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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 2

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This is the second installment of the tale by Dr. Grant Lipman of Stanford University about his recent experience with Racing the Planet:

After two days, we're in San Pedro de Atacama. The athletes are trickling in, the sky is the phenomenal pure blue of the high desert, and old friends are meeting new friends. It is now time to sort through the medical supplies, to "prep" our medical tent, which will hopefully remain empty. Since it likely will not, we will hopefully be prepared for anything. As one of my mentors likes to say, “If you're prepared, it is not an emergency.”

Little things can make a big difference. For instance, a pregnancy test will help us differentiate between the nuisance of menstrual cramps and a potentially catastrophic ectopic pregnancy requiring prompt evacuation. Each member of the medical team has a mobile cardiology kit, containing the one medicine found to save more lives than any other during a heart attack, namely, aspirin. In the spirit of mundane treatments, we will all carry emergency soda as a beverage – I've found that the quick shot of "high octane" sugar and nausea-settling affects of carbonation have made the difference between an athlete’s collapse and having him or her continue the race.

As the competitors roll into San Pedro de Atacama, the medical team is all geared up, getting amped to see some action. Dr. Marla, Dr. Jay, and Dr. Alice are looking forward to what is sure to be a memorable and beautiful Racing The Planet event.

One malady we're hoping to avoid is the bane of desert living (indeed, of all adventure travel) - diarrhea. For the desert racer, hygiene is an often overlooked necessity. While concentration and concern regarding electrolytes, pack weight, quality of gaiters, and the best tasting dehydrated food may take center stage, nothing will extinguish an athlete's fire like a case of explosive diarrhea.

To avoid diarrhea: 1) always use hand wipes or alcohol-based hand gel before putting hands to food to mouth, 2) always clean your hands after using the bathroom, especially if you've had a bowel movement, 3) pee or poop at least 50 meters (roughly 150 feet) away from camp or checkpoint or trail if you need to relieve yourself. It's too easy to track through "something," which gets on your hands when you remove your shoes, gets on your food when you eat, gets in your gastrointestinal tract when you swallow your food, and can lead to nasty diarrhea, which can lead to (best case scenario) chafing, and (worst case scenario) dehydration, metabolic issues, and collapse.

The first day of racing is over, and the runners are all safely tucked into their sleeping bags. After a mucho frio morning start, the day turned hot. The campsite was stunning, on a high plateu with the glaciated Andes stretching along the eastern skyline. It was warmer this evening, and the medical tent was not too busy. The tent this year is a massive double-sized version that I have dubbed "Casa de Medical." The medical team has stretched out in luxury, eagerly waiting the walking wounded. One poor guy’s feet look awful, with the skin of both soles completely torn off. I have never seen athlete complete a race with this kind of injury, because every footstep would be excruciating. I patch him up best as I can with some desert origami, and wish him luck. Wisely, he elects to not continue the next day.

What really caused the *#%*! to hit the fan today was not ugly feet, but rather, an old testament-styled plague of vomiting and diarrhea that swept through camp in the first 24 hours. It seems like half the competitors and staff were stricken with it. Rumors and speculations persist as to the cause - from a suspect empanada to San Pedro drinking water. Regardless of the cause, the majority of competitors responded well to supportive care with our "desert cocktail" of anti-nausea medications, antacids, and loperamide (Imodium) as needed.

My personal approach to treating diarrhea is to let it declare itself. If a person only suffers a few episodes, I treat it symptomatically. But if someone has more than four or five loose unformed stools, particularly if there are other symptoms (such as nausea, vomiting and/or fever), I prescribe an adult a dose of ciprofloxacin (750mg). Usually, within 18 to 24 hours the diarrhea is gone. We’re careful to note that if the diarrhea turns bloody or the patient looks very sick, we presume that he or she is suffering is a more virulent disease, such as dysentery – and that the athlete’s race is over. We keep our fingers crossed that it does not become too severe. Back home in Palo Alto, widespread diarrhea and vomiting would most likely be caused by a virus and self-limited, but out here with 125 miles of running at high altitude on the horizon, rapid treatment of presumed bacterial diarrhea is a necessity. Luckily, the runners do a fantastic job staying well hydrated, The often heard query at checkpoints of "have you peed?" was almost always answered with thumbs up and smiles.

Days in the desert have an Alice in Wonderland character. They stretch into one another, so that a person quickly loses track of the length of stay. Day 1 of desert racing was hot and high altitude performed a number on most competitors, with the relative lack of ambient oxygen per breath hitting them hard on the high passes. It was truly amazing that the fleetest runners did it so fast and in such style.

Day 2 of competition was notable for amazing water crossings, big sand dune descents, the media team recovering from their own illnesses (in the Atacama crossing - no one is spared), and painful feet. Dr. Marla single-handedly operated the medical tent with her usual upbeat and calm demeanor. When I arrived more than four hours later, she had not moved from her blister-curing lotus position. She gave me a Buddha-like smile and kept cranking. The competitors were great about putting their names on waiting lists, getting dinner, and then when their treatment reservation was called, coming in for care. Dr. Jay arrived later, having gotten swept up in the end of the course. He had been chaperoning a competitor who had become a bit lost, before finding himself right where he needed to be.

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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