Most people at some point in their lives have been sunburned, so you already know it’s no fun.  But besides the fact that it just plain hurts, it can have long-term consequences.  Understanding the science behind sunburn can help motivate you to avoid it in the future!

What Is Sunburn?

How exactly does sun exposure cause sunburn?  It helps to start with the source:  The sun!  The sun is really just a giant fusion reactor with no walls – held together by gravity! – that produces a continuous spectrum of electromagnetic radiation.  Infrared radiation (760-1700 nm) accounts for about 40% of the incident radiation at Earth’s surface, visible light (400-760 nm) about 50%, and ultraviolet radiation (UVR) about 10%.  The laws of physics explain that the amount of energy increases as wavelength decreases (or frequency increases); consequently, UV radiation – with its shorter wavelength – packs a much bigger energy "punch" than the other major players.

What does that mean for our skin?  To understand that you first need to know how DNA behaves in normal skin cells.  Deoxyribonucleic acid (DNA) is really just a chain of four small chemical subunits (A, T, C, or G) that are arranged in specific order.  In each one of your cells, there are a hundred billion of these little subunits linked up in a specific sequence.  Some sections in that sequence are “read” by the cell, and these are called genes, which code for proteins that make the cell perform one chemical task or another.  So, if you change that sequence you change the way the cell behaves.

Now, remember that many of the cells in your body are still dividing, especially the ones that have to be replaced frequently – like the cells in your skin that are constantly being replaced due to damage from the outside world.  When those skin cells divide, they have to make a copy – an exact copy! – of their DNA for the new cell.  If there are mistakes in the DNA then they act as genetic “typos” that keep the new cell from functioning correctly.  These DNA typos are called mutations.

When UV radiation, with its energy-packed punch, strikes the DNA in a cell, anywhere there are two “T” subunits next to each other on the chain, the energy can cause them to make a new chemical bond and stick together.  Consequently, the chain gets distorted – sort of like two teeth on one side of a zipper melting together!  This new, mutated DNA may cause the cell to stop working correctly.

The Short-Term Response

This isn’t your cells’ first time to the UV rodeo, so they have some short-term defenses!  Within hours of your sunburn, mutated cells start self-destructing (this is called apoptosis).  Think of apoptosis as an individual cell’s way of committing hari kari; the cell effectively commits suicide in order to stop causing further problems.  Additionally, your immune system starts releasing inflammatory molecules that act as chemical signals to let you know that your skin has been damaged.  You notice this as redness, pain, and swelling.  Suddenly, a hot shower or a friend’s chummy slap on the back hurt like the dickens.  In medicine this state of abnormal pain is called allodynia.

Another response that some of your cells initiate is to increase the amount of melanin – the pigment in your skin – to prevent UVR from getting through in the future.  This is why our skin gets darker after we’ve been in the sun.  The effect of UVR is so damaging to cells that similar chemical systems to block it have evolved in other species of the natural world.  For example, have you ever noticed that the shrimp you buy at the store turn from gray to pink as you cook them?  The heat of the stove is inducing a UV protection system, which shrimp have acquired in order to protect their own DNA from frying should they come to close to the surface of the water.  Shrimp use anthocyanins instead of melanin, which is why they get pinker instead of browner.  Similar compounds can be found in cacti, Japanese maples, and snow algae.  Amazingly, all of these species of animals and plants have evolved independently, which makes you appreciate just how nasty UVR must be to our DNA!  Still want a suntan?

The Long-Term Response

So, what happens if one of your cells doesn’t activate its self-destruct sequence even though its DNA has been damaged?  Well, probably nothing since the mutation probably landed in some “non-critical” stretch of DNA.  But every now and then you get a mutation in the part of the DNA that allows a mutated cell to continue to divide out-of-control.  This is called cancer, and it’s the most dangerous long-term effect of sunburn.  Effectively, every time you get sunburned, you may be rolling the dice on acquiring one of these serious mutations!

There are several types of skin cancer of varying degrees of medical scariness.  Sunburn absolutely raises your risk for basal cell carcinoma (BCC; the most common cancer known to humans!) and squamous cell carcinoma (SCC).  UV exposure may also raise your risk of melanoma, which has a greater tendency to spread and is associated with higher mortality rates than BCC and SCC.

While skin cancer is certainly the most dangerous risk of sunburn, there’s also the cosmetic impact to worry about.  UVR damages the elastin-producing cells in your skin, which means your skin gets more rigid and wrinkly with more sun exposure.  If you won’t take my word for it, take this quick test:  Look at the skin on the top of your forearms.  Notice the freckles and moles and the extra lines?  This is sun-exposed and sun-aged skin.  Now, flip your forearms over.  Looks like a baby’s bottom, right?  This is skin that has managed to miss direct sun exposure all your life.  Enough said!

Here's How to Be Sun Smart:

• Wear protective, UV-protective rated clothing.  These items such as a long-sleeved shirt, pants, a wide-brimmed hat, and sunglasses provide sun protection as long as you are wearing them.  Newer materials are lightweight, comfortable, and do not look as dorky as the 1st generation sun-protective clothing!
• Generously apply a broad-spectrum, water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 30 to all exposed skin. Broad-spectrum provides protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Re-apply approximately every 2-4 hours (even on cloudy days as UV energy can pass through clouds!) and after you towel down.  Use a water-proof sunscreen if you are planning to do any swimming or sweating.
• Seek shade when possible, remembering that the sun's rays are strongest between 10 a.m. and 4 p.m. If your shadow is shorter than you are, get in the shade. Protect children from sun exposure by playing in the shade, using protective clothing, and applying sunscreen.
• Use extra caution near water, snow, sand, and concrete.  These materials reflect the damaging rays of the sun, which can increase your chance of sunburn.  That's why you can go skiing and come home with a sunburn!
• Get Vitamin D safely through a healthy diet that may include vitamin supplements (ask your physician first!). Do NOT seek the sun as your primary source of Vitamin D.
• Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you've been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it.
• Check your birthday suit (the skin in which you were born!) at least once a year on your birthday. If you notice anything changing, growing or bleeding on your skin, see a dermatologist as soon as possible. Most skin cancers are very treatable when caught early.  Check yourself by doing a Self Skin Exam.  Or better yet, get someone to check your skin for you!

Sunburn First-Aid

How you handle a sunburn depends on how bad it is.  If the symptoms include fainting, confusion, headache, or if the pain is unbearable, seek professional medical help immediately!  If the symptoms are limited to the following, you can probably handle it yourself:

• Pain
• Redness
• Swelling
• Chills
• Blistering
• Skin peeling up to a week later

The strategy to treat sunburn is really to treat the symptoms until your skin repairs itself:

• Try to keep sunburned skin cool; use cool compresses or ice packs.
• Use moisturizing lotions.
• Avoid creams with lidocaine or benzocaine, especially in kids.
• NSAIDs (like ibuprofen) may help take some of the pain away.
• Make sure to maintain adequate hydration; avoid alcohol and caffeine as these can cause you to lose water quickly.

During the month of May (Skin Cancer Awareness Month!) there will be more articles coming on the details of sun protection.  Until then, remember that sun burns are the most preventable risk factor for all skin cancers, including melanoma!  You can have fun in the sun and decrease your risk of skin cancer and photo-aging.  Stay sun safe and skin cancer smart!

There are some golf purists who argue that the only way golf should be played is while walking.  Speaking purely from a health perspective, it’s hard to argue with their logic. Walking is a healthy form of exercise. Therefore, walk whenever you can.

On the other hand, golfers with certain physical impairments have virtually no choice. They either ride or give up the game completely.

Then there's the group of people where the decision to ride or walk is slightly blurred, yet, even more crucial—those with or at risk for peripheral arterial disease (PAD). They might want to walk the entire course but cannot do so because of their medical condition. For them, walking is an essential part of their therapy, and the more often they choose to walk, the better they may be able to forestall or even avoid progression of their disease.

PAD is a condition that affects as many as 8-12 million Americans, but only 4 million of them actually have symptoms (in other words, it can be a “silent” disease). It is a systemic vascular condition in which atherosclerosis—the plaque-forming disease that narrows and, eventually, helps to occlude coronary arteries—attacks the arteries that supply blood to the periphery of the body, most notably the legs and arms.

At first, the lack of oxygen (or ischemia) caused by the condition may only produce easily fatigued muscles. Eventually, however, it causes a symptom called intermittent claudication (IC), a severe cramping pain in the calves, thighs, or buttocks, typically made worse by activity and relieved by rest.  As PAD progresses, the activity a person can tolerate before symptoms occur gradually decreases and the time needed to rest increases. Because people with symptomatic PAD have a five-year mortality rate of nearly 30%, the condition warrants special attention. The symptoms of PAD are fairly easy to recognize and include:

• Tiredness or heaviness in the calves, thighs, or buttocks after exercise that takes a prolonged time to clear
• Aches, pains, or cramps in the same areas brought on by activity and that subside with rest
• Numbness, tingling, or coldness in the lower legs or feet
• Weak or absent pulses in the legs
• Cuts or wounds on the legs or feet that won’t heal

Some of the major risk factors for developing PAD are age greater than 50 years, obesity, elevated cholesterol levels, diabetes, high blood pressure, unstable angina or a prior myocardial infarction (i.e., heart attack), lack of physical activity, smoking, and occurrence in other family members. Also, PAD can be associated with erectile dysfunction. People with risk factors should be screened annually for possible PAD to help prevent, detect, and treat it early.

People experiencing PAD symptoms should visit their physicians to undergo proper testing and to start therapy immediately!

The added importance of recognizing symptoms of PAD is twofold:

1. People with PAD have much higher risks of developing other problems like coronary artery disease, heart attacks, and strokes, and...
2. A well-designed management plan that combines medications with efforts directed at progressively increasing activity tolerance (i.e., walking distances on the golf course) are crucial in improving long-term prognosis.

The bottom line is that there’s a place for both walking and riding when playing golf. If you are able to walk, by all means do so. If you have physical limitations or medical conditions that might worsen with walking or severely limit your round, take a cart and don’t let anyone tell you you’re not playing golf.

If you have PAD (or think you might) discuss with your physician the best way to treat your condition while playing your round by, for example, walking as much as possible but using a cart for backup. Studies have shown that a 3- to 6-month supervised walking program could help to increase pain-free walking times by 165% and peak walking times (i.e., the maximum distance you can walk even with pain) by 96%.

Finally, the rest of us golfers should encourage this “step in the right direction” by being patient with anyone in front of us trying their hardest to combine a little exercise with a round of golf. Who knows? It may be you who, one day, is pushing yourself to be able to enjoy more golf for far more years to come.

And, after all, isn’t that every golfer’s goal?

This is a great Easter ham dish, especially if enjoyed with the suggested wines!

Serving Size:  Serves a large group!

Ingredients:

• 1 cooked, "bone-in" half ham (6 to 7 pounds); can be from the shank or butt
• 3/4 cup packed light brown sugar
• Juice and zest (finely-shredded) from 5 to 7 medium Meyer lemons
• 1 1/4 teaspoons ground ginger

Preparation:

• Preheat oven to 350 degrees Fahrenheit.
• If it has any still present, cut-off the tough "rind" from ham.  Score fat and meat in a "crosshatch" pattern.
• Put ham, fat side up, in a large roasting pan and tent loosely with foil.  Bake until a thermometer in thickest part of meat reaches 120 degrees Fahrenheit (about 1 1/2 hours).
• To make the glaze:  Whisk light brown sugar, lemon juice, lemon zest, and ginger in a large mixing bowl until smooth.  Set aside.
• When the ham reaches the desired temperature, uncover it and pour the prepared glaze over it.
• Bake ham, uncovered, until glaze thickens and thermometer in meat reaches 135-140 degrees Fahrenheit (about 15-30 minutes total).  Take care to baste ham and stir glaze every 10 minutes.
• Transfer ham to cutting board.
• Collect remaining glaze into a small bowl.
• Carve ham and spoon more glaze on top.
• Serve warm.

Suggested Wine Pairings:

• Poppy Pinot Noir 2007 Monterey County (great for the price and quality!)
• Hall Sauvignon Blanc 2008 Napa Valley (just a little oak; a real palate cleanser!)
• Chateau La Mothe De Haux 2008 (a white Bordeaux with amazing fruit flavors!)
• Migration Pinot Noir 2007 Anderson Valley (rich flavors of cherry and strawberry but a bit more pricey!)
• Tablas Creek Esprit de Beaucastel white 2007 Paso Robles (the most expensive on the list but it brings out the flavor of honey and lemon in the ham!)

A New Service for the boonDOCS Community!

As a free service to outdoor enthusiasts everywhere, boonDOCS Wilderness & Travel Medicine invites you to create an emergency contact and medical information card that you can carry with you on your next adventure!

For your convenience, we designed the completed PDF document to be the size of a business card - small enough to be carried with your hunting or fishing license, ski lift ticket, or park pass. Print additional copies for your wallet/purse and to keep with your passport and car insurance/vehicle registration information!

Out of respect to your personal privacy, none of the entered information is saved.  Consequently, you will have to enter all fields again if you require an additional card in the future.  Just click on Dr. K's emergency card to the right and you will be re-directed to the emergency card generator.

And remember:  "When you're out there, be there!"