Do you remember the long standing news program 60 Minutes? If you've never seen it, you should. If you have, you probably remember the venerable Andy Rooney, who concluded every episode with commentary on a topic of interest. He would always begin his segment by posing a question to the viewing audience by asking them "Did'ya ever wonder..." followed by a witty 5 minute piece.
Well, I recently did a telemedicine consultation on Answer Health on Demand that really made me wonder how many patients wonder about various "simple" health complaints. The patient was concerned about a blistering rash and thought the fluid in them was "infecting" further, causing more of a rash. After looking at the rash, I was able to determine that it was most likely poison ivy. I reassured the patient that the fluid in the blisters would not cause more poison ivy rash and that the only way to get more rash was to get exposed to the oil from the poison ivy plant. Exposure could come from touching more plants, but could also occur from anything with the oil on it, including clothing, gardening equipment, belts, shoelaces, and pets.
This wondering got me wondering about other things patients wonder about. What follows is a list of simple summer wonderings that we can help to address for you on Answer Health on Demand.
Don't I need a steroid for my poison ivy?Usually no, unless it's extensive or on the face. Steroids for poison ivy need to be taken for a relatively long time to help (usually 14 days) and the risks and side effects of steroids usually outweigh the benefits of taking them.
Did I get an infection from this bee sting?Probably not. Bites and stings can cause a localized reaction of redness, swelling, warmth, and tenderness, appearing similar to a skin infection called cellulitis. Local reactions usually begin soon after the sting, will start out larger, and are treated with Benadryl, cold compresses, and over the counter pain medicine. An infection will usually form later, starts small at the site of the sting, and may come with a fever and tenderness.
Am I having an "allergic reaction" to this bite/sting?Probably not. You most likely are having a "localized reaction" (see above). While true allergic reactions can occur, they are much less common. They must involve a reaction distant from the bite or sting and may include a diffuse rash, wheezing, mouth/lip/throat swelling, vomiting, or passing out. These are medical emergencies and must be seen immediately at an ER.
Am I "allergic" to this mosquito bite?Probably not. You are having a "localized reaction" (see above). Various amounts of pain, swelling, and itching can occur in response to mosquito bites also. Our bodies respond to the protein to mosquito puts into our body. This local reaction can be mistaken for an infection (cellulitis) or allergic reaction.
Is that snake poisonous?Maybe (but probably not). The only venomous snake in Michigan is the Massassauga rattlesnake. They are identified by their heart shaped heads, rattler, and vertical pupils. If bitten this is a true emergency and should be seen immediately in an Emergency Department. Don't apply tourniquets above the bite site, try to suck out the venom, or use any type of device to extract the venom as these don't work. While other snakes may bite (or try to), the Massassauga rattler is the only venomous Michigan snake.
Do I have a spider bite?Maybe. These usually cause localized reactions. Occasionally a cellulitis may develop requiring antibiotics.
...but I think it was a Brown Recluse spider.Probably not. These are not native to Michigan and generally cannot survive harsh Michigan weather conditions. It's possible that a Brown Recluse made it here as a passenger on some sort of cargo from the mid-south, but not likely. Regardless, it is possible to be bitten by one, especially around undisturbed wood piles and sheds, attics, and basements. Look for 1/2 inch brown spider with a marking on the back that looks like a fiddle or violin.
...or a Black Widow.Maybe. Black Widow spiders are found throughout Michigan. They prefer to hide, but may bite defensively if found around wood piles, grills, and undisturbed garages. Females are more venomous and larger (1-1.5 inches), and have characteristic red hourglass on their underside. The bite may be sharp, and 2 fang marks might be identified. Immediate pain, redness, and swelling may be followed by muscle cramps, sweats/chills, abdominal pain, and headache. If you suspect a bite, you should seek medical attention right away. If possible bring the creature with you.
And finally... Am I allergic to the sun?
Probably not. You can get a rash from sun exposure, often called "sun poisoning." This is not truly poisoning or an allergy. Sometimes our body can react to sun exposure, especially if it has not been exposed for a while, such as when on spring break. Technically this is polymorphic light eruption, or PMLE. It's treated by covering the exposed areas, taking a break from the sun, Benadryl, and ibuprofen.
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