Carl Maronich (Host): Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. Summer is on its way. Before you head outside to mow, weed, or garden, make sure you know how to protect yourself in the summer heat. This episode, we'll share simple, practical ways to stay safe while you're working outside.

I'm host, Carl Maronich. And I'm joined by Michael Loiacono, a nurse practitioner at Danny and Gail Jones Primary Care Bel Air at UM Upper Chesapeake Health. Michael, welcome to the podcast.

Michael Loiacono, CRNP, DNP: Hi, it's very nice to meet you. And thank you for the invitation.

Host: Absolutely. And as I said, summer's on its way. It'll be here before we know it, and that means folks will be outside, doing a variety or kinds of yard work and doing things outside. So, we want to start by asking, what are some of the biggest summer yard work safety risks that people should be aware of?

Michael Loiacono, CRNP, DNP: So when it comes to summer yard safety tips and risks, I kind of classify them into about four different categories. The first category is obviously things like mowers and yard equipment injuries. Some sources actually say that lawnmower injuries can cause up to 90,000 emergency department visits annually in the US. Sometimes it can range from things like lacerations, fractures and, unfortunately, even amputations. And so, in regards to that, one of the most important safety tips is to make sure you're ensuring that you're wearing proper footwear. Make sure also that you're being mindful of sharp edges and things like blades when you're doing yard work. Also, it's discouraged kind of to allow kids and pets as passengers or have them around. So, always just being mindful of, you know, your surroundings, just in case, you know, you don't want to have any accidents.

Another category also is the heat and sun-related injuries. So of course, with summertime, it's a little bit warmer. And so, heat-related illnesses can range from things mildly like heat rash, muscle cramps. Sometimes they can also be a little bit more severe and even life-threatening, like a heat stroke. Typically, if the heat index outside is about 85 degrees or higher, usually, then it warrants some implementation of protective heat measures.

Third category is kind of more like bugs and insects and things like that in the environment. And so, insects like bees and wasps and hornets and mosquitoes and ticks, of course, things that bite and sting you. Sometimes it can have local reactions to skin like redness or swelling. But approximately, about 1% to 3% percent of those reactions can wind up being what we call anaphylaxis or a full systemic reaction. Sometimes with that, you can see things like swelling of the lips, intense itching, what we call urticaria. And then, sometimes you can also have respiratory distress and signs of shock. And so, those are medical emergencies. Usually, then, just being mindful of people that are allergic. And if you are allergic, making sure you have things like an epinephrine pen with you just in case.

And then, the last category is more with things like plant exposure. So of course, you have poison ivy, poison oaks, poison sumac. And so, another really important tip with that is to make sure you're identifying what they look like, kind of educate yourself a little bit in regards to, you know, if you have any around your yard. And then, also to take appropriate measures not just to prevent the contact of the plant, but also just to make sure you know what you need to do if it does wind up actually getting in contact with your skin.

Host: When folks are going outside, being mindful of the time of day, I would think, factors into the safety concerns.

Michael Loiacono, CRNP, DNP: It's typically better to wind up doing yard work when there's minimal risk for things like exposure to heat and UV radiation. And so, those risks are kind of highest around kind of the midday times between about 10:00 AM and about 4:00 PM. In general, kind of a practical recommendation is to typically do most of your intense, if not all, of your yard work kind of either in the early morning between about like 6:00 AM to 10:00 AM or sometime in the late afternoon, so about 4:00 tto 7:00 PM. Unfortunately, sometimes that can also wind up being when mosquitoes and bugs are a little bit more prevalent as well. So then, you have to take that into account as well.

Host: It sounds like the morning would be a better time, before the mosquitoes wake up perhaps, would be a good time to do that. But again, with being outdoors, hydration has to be a key thing as well, I would think.

Michael Loiacono, CRNP, DNP: Yes. Yeah, hydration is critically important for preventing things like heat-related illnesses during yard work. And so, actually even before yard work, it's actually recommended to consume about, like, 2 to 3 milliliters of water per pound of how much you weigh. So for instance, if you weigh about 200 pounds, then it's recommended to consume about four hundred milliliters or roughly a bottle of water, within four hours before actually doing the yard work. And now, actually when you're doing the yard work in of itself, you also want to make sure you're staying well-hydrated. So, the typical recommendation that we say is trying to drink about cup of water, which is roughly eight ounces, about every fifteen to twenty minutes, during your yard work.

And so, if you are only doing kind of quick projects lasting maybe an hour or two, water is the preferred choice. But also too, if you're doing things that are taking a little bit longer, then a lot of times we like to recommend mixing water with something that has some electrolytes in it, like a sports drink or things like that, because as you sweat, you're not just losing water, you're also losing electrolytes like salt and sodium.

Alcoholic beverages unfortunately are also diuretics. So when you think you might actually be hydrating yourself, you actually can be dehydrating yourself, especially if you're the type of person that, unfortunately, needs to use the restroom shortly after, you know, partaking in alcohol

Host: Now, talking about heat exhaustion or heat stroke, what are the signs that folks should be looking for or be aware of?

Michael Loiacono, CRNP, DNP: Yeah. Heat exhaustion and heat stroke are actually two separate illnesses, and they can actually be distinguished from each other predominantly through dysfunction of our central nervous system. So, heat exhaustion is a little less severe than heat stroke. And usually, we start seeing symptoms like kind of general weakness, muscle cramps, nausea, vomiting, dizziness. But with heat exhaustion, your body is actually still able to produce sweat. So if you see somebody with heat exhaustion, a lot of times, they're still very sweaty. Their skin is kind of cool to the touch.

Unfortunately, with heat stroke, the body then starts to become more dehydrated. And so then, we actually lose the ability to sweat. And so, as opposed to heat exhaustion with wet skin and kind of cooler, you can actually see dry skin. And it's very warm to the touch. And in addition, actually, heat stroke, it starts having more central nervous system symptoms like I had mentioned. So, you actually can start to see things like agitation, slurred speech, and you can actually have seizures, loss of consciousness, and even a coma.

Host: Michael, is physically—people who have, you know, shoulder injuries, back injuries. How should people think about that before they head out to start doing a lot of yard work?

Michael Loiacono, CRNP, DNP: Well, in so general, the most effective way to prevent, you know, joint injuries and back injuries and things like that is actually through regular exercise and things like proper body mechanics. So, when it comes to things like exercise, a lot of people want to focus more on particular body parts. But actually, it's really important to focus on the whole body. Things like working on your core and not just particular muscles because then you actually will have various other muscles to kind of distribute the stress.

And then, in regards to proper body mechanics, some of the recommendations in regards to that is things like making sure you're lifting with your knees instead of your back. And then, also, when you're carrying, make sure you're keeping the weight kind of closer to your body because if you have it farther away, it actually increases the load on the back and can wind up being more prone to injury. And then, some of the other movements, things like twisting, if you're carrying objects, sometimes you can have a little bit more of a likelihood for muscle strains. Also as well, making sure you're planning your lift as well. You know, everybody wants to get things done right away, but that's also when people start having more tendencies than have your pulled back and slipped discs and things like that unfortunately as well.

Host: When we're talking about the sun and other elements, insects and such, what would your recommendations be and what people should wear when they're working out in their yard?

Michael Loiacono, CRNP, DNP: What we mentioned already, as far as best time of day, we want to make sure it's not during the hottest parts of the day. And then, in regards to clothing, so when it comes to sun, we want to make sure that we actually will absorb UV radiation through the fabric of our clothing rather than the skin. Generally wearing darker color clothing can help protect the skin by absorbing UV radiation. In addition to that, there are actually articles of clothing with UPF ratings to help make sure that you're not getting the UV radiation and your clothes are instead.

In addition to that, when it comes to things like working around insects or ticks and things like that, typically making sure you're wearing longer sleeves. Brighter colors also makes it a lot easier to spot ticks. Other things like making sure you're not having your ankles and wrists and stuff like that exposed. So, sometimes we recommend having your pants tucked into your shoes or your socks, just to make sure that they don't wind up, you know, finding little nooks and crannies to get onto your skin and cause a little bit of complications.

Host: Sunscreen, insect sprays, are those things that you'd recommend as well?

Michael Loiacono, CRNP, DNP: Absolutely. when it comes to things like mosquitoes, obviously, the FDA-approved insect repellent is very important, especially with mosquitoes. Sometimes we run the risks of things like West Nile virus and things that they can wind up kind of harboring. And then, when it comes to ticks, there's actually a permethrin spray that you can actually spray on your clothing, and it actually will kill ticks on contact, which is good during your yard work. When you're finished with your yard work too, it's actually really important to make sure that you wash your clothes appropriately. Because if there are ticks on you, if you use things like warm water, sometimes they can still live on your clothing. So, we actually would recommend making sure that you, wash your clothes in hot water. And then, in addition to that, when you dry, make sure you're drying your clothes with hot heat as well. So, that usually will tend to kill the ticks and other bugs that could be on your clothing.

Host: Michael, what would you say about who should be especially careful when doing summer yard work?

Michael Loiacono, CRNP, DNP: A quite a few bit of people that should be especially careful when it comes to summer yard work. So myself, I specialize in geriatrics and in older adults. And so, they're actually one of the most important people that should be especially careful when they have to do yard work during the summer because, unfortunately, they're not as resilient. Unfortunately, the older we get, we're a little bit more susceptible to heat-related illnesses.

Some other people also to kind of be mindful of are patients with heart-related illnesses. We want to really keep an eye on them. And then, also, pregnant women because they have a little bit more stress on their heart because they're kind of pushing more blood around. And then, also, it's very important, patients on certain medications. For instance, diuretics, they make patients urinate a lot more frequently. And so, they're at risk for things like dehydration. And some other medicines like certain blood pressure medicines, antidepressants and some stimulants actually can either increase heat production, and sometimes they can also limit the body's thermoregulation. So, it can put you at a higher risk for those heat-related injuries.

Host: So, I would say, for those who are in that older age group, perhaps looking around the neighborhood for some young teenagers to help with the yard work might be a wise way to go. If you're able to give them a few dollars, it helps the local economy and takes off some of the burden and lower the risk to some of the elderly folks, that's my advice.

Michael Loiacono, CRNP, DNP: Absolutely. Yes.

Host: Oh, I did plenty of yard work as a kid. And it's good for youngsters to be doing that.

Michael Loiacono, CRNP, DNP: Oh, yeah. Absolutely.

Host: Back to a serious question and that is: when should someone stop what they're doing and get help if they've suddenly run into an issue?

Michael Loiacono, CRNP, DNP: Typically, we tell patients, especially the signs and symptoms of those heat exhaustion and heat stroke that we had mentioned prior. So if you start having things like your general symptoms, like your excessive fatigue, your headaches, your muscle cramps might not necessarily be severe, but that's kind of your body's way of saying, "Hey, we need to slow down a little bit, take some extra breaks," and things like that. If you find shade, you try to cool off and those symptoms persist, or if you start having those symptoms of heat stroke, like I mentioned, the delirium, changes in mental status, seizures, then that would be a surefire red flag to say, "Hey, you need emergency medical attention right away."

Host: Certainly back to kind of what you mentioned, first, if there's an injury, if you see blood, it's time to stop and then to do something about it, I would say.

Michael Loiacono, CRNP, DNP: Absolutely. And if it's something that's small, you know, a lot of people, they don't like to go to the hospital or seek medical care, and that's understandable. So if they can wind up, slowing or stopping the bleeding relatively quick, you know, then that's okay. But if you're not able to wind up kind of stemming that bleeding, then that would be also a pretty big indicator then to have somebody, you know, take a look at it and make sure.

Host: Michael, you've given us a lot of great information. Before we let you go, what do you want to make sure people take away from this conversation when it comes to being safe out in the summer heat and working in the yard?

Michael Loiacono, CRNP, DNP: You mind if I actually have two of them?

Host: Not at all. Take three if you'd like.

Michael Loiacono, CRNP, DNP: I appreciate that. So, the first one I would say is prepare, prepare, prepare. I have a friend and a colleague of mine actually who has a saying, and it always rings true. "You always fail to prepare. You're not always preparing to fail." So, preparation is absolutely crucial, you know, making sure you're taking the proper precautions before doing your yard work.

And the other one is, basically, listen to your body. You know yourself better than pretty much anybody else. And so, if you start noticing some things aren't right, you have some palpitations or dizziness and things like that, make sure that, you know, you're taking care of yourself because the yard work will always still be there. But, you know, you got to make sure that you're still there to do the yard work.

Host: Michael Loiacono, thanks so much for the all the great information today.

Michael Loiacono, CRNP, DNP: Of course. Thank you very much for having me. I appreciate it, Carl.

Host: If you enjoyed this podcast, you can find more at umms.org/podcast, on YouTube, or your favorite podcast platform. And please share it on all your social channels. And this is Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again. Thanks for listening.