Answering questions about ivermectin

What is ivermectin?

Ivermectin has been in the news quite a bit lately, but what exactly is it?

Ivermectin is a drug that is used to treat infections from parasites. It is found in a variety of medications approved for treating certain infections in humans or animals. Human medications may be taken by mouth or applied to the skin, and are used to treat such conditions as roundworms, head lice, scabies and rosacea. Ivermectin is found in some heartworm medications for pets, and may be used for a variety of parasite infections in livestock.

Can ivermectin be used to treat COVID-19?

While some studies have looked at ivermectin as a potential treatment for COVID-19, at this time both the FDA and the CDC have determined that there is not enough evidence to suggest it should be used for this purpose.

Is ivermectin dangerous?

Like any medication, ivermectin is safe when used appropriately. That means using it as recommended by your doctor or pharmacist to treat a specific health condition.

Taking large doses or taking drugs formulated for animals can be harmful. Symptoms can include nausea, vomiting, diarrhea, abdominal pain, drowsiness, dizziness and loss of coordination. A handful of cases involving large doses have resulted in very serious symptoms, including confusion, hallucinations, rapid breathing, tremors and even seizures.

Ivermectin also may interact with the common heart medication warfarin to increase the risk of bleeding.

Are people poisoning themselves with ivermectin?

Nationally, poison centers have seen a significant increase in cases involving ivermectin since late July, with about nine times as many cases in August as typical, suggesting that some number of people are using ivermectin inappropriately. While this is concerning, these cases account for just a tiny fraction of overall poison center cases, and most patients did not experience significant effects from their inappropriate use of ivermectin. However, about 1 in 10 patients in these cases did experience more severe symptoms.

At the NNEPC, we typically manage about 15-20 human exposures and 5-10 animal exposures involving ivermectin each year. Most of these are common types of poison center cases: young children or dogs getting into medications that have been left out, people accidentally taking a second dose of their prescribed medication, people getting animal medication in their mouth or eyes while dosing livestock, etc. As of this writing, the NNEPC has managed 14 human exposures to ivermectin in 2021, with four of them stemming from attempts to treat or prevent COVID-19, mostly in the past two weeks. None of these patients experienced significant effects from the ivermectin.

How should I treat or prevent COVID-19?

Any treatment for COVID-19 should be coordinated with your doctor. Ivermectin is not approved for COVID-19 treatment, but there are many other options available.

Even better is to take steps to prevent COVID-19 infection: Get vaccinated, wear masks where recommended and practice social distancing where appropriate.

Posted in Medication Safety, National News, Poison Prevention | Comments Off on Answering questions about ivermectin

Poison Center Pointers: Insects and Repellents

In the second episode of Poison Center Pointers, our poison experts discuss three of our most common arthropod pests: ticks, mosquitos and brown-tail moth caterpillars. What are the risks from these critters and what are some ways you can safely deal with them?

Subscribe to Poison Center Pointers on Podbean, Amazon Music, Apple Podcasts, Google Podcasts or Spotify.

TRANSCRIPT

Disclaimer: Poison Center Pointers is brought to you by the Northern New England Poison Center. This podcast is not to replace timely advice or recommendations. If you have an actual poisoning emergency, scenario, or question, contact the Northern New England Poison Center by calling 1-800-222-1222, text the word ‘POISON’ to 85511, or chat online at nnepc.org.

Chris: Welcome to Poison Center Pointers, a podcast presented to you by the Northern New England Poison Center.

♪Upbeat music♪

Chris: Hello to all our listeners out there and welcome to Poison Center Pointers. Today is Episode 2and we’re keeping this summer themed today. We’re talking about insects and repellents.

Karlee: Boo insects!

Carolyn: Yay summer!

[Laughter]

Chris: Boo insects, I second that. My name is Chris and I’m joined by two of my co-hosts and colleagues. Karlee, welcome back!

Karlee: Thanks for having me!

Chris: And Carolyn, thank you for being here.

Carolyn: Thanks Chris, thanks for having me.

Chris: Carolyn’s been here since insects were invented, so she has plenty of expertise, once again.

Carolyn: Thanks, Chris… yes, I invented them, thank you.

Karlee: Thanks for that…

[Laughter]

Chris: So, just to get into again what exactly we’re doing here. We’re looking to share our knowledge and experience dealing with everyday situations that we manage at the poison center. Our goal is to keep our community safe and by preventing a poisoning, or making sure you know what to do if a poisoning does occur. Hopefully this episode is a little bit more entertaining than last week when we just talked about um, ourselves!

[Laughter]

Chris: So, insects and repellents… I think we should probably start with everyone’s least favorite insect or so I would think, in northern New England, ticks!

Carolyn: Yes, we do not like ticks, ick. Ticks are an insect that are found in the woods, in the tall grass, sometimes in your yard, but usually it’s more like the woods or the grass, where they’re found. They crawl around, they don’t fly, they don’t jump, but, if you walk through the grass where they found, they will attach themselves to you.

Chris: Yes they will.

Carolyn: They feed on the blood of animals and unfortunately we are animals too, so… yuck!

Karlee: That is why they grab on. One of the reasons we worry about them is because they are a vector for disease.

Carolyn: Lots of different kinds of disease. You’ve heard about Lyme disease, that’s the more common one but there are others too. We’re not going to get too detailed, basically it is way more common for it to be Lyme disease.

Chris: In this region of the country, anyway.

[Karlee and Carolyn agree]

Chris: How about a little bit more about ticks…

Carolyn: Sure!

[Laughter]

Carolyn: Once they feed they fall off. They don’t stay attached, they don’t crawl inside, they don’t burrow and stay. They just put their head in, and they feed. And once they finish feeding, they fall off. In certain stages their life they can be really small, like, nearly impossible to see, the size of a poppy seed or the tip of a pencil. And they can be active year round even here in northern New England, ‘cause sometimes we don’t get that long hard frost or lots of snow, like last winter. So even though they’re more common in the warmer months they actually can be found year round.

Chris: Do you guys have any of your own horror stories about encounters with ticks?

[Carolyn laughs]

Carolyn: Well! My first, and only encounter actually happened here at the poison center.

Karlee: Oh?

Carolyn: Yeah, thanks Karlee!

Karlee: What?!

[Laughter]

Carolyn: Well, Karlee has dogs and we share a seat here at the poison center.  Not at the same time, but we share the same desk…

[Karlee laughing]

Carolyn: …when she’s not here, we share, and I think that she probably brought it in from her dogs. So, I found one here for the first time ever about a month ago.

Chris: Good point, right! We don’t usually find ticks inside a building.

Karlee: But dogs can bring them in…

Carolyn: …or people!

Chris: Any sort of animal.

Carolyn: And Karlee!

[Laughter]

Chris: So just a little bit of background. Why don’t we talk about some good prevention techniques? I think that’s probably what people would want to know most about.

Karlee: Yeah, so first off, we can try to avoid areas where we know ticks are prevalent which would be in the woods, grassy areas, bushes, that sort of thing. But, in northern New England, pretty hard to avoid those areas, especially when we want to get out in the summer.

Carolyn: But, if you’re hiking you can stay in the middle of the path.

Karlee: Exactly!

Carolyn: Even things as simple as that can make a difference.

Karlee: But, if you’re unable to do that there are other things, as far as you know, using clothing. You can wear long clothing to, you are obviously going to be wearing clothing…

[Laughter]

Carolyn: That’s why I was laughing…

Karlee: But long sleeves…

Carolyn: Long pants…

Chris: Long socks….

Karlee: Long pants, tuck your pants into your socks, things like that.  And also you can you use preventative sprays. So, DEET, there is picaridin…

Chris: Natural products, quite a few products available.

Carolyn: Light-colored clothing can be helpful ‘cause you can see the ticks crawling up. They don’t generally attach right away. They want to crawl up and find a spot like your under arms, behind your ears…

Karlee: Crevices…

Carolyn: Crevices. 

Chris: Back of the knee…

Carolyn: Belly button, ick.

Karlee: Hairline…

Carolyn: But, they crawl up, so they crawl up first. They generally don’t attach to your ankles or feet. So, if you have light-colored clothing, and you’ve tucked your pants into your socks like Karlee was mentioning, then you can maybe see them crawling up before they attach.

Chris: How about a theoretical, here? Say you took all those proper preventative techniques, and you come home after a nice hike in summer, and you find a tick on yourself. What do we do?

Carolyn: Well, actually even before that, no matter what you do, when you get home do a tick check.

[Chris and Karlee agree]

Carolyn: But, if you do have one, then you want to grab tweezers or tick removal tool, a lot of stores sell them… If you have tweezers you just grab it close to the skin, at the tip of the body right before the head, grab it, not too hard, you don’t want to rupture it. Just pull very slowly so that the head comes out.

Karlee: Try to not jerk or twist it. I want you to remove it as fast as you can, but also make sure you’re getting the head because of the head is retained in, there is just a greater chance to get diseases from it, or infections, things like that.

Carolyn: Or, you can do what I did when I found it here at work. I screamed, and then I grabbed it, and threw it to the ground.

[Laughter]

Carolyn: Luckily it had literally just attached, because it came right out.

Chris: But in all seriousness don’t throw it on the ground.

[Laughter]

Carolyn: No, I didn’t keep it there. You want to put it in rubbing alcohol. That will kill it, and it will preserve it. Don’t flush, you’re not killing it if you flush it. You want to put it in rubbing alcohol or crush it.

Chris: And important to note actually, if you do put it in the rubbing alcohol which will kill it, it will actually preserve it, if you’re concerned it could be harboring a disease. There are sources we have available in northern New England to have it identified. For more information you can certainly call us, chat us, text us, and we’re happy to assist. How about some common pitfalls or kind of, old school methods for how we remove ticks? We should probably bring those up.

[Carolyn and Karlee laugh]

Carolyn: Thanks for looking at me for that Chris.

[Laughter]

Carolyn: Sometimes people will call, and say they’ve used the match method. That means you light a match, blow it out, put it on the back of the tick. That is actually never a good idea. It might get the tick to remove its’ head, but he’s more likely to regurgitate the virus or bacteria, because that’s found in the salivary glands. You are more likely to get sick if it has one of these diseases.

Chris: Also, putting a burning match to your skin, you know…

Carolyn: That’s true, that’s not a good idea. I agree Chris.

[Laughter]

Carolyn: The other one is Vaseline, covering it in Vaseline, because people think it will smother it. They actually only breathe 1-2 times an hour, so you’re going to be sitting there a long time, and then you’ll have to grab the tweezers!

[Laughter]

Karlee: And those things are really just delaying the actual removal and so…

[Chris and Carolyn agree]

Chris: And there are situations where people worry, “Could I have been exposed to one of those tick-borne illnesses?” When will we recommend reaching out to your doctor or your primary care provider?

Karlee: Yeah, so, after the removal it’s important to do typical first aid. So washing really well with soap and water to the area, and if you have found it is imbedded, follow up with your primary care provider and just see if there’s any further evaluation or management. Or, certainly if you feel symptomatic at all follow up with them as well.

Carolyn: You don’t, you know, it’s not emergent. If you find the tick in the middle of the night, you don’t need to call the doctor’s office in the middle of the night, you can wait ‘til the next day. It doesn’t happen that fast.

Chris: Another important resource that we should probably refer you also is the federal CDC’s website, cdc.gov. They do have a web page dedicated to ticks, and they have all sorts of helpful hints and tips that we went over so you might also find that to be a good resource

Carolyn: Yes, absolutely.

Karlee: Just to elaborate on symptoms, if you feel that you are having fever, muscle aches, you notice that classic bullseye rash, you could ‘Google’ photos of that, that’s pretty typical for Lyme disease… but anything like that as far as symptoms go, I’d want you to follow up with your primary care provider.

Carolyn: Absolutely.

Chris: Yes. I think the next type of insect that unfortunately we encounter way too much this time of year: mosquitoes.

[Karlee and Carolyn agree]

Carolyn: Ew, yeah, not my fav.

Chris: You all might be familiar.

[Laughter]

Carolyn: Probably, if you live here.

Chris: Any pointers you all have about where you are most likely to encounter mosquitoes, and just ways to prevent exposure?

Carolyn: Sure, mosquitoes are, they like water. That’s where they reproduce and that’s where they tend to hang out. So, morning when there’s dew on the grass and in the evening, you have to be careful. You want to cover up, you can use some repellents, we’ll talk about repellents later… the other thing is, they tend to, as I mentioned, reproduce in water, so if you have any open water like standing buckets, your wheelbarrow is turned over and gets filled up in a rainfall, empty it, because that’s where the larvae are and you’ll increase the amount of insects in your yard if you have those things.

Chris: But say, you do want to spend some time outside, and you don’t want to be covered in big red bumps for the next 2 to 3 days, what do we usually encounter that people like to use here?

Karlee: Yeah you can prevent bites by some different methods. One would be using a spray that contains DEET. That would kind of be your two for one, to cover you for ticks and mosquitoes. There’s also some natural products like lemongrass, citronella, and there’s mosquito dunks…

Chris: That’s a product you can put in a standing pool of water and it’ll help get rid of any of the insect larvae that are there.

Carolyn: And remember mosquitoes, they’re annoying and we don’t like to get bit by them, but they also, they can carry diseases. We don’t generally see a lot of that in northern New England, but you know, like with anything we just want to prevent exposure.

Chris: Sure, sure. The next group of insects – something where we actually worry occasionally about medical emergencies so we should probably talk about that – and that is stinging insects. Bees, hornets, ants can bite you, pretty irritating so, do you guys have any helpful hints for our listeners out there?

Carolyn: Sure, so the first thing you want to do is get rid of the stinger if it’s still in there. They don’t all leave the stinger in there, but instead of inspecting it carefully just grab a credit card or a license, scrape across the bite site. That’ll remove the stinger if there’s one there. Don’t use tweezers or squeeze because if there’s a venom sac, it’ll hurt way more.

Karlee: And just squeeze the venom further in, rather than just removing it all together.

Carolyn: Exactly, and like with everything else, wash with soap and water, that’s the first thing you’re going to want to do. And if there’s a little swelling then apply ice. A little bit of swelling, a little bit of pain, normal, it’ll go away in a pretty short period of time. That’s nothing to worry about. But, sometimes you do have to worry.

Karlee: Yeah, that would be anaphylaxis. So you can be allergic when you get stung by any of these insects that we’re talking about right now. Usually if you’re going to see signs of anaphylaxis it’ll be within the first 15 minutes of the exposure, sometimes it can be delayed an hour or two, but most commonly you’ll see it pretty soon. And that would be, you know, difficulty breathing, swelling in your neck, hives, anything like that – if you have any symptoms you need to call 911 because it is a medical emergency.

Carolyn: Right.

Chris: So, you step into a big nest of hornets, which hopefully that never happens to anyone out there…

Carolyn: Eesh, yeah… run screaming, ouch. If you get stung by, the number they say is 50 or more, that you can actually get poisoned from the venom. Fifty is a rough number, and obviously you’re not counting when you’re getting chased by a nest…

[Chris and Karlee laugh]

Chris: That would be pretty impressive.

Carolyn: … or a swarm of bees. If you get multiple stings, just call us. You still want to do the same stuff, you want to scrape the sites, you want to wash, but there might, even if you’re not allergic, there might be another thing to worry about there, so be careful.

Chris: Yeah. I think probably my least favorite group of insects that we unfortunately do encounter this time of year would be caterpillars.

Carolyn: Caterpillars? You know you can outrun them Chris? Why caterpillars?

[Karlee laughs]

Chris: Because they look terrifying!

[Laughter]

Carolyn: Have you seen a tick?!

[Laughter]

Chris: Okay. To our listeners out there, feel free to ‘Google’ what these species look like. But…

Carolyn: They’re pretty!

[Chris laughs]

Chris: There are a couple species that we worry about particularly in northern New England: tussock caterpillars, gypsy moths, and of course the brown tail moth.

Carolyn: The dreaded brown tail moth…

Chris: Now for our listeners in New Hampshire and Vermont, don’t fret too much, they’re not really in that area.

Carolyn: That’s brown tail moths.

Chris: Yes, what did I say?

Carolyn: Specifically the brown tail moth.

Chris: Yes, brown tail moths are located more in coastal Maine and Cape Cod.

Carolyn: Lucky us…

[Laughter]

Chris: Yes, lucky us. So this might be a little bit more relevant to those in in coastal Maine, but really the same recommendations go for most of these caterpillars so, what do we worry about?

Carolyn: Yeah, go ahead Karlee.

Karlee: Yeah, as a general rule of thumb, we typically just say don’t touch the hairy ones because really the issue with these is the hairs.

Carolyn: Right.

Karlee: The hairs are very irritating when they get on your skin. They can float in the air and you can breathe them in, and it can be very irritating to your airway and cause breathing difficulty which is one of the things we do worry about and would have you watch out for. The hairs can also stay active in the environment even if they’re not on the actual caterpillar for months.

Carolyn: Months!

Karlee: Yeah, so, really important as far as prevention goes.

Chris: And what are some of those prevention techniques?

Carolyn: Yeah, you don’t want to leave your clothes hanging outside if you’re in an area where these caterpillars are found. You want to wash clothes inside, and dry them inside, use hot water, just to make sure that you get rid of the hairs and you render them inactive. And just understand that some people are just more allergic to them. Some people just have, some people don’t have any reaction at all, some have a little bit, and some are just miserable for weeks.

[All agree]

Chris: You’ll be aware if you’re sensitive to it.

Carolyn: Absolutely.

Chris: And we do have treatment remedies. I don’t know if you want to expand on that, Karlee? As a pharmacist she might know about some of that.

Karlee: Yeah, so some things that we have recommended to people could be poison ivy wipes, you could use calamine lotion, if it’s itchy you could use an antihistamine like Benadryl, over the counter things. And actually, if you go to your local pharmacy you can ask them, in this area they’ll probably be aware of some of the things that can be used. And one thing that is common is half a tube of hydrocortisone, half a tube of diphenhydramine, and witch-hazel that you would apply topically.

Carolyn: They call that the magic potion or magic lotion.

Chris: Yes, something to talk to your pharmacist about or the staff in the pharmacy because they might have it available already. One small piece I’d like to talk about with caterpillars that we do encounter occasionally, obviously because we deal with a lot of exposures in little kids – what are we worried about if a child swallows a caterpillar?

Carolyn: Oh, that can be a problem with the hairs in the mouth and the throat. It can cause breathing difficulty…

Karlee: Swelling…

Chris: It can be a medical emergency. If something like that happens we do urge you to get in contact with us.

Carolyn: Right, and again we’re talking about the hairy caterpillars.

Chris: Yes.

Carolyn: Kids eat lots of bugs…

[Chris laughs]

Chris: Which you can always feel free to call us about regardless.

[Karlee laughs]

Chris: So we should probably talk about some of the defense, the repellents, some of the commercially available products we have to prevent against this sort of thing.

Carolyn: Yeah, before we talk about the exact products, the most important thing is to read the label. I know that sounds silly, but they’re very highly regulated, pesticides are, and they’ll tell you exactly how to use them. Do not apply them more often than it states, and if it says don’t use on children it’s because they have a high level of the pesticide. So, just be very careful. You don’t want to saturate clothing for example, while it’s on your child or your body ‘cause then you’re being exposed to it constantly. You just want to be careful there.

Karlee: There are different percentages of pesticides depending on the product that you have. Some are just meant to spray on clothes, and you let them dry before you put them on. You’re not supposed to apply them to your skin. There can be pretreated tents, or things like, but yeah, read the label.

Chris: We got a lot of calls this time of year and that exact thing. So what kind of products are available? I know we touch kind of briefly on it but, what do we most commonly encounter?

Karlee: There are permethrin products that can certainly be irritating to the skin. If you do use that product incorrectly just call us and we can talk through all of the concerns for toxicity. There is DEET, which definitely can be a concern, especially when ingested it can be very toxic. There’s also natural products like eucalyptus, lemongrass oil, citronella candles, and picaridin is another option as well.

Carolyn: And even the natural products can be a problem if they’re ingested. They’re all pretty safe to use when used correctly, but it sometimes even if you use as instructed you know, you put it on the child and they lick their arm. I mean, we see that all the time.

[Karlee laughs]

Chris: Happens all the time.

Carolyn: Yeah, so just call us, we can help with those things.

Chris: And not to be total bummers and make summer seem like it’s a dangerous time, we all love summer here…

[Carolyn and Karlee laugh]

Carolyn: We do!

Chris: But frankly we get a lot of calls on all these subjects. If you have any questions, please feel free to always call us, chat us or text us. In conclusion we just wanted to thank you all again for listening to this episode of Poison Center Pointers. You can always like, share, and subscribe to us on Facebook and Twitter, or you can visit our website at nnepc.org. Remember if you have an actual poisoning emergency, a scenario, or even just a question you can contact the Northern New England Poison Center by calling 1 800-222-1222, you can text the word ‘POISON’ to 85511, and you can chat online at nnepc.org. Org thanks again for joining us today. See you next time.

♪Upbeat music♪

Chris: Hey guys, it’s Chris still here with you. I actually have some additional information and clarification from one of our specialists here who reviewed our podcast. We’ll go ahead and call this the ‘fact check’ section of the podcast. As I said one of our specialists in poison information, also the public health educator for the state of Maine, Victoria is here with us. Thanks for joining!

Victoria: Sure Chris, thanks so much for letting me criticize your work!

[Chris laughs]

Chris: The internet was going to do that anyway so, might as well keep it in house. A couple, or a few points we want to go over for the last episode. What have we got?

Victoria: Yeah, not too much. But first, I did want to mention, not to get into semantics, but…

[Chris laughs]

Victoria: …ticks are not insects, they are arachnids!

Chris: Yeah, yeah.

Victoria: They are both arthropods, insects and arachnids, and some repellants can be used for both, but they’re not in the same class. And, you know we do take our arachnids pretty seriously here at the poison center so…

[Victoria laughs]

Chris: Yeah, so we won’t get into the full differences, just know that insects and arachnids are not the same thing. What else did you want to go over?

Victoria: So you had all mentioned the CDC as a great resource to learn more about the different diseases that arthropods can carry and transmit to people. I just wanted to mention that if our listeners want more information about repellants, epa.gov is a great resource for that.

Chris: We went over a couple brief products, and if you go on EPA’s website they have information on registered repellants, versus non-registered, and it really is a great resource. We did do a bit of reviewing on our end. I think there was one last point that we wanted to go over?

Victoria: Yeah, lastly, if any of our listeners do find themselves in need of any of the over the counter remedies that we had talked about, we do encourage folks to reach out to their providers if they’re feeling unwell. And, if you do find yourself in the pharmacy and have questions about products, the pharmacist there is also a great resource. But, of course, people can call us as well if they have other questions.

Chris: Is that all we had as far as criticisms, so far?

[Victoria laughs]

Victoria: Yes, that is all I had.

Chris: Yeah? Okay, well again stay tuned for episode 3, should be coming out in a couple weeks. Again, you can always call us at 1-800-222-1222, you can chat with us at nnepc.org, and text ‘POISON’ to 85511. Thanks for joining us Victoria.

Posted in Poison Center Pointers Podcast, Poison Prevention | Comments Off on Poison Center Pointers: Insects and Repellents

Introducing Poison Center Pointers, a podcast from the NNEPC’s poison specialists

We are pleased to announce the launch of Poison Center Pointers, a podcast brought to you by the specially trained professionals who answer your calls on the poison help line at the NNEPC.

What is it like working for a poison control center? What types of calls do we get? Get insights straight from the experts themselves while learning about ways you can avoid poisonings, and what to do in cases of possible poisoning.

Our first episode provides an introduction to poison centers and your local center, the NNEPC. Visit our podcast home page on Podbean to subscribe, or find Poison Center Pointers on Amazon Music, Apple Podcasts, Google Podcasts or Spotify.

TRANSCRIPT

Disclaimer: Poison Center Pointers is brought to you by the Northern New England Poison Center. This podcast is NOT to replace timely advice or recommendations. If you have an actual poisoning emergency, scenario or question, contact the Northern New England Poison Center by calling 1-800-222-1222, texting the word POISON to 85511, or chatting online at nnepc.org

Welcome to Poison Center Pointers, a podcast presented to you by the Northern New England Poison Center. ♪upbeat music♪

Chris: Hello to all our listeners, and welcome to the first ever episode of Poison Center Pointers, a podcast presented to you by the Northern New England Poison Center. My name is Chris, I am one of the specialists in poison information, and I am joined by two of my co-hosts and colleagues, Karlee and Carolyn. Thanks for being here, guys.

Karlee: Yeah, hi everybody!

Carolyn: Yeah, thanks for having us.

Chris: In this room we have a couple decades of experience here. A couple of those decades do come from Carolyn…

Carolyn: Thanks, Chris…

[laughter]

Chris: We decided to start a podcast here to share our knowledge and experience dealing with everyday situations we help manage at the poison center. Our goal is to keep the community safe by preventing a poisoning, but also making sure that you know what to do if a poisoning occurs. We’re hoping with the podcast we can provide some entertainment value along the way.

Carolyn: Maybe…

Karlee: We think we’re pretty funny!

Chris: That may be a judgement… [laughter] With our inaugural episode we figured we should probably start with the basics, and go over a few kind of key points here. Namely, I wanted to cover who works at the Northern New England Poison Center, what exactly is it that a poison center does, why should you call the poison center, and how do you get in contact with a poison center. So without further ado, Carolyn would you like to take it away and talk about who works here?

Carolyn: Sure, Chris. Most of the people who work here are nurses and pharmacists. Everybody is pretty much trained in health care, but more importantly we are specialists and uniquely trained in poison information and poison emergencies.

Karlee: Yes, and we are here all the time, 24/7…

Chris: 365…

Karlee: Yes, exactly. And, we take calls from the general public and various healthcare professionals, whether it be an emergency department or primary care office. We cover Maine, Vermont and New Hampshire.

Chris: Thus, Northern New England Poison Center. We’re one of 55 accredited poison centers across the United States. So, that’s just kind of a brief overview of who works is here, but we do want to cover what exactly the Northern New England Poison Center does. So Carolyn, do you want to expand on that?

Carolyn: Sure, before I talk about what a poison center does, let’s talk a little bit about what is a poison. Most people don’t really realize what the poison is, or what does it mean when you work at a poison center. A poison isn’t just a referring to a poisonous snake or a poisonous spider, ‘cause luckily we don’t really have many of those around here, if any.

Karlee: Yeah, that’s why I live here.

[laughter]

Carolyn: We appreciate that! But, a poison is anything that can cause harm. Whether it means it gets on your skin and causes a rash, or because you inhale it, or swallow it, or get it in the eye.

So, we deal with all of those, we don’t just deal with things that people swallow that they’re not supposed to, although that’s more common. We can tell you, for example, how to flush an eye over the phone. And we deal with poisons whether they are from around the home, or whether they’re in the workplace, or a medication error, or whether it’s something from the environment—any of those things! And you know, people often think that we just deal with children. We really don’t, we deal with anybody. You know, if you double dose your med by accident we’re going to be able to help you with that, or any of that kind of information.

Chris: If you are wondering if we can help, just call and we will always try our best to. You know, Karlee I think we should bring up, does it have to be an emergency for the public to reach out to us?

Karlee: No, good point. It doesn’t have to be an emergency and it doesn’t even have to be an exposure. We like to promote prevention here obviously, so you know if you’re thinking about maybe bringing something into an environment where there’s an individual who could be exposed. For example, you know you’re buying a new house plant and you have kiddos around. We can give you some toxicity information in general about the plant, and you can kind of use that to make decisions.

Chris: I think a lot of familiarity with poison centers just extends from getting a product and looking on the back and seeing that label that says “If swallowed, call the poison center, or 1-800-222-1222.” There isn’t as much familiarity with what exactly it’s like to call a poison center so, do we kind of want to go into what that experience is like?

Karlee: Yeah! It’s not just you know, you call us and we say and “That’s probably poisonous. Bye!”

[Laughter]

Carolyn: That would make our job a lot easier!

[Laughter]

Karlee: No, we really do a lot more for you than that. We will assess the situation, that’s what we’re trained for. We’ll triage to determine if you can be managed at home or if you do need to go into a health care facility.

Chris: Yeah, going along with that we should probably get into why we feel it’s important the community is aware of us, and why exactly they should call us. So do we kind of want to go into that as well?

Carolyn: Sure, so first of all, when you call the poison center, the person you are speaking with, the person who answers the phone, is the person who can help you. You don’t have to wait, it’s very quick. It’s one-on-one service and we’re not managing five other calls at the same time.

We’re talking to you and we’re going to deal with your emergency or your question. So it’s one-on-one, it’s quick, it’s confidential, judgement-free—we really are there to help.

Karlee: Yep, and aside from just good quality care, other perks are that we can save you time and money. So the time aspect, I mean that we get a lot of calls from people who say that they’ve been researching something for upwards of 30 minutes to an hour online and can’t really find anything. Well, we do have evidenced-based sources to kind of give you accurate and timely information.

Carolyn: Right. A lot of times when you look on the internet you see the worst case scenario. It doesn’t take into account how much, how old is the person, you know what exactly happened, and we can access all that, and we can do it very quickly.

Chris: Along with time we even have situations where people are worried that they need to run into the emergency department for something that’s, you know, not as much of an issue from our perspective. And we’re happy to let you know that, so—saves time, saves money.

Carolyn: Right, absolutely.

Chris: A fun fact that we like to say here is that for every dollar invested in a poison center saves $13 on the healthcare system. So, pretty good return on investment.

Carolyn: It’s pretty significant.

Chris: Carolyn also brought up one-on-one personalized care. We will follow up with you on the phone. We handle about 30,000 calls here yearly at the Northern New England Poison Center, and 9 out of 10 are just managed over the phone.

Carolyn: Right! We can save you that trip to the doctor or the emergency room. And we can let you—we will tell you if you need to go.

Karlee: Yep.

Chris: Right. I think the most important thing we could go over in this introductory episode however, is how exactly the communities we serve can get in contact with us. So, what’s the most common way?

Karlee: The most common is right over the phone, people calling us. So get out your pens, and write it down. The number is 1-800-222-1222. That is the national number but if you are in Maine, Vermont, or New Hampshire you’ll be routed to us. And you know if you call us, we will send you a magnet—stick it on your fridge.

Chris: We have pill reminder boxes too.

Carolyn: Lots of good stuff!

Chris: How about for the more tech savvy members of our community?

Carolyn: Sure, let me just mention that if you call we do have an interpreter service available as well, just so you know that. But you know, if you’d rather chat, you can chat through our website at nnepc.org, as in Northern New England Poison Center.org. Or, you can text POISON to 85511.

Chris: Well that’s the majority of, really, what we wanted to cover here in this introductory episode. But you know we do plan to have a lot in store, and we’re hoping to release episodes regularly. Any ideas on those topics we should be covering soon?

Karlee: Yeah we’re excited to expand on lots of different things. I think, you know, seasonal—sort of summer or fall, or even around the holidays, just certain things you should be aware of.

Carolyn: Yeah I mean we can do things like—we could do a whole podcast on mushrooms and berries, or carbon monoxide, or what children tend to get into and how to deal with that, so, we have a lot of ideas.

Chris: Yeah, so, plenty of material to work from, but we do want to say thanks again for listening to the first episode of Poison Center Pointers.

Carolyn: Yeah, thanks everybody!

Karlee: Thanks!

Chris: You can like, share, and subscribe to us on Facebook and Twitter, and again visit our website at nnepc.org, and if you have feedback or topics you’d like us to cover you can certainly send it to us.

Carolyn: Yeah, that’d be great.

Chris: But remember if you have an actual poisoning emergency, scenario, or even just a question contact the Northern New England Poison Center by calling 1-800-222-1222, text the word POISON to 85511, or chat online at nnepc.org. So, on behalf of Karlee, Carolyn and I, thank you so much for joining us today.

♪upbeat music♪

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NNEPC notes increase in self-harm cases among young teens

The NNEPC has noted a significant increase in self-harm-related poisonings among children 16 years old and younger over the past several months in Maine, New Hampshire and Vermont.

From October 2020 to May 2021, the center managed 560 cases of self-harm among patients in this age range, more than 50% more cases than average for an eight-month span. The increase comes after self-harm cases in this age group fell slightly during the first few months of the COVID-19 pandemic.

The increase has been most significant among patients 13 and 14 years old, with the average number of cases per month during this period (30) nearly double the monthly average from 2017 to 2019 (16).

Graph showing increase in self-harm among 13-14-year-oldsMonthly cases among patients younger than 13 also nearly doubled, though the number of cases remained small (7 per month), while the number of cases involving 15- and 16-year-olds increased by a third (33 cases per month from October to May versus 25 per month from 2017-2019).

Graph showing increase in self-harm among 15-16-year-oldsThe increase in self-harm cases was mostly due to attempts by girls.

  • Girls accounted for 85% of the patients during this eight-month period.
  • The average number of cases per month involving girls during this period was 65% higher (59) than the average from 2017-2019 (36). The number of cases involving boys rose only slightly (11 vs 9 per month).

NNEPC self-harm-related poisonings have fallen overall since the beginning of the pandemic, and within most age groups the number of cases has remained well below 2017-2019 levels in recent months, making this increase among young people even more notable.

Young patients attempting self-harm are most likely to take medications that are easily accessible, such as their own medications for depression and over-the-counter medications found in the family medicine cabinet. Some over-the-counter medications can be dangerous in overdose. Parents and caregivers of youth in these age groups should consider keeping their medications locked up or otherwise inaccessible.

In addition, parents, teachers and others who work with youth in these age groups should be familiar with the risk factors and warning signs for self-harm and resources available for help.

The National Suicide Prevention Lifeline is available 24 hours a day to provide free and confidential support for people in distress, as well as prevention resources for those close to them. Call 1-800-273-8255 or visit suicidepreventionlifeline.org to chat online or get more information. Other resources include:

The NNEPC is available 24/7 at 1-800-222-1222 to provide fast, expert advice in cases of possible poisoning, and to answer questions about medications and other potential poisons.

Further reading: Similar national trends were noted in a June issue of the CDC’s Morbidity and Mortality Report.

 

 

 

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Preparing for a new baby: Steps for avoiding accidental poisonings

If you are expecting a new baby or have young children in your home, taking steps to prevent accidental poisonings is a crucial part of home safety. Many common items in and around your home may be poisonous, presenting risks for newly crawling or walking babies, who explore the world by touching things and putting them in their mouth.

The most common things babies get into while exploring like this are medications, vitamins and supplements, cleaning products, personal care products such as hand sanitizer and deodorant, toys and foreign objects, plants and mushrooms, and pesticides like ant traps and bug spray.

Some of the most serious poisonings involve prescription pain medications, marijuana, ADHD medications, cough and cold medications, and certain foreign objects like batteries, magnets and ammunition.

Following the safety tips below can help prevent many poisonings. Kids act fast, though, and sometimes despite our best efforts they will get into something, or we’ll make a mistake when giving them medication. That’s why it’s important to have the poison center number saved in your phone: 1-800-222-1222. The poison center is staffed by specially trained nurses and pharmacists who provide fast, expert help at no cost to you. With help from the poison center, 95% of poisonings involving young children can be treated at home. You can also reach us by text message by sending the word POISON to 85511 or by chatting live with our poison experts here on our website.

Making your home safer

Tips for home safety and medication safety:

  • Store all potential poisons up high, out of reach of children, in a locked cabinet if possible. Keep purses, luggage and diaper bags out of reach of children as well.
  • Store products in their original containers, and keep all nonfood items separate from food and drink.
  • Put the cap back on immediately and put products away as soon as you are finished using them.
    Be sure to replace the safety cap tightly right after using a product

    Image from the Up and Away campaign. Visit their site for more resources related to safe storage.

  • Read the label on medications, cleaners and other products, and carefully follow the instructions each time you use them.
  • When giving medication to a child, use the measuring tool provided with the medication or another marked measuring tool like a teaspoon or tablespoon. Do not use silverware or serving spoons.
  • Do not call medication “candy.”
  • Get rid of products you no longer need, such as expired medications or old pesticides, safely and promptly. Call your town office for guidance on disposal.
  • Be prepared for poison emergencies: store the poison center’s number, 1-800-222-1222, in your phone contacts and put a magnet on your refrigerator. Request a magnet online or by calling the hotline.

The NNEPC was pleased to assist Safe Kids VT with its Preparing for Baby booklet, which featured a modified version of this post. Download the booklet from the UVM Medical Center Safe Kids page.

 

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Calling the poison center can save you time and help our hospital workers

While vaccine rollouts promise some light at the end of the tunnel, the ongoing COVID-19 pandemic continues to take a toll on health care providers, with many hospitals stretched thin by the number of coronavirus patients they are treating, the extra precautions they have to take and other pandemic-related challenges.

Meanwhile, surveys indicate that fear of going to the hospital during the pandemic has led many people to avoid seeking the urgent or even emergency care they need. This is dangerous, and it’s important to seek appropriate care in a medical emergency, because the long-term effects can be much worse if you delay.

However, in many situations, emergency care is not necessary, and you can help our hospital workers greatly by avoiding an unnecessary trip. That’s where the poison center can help. Our poison specialists are available 24/7 to provide free, immediate, expert advice in cases of potential poisoning—and that includes a lot more situations than you might think. Here are just a few examples:

  • Your child swallowed a cleaning product, medication, vitamin, toy or other household item
  • You took your medication twice.
  • You took your spouse’s medication or your pet’s medication.
  • You took your nighttime medication in the morning.
  • You got a cleaning product in your eye.
  • Your skin feels irritated after you’ve used a cleaning product or spilled some on yourself.
  • You drank a cleaner or other product that was being stored in a juice bottle.
  • You feel sick after using marijuana or vaping a nicotine product.

Most of the time in cases of potential poisoning, our experts will be able to provide all the treatment information you need over the phone. In fact, 9 out of 10 times someone calls from home we are able to help them right there—and it’s 95% of the time when the case involves a child 12 or younger. In other cases, our experts will direct you to the best place for additional help, whether that’s the emergency department, your doctor’s office, your pharmacist or another health care provider. And in those cases we’ll work with your other providers to make sure you get the best and most efficient care possible.

Calling the poison center can help you avoid the time, expense and anxiety of a trip to the hospital, and it also helps our front-line hospital workers focus on those who need help the most. It’s a win-win. Save the poison center number, 1-800-222-1222, in your phone today. And remember you can also reach our experts by text message by sending the word POISON to 85511 or by chatting with us online.

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Lead poisoning is still an issue in Northern New England

Lead poisoning remains a concern in Maine, New Hampshire and Vermont, where we have some of the country’s oldest housing. Lead paint was widely used in houses built before 1950 and continued to be used in some houses until 1978.

When lead paint ages, it begins to peel and crack, turning into lead chips and lead dust. These can be swallowed by young children who are exploring their environment.

A child with lead poisoning may not show obvious signs of it, but there can be serious effects, including problems with learning, attention and behavior that can affect them throughout their lives.

Maine, New Hampshire and Vermont all now require that children be tested for lead at 12 and 24 months old. Contact your doctor to find out how to set up testing.

In addition, if your home was built before 1978, have it tested for lead. Visit your state’s lead program page for information on how:

Adults may also be at risk of lead poisoning, especially if they remove old lead paint without taking appropriate precautions. Visit your state’s lead program page above for information on safe remediation of lead paint.

If someone has swallowed or inhaled lead, call the poison center at 1-800-222-1222, text us by sending the word POISON to 85511 or chat online. We’re available 24/7 to help in poison emergencies or to answer other questions you have about lead poisoning.

You can also visit the lead page in our A-Z Poison Index for more details about lead and lead poisoning.


Chipping paint photo by Bart Everson. Creative Commons 2.0.

Hunting and fishing safety

With hunting season upon us, remember to keep all hunting and fishing products out of the reach of children at all times, even if you are just leaving the room momentarily.

Every year the NNEPC manages cases of children swallowing lead sinkers, lead pellets or other lead ammunition, which can result in lead poisoning.

Products that do not contain lead can also cause problems if swallowed. They may get stuck in the child’s food pipe or intestines and require medical help to remove.

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Practice safe canning to avoid botulism

The COVID-19 pandemic appears to have sparked a renewed interest in canning as Americans spend more time at home. While canning can be a good way to preserve food for future use, it’s critical to take steps to prevent botulism.

What is botulism?

Botulism is a rare but potentially deadly illness caused by a toxin produced by certain germs, most notably the bacteria Clostridium botulinum. Foods that have been improperly canned, preserved or fermented are among the most commons sources of this toxin, which affects the nervous system.

Low-acid foods are more likely to contain this poison when they are not preserved in the right way. Some examples are:

Image by Lolame from Pixabay

  • Asparagus
  • Beets
  • Corn
  • Green beans
  • Mushrooms
  • Potatoes
  • Spinach
  • Some tomatoes
  • Meats
  • Fish and seafood

You cannot see, smell or taste the toxin, making prevention essential.

While foodborne botulism is not common, it can be fatal if it is not caught early and treated effectively.

What are the symptoms of botulism?

Symptoms typically appear 12 to 36 hours after exposure, but can begin as early as 6 hours after or as long as 10 days later.

Early symptoms often include nausea or stomach ache, sometimes with constipation.

The effects on the nervous system usually begin in the head and face. Symptoms can include:

  • Blurred vision
  • Drooping eyelids
  • Dry mouth
  • Trouble swallowing and speaking

The illness can go on to cause muscle weakness, including in your arms and legs and in the muscles used to breathe, making breathing difficult.

How can I prevent botulism?

The best way to prevent foodborne botulism is by carefully following the instructions in the USDA’s Complete Guide to Home Canning. We recommend taking a canning or food preservation course with your local university extension, as well.

When canning low-acid foods, it is important to use a pressure canner, according to the CDC. Do not use an electric, multicooker appliance, even if it has a canning button. It is unclear if these are effective in preventing botulism. Carefully follow the processing times given in the USDA guide.

Pay close attention to your cans when you are ready to open them. Throw out any canned food—whether it’s store bought or home canned—if it is leaking or bulging or if it looks damaged or cracked. Throw out the food if the container spurts liquid or foam when you open it or if the food is discolored or smells bad.

Store any opened canned or pickled foods in the refrigerator.

The CDC recommends caution when you are throwing out possibly contaminated food. Use rubber or latex gloves before you handle it. Put the food in a sealable plastic bag, then wrap another plastic bag around it and tape it shut. Place the bags in a trash receptacle outside the house. Use a bleach solution to wipe up any spills. Wash your hands with soap and water for at least two minutes afterwards.

What should I do if I think I have botulism?

If you are showing signs of botulism, contact the poison center right away. The poison center’s experts can tell you what steps you need to take immediately and direct you to the best place for further care. Call us at 1-800-222-1222, chat with us online or text POISON to 85511.

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Poison safety during a pandemic: Guidance for school nurses, teachers and daycare providers

During the COVID-19 pandemic, poison centers across the country have seen increases in certain types of poisonings. These poisoning risks will be of concern to teachers, nurses and other staff members as they return to school under unique circumstances. The NNEPC has prepared this post to help school staff members, daycare providers and others working with children and teens safely manage the increased levels of cleaning, disinfecting and sanitizing brought on by the pandemic.

Hand sanitizer safety

Proper hand hygiene is important in preventing the spread of illnesses such as COVID-19. Washing your hands with soap and water is best, but alcohol-based hand sanitizers are a good alternative when soap and water are not available or not practical.

However, increased availability of hand sanitizer increases the risk of ingestions:

  • Pre-school-aged children may swallow hand sanitizer unknowingly or accidentally.
  • Young school-aged children and preteens may swallow hand sanitizer in response to dares or to show off.
  • Teenagers may swallow hand sanitizer deliberately for the alcoholic effects.

Swallowing enough hand sanitizer can lead to intoxication and related effects. For young children this may take only a little more than a mouthful. These effects can include:

  • Drowsiness
  • Difficulty breathing
  • Vomiting, with a risk of choking on vomit

In addition, the FDA has identified certain brands of hand sanitizer that inappropriately contain methanol or 1-propanol. These toxic alcohols are not safe ingredients for hand sanitizer and can cause more severe symptoms and even death if they are swallowed.

Because of these risks, keep hand sanitizer in a safe place where students cannot access it and supervise all use of hand sanitizer  .

Cleaner and disinfectant safety

Classroom

Classroom photo by Flickr user alamosbasement. Creative Commons 2.0.

Most accidental exposures to chemicals such as cleaning products and disinfectants involve splashes in the eye, skin irritation or burns, or breathing in fumes—either from using the product without ventilating or from mixing chemicals together. Swallowing may also be an issue, especially with young children who are exploring.

Things to consider:

  • Effects of these exposures may be immediate but they can also be delayed for minutes or even several hours.
  • Many products that do not cause irritation from a single use may be more irritating when used frequently.
  • Some people are more sensitive to chemicals than others are. Fumes may cause breathing difficulty for people with asthma or other lung conditions.

When using cleaners and disinfectants, take these safety steps:

  • Read and follow the label instructions each time you use a product.
  • Use gloves and ventilate the area while cleaning. Goggles may be appropriate if the product could splash in your eyes.
  • Avoiding mixing cleaning products—use only one product at a time.
  • Avoid using cleaning products while students are present.
  • Store cleaning products in places where students cannot access them.
  • Keep products in their original containers whenever possible. If you must put a cleaning product in a different container, be sure it is clearly labeled and stored far away from food, drinks and medications.

The poison center is a 24/7 resource

The NNEPC is here 24 hours a day at 1-800-222-1222 to provide fast, expert advice, whether a student has swallowed hand sanitizer, someone is having symptoms from a cleaning product exposure, or in any other case of potential poisoning. These situations can include cases of students eating plants or berries on school grounds, medications errors or deliberate misuse of medication, mishaps in chemistry classes, gas leaks and many others.

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NNEPC welcomes new medical director, attending physician

Dr. Mark Neavyn, NNEPC Medical Director The Northern New England Poison Center is pleased to welcome Dr. Mark Neavyn as our new medical director.

Dr. Neavyn comes to us from Worcester in his home state of Massachusetts, where he was an emergency medicine physician for UMass Memorial Medical Group and an associate professor for UMass Medical School, mentoring toxicology fellows.

Dr. Neavyn earned his MD from Jefferson Medical College in Philadelphia in 2006 and completed his residency at Drexel University/MCP-Hahnemann. He trained as a medical toxicologist at UMass Medical School before serving as the director of medical toxicology at Hartford Hospital in Connecticut. While in Connecticut he provided toxicology consultation for the Connecticut Poison Control Center and led residency education in toxicology.

As the NNEPC’s medical director, Dr. Neavyn will oversee the clinical management of calls to the center, provide toxicology consultation to other health care providers and provide toxicology education to physicians in training. He will also practice emergency medicine at Maine Medical Center.

The NNEPC is also pleased to welcome Dr. Caitlin Bonney as an attending physician for medical toxicology. Dr. Bonney has joined Maine Medical Center as an emergency medicine physician, and will assist in providing toxicology consultation for the NNEPC.

Dr. Bonney completed emergency medicine training at UMass in 2017 and a medical toxicology fellowship at the Rocky Mountain Poison and Drug Center in Denver in 2019.

She joins us from UNLV in Las Vegas, where she was an attending physician and toxicologist.

Dr. Tammi Schaeffer, former NNEPC Medical DirectorWhile we are excited to welcome Dr. Neavyn and Dr. Bonney to our team, we are saddened by the departure of Dr. Tammi Schaeffer, who has taken a position with Johnson & Johnson in her home state of New Jersey.

Dr. Schaeffer joined us as medical director in 2013 and is leaving very large shoes to fill. Fortunately for us, Dr. Schaeffer will continue to provide toxicology consultation for the NNEPC. We wish her all the best in her new role!

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