Author's note: this is part two of a story on outdoor water safety. Click here for part one.


More sun and rising mercury mean people will head outdoors to lakes and forests. But something as simple as drinking river water can lead to an illness that derails your spring.

Bethany Huelskoetter, APRN, a family medicine provider at OSF HealthCare, hits the major safety points about leisure time on the water.

• Bug bites: Coat yourself with bug spray to start the day, and avoid hanging out in tall grass where pests can hide. If your bug bite comes with skin tissue damage, chest pain, muscle cramps, sweating or nausea, see a provider right away. Also, watch for a rash in the shape of a bullseye, which is common with tick bites. To remove a tick, use tweezers to get close to the skin, and gently pull the insect out. Avoid twisting and yanking.
   
• Life jackets: Illinois and Michigan outline their life jacket laws. And some additional suggestions from Huelskoetter: for young kids, use a life jacket that straps on like a diaper. Life jackets that go over the chest could come up over the child’s head, and they could slip out or have trouble breathing. And read the life jacket label to make sure it’s right for you based on your chest size and weight.
  
  Huelskoetter also says a life jacket or any wet object has a risk of mold. So, dry the life jackets by hanging them in the sun.
   
• Fire extinguishers: Like life jackets, Illinois and Michigan laws require a United States Coast Guard-approved fire extinguisher on board most watercraft. Boat fires do happen, Huelskoetter says, and a fire extinguisher can mean the difference between a small fire and an explosion.
   
• Dirty water: It’s tough for kids who want to explore, but Huelskoetter says you should keep lake water out of your eyes and mouth. For kids, that could mean wearing goggles.
  
  “There are bacteria, parasites and other microorganisms that can get in your eyes. Also, don’t open your mouth underwater. You don’t want to drink that water,” Huelskoetter says. “If you swim in a lake and your eyes get red or itchy, that’s a sign you might have an infection from an organism in the water. So we want to put you on the proper antibiotic or whatever medication we feel is best.
  
  If you drink the water, gastrointestinal upset can occur. If you have nausea, vomiting or diarrhea, you definitely want to be seen by a provider. We’ll do testing to determine what bacteria or parasite you came in contact with so we can treat appropriately,” Huelskoetter adds.
   
• Alcohol: Drinking responsibly can be a part of your day on the water. But Huelskoetter says the rules are just like on land: A blood alcohol concentration (BAC) of .08% is the legal limit, so be aware if you’re the boat captain.
   
• Fumes: My group is in the open air. How much should we worry about boat exhaust?
  
  Huelskoetter says you should be fine, but make sure your watercraft has good ventilation. You can also buy carbon monoxide detectors made to clip on boats or life jackets. This can be extra helpful if your boat has an enclosed cabin, Huelskoetter points out.
   
• Spoiled food: Of course, you’ll want to eat on your boating or fishing trip. That could include perishable items like a sandwich.
  
  Putting the food and drink in an ice-filled cooler isn’t enough, Huelskoetter says.
  
  “Keeping your cooler covered and out of the sun is going to do wonders. It’ll keep that ice nice and cool,” she says.
  
  “Never eat anything that’s been sitting out, and now it’s hot,” Huelskoetter adds. “Once food reaches room temperature, you want to be careful. You can go by smell, too. If it doesn’t smell right, don’t eat it.”

Getting help

Have a first aid kit for minor injuries. For major injuries like a head or limb wound, gently move the person to land and call 9-1-1. The word “gently” is important to avoid further injury like paralysis.

Experts also point out that cell phone service can be spotty in the wilderness. So you should also have a global positioning system (GPS) device.

Interview clips

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When bug bites turn serious

The summer months provide the perfect opportunity to conquer cabin fever and explore the great outdoors. But before you head out for that hike, health care experts remind you to take precautions to avoid tick bites.

“A tick will get on your body and will stay there. It'll bite you and embed into your skin. If that tick is removed within 24 hours, the chance of getting ill is diminished. After 24 hours there's a chance you could get some illness transmitted from that tick itself,” says Dr. Richard Ginnetti, an OSF HealthCare primary care physician in Bloomington, Illinois.

One of the most common tick-borne illnesses is Lyme disease, which is a bacterial infection. You get it when the blacklegged tick, also known as a deer tick, bites you and stays attached for 36 to 48 hours.

The Centers for Disease Control and Prevention (CDC) estimates around 300,000 people are infected with Lyme disease each year. Dr. Ginnetti says there are tell-tale signs of Lyme disease, including a rash around the bite mark that takes the shape of a bullseye.

When caught early, Lyme disease can be treated with antibiotics. When untreated, however, the disease can develop into meningitis or other severe illnesses which can require hospitalization and further treatment.

“It looks like a bullseye – a bullseye type rash - that's pathognomonic of the disease,” Dr. Ginnetti explains. “It's relatively simply treated with antibiotics early on. However, if the first stage is missed, it can go on to develop arthritis, neurological disease and also cardiac conditions. So it will potentially cause a large amount of pathology if not treated initially.”

According to Dr. Ginnetti, the best action against Lyme disease is to pay attention to your surroundings and avoid the bite in the first place. Before heading into the great outdoors he recommends wearing long pants and long sleeves, as well as applying an EPA-registered insect repellent containing DEET.

After spending time in areas ticks are known to inhabit, such as wooded areas, tall grass, and brush, immediately check yourself, your children and pets for ticks. If one is found, remove it promptly and monitor any bite areas.

“If you find a tick on you, you want to remove it as soon as possible,” Dr. Ginnetti urges. “The best way to remove it is just with some tweezers. Get as close as possible to the tick on the skin. And then try to gently pull it off about 90 degree angle from you. That's the best way to do it. Once the tick is off wash with soap water, rub on some alcohol and it should be fine. As long as the tick has been on less than 24 hours, most of time that's all you need to do.”

The CDC gives us some simple steps to keep tick bites at bay:

Avoid Direct Contact with Ticks

• Avoid wooded and brushy areas with high grass and leaf litter.
• Walk in the center of trails.

Repel Ticks on Skin and Clothing

• Use repellent that contains 20 percent or more DEET, picaridin, or IR3535 on exposed skin for protection that lasts several hours.
• Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents with products containing 0.5% permethrin. It remains protective through several washings. Pre-treated clothing is available and may be protective longer.
• The Environmental Protection Agency (EPA) has an online tool to help you select the repellent that is best for you and your family.

Find and Remove Ticks from Your Body

• Bathe or shower as soon as possible after coming indoors (preferably within 2 hours) to wash off and more easily find ticks that are crawling on you.
• Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.
• Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and day packs.
• Tumble dry clothes in a dryer on high heat for 10 minutes to kill ticks on dry clothing after you come indoors.

Interview Clips - Dr. Richard Ginnetti