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What’s the Buzz About Bug Spray?


Summer’s here and as you shop for insect repellant, you will be faced with a choice: Should you get one with synthetic (man-made) ingredients or one that is “natural”?

Some people worry that synthetic materials used in sprays – such as DEET and picaridin ‒ may be harmful. Others claim that natural sprays don’t work well, so why use them?

Here’s what you need to know about choosing a product that will safely keep biting beasties away this summer.

Synthetic sprays

The most popular bug sprays at your local store will probably have the chemicals DEET or picaridin as their main active ingredients.

DEET is one of the most effective repellants available. It works well against mosquitoes (up to 12 hours), ticks (up to 4 hours) and other insects. The Environmental Protection Agency has approved DEET for both adults and children 2 months and older, but frequent and heavy use may cause skin irritation. For adults, look for products that contain 15%-30% DEET, but kids 12 and under should use a product with 10% DEET or less.

Picaridin is made from piperine, the alkaloid that gives pepper its peppery characteristics. It is odorless to humans but smells repulsive to insects such as mosquitoes, ticks, fleas and flies. It keeps mosquitoes away for up to 8 hours and ticks for up to 5 hours. Picaridin is slightly milder than DEET, and skin irritation is less likely. Look for spray products, which generally work better than lotions or wipes, containing 20% picaridin.

Natural sprays

Natural insect sprays use plant-based substances instead of man-made ones. Not all natural sprays work equally well, so here’s what you need to know.

Oil of lemon eucalyptus is one of the most effective natural ingredients. It keeps away some ticks, flies and gnats, but it’s most useful against mosquitoes (up to 6 hours). Though it is natural, it isn’t recommended for kids under age 3. Look for products with 30% oil.

Sprays containing 2% soybean oil have been shown to provide up to 4 hours of protection against mosquitoes. Soybean oil is safe to use on infants and children.

Unrefined essential oils such as citronella, geranium and rosemary are promoted as all-natural repellants. But despite their popularity, they typically only work for about half an hour, and then the bugs will be back.

So what works best?

For the best protection against biting insects, choose a spray with synthetic DEET or picaridin. They repel a greater variety of bugs and stay effective longer. This is especially true if you live in an area heavily infested with mosquitoes.

If you prefer a plant-based product, and you live in an area where mosquitoes are less of a problem, sprays containing oil of lemon eucalyptus or soybean oil may give you adequate protection.

Besides using bug spray, see these tips from the CDC for preventing bug bites.

Dr. Keithley cares for patients in the Arnold office. She received her medical degree from Drexel University College of Medicine and is certified by the American Board of Family Practice.

Top Health Issues for College-Bound Kids

By: Lisa Goldberg Keithley, M.D.

You have a college-bound teen? Congratulations!

While you’re selecting classes and picking out towels, be sure to also pay attention to your teen’s health. Due to large classrooms and tight living quarters, college students are at risk for some potentially serious infections, including meningitis, mononucleosis, mumps and the flu. Here’s what you need to know to keep your college student safe.


Meningitis is an inflammation of the protective membranes surrounding the brain and spinal cord that’s usually caused by a bacterial or viral infection. Symptoms include fever, headache, stiff neck, vomiting, nausea, sensitivity to light, and confusion. In some cases, it can be deadly.

Fortunately, meningitis isn’t very common, and there’s an effective vaccine to prevent it.  Many colleges recommend that students get vaccinated to prevent outbreaks.

What to tell your student: If they have symptoms of meningitis, they should put on a face mask, if possible, and get to the nearest emergency room. Meningitis is very contagious, so going to the student health center is not a good option.


Caused by the Epstein-Barr virus, mononucleosis is often called the “kissing disease” because can be transmitted through saliva. Besides kissing, mono can be passed by coughing, sneezing or sharing a glass or eating utensils.

Symptoms include a sore throat, fatigue, low-grade fever, stomach pain, and swollen tonsils. Mono can also cause serious complications such as enlargement of the spleen and liver inflammation.

What to tell your student: If they are experiencing symptoms of mononucleosis, they should get checked out at the student health center. Unfortunately, people with mono can be laid up for weeks, which is bad news for a college student.


Mumps is a viral infection that affects the salivary glands located near your ears. Symptoms include fever, headache, muscle aches, tiredness, and loss of appetite – also swelling of the salivary glands, which causes puffy cheeks and a tender, swollen jaw.

Mumps is highly contagious, but cases have been greatly reduced thanks to the childhood MMR (measles, mumps, rubella) vaccine. However, even if your child was vaccinated, there is still a small chance they can get mumps.

What to tell your student: If they think they may have the mumps, they should visit the student health center. And if mumps is spreading at their college, they may need to get another dose of the MMR vaccine as a booster.

The flu

The influenza virus usually occurs in the fall and winter, and can be quickly spread by coughing and sneezing. The flu’s well-known symptoms include fever, cough, muscle aches, sore throat, runny nose, headaches, and fatigue, which typically last up to a week. Flu can be prevented, or its effects reduced, by the annual flu shot.

What to tell your student: They should go to the student health center soon after the onset of symptoms to get antiviral medicine, which can shorten the length of the flu. And, of course, they should get the annual vaccine at home or if it is offered on campus.

Before your student heads off to college, be sure they are up to date on recommended vaccinations. Ask your MPCP doctor what your child needs to stay healthy and reduce their risk of illness.

Dr. Keithley holds her medical degree from Drexel University College of Medicine and is certified by the American Board of Family Practice. She sees patients in MPCP’s Arnold office.

The Worst Drinks For Kids

Q&A on sugary beverages by Lisa Goldberg Keithley, M.D.

Q: Kids love sweet drinks. What’s wrong with that?

A: Many children’s drinks are loaded with added sugar and have little nutritional value.  According to the CDC, sugary beverages are a main factor in the rise of childhood obesity. And kids who consume a lot of sweet drinks may not be getting enough vitamins, calcium and other nutrients.

Q: How much sugar should kids get each day?

A: Most kids consume too much sugar. The American Heart Association recommends they get no more than 3 teaspoons of sugar per day, but kids ages 4-8 typically consume 21 teaspoons per day.

Q: Do some children’s drinks have too much sugar?

A: There are definitely some popular drinks you should avoid giving to your kids. They are low in nutrients and are loaded with sugar. Here are a few of them:

  • Hi-C®: This longtime favorite is low in fruit juice ─ just 10% ─ but is high in added sugar. One 6.75-ounce carton has 6 teaspoons of sugar. That’s more sugar per ounce than in a regular Coke.
  • Hawaiian Punch®: Not much juice in this drink ─ only 5% ─ but 8 ounces contain 4 teaspoons of sugar.
  • SunnyD®: It may look like orange juice, but it’s really only 5% juice. A 6.75-ounce bottle has almost 3 teaspoons of sugar.
  • Capri Sun®: One little 6-ounce pouch has a big 4 teaspoons of added sugar.
  • Sodas: A 12-ounce can of regular Coke® contains almost 10 teaspoons of sugar. That’s more than three times the recommended daily allowance of sugar in just one drink!

Q: If sweet drinks are a bad choice, what’s the alternative?

A: Fortunately, there are healthier alternatives to giving your child “liquid sugar”. They include:

  • Wonderful water: Water is the ultimate thirst quencher and contains no sugar or calories. The Institute of Medicine recommends that kids ages 4-8 get about 5 12-ounce glasses of water each day. Older kids and teens should get 5-8 glasses.
  • Marvelous milk: Milk is rich in nutrients, such as calcium, vitamin D, and potassium, which are important for healthy bones and preventing cardiovascular disease and type 2 diabetes. The American Academy of Pediatrics recommends kids ages 2-5 drink 2 cups of milk daily. However, too much milk can lower the body’s iron stores.
  • Great juice: Pure fruit juice ─ not juice drinks ─ is packed with vitamins and other nutrients. However, juice also contains a fair amount of natural sugar, so mind your child’s daily intake:

6-12 months old: 2-4 ounces

1-6 years old: 4-6 ounces

7-18 years old: 8-12 ounces

And remember, juice shouldn’t replace eating apples, oranges, grapes and other fruits — which are an important and nutritious part of a child’s diet.

WPKeithley8884Dr. Keithley practices in MPCP’s  Arnold office. She received her medical degree from Drexel University College of Medicine, and completed her residency program in Family Practice at Chestnut Hill Hospital. She is certified by the American Board of Family Practice.

New Rules for Sunscreen

By: Lisa Keithley, M.D.

Starting this summer the Food & Drug Administration (FDA) has mandated new labeling rules for sunscreen products. These rules should help consumers better understand what’s actually in the product, and some of the limitations of sunscreen.

Since we know most skin cancers are related to sun exposure, and that the sun plays a role in premature skin aging, we must do more than just apply sunscreen. We should be avoiding the sun whenever possible during the hours of 10 a.m-2 p.m., and wearing protective clothing and hats. But sunscreen, worn daily, is a proven tool in helping us protect our skin.

Here’s what to look for:

  • The words “broad spectrum.” This means the sunscreen has been tested and proven to protect against both UVA & UVB rays.
  • Sun Protective Factor (SPF) of 30-50. The FDA is still testing products with an SPF above 50 to determine whether they are actually more effective, especially if people apply them less frequently. Those with an SPF lower than 15 must now carry a warning label that they will not protect against skin cancer.
  • “Water-resistance.” Sunscreens can no longer claim to be water or sweat proof, since all will wash off or become diluted over time. However, water resistance does help, and new labels must note a time limit of either 40 or 80 minutes before the sunscreen is ineffective. So, a new label may say: Broad spectrum SPF 30 water resistant (40 minutes)

Just as important as buying the right sunscreen is using it properly. It’s best to apply sunscreen 15 minutes before going out in the sun. And make sure to use enough- a golfball-size dollop- is a good visual. The FDA encourages the use of lotions over sprays since it’s harder to determine if enough spray is being applied, and sprays may not be as safe around the face. In general, reapply sunscreen at least every two hours, or more often if you’ve been in the water.

Remember that sunscreen should not be used at all on infants under 6 months of age, and that older children should be protected as much as possible from mid-day sun. Just one bad sunburn in childhood doubles the risk of melanoma later in life.

Lisa Goldberg Keithly, M.D.Dr. Keithley joined Maryland Primary Care Physicians, LLC in 2009 and is certified by the American Board of Family Practice. She received her medical degree from Drexel University College of Medicine in 1997 and completed her residency program in Family Practice at Chestnut Hill Hospital in 2000.