears. The ACL tear is a serious impairment that usually requires surgery and extended rehab, so it is worth taking note that the risk of this injury can be minimized by reducing the yearly load of play (in other words, taking some time off) and employing structured warm-up before play.
Of greater concern, however, are soccer-related head injuries – as even minor ones can have cumulative consequences. Head trauma, of course, is a problem in many sports, but soccer players are exposed in a rather unique manner because they are trained to repeatedly strike a rapidly moving ball with their unhelmeted craniums. A Canadian study, recently published in the journal Injury, found that 15% of soccer-related ED visits were for head injuries, of which 11% (of these) were concussions. Another Canadian study found that a disturbingly high number of youngsters (age 12-17) playing team soccer had evidence of concussion (over 50%) and that this percentage was significantly lower in those wearing protective headgear. A third study, published in the journal Neurosurgery, found decreased neuropsychological scores and reaction times in professional soccer players who had suffered a head injury the day before – even when these players claimed they did not feel any ill effects.
So, does any of this help explain the puzzling frequency of dramatic injuries at this year’s World Cup? I think it does. Some of these players, it seems, are damaged by years of forceful headers and contested corners. And thus, they have developed the deluded judgment that turf flopping is an acceptable strategic play (and one that the referee and the public won’t notice). From a purely clinical standpoint, they are wrong. The intent of flop-roll-and-face-itis may be difficult for a referee to recognize in real time, but with a remote control and a little clinical perspective, it’s a remarkably easy diagnosis.
Tuesday, May 11, 2010
Wear Insoles (Marin IJ)
My Sunday hoops game is a testament to the limitations of the human body – athletic tape is more plentiful than cartilage in this crowd. But it’s also a testament to perseverance – why else would these blacktop veterans continue to play a game that takes such a toll on the body? Some of my fellow weekend warriors have asked for advice on how to prevent and recover from sports injuries. Well fellas, in the spirit of graduation season, here goes...The following commencement address on recreation-related trauma is shamelessly modeled after an old Chicago Tribune column popularly known as “Wear Sunscreen.” My aim is to provide some flecks of wisdom for readers who, like me, are graduates of their competitive prime and fully cognizant of their performance decline.
Fellow aging athletes, if I could offer you only one tip for your athletic future, a pair of shoe insoles would be it. The benefits of insoles are self-evident; well, at the very least the benefit of having feet is self-evident. And if you are going to have feet and use them for activities that make them hurt, you should try insoles. They just might help.
Now, like insoles, the rest of my advice to weekend warriors and middle-aged rec league contestants has an inconsistent basis in medical science, and is to a large degree a product of my own experience…
Enjoy the pain and hardship of your sport. Actually, that’s bull – you cannot possibly appreciate how much the pain and hardship of your sport pounds your joints into submission. But trust me, twenty years from now you will look back with an ache of nostalgia at the way you used to move.
Warm up before the game. Hopefully your P.E. teacher taught you that. And realize that stretching alone doesn’t count; calisthenics in the sauna most definitely do.
Stop and collect your gear. Sometimes you need the knee brace. Sometimes you need the ankle wrap. The risk of re-injury is always there, so in the end you might as well wear both.
Cross-train or cross-fit. Even if you prefer not to. The best way to limit the repetitive strain of the tennis court is to balance it with time on the yoga mat. And if you succeed in doing this, please tell me how.
Swim – it is good for you – so long as the lapping of monotony against your head doesn’t drive you crazy.
Try running barefoot. But not all the time, and definitely not on gravel. If you need convincing, pick up a copy of Born To Run.
Don’t be reckless with recovery time. Middle-aged athletes are like leftovers from the Olive Garden – not so good on the third consecutive day.
Don’t worry about taking supplements – most of them won’t help, unless they are steroids, epo or HGH, and I’m not going there. Do worry about taking over-the-counter pain-killers – they do help, at least temporarily. But realize that taking too much ibuprofen is about as good for your stomach as pounding a pint of bleach. The real troubles, though, will come from the nagging pains that you ignore, like the twinge in your calf that warns that your Achilles tendon is about to snap.
Try acetaminophen first, but please don’t exceed recommended doses – a liver is a good thing to keep. Teeth are also nice to have, so if you play a contact sport, wear a mouthguard. If you knew how much a dental implant costs (I speak from experience) you wouldn’t ignore this accessory – it is clinically proven to decrease visits to the oral surgeon.
Pay attention to your diet. Especially before and after strength work-outs. Lowfat chocolate milk is probably just as good as a protein shake, and tastes better too.
Understand that many therapies – massage therapy, hydrotherapy, even aromatherapy – may be pleasant and relieve pain but do not improve performance. If you find one that does, hold on to it, for it is precious.
Take it slow with new sports – they will make your muscles ache. Similar to facing your property tax bill, the best way to limit shock to the system is by giving yourself time to adapt.
Most lower back pain will eventually get better and, for pain alone, surgery probably won’t help. Weight loss, core muscle strength and physical therapy probably will. I like to prescribe myself daily back-rubs from my honey.
Don’t feel guilty about not wanting to move on. So what if you are playing hoops against men half your age? Some of the greatest days on the court are those when you unexpectedly feel young.
Know when to ice it (right away), know when to heat it (a couple days later), and know when to walk away (if you need to, consult Brett Favre on this one).
Maybe you run the quadruple Dipsea for kicks, maybe you power walk a few laps on the weekends. Maybe you ride Camp Tamarancho on a unicycle, or perhaps you stick to the straight and flat. Maybe you can surf Ocean Beach in tsunami, or perhaps you wait for a two-foot swell at Bolinas; whatever your passion and your skill, take care of your body and get plenty of sleep too.
Accept certain inalienable truths: All athletes will get injured and the older you are the longer the recovery. You too, will one day retire. And when you do, you may fantasize that you were as springy as Lebron or as shifty as Pele. I know I will.
Be careful with the advice you heed. But be patient with those who supply it. And realize that some physicians may be better at giving advice than following their own.
But trust me on the insoles. Occasionally, I’ll even wear them myself.
Fellow aging athletes, if I could offer you only one tip for your athletic future, a pair of shoe insoles would be it. The benefits of insoles are self-evident; well, at the very least the benefit of having feet is self-evident. And if you are going to have feet and use them for activities that make them hurt, you should try insoles. They just might help.
Now, like insoles, the rest of my advice to weekend warriors and middle-aged rec league contestants has an inconsistent basis in medical science, and is to a large degree a product of my own experience…
Enjoy the pain and hardship of your sport. Actually, that’s bull – you cannot possibly appreciate how much the pain and hardship of your sport pounds your joints into submission. But trust me, twenty years from now you will look back with an ache of nostalgia at the way you used to move.
Warm up before the game. Hopefully your P.E. teacher taught you that. And realize that stretching alone doesn’t count; calisthenics in the sauna most definitely do.
Stop and collect your gear. Sometimes you need the knee brace. Sometimes you need the ankle wrap. The risk of re-injury is always there, so in the end you might as well wear both.
Cross-train or cross-fit. Even if you prefer not to. The best way to limit the repetitive strain of the tennis court is to balance it with time on the yoga mat. And if you succeed in doing this, please tell me how.
Swim – it is good for you – so long as the lapping of monotony against your head doesn’t drive you crazy.
Try running barefoot. But not all the time, and definitely not on gravel. If you need convincing, pick up a copy of Born To Run.
Don’t be reckless with recovery time. Middle-aged athletes are like leftovers from the Olive Garden – not so good on the third consecutive day.
Don’t worry about taking supplements – most of them won’t help, unless they are steroids, epo or HGH, and I’m not going there. Do worry about taking over-the-counter pain-killers – they do help, at least temporarily. But realize that taking too much ibuprofen is about as good for your stomach as pounding a pint of bleach. The real troubles, though, will come from the nagging pains that you ignore, like the twinge in your calf that warns that your Achilles tendon is about to snap.
Try acetaminophen first, but please don’t exceed recommended doses – a liver is a good thing to keep. Teeth are also nice to have, so if you play a contact sport, wear a mouthguard. If you knew how much a dental implant costs (I speak from experience) you wouldn’t ignore this accessory – it is clinically proven to decrease visits to the oral surgeon.
Pay attention to your diet. Especially before and after strength work-outs. Lowfat chocolate milk is probably just as good as a protein shake, and tastes better too.
Understand that many therapies – massage therapy, hydrotherapy, even aromatherapy – may be pleasant and relieve pain but do not improve performance. If you find one that does, hold on to it, for it is precious.
Take it slow with new sports – they will make your muscles ache. Similar to facing your property tax bill, the best way to limit shock to the system is by giving yourself time to adapt.
Most lower back pain will eventually get better and, for pain alone, surgery probably won’t help. Weight loss, core muscle strength and physical therapy probably will. I like to prescribe myself daily back-rubs from my honey.
Don’t feel guilty about not wanting to move on. So what if you are playing hoops against men half your age? Some of the greatest days on the court are those when you unexpectedly feel young.
Know when to ice it (right away), know when to heat it (a couple days later), and know when to walk away (if you need to, consult Brett Favre on this one).
Maybe you run the quadruple Dipsea for kicks, maybe you power walk a few laps on the weekends. Maybe you ride Camp Tamarancho on a unicycle, or perhaps you stick to the straight and flat. Maybe you can surf Ocean Beach in tsunami, or perhaps you wait for a two-foot swell at Bolinas; whatever your passion and your skill, take care of your body and get plenty of sleep too.
Accept certain inalienable truths: All athletes will get injured and the older you are the longer the recovery. You too, will one day retire. And when you do, you may fantasize that you were as springy as Lebron or as shifty as Pele. I know I will.
Be careful with the advice you heed. But be patient with those who supply it. And realize that some physicians may be better at giving advice than following their own.
But trust me on the insoles. Occasionally, I’ll even wear them myself.
Friday, May 7, 2010
On Labeling (Marin IJ)
On a recent trip to Safeway, I decided to pay attention to what was in my shopping cart. Standing in the checkout line, I scanned the nutritional labels on the items I’d selected. What I found was shocking; an eight-ounce package of sliced ham is infused with over two grams of sodium (nearly a full day’s supply). A small glass of Cran-Raspberry juice drink is loaded with 28 grams of carbs. A mouthful (one ounce) of Colby-Jack cheese contains six grams of saturated fat – 30% of your fat budget for the day. And, a single serving (one cup) of the frozen potpie I’d picked out for lunch has a whopping 501 calories and 26 milligrams of cholesterol. Well, I had to put that pie into the send-back pot. While making adjustments to my cart, I decided that although nutritional labels can seem scary, they are actually quite useful.
Once home, I did some research and discovered that food labels are indeed effective. They’ve been shown to benefit public health by encouraging suppliers to offer healthier choices and by encouraging consumers to choose them. What then should we think of other health-focused labels? Labeling lead levels in children’s toys – most of us can agree that this is a good idea. Nutritional content of chain restaurant food – I know that this information might change my choices at the drive-thru. Parts per million of hemp in my t-shirt – that, is probably over-kill. And how about labeling the radiation emissions of cellular phones? Well, that depends. One of my colleagues recently told me that she wasn’t too concerned about cellphones causing brain tumors because they seemed so innocuous. I agree, cellphones seem harmless (unless they are tempting you to text and drive) and they sure are convenient, but the fact is that we don’t know what the long-term risks of heavy use really are.
As I discussed in a column last year, there is some evidence that long-standing use of cellphones increases the risk of certain types of brain cancer. Most concerning is that the impact of cellphone use on the brains of children and teenagers has not been adequately studied. Could it be that cellphone use, much like drinking anti-freeze, seems innocuous at first but turns deadly later? I, for one, am not at all sure, but have advised others to limit direct held-to-the ear cellphone use as much as possible.
Given how little we know about the long-term danger (or safety) of cellphones, it seems reasonable for consumers to ask for easy access to information about the radiation (defined as the specific absorption rate or SAR) of individual phones. This is what State Senator Mark Leno’s new bill, SB 1212, would require at the point of sale (via labeling on exterior packaging). This bill, which is similar to one endorsed by Mayor Newsom in San Francisco, is set for debate in the Environmental Quality committee on April 19th. From a discussion with Senator Leno, I learned that the rationale for labeling is twofold. First, the labeling would address the fact that there is a significant and not necessarily intuitive disparity (over four-fold) between the SARs of different cellphone brands. The Environmental Working Group (EWG) has published a list of radiation levels for over 1,000 phones on their website (www.ewg.org) and if you check it out you will notice that there is a considerable difference between the lowest SAR phone (Sanyo Katani II: 0.22-0.55 watts/kg) and the highest ones (Blackberry 8820 and others: greater than 1.5 watts/kg). Second, the labeling would help to raise consumer awareness of the potential risks of what is a very common and yet modifiable exposure. Says Renée Sharp, Director of the California Office of the EWG; “We see this as a very nominal, basic step so that people can make informed choices. If people are more aware of the radiation coming out of their phone, they may be more likely to buy a low radiation phone or buy a headset or use speakerphone.” The headset, explains Lloyd Morgan of the Central Brain Tumor Registry of the United States, is the preferred risk-mitigation strategy; “Because the radiation decreases as the square of the distance from the cellphone increases (100 squared is 10,000), the difference between the lowest SAR phone and the highest SAR phone is inconsequential compared to keeping the cellphone away from your head or body.”
So, let’s think this through; is it reasonable to conjecture that a consumer who buys a high SAR phone may also buy a headset? Yes. Is it realistic to assume that some informed consumers might choose a lower SAR phone over an equivalent higher SAR phone? Seems to be. Are these actions likely to have a measurable effect on brain cancer rates? Who knows, but the answer could be yes, and if it is, requiring cellphone makers to make SAR values clearly evident seems an innocuous step with significant public health benefits. Realize also, that the Federal Communications Commission (FCC) already requires that manufacturers calculate the SARs, but that most bury the information deep in the phone’s manual. Putting the information front-and-center would give consumers the choice to pay attention, or not – and to change their behavior, or not. And much like me at the supermarket, some folks might be surprised how information can affect simple choices.
Once home, I did some research and discovered that food labels are indeed effective. They’ve been shown to benefit public health by encouraging suppliers to offer healthier choices and by encouraging consumers to choose them. What then should we think of other health-focused labels? Labeling lead levels in children’s toys – most of us can agree that this is a good idea. Nutritional content of chain restaurant food – I know that this information might change my choices at the drive-thru. Parts per million of hemp in my t-shirt – that, is probably over-kill. And how about labeling the radiation emissions of cellular phones? Well, that depends. One of my colleagues recently told me that she wasn’t too concerned about cellphones causing brain tumors because they seemed so innocuous. I agree, cellphones seem harmless (unless they are tempting you to text and drive) and they sure are convenient, but the fact is that we don’t know what the long-term risks of heavy use really are.
As I discussed in a column last year, there is some evidence that long-standing use of cellphones increases the risk of certain types of brain cancer. Most concerning is that the impact of cellphone use on the brains of children and teenagers has not been adequately studied. Could it be that cellphone use, much like drinking anti-freeze, seems innocuous at first but turns deadly later? I, for one, am not at all sure, but have advised others to limit direct held-to-the ear cellphone use as much as possible.
Given how little we know about the long-term danger (or safety) of cellphones, it seems reasonable for consumers to ask for easy access to information about the radiation (defined as the specific absorption rate or SAR) of individual phones. This is what State Senator Mark Leno’s new bill, SB 1212, would require at the point of sale (via labeling on exterior packaging). This bill, which is similar to one endorsed by Mayor Newsom in San Francisco, is set for debate in the Environmental Quality committee on April 19th. From a discussion with Senator Leno, I learned that the rationale for labeling is twofold. First, the labeling would address the fact that there is a significant and not necessarily intuitive disparity (over four-fold) between the SARs of different cellphone brands. The Environmental Working Group (EWG) has published a list of radiation levels for over 1,000 phones on their website (www.ewg.org) and if you check it out you will notice that there is a considerable difference between the lowest SAR phone (Sanyo Katani II: 0.22-0.55 watts/kg) and the highest ones (Blackberry 8820 and others: greater than 1.5 watts/kg). Second, the labeling would help to raise consumer awareness of the potential risks of what is a very common and yet modifiable exposure. Says Renée Sharp, Director of the California Office of the EWG; “We see this as a very nominal, basic step so that people can make informed choices. If people are more aware of the radiation coming out of their phone, they may be more likely to buy a low radiation phone or buy a headset or use speakerphone.” The headset, explains Lloyd Morgan of the Central Brain Tumor Registry of the United States, is the preferred risk-mitigation strategy; “Because the radiation decreases as the square of the distance from the cellphone increases (100 squared is 10,000), the difference between the lowest SAR phone and the highest SAR phone is inconsequential compared to keeping the cellphone away from your head or body.”
So, let’s think this through; is it reasonable to conjecture that a consumer who buys a high SAR phone may also buy a headset? Yes. Is it realistic to assume that some informed consumers might choose a lower SAR phone over an equivalent higher SAR phone? Seems to be. Are these actions likely to have a measurable effect on brain cancer rates? Who knows, but the answer could be yes, and if it is, requiring cellphone makers to make SAR values clearly evident seems an innocuous step with significant public health benefits. Realize also, that the Federal Communications Commission (FCC) already requires that manufacturers calculate the SARs, but that most bury the information deep in the phone’s manual. Putting the information front-and-center would give consumers the choice to pay attention, or not – and to change their behavior, or not. And much like me at the supermarket, some folks might be surprised how information can affect simple choices.
Spring Fever Can Hurt (Marin IJ)
Each spring, something stirs. Spring fever it’s called; sunshine, birds singing, an itch for exploration, and a sense of romance in the air. But in your local emergency room, spring’s stirring mean something quite different. In the ER, spring fever is hay fever and instead of bird songs we hear sniffling and wheezing. The itch is poison oak and that “sense” is an embedded tick being pulled from your skin.
With the brilliance of spring comes a myriad of outdoor opportunities, but also some hazards. If you spend a lot of time outdoors, you’re aware of these annoyances, but nonetheless the season calls for a review. So here are ways to avoid the three Ps of springtime – poison, parasites and pollen.
Poison
Thanks to El Niño’s rain, poison oak is growing like crazy and causing agony for careless outdoorsmen. With poison oak, prevention is key. So, please heed these four tips. 1) Know what poison oak looks like (shiny with leaves of three) and do not treat it like a decorative shrub – as a family friend did when she transplanted a bush from her backyard to the planter box. 2) Remember that poison oak’s oil (urushiol) is what causes the rash and that the oil stubbornly sticks to clothing – so do not follow the example of one ER patient who thanked her husband for clearing poison oak by greeting him with a naked embrace. 3) Be careful about slipping into the woods to relieve yourself in the bushes – several days later this convenience may cause prickly discomfort in the danger zone. 4) Finally, do not fall for the myth that drinking poison oak tea makes you immune – it doesn’t, in fact quite the opposite – a poison oak tea party leaves guests with painful swelling of the mouth and throat.
If, despite your best efforts, you fall victim to poison oak exposure, act quickly and you still may be okay. Wash off, as thoroughly and as soon as possible. Scrub with Technu or Fels-Naptha soap and get all your clothes into the laundry. If a rash occurs, (usually two to three days after exposure due to a delayed immune reaction) focus on alleviation. Don’t worry, you can’t “spread” the rash by touching it at this point, although you should definitely avoid scratching at it. Aveeno and oatmeal baths may help calm the symptoms, but severe cases will need steroids (such as prednisone) – sometimes for a two week course of treatment.
Parasites
Ticks are disgusting creatures. These pests are both parasitic and sneaky; they slowly crawl under clothing and discover tucked-away folds of flesh. To top it off, ticks can transmit infectious disease (such as Rocky Mountain spotted fever and Lyme disease) and in some instances inject a toxin that produces full-body paralysis. Luckily, these complications are rare, and although Lyme disease does occur on the West coast (transmitted by the nymph form of the deer tick, the Ixodes pacificus) it is much less common than on the East coast. It’s thought that we have our backyard friend and tick host, the blue-belly lizard, to thank for this –the lizard’s cold blood kills the bacterium that causes Lyme. Most of the time, ticks are merely esthetic hazards – and stubborn ones at that. There are a lot of myths about how to remove a tick: flame its bottom, smother it with Vaseline, or douse it with gasoline. These tactics might have worked for someone at some time but, really, the safest and most effective way to remove a tick is to patiently exert brute force. Using forceps or tweezers, grab the tick’s head as close to the skin as possible and gently pull until the tick releases. Once successful, do a celebration dance and flush the littler sucker down the toilet. Don’t be concerned if there is redness around the area of assaulted skin – this is a normal inflammatory reaction. If there’s a bull’s-eye appearance to the rash, however, that is more sinister and it’s time to think about Lyme disease treatment and prevention. The Centers for Disease Control and Prevention (CDC) recommend preventive treatment for Lyme disease if, and only if, all of the following criteria are met: the tick is likely to be of the Ixodes (deer tick) species, has been attached to the skin for at least 36 hours and treatment can be started within three days of removal. The treatment itself is simple: 200 milligrams of Doxycyline (this shouldn’t be given to children under the age of 8), but somewhat controversial in this area of the country (given the low rates of Lyme disease). The best way to avoid unnecessary medication is to give you and your family a thorough post-hike preening for ticks – and don’t’ forget to look in the tucked-away places – pulling an attached tick out of your belly button is not a pleasant proposition.
Pollen
Has your spring been a sniffly, wheezy, watery-eyed one? If so, you’re not alone – so far it’s been a banner year for seasonal allergies. Fortunately, you can manage the discomfort of seasonal allergies by monitoring pollen counts in your neighborhood (check out http://www.pollen.com/allergy-weather-forecast.asp) and talking to your doctor about seasonal treatments (which include inhalers and over-the-counter drugs such as loratadine). Truly miserable sufferers may need immunotherapy (allergy shots). Allergy sufferers, be advised that now is not a good time to stop and smell the flowers.
“Spring,” former Marin resident Robin Williams once remarked “is nature's way of saying, ‘Let's party!’” Particularly in this county, spring is a party not to be missed. And with a watchful eye and prudent prevention, you won’t be left with a three P hangover.
With the brilliance of spring comes a myriad of outdoor opportunities, but also some hazards. If you spend a lot of time outdoors, you’re aware of these annoyances, but nonetheless the season calls for a review. So here are ways to avoid the three Ps of springtime – poison, parasites and pollen.
Poison
Thanks to El Niño’s rain, poison oak is growing like crazy and causing agony for careless outdoorsmen. With poison oak, prevention is key. So, please heed these four tips. 1) Know what poison oak looks like (shiny with leaves of three) and do not treat it like a decorative shrub – as a family friend did when she transplanted a bush from her backyard to the planter box. 2) Remember that poison oak’s oil (urushiol) is what causes the rash and that the oil stubbornly sticks to clothing – so do not follow the example of one ER patient who thanked her husband for clearing poison oak by greeting him with a naked embrace. 3) Be careful about slipping into the woods to relieve yourself in the bushes – several days later this convenience may cause prickly discomfort in the danger zone. 4) Finally, do not fall for the myth that drinking poison oak tea makes you immune – it doesn’t, in fact quite the opposite – a poison oak tea party leaves guests with painful swelling of the mouth and throat.
If, despite your best efforts, you fall victim to poison oak exposure, act quickly and you still may be okay. Wash off, as thoroughly and as soon as possible. Scrub with Technu or Fels-Naptha soap and get all your clothes into the laundry. If a rash occurs, (usually two to three days after exposure due to a delayed immune reaction) focus on alleviation. Don’t worry, you can’t “spread” the rash by touching it at this point, although you should definitely avoid scratching at it. Aveeno and oatmeal baths may help calm the symptoms, but severe cases will need steroids (such as prednisone) – sometimes for a two week course of treatment.
Parasites
Ticks are disgusting creatures. These pests are both parasitic and sneaky; they slowly crawl under clothing and discover tucked-away folds of flesh. To top it off, ticks can transmit infectious disease (such as Rocky Mountain spotted fever and Lyme disease) and in some instances inject a toxin that produces full-body paralysis. Luckily, these complications are rare, and although Lyme disease does occur on the West coast (transmitted by the nymph form of the deer tick, the Ixodes pacificus) it is much less common than on the East coast. It’s thought that we have our backyard friend and tick host, the blue-belly lizard, to thank for this –the lizard’s cold blood kills the bacterium that causes Lyme. Most of the time, ticks are merely esthetic hazards – and stubborn ones at that. There are a lot of myths about how to remove a tick: flame its bottom, smother it with Vaseline, or douse it with gasoline. These tactics might have worked for someone at some time but, really, the safest and most effective way to remove a tick is to patiently exert brute force. Using forceps or tweezers, grab the tick’s head as close to the skin as possible and gently pull until the tick releases. Once successful, do a celebration dance and flush the littler sucker down the toilet. Don’t be concerned if there is redness around the area of assaulted skin – this is a normal inflammatory reaction. If there’s a bull’s-eye appearance to the rash, however, that is more sinister and it’s time to think about Lyme disease treatment and prevention. The Centers for Disease Control and Prevention (CDC) recommend preventive treatment for Lyme disease if, and only if, all of the following criteria are met: the tick is likely to be of the Ixodes (deer tick) species, has been attached to the skin for at least 36 hours and treatment can be started within three days of removal. The treatment itself is simple: 200 milligrams of Doxycyline (this shouldn’t be given to children under the age of 8), but somewhat controversial in this area of the country (given the low rates of Lyme disease). The best way to avoid unnecessary medication is to give you and your family a thorough post-hike preening for ticks – and don’t’ forget to look in the tucked-away places – pulling an attached tick out of your belly button is not a pleasant proposition.
Pollen
Has your spring been a sniffly, wheezy, watery-eyed one? If so, you’re not alone – so far it’s been a banner year for seasonal allergies. Fortunately, you can manage the discomfort of seasonal allergies by monitoring pollen counts in your neighborhood (check out http://www.pollen.com/allergy-weather-forecast.asp) and talking to your doctor about seasonal treatments (which include inhalers and over-the-counter drugs such as loratadine). Truly miserable sufferers may need immunotherapy (allergy shots). Allergy sufferers, be advised that now is not a good time to stop and smell the flowers.
“Spring,” former Marin resident Robin Williams once remarked “is nature's way of saying, ‘Let's party!’” Particularly in this county, spring is a party not to be missed. And with a watchful eye and prudent prevention, you won’t be left with a three P hangover.
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