Eyeball Injuries

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

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

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

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

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

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?

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.