Should DCI have rules to protect kids from themselves?

[emtbill]

In many areas of the US, science is finding out that people are vitamin D deficient. What's the #1 way you get Vitamin D?... Sunlight.

Many doctors will tell you to slather on the sunscreen before going out in the sun. However, sunscreen is very effective at blocking vitamin D production (80-90%). There also seems to be a paradox: less sunshine or more sunscreen use actually has an increased melanoma (the dangerous cancer) rate. Whereas more sunlight or less sunscreen has an increased basal cell or squamous cell (less dangerous cancer) that can be removed.

(The way to know if you have an adequate vitamin D level is to get the blood test.)

Developing a tan means that you can be out in the sun longer, decrease your burn risk. However, the darker your skin, the longer you have to be in it to get adequate vitamin D.

There's always going to be risk, you can't take it all away.

My advice would be to expose skin to the sun without sunscreen for about a half hour, (longer if your skin is darker or more tan), then apply sunscreen, put on a shirt/hat. There is a smart way to do it.

Bill RN

Drum Corps Medical Project member

PS: a great book on this subject is The Vitamin D Solution by Dr. Michael Holick

[byline]

Because sunlight just started causing a risk for this? People have been getting exposed to sunlight since well.. forever. Not saying there might not be a link here, science shows it, but at the same time its not something that should be turned into the crisis of the week.

As someone who burns easily and is one of the skin groups at higher risk for skin cancer (fair skin, freckles easily), I have some experience with this. I was never one to sunbathe; I hated it it, got bored easily, started sweating and getting bitten by bugs and so just couldn't tolerate it for more than 15 minutes. My primary overexposure to sun was in drum corps and marching band from 1974 to 1980, then teaching color guard from 1981 to 1992. I got many bad sunburns during that time, and that is key. Sun overexposure is cumulative, and that cumulative effect seems to be a factor in how susceptible a person is to skin cancer. That's why there's so much emphasis on protecting people from sun overexposure prior to the age of 18. It's the cumulative effect that doctors are concerned about.

Starting a few years ago, I am now being treated for actinic keratosis, which is basically a precursor to skin cancer. When these small growths grow crusty or scaly, I either have them frozen off by my doctor or I treat them with Aldara, a topical cream. I will have to do this for the rest of my life and pray that I never get anything more serious, but the odds are not in my favor.

Do I think it should be a rule to wear T-shirts during rehearsal? Personally, yes I do. Hats and sunglasses too, to protect eyes from UV radiation.

Here's a "Health Focus" article I wrote a few years ago. It's long, but hopefully it will provide some useful information:

When it comes to skin cancer, remember one word: change.

“You're basically looking for any changes in the skin,” explains Bonnie Schnittker, public health nurse with the Leeds, Grenville and Lanark District Health Unit. Such changes include:

• smooth, shiny bump or crater
  
• solid-red raised bump
  
• sore that doesn't heal
  
• sore or bump that bleeds and develops a crust or scab
  
• pink, red or brown patches that often go rough and scaly, then become itchy or tender
  
• yellow-white or stretched change in the skin
  

“It could start at the site of a burn, injury or scar, but then all of the sudden it starts changing after it's healed,” Schnittker adds. “Basically it's anything that's new or different, or wasn't there before.”

People who have freckles, moles or age spots need to be on the lookout for the ABCDs of skin cancer: asymmetry, border irregularity, colour and diameter.

In addition to doing regular skin checks on their own, people should enlist their spouses or partners, hairdressers and massage therapists to look for changes on those parts of the body they can't see easily, such as the scalp and back, as well as the back of the neck, shoulders and legs. These “lookouts” are not in a position to diagnose, but they can alert people to changes in skin appearance and texture.

Often you can feel evidence of precancerous sun damage – called actinic or solar keratosis – even before you can see it. Tiny rough, raised patches may turn pink or red, accompanied by itching and peeling. Or you might feel some sensitivity when applying pressure to that area.

Any changes in skin appearance and texture – whether that be a new growth or change to an existing freckle, mole or age spot – raise a red flag, especially if they do not heal. Such changes warrant a visit with your doctor. They may signal something other than cancer, but they still need to be followed up.

The Canadian Dermatology Association describes the three types of skin cancer:

• Basal cell – most common, less dangerous although the cancer continues to grow, causing disfigurement; most commonly found on face and neck; can look red, scabby, like a sore that doesn’t heal.
  
• Squamous cell – second most common form, must be removed because lesions continue to grow and damage the surrounding tissue; they may grow quickly and look like a wart, scaly, open sore, crusted skin; appears on sun-exposed areas: neck, arm, back of hand and leg.
  
• Melanoma – less common, very dangerous if left untreated; it invades other skin, reaches the bloodstream or lymph system and spreads to other parts of the body.
  

Skin cancer often takes a long time to develop, Schnittker notes, which is why it's highly treatable if caught early. The problem is that some people wait too long, and the consequences may be dire.

The Canadian Cancer Society estimates the number of non-melanoma skin cancers in 2008 at 73,000 cases, with 260 deaths resulting from non-melanomas. For melanoma, the estimate is 4,600 cases … and 910 deaths.

Skin cancer is easily preventable. People who protect themselves from overexposure to ultraviolet (UV) radiation see their chances of developing skin cancer dramatically reduced. But because North Americans prize glowing, bronzed tans – with sunburn and other types of sun damage being an inevitable result – skin cancer is the price we pay.

“Skin damage (from UV radiation) is cumulative,” Schnittker says. “For each sunburn before the age of 18, that doubles your risk of developing skin cancers.”

The earlier in life one starts, the greater the risk. Even one severe, blistering sunburn as a child or teenager greatly increases the risk of developing skin cancer as an adult. That's why it is so important to protect children from sun overexposure.

It's also why teens need to understand that getting a tan or sunburn – whether that be outdoors or using artificial UV sources like tanning booths or sun lamps – is not a wise choice.

People with the greatest risk of developing skin cancer are fair-skinned individuals, those who sunburn easily or have moles, and those with a history of sunburn.

Areas of the body that receive the most exposure to UV rays are where skin cancers most often develop: face (especially the nose), neck, shoulders, arms, hands and legs. Areas which are often overlooked, but are susceptible to UV damage, include the top of the head, top of the ears, back of the neck and back of the legs.

The easiest way to protect yourself from skin cancer is to avoid overexposure to UV radiation. Prevent overexposure by avoiding peak UV periods. In eastern Ontario, this runs from late April or early May to late October, from about 11 a.m. to 4 p.m. daily.

If you must go out during those periods, apply a chemical sunscreen or sunblock (don’t forget your lips and ears), and also wear physical barriers to the sun such as a wide-brimmed hat, sunglasses and clothing to cover the body. And seek shaded areas whenever possible.

Sunburn isn't the only type of skin damage to worry about. Different types of UV radiation include UVA and UVB. UVA rays don't cause sunburn; they prematurely age and wrinkle the skin. They are also dangerous because they are more likely to damage the melanocytes, potentially leading to melanoma. UVB rays are the burning rays which can damage skin cell DNA. So check that your sunscreen product protects against both UV types.

This past summer, Environment Canada predicted that UV radiation levels were about four per cent higher than pre-1980 levels, due to the thinning of the ozone layer. Environment Canada and the Weather Network issue UV forecasts as part of their daily weather forecasts. These UV forecasts show peak UV periods, as well as the UV reading for that day, so that people can plan accordingly.

A reading of three or above means that people should take steps to protect their skin. The higher the reading, the greater the precautions needed.

Finally, keep in mind that there is no such thing as a “safe” tan. Tanning is nothing more than sun damage caused by your skin's attempt to protect itself from further damage by adding colour. Melanin – increased skin pigment – produces this darkening of the skin. But it is still sun damage, and that damage is cumulative.

And that old chestnut about getting a tan to protect yourself from sunburn doesn’t really work, as the sun protection factor (SPF) produced by the extra melanin in tanned skin is only about two to four, well below the minimum recommended SPF of 15.

People often wonder why a tan, something that looks so healthy, can do so much damage. “We refer to it as ultraviolet radiation, which is exactly what it is,” Schnittker says. “And when you say it that way – 'What do you mean, radiation?' – then maybe the terminology will help people to see it for what it is.”

[CuriousMe]

For those who think DCI should legislate mandatory shirts while practicing.....do you also think that the government should mandate wearing shirts when out and about in the summer?

If it's age that is different, should the law state that everyone under the age of 21 be mandated to wear a shirt while outside in the summer?

If not, why? Drum corps members are not the only people under 21 who spend their summers out in the sun all day.

Where does this end? Should DCI mandate that each corps member eat a certain number of services of vegetables each day? We know there's risk if there's not enough fruits & veggies eaten....where does it end?

I feel that as adults, we have two jobs. Educate the members on what's important and why, and model that behavior. We're not talking about 6 year-olds here. How on earth will members learn how to make decisions if they're all legislated for them?

[soccerguy315]

The only requirement that DCI has for rehearsals is that performers are required to wear a head covering, because heat stoke and dehydration is a little more relevant than the long-term possibility of skin cancer.

is this true? Do you have a link to this rule?

I know this was required in my corps, but I was not aware it was a DCI rule.

[Tricia-A BD/BK Mom]

My kids have red hair, freckles and snow white skin. I wish there were a rule that they had to wear tee-shirts. Back in the dinosaur days when I was a kid I wore a tee-shirt and I was from So Cal, it was embarrassing but the sunburns and blisters I got were horrible. This was before sunscreen and the knowledge of skin cancer. I have to see the doctor every year now as a result of those times I did get burned. Every year something has to be burned off, I wish my kids would learn by my example.

I have tried to instill to my kids the importance of wearing a tee-shirt but as was the case when I was a kid there is peer pressure. Not so much pressure just the “everyone else does it” mentality. I know they do wear sunscreen but I don't believe it goes far enough to protect the skin. I am glad this question has been raised and I personally wish it were a rule.

It is hard for color guard to wear hats for protection but my daughter does wear a bandana on her forehead. She still wears a bathing suit top and thinks the burn will turn to tan, it doesn’t. Same thing with my son, I don’t know what makes them think one good sunburn makes everything all right. I have done my job trying to preach to them but they are kids/adults so sometimes things like this go to deaf ears.

[HockeyDad]

Of course it's an issue that members should be aware of (something that parents can influence before members leave on tour). However, let's not make the risk more than research is currently telling us.

When you marched, I'm guessing you stopped wearing sunscreen as the season went on because once you tanned...you didn't receive a serious burn from rehearsal, because you were tanned...there's not the same concern with that. The research I've read shows correlations between folks who had bad burns as a kid and an increase in skin cancer rates......not tans.

Actually, the research is telling us that a tan IS a sign of skin damage. Skin cells that have been damaged by UV radiation produce more of the pigment melanin and that is what produces the tan.

So if you think you're protected because you've developed a tan....that's not correct.

[emtbill]

Actually, the research is telling us that a tan IS a sign of skin damage. Skin cells that have been damaged by UV radiation produce more of the pigment melanin and that is what produces the tan.

So if you think you're protected because you've developed a tan....that's not correct.

So the thousands of years that humans have been around and not had sunscreen.....?

Melanin production is natural response to sunlight exposure produced by melanocytes in the skin to help prevent sunburn. Fair-skinned people produce less melanin, while darker-skin people tend to have more.

Many things don't grow well without sunlight, including humans.

[treadstone]

Drum Corps is often a very contradictory environment regarding members. Corps and staff who claim to go to lengths to look out for the members quickly abandon caution if it gets in the way of day-to-day operations and/or is unpopular with members. It is very likely only a matter of time until some individual who ends up having a medically catastrophic situation decides to sue and drum corps and/or DCI. Of course, many groups have "hold harmless" language in member agreements/contracts, but such is often impotent when a case is brought before civil court.

Another area is the way in which members are treated when they are ill or injured. There are select staff members who tend to pressure ill and injured members into training contrary to what is best for the welfare of the member. This happens with sprains, tendinitis, concussions, upper-respiratory and other conditions. There is also very little trust given members by staff when the member shares that they are having issues. Ironically the staff themselves are quick to want understanding from the corps director when THEY have issues. Of course, there are members who "bluff" about their physical condition, and those members end up making it hard for many others.

I am sure there have been civil suits that no one has heard about - yet it is really only a matter of time until such a situation becomes infamous and hurts an entire corps and DCI.

Jason

[danielray]

Over the past 25 years or so, it seems the activity has made quite a bit of progress in terms of health and safety.

Emphasis seems to have been placed on improving transportation safety, food safety and quality, and things like physical conditioning.

These changes seems to have developed and driven in a sort of self-regulatory way, and each address aspects of the activity that affect all participants.

Regarding protection from sun exposure, corps should and do have guidelines in place for the purpose of preventing things like dehydration and hyperthermia, as these have the potential to affect each individual participant. As the risk of skin cancer is not equal among participants, and is based primarily on genetic factors, it should be addressed in a more individual way.

Maybe a productive turn in this discussion could be brainstorm some ideas in which various individual risks or conditions that individual participants may be more effectively addressed?

I don't necessarily see the individual organizations or DCI as having the responsibility of regulating the personal habits of individual participants, but I do think each could play a role in helping to educate individuals that have potential risk factors for various serious conditions, and give them guidance on how to self-manage their risk.

I do think that DCI has been doing quite a bit of this already, through their medical project, so, I think much of that information is already there.

One thought that this thread really brings up is that there really isn't a consolidated resource dedicated to current or potential parents of participants that provides more insight into various aspects of the activity, the ability to ask questions, or share knowledge and information. Getting parents over that hurdle of trust (both trusting the activity/organizations with the responsibility of their child, and trusting their child with the responsibility of themselves) is a pretty big deal. If this was done in a more effective way, I imagine there would even be an increased number of participants... as this is a barrier to participation for a lot of kids.

Maybe this could be done with a sort of community that is similar to this one, but is limited only to parents, administrative staff of the various organizations and contributors they select?

Maybe a similar type of channel can be set up for current and former participants that have specific types of risks to be able to seek out others that are similar and share experiences, tips, encouragement, etc.?

One other point that was brought up regarding corps that generally have younger members vs. those with older members. It seems that many corps already do have different levels/forms of guidance from or engagement with educational, administrative and volunteer staff, based on the age range of participants.

It could be an interesting and potentially helpful resource to compile the average ages of various organizations along with their individual policies and philosophy of staff engagement so that parents might be able to compare to see which organizations may be the best fit for their child from this perspective.

[HockeyDad]

So the thousands of years that humans have been around and not had sunscreen.....?

Melanin production is natural response to sunlight exposure produced by melanocytes in the skin to help prevent sunburn. Fair-skinned people produce less melanin, while darker-skin people tend to have more.

Many things don't grow well without sunlight, including humans.

In the thousands of years, the ozone layer was not as under attack as it has been in the last several decades. Also, and how can I say this delicately, people had the good sense to not be out in the mid-day sun or in the sun all day, every day, all summer. Exceptions being mad dogs and Englishmen I suppose.

A pint of water is good for you. 10 gallons at once is not. For you to say that being in the sun is all good because you get Vitamin D uptake is kind of irresponsible IMO. But, you are entitled to your views. I wouldn't recommend being in the sun all day without the maximum protection you can get (a white tee shirt and hat and sunscreen) to anyone. But as has been stated so many times, these kids are all growed up and can do what they want. Except drink alcohol. Wait, that's the nanny state intruding AGAIN.