With the summer months upon us, there comes an influx of people eager to enjoy the natural resources that Block Island has to offer. From the stunning coastline to the meandering trails, there is no secret that the natural beauty of Block Island is one of its biggest attractions – yet it can also harbor some of its biggest threats. In order to ensure that your summer vacation remains as carefree as possible, here are a few tips to protect you and your family from the elements and some advice on when to seek medical care, as well as some information on what you can do at home to stay comfortable.
Poison ivy, poison oak,
Approximately 85 percent of people have an allergy to a substance in these plants called urushiol oil. There are three ways to come into contact with the oil: direct contact through touching any part of the plant yourself, indirect contact through touching a pet or a gardening tool that has the oil on it, or airborne contact that occurs when the plant is burned and the oil particles are released into the air. To prevent indirect exposure, wear vinyl or cotton gloves when handling tools or animals that have come in contact with these plants, since urushiol oil can penetrate rubber. Wearing these gloves, you can wash your pet with water and mild soap to remove the oil from their fur and wipe down your tools with rubbing alcohol. Rather than burning poisonous plants to rid your yard of them it is best to spray them with natural herbicides or simply remove and dispose of them. Be mindful that urushiol oil can be found on all parts of the plant and can stay active on dead plants for up to five years.
The best way to manage a potential exposure is to immediately wash the area with soap and warm water. Since the skin absorbs the oil so quickly, the sooner you wash it off the better! Within ten minutes of exposure, 50 percent of the oil on the skin has been absorbed, whereas 30 minutes after an exposure, 100 percent of the oil has been absorbed by the skin and can no longer be removed. It then takes anywhere from 12 to 72 hours for a rash to develop.
The rash itself is intensely itchy, and often appears as red and raised with linear vesicles (blisters). It goes away on its own after a couple days to weeks, but there are a few things you can do to manage the itch. Over the counter creams containing hydrocortisone can help with itch and inflammation. Drawing an oatmeal bath by adding ground oatmeal to hot water creates a milky mixture that can be soothing to inflamed skin due to rash or sunburn. Other over-the-counter remedies such as Tecnu and Zanfel are said to bind urushiol oil that has already been absorbed into the skin, thereby reducing symptoms. If you develop a reaction over the majority of your body, a rash that covers your face or causes swelling that interferes with your ability to see, breathe or swallow, it is important to seek medical attention. In those cases your doctor may prescribe an oral steroid such as prednisone to decrease the itch and inflammation.
Even though the itch can be intense, scratching can cause further complications. A common misconception is that scratching or touching the rash can spread it on your own body or to others. In reality, once the urushiol oil has been absorbed by your skin it is no longer available to cause the rash to spread. However, scratching introduces the risk of infection, since your nails create small cuts in the skin and introduce bacteria that can multiply and make it harder for your skin to heal.
Ticks and tick-born illnesses
New England, and Block Island in particular, is considered to be an epicenter of tick-borne illness due to the abundance of wooded and ocean-front areas and the endemic wild-life including deer and rodents that can carry these infections without falling ill. Block Island is home to three species of ticks known to carry disease: the black-legged or “deer” tick, which can carry Lyme disease, anaplasmosis, babesiosis and Powassan Virus, the Lone Star tick, which can carry ehrlichiosis, and the American dog tick which can carry Rocky Mountain Spotted Fever.
Every year at the Block Island Medical Center, 50 to 60 patients with new, acute, tick-borne infections are diagnosed and treated, and many other patients are treated for exposures. Many resolve quickly with treatment but some of these infections result in severe disease. While most people can be treated with antibiotics at home, some require hospitalization for high fever, blood or organ abnormalities and/or other complications. Most patients recover quickly but some report chronic or recurring symptoms. Early recognition and treatment is important to avoid complications.
While physicians have been trained to recognize the particular bulls-eye rash associated with Lyme disease infection, many individuals who contract Lyme disease do not develop this rash, and there are numerous other infections transmitted by ticks that are not associated with the classic rash. Therefore, if you have traveled to an area like Block Island where Lyme, babesiosis and anaplasmosis are common and you develop flu-like symptoms, fever, joint pains or fatigue, it is worth a prompt visit to your doctor for an evaluation and consideration of testing regardless of whether you have developed a rash. Your doctor can help you decide what, if any, testing and/or treatment is appropriate for you.
The best way to protect yourself from ticks and the various diseases they carry is to avoid getting bitten in the first place. If you anticipate coming into contact with ticks, keep your skin covered. Some advocate the use of bug repellant containing 20 to 30 percent DEET, or it is possible to spray your clothes with a solution containing 0.5 percent Permethrin. Clothing pre-treated with Permethrin can also be purchased online. When you return from the outdoors, run your clothes in the dryer on high heat for at least ten minutes to kill any ticks that might have ridden home on them. If you need to wash your clothes, you can dry them on high heat for sixty minutes or medium heat for ninety minutes after they’ve been washed. A shower with plenty of soap will help to dislodge and remove from your body any ticks that have not yet attached. Check your skin for ticks, paying special attention to the hairline, armpits and groin. If you find an attached tick you can remove it with tweezers, putting the tweezers as close to the skin as possible and avoiding squeezing the body of the tick, which can expel the contents of the tick into your bloodstream. You can then consult your medical provider about whether it would make sense to take a prophylactic antibiotic to protect yourself from tick-borne infections. While there is not currently a vaccination for humans against Lyme disease, pets can receive an annual vaccination and can wear special collars that contain chemicals that help repel or kill ticks on their fur, protecting their human owners from exposure to ticks.
Even though Lyme disease is thought to be an infection that only occurs in the summer months, rising temperatures have extended the season during which ticks are able to survive, making it more common to see Lyme and other tick-borne co-infections year-round.
Despite the risks that lurk beneath the island’s beauty, there is great fun to be had when the proper precautions are taken. Be sure to wear sunblock SPF 30 or above, drink plenty of water and, on behalf of the Block Island Medical Center, have a great summer!
Sarah Magaziner is a member of the Warren Alpert School of Medicine Class of 2019. The Medical content of this article was edited by Mark Clark, MD, Medical Director, Block Island Medical Center.