CLIMBING: Training for Peak Performance

The Mountaineers Books has just published CLIMBING: Training for Peak Performance, 2nd edition, by Clyde Soles. This is a classic fitness manual for climbers. The book is written for climbers of all ages, abilities and interests, and covers the latest advances in the sciences of nutrition and fitness, includes tips for preparing mentally and physically, preventing injury, and rehabilitation, and is clearly also suitable for hikers, skiers, cyclist, and anyone who enjoys recreation in the mountains.

The paperbound book, which retails for $18.95 U.S., contains 320 pages, 120 black and white photographs, 4 illustrations and 17 charts. The chapters are entitled Performance Fundamentals, Nutrition Foundation, Mental Power, Aerobic Conditioning, Climbing at Altitude, Resistance Training, Body Tuning: Joint Mobility, Flexibility and Balance, Recovery: Rest and Rehab, and Synergy: Coalescing and Planning.

The point is well made early in the book that to achieve peak performance, the goal is to enhance overall fitness and health, fine-tune aspects specific to your interests, peak for major excursions, and prevent injury through a balanced program of exercise. Furthermore, fitness is a constant lifestyle - one doesn't just train and condition episodically if there is the desire to have a regular favorable impact upon health and well-being.

I really like this book, if only because the author pulls no punches with his opinions. For instance: "A recent fitness trend has been the emergence of training cults...The most popular of these is CrossFit, which is essentially a business franchise masquerading as a new fitness program...However, there is a high risk of acute injury from many of the exercises; some of which are frivolous...And optimal performance gains always come from addressing individual weaknesses and goals, not generic training programs...It only takes attending a two-day class, with no written exam, to become a certified CrossFit trainer..." Call it like it is! I've been exercising for the purpose of athletic competition, strength and conditioning, weight control, and to be able to enjoy my outdoor recreation for nearly half a century. Mr. Soles is a breath of fresh air.

Whether dealing with nutrition, aging, hydration, supplements, emotion, exercise, or rest and recovery, the advice is sound, and in some cases superlative. I highly recommend this book.

Tags: CLIMBING: Training for Peak Performance, training, performance, wilderness medicine, outdoor medicine, healthline

Labels: CLIMBING: Training for Peak Performance, exercise, performance, training

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Essential Oil Candles as Mosquito Repellents

From the Journal of the American Mosquito Control Association comes an interesting article by BC Muller and colleagues (J Am Mosquito Control Assoc 2008;24:154-160) entitled “Ability of Essential Oil Candles to Repel Biting Insects in High and Low Biting Pressure Environments.”

Anyone who has spent much time outdoors, whether on a camping trip or enjoying a backyard picnic, has encountered the scourge of biting insects, and in particular, mosquitoes. There is no good reason to be bitten by a mosquito, and many very important reasons to avoid them, namely, the risk of transmission of infectious disease, such as dengue, West Nile virus, malaria and so on. My first experiences with mosquito repellents were the ubiquitous green (“snake”) coils and candle products, which were supposed to keep the critters away. No surprise – some of them work well and some of them do not work so well.

My thanks to the ABSTRACTS OF CURRENT LITERATURE section in the journal Wilderness & Environmental Medicine for providing the following abstract of this study, in which the investigators evaluated the efficacy of three types of essential oil candles to repel mosquitoes. These 85-gram candles contained 5% essential oil, either citronella, linalool, or geraniol. These were compared to a paraffin candle without any repellent or fragrance. Outcome measures included mosquito biting and mosquito concentration, using a technique that involved mosquito traps.

Compared with the control, geraniol candles were most effective, decreasing the female mosquito load by 82% within one meter of the candle arrangements and 36% at a distance of 3 meters from the candles. The numbers for linalool were 65% at 1 meter and 36% at 3 meters, and for citronella (the least effective) were 35% at 1 meter and 12% at 3 meters. In terms of bites, mosquito landing, probing, and biting on the subject’s hands and arms were observed and counted. The skin was carefully cleaned in a standardized fashion prior to the evaluation. Because geraniol candles were most effective in reducing mosquito load (see above), they were evaluated for biting. Using the geraniol candles in high biting- and low biting-pressure environments, in comparison to the paraffin control, the geraniol candles reduced mosquito-human interaction by 56% in the high biting-pressure zone and by 62% in the low biting-pressure zone.

What is obvious is that while geraniol candles reduce the presence and biting of mosquitoes, there is still a great deal of mosquito activity that remains. Until further notice, there is not a candle or smoke/scent emitting device for the ourdoors, short of constantly spraying insecticide, that would mitigate against using personal protection (e.g., treated clothing and insect repellents).

Tags: geraniol, insect repellent, repellent candle, wilderness medicine, outdoor medicine, healthlineLabels: geraniol, insect repellent, mosquito repellent, mosquitoes

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Thanks to the Exhibitors at the WMS Annual Meeting

At the Wilderness Medical Society Annual Meeting held in Snowmass, Colorado from July 24-29, 2009, there were a number of exhibitors. In thanks for their support of the WMS and because they had interesting products and services that I believe might be of interest to you, I'm going to mention a few of them here.

The first is Katabatic Consulting and Technical Services. Katabatic offers special environmnet medical consulting, in recognition of the need and desire to travel, explore and work in remote corners of the world. The company assists companies and individuals with logistics and medical equipment selections that suit the needs of any special environment. As advertised, "From a 10 day group trek in Nepal, a six month research expedition in Antarctica, or a long term oil platform project, Katabatic will assess the project logistics and recommend a safe and practical medical package for your goals. We use our experience and that of other medical and technical experts to recommend a needs-specific medical package. For existing programs, we review the medical plan, logistics and equipment and make recommmendations for improvement and implementation."

Katabatic also runs a Mountain School, teaching wilderness awareness for the 911 provider, wilderness first aid, wilderness advanced first aid, wilderness first responder, wilderness upgrade for EMTs and remote advanced life support. Katabatic Mountain School's teaching facility is located in the Pike's Peak region of southern Colorado. In addition to teaching at that location, KMS also offers on site courses at other facilities or regions to accomodate the needs of its clients.

The second mention is of Green Dot Systems, which offers the emOx emergency powered oxygen generator. This device generates oxygen by mixing two naturally occurring powders with water to generate 15 minutes worth of 99.7% pure oxygen. The oxygen is generated over a 15 minute period and during that time, the unit can deliver approximately 2 1/2 to 3 liters per minute of oxygen to the recipient. This is considered "low flow" in medical parlance, but might certainly be of value in medical situations where supplemental oxygen is advised.

The third mention is of Conterra Technical Systems as represented by Rescue Essentials. Conterra builds gear for emergency used designed with personal safety and convenience in mind. They are known for their bags, which are deployed in tactical, disaster and medical situations, including mountain rescue, emergency operations, on board aircraft, and in virtually any situation in which a bag carrying essential supplies might be necessary. The company also distributes rescue accessories, such as helmets, harnesses, carabiners, tripods, pulleys, brake racks, ascenders, rescue lights and headlamps, splints, and so forth.

The final mention is of SAM Medical Products, a longtime supporter of the WMS. They were also represented by Rescue Essentials, a distributor out of Salida, Colorado that features high-use EMS and tactical medical supplies at terrific prices. At this particular meeting, we received an update on the expanding line of hemostatic (blood-stopping) products, including Celox Trauma Gauze (flexible chitosan dressing), Celox hemostatic granules (no heat generated in use; works in hypothermic conditions; clots heparinized blood), Celox-D (absorbant hemostatic granules in dissolvable bags for temporary traumatic wound treatment), and Celox-A (applicator with Celox granules).

My sincere thanks to each of these exhibitors, and to others who have exhibited in the past and will exhibit in the future.

Tags: SAM Medical Products, Celox, Conterra, Rescue Essentials, Katabatic, emOx, Green Dot Systems,wilderness medicine, outdoor medicine, healthline

Labels: Celox, Conterra, emOx, Green Dot Systems, Katabatic, Katabatic Mountain School, Rescue Essentials, SAM Medical Products

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Thank You to CRZEGRL, FLIGHT NURSE for Grand Rounds

Thank you to CRSEGRL, FLIGHT NURSE for mentioning my post about using recombinant factor VIIa for rattlesnake envenomation in this week's Grand Rounds. Grand Rounds is a weekly compilation of health care posts from around the web compiled by a host, who goes to great lengths to make the collection informative and entertaining.

Labels: crzegrl flight nurse, Grand Rounds

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Evidence-Based Management of Wilderness Injuries

This is the next post based upon a presentation given at the Wilderness Medical Society Annual Meeting held in Snowmass, Colorado from July 24-29, 2009. The presentation was entitled “Evidence-based Management of Wilderness Trauma with Case Studies from Vermont Search & Rescue.” It was delivered by Tim Burdick, MD, who is a Fellow of the Academy of Wilderness Medicine, Assistant Professor of Family Medicine at the University of Vermont College of Medicine, Medical Officer for Stowe Mountain Rescue, and Medical Team Manager for FEMA Urban Search & Rescue Massachusetts Tasks Force 1.

There are clinical decision rules (or “tools”) used by physicians in order to control the number of tests (such as x-rays) they use to determine whether or not patients have specific injuries. The purpose of such rules is to avoid unnecessary testing, which can add to undesirable consequences, such as additional expense and radiation exposure. In the wilderness, the purpose of decision rules is to determine the likelihood of diagnosis, who might need an evacuation, and when it is advisable to continue or discontinue a trip.

Dr. Burdick noted that there are evidence-based clinical tools for ankle and midfoot fractures, cervical spine (neck) fractures, shoulder dislocations, and detection of fractures (broken bones) using a tuning fork.

The Ottawa ankle decision rules for the use of x-rays to determine the presence or absence of an ankle fracture were determined in patients who had mostly twisted their ankles, rather than fallen. According to these rules, an ankle fracture might exist if (1) the patient complains of pain near either malleolus AND (2) can’t bear weight for a distance of four steps OR suffers bony tenderness (when you press) in either malleolus. As it turns out, the test has a positive predictive value (e.g., when the test is positive the patient has a fracture) of 17% and a negative predictive value (e.g., when the test is negative the patient does not have a fracture) of virtually 100%.

There is something similar for neck fractures. For a blunt injury (e.g., not a stab wound, or “penetrating” injury), here are a set of criteria for which a patient should be evaluated:

1. Patient is alert and reliable
2. Patient is not intoxicated
3. There is no painful, distracting (from the examination) injury (such as a broken leg)
4. There is no focal abnormal neurological finding (such as weakness in the grip strength of a hand, or abnormal deep tendon reflex)
5. There is no midline cervical spine (neck) tenderness when the neck is examined

If all of these conditions were met by a good examination, then according to the medical literature, then only 2 out of 4307 persons initially complaining of neck pain turned out to have a broken neck.

What about dislocated shoulders? The usual admonition against attempting to reduce a shoulder dislocation prior to obtaining x-rays is to avoid tugging on a broken arm, in the event that a fracture-dislocation is present. It appears that there is a greater risk of fracture-dislocation if the victim’s age is less than 40 years and the mechanism involves “substantial force” (e.g., motor vehicle accident, assault, sports injury, or a fall from a distance greater than the victim’s personal height); or in a victim age 40 years or greater, if there is bruising around the humerus (long “upper” bone of the arm) or if the dislocation is the first for the victim. However, given all of this, it is still not clear that attempting the relocation of a dislocated shoulder that happens to be associated with an undetected fracture of the humerus is a big problem, unless one applies extreme force in the attempt and significantly worsens the break. Certainly, putting a shoulder back in place and allowing the victim greater mobility, reducing pain, and perhaps creating a situation that enables self-extrication can be extremely important.

Can someone use a tuning fork to diagnose a longbone fracture? The concept is that sound is conducted through intact bone and joints better than through broken bone. The technique is to place a vibrating tuning fork of a bony prominence beyond (distal to) the suspected fracture and then to listen with a stethoscope over a bony prominence in front of (proximal to) the suspected fracture. Sound conduction is compared between identical exams of the injured and contralateral (uninjured) limb. Decreased conduction (appreciation of sound transmittance) would indicate a possible fracure. One brief analysis of this concept in 1987, utilizing a 128 hertz tuning fork and stethoscope, indicated that it might be useful, improving the detection of fractures by a few percentage points.

Tags: evidence-based medicine, fractures, wilderness injuries, wilderness medicine, outdoor medicine, healthline

Labels: evidence-based medicine, wilderness injuries

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