Summer Safety

SARA LOMAX-REESE: Let me welcome our Einstein docs, Dr. Donee Patterson, welcome.

DONEE PATTERSON, MD: Thank you.

LOMAX-REESE: And Dr. Molly Furin.

MOLLY FURIN, MD: Thank you.

LOMAX-REESE: Welcome.  This is absolutely pertinent and relevant, summer safety, because we just celebrated the 4th of July, where a lot of people were dealing with barbecuing and fire and sun and surf and all of those things and we are now in the full throes of summertime so I am glad this particular issue is something we are going to explore today.  I want to just give it to you Dr. Donee, because you always set it up for us in terms of where we are going to go in this conversation around summer safety.

PATTERSON: There is so much that we can talk about that I struggled exactly how to narrow this down for our half hour, but I do want to say I don't think people realize that unintentional injuries, so accidents, they are a leading cause….actually the number three reason why men die in the US and depending on the year, it's the number 5 reason why women die in the US.  About 120,000 deaths a year could be prevented by just thinking about these unintentional injuries.  I want to shed light on that because it doesn't mean anything when we are just talking about numbers, but it really means something if it is your mother, sister, brother, daughter, child.  We really can make a difference.  Number one is car accidents, we hear a lot about texting and driving and distracted driving.  We really need to pay attention to that and make sure that we are really hitting it hard with our teens that are starting to drive that they really need to pay attention to what they are doing.

LOMAX-REESE: I think we need to model that as well because if we, as parents, are texting or multi-tasking behind the wheel, it's do as I say not as I do kind of thing, which doesn’t go over big with young people.  Let's talk about summer time and we have you, Dr. Furin, you are an ER doctor.  I know that a lot of people kind of misuse the ER in general and if you don't have insurance you tend to use the ER as your primary point of contact with the heath care system which can be very costly; it can be a very inefficient use of doctors' times.  I am curious, especially as we look at the summer, what are the main things that you are seeing in terms of why people come and what are the legitimate uses of the ER?  When should people come to the ER as opposed to not?

FURIN: Any time that anybody really has a concern about their health and they feel like they need to seek medical care, I think it is important for them to know that the emergency department is always available to them.  Sometimes there are other resources or other means of obtaining information or seeking medical care that may be more cost effective as well a time effective for our patients.  If they have a primary care doctor that would be the first place that we would say to try to seek additional information.  Again, if people have a real concern that they have an emergency, we are always available to them. I think some of the major topics when we were thinking about summer safety, some of the things we see a lot in the emergency department, are increase in accidental injuries and again I think prevention is the number one strategy there.  A lot of times there are reasons why people come to the emergency department that they might be able to manage t home.  Things like minor burns or scraps, minor trauma, things like bee stings or other sorts of insect bites. 

LOMAX-REESE: People do not come to the ER for a bee sting?

PATTERSON: People do come to the ER for a bee sting.

LOMAX-REESE: Unless they are allergic.  I get it if you are blowing up or having some crazy reaction, but a basic bee sting?

PATTERSON: Yes.  When I use to ride the ambulance, I use to be an EMS; I had a guy who called 911 for an acorn in his ear and when you call 911, you get fire, police and ambulance, so all those services were pulled away for a guy who had an acorn in his ear.

LOMAX-REESE: Well, I might call if I had an acorn in my ear too.

PATTERSON: I don't know if that….

LOMAX-REESE: Was it lodged in there?

PATTERSON: It was in there.  I don't know if that is a medical emergency that you need to call 911 so that the ambulance actually comes to your house.  You can call your primary care doctor and they can use tweezers to get them out or if you didn't have it maybe go to the emergency room where they have the smaller….

LOMAX-REESE: So that's a great distinction; 911 is really if you are having a heart attack…if you are incapacitated to the point where you can't drive, you can't get yourself to a doctor or an ER.

PATTERSON: And you have to think about the resources that are taken up to call for a tick bite or an acorn in your ear, it's not life threatening; he was not going to die if he didn’t get the acorn out that hour.

FURIN: That’s exactly what I wanted to say is that it is important to think about if there is a limited set of resources in your area.  I think people sometimes call 911 because they think they will be seen faster than in the emergency department or it's a more convenient way to be transported to the emergency department as oppose to finding public transportation or finding a ride.  But if you have a limited amount of resources in your area and now that ambulance is out of service for 45 minutes or an hour, somebody who might actually have a serious medical emergency who, their heart might stop beating or they might be having a stroke or a heart attack, now that ambulance isn't available for them and another ambulance is going to have to come from someplace further away to try to get that person to the emergency department.

LOMAX-REESE: Who pays for, if you do call 911 for whatever reason, who pays for fire and ambulances and EMS and all of those people to activate?

FURIN: That is actually variable; it depends on the service.  In the City of Philadelphia the ambulance service is provided through the fire departments.  I actually work with an ambulance company that is further out into the suburbans.  It is a private organization and so it really depends on where you are.  Insurance companies will often cover the bill but that money is sent to the patient and they are supposed to reimburse the ambulance company. Sometimes it can be really tricky for the ambulance service to get paid.

PATTERSON: It is quite costly.

LOMAX-REESE: So you really have to be very judicious about using those kinds of services.

PATTERSON: But we do want to emphasize that is an extreme on one end, but on the other end please, if you think you might be having a stroke or heart attack, that is the time to call 911, don't just stay home; don't wait for your children to come home from work; don't wait for a more convenient time; that is the time to call 911.  If you have an emergency, please by all means, but if it is not an emergency, please think about those resources as well.

LOMAX-REESE: Water safety is a big thing that comes up in the summertime, whether it is at a pool or at the beach where you have more variations in terms of surf and everything, but what are some kind of tried and true tips for safe water experiences in the summertime, and include water parks in that too because that is another thing that people do.

PATTERSON: People don’t realize that children, especially young children, can actually drown in just inches of water, so they will leave them alone in the bathtub or they will feel like they are OK at the edge of the ocean, but children can actually die in small amounts of water so you really need to watch your children.  One thing that I learned just by preparing for today and making sure I knew what I wanted to say, I never really thought about lifeguards on the beach.  A lot of this is straightforward things but a beach that has a lifeguard is suppose to be much safer than an unmanned life guard beach because if there is an emergency you would have to call 911 and they would have to get there and by that time the waves could take people out, so it is really important to swim in protected areas when you are at the beach and make sure you are listening to the lifeguard, that there is a lifeguard on duty, especially at pools, especially for weak swimmers.   All those things are very important.

LOMAX-REESE: Dr. Furin?

FURIN: I actually think back to an experience that I had as a teenager.  I was a life guard and I think it is really important for parents to make sure they are watching their children as well.  When you think about the number of people that a lifeguard is responsible for even though they are doing their job and they are being vigilant, it is important for parents to actually keep an eye on their children as well.  I think for adults some important tips are making sure not be swimming or doing diving if you have been drinking alcohol, that can  impair your judgement and can also dehydrate the  body more and people become more fatigued.  Also make sure you are aware how deep the water is; how rough the current is; where the type of conditions were you will actually be doing the swimming is important.  Diving injuries are a major problem.  Cervical spine injuries and paralysis, so people really need to be aware of what kind of water they are going into.  If they are doing any type of diving, make sure that the depth is adequate and that there is somebody who is able to watch them and intervene if they do have an emergency.

PATTERSON: So all these summer safety tips that we are giving they are really changed when a person is drinking alcohol.  So driving of course is changed, swimming is changed, your perception in the pool is often changed and their reaction time is changed and also for heat safety, they often get dehydrated easier and they have medication reactions so alcohol is something that you really want to do….we recommend if you don’t have to do it when you are out, please restrain, but if you do, absolute moderation and definitely not for younger people when they are swimming.

LOMAX-REESE: Absolutely.  And you do see that, you see people with coolers of beer and wine and stuff like that at the beach and so I want to talk a little bit about this dehydration.  I just spent the week at the beach so I observed a lot of summer safety dos and don'ts and so the whole issue of sun exposure, because I would see people who would go out there at 10 in the morning and would stay until 4:00 in the evening or afternoon and they would be beet red on their back, face and so I want to see, and this is for both you Dr. Donee and you Dr. Furin, what are some of the sun safety tips.  I believe the sun screen kind of information has shifted a little bit so what should people, particularly since our audience is predominately African American, we tend to believe that the melanin in our skin is a protective element which it is but that we don't really need to be as vigilant around sun safety so let's talk a little bit about that.

PATTERSON: There is so much to say; yes, African American people can get skin cancers.  Actually the number one cancer…we tend to think about breast cancer and prostate cancer and colon cancer as number one, but skin is the number one cancer that is diagnosed each year…

LOMAX-REESE: Not in African Americans.

PATTERSON: Not in African Americans, but in Americans.  I must say personally, of all the cancer, I don't want to get cancer, but skin cancer, melanoma particularly is the one that scares me the most.  It is very aggressive; it spreads very quickly; it is very dangerous so please wear sun screen, at least 30 or above and cover yourself with a hat and wear sunscreen; reapply; apply it to your children.  Watch your moles if they are changing or getting larger or getting….

LOMAX-REESE: Is that only if they are exposed to the sun or is that any mole?

PATTERSON: No, you watch any mole because you can get…

LOMAX-REESE: Are moles impacted by sun exposure?

PATTERSON: Yes, absolutely, moles are impacted by sun exposure but you can get moles on the bottom of your feet that might be melanoma.  You can get it in your arm pit that might be melanoma.  You do want to pay attention.

FURIN: There are actually high rates of melanoma even in areas that are typically covered during sun exposure.  I do just want to add since we are talking about particularly the African American populations, they have worse outcomes when they do have skin cancer, such as melanoma compared to other populations and I don't know if some of that is because there is less awareness to actually be checking your skin or to be aware of things that are changing on your skin and because melanoma is such an aggressive cancer, it is important to catch it early.  The African American population does have the worse outcome in terms of prognosis.  It is important I think for people to be aware of that.

LOMAX-REESE: When you say changing, it is darkening or widening or cracking or what?

PATTERSON: So the rule of thumb is if it gets darker; if it has irregular borders; if it is larger than an eraser on a pencil; any of those things you want to bring to your doctor's attention and don't ignore it.  It is not uncommon just to have your doctor do a skin check once a year and if you tend to have freckles, you may even want a dermatologist take a closer look at more in-depth parts.

LOMAX-REESE: we are talking with the Einstein docs this morning, I mean this afternoon, I am losing track of time and we are talking with Dr. Donee Patterson, she is a family physician at Einstein and Dr. Molly Furin who is an ER doc at Einstein.  Do we have to take a break?  OK, we are going to take a quick break and we are going to continue our conversation about summer safety.

LOMAX-REESE: And we are back.  You are listening to Health Quest Live on 900 am WURD.  I am Sara Lomax Reese and we are here talking about summer safety, which is really critical.  We are in the midst, we are right in the throes of the summer and we've got two of the Einstein docs here, Dr. Donee Patterson and Dr. Molly Furin from Einstein giving us some real important tips about water safety and about sun screen.  One thing that I wanted to touch on around sun exposure before we move on to heat exposure, is this whole question about vitamin D and we know that there is a lot more focus on vitamin D deficiency and particularly in African Americans because we have melanin in our skin which I guess blocks the access of vitamin D a little more.  I've read that there should be sun exposure, about 5-30 minutes a day, 2 - 3 times a week in order to get the proper amount of vitamin D into our system and that is without sunscreen.  I wanted to see if you could comment on vitamin D versus sunscreen in the African American community.  Dr. Donee?

PATTERSON: Sure, so yes, that is the way to get adequate amount of vitamine D but I wouldn't do that personally and the recommendations from the dermatology societies and the dermatologists that I know recommend against it because of the increased risk of skin cancer.  You can get vitamine D from other sources.  There is natural food sources; there are vitamin sources.  It is hard to get an adequate amount of vitamin D in places like Philadelphia because it is not San Francisco, it is not Florida, it is not Miami.  I personally take 1000 units, international units, of Vitamin D, it is a supplement, but leafy green vegetables and milk sources do give you vitamine D.

LOMAX-REESE: All right, I like the sun better than those.

PATTERSON: The sun is wonderful.  I have just come from the beach myself.  I absolutely love the beach, but melanoma is very scary.  It is very scary and if you have ever seen anyone have to have an absolute huge chunk of their leg taken out or their jaw taken out or part of their back, a chunk of their back taken out and have it or see it spread to the brain, it is very scary.  I would much rather wear sun screen, enjoy the sun, check my moles, and not increase my risk of melanoma.

LOMAX-REESE: OK, scare tactics work.

PATTERSON: Sorry, I'm not trying to scare you; I'm not.  But look it up for yourself.

LOMAX-REESE: So let's move on…because we are right up against the clock.  There is a lot of…in Philadelphia in particular, it can be very hot; very humid and dehydration becomes an issue and we have these heat advisories where people who are elderly or over 75 are cautioned to be very careful.  Dr. Furin, why don’t you give us some tips on what we should be looking for in terms of heat exhaustion, heat advisories, those kinds of things in terms of health.

FURIN: Absolutely; I actually think this is a really important topic because heat related deaths are some of the highest weather related emergencies.  I think we tend to think about tornados and hurricanes but there have been episodes of heat waves back in the 90s.  In Chicago there were over 700 people who died from heat related illness and the city there has really tried to increase people's awareness.  I think the most at risk populations are elderly persons, the extremes of age so also babies and infants, but people who aren't leaving their homes and apartments daily; people that don't have fans; who don't have somebody to come check on them.  Some of the things we can do to make sure that we are paying attention to our neighbors and our family and our community and people who might need additional assistance.  If you don't have air conditioning, it is important to try to get out and go some place that you can cool off at least for a short amount of time, so places like the library or senior centers or community centers in your neighborhood, making sure that you have a fan; that you have light colored window dressing; that you are opening the windows and getting as much air circulating as possible.  Usually we recommend staying out of the direct sun or heat during the highest time of the day so between 10 a.m. and 3 p.m. are sort of the worse times and then again, making sure that you are actually drinking plenty fluids, non-caffeinated, non-alcohol fluids.  Some of the early signs that people can look for are feeling fatigued, feeling weak; sometimes people experience nausea; they can get muscle cramps.  Then it is important to try to cool people down; to remove as much clothing as possible; try to get them to drink some water, some fluids.  Sometimes people can get extremely ill from being hyperthermic or being over heated and at that point people often become confused or agitated; they won't be behaving like themselves, and then that is a really important reason to call 911 to get them emergency care as soon as possible.

LOMAX-REESE: So what is actually…when you say that heat related deaths are one of the largest kind of weather related issues, death issues, what are people actually dying from if it is a heat related death?

FURIN: So there body can become so overheated from the heat itself so they become dehydrated, they stop sweating, their skin becomes dry as opposed to being sweaty and clammy and temperatures can go over 106 degrees.

PATTERSON: What is actually happening physically is you get so dehydrated that your organs actually can shut down.  Our organs need those electrolytes to be in a proper balance and the organs can shut down.  People who already have heart problems can shut down; people with asthma, their asthma can flair and their lungs can shut down; people can go into renal failure.  All those electrolyte changes can cause mental status changes, so it is…

LOMAX-REESE: Real?

PATTERSON: It's real.

LOMAX-REESE: It's really serious, wow.

PATTERSON: I do want to emphasize that for children, we don't always recognize, if we are not so hot that our children may be overheating too because they are much smaller so they will heat up quicker.  You want to make sure your children are drinking lots of fluids, that you are having them cool as well, that they have hats on and pay attention to them.  If they are waling a little slower, feeling fatigue or not urinating at regular intervals, you want to make sure you pay attention to that.

LOMAX-REESE: So as we get ready to wrap things up, what are some of the …we covered a pretty good amount of territory around the summer safety questions and issues, what are some of the take aways, the leave behinds you want to share with the audience, and we will start with you Dr. Furin?

FURIN: I think in terms of accidents and injuries, trying to look for prevention so making sure people are properly restrained in their cars, that we aren't performing distracted driving behaviors, that people aren't drinking alcohol and participating in some of those behaviors; being aware of things like water safety and other injuries around pools or beaches or places that we might not typically go during other times of the year.  Making sure we are staying cool and taking care both our skin and staying hydrated are really important.

LOMAX-REESE: Dr. Donee?

PATTERSON: As Americans we are getting better at putting our  children in car seats, but there is an age group between 5 and like 9, 10, depending on how big your child is that we forget to put them in booster seats, so it's 8 or 80 lbs and ideally if a smaller child…if a teenager does not have to sit in the front, especially if they are smaller, let them sit in the back because then their damage is less and lastly I want to make sure that people remember house fires because people do die from house fires, it is actually quite common. You need to have a plan.  If your children have never practiced going out of a window, opening the window in your house, I implore you to talk to your children today or this week about that and have a place, any place where you will meet so they are not running around the neighborhood looking for your child in the even t of your child.  Make sure that your fire extinguishers work and make sure that you have alarms.

LOMAX-REESE: Excellent; cautionary information but very vital and potentially life saving, so thank you very much, both of you, Dr. Furin and Dr. Patterson for sharing these very tangible tips for all of us.  Do you have a gift card?

PATTERSON: We do, so you can go to Einstein's facebook page, Einstein health and answer some very simple questions and you can be eligible for a $25 gift card.

LOMAX-REESE: Excellent, thank you very much.  We will see you in about two weeks.

PATTERSON: Yes.

LOMAX-REESE: Thank you Dr. Molly Furin and Dr. Donee Patterson for being here with us today.

PATTERSON: Thanks for having us.

FURIN: Thank you.