Is That Plant Dangerous? with Christopher Bazzoli, MD

Podcast Transcript

John Horton:

Hello, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

Have you ever been hiking in the woods, seen some berries or mushrooms and wondered, “Can I eat that?” Or maybe it's hours later, and all of a sudden you start feeling a little itchy. That's when you discover a rash on your arms or legs … or someplace worse. “What,” you wonder, “caused that?!”

Nature is full of surprises, which is why it's important to be armed with some knowledge before you start wandering around. There's beauty in the natural world, but there are also plenty of dangers. To help guide us safely through, we're joined today by Chris Bazzoli, an ER doc and wilderness medicine specialist. He's one of the many experts at Cleveland Clinic who stop by the podcast every week to share their wisdom. So with that, let's lace up those hiking boots and go exploring with Dr. Bazzoli. Welcome back to the podcast, Dr. Bazzoli. I always look forward to our chats.

Dr. Chris Bazzoli:

Thanks, John, me, too — thanks for having me back — I appreciate you.

John Horton:

Before we jump into our topic, Dr. Bazzoli, I'd like to talk about you for a minute. The last time you were on and we were talking about ticks, we didn't really have time to get into this, but I didn't want to miss this opportunity again, and that's just talking about your background. And I know your resume includes listings as a Fellow of the Academy of Wilderness Medicine and a Diplomat in Mountain Medicine. Those are next-level cool titles. And I'm guessing you kind of have some stories to tell from your work in that. If you could just share a little bit about what you do in that role.

Dr. Chris Bazzoli:

Yeah, thanks so much. My gateway into medicine was actually a wilderness EMT course just outside of Yosemite during a summer in college, because one of my friends, who was a few years older, had really spoken so highly of it. And I wasn't really sure at the time kind of what I wanted to do. That opened the doors. I worked as an EMT, decided to pursue medicine, and especially emergency medicine. Super grateful and lucky to have awesome mentors along the way, especially Rich Ingebretsen out at the University of Utah, a tip of the hat to him for bringing me in as a young undergraduate. And then, medical student, beginning my career in wilderness medicine, and teaching, developing curricula, and then training, a lot of training. Trained in-

John Horton:

…and you go on rescue stuff, too, right?

Dr. Chris Bazzoli:

Yeah, yeah. So I trained as an emergency medicine physician, and then pursued my fellowship in the Academy of Wilderness Medicine. My diploma in mountain medicine training was building up, working with search and rescue teams, kind of in the mountain setting. And coming back to Ohio after spending a brief stint in Colorado, becoming more involved here with our search and rescue teams, our technical rescue teams. I'm really grateful that the guys and gals allow me to join them out in the field. And I have the great joy and responsibility of helping keep them healthy and performing at the top of their game. And then, providing really great medical care to patients in really bad places. So kind of, our tagline is “Always providing great medicine in wild places and bad spaces.”

John Horton:

That stuff is just so cool. And it sounds just like an adventure in medicine, I guess. And all of that exciting stuff we just talked about — and I have to say, our topics today, not going to be that dramatic, but they are very important. So let's start with eating things that you might find while you're just kind of out in the woods. And kind of this concept of foraging for fun caught fire during the pandemic, and it really hasn't cooled down. But as we've learned, or as we see from headlines, this kind of natural way of eating isn't always safe. What kind of worries do we have if we just start nibbling as we're walking through the woods?

Dr. Chris Bazzoli:

Absolutely. And I really appreciate people trying to reconnect with our land and reconnect with our food sources and their health. And so I absolutely commend that. And we're learning a lot more about this aspect of environmental overlap with health. And as we bring climate into it and our food, we are essentially what we eat, right? It sounds cliché, but it is true.

John Horton:

I feel like there's a big “but” coming up here.

Dr. Chris Bazzoli:

But we got-

John Horton:

…leading us in gently.

Dr. Chris Bazzoli:

…yes, yes. But we got to do this safely, please. Trust me, I grew up in a very rural area. I mean, we picked a lot of blackberries from alongside the railroad track. Probably with what I know now, probably wouldn't have eaten those berries as much. We have to think about a lot of factors. So next to a railroad track or next to a highway or roadway, all of the dust and the exhaust and fumes settle on anything that we may pick and eat.

So even our foods that we pick out of the garden, really important to wash them and rinse them off before eating them to reduce soil that may contain some amount of lead. So long story short, there's just a lot of considerations. And when we talk about foraging, going out into nature, mushroom picking, it's really important that this is a skill that requires mentorship. This isn't something that we should learn off TikTok.

John Horton:

That's what a lot of people I think do when they start on that.

Dr. Chris Bazzoli:

Right. And the internet and TikTok and social media is really a cool way to get curious and learn new things. But then, when we're talking about taking a skill and applying it actually to our lives, we should really do that with mentorship. And the internet is also great for that. You can Google meetups, and there are mushroom hunting groups and foraging groups that get together, and then go out and will teach you for your region and the time of year, what is safe, what is not safe, and what you absolutely need to avoid. There's a saying among the mushroom hunters that there are old mushroom hunters and there are bold mushroom hunters, but there are no old bold mushroom hunters.

John Horton:

That's a great saying.

Dr. Chris Bazzoli:

So we can certainly do this safely. But if you are ever questioning, “I'm not sure if I can eat this, let me look it up.” The answer to that is no, you should not eat that.

John Horton:

Yeah. And I know you've talked before, when you look at a mushroom, I mean two mushrooms can look very similar. So if you're just going off of an app, it's a little tough-

Dr. Chris Bazzoli:

…not enough.

John Horton:

...sometimes to make that call. You do need that field experience, like you said, with somebody who's a mentor who's done it before, who knows how to do it safely, who can really break down what you need to look for.

Dr. Chris Bazzoli:

Yeah. What you need to look for in that season, in that region. I mean, I don't know if you saw in the news, just early this year, the West has had a much milder winter. And so a lot of good conditions for mushroom growth, kind of being cool and wet as opposed to a lot of really cold snow. And a lot of mushroom poisoning because travelers and people maybe not native to that area recognize a mushroom, and they say, "Oh, that's exactly like that mushroom from my home country," or "from my home region, just six, seven states away." Pick it, and, unfortunately, in that region, it's a different mushroom. And it's not safe to eat, and really causing a lot of … could be potentially fatal, right?

John Horton:

Well, I was going to ask that. How serious can it be? I mean, we're not just talking, you're going to get a rumbly tummy. I mean, these could be pretty dire results that you get?

Dr. Chris Bazzoli:

Correct. And it's really funny, too, the mushroom pickers are like, "Well, if you do it smart, it's OK.” But foraging, there's just too many plants that you could go wrong. And the foragers say, like, "Oh no, you can do this safely.” But there's too many mushrooms where you can really go wrong. Mushrooms, berries, leaves even, certainly can be toxic to causing liver failure, especially, we see in the mushroom. With a lot of the berries and eating plants can cause a lot of GI toxicity, GI tract toxicity, and even like renal failure. So any of these edibles growing in the wild can have, if eating the incorrect one, if eating a poisonous lookalike, can have dire consequences, even fatal consequences.

John Horton:

Hey, I watched Hunger Games. I know you got to watch what you pick out there and what you grab. Is there a surefire way to tell whether something's safe or not, or is it really, it's just specific to each plant?

Dr. Chris Bazzoli:

It's really specific to each plant in that season, in that region. And this is why it's so important to do that in a mentored and progressive way with other humans. Not safe enough to do as a self-study.

John Horton:

Yeah. Well, it sounds like if you're wrong, I mean, you could be really wrong, and not get a chance to try again.

Dr. Chris Bazzoli:

And we really don't have great antidotes. Unfortunately, we haven't quite reached a Star Trek medicine-level yet. And so a lot of these cases are really difficult for the medical community as well. Because we're really just providing kind of supportive system care with no clear fix, and watching the damage take its toll.

John Horton:

Now, we've kind of been talking a little bit like you're out kind of for fun, you're out for a hike. And, like I said, we've all been in that spot where you see some berries, and you're like, "That looks like a blackberry. I should be able to eat that." If you're in an emergency situation out in nature, you're somehow stranded or things like that, I think you start worrying, like, you've got to eat. Do you really? I mean, is it that dire that you got to start just foraging for food to kind of get you through?

Dr. Chris Bazzoli:

No. For a survival standpoint, food and calorie consumption is certainly not one of the most immediate concerns. Shelter, warmth, water are the three main immediate kinds of concerns over those first couple of days that are crucial. Really, not starting to worry about starvation for week to many weeks.

John Horton:

Yeah. Being “hangry” is not an emergency medical concern. Is that I think what I'm hearing?

Dr. Chris Bazzoli:

Yes. I would love to print that on a sign. But yes, in a survival situation, making sure that you can stay warm enough, that you're sheltered enough from the elements. And then water. We can't live without water very long. So especially dependent on the environment, finding a fresh source of water, or the least dangerous source of water that we can utilize.

John Horton:

Yeah. Well, speaking of water then, what should you look for? If you are out and you are in one of these sorts of emergency situations, where is it safe to maybe stick your canteen or take a sip, and where should you really be a little leery?

Dr. Chris Bazzoli:

Yeah. And again, I should preface, this is only in a dire situation. Luckily, a lot of the illnesses that we can contract from contaminated water, modern medicine can more effectively treat on the back end. So if you're stuck in the wilderness several days trying to make your way out, and you're between like, “Hey, do I die of dehydration or do I drink some of this creek water?” Drink some of the creek water, make it out alive, and we can treat you on the back end.

What you're looking for is really, kind of, most of it is good sense. You're looking for the cleanest, clearest thing you can find that is moving. Stagnant water is going to be much more dangerous. Obviously, if it has a lot of sediment and contaminant visibly, that's going to be more dangerous. You got to be thinking about what is up canyon or upstream from your water source. If this creek is draining from a pasture, probably not your best option. But also, if you're next to a pasture, you probably-

John Horton:

…you should be by civilization, too.

Dr. Chris Bazzoli:

...[inaudible 00:13:33] your way out.

John Horton:

There's cows.

Dr. Chris Bazzoli:

There's cows.

John Horton:

Follow the cows home.

Dr. Chris Bazzoli:

Springs, oftentimes, are a pretty good source because it's filtering through at least some amount of a geological layer that is serving as a filter. And so usually coming out running and pretty clear, and less chance of pathogen there.

John Horton:

I love that advice you gave, though. If you are stranded in one of those emergency situations, like the things you read about, where people are stranded for a couple of days, focus on getting the water in. But the eating, it sounds like if you eat the wrong thing, it can be game over right then. So you really want to minimize that, but just make sure you're staying hydrated, as you keep hoping for a rescue or finding your way out.

Dr. Chris Bazzoli:

Absolutely. You eat the wrong thing, start getting sick, that just accelerates the whole dehydration process. It's taking mental energy. It's sapping you kind of psychologically as well, which we know is so important in survival. And so stick to the basics. And then, as always, we want to hopefully prevent anybody from getting into a dire or survival situation.

John Horton:

Yeah. And ideally, we don't. So that would be the best thing. But we wanted to make sure we kind of touched on it a little bit as we're talking about eating in nature, because you could have different needs at different times depending on the circumstances. But if you're not munching your way through the forest, I know there's still some reason for caution, and that can even be with the sort of vegetation that you're brushing up against. It sounds like there's a lot out there we can kind of run into that can cause us problems.

Dr. Chris Bazzoli:

So poison ivy, especially in our area, and throughout much of the U.S. Stinging nettles, not fun, poison sumac.

John Horton:

Doesn't sound fun. Stinging nettles sounds like it delivers on exactly what it's going to promise.

Dr. Chris Bazzoli:

Exactly, exactly. Cruise along in a tee shirt and shorts, and all of a sudden, not so fun. So again, it comes back to … we've talked a little bit about, mentioned this before, too, kind of “know before you go,” especially if you're traveling to a new area. Planning your trip is so important, and planning your activities. Speak with rangers, speak with people who are local. They're a wealth of information, and usually welcoming travelers and helping you have a fun and safe adventure in the woods.

John Horton:

Yeah. With most of these plants that you can run into issues with if you come in contact with them, are we pretty much just talking kind of rashes and just some discomfort?

Dr. Chris Bazzoli:

Yeah. For the vast majority, stinging nettles, poison ivy, poison sumac, et cetera, these are going to be, for the vast majority of people, discomfort. Localized reactions. Poison ivy, for instance, this is an urushiol oil that is on the plant, the leaf surface. And so it's extremely sticky and easy to transmit, and your body is then having an allergic reaction, a localized allergic reaction to that basically toxic oil. And so similar to, like we were talking about ticks, just when you come inside, or if you're staying outside, making sure to check areas and wash. So we can wash off these oils.

If you brush against stinging nettles, trying to remove those barbs as soon as possible to help limit the contact time to your skin and your body's immune system. That'll decrease then the immune system's response, and the essentially localized allergic responses, giving us this really itchy rash, et cetera.

John Horton:

Yeah. Well, so much stuff I want to talk about, just with everything you just mentioned. With the nettles, you said taking those out. Is there a trick to doing that or what's the best way then to remove those?

Dr. Chris Bazzoli:

Yeah, this is where TikTok does start to get helpful, and the internet. There's lots of different techniques. Essentially, just best thing is something very sticky. Duct tape works great. You just have to be mindful of the way that the barbs are predominantly entering in and kind of pulling with them as opposed to against them. Kind of almost like if you ever run your hand against suede, putting your hand across it one way is nice and smooth, the other way is really against a lot of friction. So try to get that adhesive down and then pull in the smooth direction.

John Horton:

Good tips there. And then, we'll make sure we get our phone out and kind of look up those handy-dandy videos. With poison ivy, it seems like the biggest thing is just knowing when you see it. And luckily, I think we probably all know that cool little rhyme that comes with that.

Dr. Chris Bazzoli:

Leaves of three, let it be, right?

John Horton:

It's kind of ingrained in our heads now. So is that as easy as it is? If you see those kinds of leaves of three, and that could also be for poison oak, too, right? Isn't that the same sort of setup?

Dr. Chris Bazzoli:

Yeah. Poison oak is a little bit different shape of a leaf and coloration. It almost looks like a bit of an oak leaf. But typically, also in threes. The poison ivy is basically always in threes. Poison sumac starts to get more complicated with varying numbers of leaves. This is where an identification app, something like iNaturalist, or another similar app, can be helpful in identifying these because it's not life or death that we're eating.

John Horton:

Yeah, yeah. And with poison ivy, too, I always remember it's usually like a little bit shinier. And so those leaves of three, it's a little bit shinier, and that's just kind of a stay away from it if you see that.

Dr. Chris Bazzoli:

Yeah. Typically, green leaves, a little bit of shine because, again, it's that oil. And then, you'll see a little bit of redness coming into the stem and the stalk. Just takes some practice in seeing it and looking for it and seeing it and looking for it, yeah.

John Horton:

I'd say I'm one of those lucky people, or at least I always was growing up, I never used to get poison ivy. And I worked for a landscaper, I used to pick it where other people would come across it. Because they'd like, "I get hives," their rash is like crazy. It never used to bug me for some reason.

Dr. Chris Bazzoli:

Yeah. There's about 15 to 20% of the population who does not react to the urushiol oil of these poisonous leaves. The vast majority of people, 50 to 70%, we do react. And that's a delayed reaction. We call that like a delayed hypersensitivity reaction. And so that's what makes it kind of difficult for us to learn as humans, is because we come in contact with this leaf, and then we really don't get the effects for another day. And it's hard to put the two together.

That's why if you've been out in the woods, and even at a portion, you say, like, "Oh man, I was really close to some poison ivy or what I think might have been poison ivy," and you have exposed legs or arms, gosh, when you get home, just take the time to wash off. Good soap, any good soap. If you really want to get tricky with it, Dawn™ dish soap is really good. Just washing all of that oil off.

If you know that you've really come into contact or have a high suspicion, or you're that 15 or so percent of the population that reacts more vigorously, then definitely washing with a stronger soap. There's a couple of soaps out there that auto mechanics use. You may have heard of like Goop™ or something like that. And these are soaps that have resin binders to oil, and they work really well for getting grease off of a mechanic's hands or an industrial worker's hand. But they're also really great at binding this urushiol oil to remove it as much of it as possible after you come inside.

John Horton:

If you do that right away, I mean, are your odds of getting that rash, do they just drop significantly?

Dr. Chris Bazzoli:

Yeah, vastly. If we can wash this off within a matter of hours, a couple of hours, your chances of actually getting poison ivy are very, very low. Now, if you know that you are somebody who does react more strongly, there are some barrier creams which can provide perhaps four to six hours of protection. But really, the best prevention is an actual barrier of clothing. The problem is, is if it's 100 degrees out, and you got to be outside, it's hard to wear long pants, long shirt. And so we recognize that you got to balance there and try your best to do that safely.

John Horton:

Yeah. Now, if you didn't follow that advice you just gave, which was washing as soon as you came in, and then it is a couple hours later and you start getting that rash and you start itching, what can you kind of do for treatment? What are the best things you can try?

Dr. Chris Bazzoli:

Yeah. So if you start to develop what we call contact dermatitis, that rash, you may start to notice some kind of fluid-filled bubbles forming. Leave those alone. Please don't pop those. If they do open on their own, they do not contain any more of the oil. Nothing in that fluid is contagious or transferable. You don't have to worry about that.

But as a rash develops, generally recommend that you go ahead and wash that area again, just to make sure that you did remove all of the oil, especially if this is like an extended backpacking trip, or you were working in the yard last night, and you came inside and didn't have a chance to shower, and now it's the morning and you're starting to get ... make sure you wash that again really well.

And then, you're just trying to keep it protected and covered. There are some products, like I'm sure from when we were kids, like calamine lotion can help reduce some of the itching. Aloe is actually really effective, both cooling, and so it feels good, but it's also a topical anti-inflammatory, and so helps to reduce some of your body's reaction there. Systemic antihistamines can also help to reduce how much of a rash that you're going to develop and also how bad it itches.

John Horton:

Talk about those basics, the pills that we all know, Allegra™, Claritin™, Zyrtec™, right?

Dr. Chris Bazzoli:

Zyrtec. Yep. Those are perfect. And those are actually better. Those are second-generation antihistamines. A lot of people think Benadryl™, and like, “Oh, that was the original, so I'll take that.” It makes you really drowsy, and a lot of people don't tolerate it well. The Zyrtec, Allegra, Claritin, those are all second-generation, non-drowsy, and they're just as effective at reducing this itching and reaction.

John Horton:

What about, I think oatmeal baths were always a thing. Does that work, or was that just kind of a ploy by the oatmeal industry to get some product out there?

Dr. Chris Bazzoli:

Yeah, I'm not aware of any data showing that the oatmeal bath is more effective. But again, here, we're doing symptomatic, in the vast majority of cases, supportive care. So if that feels good, that's fine. But you're certainly not reducing, or you're not removing, any oils that may still be retained on the skin with oatmeal baths. And it's certainly not as good of an anti-inflammatory as aloe.

John Horton:

Is there a point where you should go in and see a doc and maybe you can get a little something extra?

Dr. Chris Bazzoli:

So we try to avoid the easy answer, say, “Oh, I have a rash and this is annoying. So maybe the doc can put me on steroids.” Unfortunately, for the type of allergic reaction that these poison ivy, poison sumac, poison oak are, it requires, really, a three-week steroid course.

John Horton:

Wow. I didn't-

Dr. Chris Bazzoli:

…it's not insignificant. If we only give you five days of steroids, you're going to start to feel better, and then it's going to rebound, potentially slightly worse than it was initially. And so for the vast majority of people, we go, "Man, I'm really sorry. Take the antihistamine, use topical aloe or a lotion to feel better. Keep this covered. And it's just going to be itchy for a few days."

John Horton:

No, I was going to say, and it sounds like you just need to be more careful the next time you're outside.

Dr. Chris Bazzoli:

Yeah, yeah. And just, really, being good about, hey, if I was potentially in a contact area, as soon as I come in, really wash exposed areas of skin and wherever we may have touched. Because if we're touching or working with our hands, and we touch and get the oil on our hands, and now, we touch the back of our neck, we can deposit the oil there. So being better about washing.

Now, there is 15% of the population or so who react much more vigorously, potentially up to the point of anaphylaxis, so being like a severe systemic reaction. So those people, their immune system, that is actually going into overdrive, and they're not just reacting locally where the oil was, but it's setting off the whole body's immune system. And so they're getting rash breaking out everywhere, potentially with difficulty breathing, GI upset, either vomiting or diarrhea. And those more disseminated signs and symptoms, absolutely a reason to see a doctor, head to the emergency department. Oftentimes, need things like fluids. And those people, we're certainly putting on that long course of steroids.

John Horton:

Yeah. I did not realize that it could get that bad. So it sounds like, yeah, anytime you have trouble breathing, any of those issues, you definitely need to get in and see somebody.

Dr. Chris Bazzoli:

Absolutely.

John Horton:

So I think we've covered a lot of the plants you want to avoid out there. But any big ones that we missed, or I don't know, what else is lurking out there?

Dr. Chris Bazzoli:

No, I think we've covered most of the heavy hitters. Thanks so much for asking great questions on foraging and our poisonous plants out there. I just always like to circle back and say that spending time outdoors is really important for us — our physical health, our mental health and well-being. And again, with a little bit of thought ahead of time, we can really do this safely.

I always reference my colleagues at the Park Service, they put together a lot of really great information, their whole “know before you go set up.” And actually, you can search on the internet, National Park Service trip planning. They have a really great guide, even just for day trips to week-long trips, traveling across the country, or just your local state parks or a national park near you. A lot of really great things to think about ahead of time. Safety and preparation don't always get the glory.

John Horton:

It's a good way to go, man. You just got to plan a little bit in advance because I'm guessing that you're not available to come with us on every hike.

Dr. Chris Bazzoli:

I'm unfortunately not. I would love to come hiking with you. But you can be the hero of your family with a little bit of planning and prevention, and everybody coming back safe, happy, healthy, having had a great time as opposed to, man, dealing with a couple of kids with a rash and illness. So “know before you go,” and a little bit of prep can go a long way to have a great time.

John Horton:

All right. Well, you gave us some great advice. And I think with that, we should all be able to get home safely. So thanks again for coming in, and I can't wait to have you back on, Dr. Bazzoli.

Dr. Chris Bazzoli:

Thanks, John. I appreciate you.

John Horton:

Nature is filled with wonders, but it pays to be careful out there. Be extremely cautious if you're foraging for potential food, and watch where you're walking, too, as some plants may leave a reminder of any encounters. Bottom line: enjoy the scenery with your eyes and maybe keep your hands to yourself.

If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.