Walking with Mosquitoes
Q I am an avid hiker, and lately I worry about possible infections from mosquitoes and other biting insects. How can I protect myself, and what symptoms should I look for?

A In the US there are a few viruses you can get from hiking in the woods, mainly from mosquitoes and ticks.

These viruses are called arboviruses (arthropod-borne), and they are transmitted to humans from biting insects. Most of the symptoms that result from an infection are: A sudden onset of a fever, malaise, or fatigue; headaches; swollen lymph glands; possibly a rash; and muscle aches and pains. The symptoms are actually a lot like a bad case of the flu. Most symptoms don’t start until seven days from the time of the bite, and depending on which virus is causing the infection, more severe symptoms can ensue, such as an unproductive cough, yellowing of the skin and conjunctiva, and abdominal pain including an enlarged and painful liver.

Diagnosis of an insect-borne infection is generally done by taking a case history and a blood test to detect antibodies. Treatment generally consists of antibiotics, corticosteroids, and supportive care.

Preventive care should include wearing long-sleeved shirts, long pants, and crew socks. For added protection, tuck the pants inside the socks. Use tick and mosquito repellants and practice good personal hygiene. After every hike, search your entire body for ticks. Look carefully at the scalp, nape of the neck, armpits, knees, and groin area. Don’t forget to check your dog. If you find a tick, don’t crush it with your fingers or give it a hard yank; this can more readily transmit the virus. Use tweezers to gradually and gently pull the tick free.

I would say the best thing you can do is enjoy the great outdoors, be proactive, but be mindful of the possibilities of infection.
— Lindsey Nelson

Poison Oak
Q I just started hiking in the woods and want to teach my children to be careful around poisonous plants. How can I identify poison oak?

A This is one way of remembering: Poison oak: Leaves of three, let them be!

Summertime walks put you in contact with poison oak, a vine or a bushy plant that has leaves with three, five, or seven lobes. Exposure to the plant’s natural oils can cause an itchy rash in up to 85% of people. It is an allergic response that occurs 24 to 48 hours after two or more exposures to the plant. The oil is found in the leaves, stems, and roots and can also become airborne when the plants are burned or cut with a mower.

The best protection is prevention. Wear long-sleeved shirts, long pants, socks, and shoes when you are hiking. Ivy Block is a brand name product for an FDA-approved preventative skin film. If you think you have been exposed, wash the area with soap and water within 10 minutes. Also wash all clothing, toys, pets, garden, or sports equipment.

Once the rash occurs it will run its course, in two to four weeks. Itching can be lessened with oatmeal baths. Antihistamines, such as Benadryl, can be helpful at night. Natural antihistamines include stinging nettle, quercetin, butterbur, and vitamin C. The oral homeopathic, Rhus tox 30c, may lessen the severity of the reaction. Topical applications of aloe, calendula, jewel weed, or blue vervain are also helpful.

Keep the rash clean by washing daily with soap and water. A secondary bacterial infection is possible if you scratch the rash, and that may need to be treated with topical antibiotics. The weeping lesions do not contain any of the plant’s oil, so these won’t spread the rash. Interestingly, those who are allergic to poison oak may also react to mangos, cashew shells, and ginkgo trees.
— Lindsey Nelson

Funny Feeling In My Feet
Q An odd sensation continues to occur under my toes, and it seems to be coming from the tendons. While walking, all of a sudden it feels like the tendons in my toes catch on something and then release past it. What is going on?

A As you run or walk and put more stress on the feet, the body responds by adding more fascia tissue to strengthen and toughen up the feet, especially the soles. As these new fascia layers are laid down they can become fibrous adhesions in the muscles and old fascia. Frequently these adhesions can cross over the tendon’s sheath. This will cause the tendon to be constricted within its sheath and impair the normal lubricating fluid flow between the tendon and its sheath.

After a period of time, this can lead to a scar tissue build-up within the tendon’s sheath or on the tendon itself (think of a rope fraying against an edge). This will feel and sound like the tendon is catching or grabbing within its own sheath. Though it rarely will be painful by itself, if the feet are used in a manner they are not accustomed to, or if repetitive stress is put onto the tendons themselves, then they can become inflamed and tender, which will exaggerate the catching sensation.

Prevention is simple: Proper nutrition and hydration, stretches for legs, feet, and toes, and foot massages. (Finally, an excuse!) My favorite stretch is putting a golf ball under the arch of the foot and rolling it around to break apart the adhesions. Having a good sports-massage therapist work specifically on the feet and tendons is usually the most beneficial. If the feet are really inflamed and tender, then it would be smart to stick with the standard treatment: rest, ice, compress, elevate (RICE). Have a healthy walking summer out there!
— Jacob May

This Issue’s Experts
Lindsey Nelson, ND, is a naturopathic primary care physician and can be reached at 503-279-0205 or by email at lindsey@clearh2o.org.

Jacob May, DC, brings careful thought and analytical thinking blended with a holistic approach to medicine. To contact Dr. May call 503-279-0205 or jacob@clearh2o.orgemail .