Staying Healthy Post Hurricane Harvey

As Texans begin to restore and rebuild following one of the most devastating storms in US history, we thought it would be a good time to talk about some of the health concerns that exist in this post flood environment and precautions everyone can take to stay healthy.

Harmful Elements in Flood Waters                                     Healthy Post Hurricane Harvey

Flood waters contain a variety of potentially harmful elements, many of which linger even after water begins to recede.  Aside from sheets of fire ants, snakes and other potential harmful critters, sharp metal bits, nails and glass shards are often prevalent and linger in debris.

In a recent interview with the Washington Post, Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, explained that sewage systems merge with flooding rain, introducing infectious human waste to streets and into flooded homes. What remains as sludge and a dirty film permeates everything it once washed over.  While the waters recede, the infectious elements remain and must be treated with caution (1).

And while it is not easy to predict which microbes will cause the greatest problems, the Centers for Disease Control and Prevention (CDC) reported 30 cases of MRSA, an antibiotic-resistant staphylococcus bacterium, in a group of New Orleans evacuees following Hurricane Katrina in September 2005. “Vibrio” pathogens, also known as “flesh-eating” bacteria, sickened two dozen people and killed six – in addition to reports of heat and infection-related skin rashes and red marks associated with biting mites (2).

Other Post Storm Concerns                                                                                             

The harmful material contained in flood waters and the contaminated and dangerous debris left in its wake are common concerns following a flooding storm (3), but there are also other lesser known concerns and areas of caution.  These include:

Scientific research is increasingly reporting the significant role that stress plays in our overall health – from a weakened immune system predisposing us to a host of illnesses, to increased risk of musculoskeletal injuries and conditions traditionally associated with physical stress only.  The type of stress that can come with the anticipation of such a storm, its duration and damaging aftermath is capable of threatening the health of an individual in ways many may not realize.  Referred to as “psychosocial” factors (frustration, dissatisfaction, depression and despair), the resulting stress has shown to induce physiological responses that can contribute to the development of musculoskeletal disorders (4).

Additionally, food and water quality that is compromised during power outages can challenge the healthiest among us if not approached with caution (5). Upper respiratory disorders associated with the rapidly growing mold following a Texas flood are a big concern.  Exposure to mold spores can prompt a rise in asthma and other respiratory illnesses.  The close proximity of individuals housed in shelters or working shoulder to shoulder in cleanup efforts can perpetuate respiratory illnesses and other communicable diseases.

Cuts and lacerations resulting from and/or exposed to flooded debris are particularly concerning to physicians.  The skin is the largest organ of the human body and should be protected as such.  Any opening creates vulnerability to not only the affected area but the entire body, particularly when exposed to potentially harmful microbes often found in flood water and debris as described earlier.

Reducing Risks and Staying Healthy Post Hurricane Harvey

There are several precautions that flood victims and those helping in their recovery should do to ensure everyone stays healthy post Hurricane Harvey.  These include:

 

  • Tetanus booster shots – Texas health officials urge people post Hurricane Harvey to get a tetanus booster shot to protect themselves against disease potentially entering the body through cuts/lacerations, unless one is current with their tetanus immunization (within 10 years). Even seemingly insignificant damage to a nail bed or cuticle should be treated as any other cut.
  • Proper garments and supplies – Clothing protecting arms and legs from flood sludge and lingering debris is strongly encouraged, along with rugged gloves for debris removal, rubber gloves for cleaning affected areas/items and face masks to minimize inhalation of potentially harmful elements.
  • Proper care of cuts/lacerations/skin rash – It is extremely important when working in flood environments to properly protect existing cuts and quickly clean and care for those occurring during cleanup. Risk of skin rashes resulting from the combination of sewage, chemicals and Houston heat can be reduced with the proper garments.
  • Adequate rest, relaxation – While it is difficult for those working to rebuild their homes and quickly reclaim their lives to contemplate taking time for themselves, it is a critical part of maintaining health and well-being. The rebuilding process for many will be a lengthy one requiring strong, healthy individuals.  Adequate rest, break from exposure to irritants and moments of relaxation/destressing can reduce risk of fatigue-related accidents/injuries, optimize mental outlook and maximize physical endurance.

 

When an injury is sustained or a respiratory or gastrointestinal irritation seems to linger, it is important to see a physician.  Postponing care can in some cases complicate an otherwise simple treatment or solution – and delay all recovery efforts.
Our health is truly one of our greatest assets. Let’s protect it!

 

 

References:

  1. The Health Dangers from Hurricane Harvey’s Floods and Houston’s Chemical Plants. Washington Post, September 1 2017.
  2. Infectious Disease and Dermatologic Conditions in Evacuees and Rescue Workers after Hurricane Katrina – Multiple States. Centers for Disease Control and Prevention (CDC). August – September, 2005.
  3. Stay Out of Flood Water, Texas Health Officials Urge. NPR – Houston Public Media News. August 28, 2017.
  4. Musculoskeletal Disorders – Psychosocial Factors. Canadian Centre for Occupational Health and Safety (CCOHS). Last updated August 13, 2012.
  5. Food and Water Safety during Power Outages and Floods. U.S. Department of Health and Human Services. FDA U.S. Food and Drug Administration. Last updated August 25, 2017.

 

Other Educational Links

 

 

It’s No Fish Tale – These Uncommon Hand & Upper Extremity Fishing Injuries Can Really Happen!

Located on the Gulf of Mexico and home to hundreds of lakes, it’s no wonder that the Texas coast is the playground to fishing enthusiasts far and wide.

Barracuda

unhook stingray2But even the seasoned sportsman can fall victim to some unlikely fishing injuries affecting the hand and upper extremity. In fact, fishermen (and women) put themselves in danger every time they come into contact with marine life – unpredictable behavior/aggressive and often forceful nature of a catch, prevalence of less commonly treated bacteria, unsanitary tools/equipment, poor wound care – all contributing to some common and not so common injuries that hand specialists see in a region like the Texas Gulf Coast.

Some common fishing injuries and conditions with which a Texas hand surgeon is all too familiar include:

fillet_2Many of these common injuries and conditions are treated non surgically and follow the same treatment protocol as any other patient with the same diagnosis – regardless of the cause.

Uncommon Hand & Upper Extremity Fishing Injuries and Conditions

Though there is very little that surprises a hand specialist practicing in “sportsman’s paradise,” an unusual injury associated with fishing will occasionally make its way to a Texas medical clinic.

Some of these uncommon injuries and conditions include:

  • Sting Ray Laceration
  • Fish Bite / Impalement
  • Fish Handler’s Disease / Bacterial Infection
  • Lodged Fish Bones, Fin Spine 

Unlike other injuries that break the skin, these types of fishing injuries are particularly concerning.  Fish and other marine life carry bacterial infections within their bodies, as well as on their skin, which can affect humans if certain precautions are not taken immediately. Some types of bacteria found in marine life are not commonly seen and do not respond to conventional antibiotics frequently used for infections.

Additionally, some marine life such as the Sting Ray utilize defense mechanisms that require special attention when used against a fisherman.

Sting Ray Laceration
While many sting ray injuries involve an inadvertent encounter between a foot or other lower extremity and a sting ray’s barb, some have occurred to the hand or wrist while trying to remove a sting ray from a fishing net or line.

These types of lacerations require more than bandaging.  Not only do sting ray barbs pierce like a weapon, all sting rays are armed with at least one serrated venomous spine at the base of their whip-like tail.  Short-tail sting rays have two tail spines: a slender spike in front of a large, jagged bayonet (1).

In addition to possible damage to muscle, tendons and nerves that can occur from the physical impalement of a sting ray barb, its venom is comprised of many different substances that can cause tissue to break down and die.
Some of the symptoms that Sting Ray venom can cause include:

 

  • Immediate and severe pain radiating up the affected limb
  • Bleeding and swelling in the affected area
  • Sweating
  • Faintness, dizziness and weakness
  • Low blood pressure
  • Salivation, nausea, vomiting, diarrhea
  • Headache
  • Shortness of breath (2)

 

Medical attention is recommended for all sting ray injuries.  Minimally, the wound will be cleaned with warm water to remove the venom and a tetanus booster given if it has been more than five years since the last tetanus booster. Tetanus prevention is required if the patient has never had a tetanus vaccination.  Antibiotics may also be required, and depending on the severity of the injury and amount of damage sustained (often the result of the delay in seeking treatment), surgical intervention to repair soft tissue damage and/or a period of rehabilitation may be required to restore strength to the injured limb (2).

Fish Bite and Impalement
While not every fish injury comes with a venomous double blow, the high risk of bacterial infection and soft tissue damage can be just as serious.  Many fish have sharp teeth, tails and pointed features that can easily break the skin.  Wrestling the unwilling catch onto the boat or beach can leave some sportsmen a bit worse for the wear.

 

Aside from the bacterial concerns that come with marine life, the forceful impact from a sharp feature of the fish can result in soft tissue damage that may require surgical repair and/or months of rehabilitation to restore hand and upper extremity function – as the hand alone is comprised of approximately 34 muscles, 120 known ligaments, and 50 nerves!

 

These types of deep puncture wounds or lacerations in the hand are also at high risk of infection and should be monitored closely.  A delay in the appropriate treatment can lead to complicated tenosynovitis and horseshoe abscess.  Additionally, marine life bacterial infections resulting from Mycobacterium marinum (M. marinum) do not respond to some conventional antibiotic treatment such as amoxicillin (3).

Fish Handler’s Disease
Not every fishing-related Mycobacterium marinum infection is the result of an obvious injury/wound.  A condition known as Fish Handler’s Disease can impact those frequently handling fish and generally affects the hands.  Any inconspicuous cut or small opening on the skin can allow the bacteria to enter the body.  The bacteria’s inability to proliferate in the warm body confines it to the affected area.

 

Common symptoms include swelling, tenderness, and bluish-purple spots. Fish Handler’s Disease is treated with special antibiotics used specifically for this type of bacterial infection.  Recovery can take months.

Lodged Fish Bones, Fin Spine
Occasionally in the handling of fish a fish bone or fin spine can lodge in the hand. Though this may not be painful or immediately worrisome to the injured party, these types of injuries are concerning.  Such injuries often leave residual fragments of foreign organic matter in the soft tissue, which can cause secondary infections such as Staphylococci and Streptococci (4).

 

Typically, x-rays are used first to try and identify a foreign body in the tissue, though are not always successful in doing so.  An MRI may be indicated to identify fine fin spines and tiny bones lodged in the body’s tissue. The surgical removal of the foreign body is important.  Failure to seek and remove the foreign body may lead to persistence of infection (4). Multiple surgical procedures may be required, and the patient is put on antibiotics to prevent infection. Physical therapy may be required after surgery to regain mobility of the hand.

 

If this type of injury goes untreated it can result in permanent disability and hospitalization for infection. Though the area may look as if it has healed, but is still tender, swollen, discolored, or abnormal in any way, individuals are urged to see a hand specialist.

 

Prevention and Precaution
Understanding the unique aspects of the marine life occupying the waters you’re sporting and utilizing protective gloves and garments while fishing can go a long way in injury prevention.  As the largest organ of the human body, our skin serves as a protective barrier.  When any area is compromised, our entire body is compromised. Individuals with other health conditions, such as diabetes or immune deficiency disorders should be particularly cautious and consult a hand specialist for proper wound care.

If not addressed properly, even seemingly minor fishing injuries can result in serious infection, lingering weakness or permanent disability – inhibiting participation in the sport you love.

 

References

 

Defending Against Turf Trauma

Football is now more than half way through the season, and we’ve seen our share of sprains, fractures, and concussions.  Many of these injuries have been discussed at length, so we thought we would talk about a growing concern; injuries occurring from or made worse as a result of the synthetic turf our kids are playing on today. Turf Concerns in Sports

Synthetic Turf Concerns

At the professional level, there is concern that the difference in buoyancy and other  attributes of synthetic infilled turf may contribute to increased risk of ligament injuries and overall musculoskeletal wear, resulting in prolonged fatigue and recovery between games. While studies continue to assess these concerns without conclusion, debates grow in women’s soccer and are capturing the attention of parents of young athletes playing on artificial turf across the United States [1,2].

There have also been a number of studies assessing increased risk of infection in football associated with playing on synthetic turf.  While studies are ongoing, there are currently no scientific findings to conclude that synthetic turf results in a higher number of infections than natural turf.  The abrasive nature of this artificial turf, though, has certainly resulted in an increased number of severe abrasions and lacerations of the skin, leaving players more vulnerable to infection.

The surface temperatures of synthetic turf are also significantly higher than that of natural grass turf when exposed to sunlight (Buskirk et al., 1971; Koon et al., 1971; and Kandelin et al. 1976, Devitt et al., 2007, McNitt et al., 2007).  This may contribute to increased bacteria growth.

Turf concerns have been noted as early as 2003 when Connecticut’s Department of Public Health launched an investigation into infections in a Connecticut college football team [3]. Of the 100 players studied, those with turf burns had an infection risk seven times higher than their scraped teammates. Cornerbacks and wide receivers, who frequently come into contact with other players, accounted for most cases. Improperly treated whirlpools could also have helped spread the bacteria.

When these bacteria become resistant to antibiotics they can spread and cause pneumonia, bone infections, or life-threatening infections of the bloodstream that are difficult to treat.

Reducing Risk for Turf Related Skin Infections

Each football season, we see a growing number of skin infections related to synthetic turf burns, abrasions and lacerations.  While many of these infections can be treated with antibiotics, those more resistant require special attention.  Parents and coaches are encouraged to educate their athletes on preventive practices to avoid the dangers of a serious skin infection.

Signs of a Turf-Related Skin Infection

Two of the most common skin infections associated with turf, both natural and synthetic, are Staph (staphylococcus bacteria) and MRSA (resistant staph).

Staph is one of the most common forms of infections that can develop from a turf wound.  This type of skin infection, also referred to as cellulitis, may or may not result from an open sore/wound.

Possible Symptoms of a Skin Staph Infection include: 

  • An area of tenderness, swelling, and redness
  • Inflammation — redness, warmth, swelling, and pain
  • Fever and sweats, as well as swelling in the area (if the infection has spread)

MRSA is a more serious type of staph infection resistant to many of the antibiotics used to treat staph and other common infections.  These types of infections require special antibiotic therapy.

Possible Symptoms of a MRSA Infection include:

  • General feeling of poor health (malaise)
  • Skin rash
  • Headaches
  • Muscle aches
  • Chills / Fever
  • Fatigue
  • Cough
  • Shortness of breath
  • Chest pains

Treatment of Staph and MRSA Infections

Treatment for Staph infection generally entails a course of antibiotics.  Treatment for MRSA requires a special class of antibiotics or a combination of multiple antibiotics – depending on the patient’s response and the severity of the infection.

Reducing Risks of Skin Infections

The Center for Disease Control (CDC) has outlined the five primary conditions for contracting and spreading MRSA and Staph infection.  Referred to as the Five “C’s”:

  1. Crowding
  2. Contact – frequent skin to skin
  3. Compromised Skin (cuts, scrapes, abrasions)
  4. Contaminated Items (sweaty towels, clothes, mats, synthetic turf)
  5. Cleanliness

For the prevention of skin infections, it is important that athletes:

  • Keep wounds covered and contained
  • Shower immediately after participation
  • Shower before using whirlpools
  • Wash and dry uniforms after each use
  • Report possible infections to coach, athletic trainer, school nurse, other healthcare providers, or parents

Other CDC recommendations addressing MRSA and Staph infection in sports can be found on their website: http://www.cdc.gov/mrsa/community/team-hc-providers/index.html .

References

1.) Meyers MC, Barnhill BS.  Incidence, causes and severity of high school football injuries on FieldTurf versus natural grass:  a 5-year prospective study. Am J Sports Med. 2004 Oct-Nov;32(7):1626-38.

2.) http://www.usatoday.com/story/sports/soccer/2014/10/15/alex-morgan-us-women-artificial-turf-world-cup/17295011/

3.) Begier et al. 2004. A High-Morbidity Outbreak of Methicillin-Resistant Staphylococcus aureus among Players on a College Football Team, Facilitated by Cosmetic Body Shaving and Turf Burns. Clin Inf Dis. 2004;39:1446-53.

(Keywords:  synthetic turf, artificial turf injuries, lacerations, Staph infection, MRSA, sports injuries, skin infections)