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Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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The 23rd Annual Meeting of the Wilderness Medical Society


"Come all who need rest and light, bending and breaking with over work, leave your profits and metallic dividends and come..." John Muir, 1874

I'm in Snowmass, Colorado at the 23rd Annual Meeting of the Wilderness Medical Society, an organization near and dear to my heart. Each summer, the WMS members and other health care providers come together to learn of new advances in the field, attend continuing education sessions, learn field techniques, and share a passion for wilderness medicine.

The program for this meeting is one of the finest ever offered by the WMS, and has been focused to a certain degree on supporting the educational requirements of candidates for Fellowship in the Academy of Wilderness Medicine. In addition, there were two terrific pre-conference events - a "Toxicology in the Wilderness Symposium" and the Advanced Wilderness Life Support (AWLS) course. Workshops included "Core (fitness) Training in the Outback," "GPS Navigation," "Improvised Splinting," "Litters & Packaging," "Medical Volunteering in Developing Countries," and many others.

We learned from many of the masters: Peter Hackett on altitude medicine, Peter Kummerfeldt on survival, Eric Johnson on dive medicine, Luanne Freer on women in the wilderness, and Mel Otten on heat illness, to name a few. Dr. Hackett, who is Director for The Center for Altitude Medicine in Telluride, Colorado, offered his views on the latest on altitude medicine. He mentioned that current scoring systems used to grade acute mountain sickness (AMS), such as the Lake Louise Score and AMS Score, may not be any more useful than the simple observation by a victim that he or she “feels sick” or complains of a headache. The headache can be graded with a simple “1-10” grading system or an analog visual grading scale.

He also noted that in the Annapurna region of Nepal, awareness of AMS among the general population that travels to this region is increasing, as estimated by the increasing use of preventive drugs, such as acetazolamide (Diamox) and a decreasing incidence of AMS. Another observation is that susceptibility to AMS appears to be related to genetic predisposition, prior history of AMS, and rate of ascent (more rapid being worse). There are data to suggest that a brief (e.g., a few days) stay at altitude within two months of another, more prolonged stay, may aid in acclimatization. Interestingly, persons seem to have a lower threshold for pain at altitude. “Triptan” drugs, commonly used to treat migraine headache, are effective approximately 50% of the time for the headache associated with AMS. A very useful therapy for the headache of AMS is acetazolamide (Diamox) 125 mg by mouth twice a day.

Dr. Hackett explained that acetazolamide (Diamox) is very effective for prevention and treatment of AMS. It may be used in low doses for this purpose – 125 mg by mouth twice a day. A low dose (62.5 mg) may be used at dinnertime to improve sleep. Gingko biloba, which comes from the world’s oldest living tree species, has been touted as an effective agent for the prevention of AMS. It is essentially harmless to administer, but there are no definitive data to recommend its use. Sildenafil (Viagra) may be used to prevent and treat high altitude pulmonary edema (HAPE) because of their effect to lower pulmonary artery pressure, which is felt to contribute to the vascular leak that generates fluid in the lungs. Dr. Hackett will be studying the use of tadalafil (Cialis) to prevent and treat HAPE.

This evening's special presentation will be "Maps, Midwives, and Medicine Men: Using GIS and Ancient Healing Wisdom to Save the Amazon in Six Dimensions," delivered by Mark Plotkin, Ph.D., one of the world's foremost ethnobotanists and President of the Amazon Conservation Team.

This morning, I completed the "Run for Research" on mountain trails. Despite being nearly a "running relic," I crossed the finish line in first place for the men's division for the short course of 1.7 miles. I was pretty impressed with myself until I discovered that I was the only male entrant in the short course. Everyone else toughed it out on the big hills, but at least I was there at the finish line to offer my congratulations.

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Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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