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After more than a year of isolation, summer is back in the DMV. We sat down with PPMW Program Director of Primary Care (and illustrator) Dr. Ryan Montoya to learn how to have a healthy and safe summer.

PPMW:  Let's start with sun protection 101. What do folks need to be aware of?

Ryan Montoya: You want to make sure that when you're out in the sun that your skin is protected, and the principal way to do that is with applied sunscreen. You want to use one that has at least an SPF of 30+ which can protect against the two major types of UV radiation associated with skin cancer. Don’t look for anything that has a bronzer added which can interfere with the sun protectant factors.

PPMW: Do I need to wear sunscreen on a cloudy day? 

RM: You should be using sunscreen generally speaking when you're outside and cloudy days can be actually more dangerous. Because you can have more UVB streaming through a cloudy day, you could be putting yourself at greater risk for skin cancer because you presume you don't need the sunscreen. 

PPMW: What are some pests that we might encounter during summer and how do we treat their bites or stings?

RM: You’re likely to get a mosquito bite (image below) during the summer. Mosquitoes sense humans based on how much CO2 is being released from the surface of their skin. To ward off mosquitos, citronella candles work well, if you're going to be in an area right beside it, and you're going to be sitting down for a long time, like say for a barbecue. But generally speaking, mosquito repellent is your method of choice. And if we're talking about stages, you want to put sunscreen on first and then insect repellent on afterwards. 

Deer ticks, which are most common in the northeast, can carry a type of bacteria responsible for Lyme disease, a bacterial infection that can affect your heart, joints, and nerves. You can recognize a Lyme disease tick bite by its characteristic, bullseye rash (image below). The treatment for Lyme disease is very simple, just two weeks of antibiotics. So, if you're going into an area where you know that ticks are occurring, dress appropriately by wearing boots and long pants, and consider applying 0.5% permethrin to boots, socks, or tents while in the area.

Bee stings (image below) happen a lot during the summer. It's important for people who are allergic to bee stings to always have an Epipen on hand. Keep in mind that if it's a bee, they tend not to sting you unless they feel like they're being attacked. Hornets and wasps, however, are aggressive and you want to stay away from them. Don't try and swat them because their stings can be very, very dangerous, especially for younger children.

PPMW: Poison ivy is pretty common in this area. What happens if I come in contact with it? 

RM: The sap from the plant gets on your skin and it causes itchiness. When you scratch it, you're exposing the affected skin to the sap, and you're also getting some of that on your fingers and scratching other parts of your body. So poison ivy tends to spread quickly. The rash has a characteristic red blotchiness (image below) . In terms of treatment, we used to give everyone calamine lotion. However, calamine can be over drying which makes you want to scratch more and then you might spread it further. Home remedies include washing the area with lukewarm soapy water or using a colloidal oatmeal solution or topical steroid cream to the dried area. Above all, avoid scratching the oil or blisters to prevent spread, and if the symptoms worsen, see your healthcare provider to get examined.

PPMW: One of our favorite things to do in the summer is to swim. What do we need to be mindful of when we're in the water? 

RM: Every body of water has its own challenges. If we're talking about the open ocean and beaches, pay attention to the lifeguards. If they are telling you not to go too close to cement breakers or to areas because of rip tides, listen to them. Because if you get caught in those situations, especially riptides, it can be lethal. 

In the pool, most of what we see are alcohol related injuries or accidents. When you're drinking alcohol, you’re not able to regulate your temperature as well and - if you drink enough - you lose your coordination. And there’s a lot of hard surfaces and people try and do pretty bold moves in pools while they're drinking. These are all recipes for disaster. So, in general, don’t engage in any wild behavior after drinking alcohol, especially around water.

PPMW: Can you talk about heat exhaustion - how you recognize it and what to do?

RM: Heat exhaustion can lead to heat stroke. The initial stages include a lot of sweat but then, as it gets to its later stages, you actually can't sweat as much. In those later stages, the skin can turn much darker or a dark red color, and people can experience brain fog. 

For people suffering from heat exhaustion, you want to bring their temperature down slowly and safely. Get the affected person to a shaded area and take off any clothes that they have that might be restrictive. If you have any ice or cooling packs or anything cold, splash it on them. If you're able, get them hydrated. If they're having a mental status changes, this is a medical emergency, and you should call for help. 

Creating shade and a lot of hydration is key to preventing heat exhaustion. This is especially true for people carrying lots of items or wearing heavy clothes - like football players and loaded down hikers. So, staying in the shade is probably your best bet.

PPMW: Any last thoughts about having a healthy summer?

RM: Sunscreen, sunscreen, sunscreen. Sunglasses always with a full UV protection. Looking on the internet is good for immediate care but to make sure that you're treating things properly, see a provider.

Tags: bite, health, insect, poison-ivy, sting, summer, sun-protection, water-safety