Nine health concerns in the summer

Ah, summer, those warm days of outdoor adventure and relaxation.

Not to dampen your enthusiasm, but as you bask in the summerness of it all, there are some health issues — beyond sunburns — that spike at this time and are worth paying attention to.

For you — and, if you're a parent, for your kids as well — here are nine concerns to keep in mind as you navigate the heat and the great outdoors.

Athlete's foot

The same fungus that causes jock itch and ringworm incites this scaly, itchy, stinging and burning rash on the feet, usually between the toes.

It may seem a minor irritant, but untreated athlete's foot can create skin fissures that become infected, says Stephen Pribut, a Washington podiatrist. One sure sign of infection: oozing pus.

The offending fungus lingers on warm, wet surfaces such as poolside pavement and the floors of locker rooms and public showers. It loves moisture, warmth and confined spaces, so once you pick it up on your skin and then sweat in your shoes, you're setting the stage for athlete's foot.

Instead of going barefoot at the pool or in public showers, wear flip-flops. As for hot-weather workouts, you might think cotton socks would be best — but they're not, Pribut says. Opt instead for “wickable” fabrics, made from synthetic fibers or merino wool, that allow moisture to move away from the skin. (If you prefer cotton socks, make sure they're clean, and take them off right after you exercise.)

As for shoes for workouts and general use, choose those that “allow your feet to breathe,” Pribut suggests. After a workout or a sweaty walk from the pool, thoroughly wash and dry your feet, especially between the toes.

Mild cases of athlete's foot are easily treated with over-the-counter antifungal powders or creams. You should start using them the first time you notice your feet are itchy, and you should use them for the entire time recommended on the package to prevent recurrence. Sometimes itchy patches develop into cracked skin that can become infected, in which case over-the-counter antibiotic creams may be necessary.

As for the toenail condition that leads to yellow, thickened nails, it is caused by a related fungus and can be prevented in similar ways, Pribut says: Give feet some breathing room and a break from nail polish one week per month. Unlike athlete's foot, toenail fungus is notoriously tough to treat once it has set in. Pribut says over-the-counter liquids and other remedies simply don't work. Instead, go for a prescription treatment right from the start. (Some people resort to laser treatments, which can be pricey.)

Coxsackie virus

One of a number of viruses that live in healthy intestinal tracts, Coxsackie is best known for causing hand, foot and mouth disease (HFMD) in children. HFMD is most prevalent in the summer months, and it seems to love kids' warm wading pools.

Bonnie Maldonado, a professor of pediatrics and infectious diseases at Stanford University Medical School, explains that in HFMD, small blisters develop on the tongue and elsewhere in the mouth, the palms of the hands and the soles of the feet; it can be somewhat painful, Maldonado says, and can cause fever, sometimes a high one. On rare occasions when an outbreak moves through a population, it can bring more-serious symptoms including asthma and neurological problems such as temporary infection of the brain. In very rare cases, the disease can cause heart infections and even heart failure.

There is no treatment for HFMD beyond controlling fevers that develop. Also, it's important to keep an infected child away from others. The virus is transmitted via close personal contact and what Maldonado calls the “fecal/oral route” — that is, when traces of stool find their way into mouths, as at kiddie pools. Diligence about washing hands after changing a diaper or using the bathroom is key.

Because fecal matter can leak out of diapers and swimsuit bottoms and into swimming pools, Maldonado recommends making sure any pool you're using is chlorinated. The Centers for Disease Control and Prevention has tips for cleaning backyard wading pools, including emptying and cleaning them after use and letting them dry out in the sun for at least four hours.

Food poisoning

Illnesses caused by food-borne pathogens can be merely unpleasant, but they also can be deadly, particularly to young children, whose immune systems are still developing, says Shelley Feist, executive director of the Partnership for Food Safety Education.

Summer's heat and humidity encourage the growth of bacteria in food and elsewhere. Add the fact that a lot of us cook and eat outdoors in the summer — at picnics, while camping — without safeguards such as refrigeration, dishwashers and food thermometers, and you've got a recipe for food poisoning.

Feist says the two-hour rule — which holds that it's safe to let food sit outside the fridge or cooler for that length of time — doesn't apply outdoors when temperatures exceed 90 degrees. So when dining outside in the summer, she suggests, don't allow food to sit out longer than one hour; put it right back in the cooler after serving your meal. And those who use grills should remember to cook ground beef to 160 degrees and solid meats and poultry to 165 degrees.

The USDA offers these tips for summertime food safety:

• Wash your hands, and bring jugs of bottled water on picnics for preparing food and cleaning utensils and dishes. Also bring along a pack of moistened towelettes for washing hands and prep surfaces.

• Keep raw meats separate from other foods in the cooler and on prep surfaces.

• Keep cold foods cold; pack them in a cooler with plenty of ice. If you don't have access to a cooler and ice (or ice packs), consider dining on foods that don't require refrigeration such as fruit and vegetables, hard cheeses, canned or dried meats, bread, peanut butter and crackers.

You can learn more about food safety by going to www.befoodsafe.org or by doing an Internet search for “USDA summer foodborne illness.”

Heat exhaustion and heat stroke

People of all ages are susceptible to heat-related illnesses, says Rebecca Noe, an epidemiologist at CDC's National Center for Environmental Health. Older people (especially those whose bodies' ability to regulate temperature has been compromised by illness or medications), young children (whose bodies haven't yet fully developed the ability to regulate their temperature), people who are obese (which can cause your body to run hot) and those who work and exercise outdoors in the heat are at heightened risk.

Heat exhaustion occurs when people are exposed to very high temperatures and don't drink enough fluids. Symptoms include heavy sweating, clammy skin, weakness, nausea, vomiting and fainting. Getting out of the heat and drinking fluids will often remedy the situation, Noe says.

Heat stroke is another — and far more serious — matter. It develops when the body temperature rises to 106 degrees, and it is a life-threatening condition. People suffering heat stroke stop sweating and become confused. Heat stroke requires emergency medical attention, Noe says: “Call 911 immediately.”

Noe says the CDC focuses on prevention with the mantra “Stay cool. Stay hydrated. Stay informed.” When it's very hot, find someplace air-conditioned — a library, a shopping mall, a public building — if possible. If you have to be outside, Noe says, drink plenty of fluids, wear loosefitting, light-colored clothing, and take frequent breaks in the shade. Also, wear a hat and take cool showers. Talk to your physician about how much water you need to keep your body hydrated. And stay informed about weather conditions and the availability of local cooling stations during heat waves.

Adults should be especially careful during the summer not to leave children in parked cars. Even with the windows cracked open, the temperature inside can rise swiftly and lead quickly to heat stroke or worse.

Heat rash

When it's hot and humid, sweat glands can become blocked by excess perspiration, trapping sweat beneath the skin and causing a red, bumpy, prickly rash — heat rash. It's more common among babies, whose sweat glands are immature, and among people who aren't accustomed to heat and humidity, says Maral Skelsey, a clinical associate professor of dermatology at Georgetown University Medical School in Washington.

Skelsey says tightfitting clothing can further encourage the rash to develop by trapping sweat against the skin instead of allowing it to evaporate.

In babies, Skelsey says, the condition tends to resolve on its own; keeping a baby cool and lightly dressed — or even naked if the temperature is warm enough — is usually all that's required. Adults, she says, may wish to treat the rash with over-the-counter topical steroid cream (to calm the itch), calamine lotion or anhydrous lanolin, an over-the-counter balm that can help keep skin ducts from getting blocked. Avoid getting overheated in the first place by taking breaks from outdoor heat in air-conditioned spaces when possible. As your body gets acclimated to summer's hot and muggy weather, Skelsey adds, it will become less prone to heat rash.

Infections from open cuts

Nothing says summer like a barefoot stroll on the beach. But if you've got a cut, even a minor one, on your foot, be aware that you're opening yourself up, literally, to infection. A variety of bacteria, including Staph. a and E. coli, and other organisms can live in sand and beach water, and that can mean trouble if they enter your body through that cut.

Alan MacGill, a foot and ankle surgeon in Boynton Beach, Fla., says the greatest concern is over MRSA, an aggressive bacteria that is resistant to some antibiotics and is one cause of necrotizing fasciitis, the rare ailment commonly known as flesh-eating disease. MRSA can cause infections in bones, lungs and other organs; if left untreated, it can become lethal, according to the CDC.

If you have a cut on your foot after spending time at the beach, shower or bathe with soap and water. Then be on alert for signs of infection, MacGill says, including redness around the cut, warmth radiating from it, drainage from the wound, fever and chills.

If those signs appear, go immediately to a doctor's office or emergency room, where you'll be examined and perhaps have your wound cultured to figure out which strain of bacteria is present. “If it is a serious infection, the patient will be hospitalized and given IV antibiotics,” MacGill says.

You'll probably also be asked when you got your last tetanus booster, MacGill adds. But don't worry if you can't remember: While adults should get boosters every 10 years, there's no harm in getting them more frequently.

Poison ivy

This condition is an allergic reaction to urushiol, an oily black substance found in the leaves, stems and roots of poison ivy and its cousins poison oak and poison sumac.

Ella Toombs, a Washington dermatologist, says it's usually easy for physicians to spot a poison ivy rash because it's linear — a line of bumps, often weepy-looking — rather than diffuse, as only the skin that actually has touched the plant reacts to the oil. In cases involving the face, eyes or genitals, or when the rash covers most of your body, or if you've inhaled smoke from a fire in which poison ivy has been burnt, a prescription drug such as prednisone may be required to calm your body's reaction. Otherwise, the itchy condition is generally just a very unpleasant nuisance that resolves itself in a couple of weeks. Cool baths and showers can provide relief in the meantime.

The best medicine is prevention: avoiding contact with the plants. (The rash itself isn't contagious; only contact with the oil causes the rash, Toombs says, though if the oil gets on a dog's fur or someone's clothing, it can cause a rash in those who touch it.) “Leaves of three, let it be,” “hairy vines no friends of mine” and “longer middle stem, stay away from them” don't make for great poetry, but they are useful in helping identify poison ivy.

Wearing long sleeves and pants and gloves while doing yard work helps, and putting on an over-the-counter ivy block lotion before heading out can prevent the plant oil from penetrating the skin. If you are exposed, Toombs suggests washing the exposed skin with rubbing alcohol, then with cold water and then showering with soap and water. You'll also want to clean any tools or clothing that may have been exposed, she says. Calamine lotion can calm the itch. Try not to scratch the rash, hard as that may be, because scratching can break open the skin and pave the way for secondary infection. Scratching, though, does not spread the rash.

Not everyone who is exposed to poison ivy will get the rash; Toombs says about half the population can tolerate exposure to urushiol. But even they should be cautious.

“I have never had poison ivy,” she notes, “but that doesn't mean that if I see a plant I'm going to go touch it.” In fact, even if you have never had poison ivy, your body can develop a sensitivity to it with repeated exposure, and someday you'll develop a rash.

Swimmer's ear

You don't have to go swimming to get swimmer's ear, an infection of the skin of the ear canal.

“It can really, really, really hurt and ruin a vacation,” says Richard Rosenfeld, an otolaryngologist in New York. Rosenfeld cowrote his specialty's latest swimmer's ear guidelines, which call for shifting away from routine use of oral antibiotics in favor of topical treatment using antibiotic eardrops and, if needed, over-the-counter pain medicines.

Moisture in the ear from the pool, ocean, a shower or even sweat helps set the stage for swimmer's ear, Rosenfeld explains, by promoting bacterial growth in the ear canal. When bacteria that normally live in even healthy ears find their way under the skin via a scratch or an irritated spot, they can spread and cause infection. Anything poked into the ear — including hearing aids, ear buds and cotton swabs — can scratch or break the skin there, Rosenfeld says. “Ironically, people using ear plugs in the pool to prevent swimmer's ear are probably causing it by poking those plugs in their ears.”

The first sign of swimmer's ear is usually a sense of fullness in the ear, Rosenfeld says, and pain if you pull or push the tragus, the triangular flap of skin at the entrance to the ear canal. “If you leave swimmer's ear alone, it will progress and become awful,” Rosenfeld says.

A physician can prescribe eardrops containing antibiotics, he says. But it's easy to treat a mild case on your own, Rosenfeld says, with a 50-50 mixture of white vinegar and rubbing alcohol. Fill an ear dropper with it and, lying on your side with the affected ear up, fill the ear with the solution. Lie still for a few minutes while the liquid is absorbed. The vinegar is acetic acid, which hinders bacteria growth, and the isopropyl alcohol is an antiseptic and drying agent.

“If you're prone to water in your ears,” Rosenfeld recommends preventive steps after swimming or showering: “Dry your ears with a blow drier on a low setting, and use an ear dropper to put rubbing alcohol in your ears, to break up the water and help it evaporate.”

West Nile virus

West Nile virus is a mosquito-borne infection that was first detected in Uganda in 1937 and first appeared in the New York City area in 1999. U.S. outbreaks have occurred every summer since then, and the disease has spread to 48 states (not Alaska or Hawaii, so far), according to the CDC.

In 2014, 2,205 people in the United States were reported as having been infected, and 97 deaths were attributed to the virus, according to CDC data.

When an infected mosquito bites a human, the insect can transmit the virus. Ingrid Rabe, a CDC epidemiologist, says only 1 in 5 people who are infected will develop symptoms, which range from fever and general discomfort to (in less than 1 percent of cases) severe, sometimes fatal neurological problems such as meningitis, encephalitis and (still more rarely) “acute poliolike disease.” Though these worst effects are extremely uncommon. West Nile virus is not to be taken lightly, Rabe says, because it has “no cure and no treatment, other than supportive treatment for symptoms.” And while “in most cases it won't progress past those relatively minor symptoms, there is nothing you can do to stop its progress” once it begins to worsen, she says.

That's why the CDC and other health agencies emphasize prevention. Rabe says people should avoid mosquito bites by using insect repellents (be sure it's approved for warding off mosquitoes), wearing long sleeves and pants when outside and avoiding the outdoors from dusk to dawn in the summer months, as that's when mosquitoes are most active. It's also smart to make sure window screens are in place and intact and to get rid of any sources of standing water such as pool covers, discarded tires and even toys strewn in the yard.

If you suspect that you have West Nile virus, the CDC recommends seeing a physician, who may evaluate your symptoms and run tests to detect antibodies to the virus, which would confirm the presence of West Nile.