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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Mountain & Wilderness Medicine World Congress

I just returned from Aviemore, Scotland, where I attended the Mountain & Wilderness Medicine World Congress, sponsored by the Wilderness Medical Society and the International Society for Mountain Medicine. I have been to many similar meetings over the past three decades, and I cannot recall a more interesting and informative gathering. The experts gathered to present their knowledge and experience were nothing less than phenomenal. Furthermore, we were hosted by the Highland Council and Cairngorms National Park Authority, which treated us to a traditional opening performance by a Scottish bagpiper, drummer and dancer, and then a delightful reception. The closing dinner was emotional and uplifting, featuring presentation of the World Congress Awards to Doctors Jim Milledge from the United Kingdom and Robert “Brownie” Schoene from the United States. Each has made extremely essential contributions to our understanding of high altitude physiology and medicine, and more important, continue to serve as inspirational role models and mentors to researchers, doctors, and explorers. The dinner was festive indeed, as we clapped in rhythm to the traditional march of a kilted Scotsman who ceremonially presented the haggis, toasted old and new friends with superb single malt scotch donated by the nearby Dalwhinnie distillery, and did our best to keep up with the young medical students as they danced with exuberance during the Ceilidh.

The educational sessions were too numerous to mention here, but here are some of the highlights: low altitude medical problems at high altitude; high altitude training for the competitive athlete – pros, cons, and individual differences (including a discussion about whether or not this practice should be banned); diving medicine – a North Sea perspective; the brain at altitude; the lungs at altitude; history of mountain medicine; hypothermia; update on frostbite; education in wilderness and mountain medicine; extreme altitude and the Caudwell Xtreme Everest expedition; medical problems of mountain guides and porters; infectious diarrhea; controversies with commercial expeditions; mountain rescue; cave rescue; anthropology, physiology, and illness in the Andes: youth expeditions; creating accessible challenge with disabled adventurers; avalanche rescue; wilderness dentistry; and a remarkable presentation about climate change and social problems observed within Inuit communities during a kayak adventure into the Northwest Passage.

As has been the case at previous wilderness medicine world congresses, there were quite a few scientific abstracts presented. Beginning with this post and a few subsequent posts, I will report to you some of what we learned from the abstract presentations.

In “Observation on ultra-microstructure of chorionic villi of placenta in low birth weight neonate in high-altitude districts,” Xin-Hua Bai and colleagues described the observation that low oxygen environments in high-altitude districts may be linked to low weight at birth, correlated with demonstrable changes in the size and structure of the placenta, which indicate that the placenta may not function differently than it does at lower altitudes.

A persistent difficulty in high altitude research is that quantifying subjective symptoms of acute mountain sickness (AMS) is difficult, due to variability in interpretation of questions asked to victims. The most commonly used method, the Lake Louise Consensus Questionnaire, allows determination of a diagnostic threshold for symptons, but does not provide for sensitive comparisons of symptom severity. In “Characterisation of the symptoms of acute mountain sickness using a seven-part visual analogue scale,” J. Kenneth Baillie and colleagues described a visual analogue scale (VAS) in comparison to the Lake Louise Score (LLS). They noted that the VAS and LLS did not correlate well, and felt that the VAS would be at least as good, if not better than the LLS, in that it was reproducible and did quite well in the areas of identifying an incriminating headache, observation that “I feel my worst,” and to a certain extent, difficulty with sleep.

Baillie and colleagues also presented an abstract entitled “Oral antioxidant supplementation does not prevent acute mountain sickness.” Their research was based on the notion that reactive oxygen species may have an effect on the blood-brain barrier that would allow fluid to leak into brain tissue, thus perhaps causing the symptoms of AMS. To investigate this notion, they compared a treatment group that ingested a daily dose of antioxidants (including ascorbic acid, tocopherol acetate, and lipoic acid) with a control group that ingested a placebo, during an expedition to 5200 meters (17,056 feet). There was not difference in AMS incidence or severity between the treatment and placebo groups.

More abstracts to follow…

photo of loch from summit of Cairn Gorm by Armin Grewe

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About the Author

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