Posted: Tue Apr 05, 2005 9:03 am Post subject: When summer outings become a nightmare
AMAZING GRACE
By Dr. Grace Carole F. Beltran
The Philippines is rich in natural resources. There are several destinations, like the underwater caves of Palawan, the Hundred Islands and the Banawe Rice Terraces, which are so mesmerizing you won’t want to return to the real world once you visit them.
I’m sure most—if not all—of you are planning a holiday this summer. Wherever you’re going, what is important is how you can make your outings safer and more relaxing for everyone in your family or group of friends.
A friend of mine just returned from an out of town get together with his family. He told me how they were all excited about the holiday, until they had parked their car at their destination. Apparently, the parking area was full of flowering trees. No one would ever think that danger was just lurking just around the corner, but suddenly, one of his teen-ager sons felt a sting on one of his fingers. Several minutes later, his son’s hand was swollen. Several minutes more and his eyes and lips were swollen. An hour later, his son started to feel something heavy on his chest and a tightening sensation.
Fortunately by the time the boy was having difficulty breathing, they had already arrived at the nearest emergency room, which saved the day for this family.
What the boy experienced is called urticaria (tagulabay), which most people would probably take for granted. For those who are well aware of the possible fatal consequences of this dermatologic problem, the earliest sting should be a warning sign that a more frightening situation may be inevitable: Angioedema and/or anaphylaxis in medical parlance.
Angioedema and urticaria should be viewed as varying manifestations of the same pathologic process. In severe neglected cases it can proceed to anaphylaxis, a fatal reaction that involves the respiratory, cardiovascular and possibly, the gastrointestinal systems. These conditions can occur together or separately.
In the boy’s case, what he had was angioedema. Angioedema involves postcapillary venule (very small blood vessel) inflammation, which allows leakage of fluid (vascular permeability) from inside the blood vessel to tissues outside of these vessels, producing swelling and all the signs and symptoms previously mentioned.
Cells known as mast cells and basophils found in the skin and different body organs release substances called mediators that cause inflammation in the small vessel walls. The release of these substances can be triggered by so many things like food (peanuts, sea foods, nuts, eggs), drugs (NSAIDS, aspirin, penicillin, cephalosporins, insulin, sulfonamides, blood transfusion, vaccines, etc.) exercise, alcohol, and even medical procedures like x-ray upon using radiocontrast agents to visualize body parts, insect bites and many others.
Clinical manifestations occur within seconds of antigen exposure (trigger factor).
Severe upper airway obstruction can lead to asphyxia (suffocation), while lower airway obstruction with wheezing and chest tightness is caused by bronchospasm (narrowing of bronchus). Severe hypotension (lowered blood pressure) is caused by massive shift of fluid from the inside of blood vessel to the outside.
The earlier treatment is instituted, the better, to prevent the occurrence of anaphylaxis, which is a far more deadly situation.
When going out of town here are some tips to help health problems:
• Bring along antihistamine and steroid tablets, or creams in case of allergic reactions. Bring all other emergency medicines that you or your family members are using just to be on the safe side.
• Insect repellants can be helpful if you intend to go around forested areas.
• Pants would be better than shorts and skirts when venturing in forested area.
• Wear aqua shoes to protect feet from injury by rocks or bites from sea creatures. Sunblock is very important too.
• Alcohol and betadine can be handy in certain situations when you might graze your skin accidentally. A simple band-aid may also be helpful in such cases.
• Moisturizing lotions can minimize acquisition of injury compared to when your skin is dry.
• Choose your destination. The Banawe Rice Terraces for example are quite tough for children and older people; the same thing goes for trekking the rough terrain by horse of the slopes of Taal Volcano. This is best only for the young and fit.
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