Summer Tips

Don't Eat the Potato Salad!

Updated, June 2018

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Don’t eat the potato salad . . . unless you know it’s safe! Summer means cookouts, picnics, and beach parties with family and friends. Unfortunately, they are also occasions for getting a stomach bug from improperly handled or stored food.

To keep yourself and others from getting sick, take a few moments to review what causes “food poisoning” and some food safety tips.

Foodborne Illnesses

The following organisms commonly cause foodborne illness or “food poisoning”:

·      Norovirus. Many persons have never heard of this virus, but it affects over 5 million people per year. It leads to inflamed stomach and intestines and results in stomach pain, nausea, vomiting, and diarrhea. Proper hygiene after using the toilet or changing diapers and safe food handling will prevent most infections.

·      Salmonella. This bacterial infection causes abdominal cramps, diarrhea, and fever, usually within 12-72 hours. Most people recover without medical treatment, but sometimes severe diarrhea requires treatment or hospitalization. If the infection spreads, it can cause death. Very young, elderly, and immune-compromised persons are most at risk for severe infection.

·      Clostridium perfringrens. This bacterium causes about 1 million infections per year. Diarrhea occurs 6-24 hours after infection, but usually without vomiting or fever. Symptoms last about 24 hours, and most people recover without medical treatment. Very young or elderly persons can experience more severe symptoms that require treatment.

·      Campylobacter. This bacterium causes diarrhea (sometimes bloody), abdominal cramping, and fever 2-5 days after exposure. Symptoms last 1-2 weeks. If infection spreads to the bloodstream, usually in immune-compromised persons, it can become life-threatening.

·      Staphylococcal aureus. The staphylococcal bacterium produces toxins that cause vomiting, nausea, abdominal cramping, and diarrhea within 30 minutes to 6 hours of exposure. Since the toxins are resistant to heat and salt, they can survive cooking. Infections typically occur in foods that people handle but do not cook (sliced meat, puddings, pastries, and sandwiches). Contaminated food does not smell or look spoiled.

·      Escherichia coli (E. coli). Most E. coli bacteria are harmless or even beneficial, but some cause diarrhea (sometimes bloody), abdominal cramping, vomiting, urinary tract and other infections. While most infected persons get better in 5-7 days, some strains of E. coli cause a life-threatening condition that requires medical attention. If you have diarrhea that lasts for more than 3 days or is accompanied by high fever, blood in the stool, or so much vomiting that you cannot keep liquids down and you pass very little urine, go to an urgent care clinic or other health care provider. An outbreak of one strain of E. coli in the spring of 2018 was traced to contaminated romaine lettuce.

·      Listeria monocytogenes. This bacterium causes a serious infection, Listeriosis, that is especially dangerous for pregnant women and persons over 65. Although there are only about 1,600 cases per year, the mortality rate for those infected is about 16%. Foods most at risk for contamination include unpasteurized dairy products (especially soft cheeses), raw sprouts, and melons. Persons at high risk should probably avoid these foods.

Most of the time, foodborne illnesses will not require medical attention. But young children, elderly persons, and anyone whose immune system is compromised can develop more severe infections and symptoms that can become life-threatening.

Basic Food Safety

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Clean, Separate, Cook, Chill. This should be the mantra of every person who handles, prepares, and cooks food. Heed these four rules and you will eliminate nearly all foodborne illnesses from your life. It’s really that simple.

Still, a few specific tips will make safe food handling easier and more effective.

Potato Salad, Eggs, and Dairy

While potato salad serves as a primary example, other salads that include mayonnaise, eggs, and dairy products need special attention.

·      Keep prepared salads cold—that means 40ºF or cooler—in the refrigerator or ice chest until they are served.

·      No more than 2 hours (1 hour if surrounding temperature is 90º or higher) after serving, these foods should be chilled again. Remember, many bacteria thrive in warm, moist environments.

·      Even better, place serving dishes or pans for these foods on a bed of ice while they sit out.

·      If these dishes sit out more than 1 or 2 hours (see above), throw the food out! Better safe than sorry!

·      Rinse all produce under running tap water before using or packing it in a cooler.

Chicken, Beef, Pork, and Seafood

Favorites for outside grilling, raw meats require special handling.

·      Use separate cutting boards for animal products only, and wash these surfaces often with warm, soapy water.

·      When handling raw meats, wear disposable, vinyl gloves that you discard before touching other surfaces, utensils, or food.

·      If gloves are not available, wash your hands thoroughly (at least 20 seconds) before and after handling raw meat.

·      Marinate meats safely in the refrigerator. If you want to use some of the marinade as a sauce, reserve a portion ahead of time and separate from raw meat. Never reuse marinade that has been in contact with raw meat.

·      Cook food thoroughly (see chart), and use a meat thermometer to check (you can’t always tell by looking).

·      Keep cooked meats hot while serving. As with cold foods, do not let cooked meats sit out more than 1-2 hours.

·      Never use platters, dishes, or utensils that have touched raw meats to serve food after cooking unless such items have been thoroughly washed. Not heeding this rule is a major cause of cross-contamination and illness.

Raw Fruits and Vegetables

Bacterial contamination of raw fruits and vegetables account for roughly half of all foodborne illnesses according to the CDC. This is distressing because eating these foods results in many health benefits. Washing these food items is essential, but the absence of cooking means that bacteria cannot be killed.

Some experts have warned against pre-cut and washed vegetables, especially lettuce or spinach, that have become so popular because they reduce meal preparation time and trouble. Nevertheless, the jury’s still out on the safety of such items because many pre-washed products are rinsed several times in a chlorinated bath, thereby removing more bacteria than might be achieved when washing at home. Intact heads of lettuce—as with romaine or iceberg—are difficult to wash thoroughly because water cannot penetrate to the inside of the head or even the leaf’s surface.

Be sure to wash all fruits and vegetables before peeling or cutting them to prevent contamination. Keep them isolated from surfaces that have contacted meats, poultry, or seafood, and refrigerate them immediately, at least within 1-2 hours of washing. Above all, do not purchase bruised or damaged items, especially if they will be eaten raw.


Cleanliness and Storage

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Keeping yourself, dishes, utensils, and preparation surfaces clean, while storing food properly, will prevent most foodborne illness.

·      Wash your hands for at least 20 seconds in warm, soapy water and before, during, and after handling food. Handwashing after handling raw meat, but before touching other food, utensils, or surfaces, is especially important.

·      Similarly, clean food preparation surfaces—countertops, cutting boards, refrigerator shelves—often. Be especially careful to avoid cross-contamination from raw meats on such surfaces.

·      A consensus seems to be building to avoid antibacterial soaps. There is little evidence that they help prevent bacterial infection, and some evidence that they might contribute to antibacterial resistance.

·      Use separate cutting boards and other surfaces to prepare raw meats (glass or other impermeable surfaces preferred) and keep them separated from surfaces on which fruits and vegetables are prepared.

·      Consider using disposable paper towels for cleaning food preparation surfaces instead of sponges that can harbor nasty bacteria. If you use sponges, keep them as clean as possible and toss them in the trash often.

·      Also consider using disposable vinyl gloves for handling raw meat. Toss them in the trash before touching other utensils, surfaces, or food.

·      Store raw meats in leak-proof containers and separate from vegetables and fruits.

·      Store fruits, vegetables, meats, eggs, and dairy products properly, usually at 40ºF or lower. (Yes, eggs in the U.S. should be refrigerated.)

·      Do not thaw meat on the counter. Meat should be thawed in the refrigerator or, more quickly, in a microwave oven (follow instructions). If left on the counter to thaw, raw meat quickly becomes a site for bacterial growth.

Be safe when you cook out! Your family will thank you for being fussy about food safety. If, despite your best precautions, you or others become ill, monitor the symptoms. If diarrhea is severe and long-lasting or if vomiting prevents ingestion of fluids, seek medical attention.

And remember, we at Kathy’s Urgent Care are here to help. If you live or work near one of our convenient locations, just walk in. We’re open 7 days and evenings every week.

To add or view comments, click on the title of this article above.

Could You Have Lyme Disease?

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Spring is finally here! Time to get outdoors, do some gardening, clean up the lawn, and enjoy warmer weather after a cold, damp winter.

Just remember, ticks have been waiting for this season too! They lurk on bushes, trees, old leaves, grass, waiting for you, your children, or your pets to pass by so that they can latch on to a new host and continue their lifecycle. And they can transmit bacteria for a debilitating condition known as Lyme Disease (named for the earliest known outbreak among children in Lyme, Connecticut, in 1975).

Ticks easily work their way into any crevice of your body—your armpits, your groin, your hair, your waistline—or the fur of your dog or cat. Once attached, they bury their heads into your skin and begin to feed.

Worse, they are extremely hard to detect since, at this time of year, they can be as tiny as the period at the end of this sentence. You might not even notice that you have been bitten until they swell large enough to be seen or until you develop early symptoms of fatigue, headaches, or a rash.

Such symptoms might only be disgustingly annoying, but could you have Lyme Disease?

What Is Lyme Disease?

A tick-borne infection, Lyme Disease is caused by the bacterium, Borrelia burgdorferi, that results in 3 stages of symptoms:

1.     Early localized (occurring within a few hours or days) – fatigue, fever, telltale rash, muscle or joint pain, or headache.

2.     Early disseminated – flu-like symptoms, weakness in arms or legs, vision difficulties, heart palpitations, chest pain, rash, or facial palsy.

3.     Late disseminated (occurring several weeks or months after infection) – arthritis, dizziness, severe headache or fatigue, and mental confusion.

Sometimes, but not always, a rash develops that looks like a bull’s eye or target. This usually appears at the site of the tick bite, but it can occur elsewhere on the body later.

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When early symptoms appear, you should seek medical attention as soon as possible. In 90% of cases, a 3-week course of antibiotics will eliminate the disease.

Later, untreated stages might require intravenous antibiotics and other measures. A blood test might confirm the presence of Lyme Disease antibodies, but the test is not considered accurate until a few weeks after infection. The test also cannot confirm that the disease has been cured since the antibodies can linger in the blood for months or even years without the disease being present.

In a few cases of late-stage Lyme Disease, debilitating symptoms can endure for years. This is a major concern for afflicted persons and their families.

For more detailed information about the disease and how it is treated, consult the following sources:

Centers for Disease Control and Prevention (CDC): Lyme Disease

WebMD – Lyme Disease: What to Know in 2018

MedicineNet – Lyme Disease

American Lyme Disease Foundation, Inc. (ALDF)

How to Prevent Lyme Disease

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The best way to prevent Lyme Disease is to avoid being bitten by a black-legged tick.

·      Wear protective clothing when outdoors. No flip-flops or shorts in the woods!

·      Use an effective insect repellent (at least 20% DEET, picaridin, or IR3535 formula), or treat clothing and gear with 0.5% permethrin. (For help in selecting effective products for you and your family, use the Environmental Protection Agency (EPA) tool.)

·      Examine every part of your body as soon as you return indoors. Ask relatives or friends to help you check areas that you cannot see. Don’t be bashful about this! Also remember to check the bodies of your children thoroughly.

·      Check any dog or cat that has been outside every time they come in. Medications are available that prevent ticks from hosting on dogs or cats, and they generally work. But be careful, since some medications that work for dogs are toxic to cats.

The second-best way to prevent Lyme Disease is to remove any ticks promptly. Infection usually occurs only after a tick has been feeding for 24 hours.

To remove a tick, grasp it with tweezers as close to the head as possible and lift straight up.

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If you need assistance removing a tick or if your attempt is unsuccessful, come to Kathy’s Urgent Care. We’ll be happy to help and to answer your questions.

Final Thoughts

Remember that the risk of Lyme Disease is highest in the Northeast, from Virginia to Maine (especially including Connecticut!). With warming climate conditions, ticks easily survive the winter and become quite active from early spring through fall.

Ticks can also carry other very serious diseases such as Powassan virus (POW) for which infection can occur within 15 minutes of a tick’s bite. The POW virus can infect the central nervous system, causing encephalitis or meningitis. There is no known cure and no vaccines or medications to prevent or treat infection.

For additional information about ticks, tick-borne diseases, and how to cope with them, see my previous blog, Ticks Can Make You Sick!

If you think that you or a family member has been bitten by a tick or if you need assistance in removing a tick, come to Kathy’s Urgent Care or another medical facility. Time can be important, and we’re open 7 days a week!

To add or view comments, click on the title of this article above.

Don't Eat the Potato Salad

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Don’t eat the potato salad . . . unless you know it’s safe! The end of summer, Labor Day outings, final days at the beach—all occasions for cookouts, picnics, and beach parties with family and friends. Unfortunately, they are also occasions for getting a stomach bug from improperly handled or stored food.

To keep yourself and others from getting sick, take a few moments to review what causes “food poisoning” and some food safety tips.

Foodborne Illnesses

The following organisms commonly cause foodborne illness or “food poisoning”:

  • Norovirus. Many persons have never heard of this virus, but it affects over 5 million people per year. It leads to inflamed stomach and intestines and results in stomach pain, nausea, vomiting, and diarrhea. Proper hygiene after using the toilet or changing diapers and safe food handling will prevent most infections.
  • Salmonella. This bacterial infection causes abdominal cramps, diarrhea, and fever, usually within 12-72 hours. Most people recover without medical treatment, but sometimes severe diarrhea requires treatment or hospitalization. If the infection spreads, it can cause death. Very young, elderly, and immune-compromised persons are most at risk for severe infection.
  • Clostridium perfringrens. This bacterium causes about 1 million infections per year. Diarrhea occurs 6-24 hours after infection, but usually without vomiting or fever. Symptoms last about 24 hours, and most people recover without medical treatment. Very young or elderly persons can experience more severe symptoms that require treatment.
  • Campylobacter. This bacterium causes diarrhea (sometimes bloody), abdominal cramping, and fever 2-5 days after exposure. Symptoms last 1-2 weeks. If infection spreads to the bloodstream, usually in immune-compromised persons, it can become life-threatening.
  • Staphylococcal aureus. The staphylococcal bacterium produces toxins that cause vomiting, nausea, abdominal cramping, and diarrhea within 30 minutes to 6 hours of exposure. Since the toxins are resistant to heat and salt, they can survive cooking. Infections typically occur in foods that people handle but do not cook (sliced meat, puddings, pastries, and sandwiches). Contaminated food does not smell or look spoiled.
  • Escherichia coli (E. coli). Most E. coli bacteria are harmless or even beneficial, but some cause diarrhea (sometimes bloody), abdominal cramping, vomiting, urinary tract and other infections. While most infected persons get better in 5-7 days, some strains of E. coli cause a life-threatening condition that requires medical attention. If you have diarrhea that lasts for more than 3 days or is accompanied by high fever, blood in the stool, or so much vomiting that you cannot keep liquids down and you pass very little urine, go to an urgent care clinic or other health care provider.
  • Listeria monocytogenes. This bacterium causes a serious infection, Listeriosis, that is especially dangerous for pregnant women and persons over 65. Although there are only about 1,600 cases per year, the mortality rate for those infected is about 16%. Foods most at risk for contamination include unpasteurized dairy products (especially soft cheeses), raw sprouts, and melons. Persons at high risk should probably avoid these foods.

Most of the time, foodborne illnesses will not require medical attention. But young children, elderly persons, and anyone whose immune system is compromised can develop more severe infections and symptoms that can become life-threatening.

Basic Food Safety

Untitled.png

Clean, Separate, Cook, Chill. This should be the mantra of every person who handles, prepares, and cooks food. Heed these four rules and you will eliminate nearly all foodborne illnesses from your life. It’s really that simple.

Still, a few specific tips will make safe food handling easier and more effective.

Potato Salad, Eggs, and Dairy

While potato salad serves as a primary example, other salads that include mayonnaise, eggs, and dairy products need special attention.

  • Keep prepared salads cold—that means 40ºF or cooler—in the refrigerator or ice chest until they are served.
  • No more than 2 hours (1 hour if surrounding temperature is 90º or higher) after serving, these foods should be chilled again. Remember, many bacteria thrive in warm, moist environments.
  • Even better, place serving dishes or pans for these foods on a bed of ice while they sit out.
  • If these dishes sit out more than 1 or 2 hours (see above), throw the food out! Better safe than sorry!
  • Rinse all produce under running tap water before using or packing it in a cooler.

Chicken, Beef, Pork, and Seafood

Favorites for outside grilling, raw meats require special handling.

  • Use separate cutting boards for animal products only, and wash these surfaces often with warm, soapy water.
  • When handling raw meats, wear disposable, vinyl gloves that you discard before touching other surfaces, utensils, or food.
  • If gloves are not available, wash your hands thoroughly (at least 20 seconds) before and after handling raw meat.
  • Marinate meats safely in the refrigerator. If you want to use some of the marinade as a sauce, reserve a portion ahead of time and separate from raw meat. Never reuse marinade that has been in contact with raw meat.
  • Cook food thoroughly (see chart), and use a meat thermometer to check (you can’t always tell by looking).
  • Keep cooked meats hot while serving. As with cold foods, do not let cooked meats sit out more than 1-2 hours.
  • Never use platters, dishes, or utensils that have touched raw meats to serve food after cooking unless such items have been thoroughly washed. Not heeding this rule is a major cause of cross-contamination and illness.


Cleanliness and Storage

Keeping yourself, dishes, utensils, and preparation surfaces clean, while storing food properly, will prevent most foodborne illness.

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  • Wash your hands for at least 20 seconds in warm, soapy water and before, during, and after handling food. Handwashing after handling raw meat, but before touching other food, utensils, or surfaces, is especially important.
  • Similarly, clean food preparation surfaces—countertops, cutting boards, refrigerator shelves—often. Be especially careful to avoid cross-contamination from raw meats on such surfaces.
  • A consensus seems to be building to avoid antibacterial soaps. There is little evidence that they help prevent bacterial infection, and some evidence that they might contribute to antibacterial resistance.
  • Use separate cutting boards and other surfaces to prepare raw meats and keep them separated from surfaces on which fruits and vegetables are prepared.
  • Consider using disposable paper towels for cleaning food preparation surfaces instead of sponges that can harbor nasty bacteria. If you use sponges, keep them as clean as possible and toss them in the trash often.
  • Also consider using disposable vinyl gloves for handling raw meat. Toss them in the trash before touching other utensils, surfaces, or food.
  • Store raw meats in leak-proof containers and separate from vegetables and fruits.
  • Store fruits, vegetables, meats, eggs, and dairy products properly, usually at 40ºF or lower. (Yes, eggs in the U.S. should be refrigerated.)
  • Do not thaw meat on the counter. Meat should be thawed in the refrigerator or, more quickly, in a microwave oven (follow instructions). If left on the counter to thaw, raw meat quickly becomes a site for bacterial growth.

Be safe this Labor Day and on other occasions when you cook out! Your family will thank you for being fussy about food safety. If, despite your best precautions, you or others become ill, monitor the symptoms. If diarrhea is severe and long-lasting or if vomiting prevents ingestion of fluids, seek medical attention.

And remember, we at Kathy’s Urgent Care are here to help. If you live or work near one of our two convenient locations, just walk in. We’re open 7 days and evenings every week.

Authored by Dr. Brown.