The Value of Pre-Acclimatization

We encourage everybody to who is planning on the climb of Rainier to make an effort to visit high altitude prior to the course. This is easier for some than others. Look back to this blog for more details!

Physical Preparation for Rainier

Now it’s time to think about our climb to Rainier. Physically preplanning your summit day will enhance your chances of getting to the top, and enjoying it. If you have not been exercising, do so now. Cardiovascular fitness will be key. Engaging in activities specific to the goal will be important. Running and/or walking around with a heavy backpack (at least a third of your weight) for 30 minutes for 3 times a day will help. Get your heart rate up to 80 percent of maximal (220 minus age is your “maximal”-an easy formula). Cross train at least once a week doing a favorite activity, preferably climbing and or swimming for overall conditioning. If you are not fit, start your exercise slowly. If you are in good shape, you can double these workouts.
Increase complex carbohydrate intake (pasta for example) once you are doing this regimen, unless you need to shed a few pounds. In the latter case, decrease carbohydrate content, but keep protein intake the same. Substitute red meat intake for chicken or fish, or beans with corn or rice. Stop smoking, and if you have any health problems or are over 50, get a medical exam if you haven’t done so before.
If you are around high altitude, begin acclimatizing. This will be crucial. Initiate by going up to 8,000-foot elevations once or twice a week to walk in the first week for at least 2 hours. If possible, spend three days over 8,000 feet the second week, with a sojourn to 10,000 feet, walking. Spend the third week doing three of your routine workouts over 8,000 feet, going to at least 80 percent of maximal heart rate for 20-30 minutes. If adventurous, do one of your workouts at 10,000 feet. Rest at least a day between workouts.
Continue this the fourth week, especially if you were unable to do this routine during week 3. For the fifth and sixth week, if possible, add a hike (with a backpack) to 12,000-14,000 feet, or whatever is highest for you. Keep well hydrated at all times, and consider drinking “Endurox” or “Accelerade” to your hydration regimen. For “extra credit,” sleep above 10,000 feet once a week on weeks 3-5.
This regimen should reduce your chances for high altitude illness. Before you undertake this suggested program, MAKE SURE YOU CLEAR IT WITH YOUR PERSONAL PHYSICIAN FIRST, AND DO NOT UNDERTAKE THIS PARTICULAR REGIMEN IF YOU HAVE CARDIOPULMONARY DISEASE OR OTHER ILLNESSES THAT MIGHT FLARE UP AS A RESULT OF THIS REGIMEN. AND EXERCISE CAUTIOUSLY AT ALTITUDE IF YOU HAVE HAD PROBLEMS AT ALTITUDE BEFORE. You may contact us for further information.
dario

One of our Rainier participants writes:

" I am looking forward to the conference in just a couple of months. I was wondering if you knew through your blogging or people signing up.....if there are any folks sharing rides from SEA TAC down to Ashford for the conference? I was hoping to rideshare with some one, pay for gas, etc..."

Now is the time to but tickets to Seattle and make travel arrangements. I can help coordinate rideshares if there is interest. Send an email to info@mmmedicine.com

Cheers,

Joe Alcock

Arriving in Seattle

When you arrive at the Seattle-Tacoma (SeaTac) airport, you may find a spectacular view of Rainier to the south. The anticipation of a new, and different medical conference rises in your mind, and the anticipation of summiting this beautiful, Fuji like peak creates excitement. You might not even know much about high altitude, but you know you will after the conference. You have been running and training a bit at the gym in order to prepare you for a more adventurous type of CME. But you forgot a few supplies. No worries, because beautiful Seattle has it all! You can go to REI at 222 Yale North in Seattle (phone 206-223-1944, see http://www.rei.com/seattle for store locations) to load up or rent equipment for our excursions. Besides, a little detour is worth it. Nearby boasts the Space Needle, built for the World Expo in 1962, with a surrounding park, zoo, and museums (http://www.spaceneedle.com/restaurant). You might even plan to stay by the seaside community of Queen Anne and eat seafood overlooking the spectacular waterfront.

The Puget Sound, and the surrounding islands are rich with open air markets, kayaking possibilities in the San Juan Islands, fishing, and excursions to Victoria Island. Before or after the conference, Seattle is not to be missed! TripAdvisor.com can keep you apprised of good places to stay. Your family will enjoy these options, as well. Don't hesitate to contact us at worlddoc@comcast.net for more information.

Telluride Mountainfilm 2008

The 30th Mountainfilm in Telluride, Colorado will be held on May 23 - 26. This is a four-day experience that draws athletes, artists, and activists from around the world. The wide range of short and feature length films aims to inspire and challenge the audience. Mountainfilm in Telluride seeks to explore critical and compelling issues the world is facing while showcasing the art of documentary and filmmaking.

A few highlights from the upcoming lineup of non-film events include:
“Moving Mountains Symposium on Water”
“Tribute to the Late Sir Edmund Hillary” hosted by David Breashears
“Foreign Policy Roundtable, Hot Spots Around the World” with Christiane Amanpour, Richard Holbrooke, Roger Cohen and Samantha Power
“The Village Green,” a discussion Ashton Hayes, England, and its efforts to be carbon neutral

Big names in the world of travel, art, adventure, and environmental awareness will grace the event. Early bird tickets are on sale until May 1. For more information please visit mountainfilm.org.

International Activities-A Refocus

Our phenomenal month with our wilderness medicine class has catapulted us to many activities in the wilderness and international medicine scene. Our Mount Rainier 2008 conference on July 31 to August 3 is gonna be amazing, and many of you know about it. But in the works is an amazing international emergency medicine conference in Buenos Aires, Argentina. On June 11-13, we will join in with the American College of Emergency Physicians (ACEP) and the Argentine Society of Emergency Medicine (SAE-Sociedad Argentina de Emergencias) to bring participants an exceptional educational event, whether you speak Spanish or English. Not only will talks on emergency and wiliderness medicine be given, but a unique opportunity to meet with the "movers and shakers" in emergency medicine throughout the Americas will be there. And don't forget the Patagonia backcountry skiing and jungle tours to take place after the conference! More information can be found at http://internationalemergencymedicine.blogspot.com.
Also in the makings are a four day mountain medicine survival course in October, and an opportunity to participate in many other activities in the future. Feel free to mail us at mail@mountainandmarinemedicine.com for more info!

Congratulations to Wilderness Medicine Class Participants

Our March Wilderness Medicine Class at the University of New Mexico was our best yet! Congratulations to our student and physician participants. We wish you well in all your future endeavors.

Our next course will be our Mt. Rainier High Altitude Medicine Course this July 31 - August 3, 2008.

Sneak Peak of upcoming courses: events for the upcoming fall and winter will include a some courses a little closer to home here in New Mexico. We are busy planning a weekend survival course in a spectacular little-known wilderness area and a wilderness medicine course for non-medical providers!

Check back for more details!

Joe Alcock MD

Wilderness Medicine Tip of the Week

Woman killed by Eagle Ray! Mortality from stingrays is increasingly reported. Read on...

The LA times today reports that a woman encountered a stingray that leaped into the boat she was traveling in. She may have died from a wound inflicted by the calcium carbonate barb of a full size eagle ray (example pictured above).

The UNM wilderness medicine class visited the stingray exhibit 2 days ago for a scenario-based learning experience; marine stings were discussed in great detail at the Albuquerque Biopark aquarium. As we discussed, approximately 4 instances of stingray barbs penetrating the heart have been reported in Australia. Most readers no doubt are aware of Steve Irwin's well-publicized untimely death by this mechanism. Exsanguination and arterial lacerations have also caused human deaths.

Short of cardiac penetrating trauma, first aid consists of immersion of the affected extremity in non-scalding hot water. The venom that surrounds the calcium carbonate barb is heat labile. Prompt hot water treatment results in impressive pain relief. Xrays may be necessary to rule out retained foreign bodies. Tetanus vaccination is indicated - as in all lacerations. Be aware that marine injuries may be complicated by unusual pathogens - such as Vibrio species and Mycobacterium marinum.

The best approach is to avoid being stung altogether. Most bathers can avoid injury by shuffling their feet when entering the water. Otherwise - avoid cornering a large sting ray in shallow water - as Steve Irwin reportedly did. The recent death of the boater encountering a leaping ray, while seemingly bizarre, has been reported more than once in Australia. If a ray leaps into your boat, you may just be out of luck! Be aware that the stinging barb is located about 1/3 of the distance down the tail from the body of the fish.

Finally, note that hot water is the treatment of choice for most penetrating marine stings, including stonefish, scorpionfish, even invertebrate stings such as urchins. Hot water is increasingly recognized as effective treatment for box jellyfish stings and portuguese man of war stings. More on that later!

Médecine de la montagne/Medicina de la montaña

For Francophones and Castillano wilderness enthusiasts:

Médecine de la montagne et de l’environnement.
Ici vous avez un site pour l’information sur la pratique de médecine dans les terrains extrêmes, et la médecine “d’improvisation.” Il y aura des podcasts sous cette rubrique en français dans l’avenir. Notre conférences sur la médecine de la montagne à Quito Equateur et Chamonix faisaient un, no, deux tabacs! Nous avons un mois de médecine de l’environnement chaque mars à Nouveau Mexique, et nous aurions notre prochaine course de médecine de la montagne à Mont Rainier, dans l’état de Washington. Nous sommes en train de collaborer avec l’Ifremmont (www.ifremmont.org) pour developer la formation de médecine de l’environement en français et anglais. Voilà une photo de notre course de survie et navigation dans le désert de Nouveau-Mexique. Vous pourriez nous contacter a www.mountainandamrinemedicine.com/contact/ pour plus d’infos.

Medicina en ambientes extremos
Aquí hay un sitio dedicada a la medicina en terrenos remotos, incluyendo medicina en el yermo y medicina improvisaciónal. Para los hispanohablantes, hemos proporcionado “minicursos” sobre estos tópicos. Infórmense aquí en este sitio lo que estamos haciendo en cuanto de la capacitación de un tópico muy interesante. Recientemente, hemos hecho un congreso de mal de montañas y altura a Quito Ecuador y Chamonix Francia, un curso de buceo en Bonaire (al mar caribe) y tendremos un congreso a Monte Rainier, en el estado de Washington. Hemos hablado en el congreso internacional de la Sociedad Mexicana de Medicina de Emergencias (a México, DF.) sobre la tema de “Hipotermia,” y vamos participar al congreso de la Sociedad Argentinas de Emergencias, a Buenos Aires el 11-13 junio 2008. La foto es una foto de navegación y supervivencia en el desierto de Nuevo México. Escriben al sitio de www.mountainandamrinemedicine.com/contact/ para mas información. También hay información sobre el sitio de www.reeme.org.

Bizarre death in Chamonix

According to reports, a man fell from a cable car (gondola) in Chamonix, France to his death. The gondola was one that travels to get to Planpraz, the mid-station to Le Brevent. This is of interest, because I took that gondola as did many of the Chamonix High Altitude Medicine participants during our marvelous excursion and course there last summer.
Read more
http://snowheads.com/ski-forum/viewtopic.php?t=37292

This is what the area looks like in winter.

Link to description of our course in July, 2007.