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.

Blisters Revisited

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

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

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

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?

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

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.