Buck Tilton

The End of the Line

2011-03-27T12:41:00.000-07:00

It's painfully obivious that I have not been blogging for a long time. Life, frankly, has become far too busy, and I'm not going to pretend that it will change any time soon. If, however, anyone wants to chat, please give me a call on my cell: 307-349-8371. I hope I'll be at "the end of the line."

RICE Revisited

2010-12-06T16:34:00.000-08:00

Thanks to Dr. Gabe Mirkin, who gave us the acronym RICE, we have used rest, ice, compression, and elevation for musculoskeletal injuries for years. Then, for a while, we taught IRICE, adding ibuprofen to the acronym. Time hiked on, and we dropped ibuprofen, after learning the negative effects on healing from high doses of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Now we have a small but suggestive study that could lead to dropping the second I.

The fact: we don't know when inflammation is a healthy response of the body and when it's not. We often try to suppress it, in brain injury being one example, in some heart attack patients being another.

This recent study was done on mice by well-respected researchers. The short version is this: 1) Ice slows the entry of macrophages into injured muscle. 2) Macrophages release IGF-1 which promotes healing. 3) Markedly lowered levels of IGF-1 are associated with delayed healing.

RICE will continue to be the standard of care, but watch the evolving literature on this question. Ice may be another do-do bird of medicine, like ibuprofen in high doses, a mask for pain that gets you back into action sooner, but which is mistakenly interpreted as healing.

Going Up

2010-10-31T17:41:00.000-07:00

Thanks to a tip from my friend Tod Schimelpfenig at WMI of NOLS (www.nols.edu), I checked out an article--available free if you type "High Altitude Medicine and Biology" into Google--entitled “Incidence and predictors of acute mountain sickness among trekkers on Mount Kilimanjaro.”

Kilimanjaro, the highest point on the African continent at a smidge over 19,300 feet, is notorious for altitude illness due to the rapid altitude gain it requires. Schedules and park fees apparently drive people to make the ascent from just about sea level in 5-6 days. While the study has some significant limitations, it showed a high rate of Acute Moutain Sickness (45%) and no protective effects from a mid-climb rest day or from acetazolamide. The study suggests, but does not prove, that you can go so high so fast that an occasional rest day or acetazolamide does not help.

The study also reports that a large number of climbers continue to ascend even though they have the signs and symptoms of AMS. You will also see, should you choose to read it, a reportedly and amazingly high rate of High Altitude Cerebral Edema (18%).

David Shlims, MD, long a doc for the Himalayan Rescue Association, gave the staff of WMI three, simple, golden rules for altitude at the WMI Staff Meeting in 2007:

1) If you feel unwell, it is altitude sickness until proven otherwise.
2) Never ascend if you have symptoms of altitude sickness.
3) If you are getting worse, then descend immediately.

Wise words indeed.

Eyeball Injuries

2010-10-11T13:31:00.000-07:00

Just a few days ago, my younger daughter, aged 7, and I sat in the office of the local eye doctor. She, the doctor, announced my child's distress was due to a scratched eyeball. And thus this blog. Scratches to the eye that do not involve any loss of sight--which the local doc made sure of--are best treated with an ophthalmic ointment and no patch. They usually heal faster, in a couple of days, without a patch, and foregoing the patch allows the owner of the eye to keep walking in the woods--if that's where you are--without being blind in one eye. I probably would not rinse the eye unless I had sterile eye wash. The abrasion will hurt, and tears will pretty much wash out the wound. A small, inexpensive tube of eye ointment is available OTC and a great idea for a first aid kit. Out there, tell the eye owner to keep sunglasses on as much as possible. If pain is really severe, however, after an injury to the eye, I would seek medical attention for the patient. I would, however, not necessarily place a patch over the eye. If I saw blood leaking from an open wound in the eye and/or if there is a loss of ability to focus that eye, I would seek medical attention also. Remember, however, the patient will be usually be light-sensitive, and that is not a loss of ability of focus. With a bleeding wound to the eye, I would patch the eye. If a hike out is then required, please assign someone to walk, at all times, with the patient.

Trekking Poles Revisited

2010-09-12T11:48:00.000-07:00

Few are those who haven't at least heard of the advantages of trekking poles. The short version is this: You are better balanced, and that means easier walking with less energy required and fewer injuries. You may be taking a few pounds off your hips and shoulders. But are you maximizing the use of your poles? First, I suggest avoiding the straight grip. An ergonomic grip on your poles will be more comfortable, and your hands will be less tired. Some hikers with arthritic hands, as you might anticipate, report less pain with ergonomic grips. Second, be sure your poles have wide, comfortable wrist straps, and use them correctly, and use them all the time. In case you aren't sure: Put your hands up from the bottom of the wrist loops, up through the loops of the straps, and then settle the straps comfortably around your wrists. Snug them up--but not too up. Tight straps cut off blood and comfort, and too loose the straps do not work nearly as well as snug-fitting straps. The straps will take a lot of additional stress off your hands. Finally, you might possibly get an even easier "ride" with poles that have shock absorbers. But, yep, all the extras bump up the retail price quite a chunk. For more info: www.rei.com/expertadvice.

Being a Lightning Rod

2010-08-15T08:03:00.000-07:00

Lately in these parts, a lot of discussion has been about what makes you more attractive to lightning, more likely to be injured or killed. Recent data indicates that human fatalities each year occur approximately half the time from the effects of the ground current (the human is not hit directly) while only about two to four percent occur when the human is the target. With ground current as the most likely culprit, you definitely want to limit your contact with the ground during a storm. The old "lightning position," huddled up on a non-conductive pad with your feet close together (although it has never been proven safer), is suggestive of being safer. If you are walking toward a safer spot with trekking poles, do not let them touch the ground during a storm. They may conduct ground current up into your body. Carry them in your hand and away from the ground or in your backpack. The old and basic principles of lightning safety still apply: look for the safest spot as soon as you start hearing thunder, stay out of the open, avoid being near large bodies of water, do not hang out beneath or even near tall isolated objects, and stay out of wet caves or overhangs. Look for low rolling hills or trees of approximately uniform height.

The Gaper

2010-07-21T06:41:00.000-07:00

No, not someone who gapes, often with a dumb look on his or her face, but a wound, typically a laceration, that gapes open after being cleaned (with pressure irrigation). In the wild med biz, there has been a sort-of guideline stating a wound that gapes open more than one-half inch is best treated by being pulled closed and held in place with wound closure strips or improvised strips (say, from tape). There has been the birth of a new guideline: If the wound gapes open after cleaning, consider closing it with . . . well, you know the rest. If the wound has been well cleaned, there are several healthy reasons, way out there, to close it. It's more comforting to most patients, it usually heals better with less scarring, and it may reduce the chance of infection (since you have "closed the open door" that invites germs in).

Snakes Again and Again

2010-07-07T08:34:00.000-07:00

With the season of the serpent well upon us, a couple of interesting (I thought) snake questions recently appeared on my screen. The first reader wondered if it was true that a pit viper will bite itself in order to kill itself if it knows it's dying anyway. People who know snakes much better than I do say "no," and, in fact, state that poisonous snakes are immune to their own specific venom. So, there you go. The second reader asked if putting kerosene on pit viper bites would help. Well, that theory goes back a long way, at least more than a century in U. S. where rural dwellers soaked snakebitten extremities in kerosene and didn't die. But so few people die from poisonous snakebite in the U.S. anyway, almost always less than 10 deaths a year from thousands of bites in recent decades, the I-tried-it-and-it-worked theory is useless. And, again, the experts are pretty sure, based on science, that a kerosene-soaked snakebite, although it wouldn't hurt, wouldn't help.

Evolutionary Diarrhea

2010-06-29T13:52:00.000-07:00

Three or more loose or watery expulsions from your bowels in a day and most docs would declare you a sufferer of diarrhea. But today's question is not whether or not you have it but whether or not you should try to stop the rush of fluids from your GI tract. “Diarrhea is a natural cleansing and should not be stopped,” say a growing number of people. That might be true--more importantly, it might not. Some diarrheal illnesses may be simply though uncomfortably removing bad things from your body, and some may be a symptom of serious sickness, perhaps even a threat to your longevity. And sadly, out there in the wild places, we don't know for sure which is which. Therefore we take steps based on what we do know--and that means we do not treat all cases of diarrhea. We know that if the patient is threatened with dehydration from prolonged diarrhea, we need to try to stop the diarrhea. And we know if travel is necessary but hindered by diarrhea, we need to try to stop the diarrhea. Otherwise it's a matter of inconvenience, and let the natural cleansing continue. The whole idea, by the way, that many of our responses to health challenges are the result of evolutionary adaptations is a very interesting one. For more ideas such as diarrhea-as-cleanser can be found by typing "evolutionary medicine" into your search engine.

New Treatment for Rabies?

2010-06-11T09:46:00.000-07:00

The 15 year old female in Wisconsin who recovered after being diagnosed in an advanced stage of rabies after a bat bite marked a milestone in medicine. According to the Centers for Disease Control and Prevention (CDC) this has never happened before. A few people have recovered after showing the early signs of rabies and after being given the rabies vaccine--but no recoveries from advanced rabies have ever been reported. Doctors induced a coma and administered a mixture of antiviral medications, the names of which I do not know. Could this be a new treatment worth using on the next patient with rabies? Who knows? Certainly the treatment will be tried again, and, if it works, the medical world will be closer to learning the answer.

With warming temps and larger numbers of bite-able humans going to the wild places, a few reminders about rabies, it seems to me, are in order:

- Regard all animal bites as a potential rabies exposure.
- Clean the wound thoroughly with soap and disinfected water.
- Evacuate all animal bites immediately for the initiation of the rabies vaccine.
- Avoid close contact with animals, especially if they demonstrate erratic or unusual behavior.
- A prophylactic rabies vaccine is available for people who work or travel in high risk areas.

Blisters Revisited

2010-05-19T09:13:00.000-07:00

More and more here in Wyoming, the weather favors hitting the trails, and that makes it seem as if a few reminders on blister prevention (and a bit of fairly new data) could be in order. But first a pre-reminder reminder: blisters are formed where shear forces are at work, separating outer layers of skin from inner layers--and they probably form easiest on damp, hot skin. Logic would suggest, therefore, that anything to keep your feet dry and cool will help prevent blister formation. But that isn't true. Some things work, some don't. Reducing the shear forces on blister-prone sites, such as of course the heels of your feet, is preventitive and possible with moleskin and other products made especially to do the job, such as Blist-O-Ban. Lightweight liner socks that wick away foot moisture are also preventitive when worn beneath heavier socks. Tape can work, but blisters can form beneath tape, so beware. On the other foot, lubricating agents (such as petroleum jelly, mineral oil, glycerin) work for a brief period of time, about a hour, but then increase the risk of a blister by softening the skin. Drying powders seem like a good idea since they absorb moisture, but they typically clump and can form an abrasive surface--and are not recommended for most people. Antiperspirants work to prevent sweating, and some hikers love them on their feet, but whether they actually work or not to prevent blisters remains uncertain. And, finally, you are still wise to buy your hiking footwear late in the afternoon, when your feet are puffiest, and make sure your boots fit.

When Ca-Ca Fails to Occur

2010-04-24T05:50:00.000-07:00

A nephew of mine, a young one, wound up hospitalized recently due to a lack of doo-doo. Okay, not really a lack but a failure for it to appear. He was seriously constipated. Extended periods of time with no bowel movements, and the nasty stuff we want on the ground can become even nastier inside of a GI tract. And fatal cases of constipation are not that unusual--although they are usually related to drug use and more common in the elderly. It is not out of the question, however (and it has happened), that you could face an evacuation decision (stay or go) when your assessment is constipation. The patient typically reports several days of inadequate hydration. You may have to curiously dig for more info than the standard SAMPLE history will supply, going back over a week of history. High fat diets (say cheese) and low dietary fiber may also contribute to constipation. Combine those factors in someone who is hesitant to squat in the wild outdoors, and you have a formula for serious constipation. You can try increasing hydration for the patient, adding fiber, stimulating the bowels with caffeine or alternating cold fluids with hot fluids. But if vague abdominal pain in the lower quadrants increases, perhaps becoming less vague, and especially if a fever develops, you have someone on your hands who needs to be in other hands--those of a hospital-based physician. My nephew, by the way, seems to be on his way to wellness, thank you.

Putting Salt in a Wound

2010-04-10T16:49:00.000-07:00

Well, actually, no, I am not advocating putting salt in a wound. But there was a time when many of us, including me, thought a hot salt water soak for a dirty and/or infected wound and salt water gargles for a sore throat or a dental infection were beneficial, or at least more beneficial than plain water. Perhaps, we said, bacteria were dehydrated by salt, and died. And we kind of figured that salt water would draw germs from an infected wound because body fluid, being less salty, would flow out into salty water as nature sought a balance. Then one day someone asked for evidence--and there was none, not even from the docs who had recommended salt water for medical use in the wilderness. Now we know the salt not only fails to help, it dehydrates the healthy tissue along the edges of wounds, possible slowing the healing process and certainly not helping. So, save the salt for improving the taste of food and remove it from your list of first aid uses.

Apologies

2010-03-16T16:57:00.000-07:00

When you have a "real" job, which I think I do, it's simply amazing how quickly the days pass between postings. Once upon a time--and for more than 20 years--I worked in the field of wilderness medicine--and that was all I did to earn a living (and my mom still asks if that was a real job). Now I have to be on campus and at least near my office every morning by 8:30-ish. Otherwise the administration of Central Wyoming College becomes . . . well, suspicious. It is, to say the least, astounding that it's been almost a month since I posted.

In that month, however, I received the third edition of Wilderness First Responder, one of only two books I've written that has (1) not only persisted but also (2) received an award for being well written (that award coming from the American Medical Writers Association). It has once again been adopted for another year by NOLS (National Outdoor Leadership School) as their text for WFR courses, despite the fact that the picture on the front cover shows a young man pulling an elastic wrap onto an extremity instead of rolling it on, something that disturbs me a bit. Anyway, you can find the book by clicking on Buck's Books back on my home page or going directly to www.amazon.com. And if you check here regulary, I apologize for being away.

Does Your Dog Bite?

2010-02-20T13:42:00.000-08:00

You might be surprised--or maybe not--to learn that dogs bit to death an average of 19 human beings in the United States every year between 1979 and 2005 inclusive of '79 and '05. You might be further surprised to learn that dogs inflict wounds on humans more than 4 million, yep million, times per year. Although the fatality rate is low, a lot of bites cause permanent scars (physical and emotional), serious infections, and, generally speaking, a bad time for the patient. Almost all of the biting dogs are domestic (not wild) and they are pets (not aimless wanderers in search of a handout), and many of the bitten are owners of the biters. I have a sweet little dog, a Corgi, and he wouldn't bite a flea--okay, maybe a flea--but in some situations could he become a biter? Here are some points to ponder:
__Do not smile at a strange dog. A show of your teeth could be considered aggression.
__A dog holding its head high usually is curious. A dog with its head held low usually means potential danger.
__Never run away. It signals the dog to chase you.
__Speak firmly: "No," or "Go away."
__Do not face a threatening dog and make eye contact. Stand sideways to the dog and watch it peripherally--it's less challenging to the dog.
__Do not extend your hand for a threatening dog to sniff. Despite lots of opposing opinion, it gives the dog something easy to bite.
__Remain still and at least appear calm. Most dogs have short attention spans and will soon lose interest in you.
__If the dog bites, attempt to stay still. Struggling tempts the dog become more vicious. Most dogs, even after delivering a bite, will eventually lose interest and leave the area.

Ibu to the Rescue

2010-02-08T15:29:00.000-08:00

A recent study reported in the Annals of Emergency Medicine 2009:54 revealed that children aged 4-18 years who had suffered fractured arms and who were treated with ibuprofen experienced less side-effects (not surprising) and less pain (very surprising) than children--same ages, same injuries--who were treated with acetaminophen and codeine. Who wudda thunk it? The dose of ibuprofen, by the way, was 10 millgrams per kilogram (2.2 pounds) of body weight. It's a bold extrapolation, yes, to say anyone in pain treated with ibu (over-the-counter) will suffer less than if treated with acetaminophen and codeine (prescription)--but it certainly seems worth a try. And out there in the wilds ibuprofen is often our only choice. I will certainly use it with even more confidence than in the past. You can read more about the study and Paul Auerbach's thoughts on it at www.healthline.com/blogs/outdoor_health.

Neck and Neck

2010-01-22T18:07:00.000-08:00

An argument heard at least now and then at gatherings of those who at least think themselves savvy in the ways of wilderness medicine concerns the effectiveness of improvising a cervical collar with a SAM Splint (http://sammedical.com). Whether you are pro or con, take a look at Wilderness and Environmental Medicine (Volume 20, Number 2, 2009). You'll be able to read a report on a study done by McGrath and Murphy comparing a Philadelphia cervical collar (used on ambulances) with a collar improvised with a SAM Splint. The results, briefly stated, suggest the SAM Splint, used according to the directions that come with the device, are, once again at least, as effective as the Philadelphia collar. The study, in case you're interested, tested motion of the neck in extension and side to side. Personally, I have been teaching use of the SAM Splint as an improvised cervical collar for just about 25 years. I will continue to do so--but with renewed confidence.

Back At It

2010-01-15T06:10:00.001-08:00

No blog since November 10? In case someone was wondering if I had died, the answer is no, but I felt, now and then, sort of like I was. My lumbar spine, slowing giving out over the past decade or so, gave up completely. The first signal was pain in the posterior region of my acetabulum, the back of my right hip. Gradually the pain moved down the outside of my thigh, under my knee, and down my shin to the top of my right foot. "Classic presentation," said the spine surgeon in Billings, Montana. I said the pain, classic or not, was keeping me pretty much off my feet. So he operated, removing bits of my lower two vertebrae and a smidge of my sacrum to make room for the nerves to emerge freely. I am quite happy to report I feel like a new man--or at least a man with a new lower spine.

WFA in the News

2009-11-10T16:51:00.000-08:00

A meeting of the minds of the largest providers of wild med training, an effort spearheaded by Tod Schimelpfenig of the Wilderness Medicine Institute and David Johnson of Wilderness Medical Associates, produced a first draft of minimum requirements and scope of practice for wilderness first aid. Several attempts to produce such a document in the past failed despite the fact that, as Tod says, in his opinion, ". . . the content of the major providers is very consistent." Tod continued: "Conversations with David Johnson, MD, of WMA over the past year, and the actions of the BSA WFA curriculum project led us to sense we are at a tipping point and should move forward on these questions of standard content." Perhaps at last the time has come for a national standard. I have certainly witnessed a few near misses. If you're interested in taking a look at the document, send me a comment with the email address you wish it sent to. And you can read more at www.wildmed.com/blog/is-there-a-standard-in-wilderness-medicine-training/.

H1N1

2009-10-25T13:16:00.000-07:00

It may be impossible to avoid contact with H1N1 (the piggy flu) or with at least some flu virus this year. But you can avoid allowing the virus to proliferate enough to cause disease. Keep in mind the pathways for the germs to enter your body are the nose and mouth, and keep in mind these six preventative outdoor and/or indoor steps:
1. Wash your hands often (and if you haven't gotten that message, you are from off-world).
2. Keep your hands off your face unless you are eating or bathing (and wash your hands before eating).
3. Gargle twice a day to rinse out germs that might have entered your mouth. Listerine works fine, but so does warm, salty water.
4. Blow your nose at least once a day. A quick swabbing with salt-water-soaked cotton would be even better.
5. Get enough vitamin C via fresh fruits and veggies and/or supplements.
6. Drink plenty of warm fluids, such as coffee and tea, every day. It's sort of like gargling in reverse. Flu germs in your mouth are flushed into your tummy where they cannot survive.

Bagged Arms Go Numb

2009-10-18T10:52:00.000-07:00

A question that comes across my desk semi-often is this: why do my arms go numb from the elbow to the hand after a night in my sleeping bag? The numbness usually can be explained by the fact that people sleep differently in their bags. With less room, they curl their arms at the elbows and often at the wrists as well, especially if they snooze with their hands tucked under their chins. This position, if prolonged, will irritate the median and/or ulnar nerves, and the result is numbness. On the positive side, nothing serious is happening, and soon after the arms are straightened, the numbness goes harmlessly away. If folks had rather avoid the problem, they can try a bigger and/or more insulated bag. Bigger, of course, means more room and less need for elbow flexion. More insulated could mean sleeping warmer with less need to curl up to hold in body heat.

Charlie Houston

2009-09-30T15:15:00.000-07:00

On September 27 Charles Houston, MD, slipped away peacefully in his Vermont home at the age of 96. As a pioneering mountaineer, he had few equals. First ascents of Foraker and Nanda Devi were his, and numerous other climbs in Alaska and the Himalayas. A fine writer, Houston's book, K2: The Savage Mountain, chronicling his second expedition to the world's second highest mountain, is a true classic in mountaineering literature. But Charlie Houston contributed most profoundly to the world through his unprecedented research into high altitude medicine. He is indeed credited with the first identification of high altitude pulmonary edema. Houston established and for ten years directed altitude medicine research on Mount Logan in Canada. Much of what we know today and depend upon when we acclimatize to high altitude or treat those who have not acclimatized can be traced to roots on Logan. A classic in wilderness medicine literature, Going Higher: Oxygen, Man, and Mountains, was written by Houston. I remember him best as a kind man who generously answered all my questions when I was young in the field of wild med. I will miss him.

Sprained Ankles

2009-09-09T17:35:00.000-07:00

Sprained ankles remain one of the most common wilderness injuiries--and if you're surprised, you haven't been paying close attention. A recent study strongly suggests that severely sprained ankles recover more quickly when the ankle is completely immobilized in a rigid cast that keeps the ankle in the position of function--for a short time. The study does not specific exactly what a "short time" is, but you can read more about it at www.healthline.com/blogs/outdoor_health. In the meantime, we can rest assured that properly applied elastic wraps fall far short of immobilization. Elastic wraps, however, are far better than nothing. And if you've mastered, or at least partially mastered, the art of "immobilizing" a sprained ankle with athletic tape, we can extrapolate and say that a great ankle-taping job, a job often performed by athletic trainers and less often by Wilderness First Responders and WEMTs, will speed healing and promote usefulness far better than an elastic wrap. Sprained ankles are going to remain common for a long time, but we can add even more weight to the skill of taping a sprained ankle in the wilderness.

Two-Step Disinfection

2009-08-31T16:13:00.000-07:00

The lapse in blogs, and please forgive me, arose from classes starting back at Central Wyoming College where I teach. I was asked today about two-step water disinfection processes. There are several, but of specific interest this afternoon was the combo of filtering and adding chemicals. Which should you do first? No hard science tells us. Here are some thoughts: If you use your filter first, you'll remove quite a few "things," including larger germs, leaving your chemical with less demand being put on it. Speaking much more practically, it's simple to filter some water, say, out of a lake, and then add a chemical. Not so easy, it is, to collect water, add a chemical, and then, after waiting the appropriate amount of time, use a filter. But throw this into the mix: if your filter has a charcoal (carbon) stage, using the filter second will remove the unused chemical--and its taste and smell.

How to Die

2009-08-16T07:09:00.000-07:00

My newest book, How To Die In The Outdoors: 110 Grisly Ways to Croak, can be ordered pre-publication now at www.amazon.com. Here is an excerpt:

"One of America's greatest losses, bison (Bison bison) once flowed like a vast, hairy sea, numbering in the millions, from the Alleghenies to the Sierra Nevada, from southern Texas to the Great Slave Lake in Canada, wandering in search of grass and water. Resembling old world buffaloes, North American bison are a different species distinguished by massive, shaggy heads and shoulders and relatively small hindquarters. A mature bull may reach 6.5 feet in height and weigh in at more than a ton. Unmolested, they are a docile group, what remains of them, not given to harming humans.

Often viewed with pet-like affection by tourists to areas where they are protected, bison are sometimes pressed too closely by humans, arousing their sense of preservation, a survival instinct that has caused bison attacks in parks to outnumber bear attacks by more than four to one. Thundered into by the huge weight and muscle of a bison, you'll go somersaulting, coming to a stop battered, bruised, probably broken, and often dead. In addition, a horn or two will have gored you, in the butt if you’re running away, in the abdomen if you face the charge. Your day will really fall apart if you happen to disturb an old bull whose herd follows nervously after him. In such a case of trampling, depending on the size of the herd, what is left of you may be difficult to recognize and separate from the chips of dung that typically litter bison feeding grounds.

To Live: American bison rarely charge a human unless they approach to within 25 feet or less.

To Paste or Not

2009-08-10T08:20:00.000-07:00

Leon Nelson, dentist and mega-avid backpacker, recently shared a few thoughts about toothbrushing, and I found them highly informative--and interesting. When thinking of your teeth, start by remembering that the source of all gum disease and tooth cavities is plague, a film of bacteria that forms on your chompers. Healthy teeth and gums require you to disorganize the plague at least once every 24 hours. To do this you do not need toothpaste--but you do need to brush, says, Leon, for at least four (4) minutes. And you do need to floss once a day. Brushing should be with a regular toothbrush, and you should clean the cheek side of your teeth for two (2) minutes and the tongue side for two (2) minutes. Flossing, continues Leon, should be up and down and not back and forth. But, hey, is it okay to use toothpaste? Sure, but leaving the paste at home you save weight, attract no bears with your minty white stuff, and the paste, according to Leon, does not make your teeth cleaner if you follow Leon's Dry Brushing Plan. He does further suggest, however, that a 30-second dry brushing now and then removes food sticking to your teeth, undoubtedly to some benefit--at least socially.

Stroke? Stick Out Your Tongue

2009-08-03T09:49:00.000-07:00

A stumble and fall on the trail could have numerous causes including, more likely of course in older hikers, a stroke. Remember an individual can fall, rise up, seem fine (without a closer check), and collapse later. For years the first three letters of STRoke have served as a reminder of ways to check the patient for indications of stroke.
S: ask the patient to Smile.
T: ask the patient to Talk, to repeat a simple sentence such as "It's a sunny day today."
R: ask the patient to Raise both arms.
A fourth indicator of stroke should now be added to your checklist. Ask the patient to stick out his or her tongue. If the tongue goes to one side or the other, instead of straight out, if the tongue looks "crooked," you have another sign that a stroke has occurred. If any one of the four subtle indicators is present, the patient should be kept at rest and help should be summoned ASAP. The sooner the patient arrives at a hospital, the greater the chance of survival!

Paddling PFDs

2009-07-22T07:21:00.000-07:00

Over the past week I paddled a string of lakes in northern Wisconsin with family and friends (and it was an excellent vacation). I was also reminded, while reading an article in a local paper, about the importance of wearing PFDs. Of all the drownings recorded so far this year, only two of the fatal events involved people in PFDs, and those drowning were in whitewater. PFDs save lives! But yours needs to fit properly and be appropriate for the activity. To get the best fit, buy from a reputable dealer and ask to be fitted. Fit-wise, it is especially important that your PFD is not too loose: you can slip out of it and/or find yourself floating with your head too low in the water. Activity-wise, the USCG approves five types--Types I-V (www.pfdma.org). Type IV is throwable and Type V is for "special use," and both types are seldom appropriate for paddling. With Types I-III, the lower the number the greater the flotation. Type I PFDs are recommended when you might be drifting a long time waiting for rescue, and they are heavier and less comfy than Types II and III. Type II will give you plenty of flotation in almost all paddling conditions, but they are not as comfortable as Type III. Most paddlers end up with Type III. But consider safety first, and choose wisely.

The Recovery Sock

2009-07-07T12:31:00.000-07:00

"Compression" shows up commonly in medical conversations. It's uses have been well known for more years than even I have. Compression prevents, or at least significantly reduces, venous stasis (blood pooling in areas where you don't want blood to pool). It, in other words, promotes healthy circulation. The use of compression in athletics to encourage healthy blood flow and thereby reduce lactic acid buildup and, more than likely, increase performance to some degree is relatively new technology. Enter the Recovery Sock (http://recoverysock.com) and I wore a pair on my last adventure. They are padded in the high impact areas, and the compression they provide decreases gradually, and appropriately, from toe toward knee. It has literally been years since my feet have felt as good after a bout of use. Some of you know I have a fused ankle, and a puffy right foot and ankle are among the prices I pay for staying on the trail. I removed the socks each night to find a greatly reduced amount of swelling. Do they do what they claim to do? I can't say for sure about everything, but I can say that Recovery Socks will be on my feet in the foreseeable future. They are pricey at about $35 per pair, but the benefits as I see them are worth the dough.

Numb of Toe

2009-06-29T16:04:00.000-07:00

"Numb toe," most often the big toe, and even more often the outside of the big toe, is a pretty common complaint I hear from hikers. The cause, again most often, is an improper boot fit. Or maybe those same boots are not laced snugly enough. Either way, on the downhill leg of trails, the part where toes are smushed against the toe end of the boot, this happens: the nerves of the toe are crushed and/or the circulation gets cut off too long--and the toe gets numb and stays numb. If it happens occasionally, it's not a big deal. But if it happens all the time, and especially if the toe does have enough recovery time before the next hike, you should try to find a boot that alleviates the problem and/or try lacing up more snugly. Go for boots that are wider in the toe box and/or boots that are a bit longer than the offending footwear. If that doesn't work, custom insoles may alter the pressure on your toes enough to keep numb toe away. And if that doesn't work, a visit to a foot specialist is recommended. Persistent toe numbness may lead to permanent damage.

Adios Iodine

2009-06-24T13:30:00.000-07:00

The European Union has banned the sale of iodine as a water disinfectant as of 25 October 2009, a decision that will affect all 27 countries that are members of the EU. Will this decision lap over into the United States? Who knows? The potential for a global impact certainly exists. The use of iodine in field water treatment has been questioned by some authorities for years, primarily due to the lack of definitive info--is it safe? or is it not safe?--and so far I have not found any reasons clarifying why the EU made their decision. The Centers for Disease Control (CDC) still approves use of iodine but warns the use should be limited to no more than "a few weeks." Consumption of iodinated water remains contra-indicated for pregnant women, anyone with a history of thyroid disease, and anyone with a known allergic response to iodine. You can find a few more details at www.outdoorindustry.org.

Ticked Off

2009-06-17T06:25:00.000-07:00

Recently a disease transmitted by a tick developed into encephalitits (an inflammation of the brain) and a human being died. The case was reported in the New England Journal of Medicine (http://content.nejm.org). It is not usual for an encephalitis to be the end result of a tickborne illness--the disease can, in fact, produce very few symptoms--but obviously death does sometimes occur. Ticks may also be carrying other diseases, such as babesiosis, Rocky Mountain spotted fever, and Lyme disease, that occasionally become a serious threat to life. The bottom line: it is that time of year to be wary of ticks. Most insect repellents, despite the knowledge that ticks are not insects, repel ticks. Wear light-colored clothing, allowing you to see free-ranging ticks and pick them off before they embed. After a walk outside, a careful inspection for ticks on your body is highly recommended. Remember ticks like to embed in well-hidden spots, and ticks in the nymph stage, when they are incredibly tiny, can pass germs--you will do well, therefore, to have a friend help you with the inspection. Remove all embedded ticks immediately with sharp-pointed tweezers, grasping the tick perpendicular to its long axis, and gently pulling it straight out. If an illness develops after removing an embedded tick, seek a physician's evaluation ASAP.

Don't Get Sunburned

2009-05-28T07:15:00.000-07:00

And now for a moment (or two) of blatant self-promotion: my new book is out and available for purchase. The title is Don't Get Sunburned: 50 Ways to Save Your Skin. It's all about how ultraviolet light damages your skin, how ozone depletion increases the chance of damage, and about how to keep from getting damaged. In case you didn't know, there's a new UVA rating system for sunscreens (the old system only rated protection from UVB) and I cover the new system and things like the effects of UV light when altitude, wind, latitude, season, and skin wetness are added to the equation. There's info on skin types, baby skin, already-sunburned skin, and skin cancer. The price: $7.95--and the cover is as pink as burned epithelial tissue. You can see more at www.mountaineersbooks.org.

A Death in the Family

2009-05-12T10:05:00.000-07:00

On 28 April John Evans, a complete mountaineer and rescue ranger on Denali, a wonderful gentleman, and a great friend died in a climbing accident in Wales. I had the immense privilege of working several patrols on Denali with John, the last in the spring of 2008. In past years, we had taught together, climbed together, and sipped quite a few fine drams of single malt together. He was the kind of man you could not help loving, and I will miss him tremendously. I chose to post the news here, knowing many of you never had the pleasure of meeting John Evans, but feeling the need to send out a few words in quiet celebration of his life. Thank you for listening.

The Sunglasses Myth

2009-05-04T09:20:00.000-07:00

Tod Schimelpfenig over at NOLS has been investigating the notion that cheap sunglasses can keep your pupils dilated and cause sunburn of the retina. Experts questioned by Tod agree this is a myth. Simply stated, not enough radiation is going to reach the retina to cause a burn, even with intensely reflected light from snow, and even with really inexpensive sunglasses. But there's more at risk than your retina! If your cheap sunglasses have low UV protection you most likely will increase your risk of injury to the cornea--the risk of snowblindness. And, over time, the risk of cataracts, macular degeneration, and even eye cancer. Cheap sunglasses, however, can have high UV protection, which is, of course, what you want--and need. Bottom line: Your sunglasses need to provide protection as complete as possible from all ultraviolet light, and they need to wrap around to keep UV light from creeping in from the side. You don't have to pay a lot of money for protection, but you do have to pay a lot of attention to what you're purchasing.

Fight or Flight: Lion Attacks

2009-04-22T05:52:00.000-07:00

Mountain lions, according to a recent article in Scientific American (www.ScientificAmerican.com), may be less likely to attack if you run away. This, of course, is contrary to popular expert opinion. The article reports a study done by Richard Coss, an expert on predator-prey relations, that involved 185 lion attacks between 1890 and 2000. Coss said 43% of people who stood still facing a lion were injured compared to 17% who were injured while fleeing. The study does admit, however, that those who fled had a slightly higher chance of being killed, although he reports that only 18 people actually ran. Half of those who ran escaped without injury. Coss did not study encounters with mountain lions or near-attacks from lions.

I'm confused. First, he does not define "attack" and "near-attack." Were the 185 people pounced on? Or did they just "feel" attacked? Second, he says the people stood still. That's not what you're supposed to do. You're supposed to shout and scream, show your teeth, stand tall, and, finally, counter-attack with sticks and stones (to less than claw range) if the lion charges.

Bottom line: Almost all experts remain convinced that cats chase things, and usually catch them. So, I won't run. And I won't just stand there. Besides, I'm really slow.

Big Bite Protection

2009-04-15T11:52:00.000-07:00

Although snow threatens to fall on Lander today, there are places where the sun shines warmly and bears are starting to wake up. They wake up hungry. And even though humans remain way down on the list of choice items to break a bear's fast, numerous questions related to staying safe in bear country have flowed onto my screen in the past week. Here are several:

If food has spilled on a sleeping bag, could the smell attract a bear? Answer: Yep. Don't eat in or near your bag, wash it when food has spilled on it, and don't even sleep near the clothes you cooked and dined in.

Can you outrun a bear by running downhill? Answer: Nope. They are more clumsy and slower going downhill than up, but they are still a lot faster than a human, even a really scared human.

Does the odor of DEET attract bears? Answer: Nobody knows for sure. No bear has ever been seen showing interest in DEET products. DEET does not smell like food, so the chances of it drawing a bear to you are slim.

Will bear spray repel snakes? No snake repellent has ever been licensed as a product, but people report bear spray drives snakes, even venomous snakes, away. If you feel threatened, shoot for the snake's face. For more info: www.peacemakerpepperspray.com.

A Pain in the Tooth

2009-04-07T18:07:00.000-07:00

My wife Kat had been complaining of pain in her mouth for about two weeks while I, the questionably considerate husband, kept repeating absurdities that all resembled "Hey, suck it up." Then, several mornings ago, she woke me to display a red right cheek obviously swollen from about an inch below her eye to the line of her jaw. She stated emphatically--and convincingly--that the pain was now intense. The dentist could see her the next day. She swallowed the strongest painkillers we had on hand, which helped a little, and applied cold packs to the cheek, which helped a bit more. She rinsed her mouth with warm, salty water. She kept complaining. Inspection revealed no discoloration of the gum near the pain site, even though I now suspected I would see it. The dentist diagnosed an abscessed tooth, prescribed an antibiotic, did a root canal to remove the diseased nerves and pulp, and filled the empty space. If this had occurred way back in the wilderness, there isn't really anything else you can do. However, the infection in an abscessed tooth can migrate and become, in the worst-case scenario, a threat to life. You need to recognize one, and evacuate the patient ASAP. (Early assessment could also, possibly, improve marital relations.)

No Gas Shortage

2009-03-30T07:46:00.000-07:00

Reading recently that the average human passes gas about 14 times every day caused me some thought. Mostly I asked myself: how did they figure that out?--and I decided I like my current job just fine. The report stated that this gas normally does not smell bad. Ah, at least the researchers have that going for them. Wilderness flatulence is rarely a problem, other than socially, but it has greatly disturbed a few high altitude climbers. At higher elevations, gas expands more quickly, causing, sometimes, a great deal of pain, a problem dubbed High Altitude Flatus Expulsions (HAFE). If gas proves a problem, here are a few tips: eat smaller meals, take it easy on fats, and leave the bubbly drinks behind. (I have seen more than one party on Denali lugging a sled full of Coke and beer.) And when you're packing your food bag, cut down on foods containing beans, eggs, meat, and cauliflower, sources not only of gas but of smelly gas. You might also like to know that exercise helps keep your bowels moving smoothly and with less gas. Consider, finally, packing an anti-gas product such as Beano (www.beanogas.com). Save on gas!

UV Light Disinfection

2009-03-22T14:10:00.000-07:00

A busy schedule, much of it keeping me away from computers the past month, has caused a marked decrease in my postings. Hello to all who have checked back in--and thank you for your patience.

With the increasing use of ultraviolet light devices to disinfect water an increasing number of questions about the devices have hit my screen during my absence. If you follow the manufacturer's directions, you're pretty much assured safe drinking water (see www.steripen.com). But what about the water on the outside of the bottle? It's not safe. Only the water inside the bottle is disinfected, and that does not include the water trapped in the threads of a standard water bottle. If you wipe the threads dry with a clean cloth, however, you will remove most--maybe all--of the pathogens trapped there. In other words, a thorough drying of the threads and it is highly unlikely you'll get a waterborne illness. On the other hand, the safest bet of all is to use a container other than your water bottle to scoop up the water you'll be disinfecting. A cup you'll be washing later will work fine.

Tooth Talk

2009-02-16T05:15:00.000-08:00

Someone asked recently if it's really possible to replace a tooth that has been knocked out of a mouth--or is the idea just wishful thinking. Fact is you can probably get the tooth back in the empty socket if you don't dally. Hold the tooth by the crown (the white part) and gently rinse it clean. Do not scrub it clean. The tooth's owner should rinse his or her mouth clean with water, as if rinsing the mouth after a tooth brushing, spitting out, of course, the rinse water. Be sure to orient the tooth correctly, and press it gently but firmly into the socket. It should settle in with a soft and satisfying little "click." This does not necessarily mean the tooth will survive--but it does have the best chance in the socket. If you can't get the tooth back in the socket, save it, preferably in milk (yes, that story is true), but water will do. However, an hour or more away from a dentist and the tooth is unlikely to be successfully replaced.

HAPE Country News

2009-01-29T15:20:00.000-08:00

High Altitude Pulmonary Edema (HAPE), a non-cardiogenic form of pulmonary edema, remains a threat to people who ascend quickly to elevations above 2500 m (8250 ft). In a recent report in Wilderness & Environmental Medicine, Vol 19, No 4, 2008, the journal of the Wilderness Medical Society (www.wms.org), Drs. Stream and Grissom briefly reviewed a study showing inhaled salmeterol reduces the risk of HAPE in HAPE-prone individuals by 50 percent. (You' ll have to chat with a doc about a 'script for salmeterol.) But, more importantly, it was reported that there is nothing new in the preferred treatment for the problem: patients who descend 500-1000 m (1650-3300 ft) and/or who are treated with supplemental oxygen at a rate high enough to keep their oxygen saturation at 90 percent or more, get better--given adequate time. Those patients on O2 should avoid strenuous activity as well.

An Abrasive Thought

2009-01-21T08:20:00.000-08:00

New evidence suggests a long-held belief might not be as worthy of being held onto as we have thought. I just returned from a short trip to Dallas (actually Irving, TX) where a group met to discuss wilderness first aid (and I hope to report more on that later). One topic was abrasions, a wound typically causing the patient pain--sometimes more than a little--when it is scrubbed clean. According to Dr. William Forgey, an application of an antibiotic ointment applied liberally within 10-15 minutes of the injury and you do not need to scrub. The ointment penetrates the skin, promoting the resistance of infection while protecting the site--and patient's so treated may actually develop an infection less often than when scrubbed. Doc Forgey did recommend removing large particles contaminating the wound prior to applying the ointment. You can brush those particles out with sterile gauze. And he further noted that we need to be ready to scrub if the wound is older than the 15 minutes (or so) time limit.

Two People and One Bag

2009-01-05T09:03:00.000-08:00

The temp dropped to zero again in Lander, and that might help explain the return of an annual winter question: are two people in one sleeping bag effective when one person is hypothermic? Despite the popularity of this proposal, snuggling is not a great warming method. The warm person adds very little heat, certainly not enough to reverse significant hypothermia quickly--and there are possible negative results. Two people seldom fit into one bag, and if you can't close the bag, heat retention is lost. If the heat donor wants out, much of the heat that has been retained is lost when the bag is opened. The warm person might be more useful making hot water bottles for the cold person, building a fire, or carrying out a message asking for help. It is not necessarily "wrong" to put two people in one bag, but neither is it the "standard of care," and there are usually better things to do.

Holiday Greetings

2008-12-26T06:07:00.000-08:00

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

2008-12-16T08:26:00.000-08:00

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

2008-12-10T09:32:00.000-08:00

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

2008-12-03T12:05:00.000-08:00

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

2008-11-10T08:01:00.000-08:00

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

2008-10-24T11:38:00.000-07:00

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

2008-10-15T12:18:00.000-07:00

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

2008-10-03T08:50:00.000-07:00

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

2008-09-19T08:11:00.000-07:00

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

2008-09-04T10:24:00.000-07:00

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

2008-08-13T08:46:00.000-07:00

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

2008-08-03T11:27:00.000-07:00

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

2008-07-21T07:49:00.000-07:00

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

2008-07-12T12:12:00.000-07:00

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

2008-06-25T20:20:00.000-07:00

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

2008-05-27T09:56:00.000-07:00

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

2008-05-12T12:47:00.000-07:00

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

2008-05-04T05:41:00.000-07:00

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

2008-04-26T07:59:00.000-07:00

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

2008-04-16T06:35:00.000-07:00

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

2008-04-01T14:15:00.000-07:00

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?

2008-04-01T13:51:00.000-07:00

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.