Holiday Greetings

Just a quick but heartfelt message here: I hope your Christmas was the merriest and brightest, and your New Year is the best ever!

Cold Tolerance

This question crosses my screen fairly often: Is it possible to increase your tolerance for cold? This is really two questions. If you're wondering if individuals can "feel" cold less if they are acclimatized to cold, the answer is a big YES. People who spend a lot of time outside in the cold definitely feel the stress of cold less, so they tolerate cold better. If you're wondering if you can become more resistant to frostbite and hypothermia, the answer is probably no. Eskimos, for instance, who spend much of their lives in extremes of cold, and who are very tolerate of cold, can freeze just as fast as those who spend most of their lives in Figi. I say "probably no" because there does exist a small but growing body of evidence suggesting some people can become more resistant to cold injury. If it becomes fact that some people are more resistant to cold injury, the fact will likely remain academic, not much use to most outdoor enthusiasts. This remains a fact: people who avoid frostbite and hypothermia know how to dress and act properly in the cold outdoors.

Of Little Broken Arms

Bo, my five-year old daughter, held her left arm tightly to her chest, refusing to let me see it, while she wailed with pain. Assessment point one: guarding. When she calmed down enough for a gentle palpation, I found point tenderness just below the elbow, and that was assessment point two. And point three: there was a little swelling at the site. I took her to the hospital where an X-ray revealed fractures to both radius and ulna, and now she wears a bright pink cast immobilizing her arm from mid-humerus to fingers. Signed by her classmates in kindergarten, she bears it proudly, something like a pink badge of courage. The mechanism was landing on her outstretched arm while bouncing on a neighbor's trampoline, and she was added to a long list. During a recent six-year period, the number of children injured on trampolines has doubled. The number has reached to more than 60,000. For more trampoline stats, check out www.sciencedaily.com. Based on the stats, some experts are calling for a ban on the devices.

Back To It

Hard to believe, it is, that almost a month has zipped past--and I apologize for being away so long (just in case anyone is reading this). Here is part of my excuse: picking up Bo, my littlest and youngest daughter, pain shot through my lower back. I could walk, hunched over, and it felt better to sit still. No pain radiated down either leg. My self-assessment: pulled muscle. And I was correct, I learned, after a visit to the doc. Cold packs were indicated, and they helped, as did gentle stretches from a seated position. The doc recommended putting one ankle on the opposite knee and leaning forward slowly for the stretch. I now recommend the same stretch for easing tension in the lumbar region. Two chiropractic adjustments have been worth the time. Sleeping has been easiest on my side. Despite my preference for sitting still, slow walks have helped circulation and, therefore, healing. But it remains important to forego any lifting and toting. After a week, life has become much better--though stiffness and some soreness nag. If this happened on the trail, I'd do the same thing . . . excepting, of course, the chiropractor.

Naked or Not

With the temps decreasing, the questions concerning sleeping warm are on the rise. Lately, this has been the most common one: Should I sleep naked in my bag or in clothes? As with so much in life, no answer addresses all situations. If your sleeping bag contains adequate insulation for the temperature, and if your bag contains the proper amount of room inside for you, most people sleep better, and warmer, in long underwear or at least a layer of light clothing--and your bag stays cleaner. What you never want to do is dress in extra layers that compress your bag's insulation. You need the dead air created by insulation to hold in your body's heat. If you have a roomy bag, you can safely sleep in extra layers for extra warmth. If you find yourself in a chilly bag without extra room, you might sleep warmer naked. You won't know for sure without experimentation.

MI and Aspirin

Kate, one of my students at Central Wyoming College (www.cwc.edu), asked in class about the dose of aspirin to give someone who might be experiencing a myocardial infarction (MI). Aspirin, a great drug that's been available over-the-counter since 1897, is certainly recommended when you're thinking, hey, this could be a heart attack. The "blood-thinning" properties of the drug tend to improve the outcome for the patient. Yes, the dose has changed over the years, and remains somewhat controversial, but most experts currently recommend 3-4 baby aspirin (each containing 81 mg) or one adult aspirin (with 325 mg). The aspirin gets to work a bit quicker if the tablets can be chewed before being swallowed with a swig of water. Then keep the patient physically and emotionally at rest until help can be found for an evacuation. If evacuation is delayed into additional days, each day should include more aspirin, once a day, at the same dose.

One-Ten-One

More than a foot of snow fell on Lander during the past week. It's that time of year when many beloved myths experience a rebirth. One of my favorites says something like this: If you fall into icy water, you might as well give up since hypothermia will kill you in minutes. It just ain't so. What does happen, and how you should respond, is summed up in the words "one minute--ten minutes--one hour," a slogan created by Gordon Giesbrecht, Ph.D., the guru of cold. After a plunge into very cold water, use to first minute to calm yourself and control your breathing. Those who don't are the ones who panic and drown. You then have approximately 10 minutes of useful movement. Use that time attempting to get out of the water or at least figuring out how to stabilize yourself. After 10 minutes, you should remain still to reduce heat loss. You have about one hour before you'll lose consciousness from hypothermia. If you're wearing a PFD, another hour or so will pass before your heart stops from the cold. One-ten-one. Remember it. And for more information read Hypothermia, Frostbite and Other Cold Injuires by Giesbrecht and his co-author James A. Wilkerson, M.D. (www.mountaineersbooks.org).

Air-Drying v. Wiping

Someone concerned about the germs that could be setting up housekeeping on backpacking kitchen gear asked which was better--letting washed gear air-dry or wiping it dry with a cloth. There are several variables here. Some germs may remain viable on wet gear, and wiping them off with a clean cloth gets rid of them. "Clean" is an important word. A grimy rag is less safe than air-drying. But then in areas where the air is dry, such as my home state of Wyoming, moisture on gear dries fast enough to make air-drying perfectly acceptable and probably as safe as drying with a clean cloth. In humid regions, try to keep a clean cloth available, something you can do by washing the bandanna you dried the dishes with after kitchen clean-up.

Outdoor Injuries

Those of you with no interest in numbers may choose to read no further. If you're still reading, these stats come from Wilderness and Environmental Medicine (the official publication of the Wilderness Medical Society), 19, 91-98 (2008)--and you're going to learn about the number of outdoor injuries in 2004 and 2005. During those 2 years, an estimated 212,708 injuries were sustained in outdoor activities and treated in hospitals. Sounds like a lot, yes, but the stats include just about any activity you can think of including skiing, horsepacking, skydiving, and snowmobiling. Lower limbs were involved in 27% of the injuries, upper limbs in 25%, and the head and neck in 23.3%. The most common diagnoses were fractures (27.4%) and strains or sprains (23.9%). Males were injured in 68.2% of the accidents. The most dangerous activity? Snowboarding, with a whopping 53,996 estimated annual injuries. Second was sledding, which includes sliding down snowy hillsides on tubes and disks (22,780 annual injuries), and third was hiking (13,448) which included anyone out for a walk anywhere outdoors. Short version: It's statistically much safer on ground than snow. For more info, check out www.wms.org.

Bleached Water

Someone recently asked if he could use household bleach to disinfect water on the trail. The short answer is "yes." Here's more info: Household bleach typically runs about 5% chlorine. We know that 0.1 ml to 0.2 ml of 5% chlorine bleach added to a liter of water will disinfect it, if you wait about a half hour, killing everything except Cryptosporidium (and it may take an hour or more to kill Giardia). A problem arises in measuring bleach into a water bottle. You can use a measured dropper, one that tells you how much fluid is being dropped, and that's the only way to be sure of your measurement. Others guess at the amount, using a non-measured dropper and estimating that a standard "drop" will be about 0.04 ml. Guessers often add 8 drops of bleach per liter of water in an attempt to be safe rather than sorry. The result is water tasting nastily of bleach, but it won't hurt you. Frankly, even though bleach is cheap, I'd rather use a product that guarantees safe water, such as chlorine dioxide tablets (www.rei.com/product/736898).

HAFE

The Outdoor Retailer Show in Salt Lake City was another highlight of my year, added to greatly by the presence of the awesome trio from Celtic--Kurt, Brian, and Bill. (Celtic, an advertising and public relations firm, designed and maintains this site. Check them out at www.celticinc.com). The people with problems who stopped by the first aid station were as I suspected (see the previous post), and dehydration was especially rampant, a reminder to keep your urine clear or lightly yellow in color.
Someone asked about intestinal gas at higher altitudes. High Altitude Flatus Expulsions (HAFE) is a real and discomforting, though rarely serious, problem for those arriving at upper elevations of Earth. Air in your tummy expands like air trapped in a plastic bag. The products Beano and Gas-X have been shown to help alleviate the discomfort. You and your tentmate might both appreciate the alleviation.

Outdoor Retailer

I leave in a few days for the Outdoor Retailer Show in Salt Lake City, my 34th stint in the First Aid Station. After thousands of OR patients, most of them non-serious, I know what I'll see: People forgetting some of the basics of a healthy life. They'll wear pretty shoes that rub them the wrong way, they'll dehydrate, they'll fail to get enough rest, and they'll eat way too much and/or something strange to their digestive systems. But, on the other helping hand, it's sort of like job security for me.
I'll be signing free copies of my new book (Knots You Need, totally non-medical) on Aug 8 at 4PM and Aug 9 at 5PM. If you can't drop by, you can always order (and pay for) a copy (www.globepequot.com), and if you do, I thank you.

Season of the Snake

Definitely, there is something unsettling about getting bitten by a venomous snake (or, hey, any snake). But you know one of the most important things you can do, should it happen to you, is stay calm (whether you're the bitten or the rescuer). Someone recently--and creatively--asked could he take a Benadryl (www.benadryl.com) or another antihistamine. Benadryl does have a mild sedative effect. It can help you sleep. I don't, however, think it would help. The over the counter tabs are not strong enough unless you took enough to be dangerous. And if you were able to chemically alter the patient's level of consciousness, you really would not want to. LOC gives evidence of how the patient is handling the emergency. The only definitive treatment for snakebite remains antivenom. Do what you can, non-chemically, to keep the bitten calm--and find a doctor.

Picaridin

Could be the name of a Knight Templar, but picaridin is an insect repellent, available in the U. S. only relatively recently, although it has been on store shelves in Asia, Europe, and Australia for far longer. It is derived from a substance known as piperidine and was first developed by the people who make Bayer. The EPA has approved it for anyone three years old and up. Less irritating than DEET, and with no indication of any toxicity whatsoever, it works about as well, in the only study done so far, as six percent DEET--which means you have to apply it more often than DEET. I just returned from a trip into Theodore Roosevelt National Park, ND (I love the Badlands) where mosquitoes were moderately nagging problems, as usual, at dawn and dusk. I used picaridin (www.cutterinsectrepellent.com) and found it not only much more pleasant to use that DEET but satisfyingly effective in the conditions on the trail and in camp.

Back from Alaska

Winter camping in June: There's nothing like it. Temps at night reached, at the lowest, 5 above 0, and the mercury rose at midday to 50 F and more. It was a jungle, without insects, while the snow and ice beneath our tent was estimated to be 4500 feet thick (yep, nearly a mile). Almost everyone who climbs Denali gets off an airplane that landed on the Southeast Fork of the Kahiltna Glacier at about 7300 feet elevation--a few feet from the ranger tent where I was working (and sometimes just relaxing). They also almost all leave the mountain there, except for two young Japanese climbers who, this year, disappeared and failed to reappear after ten days of intensive searching--bringing the historical total to 100 dead on Denali. But two others were found, and, with other patients, I had a chance to splint arms, patch wounds, inspect and pontificate on frostbite, melt a ton of snow for water, and wax poetical on what is absolutely one of the most beautiful spots on this planet. Not a bad summer vacation.

Off to Denali

Early tomorrow, May 28, I fly to Alaska where I'll, once again, be a volunteer on the snowy slopes of Denali (www.nps.gov/dena/). The work: Hang out at base camp near 7000 feet elevation on the Kahiltna Glacier in case a climber needs wilderness medicine and/or rescue. I will be hanging out with Daryl Miller, the ranger who has made more contributions to mountain search and rescue than any other person, living or dead. With no access to the wonders of blogging, it will be about three weeks before you see from me. In the meantime, stay well.

Burns: The Sweet Truth

Bee better faster after a burn. How? The International Journal of Lower Extremity Wounds, in a review of 15 studies, gives the answer: honey (http://ijl.sagepub.com). Burned skin recovered faster, up to four times faster, covered with honey instead of antibiotic creams and modern burn dressings. A natural anti-microbial and anti-inflammatory, honey eases the ouch while it promotes healing. The process: Cool the burn, smear honey on gauze, apply it to the burn, change the sweet dressing twice a day. Find a doc if the burn is serious. And, if you don't spread the honey on gauze, you can spread it on a cracker.

Nose Knowledge

How do you fix, someone recently asked, a broken nose out there in the wild places. Here is the short answer: Don't even try. When a fractured snoze reaches an emergency room, there is typically too much swelling to allow the doc to act. Waiting five days, even up to ten days, for the swelling to subside is not uncommon. And a hard blow, so to speak, to the nose might break other parts of the face. If the accident shifted the nose off to one side, attempting to move it back could cause greater harm. Apply cold to the nose, suggest some painkilling pills, and find a doctor--and it's highly unlikely you will need to rush. You'll find lots more nose knowledge in Wilderness Medicine, Fifth Edition, published by Mosby (www.us.elsevierhealth.com).

Bear Huffing

Out here in Wyoming, even though it snowed last night, bears will be waking up fairly soon. Someone recently asked me if he could huff at a bear who huffed at him. Would it intimidate the bear into running away? A lot of people mistakenly think a bear turning to the side and making a huffing noise indicates aggression. Not so. It indicates a nervous and distressed bear. A bear considering an attack will face you silently, and maybe move toward you. In both cases, you should face the bear, stand your ground, stand tall, and show the bear you are not afraid--even if you are. As far as I know, humans huffing at bears has never been studied. I do, however, suspect huffing at a bear might make it think you're nervous and distressed. Until more is known, I think we should leave huffing to the bear. For more info, the best book on dealing with bears I've ever read is Dave Smith's Backcountry Bear Basics (www.mountaineersbooks.org).

Hands-Only CPR

Since 2005 the American Heart Association has been suggesting that it's okay for bystanders who witness a cardiac arrest to start chest compressions on the patient but not bother with ventilations (mouth to mouth or mouth to mask). Now several studies have confirmed that, yes, if hypoxia (lack of adequate air) was not a part of the cardiac arrest (and in most arrests it isn't), then it doesn't alter the outcome for the patient if only compressions are performed. Just call 911 then jump right in and begin hard, fast, uninterrupted chest compressions. You can read all about it at http://circ.ahajournals.org (once there, search for hands-only cpr). Out there, of course, where we spend a lot of time, hypoxia may well be involved--drowning, avalanche burial--and those folks will need ventilations. And we don't often have access to 911. So, at least for now, we should keep our CPR skills, compressions and ventilations, ready for action.

Welcome

Please accept my personal welcome--at least as personal as I can make it--to the grand opening of bucktilton.com, my website, where you can, should you be interested, learn a lot about me, what I'm doing, and what I would like to do. For more than 25 years I have been privileged to work as an educator in wilderness medicine, rescue, and survival--and in the process I co-founded the Wilderness Medicine Institute (WMI), now a division of the National Outdoor Leadership School (NOLS). During those years, in addition to my books, magazines have published more than 1,000 articles I've written, and I've been a contributing editor for Backpacker since 1989 (check out my Medicine Man column). When not teaching or writing, I've been out there--hiking, paddling, biking, climbing (and falling) far more miles and times than I'll ever be able to remember. Having been there, I can help. So, have a look around . . . and let me know your thoughts. Thank you for joining me!

Any Questions?

With Spring on the verge of springing, at least out here in Wyoming (where the weather tends to ignore the calendar), thoughts are turning to trails, rivers, and mountains--any place without walls. If your mental meanderings give rise to any questions about wilderness medicine, outdoor health and safety--or anything, really--please, send them my way at the Atwater Carey site where you can Ask the Expert.