Summertime in Montana: It's Not Just the Bears
Paul E. Shingledecker, MD, FACP, Hospitalist
Marcus Daly Memorial Hospital
1200 Westwood Drive
Hamilton, MT 59840
Many people think of bear attacks as the main danger of a Montana summer.
However, the bigger health risk is from the small things that you don't
see that such as insects, microbes, ultraviolet light, and heat. This
is especially true for those with chronic health issues, such as congestive
heart failure, angina, hypertension, COPD, asthma, diabetes, cirrhosis,
and sleep apnea.
Insects including mosquitoes and ticks are a well-known hazard during
the Montana summer. Lewis and Clark first recognized this as they wrote
"the musquetors were extremely troublesome to us", often requiring
them to change campsites. Besides being irritating, mosquitoes can transmit
West Nile Virus and encephalitis while ticks can transmit diseases that
include Rocky Mountain Spotted Fever, Colorado Tick Fever and Tickborne
Relapsing Fever. The best ways to prevent these issues are avoidance and
use of repellents. You should restrict outdoor activities during the prime
mosquito times of dusk and dawn.
Bug bites are also prevented by applying insect repellents that contain
at least 20% DEET and wearing clothing pretreated with permethrin. To
reduce the itching and swelling after a mosquito bite, apply OTC hydrocortisone
or antihistamine cream, use a cool compress, and take an oral antihistamine.
If you are bitten by a tick, remove it with a fine-tipped tweezer, grasping
the tick as close to the skin as possible and pulling upward with steady
pressure while avoiding twisting or jerking. You should seek medical attention
if, within several weeks after a tick bite, you develop fever, chills,
muscle or joint aches, fatigue, headache, or a rash.
Bacteria and other microbes are unseen hazards often encountered during
the summer. It is easy to get acute gastroenteritis (food poisoning) such
as salmonella from food eaten at picnics and outdoor events. To prevent
food poisoning, meals need to be served at the proper temperature. Cooked
foods should be kept at an internal temperature of 140 degrees or greater.
Cold foods such as potato salad should be kept at less than 40 degrees.
Food left out at room temperature should be discarded after 2 hours. Because
it may contain giardia and other microbes, surface and untreated well
water can also be a source of gastroenteritis. Water should only be used
from known safe sources or after it has been properly treated. If you
do develop mild diarrhea after ingesting bad food or water, you can use
OTC medications such as Immodium AD and drink electrolyte-containing beverages.
You need to seek further medical attention if you experience diarrhea
with fever, excessive vomiting, abdominal pain, or blood in stool.
Another unseen summer risk in Montana is exposure to increased ultraviolet
(UV) light from the sun causing those painful sunburns. UV light can also
produce burns of the eye cornea and can later lead to cataracts. The amount
of UV light increases by 4% for every 1000 feet of elevation gained and
is further increased by reflection from sand and water. That's why
you're more likely to get a sunburn by laying on the beach at Lake
Como or floating down the Bitterroot. Medications can further increase
sensitivity to sunlight and include sulfonamides, phenothiazines, diuretics,
doxycycline, and topical antibiotics. To reduce your risk of UV exposure,
you should wear sunscreen SPF 30 or greater and sunglasses.
Sunscreen should be applied 20 minutes before exposure and reapplied every
2 hours. If also using bug spray, first apply sunscreen and let it dry.
Mild sunburn can be treated with cool wet towels, ibuprofen or naproxen,
acetaminophen, hydration, cool bath, and moisturizing cream. You shouldn't
go back into the sun until the burn has healed. You should seek medical
attention if the sunburn is severe with blistering second degree burns
that involve more than 15% of the body or if you have a high fever greater
than 101 degrees, dehydration and extreme pain that lasts more than 48 hours.
Summer also brings heat and increases the risk of dehydration, heat exhaustion
and heat stroke. For those with chronic kidney disease, diabetes, hypertension,
heart disease, or otherwise using diuretics ("water pills"),
this can lead to acute kidney failure and electrolyte problems. It is
essential to stay well hydrated. You should have at least 8 glasses of
water (64 ounces) per day. A good rule of thumb that we used in Iraq is
to drink fluid until your urine is nearly clear.
Altitude presents its own unique challenges for those travelling during
a Montana summer. Acute mountain sickness (AMS) can occur as low as 5000
feet but becomes more common above 8000 feet.
Symptoms include headache, nausea, poor sleep, loss of appetite, and fatigue.
Severe forms of altitude sickness include swelling of the brain or high
altitude cerebral edema (HACE) with additional symptoms of drowsiness,
confusion, and loss of coordination. Another form is high altitude pulmonary
edema (HAPE) or fluid accumulating in the lungs with marked shortness
of breath, cough, and weakness. These conditions are treated by immediate
descent to a lower altitude and require further medical treatment. AMS
can be prevented by not going from a low altitude to sleeping at higher
than 9000 feet in 1 day. You should also minimize caffeine use, avoid
alcohol above 8000 feet for the first 48 hours, and not smoke.
Higher altitude can be even more hazardous for those with chronic health
problems especially conditions that require wearing oxygen. The amount
of oxygen available to you decreases with altitude, by 25% from sea level
at 8000 ft and 44% at 14,000 ft (such as Pikes Peak, Colorado). Travelling
by air also lowers oxygen levels as airplane cabins are pressurized down
to an equivalent maximum altitude of 8000 ft. The average person's
oxygen saturation decreases by 4% after 3 hours of flight. If you have
use supplemental oxygen or have a borderline oxygen level, you should
consult your physician before travelling to higher altitude or on an airplane.
Guests should be cautioned about this risk before travelling to Montana.
Out of state visitors with chronic health problems are frequently hospitalized
with shortness of breath and respiratory difficulties.
Travelling during the summer presents other health challenges. The risk
of a blood clot (deep venous thrombosis and pulmonary embolus) increases
with sitting on an airplane or in a car for an extended time. It is further
increased if you have cancer, a family history of clots, use estrogen
pills, had recent surgery, or a previous blood clot. You should take frequent
breaks, walk every 1-2 hours, wear compression stockings, perform calf
exercises, and ask your physician about using aspirin during trips.
Those with chronic health problems should take further precautions while
travelling. You should never be separated from your medications and medical
equipment. They should be kept in a personal item or carry-on luggage.
I recommend packing extra medications to last the entire trip plus extra
days in case of delays. You should always carry a list of your medications,
allergies, medical history, and emergency contacts. If indicated, obtain
a medical alert bracelet or necklace. Always take your essential medical
equipment including diabetic supplies, epinephrine pens, inhalers, extra
oxygen, and CPAP machine. As the advertisement says, "Don't leave
home without it".
Following these tips can lead to a healthy and safe summertime in Montana.
Besides being a hospitalist at MDMH, Dr. Shingledecker is a former NPS
Ranger and retired US Air Force flight surgeon/critical care physician.
The weekly health column is brought to you by Marcus Daly Memorial Hospital
and the Ravalli Republic. For questions regarding this week's health
column please contract, Paul Shingledecker, MD Hospitalist at Marcus Daly
Memorial Hospital, 1200 Westwood Drive, Hamilton, MT 59840. Working together
to build a healthier community!