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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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Medical Care for Ultra-Endurance Desert Racing

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Two weeks ago, I was preparing to put up a series of guest posts by my friend and fellow emergency medicine colleague at Stanford University, Dr. Grant Lipman, when the A (H1N1) influenza situation rose in priority. So, medicine for the outdoors took the back burner. Now, I'm happy to report that the avian flu situation is settling sufficiently to allow me to get back to the usual theme of this blog, which is wilderness and outdoor medicine.

Dr. Lipman is a lead physician for Racing The Planet, and recently returned from another stint as a race physician. He has graciously written three diary posts for this blog, the first of which appears here.

Desert Racing

Grant S. Lipman, MD

I have seven huge boxes of medical supplies filling up my extra room and more are arriving every day. It is a harbinger of the adventures to come. Luckily, most members of the medical team are from Stanford and live nearby. They're coming soon so that we can divvy up the goods - the easier to get by the airline shipping regulations and keen eyes of international customs agents. I'm definitely starting to get excited for San Pedro de Atacama and all the fun to be had with Racing The Planet! The athletes will be running 150 miles in seven days, while carrying all of their own gear and food for the week, at high altitude and among some of the most treacherous cross-country terrain in the world. Good fortune, I hope...

There is a lot of concern about running at high altitude. While air at all altitudes contains 21% oxygen, the higher you go in elevation, the lower the barometric pressure, so the more dispersed the oxygen becomes in a low pressure environment. At altitude, you will be taking more breaths to obtain the same amount of oxygen ("O's"). At 19,000 feet, because of the declining barometric pressure, there is only 50% of the inspired oxygen per breath than exists at sea level. On the summit of Mount Everest (29,029 feet) - the oxygen content is only 23% of that at sea level!

San Pedro de Atacama is at a lofty 2400 meters (about 8000 feet) above sea level. Arriving in town, you may feel a bit more winded than usual carrying your bags into the hotel. No, you have not lost your hard-earned endurance and stamina. Rather, you're feeling the effects of high altitude. While few people suffer from serious altitude illness here, there are still a few simple measures one can do to prevent feeling unwell. These measures include drinking lots of fluids - so, hydrate hydrate hydrate. (A good rule for reading medical advice is if it is said three times in a row, it must be important.) Avoid ingesting alcohol, eat a diet comprised of 70% carbohydrates, and do not take any respiratory depressants (alcohol, sleeping pills, and so forth). Take ibuprofen for a headache (a study soon to be published shows ibuprofen taken as three therapeutic doses prior to ascent may prevent both the frequency and severity of high altitude headaches). Avoid excess exertion the first couple of days at high altitude, warm up slowly prior to exercise, and most important, allow your body become acclimatized. If I find that someone has a history of altitude sickness or are feeling poorly (headache, nausea, fatigue, winded... like a hangover, but without the preceding inebriation), I direct them to find one of the medical team or Racing The Planet staff members immediately.

It seems that it takes two days to get almost everywhere in the world. There is a minimum of one day of international travel to arrive to the country in question, breathing recycled air, eating unhealthy food, suffering poor sleep, and if one is really lucky - listening to crying babies and nurturing deep vein thromboses while riding in cramped conveyances. Day Two involves inter-country travel. Luckily, Chile has fantastic roads and prompt national airlines.

Now, the old "me" would have spent the eight-hour airport layover ensconced on a comfy chair, feet up on my duffel bag, earphones glued in place, sleeping the one-eye-open sleep of international travelers everywhere. But the new "me" (traveling with my lovely fiancé Ashlie) has come to appreciate a day hotel, with showers and soft beds. The wilderness will come, but there is time for one last pamper!

Preview the Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 24-29, 2009.

Join me from January 24 to February 2, 2010 for an exciting dive and wilderness medicine CME adventure aboard the Nautilus Explorer to Socorro Island, Mexico to benefit the Wilderness Medical Society.

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About the Author

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

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