Tick identification chart from the CDC

The tick we worry about most in our region is the black-legged tick, also known as the deer tick, which can carry Lyme disease. Recorded cases of Lyme are increasing across northern New England. Besides Lyme disease, various types of ticks in the region can transmit anaplasmosis, babesiosis, Borrelia miyamotoi, ehrlichiosis, and Powassan virus. While symptoms of tick-borne diseases vary, they typically include flu-like symptoms such as fever, headache, chills and body pains.

Ticks are most active in late spring and early summer when young ticks, known as nymphs, are looking for an animal to feed on, and then again in October and November when adult ticks are looking for another meal before colder weather arrives. Some species, including the deer tick, are active whenever the temperature is above 40 degrees, even in the winter.

New potential concern

Many recent reports have focused on the lone star tick, which is found throughout the eastern and southern United States. This tick’s range may extend to the southern edges of northern New England, but cases of lone star tick bites in the region are rare. However, this tick’s range is likely to expand, and experts in our region are monitoring the situation.

Lone star ticks are typically easy to identify. Females have a single white or gold dot, or “lone star,” on their back, while males have white spots or streaks on the outer edge of their body.

Lone star ticks can carry several diseases, including Bourbon virus, Heartland virus, southern tick-associated rash illness, tularemia, and ehrlichiosis. The most attention-getting reports have involved cases of allergic reactions to red meat (alpha-gal syndrome) following bites from lone star ticks.

Keeping track of the problem

The northern New England states are interested in monitoring ticks and there are resources in each state to identify them.

• Maine: University of Maine Cooperative Extension tick lab
• New Hampshire: UNH Cooperative Extension insect and arthropod identification
• Vermont: Vermont Tick Surveillance Program

How can you prevent tick bites?

When possible, avoid tick habitat, such as wooded and brushy areas with high grass and leaf litter.

If you are going into tick habitat, follow these steps:

• Treat your clothing and camping gear with a product containing 0.5% permethrin, carefully following the instructions on the product label. Pre-treated clothing and gear are also available from some stores.
• Wear light-colored clothing to make it easier to spot ticks crawling on you.
• Wear long pants and socks and tuck your pant legs into your socks.
• Use an EPA-registered insect repellent such as DEET.
• Check yourself, your children, your pets and all clothing as soon as you come back inside. Shower as soon as possible.
• If you do find a tick, remove it as soon as possible using fine-tipped tweezers. The CDC has full instructions.

If you develop symptoms after a tick bite, contact your health care provider.

For more information

The CDC has a thorough guide to common ticks in the United States and the diseases they carry. In addition, the Northern New England Poison Center can be a resource for questions about tick bites and tick-borne diseases. Call 1-800-222-1222, chat online or text the word POISON to 85511.

“I can’t believe we are finally here!” Louise said as she embraced her niece Cara.

“I can’t believe Uncle Frank got on a plane!” replied Cara, reaching out for the grouchy man wrangling luggage in her entryway.

“I can’t believe they can charge $5 for a coffee at the airport,” Frank grumbled, unceremoniously dropping the bags.

Frank and Louise followed Cara into the family room and sank into the sofa, happy to stretch out after a long flight. Cara’s husband, Bill, joined them, accompanied by a shy 3-year-old boy.

“Can I get you anything? Dinner is almost ready,” Cara said. “Wow, Auntie Lou, your ankles look swollen! Is that something new?”

“Yeah, she’s taking on water—man the lifeboats!” Frank quipped. Louise shot Frank a look that could sink a ship, but brushed off Cara’s concerns and turned to the little fellow now sitting in Bill’s lap.

“Hello Christopher! You don’t remember me, do you?” she said. The boy buried his face in his dad’s chest. “That reminds me, I need to take my medication. My pill minder is in my purse, where did that land?”

“I’ll get it for you.” Cara retrieved the bag and set it in Louise’s lap. Louise found the pill minder and snapped open that day’s compartment, removing two round pink pills and one white oval pill.

“Candy!” chirped Christopher with sudden interest.

“No, no,” laughed Cara, “those aren’t candy, that’s Auntie’s medicine!”

Christopher looked disappointed as Cara explained, “When he’s a good boy at the supermarket or at church he gets a candy.”

Louise took her meds, returned the pill minder to her purse and placed it on the floor next to the sofa. They spent the next two hours catching up on family news over dinner.

After a long day, Frank was ready to call it a night. “You two can chat, but I need my beauty sleep. Where are we sleeping, Cara?”

“Up the stairs, second door on the right,” Cara replied.

Bill headed toward the living room. “Let me give you a hand with the luggage—WHOA, hey buddy, hold it right there!”

As he came around the corner he had spotted Christopher elbows deep in Louise’s purse. The pill minder was on the carpet, with two of the compartment doors unsnapped and empty, and several pills on the carpet as well.

“Candy!” Christopher said. In his hand a small round pink pill was dissolving.

“Not candy, buddy. How many did you have? Cara, come in here please!”

Cara and Louise appeared, responding to Bill’s urgent tone.

“It looks like he’s gotten into Lou’s pill minder. I can’t tell if he’s eaten any,” Bill said, taking the pink pill from the boy’s hand. “Open your mouth and stick out your tongue, buddy.”

“How did he even get the thing open?” Frank said from the sidelines. “Louise has to fight with it half the time—I thought it was supposed to be childproof!”

“He’s a little Houdini—‘childproof’ is a myth,” said Bill. “I don’t see anything in his mouth—are there any missing?“

Cara and Louise gathered the pills, coming up with three pink ones and two white ones.

“There should be three pills in each compartment, two pink and one white. I have my medication list right here. The white one is for my fat ankles. One pink pill is my thyroid pill, the other is my heart medicine but I don’t know which is which.”

“Uncle Frank, the number for poison control is on the fridge,” Cara said.

“That’s OK, I’ve got it in my phone,” Frank said, pulling out the device. “Did you know it’s the same number nationwide?” He dialed the number, 1-800-222-1222, and was connected to the closest regional poison center.

The specialist who answered asked for Christopher’s age and weight and whether he was showing any effects from the medicine. Then she asked about the color, shape and markings on the pills. The missing one was identified as Louise’s thyroid pill, which was fortunately the least concerning of the three. The specialist explained that this was not an emergency and described possible complications they should watch for.

Crisis averted, Louise promised to be more mindful of her meds with a little one around.

It was evening in the Wilmot household, and Louise heard Frank fumbling around in the kitchen.

“Don’t bother looking for cookies. I’ve hidden them!” she chided from her chair in the family room.

“I knew telling you about my doctor’s appointment was a mistake, missy. And I’m not looking for cookies, I’m trying to figure out this new medicine pen thingy,” Frank replied.

Frank’s recent bloodwork had been concerning and with his family history of diabetes, his doctor had prescribed Ozempic, a weekly medication that came in an auto-injector.

Louise entered the kitchen and found Frank, one sleeve rolled up to his elbow, trying to slip a thick elastic band off a broccoli bunch and up his forearm. A pen-like device, and a tray of small pods lay on the counter next to the broccoli.

“What in heaven’s name are you doing?” she asked.

“I wish I knew. Help me with this thing. How am I supposed to find a vein?”

“I don’t think you are supposed to! Didn’t they show you how to do this at the doctor’s office? Aren’t there directions in the box?” replied Louise.

“There’s a whole sheet of directions, in tiny print. Yes, one of the nurses tried to show me how to use this, she made me take my shirt off and you know how I hate that. Maybe I can just jab it into my leg like that EpiPen your cousin used when he had that bee sting.”

“If it worked like his EpiPen, it would have to jab into a muscle. That would rule out taking off your shirt,” Louise said with a smirk. She picked up the instruction sheet.

“You’re right, these directions are hard to read, but the photos don’t show any jabbing.”

She gingerly picked up the auto-injector and inspected it.

“What number are you supposed to be at? Do you get a new one of these every week?” she asked, noticing the dial on the pen. “And what are these little pods?”

“I have no idea. Are we playing twenty questions? Is there a grand prize?” Frank asked.

“Do you have to start this tonight? Can’t we wait and talk to the doctor or the pharmacist tomorrow? I’m really not comfortable at all with this—are you?”

“You’re not comfortable? I’m the one taking the jab! No, I’m not real sure what I’m supposed to do with these little bits and bobs. But I don’t know if I can wait until tomorrow and the pharmacy is closed.”

Louise thought for a moment, then suggested a call to the poison center. “They were pretty helpful when we had that question about my thyroid medicine. I’ve got their number right here in my phone.”

The specialist at the Northern New England Poison Center reassured Frank that he could wait until morning when the pharmacy was open to get a demonstration on how to administer Ozempic properly. She explained how to properly store the medication, and how to get rid of the auto-injector once it was empty. She also let him know about common mistakes people make with the medication, such as dialing in the wrong dose, and side effects like upset stomach or vomiting. She encouraged him to call with any questions he had while taking the medication going forward.

After the call, Louise placed everything back into the box and returned it (and the broccoli) to the refrigerator. Frank unrolled his sleeve and began rummaging around in the cabinets, in a fruitless effort to find the hidden cookies. He turned around to find Louise offering him a small apple and an admonishing look. The hunt for contraband would have to wait.

It was Saturday morning in the Wilmot house and Frank and Louise were enjoying their coffee on the back patio. Louise was flipping through photos of weed-free flower beds in a garden magazine as Frank scrutinized the rose bushes surrounding the patio.

“Do you remember the roses my father used to grow? The size of dinner plates, and not a beetle to be found. Look at these leaves—they’ve turned them to shreds!” he lamented.

Frank had made a hobby of plucking Japanese beetles off his roses for the last few weeks, but the beetles had called in reinforcements, so he headed off to the shed to take the battle to the next level. The shed was dark, and cluttered with half-empty spray bottles of “nontoxic” and “organic” pest control products that Louise had insisted on buying.

“Lord knows, we wouldn’t want to use something toxic on bugs we are trying to kill, on plants we’re not going to eat,” Frank muttered, before spying what he was after. “Aha—just the ticket!”

Louise looked up from her magazine to see Frank approaching the patio, donning rubber gloves.

“Performing surgery on the roses, Dr. Wilmot?” she quipped.

“Nope, just donning my armor for battle against the damn beetles. Can’t be too careful with this stuff!”

“I thought you only spread that chemical on the lawn to kill the beetles,” Louise asked.

“Well, I must not have gotten the buggers in their larva stage,” he replied, “and the label says it will work on them once they’re at the chomping stage, too.”

Frank began carefully spraying the rose bushes, but a sudden gust kicked the spray back onto his exposed forearm.

“Maybe you ought to put on long sleeves, there’s a bit of a breeze today. Don’t get that stuff all over you, Frank!”

“Thank you, Captain Obvious, I’ll try not to. I’m almost done here.”

Finished, he closed the container and returned it to the shed, wiping off his forearm and a bit on his shin as well before removing his gloves and disposing of them in the garage trash.

“You’d better wash up—use the dish soap, that stuff works on everything,” said Louise. “And don’t use my good towels to dry off! Good lord, you’ve got it on your shorts as well! Stand there, I’ll get you a bag to put your clothes in, you can strip down here on the patio.”

“Well, that ought to entertain the neighbors.”

Frank emerged well scrubbed from the bathroom, wrapped only in the towel usually reserved for the dog. His forearm and the patch on his shin looked particularly pink and he touched one area gingerly. Louise noticed, too.

“What have you got going on there? Is that from washing up or are you having a reaction to something? Does it hurt? Itch?”

“Now don’t panic, it’s just a little irritated,” Frank replied. “I think I got everything cleaned off but…”

“I’ve got some first aid cream, but I don’t know if that would help,” Louise said. “I’m going to toss your clothes in the trash.”

“Oh no you don’t, Louise, that’s my good tie-dyed shirt and my favorite cargo shorts!”

“All right, all right, let’s call the poison center and see if they can help us with your skin and my laundry.”

A quick call to the Northern New England Poison Center reassured them that Frank was likely having a mild dermal reaction to the pesticide, and that his symptoms would likely go away on their own in the next few hours. The poison specialist suggested long sleeves/long pants when using the product in the future. He also advised Louise that washing the shirt and shorts alone with hot water, regular detergent and an extra rinse should be enough to decontaminate them.

The Northern New England Poison Center is available 24/7 at 1-800-222-1222 to provide free, confidential expertise regarding mishaps with pesticides, medication errors and other types of potential poisoning.

It had been a long day in the Wilmot household. Tomorrow was their grandson Pete’s 13th birthday, and they were hosting a surprise party, so today had been full of cleaning, cooking and yard work. The afternoon had included conversations like:

“Frank, can you get the stepladder from the garage? I want those windows washed.”

“What 13-year-old boy cares if the windows are clean, unless there’s a 13-year-old girl on the other side?”

“Just get the ladder please.”

And:

“Leave those cookies alone, Frank. They’re for the party!”

Their chores done, Frank and Louise snacked on some leftovers, too tired to cook. A half hour into the evening news, Louise rose from her chair, saying, “That’s it, I can’t keep my eyes open! I’m off to bed. Don’t you stay up too late.”

“I just want to catch the baseball scores. I’ll be right in,” Frank said.

“Right after I sneak a cookie or two,” he thought to himself. He waited, listening to her complete her bedtime routine. Finally hearing the soft hum of her CPAP machine, he snuck into the kitchen and found the tin of fresh chocolate chip cookies.

He had just popped a cookie into his mouth when their dog, Bailey, startled him, whining for a piece of contraband. The cookie in Frank’s mouth went down wrong and he began to cough. Not wanting to wake Louise and face her wrath, he grabbed some orange drink from among the bottles of soda on the counter and took a big swig.

The first gulp washed down the cookie, but the second told him it was not orange drink. Peering at the label he realized he had just swallowed several ounces of an orange-colored cleaning product. He turned to the sink and quickly rinsed the soapy taste out of his mouth with water.

“Now what?” he wondered.

He took a look at the caution label on the bottle, which recommended a call to poison control. The national number on the label put him right through to the Northern New England Poison Center, and he whispered his situation to the poison specialist.

After identifying the product, the specialist advised Frank not induce vomiting, and explained that he might feel sick to his stomach and could vomit. He recommended that Frank not head right to bed but sit up for a little bit and sip some water until any nausea passed. He also recommended storing cleaning products away from food items in the future, as this kind of poisoning is fairly common.

“Well, you pay for your pleasures,” thought Frank as he settled into his chair and reached for the remote, emitting a bubbly burp.

The Northern New England Poison Center is available 24/7 at 1-800-222-1222 to provide free, confidential expertise in cases of cleaning product mishaps, medication errors and other types of potential poisoning.

“That was a fine piece of meat, Louise,” Frank announced, settling into his recliner after dinner.

“You don’t want to know what it cost!” replied Louise. “But you only turn 75 once, so consider that your birthday gift, pal.”

“I’ll take it. Last year you got me socks. The sautéed mushrooms and onions were a nice touch.”

“I used a little Marsala on the mushrooms Claire gave me. Put on Channel 9, I want to catch the news,” Louise said, joining him in the den.

An hour later, the sound of Frank’s recliner snapping closed roused Louise from her evening nap. He headed toward the hall bathroom with what seemed like urgency.  A man on a mission, she thought to herself, reaching for her book and reading glasses. She was halfway through the chapter when she realized Frank had not yet returned to his chair.

“Are you ok in there?” she asked through the bathroom door.

“Not at all. Must have been the Marsala” he groaned, giving her a too-detailed description of his misery.

But Louise had a different suspect in mind. She stepped into the kitchen and retrieved the bag of mushrooms she’d gotten from their neighbor. “Honey mushrooms,” Claire had called them, picked that morning while out with her foraging club. Not a fan of fungi, Louise hadn’t eaten any. Claire was a seasoned forager, but could she have made a mistake identifying these mushrooms? She thought to call Claire, but then spotted the Northern New England Poison Center magnet on the refrigerator.

A few minutes later, she tapped on the bathroom door.

“Leave me alone to die,” Frank moaned. Louise rolled her eyes.

“You’re not going to die, honey. I was afraid the mushrooms might be the problem, so I called the poison center, and—”

“Claire never liked me! She’s trying to kill me, isn’t she?”

“No, Frank, I talked to the poison specialist and sent her pictures of the mushrooms. She told me they’re not poisonous, but she also said that even non-poisonous mushrooms can cause stomach problems if you aren’t used to a particular type. Your symptoms are completely normal.”

“How comforting,” Frank replied sarcastically. “Next year, hold the mushrooms and get me socks…”

There are toxic wild mushrooms in our area. If someone has ingested a mushroom and you are concerned that it could be poisonous, call the Northern New England Poison Center at 1-800-222-1222 for free, confidential expertise, 24/7.

Louise woke to the sound of Bailey, her wheaten terrier, whining to go outside, so she stepped into slippers and a robe and headed to the kitchen. 

She let Bailey out into the backyard, then reached into the cabinet for a glass and her thyroid pills. “Only four left,” she noted as she swallowed the blue pill with a sip of water, “I’ll have to call for a refill.”

Suddenly an eruption of barking came from the backyard: her neighbor Angela’s cat had Bailey cornered against the hedge separating the yards again. “Grand,” thought Louise as she placed her glass in the sink and hurried out to rescue Bailey, “he’ll wake the entire neighborhood.”

“Satan, you leave him alone and go back to your own yard!” Louise stage whispered, flapping her bathrobe at the fat feline.

“Her name is Satin, not Satan,” snapped Angela, responding to the racket from her own back door, “I don’t know why your dog can’t leave her be!” 

The cat waddled victoriously home through the hedge. Louise retrieved her dog, not bothering to point out who had been the instigator. 

Once back in the kitchen she reached into the cabinet for a glass and her thyroid pills. She swallowed the blue pill with a sip of water and as she placed the glass in the sink, she noticed another glass there. With a sinking feeling, she looked at the two glasses and realized her mistake. A quick recount of the pills in the bottle confirmed it: she had taken her medicine twice. 
“Frank!”

“Just toast and coffee for me” her husband replied from the bedroom.

“No, Frank, come here, I think I’ve got a problem!”

“Knew that when I married you” he muttered, entering the kitchen. “What’s up?”

“I think I took my thyroid pill twice. I got distracted by the chaos outside, and I took it twice!”

“All right, let’s not panic. We can call the pharmacy. How do you feel?”

“I feel fine right now, but the pharmacy isn’t open yet,” she replied.

“Where’s that magnet from the poison center? Don’t they handle these types of things?” Frank said, looking among the photos and notes on the fridge. “Here it is!”

A quick call to the Northern New England Poison Center allayed their fears. The poison specialist reviewed the medication and dosage, asked whether Louise usually had any side effects from the medication, went over Louise’s medication list, and reassured her that it was not an emergency. She even offered to send them a pair of pill minders to sort medications for each day.

“Crisis averted,” Frank said, “how’s about that coffee?”

Medication errors happen! If you think you’ve taken too much or the wrong medication, you can call the Northern New England Poison Center 24/7 at 1-800-222-1222 for free, confidential advice.

Let’s start by talking about what melatonin is: melatonin is a hormone produced naturally by humans and animals to help regulate sleep. Because of this natural function, melatonin is also chemically manufactured and sold over the counter as a supplement with the intention of aiding sleeping or lessening the effects of jet lag.

Generally speaking, melatonin is very safe for adults and unlikely to cause problems if you use it according to the directions on the label. However, taking too much—relative to your weight—or taking it with medications that cause drowsiness can lead to symptoms like dizziness and confusion. This is especially true for young children who get into melatonin while exploring. Taking what is a small amount for an adult can be a big amount for a little body.

Fortunately, most children who get into melatonin can be managed at home with advice from the poison center—a trip to the emergency department is rarely necessary. Give us a call any time at 1-800-222-1222.

The increase in exposures to melatonin likely suggests that more and more people have it in their homes, especially since the start of the pandemic, which has negatively affected many people’s sleeping habits. It’s a good reminder that we need to keep all medications and supplements up high, out of reach of children and pets. It’s also a good reminder to check with your doctor or other primary care provider before you or your child starts using a new supplement. Your doctor can talk to you about possible interactions, side effects and other considerations.

Don’t hesitate to contact the poison center with questions about melatonin. We’re available 24/7 by calling 1-800-222-1222, chatting online or texting POISON to 85511.

TRANSCRIPT

Karlee: 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.

Chris: Hello to all our listeners out there, and welcome back to Poison Center Pointers.  My name’s Chris and I have Carolyn here with me.

Carolyn: Hi everybody!

Chris: We don’t have Karlee with us this week, and why is that?

Carolyn: Karlee is on vacation. She’s going to be so sad she missed this podcast, just down in Florida with the warm weather…

Chris: I’m sure she’s just looking at toxic snakes and bugs and all that. I’m sure she’s actually not enjoying the weather. She’s studying up on poisons.

Carolyn laughs

Carolyn: Oh that’s probably true.

Both laugh

Carolyn: We miss you, Karlee! But at least this way any jokes we can make about Karlee instead of me and my age.

Chris laughs

Chris: That’s right! No age jokes…

Carolyn: Just poison information, just the facts.

Chris laughs

Chris: Karlee did choose a good week to take off, it’s a pretty exciting week here.

Carolyn: That’s right, very exciting.

Chris: It’s National Poison Prevention Week!

Carolyn: Wahoo!

Chris: It’s the third week of March every year, from March 20^st to 26^th this year. It’s a week dedicated to raising awareness about poison centers and the Poison Help hotline. What’s that phone number again?

Carolyn: 1-800-222-1222!

Chris: They want us to plug that.

Both laugh

Chris: So National Poison Prevention Week was started in 1961 by Congress. As I said it’s to raise awareness, reduce unintentional poisonings, and promote poison prevention. We even have a National Poison Prevention Week Council. Each year they hold various virtual events, even an artwork contest. A lot of that is available at AAPCC.org, which stands for American Association of Poison Control Centers.
There is a banner you can click on that will bring up more information. I believe all the virtual events this week are hosted on their Facebook page. Additionally you can find the link from there. 

So it’s National Poison Prevention Week, but it also happens to fall on….

Carolyn: Spring!

Chris: Spring! That’s right! What’s that called again?

Both laugh

Chris: So, it’s a week after daylight saving time…

Carolyn: Above freezing some of the time…

Chris: Yeah some of the time. It got into the 50s last week. It’s after March 21^st. What do we like to do this time of year?

Carolyn: Go outside and play!

Chris: Well, yeah…

Carolyn: But inside we do spring cleaning.

Chris: The responsible folk do some spring cleaning.     

Both laugh

Chris: So we figured, to go along with Poison Prevention Week we’ll talk about one of our, um, a topic that we get numerous calls—this is a daily call for us.

Carolyn: Yeah we get calls about cleaners all the time, but we thought you know, it’s spring, spring cleaning, let’s talk some about cleaners in depth.

Chris: Yes, let’s talk about household cleaners and chemicals. I compiled a nice bulleted list…

Carolyn: It’s very nice.

Chris: Yeah it’s very nice.

Both laugh

Chris: …of quite a few different cleaner types categorized by what might use them for. Figured we’d just go through briefly what kind of toxicity we worry about, and go through a few exposure scenarios, how to deal with them, and as always, some helpful prevention tips.

Carolyn: Sounds good!

Chris: Alright. The first cleaner topic…

Carolyn: The first one: oven cleaners and degreasers. Dun dun dun!

Chris laughs

Carolyn: I’m gonna give these a three skull and crossbones on the skull and crossbones scale. That’s a scale I just made up, by the way.

Chris: Sounds scary.

Carolyn: Yeah, it’s top three.

Chris laughs

Carolyn: Oven cleaners and degreasers are corrosive. They can definitely cause burns, so we need to take care of it right away. You definitely want to be careful when using those products.

Chris: Right, so you’ve been using your oven all winter because no one wants to go out and grill, except if you’re a hearty New Englander.

Carolyn: A Mainer!

Both laugh

Chris: New Hampshire and Vermont too, they may still be getting out there. You know you gotta clean out that oven, but those chemicals can be very nasty and corrosive as she said.

Carolyn: What’s the next one, Chris?

Chris: Let’s go with bleach. That’s a heavy hitter. And going along with that I guess we should just say mold and mildew cleaners as well, if you have any buildup from the winter. What are your thoughts?

Carolyn: Well with bleach, it depends on the percentage. And this is probably a good time to say when you do call us make sure make sure you have access, if you can, to the bottle so you can tell us exactly what the product is because all these cleaners, they’re all different. There isn’t just one name brand or one type, even bleach, there’s different percentages. They’re often low, the household cleaners, and those usually can be dealt with at home, but sometimes some cleaners can be more concentrated.

Chris: Right. And that’s what the percentage kind of, indicates. And we worry about the concentrated ones. Concentrated bleach can cause a burn, absolutely, if you get it on your lips, in your mouth…

Carolyn: …eyes…

Chris: Yep, skin, eyes, or you inhale it. It’s going to be very irritating. Generally household bleach is better tolerated.

Carolyn: Thankfully, it tends to do that, because it’s actually a fairly common call, most people have it in their house.

Chris: The chemical in it is called sodium hypochlorite, and you find that in mold and mildew cleaners a lot. So a lot of the same concerns there. Again a lot of variability, but we’re just, kind of going by use, that’s how we’re categorizing them here. But, there is variability in what they contain, but a lot of these contain bleach.

Chris: How about toilet bowl cleaners? Hopefully you don’t just use these during spring and you clean your toilet regularly.

Carolyn: Right!

Both laugh

Chris: They can be a concern right?

Carolyn: They definitely can! And again there’s a really wide range of toilet cleaners. Some of them can be, for example, strong acids, so again can cause burns. So again, knowing the exact name of the product. And, there’s the kind that that you use when use when you do your bathroom spring, well hopefully year round…

Chris laughs

Carolyn: But then there’s also the tablets that you put in the tank or put in the bowl, so there’s a very wide variety of those.

Chris: But again a lot of the sprays contain acids which can cause an immediate burn.

Carolyn: Immediate.

Chris: Some have ingredients that are called alkaline, which means they have a high pH instead of a low pH like an acid. Now it sounds maybe less scary than an acid, but it can cause just as bad if not worse of a burn.

Carolyn: Absolutely.

Chris: Let’s keep rolling with the scary ones: drain openers.

Carolyn: That also gets a three skull and crossbones on my list.

Chris laughs

Carolyn: Again that’s my own list. Drain openers as you can imagine, they’re meant to dissolve hair and dirt or whatever gets thrown down a drain accidentally or on purpose. They are very, they can cause burns very easily and very quickly.

Chris: Again they can be concentrated acids or alkalines.

Carolyn: Yeah, either one, right, and again, either direction can cause burns so be careful with these products.

Chris: How about laundry detergent? And everybody’s favorite, if there’s one thing you might know one the poison center for, it might be the Tide Pod challenge, huh?

Chris laughs

Carolyn: Oh, let’s hope not!

Carolyn: Laundry pods in general are very concentrated. We follow those closely, even for a day or more in some cases to make sure they’re not causing a burn. The pods are more concentrated, we worry about laundry detergent too, but pods are much more concentrated.

Chris: They don’t contain those acids and alkalines that we talked about but they are high concentration detergents, which is a chemical used to clean. It’s just the concentration of it that is so irritating.  

Carolyn: Exactly.

Chris: Laundry detergents can have a little more of a variety.

Carolyn: Yes, huge variety. You’re talking liquid, powder or a combo. There is so much variety.

The dishwasher pods are not the same as the laundry pods. Again, there’s detergents in there and we’re careful with them, and of course they’re at eye level.  But…

Chris: They are not tasty and you don’t want to bite into them.

Carolyn: Laundry pods, I’m telling you, even as an adult I want to play with that thing! They just look so fun and squishy but it very easily can break and get into your eye, and now you’re in trouble.

Chris: Let it be known that we do not recommend that.

Carolyn: No we don`t! And I never have done that.

Chris: That’s an official stance of the Northern New England Poison Center.

Carolyn: Of course, of course.

Chris: I guess we can talk about the more commonly encountered cleaners that are maybe a little bit less of a concern, but in the right circumstance absolutely can be a problem. Ones we get a lot of calls on, what are you thinking?

Carolyn: Dish soap would be the first thing, dish soap and hand soap, you know the pumps, right? Or the squeezy bottles.

Chris: Dawn, Ajax, whatever brand you like.

Carolyn: Yeah, exactly. Yeah those, they will definitely cause vomiting is what they usually do, they irritate the stomach and they make you throw up sometimes. But usually, they don’t do more than that. We generally don’t see burns with those. I mean certainly in the eye, that can be a different scenario but thankfully we tend to… We can handle those pretty quickly and easily when you call us.

Chris: Room sprays, deodorizers, you know, like fragrances generally not as big of a deal. Obviously you don’t want to drink from them.

Carolyn: Unless you spray them right in the face.

Chris: Yeah, they can be a little irritating. Honestly you smell enough of them it’ll give you a headache more than anything.

Carolyn: That’s true. That’s true with a lot of these cleaners actually. Disinfecting wipes are another one, we are using those a lot lately, right? As a whole society, everybody is and you just have to be careful with them. As always, wash your hands after you use them but we generally don’t see a lot of issues with those. We generally don’t have to send to the hospital.

Chris: A couple of atypicals. Atypical cleaners I guess so to speak that tend to be an issue. Wheel cleaner, wheel cleaner contains a chemical, some of them do anyway, contains a chemical called hydrofluoric acid and that’s really bad stuff if you get it on your skin, your hands or anywhere, um, it has the potential to cause some severe toxicity so that is one you want to keep stored away from the children. Keep it in a safe environment, make sure you are following the directions.

Carolyn: We’re talking about wheels of a car. So obviously you wouldn’t as likely have this in the house but you might have it in the garage.

Chris: Another good one to keep stored away: gun cleaners, gun-bluing agents.

Carolyn: Yeah, some of those can be very poisonous.

Chris: Gun-cleaning solutions. And then we kind of mentioned briefly with the percentage or concentration in bleach. I think you might have mentioned the word industrial I’m not sure but, industrial cleaners, right?

Carolyn: Yeah.

Chris: What are we worried about with those?

Carolyn: Well, they are just more concentrated, they have higher concentrations of some of these things that can cause a burn. So, be careful. Typically, typically people don’t have them in their house but maybe they use them at work or they might think to bring a product home because it works so well there, but they’re a different ball game.

Chris: I think that’s a pretty good list of what we’re using inside the house for spring cleaning. Maybe we’ll touch on the outside of the house cleaners and products we might be using once it gets a little warmer.

Carolyn: Another time! Something to look forward to!

Chris: Yeah, the grass is still dead, we’ll wait a second on that.

Carolyn: It is not green yet.

Chris: What are some of our common exposure scenarios that we encounter with children?

Carolyn: Yeah, so most of our—we have calls about adults getting exposed to cleaners, and children. So, first of all, with children, there are things like a lot of—when you put these products at the children’s eye level. For example, in buckets on the floor, a child thinks, oh a bucket full of water, and might want to even taste it or play with it. Same thing with the dish washer pods: dishwasher is open, the child wants to help, and they see that dispenser and they stick their finger in there ’cause they think it’s something to eat. And then with the toilet bowls. You know again, those are at eye level for a child and if they have that pretty blue water, they might actually stick a cup in there or certainly their fingers and taste it. So thinking about what’s at eye level, what they can be exposed to because they’re going to be attracted to that. You know if it looks like something fun.

Chris: Maybe one of the most common calls we get: kids opening up a door, like a pantry door, or storage closet, and just grabbing a bottle off the ground underneath there, right?

Carolyn: Yeah, of course.

Chris: Spraying themselves in the face or the eyes or inside the mouth

Carolyn: They want to help. They see what the parent is doing and they grab the bottle and they just don’t know to turn the sprayer away from their face and they spray it in their face or another child’s face. Definitely can be a problem. You know unfortunately once they’re old enough to really be helpful for cleaning the house, they don’t want to anymore!

Chris: Yeah.

Carolyn: But when they are little they can get into some trouble there and cause some issues.

Chris: How about with the adults? What are some of the more common situations?

Carolyn: The adult situations are more like not using gloves when maybe you need to. Not being in a well ventilated room.

Chris: Mixing cleaners!

Carolyn: Mixing cleaners, that’s probably number one, right? I can’t believe I didn’t say that first.

Chris: When you mix them it makes them stronger – get that grit out.

Carolyn: No! Chris, no! When you mix them it can cause a reaction and it can be more poisonous.

Chris: Right, cleaners we mix because we think it can increase strength, the strength of the product. Or adding a cleaner after you use the drain opener.

Carolyn: Right, yeah, all of those.

Chris: Mixing bleach with an acid or mixing bleach with ammonia can produce toxic fumes that can be a problem.

Carolyn: Or bleach on urine, like animal or a person.

Chris: Like cat urine.

Carolyn: That’s a big one, yeah.

Chris: Again, that’s all kind of dependent on the circumstances, and it can be an issue and is irritating. Don’t mix cleaners!

Carolyn: Yeah—don’t mix them! And you know, when you look online, which a lot of people do, it’s really scary, and as always, of course we want you to call. We can help with those situations.

Chris: We can put it into context.

Carolyn: Exactly. And another thing about kids, sometimes they get into—you put the cleaner away, you dump the bucket, you’re all set and you forget about the rag or the sponge. And you know, especially a little one crawling around, maybe teething, they’ll stick that thing in their mouth.

Chris: And now they get bacteria and cleaner in their mouth.

Carolyn: Yeah, or sometimes the new baby doesn’t smell too good because they have a dirty diaper and they’re spraying deodorizer all around, you know, on the child.

Chris: Well, how would we handle a situation, say the kid grabs a bottle and sprays themselves on their skin or in the eye—what’s the best thing to do?

Carolyn: Well, of course, call us. But first, you want to get it off, right? You want to get it off, so let’s start with eye. If it gets in the eye, no matter what the product is, the most important thing is to get it out of the eye. And we can, we will definitely help you with that when you call. Just to get you started, what we always recommend is using room temperature water, so it’s comfortable for the eye. You want to pour it over the bridge of the nose so it’s flowing through the eye, not being poured directly on the eye. In other words, we don’t want pressure, don’t grab a garden hose or something. You don’t want pressure on the eye. And we want to do that for 15 minutes, sometimes more, depends on the cleaner. And when you call we’ll tell you.

Chris: A lot of times, the flush can be the solution.

Carolyn: Right!

Chris: Other times, if it’s a nasty enough cleaner, it may still require evaluation in a health care facility, but the best first step is almost always a flush. But, if something gets in your eye, give us a ring.

Carolyn: Yeah, we can definitely help with that.

Chris: Same goes for skin, right? Um, and again, it’s all dependent on what kind of cleaner you got here. We talked about oven cleaners and drain openers being super corrosive potentially. Dish soap, not so much. Obviously you’re putting hand soap on your hands it’s probably not going to cause a burn. But there are ones that can cause a nasty burn and you need to wash off the area with warm water.

Carolyn: Right, anything left on the skin, you know you get a little bleach on your pants and you don’t think anything of it, and hours later you realize you end up with a chemical burn, so we have to be careful. Same thing with—and that’s a good thing to note too, if a child gets into it, they probably got it on their clothes. You need to change them and wash them up.

Chris: Right, might be time for a bath. How about an inhalation exposure?  I mean, this can occur with kids and adults. Maybe even more so with adults, we get calls on where they are cleaning in a poorly ventilated room and they inhaled quite a bit, or combined cleaners. Created a fume. What do we do in that circumstance?

Carolyn: Fresh air right? Number one, fresh air.

Chris: Get out of the room.

Carolyn: If you can easily open the window, but don’t stay in the room for any longer than you need to—get some fresh air. Go sit outside. If it’s the middle of winter, which of course we’re talking about spring, just for future reference, you can open a window and sit right there. But you really want to…

Chris: Get some fans going potentially if you want to get a cross breeze.

Carolyn: Exactly.

Chris: It’s all about getting fresh air and if you have like a condition like asthma or COPD and your airways are a bit more reactive we might have to consider things differently so it’s something worth noting, or if you’re having persistent coughing, chest pain, difficulty breathing—anything like that, obviously concerning, and regardless we want you to give us a ring and we can talk about management from there.

Carolyn: Don’t wait until it’s really bothering you.

Chris: Last big piece is probably ingestion or swallowing some of these chemicals, right?

Carolyn: Yeah, that’s probably our most common one I would say for cleaners. And, you know, you can always rinse out the mouth, but you don’t always push fluids, and that’s something that people don’t—that happens sometimes, but we don’t want necessarily to give a ton of fluids, it really depends on the cleaner.

Chris: Don’t make yourself vomit either!

Carolyn: And definitely don’t do that—yes, right—thanks, Chris. Because if it burns going down, it’s gonna burn coming back up. So, be really careful. Rinse mouth, give us a call.

Chris: Another one, there’s a great range of what’s in these types of cleaners. Some of them, if you swallow a little bit, it’s not a problem at all.  Some of it’s a big deal. So, it’s another area where we can provide context. How about prevention tips? It is National Poison Prevention Week, as I mentioned!

Carolyn: Oh, that’s true! We shouldn’t leave that out, right?

Chris: That’s our big piece here, that’s what we’re doing this week!

Carolyn: That’s true.

Chris: So, I think we probably touched on a couple of the big ones but do we have any helpful hints right now?

Carolyn: I think, you know, one simple one obviously we can all do is reading the label. I know that sounds silly, but you know sometimes we forget to read the label. Should we be wearing gloves? Should we, does it say right there open the windows because this has strong fumes, right?

Chris: Do you need a mask?

Carolyn: Do you need a mask, right? Just making sure what, what you need to do. Is it supposed to be diluted—you know—were you supposed to use this with water instead of straight?

Chris: That’s a great one.

Carolyn: You know, sometimes you don’t know until you take a look at the label.

Chris: Um, something we’ve mentioned on previous podcasts, I think we talked about antifreeze in this sort of context—store products in their original containers, right? Don’t put them in a milk jug, don’t put them in a soda bottle, a glass. How many times have we had people drink cleaner that they thought was a cup of water?

Carolyn: So often, so often, yeah.

Chris: And that can be a problem.

Carolyn: And it’s not just kids, it’s kids and adults. You see a glass full of something, it’s by the sink, you just assume it’s water.

Chris: That’s right. I think we hit enough on do not mix cleaners, they get the message.

Carolyn: Yeah, I think so.

Chris: Don’t mix them!

Carolyn: Yes, don’t, just don’t!

Chris: As you’ve said, we just mentioned storing products in the original containers. We definitely get calls where, cap was left off, kid just happens to grab it, put it down in a matter of seconds.

Carolyn: Yeah, I mean kids are fast.

Chris: Keep those products high and out of the reach of children and pets.

Carolyn: Yup, or a locked cabinet if you have one.

Chris: Make sure you’ve got safe conditions for cleaning. Mask, gloves, good ventilation!

Carolyn: Right—there you go!

Chris: We got anything else on the list?

Carolyn: I think that sums it up. I think that’s pretty good. We just need a little bit warmer weather so we all open our windows and start doing this.

Chris: Another couple weeks. We’re getting another cold snap and some snow, let’s be real. In April, it’s going to happen once.

Carolyn: It did snow last night.

Chris: After that it will be all right.

Carolyn: OK.

Chris: We should plug that the NNEPC does have a blog on this exact topic. If you go on NNEPC.org and search: Stay safe while spring cleaning.

Carolyn: Nice.

Chris: You’ll find a nice blog post we have on some of what we covered. Hopefully we gave you a little more insight. Again, can’t encourage you enough to go on aapcc.org and check out some of the links they have on National Poison Prevention Week. Again there are virtual events available on Facebook. We want to thank you all again for listening to this episode of Poison Center Pointers. You can like, share and subscribe to us on Facebook, Twitter, and visit our website at nnepc.org. If you have an actual poisoning emergency, scenario or even just a question, contact the NNEPC by calling—what was the number again?

Carolyn: 1-800-222-1222.

Chris: Text the word POISON to 85511 and chat online at nnepc.org. Best of luck cleaning everyone!

Carolyn: Yup—happy spring!

Chris: Happy spring!

Carolyn: And happy Poison Prevention Week!

Chris: It’s going to be in the 70s next time we have something hopefully.

Carolyn: That would be awesome. Bye, everybody!

End music

There are many types of medication errors. Accidentally taking a dose twice is the most common type we receive calls about. Calls about other types of dosing errors, such as measuring out the wrong amount, are also fairly common, along with calls about taking the wrong medication, such as taking a spouse’s, sibling’s or pet’s medication by mistake.

Heart medications and antidepressants were the drug categories most often involved in medication errors we helped manage in 2021, and these were also the categories with the biggest increases over the past two years.

Errors involving hormone-related medications (such as for diabetes or thyroid issues), antihistamines, and anticonvulsants or mood stabilizers (such as lamotrigine or gabapentin) are also up significantly. There has been an increase in errors involving acetaminophen, and pain medications as a group (both prescription and over-the-counter) are the third most common type of drug involved in medication mistakes.

There are many possible reasons for these increases. The pandemic has brought on many new stresses and distractions, which can make errors more likely. In the case of antidepressants and other mental health medications, CDC survey data suggest there has been a notable increase in the number of prescriptions over the past year and a half or so, and with any substance, wider availability means more opportunity for poisonings.

Tools for preventing medication mishaps

Fortunately, there are many tools available to help you and your family manage your medications, including a number available on our website.

• Our 2012 booklet Medication: What You Need to Know covers the basics of medication in an easy-to-read format. The booklet is available as a PDF download, or you can request a hard copy. While the booklet is specifically aimed at adults 60 and older, the information can be of use to people of all ages.
• Along with the booklet, we have a ready-made medication calendar to help you keep track of your medications and when you’ve taken them. Even if you don’t use our calendar, consider using it as a template to create your own. A calendar can help ensure you don’t miss a dose or take one twice.
• Keeping a list of your medications is important for you and your health care providers to prevent interactions. Consider downloading our medication chart, medication wallet card, or both to keep track of the medications, vitamins and supplements you take.
• Keeping your medications in their original container is the ideal storage method. However, we know that doesn’t work for everyone. A child-resistant pill box is the second best way to store and track your medications. Make sure any pill box you choose is labelled as child-resistant, and keep in mind that it is only resistant–nothing is truly child-proof. Given more than a few minutes, some children can get into anything! We have some child-resistant pill boxes available to order for free from our website.

Safely using, storing and disposing of your medications also helps prevent poisonings of children and pets. Learn more about safe disposal on our Medication Disposal page.

Remember, we are here to provide fast help 24/7 regarding any kind of medication error, whether you gave your child a double dose, you took the dog’s medication, or anything in between. Call us at 1-800-222-1222, chat online or text the word POISON to 85511.