Summer Lovin’
Physicians share their prescriptions for a safe, happy, worry-free summer
by Jill Lupine

Summer seems to make everyone just a little bit happier—school’s out, the sun is shining, and the joys of vacation are within reach. Yet the hot and sticky months also present some unique challenges to the health of the human body. Leading physicians in the Philadelphia area suggest these threats include everything from the annoyance of hay fever and the ever-present threat of dehydration to potentially life-threatening conditions such as Lyme disease and severe sun damage.

“In general, in the summer months we see a peak in presentations of people with lightheadedness, dehydration and heart palpitations,” says Laura Immordino, M.D., a cardiologist with the Lankenau Heart Institute at Bryn Mawr Hospital, a division of Main Line Health. “We do see these conditions all year round, but in the summer months we see them more frequently. … When you’re dehydrated, the heart has to work harder, and when it has to work harder, it can be put under stress. For people who already have heart disease, it can be like the perfect storm.”

Residents of southeastern Pennsylvania might be particularly susceptible, due to the prevalence of obesity, metabolic syndrome and other conditions that can affect one’s health. Statistics from the U.S. Centers for Disease Control and Prevention suggest that Philadelphia County ranks last in Pennsylvania—67th out of the state’s 67 counties—in terms of the factors that influence the overall health of a county, including health behavior and clinical care, as well as social, economic and physical environment factors.

“These kinds of problems make it harder for patients to compensate for the heat,” says Dr. Immordino. “This suggests people in the Philadelphia area could have health concerns more frequently, and they are also more likely to have coexisting medical problems that can exacerbate the effects of the heat.”

Outdoor picnics and daylong festivals, walks in the woods and other daytime events could expose residents to not only the potential for excessive sun exposure—thereby putting them at risk of developing skin cancer—but also food poisoning and foodborne parasites. The resulting symptoms will affect some segments of the population—pregnant women, for example—harder than others, according to Cheung Kim, M.D., chief of obstetrics and gynecology at Einstein Medical Center Montgomery in East Norriton, which is part of the Einstein Healthcare Network.

“Summer is also a time when we see more trauma and falls, particularly in the second trimester [of pregnancy], when a woman’s center of gravity is really changing,” says Dr. Kim. “People are also traveling more, so they must take travel precautions. I don’t encourage plane travel for the third trimester; there are long periods of immobility [on a plane], which is an increased risk factor for developing blood clots.”

The things that make summer so great can also add complicate a pregnancy, or at least make it more inconvenient. For example, many pregnant women develop melasma, also known as the “mask of pregnancy,” whereby brown or gray-brown patches develop on the face as a result of excess melanin triggered by hormones. Dr. Kim encourages the use of sunblock or other protection anytime a woman spends time outdoors, as the sunlight will further stimulate the production of the brown pigment.

Also, Lyme disease is a looming threat, especially throughout the Philadelphia area, where ticks infected with the bacterium that causes the disease abound. Pennsylvania reported nearly 5,000 confirmed cases of Lyme disease in 2013—more than any other state, according to CDC statistics. The disease causes chronic fatigue and potentially debilitating symptoms similar to arthritis, and in later stages it can also endanger the heart, brain and nervous system. Patients in the early stages of Lyme disease usually have a full recovery when treated with antibiotics such as doxycycline and amoxicillin, though doxycycline is contraindicated during pregnancy, according to Dr. Kim.

“There are some limitations that come with being pregnant, but most of them are just annoying—nothing too serious,” he says. “Mostly it’s about taking little precautions, especially in the summer, when you have to drink more fluids. We see a lot of pregnant women in the summer who think they are in labor or that there’s something wrong, but really they’re just not drinking enough water.”

Breathe Easy
In the world of Douglas Nadel, M.D., an otolaryngologist with Pinnacle ENT Associates LLC, also known as PENTA, the return of warmer weather also increases the incidence of allergic rhinitis, commonly known as hay fever. PENTA, which is an affiliate of Penn Medicine Ear, Nose and Throat Network, has 17 offices in Bucks, Chester, Delaware, Montgomery and Philadelphia counties.

“In this area we usually get tree pollen in March and April, grasses in mid-May to late June, and ragweed from mid-August to September, and it tends to go away when we get a good frost,” says Dr. Nadel, whose practice is based in Doylestown Hospital. “We also get mold here, especially in Bucks County, though it tends to be prevalent in any area that gets humid and damp. One of the mainstays of treatment is avoidance. If there’s a high pollen count, stay inside, and if you’re doing laundry, don’t hang up your clothing to dry outside on high-pollen days.”

On an annual basis, hay fever affects 40 million to 60 million Americans, according to the American College of Allergy, Asthma and Immunology. Depending on the person and the severity of the symptoms—runny or stuffy nose, sneezing, itchiness, fatigue, etc.—hay fever can be simply irritating or downright debilitating. Medications used to treat symptoms of allergic rhinitis, allergic asthma and related conditions include everything from over-the-counter antihistamines for seasonal allergies to prescription drugs for more severe cases. A third option would be allergen immunotherapy, or allergy shots, which can decrease a person’s sensitivity to allergens and often relieve allergy symptoms over the long term, even after treatment has concluded, according to Dr. Nadel. 

Another ENT-specific condition that becomes more common as spring leads into summer is otitis externa, otherwise known as swimmer’s ear.

“Swimmer’s ear is an infection of the outer ear canal, and we call it that because the germs that cause it—usually bacteria, sometimes fungus—like living in moist and dark places, like the ear canal when it gets wet,” Dr. Nadel says. “Just like you don’t have to be an athlete to get athlete’s foot, you don’t have to be a swimmer to get swimmer’s ear; it can be caused anytime you get water in your ear—sometimes even just getting a shower. It can result in severe ear pain and swelling in the ear canal, and sometimes it can muffle the hearing and also cause other, more serious problems.”

Treatment options include ear drops containing antibiotics, and sometimes a corticosteroid to reduce inflammation, according to Dr. Nadel. Despite its prevalence, swimmer’s ear is largely preventable; Dr. Nadel often recommends an over-the-counter product called Swim-EAR, while waterproof earplugs are recommended for people who are prone to these infections anytime they intend to spend time in the water, including the shower.

‘Ready to Change’
With swimsuit season right around the corner, many people have begun to fret over how those swimsuits will appear when they are in their rightful place on the body. As a result, many have given serious consideration to weight loss programs supervised by local physicians.

“The most important factor is that you have to be ready to change,” says Ashish Sitapara, M.D., owner of Signature Medicine Center for Wellness and Healthy Living, which is based in Newtown.  “By ‘ready,’ I mean you need to look in the mirror and say to yourself, ‘I’m ready to make a change in my life.’ And the first change starts with putting yourself first. If you can do that, you’re ready to successfully lose weight.”

An effective weight loss program includes two components, according to Dr. Sitapara: first, helping patients lose the weight; and second, teaching patients how to keep the weight off. Dr. Sitapara’s program relies on stimulus control, made simpler by calorie control through meal-replacement foods. He also recommends technology apps such as MyFitnessPal and Lose It! to help patients work past the normal plateaus often encountered through traditional dieting. In addition, because Dr. Sitapara oversees patients on the program, he can review any medications a patient might be taking and, when necessary, adjust those medications so they are not contributing to a patient’s weight issues.

“Remember: Your new clothes are your friend,” he says. “Remember that your spouse or friends say how great you look. Remember the prescription medications you were able to come off. But remember: Weight has a funny way of creeping back up on you. I always teach our patients the ‘TAPE 1-2-3 rule.’ Once you’ve achieved a successful weight loss, write your goal weight on a piece of masking tape and tape it to your scale. Weigh yourself every Monday, Wednesday and Friday. If your weight goes up 3 pounds from your taped number, it’s time to refocus and use the tools we taught you to get back down to your previous weight.”

With any summertime activity, physicians recommend exercising one’s best judgment, particularly when it comes to children. Mark R. Zonfrillo, M.D., a physician with the Children’s Hospital of Philadelphia whose practice is rooted in pediatric emergency medicine and injury research, says CHOP sees “a significant increase” in injuries during the summer months. These include cuts, fractures and head injuries, including concussions, as well as more serious injuries. “The summer months are a wonderful time for kids to be active outside or relax at the beach,” Dr. Zonfrillo says. “Kids should make sure that if they’re exercising in the sun or heat, to apply sunscreen, take plenty of breaks and stay hydrated, even if they are not thirsty. Children and youth should always wear helmets while bicycling or participating in other wheeled sports.”

No matter the activity, common sense and caution should prevail. When swimming in any body of water, for example, Dr. Zonfrillo suggests having children swim only in areas that are supervised by both lifeguards and parents or guardians. When using playground equipment, make sure it is “developmentally appropriate” for children, given their age and size, and that they are using it as directed. Doing so, he suggests, could prevent an unwanted trip to the ER.

And although safety should be the No. 1 priority for people of all ages, summer is a time for staying busy, for getting outside, for celebrating life. In other words, be safe but make plenty of room for fun, sun and exercise.

“I would not want the heat to discourage people from exercising,” says Dr. Immordino of Main Line Health, “but the biggest hints to follow would be to schedule exercise in times when it avoids the hottest times of the day—early morning hours or the evening. It’s important to stay cool with light, breathable clothing, to wear sunscreen and to stay hydrated. Even if you don’t feel thirsty, drink eight glasses of water a day, and be aware of the symptoms that might suggest you’re overheated; listen to your body and take breaks. And don’t be afraid to modify your routine; on really hot days, move the exercise indoors.”