Mountain Lion Attack

An unfortunate man was attacked recently by a female mountain lion at Prairie Creek Redwoods State Park in California. Mountain lions occasionally prey on humans, usually in a stealth attack. The following information is condensed from the chapter on wild animal attacks by Dr. Luanne Freer in the forthcoming textbook Wilderness Medicine:

North American mountain lions (also known as cougars) are clever and (usually) shy animals. However, they are encroaching with increasing frequency into populated areas of the western United States, probably because of human expansion into the wilderness and an increased population of protected animals. Decreased natural food supply is another reason why they may approach populated areas or attack humans. Suburban dwellers (who typically are ignorant of wild animal behavior) are now in regular close contact with mountain lions in their homes and parks, whether they realize it or not. I personally have seen mountain lions in a popular hiking park in the San Francisco Bay area, as well as rummaging through a dumpster in the relatively urban setting of Los Gatos, California.

Victims hiking, jogging and biking may evoke a predatory response. Young animals that are forced out by adults and must find their own territory are the most frequent attackers of humans. Female animals may attack in defense of their young. Children are the preferred victims. There has been only one alleged report of a mountain lioin as a primary man eater, but cougars have sometimes partially eaten victims of their attacks.

The mountain lion hunts like a domestic cat: crouching, slinking, sprinting, pouncing, and then breaking the prey’s neck. The types of injuries to the neck are similar to those described for lions and tigers. Like many potentially dangerous wild animals, the mountain lion can often be scared off by the victim’s aggressive behavior, even after the attack has begun. In 2002, a man fought off and killed an attacking cougar with a pocket knife. In this most recent attack, the wife of the victim was able to repel the animal by striking it in the snout with a branch and stabbing it with a pen.

In addition to the injuries inflicted with claws and teeth, the animal may inoculate the wound with bacteria that can cause serious infections.

Tags: mountain lion, cougar, animal attack, physician, health, wilderness medicine, outdoor medicine, healthline

Permalink | 0 Comments| Email Post

Post your comment

Brain Oxygenation During Exercise at High Altitude Improves with Acetazolamide

It’s well known that barometric (atmospheric) pressure, and therefore the amount of available oxygen, decreases with altitude, such that at an altitude of 18,000 feet, only half the amount of oxygen is available for breathing in inspired air as that available at sea level. This diminished oxygen is the main reason why it is essential to ascend slowly enough for one’s body to acclimatize and, hopefully, avoid the ravages of high altitude associated afflictions, such as acute mountain sickness, high altitude cerebral edema, high altitude pulmonary edema, and so forth.

Acetazolamide (Diamox) is a drug that helps the body mimic and accelerate the physiological changes that accompany the acclimatization process. It is used quite often by persons who ascend to high altitudes to assist with acclimatization in order to avoid becoming ill. It is also useful to a lesser degree for the treatment of the early stages of altitude-related illnesses. It’s precise mechanisms of action may include promotion of urinary excretion of bicarbonate (which boosts acclimatization), diminution in the production of cerebrospinal fluid (thus decreasing fluid accumulation in the central nervous system that might contribute to brain swelling or other deleterious effects), and stimulation of breathing, which improves general oxygenation, particularly during sleep.

In the most recent issue of the journal High Altitude Medicine & Biology, Jaap Vuyk and colleagues studied members of the Dutch 2005 Cho Oyu (a 8201 meter peak in Tibet) expedition. They were interested specifically on the influence of acetazolamide and exercise on heart rate and oxygen saturation (limbs and brain), the presence and severity of acute mountain sickness, and psychomotor function. They were able to demonstrate that acetazolamide diminished the exercise-reduced reduction in brain oxygenation that is normally observed under these conditions. They further observed that after several weeks at high altitude, all climbers showed the same physiological measurements, which was attributed to the climbers not taking acetazolamide becoming acclimatized and therefore no longer at a relative disadvantage. This study provides more support for the contention that acetazolamide is a useful drug for climbers, trekkers, and others who sojourn to high altitude.

Tags: high altitude, acetazolamide, medical, Diamox, acute mountain sickness, wilderness medicine, outdoor medicine, healthline

photo by Mathias Schar

Permalink | 0 Comments| Email Post

Post your comment

To the Ends of the Earth

Gordon Wiltsie has written and illustrated (with photographs) a beautiful 224-page hardcover book, published by W.W. Norton, entitled To the Ends of the Earth. Adventures of an Expedition Photographer. Wiltsie is considered one of the world’s preeminent “expedition photographers.” We are treated to his talents in every conceivable way – both artistic with his photography, and literary with the prose that accompanies the images.

I am in awe of the Preface, where the reader is introduced to the motivations and heart of Gordon Wiltsie. He shares credit with many who have contributed to his success, while laying claim to his expertise and the important ways that his activities and photographs are viewed by others. Throughout the book, he successfully points out that adventure entails risk, but that for him and others, the rewards are worth the potential catastrophes.

The photographs tell stories, so they are not always poster images suitable for wall hanging. Rather, they support the stories and guide us through the tales of adventure. I am in favor of this method, because rather than being enticed to quickly flip through the book in search of monumental portraiture, I was able to readily move back and forth from words to photos, to understand how the threads were been woven into tales. I took my time reading the book, because I found myself drawn into each story.

If you appreciate the wilderness and wish to inspire yourself to become more adventurous, or just to understand the motivations and trials of those who have already committed themselves to expeditions into the wild, this is a book that you should read. Gordon Wiltsie has created a wonderful book, and I highly recommend it.

Tags: To the Ends of the Earth, Gordon Wiltsie, medical, physician, health, wilderness medicine, outdoor medicine, healthline

Permalink | 0 Comments| Email Post

Post your comment

Influence of Fluid Intake on Acute Mountain Sickness

Acute mountain sickness (AMS) is a problem seen at high altitude (usually considered to be above 3000 meters), characterized by a constellation of symptoms that include headache, nausea, dizziness, diminished or no appetite, weakness, fatigue, inability to keep up physically, and difficult sleeping. It ruins many adventures, including ski trips and treks at moderate altitudes, so avoidance is at least as important as treatment.

In the most recent issue of the journal Wilderness and Environmental Medicine, Dr. Maria Nerin and her colleagues report upon a study of a group of mountaineers, in which they documented an association between decreased fluid intake (dehydration) and a higher incidence of AMS. Although their study did not demonstrate statistical significance, it was in support of previous observations in which a similar relationship between dehydration and AMS has been noted.

There are many reasons why persons who ascend to high altitude become dehydrated. They drink less because they have diminished thirst and appetite. Water may be difficult to obtain in a mountainous region, particularly if ice must be melted. It may be a nuisance to carry the extra weight of sufficient water to not only avoid dehydration, but stay extremely well hydrated. Water losses may be greater due to rapid breathing in a cold, dry climate, and increased energy expenditure may consume water during the metabolism of fat, protein, and carbohydrates. Diarrheal illness may contribute to water loss.

One measure of fluid balance is urine output. The mountaineers who were more prone to AMS showed reduced urine output, which indicates that insufficient water was consumed or that water ingested was utilized to a greater degree.

The logical conclusion is that hydration at high altitude must be adequate to prevent or diminish the occurrence and severity of AMS, and perhaps other high altitude disorders that might be influenced by dehydration. The standard rule to drink enough to pee often and pee clear continues to be good advice.

Tags: high altitude, fluid, acute mountain sickness, AMS, health, wilderness medicine, outdoor medicine, healthline

photo by Terry Johnson

Permalink | 1 Comments| Email Post

Post your comment

Removing a Helmet

I’ve mentioned many times the importance of wearing a helmet for safety. That’s especially important for skiers and snowboarders, who are involved in falls and collisions. You need to protect the precious cargo inside the bony box that comprises your skull.

As a Doctor Ski Patroller, I’m often called on to aid a downed skier. If the problem is not related to head and/or neck injury, and the victim is wide awake, then a helmet is straightforward to remove. However, if the victim has altered consciousness (up to and including unconscious) or may have suffered a neck injury, it is important to take extreme care in removing his or her helmet. Remember, a person can be alert and have suffered a severe neck injury without really appreciating the fact that the injury has occurred. This happens if the victim is distracted by pain elsewhere (e.g., a broken ankle or leg), is extremely cold, or even slightly under the influence of alcohol or recreational drugs.

To remove the helmet, follow these excellent recommendations offered by John Nichols, M.D. of the National Ski Patrol System, Inc.:

1) Helmet removal is a two-person maneuver.
2) Have one person (Rescuer 1) maintain in-line (straight) alignment of the victim’s head and neck while the second (Rescuer 2) prepares the helmet for removal (unbuckle the helmet, loosen straps, remove goggles and obstructing objects).
3) Rescuer 2 now moves to hold the victim’s neck and base of the skull from beneath the helmet. The best position for this is below Rescuer 1, who now moves to the head to be ready to remove the helmet.
4) Rescuer 1 now removes the helmet by lifting it straight off in line with the victim’s body, taking care to not flex (bend forward) or extend (bend backward) the head and neck.

The decision about whether or not to remove a helmet in the field is made according to medical necessity. If the helmet is not interfering with a rescue or transport, it may be left in place until medical care is reached. However, if it must be removed, for instance because an airway must be managed or a bleeding point identified, follow the instructions above. Remember to keep the head and neck in line and protected from movement after the helmet has been removed.

Tags: helmet, safety helmet, removing a helmet, wilderness medicine, outdoor medicine, healthline

photo by Paul Auerbach

Permalink | 2 Comments| Email Post

Post your comment

Winter Specialty Meeting on Mountain Medicine - Don't Miss Out!

In a previous post, I wrote that I'm very excited to have been invited to speak at the upcoming Winter Specialty Meeting on Mountain Medicine sponsored by the Wilderness Medical Society (WMS). This continuing medical education (CME) meeting will be held March 16-21, 2007 at Park City, Utah. The focus is upon medical topics related to the mountain medicine aspects of wilderness medicine. These include a preconference workshop on avalanche awareness, rescue, and medical treatment, in part taught by the Exum Utah guides and with input from the Utah Avalanche Forecast Center and the Canyons Ski Patrol. In addition, many of the presentations are designated for credit towards Fellowship in the Academy of Wilderness Medicine, and there is also an opportunity to become certified in Advanced Wilderness Life Support.

Topics that will be covered in the educational sessions that comprise the main meeting include high altitude illness, eye care at high altitude and in the wilderness, medical kits and antibiotics, patient assessment, hypothermia, cold weather hiking and trekking, ski and snowboard injuries, litters and evacuation, lightning, frostbite, and many others.

Special evening programs will be the film "Everest ER: Everest Base Camp Medicine" with comments by an expert panel led by Eric Johnson, M.D., who spent this past climbing season at the medical clinic at Everest base camp each climbing season, and "Impossible Dreams" presented by Geoff Tabin, M.D., who was the fourth person to climb the "7 summits," the highest points on all seven continents.

The conference will be held at The Yarrow Resort Hotel & Conference Center. It should be a terrific event for physicians, nurses, paramedics & EMTs, wilderness medicine educators, and other persons interested in learning more about practical aspects of medicine practiced in the mountains.

The educational programs will be excellent and the snow should be awesome, so I hope to see you all there. The proceeds benefit the WMS, which advances the education, science, and practice of wilderness medicine.

Tags: Wilderness Medical Society, mountain medicine, WMS, medical, physician, health, wilderness medicine, outdoor medicine, healthline

Permalink | 0 Comments| Email Post

Post your comment

Jellyfish in Florida

This time of year, Portuguese man-of-war jellyfish wash up on the beaches in South Florida. When they are in the area, strong breezes directed toward shore drive them into the surf. As the lifeguards and residents in the area know, they can pack quite a punch, even after they are dead and dried up, as the stinging cells may remain active.

In addition to the skin rash, pain, and general symptoms of muscle pain, weakness, nausea, abdominal pain, and vomiting that may accompany a sting, it is extremely important to remember that a sting from a jellyfish can cause an allergic reaction, which can become life threatening. Anyone known to be allergic to jellyfish should carry medications (e.g., antihistamines and epinephrine) with them when they might be exposed to jellyfish.

Here is more information about what to do if stung by a Portuguese man-of-war jellyfish along the U.S. coastline:

1. Immediately rinse the wound with seawater, not with freshwater. Do not rub the wound with a towel or clothing to remove adherent tentacles. Nonforceful freshwater rinsing or a rubbing variety of abrasion (the latter in the absence of simultaneous application of a decontaminant such as vinegar) is felt to stimulate any microscopic stinging cells. that have not already fired. Surf life savers (lifeguards) in the United States and Hawaii have reported that a freshwater hot shower applied with a forceful stream may decrease the pain of an envenomation. Commercial (chemical) cold or ice packs applied over a thin dry cloth or plastic membrane have been shown to be effective when applied to mild or moderate stings. A warm-hot pack at temperature of approximately 40 to 41 degrees Centigrade [104 to 105.8 degrees Fahrenheit] (taking care to not burn the skin) may be even more effective.

2. Acetic acid 5% (household vinegar) is the treatment of choice to diminish pain from the sting. The vinegar should be applied continuously for at least 30 minutes or until the pain is relieved. Other substances that may be effective include isopropyl ("rubbing') alcohol (40% to 70%), dilute ammonium hydroxide (household ammonia), sodium bicarbonate (baking soda), olive oil, sugar, urine, lemon or lime juice, and papain (papaya latex [juice] or unseasoned meat tenderizer powdered or in solution). Perfume, aftershave lotion, and high proof liquor are not particularly effective. Other substances mentioned to be effective at one time or another, but which are not to be used, are organic solvents such as formalin, ether, and gasoline.

3. As mentioned above, antihistamines may be useful if there is an allergic component. The administration of epinephrine is appropriate in the setting of a severe or rapidly evolving allergic reaction.

4. Once the wound has been soaked with a decontaminant (e.g., vinegar), remaining (and often “invisible”) stinging cells must be removed. The easiest way to do this is to apply shaving cream or a paste of baking soda, flour, or talc and to shave the area with a razor or similar tool. If sophisticated equipment is not available, the nematocysts should be removed by making a sand or mud paste with seawater and using this to help scrape the victim’s skin with a sharp edged shell or piece of wood. The rescuer must take care not to become envenomed; bare hands must be rinsed frequently. If a scrub brush or pad has been used to treat the envenomation, this step may not result in as much, if any, clinical improvement.

Tags: jellyfish, Portuguese man-of-war, Florida, wilderness medicine, outdoor medicine, healthline

photo by Larry Madin

Permalink | 6 Comments| Email Post

Post your comment

Thank You to Dr. John La Puma for Grand Rounds

Thank you to Dr. John La Puma for including my post about wild plants and mushrooms in this week’s Grand Rounds. Grand Rounds is a weekly hosted event where a medical blogger recommends notable posts of the prior week from other medical bloggers. This week, food was the featured theme.

Permalink | 0 Comments| Email Post

Post your comment

Another Man and a Boy to Admire

I recently posted twice about the fire storm in southern California, the first with advice about surviving a wildfire from my friend Marty Alexander, and the second with a story about the father of a good friend, who managed to escape and keep himself together in the midst of the conflagration surrounding him.

This post is entirely different, and speaks to the tragedies of injury and death from wildfire, as well as to the bravery and dedication of firefighters. Marty Alexander was contacted by Richard Halsey of The California Chaparral Institute with this story, and requested that I distribute it.

Here goes:

"Friends,

Fifteen year-old Richard Varshock was critically burned during the Harris fire in San Diego County on October 21. He and his father Tom were at their home when the fire hit. A CDF engine company was on scene when a burnover occurred. Richard’s father died in the flames. Several CDF firefighters were seriously injured. Richard remains in serious condition at the UCSD burn unit in San Diego. His mom, Diane, is by his side everyday.

There are times when it is important to come together as a community to help each other out. This is one of them.

The Varshock family did not have fire insurance on their home, which was destroyed by the flames, and their health insurance will not cover much of the costs for Richard’s recovery.

Please consider donating some love. You can do so in a number of ways as described below. I have included two news stories about the incident in addition to attaching a photo of Richard.

Thank you,

Rick

Tax-Deductible Donations Can Be Made To:
Varshock Family Foundation
PO Box 3484
San Diego, CA 92163
Tax ID No. 26-1307576

Schoolmates help out badly burned boy, 15
By Tony Manolatos, UNION-TRIBUNE STAFF WRITER, November 2, 2007

SAN DIEGO – Tributes and support continue to pour in for the family who lost their home and a loved one to last week's wildfires.

Thomas Varshock and his son, Richard, 15, were overrun by flames in the early hours of the Harris fire while trying to save their Potrero home.

The father died and the son is recovering from lung damage and burns to over more than half of his body. He remains in critical condition at UCSD Medical Center in Hillcrest.

Friends and family plan to honor Thomas Varshock, a geological engineer, at a private memorial service today. He was 52, and was one of seven people who lost their lives to the fires, which burned 369,000 acres and destroyed nearly 1,700 homes across San Diego County.

Dr. Raul Coimbra, who oversees trauma, burn and surgical critical care at UCSD, said last week that he expected Richard Varshock and the other burn victims to survive.

Richard is a sophomore at the high school and a varsity wrestler. “He's doing well,” Coimbra said. “He's a big, strong boy.”

Yesterday, Richard's aunt, Julie Varshock, said he was “improving at a rate greater than what the doctors anticipated.”

Julie Varshock said the family did not have homeowners insurance. The Valhalla High School wrestling team has rented and furnished an apartment near the hospital for Richard's mother, Dianne.

His friends are outspoken. “Richard is one of the nicest guys you can meet, so please pray for him."

Burned firefighter anticipated dying
By Tony Manolatos, UNION-TRIBUNE STAFF WRITER, October 27, 2007

Andrew Pikop couldn't outrun the flames that were scorching his back. He heard the helicopter there to rescue him, but he couldn't see it through the blinding smoke and sand. He took cover, first in his fire safety tent and later behind a rock.

As he tried to shield himself, he thought about his family and friends.

“And I thought about how much this is going to hurt – burning to death,” Pikop said yesterday from his hospital bed. “I was absolutely sure I was gonna die.”

Pikop, who turns 24 next month, is one of four Cal Fire firefighters injured while trying to rescue a father and son who fought to save their Potrero home in the early hours of the Harris fire on Sunday morning.

In his first interview, Pikop picked at the white dressings that cover most of his body.

“I'm on a lot of meds, so the pain isn't that bad,” he said. “It hurts when I walk and when I shower. They have to scrape all the dead skin off my back.”

He shares a room in the burn unit at the UCSD Medical Center in Hillcrest with Capt. Raymond “Ray” Rapue, whose face and hands are badly burned.

“When it rains it pours,” Rapue said.

Rapue, 53, was in charge of Pikop and the two other firefighters, whose names have not been released. Both are in critical condition at UCSD.

Information about the firefight has been scarce. Cal Fire has a team of 15 investigating the incident, and everyone involved has been ordered not to discuss the details. But a picture of what happened is beginning to emerge.

Unit Chief Henri Brachais, the lead investigator, said the firefighters were trying to save Thomas and Richard Varshock, whose home is off state Route 94 and Emery Lane in a remote part of San Diego County near the U.S.-Mexico border.

Thomas Varshock died. His 15-year-old son, whose hospital bed is down the hall from Pikop's, has burns to more than 50 percent of his body. On Wednesday, he was covered with a white blanket. His face was bandaged and he was hooked to a ventilator.

Brachais said the fire crew was stopped at the Varshock home when “a burn-over occurred.”

“The fire went up the hill and flames went over the truck,” he said.

Like any other day

For Pikop, the day started like every other Sunday. The crew at the San Marcos station was mowing the lawn and trimming hedges.

Rapue, the captain, was normally based at Cal Fire's Rincon station, one of 18 in the county. He was covering the San Marcos station because the regular captain was off.

The four-member team heard about the fires on the radio, so they weren't surprised when they were dispatched to Potrero, 67 miles away.

The call came in shortly after 9:30 a.m., said Pikop, who started with Cal Fire less than five months ago.

Pikop grew up in the small town of Exeter near Fresno with his parents, Gary and Conselo, and two brothers. An adventure junkie who snowboards and roller blades, he worked as a volunteer firefighter for two years and as an EMS technician for a year.

When Pikop came home from a fire call, his parents sometimes smelled smoke on his clothes, but he always told them he was fine.

“He had a calm attitude,” his mother said. “I think that helped save his life.”

Still, his first call as a volunteer firefighter shook him – he was alone when he arrived at a car wreck that had killed a motorist.

His confidence grew as the calls increased. He sometimes shared his experiences with his 25-year-old brother, Joshua, a U.S. Coast Guardsman.

“I was just amazed at how he handled it all,” Joshua said yesterday. “But he's adventurous. He needs action.”

In May, Pikop finally got the job he'd wanted: a seasonal post with Cal Fire. His contract extended to sometime in November, depending on the severity of the wildfire season.

About two weeks ago Pikop called his brother and told him his first fire season was shaping up to be a bust.

“He thought he was going to get laid off,” Joshua said. “He said, 'There's nothing going on. It's been dead.' ”

Arriving in Potrero

Engine 3387 arrived in Potrero at about 11 a.m. It pulled up to the Varshock residence about an hour later.

What happened next isn't entirely clear, but at some point all four firefighters and the Varshocks took cover in the firetruck.

By then, the fire was raging and Santa Ana winds were knocking down power lines.

“At first I wanted to help my crew get out, but once the fire blew up it disoriented me,” Pikop said.

Somehow he became separated from the firetruck. He heard his colleagues yelling his name, but he was running from flames and couldn't find them.

“I ran through flames. I ran from flames. But the fire caught up to me,” he said.

He figured he was on his own. He assumed the rest of the crew was dead.

Other firefighters working in the Potrero area heard their colleagues radioing for help. They tried desperately to reach the engine, but they couldn't drive through the flames.

A helicopter pilot with the U.S. Forest Service was nearby, dropping water on the fire. The pilot heard the radio calls for help and located the engine from the air.

The pilot, whose name hasn't been released, landed and picked up the three firefighters and the Varshocks from the firetruck. He flew them to a Cal Fire station about a half mile away, then returned to look for Pikop.

About half an hour later, the pilot spotted Pikop and airlifted him to the station. An air ambulance flew everyone to UCSD, where they were admitted at 1:30 p.m.

A few hours later, Conselo and Gary Pikop were making the 6½-hour drive to San Diego. A hospital official was waiting for them in the lobby. It was just after midnight when they saw their son.

“We held his hand, we hugged him and we cried together,” Conselo Pikop said.

Fair condition

Andrew Pikop was listed in fair condition yesterday with first-degree burns to his back, arms and legs. He has second-degree burns on his nose and ears.

When some firefighters came over to his bed to pay their respects, he immediately asked for an update on the wildfires. He is eager to get back to work, he said."

photo is of Richard Varshock

Tags: wildfire, fire, Richard Varshock, Andrew Pikop, survival, wilderness medicine, outdoor medicine, healthline

Permalink | 0 Comments| Email Post

Post your comment

Wild Plants and Mushrooms

Many American consumers have gone “organic” in their eating habits. Some have extended their natural culinary enthusiasm to sampling wild plants and mushrooms. They should be forewarned that this approach requires perfect knowledge about what is safe and not safe to eat. Toxic plants and mushrooms may be eaten by curious children, or by hikers and amateur herbalists who mistake their selections for edible species. Never eat wild plants, mushrooms, roots, or berries unless you know what you’re doing.

There are few specific antidotes for toxic plant ingestions, so most victims are managed according to their symptoms, which may include sweating, nausea, vomiting, diarrhea, shortness of breath, slow or rapid heartbeat, pinpoint or dilated pupils, salivation, increased frequency of urination, weakness, difficulty breathing, hallucinations, and many others.

Some notable toxic plants and mushrooms are as follows:

Oleander is a shrub, up to 20 ft (6 m) tall, commonly found along highways and in gardens. It carries attractive clusters of red, pink, or white flowers. The entire plant is toxic, including smoke from burning cuttings and water in which the flowers are placed. There have been deaths from use of the branches as skewers for roasting hot dogs. Symptoms begin 1 to 2 hours after ingestion and include nausea, vomiting, abdominal cramps, diarrhea, confusion, and blurred vision. In serious ingestions, the heart’s rhythm may be disturbed.

Foxglove is a European import that has toxic leaves and toxic tubular pink or purple flowers. Poisonings occur from ingestion of the plant parts or from foxglove tea. The symptoms are the same as those of oleander ingestion. There is a specific antidote, consisting of injectable antibodies, for this particular poisoning.

Water hemlock (“beaver poison”) is found in salt- and freshwater marshes and along riverbanks. A member of the carrot family, the plant grows to 6 ft (1.8 m) and has clusters of whitish, heavily scented flowers, along with a bundle of tuberous roots. It is easily confused with wild parsnip, celery, or sweet anise. When injured, the stem and trunk exude a yellow oil that smells like celery or raw parsnip. The entire plant is toxic. Symptoms begin 15 to 60 minutes after ingestion and include excessive salivation, abdominal pain, diarrhea, and vomiting. In a serious ingestion, the victim may suffer seizures and collapse, while having difficulty breathing. Death may occur.

Castor bean is a treelike shrub that may grow to 15 ft (4.6 m) with clusters of spiny seedpods, which contain seeds with coats that resemble pinto beans. The seeds contain a potent toxin (ricin) that causes immediate mouth burning and abdominal pain, followed by vomiting, diarrhea, abnormal heart rhythms, and collapse.

Monkshood is a flowering plant with tuberous roots and blue helmet-shaped flowers. The leaves and roots are particularly toxic. Ingestion causes immediate mouth and throat burning, followed by vomiting, diarrhea, headache, muscle cramps, sweating, drooling, blurred vision, and confusion. In a serious ingestion, there may be abnormal heart rhythms and collapse.

Poison hemlock is a marsh plant that grows to 9 ft (2.7 m) with leaves that resemble a carrot top. The white flowers are clustered and smell like urine if they are crushed. The seeds and white unbranched tuberous roots are also toxic. The symptoms are similar to those of water hemlock ingestion, without significant abdominal pain or diarrhea. Death may follow seizures or paralysis with breathing failure.

Pokeweed is a widely distributed plant with clusters of white flowers and plentiful round purple berries. Ingestion of the root (commonly mistaken for horseradish) or the berries (a favorite of children) causes the intoxication. Symptoms include sore mouth, tongue, and throat (delayed by 2 to 3 hours); thirst; nausea; vomiting; abdominal cramps; and diarrhea, which may become bloody. The illness can be severe and last for up to 2 days, particularly if the roots were ingested.

Rhododendrons are common flowering plants that contain a number of toxins. Poisoning has occurred following ingestion of honey made from the flower nectar. Symptoms include mouth burning, followed by drooling, vomiting, diarrhea, headache, and numbness and tingling. Serious ingestions cause weakness, blurred vision, seizures, and collapse.

Jimsonweed has white or purple flowers, with prickly seedpods. Adults sometimes ingest a tea made from the leaves or flowers. The entire plant is toxic. Symptoms include dry mouth, rapid heartbeat, hot and dry skin, weakness, difficulty in walking, dilated pupils, and inability to urinate. Severe poisonings cause fever and collapse.

Skunk cabbage is a marsh and forest plant that grows to 6 ft (1.8 m) and has broad pleated leaves. The entire plant is toxic and causes symptoms similar to those that follow ingestion of monkshood, but generally much less severe.

Pyracantha is a thorned shrub with white flowers and clusters of small red berries. Ingestion of the berries in large quantities causes nausea and diarrhea. Birds sometimes eat fermented pyracantha berries and become intoxicated. Scratches from the thorns may cause a burning skin irritation.

Amanita phalloides (death cap) is a gilled mushroom with a shiny yellow to greenish cap found in the western United States. The entire mushroom is toxic and cannot be detoxified by cooking. Symptoms occur 6 to 12 hours after ingestion and include abdominal pain; persistent nausea, vomiting, or diarrhea; low blood pressure; and rapid heartbeat. The victim may appear normal for the next few days, but then rapidly shows signs of massive liver inflammation and destruction, which include jaundice (yellow skin and eyeballs, darkened urine), easy bleeding, and altered mental status. Fatalities are frequent with this species, as well as with Galerina autumnalis.

Amanita muscaria (fly agaric) is a gilled mushroom with a variably colored (yellow, red, warty, and so on) cap. Most poisonings are intentional, because people brew and drink Amanita tea for its hallucinogenic effects. Symptoms occur 30 minutes to 2 hours after ingestion and include euphoria, difficulty walking, dizziness, hallucinations, and blurred vision. Severe ingestions can result in seizures and death.

Coprinus atramentarius (inky cap) is a gilled fungus with a conical cap that liquefies and turns black when picked. If alcohol is consumed within 24 to 72 hours after ingestion of the fungus, the victim suffers abdominal pain, vomiting, sweating, facial flushing, and headaches. Cortinarius rainierensis may cause the victim to have enormous thirst and increased urination 3 to 17 days after ingestion, due to a toxic effect on the kidneys.

Many other plants (wild and houseplants) can cause illnesses if consumed in sufficient quantities (one apple seed will not poison you). When in doubt as to the identity of a plant ingested, its quantity, or its potential toxicity, it is wisest to immediately consult a certified poison (control) center or a physician.

Tags: plants, toxic plants, toxic mushrooms, wild plants, wild mushrooms, wilderness medicine, outdoor medicine, healthline

photo of foxglove courtesy English Country Garden

Permalink | 0 Comments| Email Post

Post your comment

Nominated for Best New Medical Weblog of 2006!

I just learned that Medicine for the Outdoors has been nominated for "Best New Medical Weblog of 2006." It's an honor to be considered, particularly in light of the other excellent blogs that have been also been nominated.

If you enjoy reading Medicine for the Outdoors and wish to cast a vote of support, follow this link to where you can vote. Votes must be in by Sunday, January 14, 2007. Thanks to Medgadget for hosting this event.

Thanks for being a reader. I look forward to continuing to help keep everyone healthy and safe in the great oudoors.

Permalink | 0 Comments| Email Post

Post your comment

Thank you to Musings of a Distractible Mind for Grand Rounds

Thank you to Musings of a Distractible Mind for including my post about drinking alcohol in the wilderness in this week’s Grand Rounds. Grand Rounds is a weekly hosted event where a medical blogger recommends notable posts of the prior week from other medical bloggers.

As always, I am impressed by the creativity and effort that goes into hosting this weekly event.

Permalink | 0 Comments| Email Post

Post your comment

"Avoiding Disaster In Adventure Travel" by Jay Lemery

I had the good fortune this past year to travel to Everest Base Camp with Dr. Jay Lemery, the director of Wilderness and Environmental Medicine at Weill Cornell Medical College and an assistant attending in emergency medicine at New York-Presbyterian Hospital/Weill Cornell Medical Center. Jay is a rising star in the field of wilderness medicine, and his fondness for the wilderness is matched only by his unrelenting sense of humor.

What follows is a piece that Jay wrote for Science Briefs, an electronic newsletter published by the Office of Public Affairs that focuses on innovative medical research and patient care at Weill Cornell Medical College. I couldn't have done better myself, so I thought I would pass it along:

"Each year, flocks of adventurer-travelers head for the mountains and deserts only to find themselves lost, injured, sick or cold; in a remote place far from help; and with the sun going down. These situations can sometimes turn from anxious to dangerous, and what makes them more unfortunate is often the back story. Many of these misfortunes could have been avoided or minimized if only the travelers had packed certain items into their packs or knowledge into their heads before venturing into the great outdoors.

'People need to remember,' says Jay, 'In the wilderness, help isn't always nearby, and salvation often needs to come from within.'

Obviously, some trips require more preparation than others, but every trip requires some. Below are several tips from Jay that might help you:

Communications

Inform people where you are going, and share your route and expected return date with them. If you're going to a place with rangers, inquire if you should register as a visitor. Have a method to communicate with people in your party as well as civilization. This may require more than mobile telephones, which sometimes have sketchy or no reception in remote areas. A radio may be necessary, and, if it is, know how it actually works and how to properly summon help with it.

Navigation

This section should be divided into two parts: not getting lost and guiding help toward you. Having maps of the area and a compass, and knowing how to read them, will assist with both parts. A GPS (global positioning system) device might also be helpful, but have a map and compass in case the device fails or the satellite is temporarily out of order. 'Carry a source of light and carry a back-up source as well,' says Jay. 'This will help you navigate in darkness and prevent accidents such as falling into a crevasse.' Lights can also signal help if needed. Tiny LED (light-emitting diode) headlamps provide a fair amount of light, and some can work for around a hundred hours on a single set of batteries. Lastly, carry a whistle, which can attract attention or, if lost, guide ground rescuers to you.

Surviving Weather

Especially in mountainous and desert regions, weather and temperatures can change quickly. It is not unusual for the temperature to dip 30 to 40 degrees (Fahrenheit) when nightfall arrives. Cold or warm fronts, with rain, snow or storms can also move in quickly.

To handle these conditions bring clothing that is versatile and dries quickly, such as synthetics, which dry much faster than cotton. Create a base layer that wicks perspiration away from your skin. Create a mid layer that will retain body heat; typically, fleece is used. And, bring an outer layer - a wind and waterproof jacket and pants - to repel the elements. A lightweight foil blanket can also be handy to retain body heat in an emergency. It can function as a wind and waterproof shelter as well.

Injuries and Illness

'Fortunately, most injuries that occur in the wilderness are what physicians call minor trauma - sprains, blisters, or rashes - and the most prevalent medical illness is gastrointestinal upset,' says Dr. Lemery. (Amen. Jay had to help pick me up after I was struck down with a nasty case of diarrhea in Nepal.) Pack a first-aid kit with tape, bandages, gauze and antiseptic solution, and most minor traumas can be kept from becoming major ones. A key point is to administer treatment quickly in order to avoid infection. For example, when you feel a hot spot on your foot (a blister forming), stop and wrap it before it becomes infected.

Be careful of sunburn, too - another common minor trauma. Bring a wide-brimmed hat, sunglasses, and sunscreen for protection. Ideally, bring clothing that offers complete coverage in case you're lost or stranded and run out of sunscreen. Remember the same clothing that keeps you dry or warm can also shield you from the sun.

For gastrointestinal upset, over-the-counter antacids and anti-diuretics are usually sufficient. However, if the illness persists for more than several days or worsens, you probably should break your route and seek medical attention. Most people get gastrointestinal upset from drinking contaminated water or eating contaminated food. Having a method to (disinfect and) purify water (such as iodine tablets or filters) and an adequate non-perishable food supply can reduce the risk of getting GI distress in the first place.

Insects

If going to a subtropical area where malaria is present, take prophylactic medications (typically, Chloroquine or mefloquine) to protect against malaria. In all areas, insect repellent, long-sleeved clothing and netting can help prevent insect bites and ward off the annoying 'buzz' that prevents a good night's sleep. Consider an EpiPen (or Twinject) if someone in your group has known allergies to insects.

Rescue and Evacuation

And finally, what if something really goes wrong? 'Ask for help,' says Dr. Lemery. 'Don't hold strong and fall into even greater danger.' Keep in mind, however, that help is not always free. Rescue squads usually charge for their services as will medical providers once the helicopter gets back to civilization. Sometimes your regular medical insurance policy will cover medical expenses (check your individual policy) but, if not, a traveler's medical insurance and 'rescue insurance' policy can save considerable expense. These work like most kinds of insurance. Holders pay a premium and are entitled to services if needed.

Travelers in certain areas might also want to consider contracting with an evacuation company. These companies usually know how to navigate local politics and can evacuate clients from a region or country - often very quickly. In areas with poor medical facilities, an unstable political situation, or the propensity for natural disasters, contracting with an evacuation company can be helpful. These companies frequently function like insurers. You buy a policy and summon help if needed."

Thanks, Jay. Let's go on another adventure...

Tags: travel, adventure travel, travel medicine, wilderness medicine, outdoor medicine, healthline

photo of Dr. Jay Lemery by Paul Auerbach

Permalink | 0 Comments| Email Post

Post your comment