Spring has sprung, and summer is around the corner. You know the signs. Dad fires up the grill, oil companies raise gas prices, and kids come down with itchy rashes. The poison plants are back, and this summer they promise to send two million Americans to the doctor’s office.

The three most common culprits–poison ivy, poison oak, and poison sumac–are native to the Americas. European explorers hadn’t seen them before. Sometime around 1600, Captain John Smith recorded his encounter when he wrote, “The poisoned weed is much in shape like our English ivy, but being touched, causeth redness, itching, and lastly, blisters.”

Pocahontas could have warned him. After all, Native Americans knew all about poison ivy. Indian warriors coated their arrow tips with it, and medicine men rubbed the leaves on infections in an effort to break open the swollen skin.

Colonial doctors paid attention. They jumped on the poison ivy bandwagon and expanded its use to the treatment of herpes, eczema, arthritis, warts, ringworm, and even rattlesnake bites. Use of poison sap in early American medicine was so widespread that poison oak was listed in the Pharmacopoeia of the U.S. as an official therapeutic agent.

Today we know the rash of poison plants is a contact dermatitis. Upon first exposure, most folks develop antibodies against the sap. On subsequent exposure, the antibodies attack the sap, resulting in the bothersome rash. The few who don’t make antibodies, won’t get the rash. But they should still watch out–antibody production can begin anytime, making a fool out of poor Uncle Pete a day or two after he rubs poison ivy up and down his arm just to prove he ain’t allergic.

So what is poison sap anyway? The offending chemical is urushiol, a yellowish oil inside the leaves, stems, and roots of the poison plants. Because it’s inside the plant, undisturbed leaves won’t harm you. However, if the leaves are chewed by insects, stepped upon, or otherwise damaged, the oil leaks onto the plant’s surface where it can come into contact with human or animal skin. As it turns out, only humans and closely-related primates break out with the rash. Dogs, cats, cattle, and sheep are not affected, but they can convey the oil to their human keepers. Clothing and tools also spread the oil, and since the sap remains allergenic for years, unsuspecting spring gardeners can get the rash from last season’s gloves.

If you come into contact with poison sap, or at the first sign of rash, you should take a long shower with plenty of soap and water. Avoid immersing in a bath because the oil can float, spreading to other parts of your body. Washing the oil from your skin will stop further spread. Rash may still appear in new areas, but this is because areas exposed to smaller amounts of sap take longer to break out.

Once you have the rash, it stays awhile. The skin has to repair itself, a process taking 10-14 days. All you can do in the meantime is treat the symptoms. With mild cases, over-the-counter hydrocortisone cream and oral antihistamines–like Benadryl–is the best combination to control inflammation and itching. If you have widespread rash, face involvement, or infected blisters, it’s time to see your doctor. You might need steroid pills, a shot, or an antibiotic.

As always, prevention is best. All three poison plants have compound leaves with three leaflets. My grandma used to say, “Leaves of three? You let them be!” and she was right. The leaves are glossy green with a smooth surface. In the fall, the foliage may turn orange or scarlet. Poison ivy is a stout weedy vine that often climbs trees. Poison oak is larger and more shrub-like. Poison sumac grows in swampy areas and can reach up to twenty feet in height.

There is a medicine that prevents the rash by providing a barrier on the surface of exposed skin. IvyBlock (bentoquatam) is available over the counter and approved for age six and up. It should be applied 15 minutes before exposure and reapplied every 4 hours for continued protection.

So get out there and enjoy the Spring. Grill your burger. Fill your tank. Take a ride in the country. But when you get there, remember what my grandma said. Otherwise, you might end up in the waiting room, scratching your sores with those other two million Americans.

Mike is an American pediatrician. Read more at http://www.pediascribe.com

COPYRIGHT 2006 Mike Patrick Jr, MD

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Mumps is sweeping the Midwest with the speed of a California wildfire. Doctors have diagnosed a thousand cases of the viral disease, and there’s no end in sight. Those most at risk for severe disease in the outbreak are adults with waning immunity and unvaccinated children.

Adult cases are understandable. After all, immunity from vaccination can decline over time. The involvement of unvaccinated children, on the other hand, is inexcusable. Free MMR vaccine is available to every American child at local Health Departments, and moms and dads who fail to get it for their children should spend an afternoon in the public stocks with “bad parent of the year” signs hung around their necks.

Vaccines are becoming victims of their own success. Today’s parent doesn’t remember the day when measles and diphtheria killed thousands of American children. They weren’t around when polio paralyzed a generation. They didn’t witness the miracle of Dr. Jonas Salk’s polio vaccine. In those days parents clamored to get their kids immunized, and thousands of children were spared a lifetime of metal braces and wheelchairs.

Today’s parent doesn’t exactly clamor for vaccines. Instead, she approaches them with reluctance and fear because of ranting quasi-scientists and militant moms who blame childhood vaccines for little Bobby’s autism.

The MMR-autism flap began in 1998 when Dr. Andrew Wakefield, a British bowel specialist, conducted a chart review of twelve patients. Really, I’m not making this up. Twelve patients. Based on that chart review, Dr Wakefield concluded that MMR causes intestinal inflammation, which leads to “leaky bowel,” which allows harmful toxins to enter the body. These toxins then travel to the brain and cause autism. Since every autistic child in the developed world had received an MMR vaccine and since autism is most commonly diagnosed between the first and second birthdays, around the time of the MMR, many parents of autistic children clung to the report like a colony of mold on old bread.

Never mind that the United Kingdom Medical Research Council condemned Dr. Wakefield’s report. Never mind that other medical researchers from around the globe found fault with his research methods. Never mind that subsequent well-designed statistically significant studies failed to show any link between MMR and autism. These stricken parents had found what they wanted–a reason.

So now many parents fear the MMR vaccine, and some downright refuse it. They’ll put their children in a speeding automobile a median’s throw away from a twenty-ton eighteen-wheeler rocketing in the opposite direction. They’ll let their children ride in an airplane traveling 500 miles-per-hour at an elevation of 35,000 feet. They’ll allow their children to swim unattended and ride bicycles without helmets and get on slapped-together carnival rides run by a guy sporting more tattoos than teeth, but they won’t get the MMR vaccine. It’s too risky. After all, Dr. Wakefield looked at twelve kids, and those militant moms–the ones who don’t want you vaccinating your children–agree with him.

Perhaps the current mumps outbreak will begin to change this misguided attitude. I guess mumps is as good a start as any. It’s an uncomfortable disease, but rarely fatal. You get headache and fever and painfully swollen salivary glands under the jaw. Ovaries and testicles can swell. Every now and then deafness results, or the brain swells. But for most, it’s a walk in the park compared to other vaccine-preventable diseases. The results of a widespread measles outbreak would be worse, and if diphtheria or polio ever raise their ugly heads, it will be tragic.

If you are one of those worried parents who haven’t vaccinated your children, please give it another thought. Talk to your child’s doctor. Sure, there may be some risk with immunizations, the most common being allergic reaction, but the benefit far exceeds the risk. If you still disagree with me, that’s fine. Don’t get the MMR. Don’t get any vaccines. But maybe you should also keep your children out of cars and airplanes. And please, oh please, don’t get them anywhere near those carnival rides.

Mike is an American pediatrician. Read more at http://www.pediascribe.com

COPYRIGHT 2006 Mike Patrick Jr, MD

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The recent immigration rally on the National Mall sparked controversy for Montgomery County High School in Rockville, Maryland. School officials allowed students to participate in the march and to claim state-required “community service” hours for the experience. This decision set off the tempers of otherwise-sensible parents, who inundated district offices with irate phone calls. They wanted an explanation. After all, community service is helping old folks in the home or serving lunch at the shelter or raising money for your favorite charity. It’s not about picking sides in a political debate. Or is it?

Not sure myself, I decided to visit the Maryland State Department of Education’s website to get their side of the story. I discovered something interesting–Maryland doesn’t require community service at all. What they require is “Student Service Learning” or SSL. Their site specifically states that SSL is not the same as volunteerism, community service, or work-study internship. So what is it?

SSL is an activity that meets 7 core criteria. First, it must fill a recognized need in the community. This may be a direct action (serving meals), an indirect action (fundraising), or an advocacy action, advocacy being defined as “educat(ing) others about a particular issue with the goal being to eliminate the cause of a particular problem.” The activity must be linked to curricular studies, help develop student responsibility, establish community partnerships, and equip students with knowledge and skills. The student must plan ahead for the activity and must write a paper reflecting on the experience.

So did participation in the immigration rally meet the requirements for an SSL activity? I think it did. The rally served to educate the American public by generating discussion of immigration issues, and the goal of the rally was the elimination of problems faced by immigrants; therefore, the advocacy criteria was met. The immigration rally was certainly linked to curricular studies. The students witnessed Amendment I of the Bill of Rights in action. For those of you who forget the wording from your own curricular studies, let me refresh your memory:

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances.

By actively exercising the right to peaceably assemble, these students gained a stronger sense of the First Amendment than they would have gotten from merely reading the words in a textbook.

But what about the other criteria? Did the rally develop student responsibility, establish community partnerships, and equip students with certain knowledge and skills? Again, I think it did. The students had to attend the rally under the supervision of CASA, a Maryland-based advocacy group for low-income Latinos in the D.C. Metropolitan Area. Through their involvement with CASA, students were exposed to other services CASA offers, such as English language and citizenship and financial skills classes.

The final two criteria were also met. Students planned ahead for the activity by contacting CASA and arranging time to attend the rally, and they were expected to complete a written report reflecting upon their experience.

In my mind, the immigration rally easily met the requirements for Student Service Learning as defined by the Maryland State Department of Education. So really, the irate parents should complain to the State if they want the advocacy clause removed, not the local school district. In the meantime, if these parents objected to the rally, they should have forbidden their minor children from participating and steered them toward a different experience.

I suspect the real problem is that the complaining parents disagree with CASA’s view of immigration reform. Perhaps these parents disagree with mass citizenship for illegals. Perhaps they feel illegals should be rounded up and sent south. Perhaps they feel a wall should be built along the U.S.-Mexico border. That’s fine. There is certainly merit to those opinions as our national debate on immigration reform continues.

But parent opinion on immigration issues is not the point here. The point is teaching our children that we have the right to peacefully voice our opinion in the United States of America without fear of imprisonment or execution. That is a right we should never take lightly. That is a right folks in China and Iran and North Korea hunger for. That is a right that could be extinguished in our own country if we fail to teach and defend it.

Mike is an American pediatrician. Read more at http://www.pediascribe.com

COPYRIGHT 2006 Mike Patrick Jr, MD

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