Skin and Bones

Dealing with ailing bodies and human foibles all day long, it’s no wonder doctors have a sick sense of humor, me included.  When people show me their kids’ rashes in public, I play it straight and happily consult.  However, occasionally adults will haul up their shirts at parties to show me the latest blemish on their bellies or backs and ask, “Hey Doc, what the heck is this?” I nod confidently: “It’s definitely cancer,” I say. Then I give them a wry smile that says, hey, only kidding!

Given the warm winter we’ve had, the early spring, and the early school closings, I predict a rough summer for rashes.  Children meet the outside world with their skin.  When falling off bikes or monkey bars, not “sticking the landing” as they say in gymnastics, they get scrapes and cuts and bruises.  When they plow through vegetation exploring or searching for stray balls, their skin gets irritated by thorns or poison ivy. Mosquitoes enjoy a blood meal from our children, and later, when the bite itches, they tear at themselves with ragged, dirty fingernails.  Sun cooks hot, exposed skin too.

We’re all learning new habits from Coronavirus concerns, like washing our hands more often and extra carefully, wiping down potentially contaminated surfaces, and trying not to touch our faces.  It’s also a good time to improve skin-care habits for children.  That’s the best prevention for skin injuries and infections that we’ll see in the Emergency Department in the coming months.  Paradoxically, skin is hardest to hurt when it’s soft and pliable.  It bounces back, and heals better.  Hard dry skin cracks under pressure and itches worse when insulted.

Kids should use moisturizing soap. Buy brands like Dove and Caress, which are easy on skin, rather than harsh drying soaps like Ivory, Zest, Dial, or Irish Spring.  Washclothes and vigorous toweling also can irritate, so kids should use only their hands and the soap, and pat dry with towels. Advanced Parenting involves using white lotion to moisturize kids’ skin, putting on sunscreen, and applying bug spray.  When a kid gets a cut or scrape, “rub dirt on it” is just a joke!  Wash broken skin with soap and water, and dress it with neosporin and bandages.  Please keep those grubby ragged fingernails clean and short.

In 2008, New York City mom Lenore Skenazy was shopping with her 9 year-old son.  They had ridden the subway, and that day he begged Ms. Skenazy to let him ride home by himself.  Having taught him how to read subway maps and distinguish between uptown and downtown trains, she decided to let him go.  He got home safely and was ecstatic with his feat.  But when Ms. Skenazy wrote about his adventure in a newspaper column, she set off a storm of controversy.

Some called her the “world’s worst mom.” Child Protection paid her a visit.  Others praised her for giving her child freedoms not allowed by “helicopter parents,” so-called because they hover over their kids’ every move. Ms. Skenazy then briefly had a reality TV series where she coached such parents on letting their kids ride bikes or slice vegetables.  The show’s title: World’s Worst Mom.

Fortunately, we in Acadiana needn’t worry about children navigating crowded cities. But they will be having adventures on bikes and trampolines, or dirt bikes and ATVs.  Most emergencies we’re seeing now are injuries from these. If your child falls off a bike or monkeybars, check the head first.  Head injuries are the most common serious injury in pediatrics.  If the kid has been knocked out or is acting confused, get them into us right away.  Please put helmets on bike-riders before this happens!

If the head checks out okay, limbs are next.  Broken bones are obvious: the child cries and points to the dinged wing.  Sometimes it’s bent in an unnatural way.  The best care for an injured arm or leg is to immobilize it. Preventing the hurt part from moving is the best pain control.  Tape it to a rolled up newspaper or magazine, or a handy board. Give your child some pain medicine, like ibuprofen or tylenol.  DON’T give your child anything to eat or drink.  They’ll need an empty stomach if anesthesia is necessary.

If your child crashes a motorized bike or ATV, you’ll feel like the World’s Worst Mom- these vehicles’ power and speed are too dangerous for little bodies.  Bikes are good enough, and better exercise for their skin and bones.

Arachnophobia

As a kid, spiders freaked me out; even touching a picture of one gave me the willies.  The worst was in 1983, when I was on a mission trip to Haiti.  One night I was getting in bed, when I decided to pull back the covers first.  I peeled the sheet back a little, and a large black beetle ran out. Weird, I thought, what else is in there?  Peeling back a little more, a lizard ran out. A little more, another beetle.  Tired of that game, I yanked the sheet all the way back and there was a scorpion.

Hairs standing on end, I thought, “what if I had climbed in without looking?”  After 5 minutes I worked up the courage to flick the bottom sheet to toss the beast on the floor, where I kept stomping and jumping back, I’m sure yelping too, until it was dead.  Then for the only time in my life, I said, “I need a drink,” and sought a bar.

While we do have the rare scorpion in Louisiana, far more worrisome arachnids are ticks. Ticks encounters are more common in the fall, when they are most active and their human targets are back outside in cooler weather.  Ticks don’t sting like scorpions, but they can transmit some nasty infections.  The two deadliest are Rocky Mountain Spotted Fever and it’s cousin, Erlichiosis.  After a bite, the victim develops fever, headache, and fatigue. Days later a rash of tiny spots appears all over, and the patient gets deathly ill.  Another tick-borne infection is Lyme disease.  This starts with a rash that looks like a target- central redness surrounded by a pale ring, in turn surrounded by a red ring.  If undiagnosed, Lyme can later cause joint pain and swelling and heart and nerve damage.

Fortunately, all these infections are more rare in Louisiana than other states.  Lyme is found more north, and despite it’s name Rocky Mountain Spotted Fever is mostly in the mid-atlantic states.  However, you can get them, so avoid tick bites.  If hiking in the woods, use bug spray on your socks and pants, and tuck your pants into your socks (ticks climb upward).  When showering later, inspect yourself for ticks- they can be tiny and sneaky.  If you pull them off within 24 hours, you greatly decrease your chance of disease.

Enough about scorpions and ticks; we need to talk about the most common arachnid we encounter- spiders.  Spiders have an undeserved reputation as bad guys. But only once in 24 years of practice have I seen a bite from the worst of American spiders- the Black Widow.

The 15 year-old farm boy had left his boots in the barn.  That morning when he put them on, without socks, he felt a pinprick between two toes. Thinking nothing of it, he went to work.  That afternoon he began to feel lousy- sweaty, crampy, and weak.  He came into the Emergency Department pale, damp, and breathing hard.  After hearing his story, it was pretty clear what happened.  We admitted him to the Intensive Care Unit for fluids, muscle relaxers, and pain medication, and he eventually recovered.

The other “bad” spider in our area is the Brown Recluse. This spider’s bite is also rare. When bitten, the victim usually feels nothing.  However, over the next few days the bite site can get red, swell, and develop a bluish blister of dying tissue.  It looks like an abscess (or “boil”), but with blue-black tones and an open wound where the skin has died.

Because of what the Brown Recluse bite looks like, many assume every boil is a spider bite.  Day after day kids and adults come to the Emergency Department complaining of a “spider bite,” when the vast majority of these are due to other skin traumas like cuts and scratches and mosquito bites, that become infected.  

Though unusual, you don’t want a spider bite in the first place, so it’s best to avoid putting your hands and feet where spiders live.  Both Brown Recluses and Black Widows like dark areas, only biting when their hiding spots are invaded.  So wear heavy gloves when putting your hands in wood piles or other dark spaces.  Keep household and outdoor storage uncluttered- spiders love to hide in old yard debris piles and stacks of bricks.

And keep your boots indoors!