It’s all about the water

Most people, especially around the hot, summer months, begin trying to get near some water. Lakes, rivers and beaches are very popular places to spend a few days away from “regular life”. Just as water provides a great recreation area, it also provides life for us mammals. The importance of staying well hydrated, especially in summer months, cannot be underestimated.

The amount of water and fluid in your body is something few people think about until there is a problem — problems can occur with too much or too little. A basic guide for figuring the basic amount of oral fluids a person should be drinking is based on weight. A 20 kilogram (44 lbs) person should be taking in about 1500 mL per day. For those of us that weigh more than that, just add 20 mL of fluid, per day, for each additional kilogram. A person weighing 150 lbs (68 kg) should be drinking about 2.5 liters of water, providing there are no prior medical conditions that limit water intake, daily. This is more than most people I know drink, and they are not doing fun stuff like playing at the beach, hiking or exploring a new city on a hot summer day. The people that are exerting themselves in hot climates need to pay attention to how hydrated they are.

There is no easy way to say this, but one of the most effective ways of judging your hydration status is to check the toilet. How often are you urinating and what color is it? Early doctors used to taste patient’s urine as part of their analysis. You can skip that part and just see if your urine is a nice, clear color or darker yellow. Darker yellow urine may mean that your are dehydrated. When somebody becomes more and more dehydrated, they begin to urinate less and less. Oh, don’t try to fool yourself by thinking “I am going to pee all the time, I am fine” if you are drinking alcohol. Alcohol is a diuretic and makes you urinate more, but leaving you further dehydrated.

Most everybody who is active in hot weather locations should think about at least getting the minimum daily fluid intake. Those who are really active, like im an outdoor sport, hauling heavy bags around the streets or even just sitting in an extra warm room, may want to think about increasing their daily intake of water above the minimum requirements. I call this “maintenance plus one-half” and it is just like it sounds. If you should be drinking a minimum of 2 liters per day, it should be upgraded to 3 liters per day. Some ultra-endurance athletes are required to drink 10 liters of more to compensate for their body’s losses!

Electrolytes help regulate the body’s balance between acidity and alkalinity, as well as help to control water movement in the body. Glucose, or sugar, is vital in helping water move from the intestines to the blood stream. As water is consumed, it goes to the intestines. From there, the water molecules are absorbed through the intestinal wall into the blood stream. When there is also glucose in the intestines, the water molecules can travel across the tissue wall faster and get into the blood stream, where it is most needed. This is the basic principle of why Oral Rehydration Solutions (ORS) and sports drinks are so effective in treating dehydration.

You can make your own ORS with water, a few pinches of salt and 2 spoons of sugar added to one liter of water. You can also add some fruit juice to the water or even cut up pieces of fruit, like a banana, for some additional electrolytes such as potassium.

The key to battling dehydration is to first be aware of the symptoms an keep and eye out for them and second, to be aggressive before symptoms become more severe. Check with your personal health care provider about how much water you should be drinking and ensure that you have no underlying conditions that could be made worse by oral rehydration. Remember that in hot environments, it is all about the water.

Avoid “un-packing breakfast” due to motion sickness

Lots of people get motion sickness. It is rumored that Christopher Columbus even had trouble with sea sickness. Fortunately, you don’t have to dread that ship, car or plane trip for fear of “un-packing your breakfast” in full public view. There are a number of effective treatments and preventions for those who suffer from motion sickness — the goal is to keep trying until you find one that works, for you!

The basic problem with motion sickness is not in the stomach, but in the discoordination of the visual signals sent by the eyes, the inner ear (responsible for balance) and the brain. The Travel and Tropical Medicine Manual cited one study involving over 20,000 passengers crossing the English Channel and the North and Irish Seas. Their data showed that motion sickness was more common in females than males and the older you were, the less likely you were to be effected. Over one-third of the passengers in the study felt symptoms of motion sickness. For the lucky ones that have never felt motion sickness, the symptoms include cold sweats, nausea and weakness.

Where to sit and Where to look

Choose a seat with the smoothest ride, if possible. Over the wings of a plane, the front seat of a car, forward facing seats and laying flat on your back are all places to help minimize motion sickness. When the “feeling of yuck” starts to creep in, try to focus on a distant object (it will be moving the least) or close your eyes. Avoid reading or focusing on objects close by — their motion is much more obvious.

What to Take

There are several options for prevention and treatment of motion sickness. The two main medicines used are Scopolamine and Anti-histamines. Anybody who has been on a cruise has likely seen the scopolamine patch, on fellow passengers. Anti-histamines that are commonly used include diphenhydramine (Benadryl), promethazine and meclizine (Antivert). All of these medications come in different forms, some including patches, chewable tablets and pills. Scopolamine has some common side effects including dry mouth and blurry vision and should not be taken without prior discussion with your doctor due to some interactions with other medicines and medical conditions such as glaucoma. Anti-histamines commonly cause sedation, which, depending on your personal trip, may be a good thing. Just like with scopolamine, check with your doctor before taking these medicines.

The Rough Guide to Travel Health discusses several “homeopathic” remedies to motion sickness, including Cocculus 30c, Nux vomica 30c and Petroleum 30c taken in combination. One of my favorite “natural remedies” for nausea is Ginger and it can be found in many forms, including capsules. Although there are limited studies using ginger in treatment of motion sickness, it’s has been shown by some researchers to be effective in chemotherapy induced and pregnancy related nausea.

Motion Sickness Bands are a hot topic in travel medicine. Do they work? Are they a waste of money and do they only provide a placebo effect? I know some people who swear by them to prevent motion sickness. I do not use them, personally, but I have also never had a problem. What I do know is that there is conflict in the medical literature. The bands work by applying pressure to the P6 Neiguan accupressure point at the wrist. Several studies have shown this method to be effective in controlling other causes of nausea (pregnancy induced and during medical procedures) but no real research has been done with motion sickness that I know of.

Real Life

Like with anything, having a good trip requires some bit of pre-planning. Speak with your doctor about some options you can use for motion sickness and try them out before your trip. Four hours into your 10 day cruise is not the time to find out your chosen medication is not working or causing you to sleep away your holiday. I always try to live by “real world rules: two is one, one is none”. Carrying a back-up motion sickness remedy is a good idea, should you find yourself out of your first option or not able to access it. Lastly, if you are going to need to “un-pack breakfast” on a boat, try to make it to the down-wind side.

For some more reading, check out:

CDC Traveler’s Health: Motion Sickness

Medicine for the Outdoors celebrates two year anniversary

Travel health and the emerging specialty of “wilderness medicine” have obvious overlap. Dr. Paul Auerbach is one of the leaders in wilderness medicine: helping found the Wilderness Medical Society, co-author of A Field Guide to Wilderness Medicine and numerous journal articles and serving as faculty to the Stanford Fellowship in Wilderness Medicine.

His blog, Medicine for the Outdoors, is celebrating the two year anniversary. For those who haven’t yet had a chance to visit, it is filled with practical information and advice for those exploring their environment and wanting to come back from the experience in good health. Travel and expedition medicine is the focus of my career and I find myself citing Dr. Auerbach’s work and information, in my work. He is one of the pioneering physicians who helped elevate this field of medicine to a new and unique specialty.

A visit to his blog will allow the reader to learn about things from jellyfish stings and dislocated shoulders on the trail to malaria medications and outdoor recreation. This is truly an opportunity to read, first hand, the information from a leader in wilderness and expedition medicine. I highly recommend a visit to his blog, if you get a chance. Oh, and don’t forget to congratulate him on his two-years of dispensing great advice!

Are the shoes worth the blisters? (and what to do if they are!)

Photo: Daniel MorrisIt is unfortunate that what looks good, doesn’t always feel good. I think this is no more apparent than with a pair of shoes. You have a killer pair of new shoes that you’ve been waiting to wear on your trip and that day is finally here! New shoes on your feet, you head out for a day of sightseeing in your new city. But this is a recipe for blisters — nothing can slow down a day of hiking, shopping or sight seeing quicker than hotspots on your feet.

Understanding how blisters form and some basic treatments just might allow you to ambulate with less pain and save that pair of shoes, as well.

If you remember from the hazy days of high school biology, the skin is made of 2 layers: a thick, inner layer (dermis) and a thin, outer layer (epidermis). As heat, caused by friction and rubbing, forms a “hotspot” on the foot, the two layers of skin begin to separate and fluid fills in this space. Moisture from sweat or water acts as a lubricant between the sock and the foot as well as softening the skin. This increases friction potential and a greater chance for a blister. This concept is key for helping to understand blister prevention.

Blisters commonly occur in areas of softer skin, that are not used to being roughed up by shoes. The shoes you wear everyday have already toughened up your feet in the areas that that specific shoe rubs. However, the new pair of shoes or the shoes you do not commonly wear will rub your feet in new,potentially soft areas. Common sense dictates that you should not wear a pair of shoes new to your feet on a day that you have a lot of walking to do. If you have the time, try wearing your shoes around for a few hours at a time with thick and comfy socks. Even if you are just walking around your house, having the shoes on your feet help decreases the chances of future blisters. That’s in a perfect world, however, and I don’t know about you, but I rarely visit there.

One of my best “tricks of the trade” for blister prevention was taught to me when I was a doing some adventure racing. Remember that refresher on skin anatomy and moisture acting as a lubricant to increase friction? Decreasing moisture on the feet decreases the chance of hotspot formation that will lead to a blister. Roll-on or stick deodorant is the ticket. Not only will it help your feet smell like an alpine meadow, but stick deodorant is an effective anti-perspirant. A good coating on both your feet, getting all surfaces, will reduce “feet sweat” and the friction that a sweaty sock allows. Apply this stick deodorant liberally and then place a sock over the foot. Try not to remove this sock until you know you are done for the day. There are some commercially made products, such as Bodyglide, that are designed to increase lubrication/friction as well, eliminating the chaff associated with unprotected skin. I suggest some personal trials before your trip to find which method works best for you.

Should you find yourself in the very unlucky position of feeling a hotspot forming on your feet, don’t give up hope! You can still finish your walking tour or make it to the end of the shopping area, with minimal pain. Moleskin is a product bought at most stores that sell athletic footwear or hiking stores and is a self-adhesive sheet of padding that works miracles on blisters. This sheet of fabric can be cut to proper size and placed directly over the hotspot at the first sign of irritation. Acting as additional padding and a friction reducer, moleskin will allow you to finish your day with minimal problems. Just make sure to cut a little hole in the center of your piece of moleskin about the size of your blister. A kind of “moleskin dough-nut” is the goal — you’re going to stick that moleskin over the blister allowing it to poke through the little hole you cut. This keeps the blister from popping, hopefully, and takes away some of the pain associated with the raw and inflamed tissue. Some athletic tape also can be applied over the moleskin dough-nut to help it adhere to the foot a little better and prevent it from moving out of position.

“To pop or not to pop” is a common question with blisters. I think that a popped blister is merely a nice route for infection to enter your body and I generally try to avoid popping blisters unless it involves a more extensive treatment process. A popped blister merely has had the fluid removed from it — there is still a space created by heat and friction between the two layers of skin and they will continue to rub together, causing more damage. A blister has been “unroofed” when the top layer of skin has come off or been removed. This is now exposed and raw skin. The area should be cleaned with soap and cool, clean water. A topical antibiotic, such as Neosporin, works great for helping prevent infections.

As with most travel related health issues, some proper prior planning prevents poor performance. Remember to break those shoes in, before your trip. A coating of stick deodorant can go a long way in hotspot and blister prevention and moleskin is a great tool too use when the hotspots and blisters start forming. Also, if you see somebody hobbling around in killer but brand-new shoes, offer them some of your moleskin, you’ll save their day.

Don’t get burned on your next trip

You are finally there…the perfect beach, the perfect companion and the perfect drink in your hand. This is what you’ve been working and waiting for. You’ve left the mobile phone off and are dedicated to not letting anything ruin your trip. Besides the calls from work though, sunburn can ruin a holiday pretty quick.

Basics: Your Skin and the Sun’s Rays

You may remember from hazy days in high school biology that the skin has two main layers: epidermis (thin, outer layer) and the dermis (thicker, inner layer). The skin has many functions and one of them is protection from the sun. The amount of melanin in the skin can effect the skin’s ability to protect against sunburn and damage from ultraviolet light, as most light skinned people can tell you. Being very light skinned, I get a “light pink” just going outside to get my mail.

This sun’s ultraviolet light has three main types, UVA, UVB and UVC. People are exposed to much, much more UVA light than UVB, but it is actually UVB that is responsible for most sunlight induced erythema (sunburns). The UVC light is largely absorbed by the Earth’s atmosphere. An interesting article that discusses the interplay of UVA and UVB and UVA’s possible role in skin damage can be found here

Prevention

The best way to avoid getting a sunburn is to protect yourself and there are several ways to do this. Sunscreens, clothing, sunglasses and avoidance of peak sun hours (10 am to 3 pm) are all common tools in the war on sunburn. Glasses, contact lenses and sunglasses protect the eye from most UVB rays. For those of you that are “into shades” you can read a bit more about things like light transmission and distortion.

Sun protection clothing is a very useful item and quality counts — specifically the tightness of the weave in the garment. Material, proper, does not seem to be as important as this “weave tightness”, as evidenced by Lycra. When stretched, Lycra blocks only 2% of UVR compared to 100% when lax. The term to know is UPF (ultraviolet protection factor) and is similar to SPF for sunscreen. This is the amount of UV rays that are able to pass through the clothing. A UPF rating of 50 means only 1/50 of the sun’s UV rays pass through, offering substantial protection because only 2% of the suns rays get to your skin.

Sun Protection Factors (SPF)

The famous SPF rating of sunscreens is a commonly misunderstood factor that compares protection times of different strengths of sunscreen. This number is actually a ratio that uses the amount of time it takes to get a sunburn in a person wearing sunscreen versus one without protection.

For example, a person gets a sunburn in 10 minutes of sun exposure, without sunscreen. Wearing SPF 2 will protect their skin from sunburn for 20 minutes, or double their “unprotected” time it takes to burn. Wearing SPF 15 will give 150 minutes of protection or about 2 1/2 hours and SPF 50 offers 500 minutes of protection, or 8.3 hours. SPF merely gives an amount of time one is supposed to be protected from a sunburn. Interestingly, higher SPF values are associated with protection from UVB absorption. SPF 2 only blocks about 50% of UVB, while SPF 15 blocks 93% of UVB and SPF 50 blocks 98% of UVB rays.

Sunscreen

The method by which the sunscreen is applied is very important. Creams and lotions generally spread well and allow good skin penetration. Gels tend to wash or sweat off easily, and some contain alcohol which can sting the skin. Sticks make it hard to cover a large area of skin. Oils traditionally spread thin and some can cause acne. Ointments/waxes are generally left to extreme environments and help resist skin chap and frostbite. Aerosolized and sprays make an even coating difficult, allowing for unprotected patches.

The biggest problem with sunscreen is that it is not properly used. This means adequate application in the beginning and re-application — frequently. Apply the sunscreen, liberally, to all exposed skin areas. Remember to get the neck, ears and backs of hands, too! Re-apply after swimming or water contact. Sunscreen goes on the skin first, then bug spray goes on top. Remember that use of DEET and sunscreen together decreases the sunscreen’s protection by 34%. Try not to let the sunscreen run into your eyes, as this will cause some irritation, trust me.

Sunscreens are a major cause of skin irritation, also. Oxybenzone is a common link in these products and is commonly know as PABA (p-aminobenzoic acid). Up to 4% of the population are adversely affected by this compound. If you have a sensitivity to PABA, make sure to select a PABA-free lotion.

Sunburn Treatment

OK, it happens. Forgot the sunscreen, didn’t re-apply, didn’t use enough the first time, whatever. You now have a burn and it hurts. For immediate relief, cool water soaks or compresses help with pain. Topical anesthetics do work and the preferred ones include menthol or camphor. Aspirin and ibuprofen are very good at reducing pain and swelling/inflammation. Sun avoidance for 48 hours may also help speed healing time. Lastly, ensure adequate hydration. My personal “sunburn remedy” is a lot of water.

More severe sunburns can be associated with blistering of the skin, fevers/chills, and even vomiting. If your skin blisters, try not to beak them. If they do break, wash the area with soap and water and consider applying a thin layer of antibiotic cream.

Hopefully, most everybody associates sun exposure and burns with skin damage and even cancers, later in life. Even if this is not as catchy as the “Everybody’s Free to Wear Sunscreen” essay, hopefully this will help you remember to wear your sunscreen and avoid a few days of discomfort on your “perfect beach holiday”.

For more information check out:

CDC Travel Health: Sunburn