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The Dose Transcript for June 26, 2024

Host: Brian Goldman

DR. BRIAN GOLDMAN: Hi, I'm Dr. Brian Goldman. Welcome to The Dose. Last summer, a good friend of mine broke her femur on a hike in Italy. So, I know a bit about this subject from that standpoint. Whether it's a trip abroad, a cottage or a canoe trip, it could well mean travelling someplace where getting medical attention is challenging. So this week, we're asking, what should I do to prepare for a summer or travel-related medical emergency? Hi Shaneka, welcome to The Dose.

DR. SHANEKA KULASINGHAM: Thank you for having me, Brian.

DR. BRIAN GOLDMAN: Here's a debate question for you. Thinking about and preparing to deal with the bad things that can jeopardize your health while vacationing this summer takes the fun out of travelling.

DR. SHANEKA KULASINGHAM: Usually, for us, it's taking all our four children with us and trying to make sure that we don't have two bags with us with every child.

DR. BRIAN GOLDMAN: Two bags with every child! What do you put in those?

DR. SHANEKA KULASINGHAM: Many first aid kits.

DR. BRIAN GOLDMAN: Many first-- Are you telling me that you actually tailor-make your first aid kits for the child?

DR. SHANEKA KULASINGHAM: I'm just joking, really. But we do try to take in medications and things for sprains and broken bones, etc., as we have for very active children.

DR. BRIAN GOLDMAN: Okay, so I love the fact that not only are you a physician, but you are also an end user. You're somebody who's thinking about this from the standpoint of a patient, so you're the perfect person to talk to. Before we begin though, can you give us a hi, my name is? Tell us what you do and where you do it.

DR. SHANEKA KULASINGHAM: Hi, my name is Shaneka Kulasingham. I'm an emergency physician at Saint Joseph's Hospital in Hamilton.

DR. BRIAN GOLDMAN: Okay, let's begin our conversation. What are some of the common health hazards that we should anticipate encountering during the summer?

DR. SHANEKA KULASINGHAM: Well, as with warmer weather and longer daylight hours, people are out more often, and summer is the ideal time for outdoor sports and recreational activities. So commonly we do see in our emergency department many more orthopedic injuries: broken bones, sprains, strains, tears. But there's also, because of the fact that people are trying to enjoy outdoor time with families and kids, they may, like, be on just bikes or skateboards and things that they often wouldn't do in the winter. And so, there is also just more serious injuries with ATV accidents or hiking, where that is much more common during travel season.

DR. BRIAN GOLDMAN: Let me ask you this question. What are some of the orthopedic injuries that you would expect people to be able to treat on their own and keep going without getting an X-ray?

DR. SHANEKA KULASINGHAM: I think that's very difficult to sort of quantify and qualitate. Because somebody can be walking and roll their ankle, and obviously if they're able to weight-bear with minimal discomfort, then they could probably use what we call RICE, which is Rest, Ice, Compression, Elevation. But it's hard to quantify people's pain threshold. There are people that had walk-on fractures and then present a couple days later. But if there's minimal swelling, you're able to walk on it, Tylenol takes care of the pain, that is something where you could probably go to a pharmacy, get a tensor. Elevate; ice. But if the pain persists, there's swelling and more bruising, then probably you do need to have at least your family doctor or an emergency visit to check that out.

DR. BRIAN GOLDMAN: How concerned should people be about insect bites while out in nature? And let's not forget sun exposure.

DR. SHANEKA KULASINGHAM: Let's start with sun exposure. That has become more and more of a problem with our extreme heat. It's very important to apply sunscreen and reapply sunscreen, and I think people sometimes misunderstand when they put on an SPF 50, thinking that they had 50 minutes where they can be outside and they won't burn. And that is not what the SPF is really indicating. It's just more of a likelihood of how long you have until you have to reapply the sunscreen. But trying to make sure that you're wearing a hat, finding shade, making sure you're drinking plenty of fluids. Try to limit sun exposure between ten and two, where the UV is much higher during those hours. If possible, to wear light, thin clothing that covers your skin. Those are sort of some basics in terms of how to prevent some sunburns, heat exhaustion, those sort of things. In terms of bites: most commonly in Ontario it's typical mosquitoes, bees, wasps. But also now in certain regions -- especially Hamilton -- there is a lot more ticks and ticks that do carry Lyme disease, depending on where you are, if you're going for a hike. Because ticks love bush, trees. That type of environment. You want to try to wear clothing that are long-sleeved, shirt tucked into your pants, pants tucked into your socks. Light-coloured, mainly because you can visualize or see the tick. Because if you're wearing dark colours you may not see it. After you get home, to make sure you remove all the clothing and actually check your body from head to toe. Because they can be found in various places on your back, things like that. And remove them immediately with a tweezer and pull the entire body upwards and out. Mosquitoes would be more like trying to wear insect repellent as well if possible.

DR. BRIAN GOLDMAN: I want to get into talking about some of the topical creams and ointment remedies, over-the-counter remedies, that people can bring. You know, for things like sunburn, for insect bites. So, you've worked hard to try to prevent those. But with the best of intentions, somebody's got a bad sunburn, your party's getting eaten alive by mosquitoes, or you've gotten a burn. You know, at the campfire, you've spilled some hot coffee on your hand. You don't want to run and seek medical attention unless you absolutely need it, so what kinds of remedies would you recommend bringing along?

DR. SHANEKA KULASINGHAM: So if we start with burns, sunburns aren't that different from burns from hot water or a cup of coffee, etc. I think the most important thing when you have a burn -- so if your skin is becoming sensitive or there's actually blistered areas -- the first thing is to cool that area off. Especially, like, when it is something like hot water or a coffee, tea. Things like that. You want to just be applying cold compresses on it until that sting, that burn starts to go away. And that may be an hour, that may be two hours, that may be three hours. And then obviously avoid any re-exposure, whether it's sunlight, etc. After some of that pain resolves, you can certainly take some anti-inflammatories with it like Advil or Aleve. And then it's just applying an antibacterial ointment -- something like Polysporin. Just because when things blister up, or even sometimes you'll have little micro blisters you want to prevent. The biggest thing with the sunburns once it's gone through the skin, like a partial thickness, you want to prevent an infection. So, making sure that area is covered with an antibacterial ointment.

DR. BRIAN GOLDMAN: A hot tip for those of us who tend to store old medications in our medicine cabinet: you really have to replenish that antibiotic ointment like Polysporin and buy a fresh one if you're going on a trip. Don't use the one from three years ago. What about deeper wounds and lacerations? You know, it would be a shame... You know, you've got a two-centimetre, three-centimetre laceration and, you know, the doctor in the party or the nurse in the party says, well, that needs stitches. It would be a shame to kind of have to break camp for that, but I suppose in some cases you might have to do that. Are there any things that people can bring along to help them close up wounds, for instance?

DR. SHANEKA KULASINGHAM: If it's a two-, three-centimeter laceration, and certainly if it's over joints. Because when there's movement, like, say, over a knuckle or a knee, hard to really close that on your own because any movement disrupts it and opens it up. If it's on your lower leg and it doesn't appear to be that deep, or you're not overly concerned about the scarring and you're able to keep it clean, you can buy in pharmacies what we call Steri-Strips or little Band-Aids, and you try to bring the edges of the wound together and put the tape along it to try to keep that wound closed. Now, obviously within-- after you do that, in 10-15 minutes, if you find that that wound is opening up, you may need to go in for stitches. Sometimes scalp wounds, if it's not bleeding, you can... a handy trick is like, twisting your hair to try to keep that wound tightly closed. So we actually call them hair sutures. And I've seen parents quite effective in doing that with their own children -- just twisting the hair to try to keep that wound closed because scalp wounds close very quickly. So, if it isn't opening, if it's not bleeding and there's no signs of concussion, I've seen people use the hair to try to tighten that wound closed. And then obviously, just superficial wounds. Is just the main thing is first irrigating it out, making sure it's clean; putting some Polysporin on it. And then obviously the initial step is obviously controlling the bleeding. So compression is the most important thing for the first five to ten minutes -- putting pressure on it to stop the bleeding. And then you'll have a better chance of taking care of the wound and closing up the wound.

DR. BRIAN GOLDMAN: Just to further-- make a further comment on scalp lacerations. You know, they seldom, if ever, get infected. The blood supply to the scalp is excellent, and that means that the dead material and debris gets cleaned out very quickly and tend to heal very, very well without skin closure. Although, if you have a very deep scalp laceration, it needs to be closed in layers. Because, if not, then you end up with a big bump there that could be quite unsightly.

DR. SHANEKA KULASINGHAM: Also, if it's that deep, then it would be advised to see a physician to... just concerned of head injury and things like that that would need to be assessed.

DR. BRIAN GOLDMAN: You mentioned Advil, and I want to switch over to some of the over-the-counter remedies that people can pick up without a prescription. Things for nausea, things for headache, aches and pains, fever, etc. What do you bring along and how do you recommend using it?

DR. SHANEKA KULASINGHAM: It's always important to have some basic medication. Advil and Tylenol -- I bring both. Advil's great as an anti-inflammatory. Both are good to reduce fever, so whether it's liquid or tablets. Tablets are a little bit easier to store and put in little Ziplocs and label it rather than bring entire bottles, depending on how long you're away for. Antihistamines are very helpful, especially with bites, seasonal allergies. Sometimes even just as a decongestant if you get an upper respiratory infection while you're away. So, a non-drowsy formulation like Reactine or Claritin -- I think those are really important to bring along. Polysporin would be great for... you never know what sort of wounds you might get. And then for nausea, there are now some non-drowsy formulations of Gravol which could be useful if you end up picking up a bug or something like that, to control the nausea.

DR. BRIAN GOLDMAN: What are some of the non-medication things that you recommend packing in a first aid kit? I'm thinking in terms of bandages and slings and safety pins and that kind of stuff.

DR. SHANEKA KULASINGHAM: I would definitely have a couple sized different types of tensors. I've got very active children... rolling ankles, things like that. Maybe just for compression anywhere, I think it's a useful thing to have in a first aid kit. A sling is useful, but I find that most times if somebody needs a sling, they're likely going to need to be assessed by a physician. It's hard to put an arm or something in a sling and not have it checked out. And you don't want to immobilize anything for that long without having a physician look at it. And also various sized Band-Aids: some smaller ones for smaller wounds on hands, but even larger ones for knees. Those sort of things. I think having a selection of Band-Aids when you're out and about, maybe even some saline to flush out a wound. That would be great in a first aid kit. So you can do that, apply some Polysporin and put on a Band-Aid. And even some compression with a tensor if you have it if the bleeding is a little bit brisker.

DR. BRIAN GOLDMAN: Here's a question for you. Suppose you're travelling in a fairly large enough party and you're, you know, on a canoe trip or you're hiking, you're on a camping trip, would you ever think of bringing an EpiPen? Obviously, if somebody in your party has anaphylactic reactions, they should be bringing their own EpiPens. But have you ever thought about doing that?

DR. SHANEKA KULASINGHAM: It's a great idea. Especially because we do see some of those sort of things. I guess it depends on who's coming, what your little group looks like in terms of their other health. You would also need to know how to use it and so you'd need to go to the pharmacy. There's extra steps to take. And certainly people that, like you mentioned, that have had any sort of anaphylactic reaction or allergic response, carry EpiPens. And that's another important thing to make sure you remember, because most people have one or two and they don't know where it is, etc. We usually say use an EpiPen if you can't get to a physician, and even after you use an EpiPen you need to see somebody. So, it's a little difficult to answer because if people are uncertain when to use it, you've never had a reaction before, you don't know what to expect... it's hard to sort of say, here's an EpiPen for you and for you, and if this is what happens... It's not something we typically do. I think there's people that are in the health-care profession that might know a little bit and say, okay, well, I'm going to bring an EpiPen with me just in case any of the people that I'm travelling with have a reaction. But I don't know if we actually tell a family, well, why don't you-- here, take an EpiPen. I feel like even people that have anaphylactic reactions, allergic reactions, are always hesitant to take it; to actually inject themselves. So because of that hesitation already that exists for people that have reactions, it's... Ones that have never had a reaction, it'd be hard to sort of educate the surroundings of that.

DR. BRIAN GOLDMAN: Okay, let's pivot away from, you know, people going on summer vacations closer to home where they're cottaging or they're hiking or camping, that sort of thing, and switch over to people who are travelling abroad, for instance. Let's just say they're travelling abroad for two or three weeks or a month. If they have prescription medications, they need to bring them along with them. How much do you recommend that they bring?

DR. SHANEKA KULASINGHAM: I would always say that you should bring in at least an additional week of medication, because you just don't know if something's delayed, etc., you lose a couple of tablets. So it would be useful, minimum, a week. Two weeks would be even better. So if you're away for three weeks, have five weeks' supply of medication. And even sometimes to put a couple of those weeks in separate areas so that if something goes missing-- I usually say for medications that are really important to have it in your purse or hand luggage versus putting it away in your actual suitcase if you're checking something. Or having it in two different spots.

DR. BRIAN GOLDMAN: Some people will be bringing controlled substances with them. Should they bring an authorization, a prescription, some kind of documentation that they're supposed to be taking it?

DR. SHANEKA KULASINGHAM: Yes. Get your family doctor or someone to write a little note; say, this is a prescription medication that I've been given, etc., so there's less delay, less trouble. Another thing that I find important is just a small little piece of paper with all your medications listed, maybe your medical illnesses. Whether you've had a heart attack, etc. And if you've had any recent chest pain or any sort of things like that, carrying an ECG. A photocopy. I tell all my patients that have ever come to the E.R. if they've been in and out with chest pains, to have an ECG. Just roll it up, put in your wallet. You may need to-- The photocopy may wear down, you may need to replace it, but it is so helpful to have that when you do travel.

DR. BRIAN GOLDMAN: And, you know, depending on where you travel, if gastroenteritis is endemic, and traveling there you're likely to get infected... Do you recommend that people bring antibiotics with them?

DR. SHANEKA KULASINGHAM: I would only recommend it in patients that are immunocompromised or have had repetitive episodes of it, or if you're gone for an extended period of time to certain areas where you know you're not going to be able to access health care. People that go onto hikes and they go to Machu Picchu, or they're doing something like that where there's probably other medications that they need to bring as well with the climb, etc. But then I do think it's worth considering that. I feel like some people don't consider it and then they get there and... So it is something like if you're going for an extended period of time, if you're doing an activity that you have no access to medical care, it is worth, I think, going to a travel clinic and getting those medications, making sure your immunizations are all up to date. Most people have both their hepatitis B and hepatitis A now, but not everybody has their hepatitis A. So, it is useful to seek some travel expertise in terms of their hepatitis A status. Sometimes places are endemic for cholera, malaria. So there are medications that can help prevent it.

DR. BRIAN GOLDMAN: How important is out-of-country health insurance?

DR. SHANEKA KULASINGHAM: Very important. I think everybody needs to have it when they travel. It's extremely expensive if you are caught with some sort of illness -- just even a fracture, things like that -- without any insurance. The older you are, it does get a little bit more expensive. But I think you never know, so I would never travel without making sure there was some sort of insurance.

DR. BRIAN GOLDMAN: Finally, we've talked about what we can do, but at what point-- I mean, some people are just overly adventurous and they actually don't know that they need to seek emergency care. Let's talk to them. At what point should people seek professional medical help?

DR. SHANEKA KULASINGHAM: It depends on the duration. So if you cannot continue your regular activity, you have a fever that persists, you have a part of your body where you can't weight-bear or use, all of those sort of things, I think you do need to seek medical attention within a few days of any sort of injury if things are not getting better.

DR. BRIAN GOLDMAN: And I would also include nausea that's not relieved with anti-nausea medications; diarrhea that's-- you know, severe diarrhea that's not relieved with over-the-counter remedies. And likewise, headaches. Especially headaches... You know, if you have a headache with a fever and you've taken some Tylenol and it's not getting better, maybe you have a bit of a stiff neck. Maybe you've had an insect bite. Maybe you've been bitten by a tick. I'm kind of painting a picture there, but use your common sense. If the remedies you brought with you aren't helping, you should seek medical attention.

DR. SHANEKA KULASINGHAM: Right. And I'd also like to add one thing. With the warmer weather, longer daylight hours and everyone is out more, just a little bit of prevention, again. Just like when you're biking, skateboarding, whatever it is that you're doing, try to make sure that you're wearing protective gear: helmets, kneepads, etc. Like I mentioned, sunscreen, limiting sun exposure, being careful. We've also seen lots of children with burns from when people are out with grills and bonfires, etc. And not having children swim without supervision. Drownings and near-drownings are often common as well at this time. And just, not even five minutes. If children are in the pool, to always have them supervised. Drinking plenty of fluids to stay hydrated, to limit heat exhaustion that could cause heat stroke. And then also if you're doing physical activity -- just warming up before engaging in physical activity, things like that, can go a long way in prevention.

DR. BRIAN GOLDMAN: Dr. Shaneka Kulasingham, you are a fund of knowledge on how to get people prepared to have an enjoyable and adventurous summer or travel vacation, and I hope you and your kids have a safe summer with all those bags of first aid gear that you're bringing along with you.

DR. SHANEKA KULASINGHAM: Thank you so much. Thank you for having me.

DR. BRIAN GOLDMAN: Dr. Shaneka Kulasingham is an emergency physician at St. Joseph's Healthcare Hamilton, and an assistant clinical professor at McMaster University's Department of Emergency Medicine. Here's a dose of smart advice: Wherever you go this summer, you should prepare to render first aid and deal with minor medical issues. A travel first aid kit should contain enough medicines and supplies to deal with minor injuries and ailments. It should include antiseptic, sterile solution to clean wounds, bandages, dressings, gauze, medical tape, safety pins, scissors, dressings for blisters, compressible bandages for sprains, tweezers to remove splinters or ticks, disposable latex or vinyl gloves, and a thermometer. Bring over-the-counter remedies for headache, nausea, stomach ache, diarrhea, and allergic reactions. You might want to include antibiotic eyedrops for pinkeye. You should also bring oral rehydration solutions and powders. If you're in a remote area without potable water, you may need to bring water purification tablets. You should also bring antibiotic ointment, aloe vera for sunburn and calamine lotion and hydrocortisone cream to relieve itchy skin bites. If you take prescription medications, make sure you bring a week or two more than you need in case your flight is cancelled or you get stuck in a remote area. If you take controlled substances like prescription opioids or stimulants for ADHD, bring a doctor's note authorizing you to bring them, to show to customs agents. If you travel abroad, purchase out-of-country health insurance, especially if you have pre-existing medical conditions. Also, bring a summary of your illnesses; a list of medications and dosages. If you have pre-existing heart disease, bring a copy of your most recent EKG. One last point: We're talking first aid here. You should be able to manage most first-degree burns, insect bites and superficial cuts, as well as mild headaches, viral coughs and colds, and traveller's diarrhea. For more serious things, seek medical attention. For instance, if you have a head injury, if you can't use an injured arm or can't walk on an injured limb, and when over-the-counter remedies don't relieve headache or nausea. If you have topics you'd like discussed or questions answered, our email address is thedose@cbc.ca. If you liked this episode, please give us a rating and review wherever you listen. This edition of The Dose was produced by Sameer Chhabra. Our senior producer is Colleen Ross. The Dose wants you to be better informed about your health. If you're looking for medical advice, see your health-care provider. I'm Dr. Brian Goldman. Until your next dose.

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What can I do to prepare for a summer medical emergency? - Transcript

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