#40 Skin Cancer; Part One of Two
Excerpts from S.afety O.n S.ummits by Rick Hartman
My sister, Rose, called this past week. Her husband Bruce died early this morning. He had that melanoma in his eye and about nine months later it spread to the liver. In spite of four different rounds of chemo, the cancer just took over. An active fellow, he never drank, smoked or even drank soft drinks. They were our camping buddies. Ann S.
All Highpointers are active folks, drawn to the great outdoors and especially high elevations, where skin cancer should be a concern. This maturing columnist now has a regular relationship with a dermatologist. The routine exams result in liquid hydrogen being applied and recently, part of one ear was carved off, after developing a basal cell carcinoma. All who are active in the outdoors should consider they are potentially a victim of this skin cancer epidemic, now recognized as the most common form of cancer in the United States. Once more S.O.S. touts: “Avoidance is the key.”
Previously considered an affliction of older humans, skin cancer is now recognized to have very little to do with seniority or just people. One albino humpback whale, known for 28 years off of Australia, has been recently photographed with pink discolorations around its dorsal fin. It is suspected to be skin cancer, which likely developed from its long periods of being on the surface, basking in the sun.
Recall that the epidermis (skin) is the largest organ of the human body. Current odds favor one in five Americans will develop skin cancer and there is strong evidence that skin cancer is growing among the young; here at least, the dermatologists are taking notice. A recent article in the Journal of the American Medical Association addressed the rise of carcinomas in those under age 40; defining the problem, however not so much the cause. The primary cause is ultraviolet (UV) radiation from excessive sun exposure and tanning beds. Other causes include exposure to sun lamps, chemicals, and petroleum by-products. The effects of the sun on our skin are lifelong and progressive, and older skin is more prone to sun damage, as the self-correcting processes of our cells wane with age.
The World Health Organization has declared ultraviolet radiation as a carcinogen. There are three types of ultraviolet rays:
- UV-A: penetrates deep below the skin surface, causing wrinkles and age spots.
- UV-B: burns skin and eyes.
- UV-C: the strongest and most dangerous UV ray, it is effectively blocked out by the Earth’s ozone layer.
- UV-B radiation intensity increases with the time of day, it is more intense in summer, at the Equator, and at higher altitudes. UV-B radiation exposure will increase 4% for every thousand feet increase in altitude. Yet, at a mean elevation of 1,117’, Phoenix, Arizona is recognized as having the seventh highest UV Index level in the United States.
The UV Index Scale, developed by Canadians in 1992, is represented as: 0-2 “low danger”, for the average person; 3-5 “moderate risk of harm”, from unprotected sun exposure; 6-7 “high risk of harm”, protection against the sun is needed; 7-10 “very high risk of harm”, use extra precautions, skin will be damaged ; and 11+ “extreme high risk of harm”, take all precautions, skin can burn in minutes. If the forecast “UV index” is -3- or higher, we should protect ourselves. Keep in mind, infants under six months should be kept out of direct sunlight as much as possible and sunscreen and sunblock is not recommended to be used on them.
Studies reveal 80% of a person’s lifetime sun exposure occurs during childhood. Children’s skin is more delicate than adults’ and kids spend longer periods in the sun unprotected. Thus, learning as adults and teaching children quality sun protection behavior, we can address the increasing skin cancer rates. Simple protection behavior begins with the University of Arizona Skin Cancer Institute’s “ACE”: Avoid too much sun, Cover-up and Examine your skin. Their website is: www.azskincancerinstitute.org.
Avoidance
This can be accomplished by limiting exposure when the sun rays are the strongest (10 am to 4 pm). If outside seek shade; avoid tans and burns from the sun, as well as indoor tanning beds. Try to avoid reflective surfaces such as water, glass, concrete, sand and snow. Sunlight reflecting off of snow (80%) and white sand (17%) can nearly double the strength of UV rays. Cloudy days are deceptive as 80% of the sun’s UV rays will pass through clouds.
Cover-up
When outdoors, minimize your exposure by wearing long pants and long sleeved shirts (darker colors with a tightly woven pattern are best), cotton gloves, a large brimmed hat (offering greater ear and neck protection) and closed toe shoes.
Covering-up also includes our eyes, which are susceptible to serious damage from UV radiation. Purchase and wear sunglasses that block 99-100% of UV-A and UV-B rays (see: S.O.S. #31, “This and That”/ Sunglasses). Good eye protection is not a luxury; it is a crucial necessity. Here again, buyer beware, as there is no standardized testing and labeling of sunglasses. Some expensive sunglasses offer little UV protection and cheap ones can be very good! Serious vision problems can result from cumulative eye damage from unprotected sun exposure, even on cloudy days. The sun’s UV rays can create solar-induced cataracts on the lens of the eyes, benign growths on the white part and cornea of our eyes (known as: pinguecula or pterygium), and can penetrate to the back of the eyes, where ocular melanoma can occur and the retinas may suffer damage as well. Also, there are eyelid malignancies recognized to be caused by sun exposure. Refer to: www.thevisioncouncil.org for further information.
For our skin, apply a broad-spectrum sunscreen on all exposed areas with a Sun Protection Factor (SPF) of 30 or higher and a lip balm with a high SPF (See next Quarters’ Part Two topic: “Sunblocks and Sunscreens”).
Recent advances have created sun-protective clothing (hats and garments) which are designed to block both UV-A and UV-B radiation. Their ability to protect is affected by weave, color, weight, stretch and wetness. Synthetic fabric materials such as polyester, Lycra and nylon protect well by absorbing UV radiation. Some products may have UV absorbers added in during the manufacturing process. Simply stated, the more dye (darker color) the better protection; the open/less dense the fabric, the worse protection. Getting the fabric wet reduces the protection by as much as half, except for silk. UV blocking clothing is rated by a “UPF” (Ultraviolet Protection Factor) from a 1996 designation.
By Federal Trade Commission standards, these ratings are more accurate as to fabric’s ability to block UV radiation than the Sunblocks/Sunscreens’ SPF ratings are. A rating of UPF15/24 is deemed “good”, blocking 93-95% of UV radiation; UPF25/39 is deemed “Very Good”, blocking 96-97.4% of UV radiation and UPF40/50 is deemed “Excellent”, blocking 97.5-99% of UV radiation. Washing the fabric requires following the laundering directions on the garment, however chlorine bleach is not recommended and line drying is preferred across the board. Some items may specify hand washing only and too, could be stained by contact with sunscreen lotions. No information was found on how many washings UV blocking fabrics could sustain until their properties were diminished. As a consumer consider darker colors and heavier weaves will be a heat retention (disadvantage) issue, while ventilated weaves, moisture wicking, and antibacterial properties will aid in breathability. Manufacturers are: Coolibar, Patagonia and Solar Tex. A final note, garments with the lowest UV protection are: bleached cotton, polyester crepe, viscose, knits, undyed/ white jeans (denim), lightweight linens and worn, old fabrics.
Examine
Our skin should be examined once a month. Early detection of skin cancer usually results in very successful treatment. Common moles are smooth, symmetrical, with even borders and usually have a single shade of brown color. If need be, compare any questionable spot to your own common mole to self-identify a concern. Many times the questionable spot is where you cannot see it (ears and back of neck, for example), so your exam should include another’s help. Finding any questionable spot on yourself or mate requires a doctor’s exam right away. Pay attention to any spot that forms a scab, re-scabs and fails to heal. Suspect: scaly, thickening skin that develops in a small area, often on the face, neck or hands or a mole-like growth that increases in size, darkens, becomes ulcerated or bleeds easily. Finally, be concerned about any sore, blister, skin patch, blemish or pimple that does not heal in two to three weeks. Take particular note of strange color, shape, size and edging.
Non-Melanoma Carcinomas
Basal and squamous cell are the two categories of non-melanoma carcinomas (95% of cases). These are diagnosed in a million new cases annually. Most are sores or bumps found on habitually exposed skin that scab over and never seem to heal; they can be pink, red, white or yellowish in color. It is easy to forget about them, until they become bothersome, bleeding and scabbing once more. These rarely metastasize, and are easily cured if caught early. But if untreated, they can become invasive and could require major surgery. Most occur on the head or neck, with the ears, eyelids, lips and the nose all being prominent sites. Thus, being on exposed areas, any required medical treatment can be very disfiguring, ultimately becoming a quality of life issue.
Mohs surgery is a micrographic surgery for basal and squamous carcinomas. It combines tumor removal surgery with the pathology lab work, to ensure it is all removed. Simultaneous pathology reports advise the surgeon how superficial the carcinoma is. Looking for clear margins presents proof that all of the cancer was removed during the surgery. However, it can return after the surgery. Much like a tree’s roots, if all of the cancer is not removed it can come back, so the surgery often goes deep. Mohs can result in a lengthy surgery, as the process may need to be repeated until the laboratory slides indicate “all is clear”; the goal being total removal of all the carcinoma.
Melanoma
Then there is Melanoma, which accounts less than 2% of the carcinomas, but most of the skin cancer deaths. This is the dangerous skin cancer. It is the most common skin cancer for those under age 30 and melanoma cases are increasing faster in young women (15-29 years) than men of the same age. The annual expectation for new cases of melanoma runs consistently at 6,000, with over 9,000 victims dying of it annually. Over the last 30 years the number of cases has increased by 3% annually. If detected “locally” the five year survival rate is 97%, detected “regionally” the rate is 60%, and detected in the metastatic stage the survival rate is just 14%. Melanoma arises from the melanocyte cells (which are responsible for making pigment) at the bottom layer of the skin’s epidermis. Melanoma can occur anywhere on the body. It is renowned for developing under finger and toe nails, thus removal of nail polish, if doing any formal medical exam, is highly recommended. It has also been known to develop in the palms of the hands, the bottom of feet and in the scalp. Considering eye melanoma, benign lesions around the retinas (known as: choroidal nevus), have a 10% possibility over ten years of becoming malignant eye cancer. Comparing photographs of the lesion can help determine if it is growing. Anyone diagnosed with choroidal nevus is well advised to participate in yearly eye exams.
Melanoma’s ABCE’s are:
Asymmetry: In early stages melanomas are asymmetrical. If a hypothetical line were drawn through the middle, it will fail to create matching halves.
Border: The borders of early melanomas are often uneven, having scalloped, blurred or notched edges.
Color: Melanomas present varied shades of brown, tan or black; progression will see a “spotty” appearance with dashes of red, white and blue.
Diameter: Early melanomas tend to grow larger than a common mole; growing to at least the size of a pencil eraser (6 m/m or ¼ inch). Do be concerned at any growth of a mole!
Evolving: Suspect “spots” that show any of these changes over time: shape, size, shades of color, sensation (an itching or tenderness) or surface bleeding should be reason for a medical exam.
Surgery remains the best course of treatment for melanomas. A complete lymph-node dissection was the previous accepted co-procedure, but this always left patients with many side effects. Since the early 1990’s the standard of care for localized melanomas with a significant risk for a metastasis into the lymph-nodes, is surgery combined with a sentinel-node biopsy. The sentinel-node biopsy focuses upon cancer’s known tendency to spread through the lymphatic system. Metastatic identifies a skin cancer that spreads into other parts or organs of the body, first by moving through one or two “sentinel” lymph-nodes (the nearest nodes) that the tumor has drained into. The surgically removed sentinel nodes are sent to pathology where tests determine if the cancer has spread into the lymphatic system.
In May of 1981, 36 year-old Raggae/musician Bob Marley of Kingston, Jamaica died from Metastatic Melanoma. First seen as a lingering painful “sore” under his toenail in May of 1977, this “non-classic” (meaning unusual location, presentation or patient) melanoma continues to be a challenge to this day for early diagnosis. Simply stated, no one considers people of color being at-risk for skin cancer and that a melanoma could occur under a toe nail. Add in the Rastafarian sub-culture/religion disapproves of amputation, and the inability to use the best course of medical treatment, sealed Marley’s fate. This is likely also true in the lead-in story of Bruce, where a delay to remove his one eye, allowed the liver metastases to develop. In both of these illustrations the best course of medical treatment had cosmetic ramifications that presented huge quality of life issues and an untimely death for each patient.
Vitamin D
Finally, sunlight elevates our mood; sunny days are always a joy! Our bodies naturally create Vitamin D (which is actually a steroid hormone) when skin is exposed to direct sunlight and for most of us, our Vitamin D needs are met in this way. Vitamin D maintains strong bones, a healthy immune system and aids the muscles within our bodies to move. Vitamin D helps the body absorb calcium from food or supplements and protects the elderly from osteoporosis. Low Vitamin D levels are associated with diabetes, autoimmune disease, cancer, obesity, possibly depression (one may influence the other!), and soft bones, known as: “rickets” in children and “osteomalacia” in adults. A CDC study in 2006 determined 25% of the US population was deficient in Vitamin D. Levels of Vitamin D often become depleted in our body during winter, as we stay inside and the sun is not as intense. The American Academy of Dermatology recognizes Vitamin D is required for good overall health. So here is the crux: avoiding the sun either outright, by use of clothing or by using sunblock/sunscreen is certainly prudent to avoid skin cancer, but it risks a Vitamin D deficiency. A simple blood test can determine one’s Vitamin D level. All of us should be certain we have an adequate and safe supplemental intake of Vitamin D to maintain the body health required for our demanding hobby.
Remain Sun Safe!
#41 Sunblocks and Sunscreens; Part Two of Two
“During the Middle Ages, probably one of the biggest mistakes was not putting on your armor because you were just going down to the corner.” Jack Handy
Archaeologists recognize early Egyptians used natural formulas for sun-blocking, whereas modern man patented our first products in the mid-1930’s. Sunscreens are applied externally to protect the skin from harmful effects of the sun. Using them prevents sunburn, decreases the risk of skin cancer, delays premature skin aging, and decreases the effects of sun-photosensitivity caused by prescription antibiotics and some medications. The active ingredients within sunscreens work to prevent the sun’s ultra violet (UV) rays from penetrating the deep layers of the skin either blocking, absorbing or reflecting off the UV rays. There are three types of ultraviolet rays, UV-A which goes deep into skin and causes wrinkles and age spots, UV-B which burns skin and eyes, and UV-C, the strongest and most dangerous rays, which are blocked out by the Earth’s ozone-layer.
Two points: the more expensive sunscreens do not necessarily translate into better in quality and presently, there is no FDA-approved rating system that measures UV-A protection levels. The Sun Protection Factor (SPF) displayed on the label refers to a product’s ability to effectively screen/block the sun’s harmful UV-B rays and can range from SPF-2 to as high as SPF-70 “+”. The higher numbered SPF indicates its ability to provide greater sunburn protection. The American Academy of Dermatology now recommends the minimum SPF requirement to be: “30”. The SPF number is multiplied by the number of minutes it takes unprotected/exposed skin to sun burn.
Thus SPF 30 “times” the 10 minutes unprotected skin will burn, equals 300 minutes (five hours) of protection with that SPF 30 product. The SPF-15 rated product simply means one can be in the sun 15-times longer than without sunscreen before a sun-burn can occur. Products rated SPF-2 can be expected to absorb/block/reflect 50% of UV-B radiation, SPF-15 will do 93%, and SPF-30 will do 97%. However all of these examples are a generalization, as individuals with fair skin will react differently than those with dark skin. For fair skin individuals, who sunburn easily, selection of a higher numbered SPF product providing additional protection is in order, as well as reapplications every two hours. Sunscreens do not protect against all of the sun’s radiation, so by simply applying sunscreen, it does not mean one can stay out longer in the sun. However, in our hobby, here is the huge challenge we face: the 23 hours of daylight on Denali, where no shade exists, on that mountain sun avoidance becomes impossible!
No one sunblock/sunscreen and no single ingredient can block the entire UV spectrum. As consumers we do need to check the product labels! Sunscreens use chemical based agents; their special ingredients absorb/block/reflect the UV-B ray energy and stop penetration into the skin. Recent sunscreen products now employ several chemicals to attain the coveted “Broad Spectrum” status granted by the FDA. Sunblocks are physically based. They were the first “Broad-Spectrum” products, using the ingredients “zinc-oxide” and “titanium-dioxide” designed to block, reflect away or scatter both UV-A and UV-B radiation. However, the physical traits of these first broad-spectrum sunblock products were unacceptable to many users. Cosmetically, they were messy, visible, and did not easily wash off. However, the newer products have taken to touting brightly colored preparations that have become popular with recreating youth. These first physical-based sunblocks remain highly recommended for those who have unusual sensitivity to UV radiation and, as a plus, they rarely cause skin irritation.
The two active mineral ingredients used in the first sunblocks were zinc-oxide and titanium-dioxide; and both are approved by the FDA. This is the white stuff we have all seen on the life-guard’s nose and forehead. Modern chemistry has allowed manufacturers to effectively reduce the size of these two minerals into nanoparticles (a millionth of a meter); termed as: “micronized”, “nanosized” or “ultrafine”. By this reduction in size, nanoparticles allow more even coverage. Studies have shown both micronized zinc-oxide and regular zinc-oxide offer very effective UV protection by reflecting sunlight before it reaches the skin. Regular sized zinc-oxide and titanium-dioxide are non-toxic, non-irritating and highly effective sunblocks. The current trends of nanoparticles has eliminated the unappealing stark white color, but such a reduction in size has allowed the concern to be raised that nanoparticles could potentially penetrate through skin and cell walls, to be carried through-out the body. However, there is no clinical evidence of this presently.
Labeling is not required at this time to identify nanoparticles in product formulas. If your sunscreen/sunblock of choice has either zinc-oxide and/or titanium-dioxide and goes on clear: suspect nanoparticles in the formula. Scientific studies show micronized zinc-oxide and titanium-dioxide can penetrate the outermost layers of the skin; however it does not get to living tissue or the blood stream. Micronized zinc-oxide and titanium-dioxide are highly toxic if inhaled, becoming a potential health problem, thus some experts advise against powders and spray which contain them. Lotions and creams are considered safer, as inhalation is unlikely. Posted on the www, micronized zinc-oxide and titanium-dioxide are “not a risk to human health”; but the jury remains out on this concept, as some www sites do recommend risk avoidance.
As of mid-2012, the FDA implemented new regulations prohibiting manufacturers from using the terms “Sunblock” (as a descriptor), “waterproof” or “sweatproof”, “instant protection”, any claim of “protection for more than two hours” and SPF values must be no higher than: “50+” on any across-the-counter sunscreens. There is no evidence proving products with 55 to 100”+” SPFs provide greater protection, thus the FDA addressed this false sense of safety likely held by consumers.
Do not be misled; no sunscreen is waterproof or perspiration-proof. If labeled “water-resistant” it will maintain the SPF level for 40 minutes of water immersion. If labeled “very water-resistant” the SPF level will be maintained for 80 minutes. By toweling yourself dry you wipe away sunscreen. So reapply frequently for continued protection. Certain products may be ineffective, as their ingredients may break down upon exposure to the sun. It is recommended by the American Cancer Society consumers choose the “Broad Spectrum” products; they have protective ingredients to combat both UV-A and UV-B rays. The “Broad Spectrum” selections should contain any or all of the “big four”: zinc-oxide, titanium-dioxide, avobenzone or mexoryl.
There are various forms of sunscreens: butters, cream, gels, lotions, oils, ointments, pastes, sprays, sticks, and lip balms. The oil-based products contain insufficient amounts of sunscreen agents and are usually rated at SPF -2 or less. The safety of spray-on products is being reviewed by the FDA. Sprays are suspected of providing less SPF protection than label claims and pose a danger if inhaled or used around heat sources. Always use caution; as spray types are flammable. Do not use spray applicators or alcohol- based sunscreens near heat, open flames or while smoking! To avoid inhalation, spray onto your hands and then apply to your upper body areas. All sunscreens are only for use on the skin, lip balms are only for lips, and none of the products should be applied onto mucous membranes. Read the individual product label and comply with the directions.
Products that contain PABA (para-aminobenzoic acid), lisadimate, padimate or roxadimate may discolor and stain clothing, upholstery of vehicles or furniture. PABA can react with sensitive skin. If you develop a rash, the likely culprit is PABA. Other rare ill-effects of PABA are slowing/shortness of breath, irritations and swelling with eyes, ears, nose, throat, skin nausea or vomiting, intestinal discomfort, dizziness and nervousness. If you develop any of these symptoms, stop using the product and seek medical attention. Consider, at high altitude, most of these reactions can be life threatening. Always test a new sunscreen product by first applying it onto a small patch of skin, as a skin reaction (rash) could develop. If the sunscreen gets in your eyes, rinse thoroughly with water. Avoid applying sunscreen to damaged or broken skin. Finally, sunscreen should not be applied on infants less than 6 months of age. Infants, if outdoors, should remain out of the sun and wear protective clothing (hats, long sleeved shirts and pants). For children older than 6 months, use a SPF of 15 or higher and avoid the alcohol-based sunscreens.
Use sunscreen by generously applying it to all exposed skin: the ears, scalp, face, (around eyes), the neck, hands and forearms. This should be done at least 20 minutes before going outside and reapplied every two hours. There is no such thing as “too much”. The best description for how much volume to apply is: an ounce, appearing as “a golf ball-size” portion of lotion in your palm. Sunscreen should be used even on cloudy days, as 80% of UV radiation will pass through clouds. If on snow, ice or water, reflected solar radiation will burn the inside of your nose and ears. So here is the challenge: the inside of those orifices will get burned, however sunscreen should be avoided on/in mucous membranes! At high altitude, our panting while on snow and ice will often result in a sun-burned tongue and roof-of-the-mouth (this feels as if they were burned by a hot beverage), preventing that occurrence becomes yet another challenge. It’s nearly impossible to protect these potential sunburn locations; perhaps a scarf, worn like a train robber, is the solution.
The FDA maintains the ingredients within sunscreens are safe and the benefits of regular use outweigh any potential risk. These ingredients have been used for many years and the FDA believes there is no reason to suspect the chemical ingredients are unsafe for consumers. However, buyer beware, the FDA does not strictly supervise its own labeling regulations. So now to the “fine print” which always seems to go along with the “better living” enjoyed through chemistry. Putting chemically based sunscreens on our skin is a classic damned if you do and damned if you don’t situation. The issue must be openly shared. The quandary: ounces of carcinogen containing lotion smeared on our skin versus the “amount” of UV radiation exposure received. There is a counter-concept concern that overzealous use of sunscreens may be partly to blame for the rise of melanoma and other cancers.
Chemicals in some sunscreens are known to accumulate within our bodies, this because the human organism is not naturally capable of eliminating or using them in an efficient manner. Here are a few facts: our human skin has evolved to effectively keep out toxins, but some chemicals can pass through, and applying sunscreen does more good in protecting skin’s DNA against UV radiation than any potential chemical harm claimed by internet postings. At this time, testing on humans has produced mixed results, there is no clinical evidence to prove or disprove the below chemical side-effect concerns to human DNA. Know: S.O.S. struggles to remain neutral in this debate. After all, the chances are apparently slim regarding the chemical considerations, but certainly not so in the skin cancer realities. One fact is solid: UV radiation is bad for our skin. Thus, the reader must make the final decision and do what is most comfortable.
The most common active chemical ingredients used in sunscreens sold in the United States are: Oxybenzone, Octisalate, Octyl methoxycinnamate (Oxtinoxate), and Avobenzone (Parsol 1789). Here are their negatives. Oxybenzone is claimed to penetrate the skin and cause sensitivity to light; some scientists argue this chemical maybe a contributing factor in the recent rise in melanomas among sunscreen users. Other studies are claiming that Oxybenzone behaves much like the hormone Estrogen, leading to a suggestion it could be a factor in breast cancer. The CDC discovered Oxybenzone was present in 96.8% of the urine samples they tested. Being only rubbed on our skin, it apparently gets around! Avobenzone (Parsol 1789) has been recognized to penetrate skin, but so far, most studies have shown it to be non-toxic. There is the claim that Avobenzone (Parsol 1789) becomes unstable when exposed to UV rays and more easily so, when mixed with other sunscreen active ingredients.
Most Common Ingredients
| Active Ingredient Type and percent | Type of radiation Blocked or Absorbed | Identified Toxicity Class |
|---|---|---|
| Avobenzone (Parsol 1789) 1 to 3% | UV-A | Possible carcinogen, if ingested. |
| Homosalate 6 to 15% | UV-B | Endocrine disrupter. |
| Octocrylene 0.8 to 10% | UV-B | Bio-accumulative in wildlife, liver issues and carcinogenic. |
| Octyl methoxycinnamate (Octinoxate) 7.5% | UV-B | Hazard ranking: moderate to high. Accumulates in the body, disrupts liver, the endocrine system, and is a carcinogen. It is restricted in Japan. |
| Octisalate 2-5% (Octyl Salicylate 3%) | UV-B | Broad systemic effects in animals at moderate doses. |
| Oxybenzone 2 to 6% (6Benzophenone-3 5%) | UV-B, UV-A | Hazard rating: High. FDA approved in 1978 for 6 months and older humans. No data of significant health or hormonal problems in humans. But claimed carcinogen and contributor to vascular disease. May affect brain and nervous system in animals. CDC studies show 98% of American bodies are contaminated. |
| Titanium-dioxide 2 to 8% | UV-A and B | broad spectrum Carcinogen when in nanomaterial form. |
| Zinc-oxide 3.8 to 9.1% | UV-A and B | An inorganic compound used in broad spectrum blocks. Evidence of reproductive toxicity. Bio-accumulative in wildlife. |
Less Common Ingredients
| Active Ingredient Type and percent | Type of radiation Blocked or Absorbed | Identified Toxicity Class |
|---|---|---|
| Aminobenzoic acid | UV-B | Carcinogen; implicated in cardiovascular disease. |
| 6Benzophenone-2 | UV-B, UV-A | Hazard rating: High. Not approved in US due to strong evidence of hormonal disruption in humans and wildlife. |
| Cinoxate | UV-B | Evidence of skin toxicity. |
| Dioxybenzone | UV-B, UV-A | Strong evidence of skin toxicity and carcinogen; hormone disrupter. Found in waterways, soil and air. A “gender bender” in animals. |
| Ecamsule (“mexoryl SX”) (terephthalylidene dicamphor sulfonic acid) | UV-A/lesser of: B | Considered safe, not mutagenic in vitro studies. Water soluble. Patent held by L’Ore’al since ‘82. FDA approved in 2006. |
| Menthyl anthranilate | UV-A | |
| Mexoryl XL (drometrizole trisiloxane) | UV-A/B | European approved. Not FDA approved for over-the-counter U.S. sunscreens. Oil soluble. Patent held by L’Ore’al. |
| PABA (para-aminobenzoic acid) | UV absorber and filter | Hazard rating: High. Known history of allergic reactions; poisoning can occur with some lotions. A known carcinogenic. FDA classifies it: “safe for general or specific, limited use.” |
| Padimate O | UV-B | Carcinogen. Related to PABA (above). Suspected of DNA damage. But all studies are inconclusive. |
| Phenylbenzimidazole sulfonic acid | UV-B | Carcinogen. |
| Retinyl palpitate | Protects against skin aging | A form of vitamin A, found naturally in skin. No evidence of increased risk of skin cancer. One form: “retinoids” used for decades to prevent skin cancer for those of high risk. |
| Sulisobenzone | UV-B, UV-A | Strong evidence of skin toxicity, affects sense organs in animals. |
| Trolamine salicylate | UV-B |
Caution is advised with all tanning agents (both sunless and sunscreen types) as potential side effects and reactions can occur when combined with other medications (even over-the- counter meds). Avoid using them while pregnant or breast feeding or with knowledge of personal allergies to anything else.
Once more, kudos are extended for Bill Jacobs’ continued outstanding editorial efforts on these S.O.S. articles. A very special expression of total gratitude is extended to Denise Spartonos and Lisa Quale of the University of Arizona Cancer Center‘s Skin Cancer Institute; their devoted assistance in this article series was a very critical component!
For additional information: http://www.aad.org/spot-skin- cancer
#44 Driving Revisited
“I’ve been drivin’ all night, my hand’s wet on the wheel, there’s a voice in my head that drives my heel.“
“Radar Love” by: Golden Earring, 1973
In the United States traffic collisions have remained the number one cause of all “accidental” deaths. Driving was first addressed in S.O.S. #3 (Issue #62, 3/2003). Safe driving requires courtesy, personal responsibility, judgment, good reflexes, experience, and common sense, just like our hobby! Nonetheless, whether by the alignment of the planets, destiny, the odds, or the probabilities, anyone of us is at risk for an automobile wreck. If you want to play those odds, most bad collisions happen on paved roads (rather than dirt) and the fatalities are on interstate highways and in the cities.
In just the Club’s membership over the past year (2015), Terry and myself survived a head-on collision outside of the Grand Canyon that totaled our 4-Runner, while in Alaska Fred Lobdell survived a “ran-off-roadway” incident (see side-bar), Greg Griffith tragically perished in an icy skid-off-roadway crash in Idaho and there may have been others. In these examples, single vehicle crashes seemingly are the majority, however in 2014; Arizona solo crashes were a mere 17% of the total, yet resulted in 37% of the fatalities.
A.B.C. (“Always Be Careful”) applies to our daily lives, our climbing hobby and certainly equally to driving! Why needlessly place ourselves at-risk for injury? The continual causes of fatal accidents are known: impairment, speeding, and unsafe lane changes; all compounded by a failure to use seatbelts. In just Arizona, of the total 774 fatal crashes in 2014, one third (34%) of those killed were not using safety devices (seat belts/helmets). Front seat occupants by using seat belts, can lower the risk of fatal injury by 45%. The failure to “buckle-up” increases the likelihood of being ejected by 30-times, resulting in a 75% chance of being killed. Finally, over the past 30 years, 42% of the police officers killed in traffic accidents were not wearing their seatbelts! Do consider Google’ing the series of “Arrive Alive” videos. They address impaired driving, excessive speed, distractions, and seal belt use. Please save a life: buckle up and slow down.
Air bags are explosive devices! Front seat occupants should have at least ten inches from their chest to the air bag cover. Side-impact air bags place children at risk for serious or fatal injury. Do not allow children to lean against any air bag devices, rather have them in a properly installed and an appropriate for age, child restraint system.
“Distracted driving” has become the catch word of late, the result of a new national menace; so much that April is the awareness month. Keeping one’s full attention on driving is not simple. Cruise control, playing favorite tunes and a ribbon of black top in front of you makes it tough to pay attention to what really matters. Simply adding in the handing of an electronic device makes us three times more likely to crash. This more complex activity, results in a twenty-three percent likelihood for a crash. While in the driver’s seat: texting, talking on hand-held cell-phones, C.B. radios, eating dinner or working your G.P.S. are basic set-ups for disaster. As of 2016, 48 states outlaw texting-while-driving in some manner. Just sending a text can take your eyes off the road for at least 5 seconds (you will travel 100 yards at just 55 mph). Use a hands-free device, if you must multi-task. But consider there are four other types of distracted driving: taking your eyes off the road, taking your hands off the steering wheel, allowing your mind to wander to something other than driving, and having an unrestrained pet in the car.
Tires (see: S.O.S. #21 “Tires”) are really where the rubber meets the road. Shreds of tires from extremely dangerous blow outs and tread separations are recognized as the most common roadside debris. The danger is significantly reduced by maintaining properly inflated tires. Plus exposed steel rims on pavement will create sparks (-as do dragging trailer safety chains-) and a wildfire can result!
The four D’s: Don’t Do Drowsy Driving. We all have done it and Fred Lobdell was lucky to have survived his experience! Pull over and stop at a safe location, allowing yourself to sleep. The potential for death or serious injury to yourself and others makes this concept non-debatable.
The failure of others to use a vehicle’s turn signals is a personal peeve of this columnist. Of all the wheels, pedals, buttons and levers available within a vehicle, one would assume the use of the turn signal lever requires the least effort. The only explanation that can be is that owners’ must believe the devices are too expensive and they chose to not purchase the option from the factory.
Big rigs could be an entire article in-of-themselves. Never linger anywhere around a semi-truck and trailer on the highway. The “No Zone” is a blind spot unique to these rigs and it has a dubious statistic: 35% of fatalities involving trucks occur there. Know there is the left side for passing and then there is the suicide. Only after you can see the entire truck in your mirror is it safe to move back into the lane ahead of it. Do take clues from the actions of big rig drivers, they are up higher and can see farther ahead.
Catch terms for speeding are “speed kills” and “speed kills bears” (consider here even deer or pedestrians). Time to be saved by speeding: go 80 mph for 16 miles: it takes 12 minutes, at 65 mph it will take 15 minutes, and at 50 mph it will take 19 minutes; just seven minutes difference. Here it is another way: 25 mph covers 37 feet per second (fps) with a documented 85 feet to come to a stop, 30 mph covers 44 fps with 113 feet needed to stop. Now at 80 mph it requires 481 feet to stop (at 85 mph: 543 feet!), 65 mph 353 feet, and at 50 mph 236 feet to stop. If you are adding speed to save time, at the least: anticipate the need for greater stopping distance. Please do not drive too fast for the road conditions present. Roadways with any pedestrians or bicyclists or with surfaces that are wet, icy, rough or narrow and environmental issues such as: fog, wind, rain, dusty or snow should all be a clue to slow down.
Regarding the passing other cars: one former Route 66 “Burma Shave” roadside advertisement sign said it best: “When you cannot see, it may get you a glimpse of eternity.”
Highway workers are a certainty, during our summer peak bagging trips. When present they are “protected” by a double fine construction zone. Consider Michigan has a 15 year sentence and 75-K fine for any driver who injures or kills a highway worker and New York will suspend a driver’s license, after two “work zone” speed violations. Always slow down and, as “distance is time”, move over for: any stopped temporary worker, fire department, law enforcement traffic stop or any vehicle with flashing lights that is on the median ahead of you. This especially includes tow-truck drivers.
Night-time driving is serious stuff. It is easy to “over-drive” the distance lighted by the headlights and run into “something ahead” before you can completely stop. Anticipate that pedestrians, bicyclists and animals are very difficult to see in the dark. Do dim your high-beams when approaching cars come into view. Be aware that in some states, flashing your high beams at another car is a traffic violation. If the other driver does not dim their lights, look to right edge of your lane; most states now have a solid white “outside” line to assist drivers in this situation. Failing to dim your lights to “get back at the other guy” results in both of you being blinded at the same time.
The greatest hazard we face is while driving is winter weather. Under such conditions, vehicle dynamics are completely different. The ABS brakes cannot be relied upon to prevent sliding wheels and steering input will not alter the vehicle’s momentum direction. Suggestions for winter driving are: have the correct number of snow chains/cables and be willing to put them on your drive wheels before needed, slow down, be patient and plan extra time to get to your destination. If snow plows are on the road stay back at least four car lengths and never pass a plow that is snow and ice off the road. Be conscious to brake slowly, avoid jerking the steering wheel and increase the distance between your vehicle and those ahead. Suggestions for winter driving survival are: wear warm clothing, make sure you gas tank is at least ¾’s full, and do notify someone of your destination, route and arrival time When driving in rain turn on your windshield wipers, defroster, and low beam headlights (see and be seen). Anticipate roadway pavement will the most slippery at the beginning of rain, as oil and dust has not yet been washed away. In heavy rain you may not be able to see more than 100 feet ahead and at speeds above 50 mph, tires can hydroplane. Any slight change in direction, a gust of wind or application of the brakes: can result in a skid and then you have just become a passenger! Slow down! On wet roads: travel 5 to 10 mph slower, on packed snow: reduce speed by half and on icy roads: slow to a crawl. Shaded areas will freeze first and dry out last. Bridges and overpasses will freeze before the rest of the road does. High or gusty winds are an unpredictable hazard. This is not just for big rigs which become a hazard to all vehicles around them; so do give them a wide-birth. In high winds, do not use cruise control. Maintain a firm grip on your vehicle’s steering wheel, watch for blowing debris on the road, as it can reveal conditions ahead allowing you can anticipate and avoid it.
Collisions with wildlife are way-too-common. Wildlife are “creatures of habit”, ask any hunter! In 2011 over a million vehicle-vs.-animal collisions were documented by insurance carriers. Consider that many had minor damage and were not reported due to high deductibles or a lack of collision coverage. States with the most documented auto/deer collisions are: Michigan, Pennsylvania, South Dakota, and Iowa. Running over the little ones are emotional events, but hit an elk, horse or steer (800 pounds-plus) and by height alone, any are likely coming over the hood and through the windshield. None of the four-legged creatures sport reflectors, so at night certainly consider slowing down. All of these creatures are drawn out of the thick woods to the roadsides, where plentiful sunshine and run-off makes for healthy green forage.
Four months documented to have the greatest number of deer collisions, they are: October/November (the rut!) and June/July (the new fawns demand nursing does to find nourishment). Do not be apathetic and ignore any yellow posted roadside signs warning of elk/deer activity. Be alert, slow down and scan both sides of the road ahead. Especially be wary at sunset and early dawn, this is when animals are most active. Do not assume any animal to act rational to: on-coming headlights, a honk of the horn or to avoid your car by running away in the correct direction. Add to this there is no evidence that the little plastic deer whistles have any effect in avoiding collisions. Lastly, employing the swerving tactic only invites a head-on or side-swiping collision with the “other guy” or a run-off the roadway into an unacceptable barrage of off-road hazards.
Also, we should pre-set “AM #1” on our vehicle radios to: 1610; this is a nationwide channel dedicated to “travel advisories”.
All of us should have seasonally-based emergency kit in our vehicle and a fully charged cell phone. In every kit: some form of long term food (an MRE or two), medications (OTC and prescriptions), a flashlight, extra clothes, a shovel, and hazard reflectors. In summer it should have extra water. The winter kit should have blankets, an ice scraper, and some sand for getting traction.
Parking on a hill: facing downhill, turn the front wheels into the curb; facing uphill, front wheel should be turned away from the curb. Allow the car to gently roll into the curb and then set your parking brake. If there is no curb, turn the front wheels turn the wheels in anticipation that the vehicle will roll away from the roadway.
Keep in mind all newer vehicles have detachable headrests that can be used to break open the side windows from the inside, in case of a fire and or an emergency.
So in conclusion, if you care for yourself and others: please remain safe by driving the speed limit, not allowing yourself to be distracted by “devices”, and wear your seat belt.
My gratitude to Andy Martin, Fred Lobdell, and Bill Jacobs; their inspiration and assistance in the completion of this article was critical. Please remain safely seat belted in during your travels.
#45 Safe Hiking
“There are no limits, there are only plateaus and you must not stay there. You must go beyond them!“
Bruce Lee, Actor and Martial Artist (1940-1973)
Presented here is a brief review of concepts to be mindful of whenever trekking in the wilds. These are gleaned from previous S.afety O.n S.ummits’ columns.
Cell and satellite phones, along with personal locator beacons, have technological limits in the backcountry. At the least, ensure the devices are fully charged before you leave. Always tell someone where you are going and when you expect to return. Provide the names, addresses and phone numbers of all those going along and the description of the vehicle(s). Once underway, stick to that original itinerary or if you change the plan, advise whomever knows of your itinerary. It should be clearly understood that at the agreed upon overdue time, the proper authority should be notified.
Solitude is great, but such solo experiences can be a foundation for disaster when the dominos begin to fall. The most common recommended hiking number is four persons. Thus if an injury should occur, one member can stay with that person, while two go for help. An injured hiker should never be left alone.
Several points should be considered in planning your trip, use guide books, topographical maps and information gleaned from others. Anticipate when trekking, the general pace will likely be two miles-per-hour with an additional hour required for each 1,000 feet of elevation gain. Monitor your route on the map and always maintain an idea of the best way to return to civilization.
Check the weather report before setting out. Even better, have an idea of an extended forecast. But always bring foul weather gear along just in case, as mountain storms can be sudden and violent. Carry sufficient water, more so if hiking on ridges, and especially if temperatures are going to be high. The most serious dangers we face in the backcountry are extreme heat, cold, high winds, and precipitation. In high places, July snowstorms are a reality, as are summer thunderstorms. Be prepared for both. A safe operating policy in summer is to start for the summit just before dawn and strive to be back down by early afternoon, all in an effort to avoid thunderstorms.
If the summit is not attained by noon, seriously consider turning back, especially when thunderstorm activity is either seen developing or in the forecast. You do not want to be caught on either a peak or an exposed ridge in a lightning storm. If it happens, stay away from lone trees and high rocks, as they can attract a lightning bolt. Know that “Space Blankets” are suspected as doing the same. Under such conditions, the safest place to be is inside your vehicle or a structure. Remain out of shallow caves or depressions, as the electrical current traveling on the surface may still jump to your body. To better insulate yourself from the ground, place your backpack and/or foam pad under you and squat down. Only your two feet should make contact. Admittedly, this position is extremely difficult to maintain for extended periods of time. Remain away from your metal and carbon-fiber gear, but do not abandon it.
Beware of loose rock or evidence of a rock fall zones. It would be wise to bunch-up the team in such areas rather than being spread apart, with some below and some above. One rock set loose could result in a tragedy for someone below. If a rock is sent rolling downhill, “rock etiquette” requires one to loudly yell: “ROCK!” Never (never!) roll rocks down a mountainside for entertainment (trundling), as others could be below!
Always be properly equipped. Do not be dependent upon others when afield. Recall: “ATGAT”; All The Gear, All The Time. Every year, in all seasons, people needlessly die from “exposure” (hypothermia). Having proper clothing is critical when foul weather becomes our unintended backcountry experience. Wear a wicking shirt and underwear as your primary layer. Basic items in our packs should be: a pile sweater, gloves, warm head gear, top and bottom rain gear, and the ability to make fire.
A simple first aid kit should also be a constant companion. The kit can focus on: feet issues, headaches and lacerations/thorns. There is always the possibility that one of us could discover a hiker in peril. Could you ignore or abandon them? Knowledge is strength, so commit to attending a first aid training class! Also, consider that water sources in the field are polluted in one way or another. When in the field always have the ability to purify water in case of an emergency. The product “Aquamira” fills this critical need by its light weight and minimal size. The “Ten Essentials” (S.O.S. #5 and #39) absolutely can make the difference in a survival situation.
Acclimatization is our friend. Mountain sickness is not. Taking time for our bodies to adjust to higher altitudes avoids the mountain miseries of a general feeling of malaise, headaches, shortness of breath and vomiting that can result from rapid ascents above 9,000 feet. A few clues to help avoid such negative high altitude experiences would include: be in good physical shape, have plenty of rest and sleep, drink sufficient water while trekking, and avoid both alcohol and smoking.
Mountaineering is a serious subject often addressed in movies, books, and audience presentations. So far it has never been covered in S.O.S. With the exception of Rainier, Hood, Gannett, and Denali, our summer hiking in high-places, can be generally considered a walk-up hobby. But winter creates a vastly different operating environment, especially above timberline. Thus, in winter a “routine” day-hike should never be considered. Rather, all winter climbs should be planned like an expedition. Weather can degrade rapidly, temperatures can plummet into the minuses, exposure to wind becomes a critical issue, and movement will be slowed by weight and terrain conditions.
As such, team members’ standard equipment items should include (along with the knowledge how to use them): snowshoes or skis (with climbing skins), crampons, ice axe, climbing rope, harnesses, snow shovels, and snow-goggles. The potential for an avalanche demands an additional skill-set, combining knowledge, alertness and avalanche beacons attached securely onto every member of the team. All mountaineering gear should be selected with the consideration that it could literally become your survival gear. When considering a winter climb, each individual must carry a sleeping bag and foam pad. In addition, spread throughout the team: a small gas stove with a cook pot, fire making ability and a first aid kit. Climbers should use layers of warm clothing. It is critical to have the ability to increase or decrease warm layers to adapt as need be to the changing environmental conditions.
The choice to become a team must carry through the entire climb, from start to finish. To be successful as a team, each member must know the limitations and strengths of one-another. Do not plan anything beyond the abilities of the weakest member. The team’s pace should match that of the slowest person. Do not separate! It is critical to remain together; individuals cannot be allowed to fall behind or to push far ahead, especially in the dark. Agree to one person up front setting a fair pace and one person to always to be “the caboose”, from whom no one falls behind.
Disregarding this simple basic tenet has been repeatedly recognized as the first error (“the falling dominos!”) that frequently results in a tragic backcountry fatality. All-too-often when in the backcountry, “separating” is the first step in the lead-up to a tragedy. Using hand-held FM radios will allow for greater flexibility in this area. Here too, never allow pride or ego to effect the necessary decision to turn back. Remain adaptable to the changing field conditions. Here the application of good judgment will allow another day’s return to the summit.
Finally, whistles are a recognized basic communication device. Over extended time, one can continue blowing a whistle longer than repeated yells. Often wind and terrain will affect verbal communication. Lately many backpacks are being sold with a whistle as standard equipment. Here are three accepted standard signals that we should know:
- Distress: 3-evenly spaced signals, given in 30 seconds, repeated as required.
- Acknowledgement: 2-signals, given in quick succession.
- Return to Camp: 4-evenly spaced signals given within 30 seconds, repeated as required.
This columnist wishes to once more express gratitude for Bill Jacobs’ edit work!
Continue to remain safe in your travels!