Wilderness Medicine – As The Crow Flies

Do it yourself iron supplement

I suspect I’m anemic. In the Hesperian books “Where there is No Doctor” and “Where Women have no Doctor”, they recommend putting a clean piece of iron, like an iron nail, in a little lemon juice for a few hours. Then making lemonade with the juice and drinking it.

I wasn’t sure if my nails were all iron so I’ve been soaking water and lemon juice in my cast iron skillet and drinking the water. I’m feeling less anemic now.

Note: You can download all of Hesperian’s books at http://www.hesperian.org/ for free.

Urinary Track Infections(UTI) on the trail

When I suspect a urinary track infection I:

Drink plenty of fluids

Take vitamin C. It’s supposed to make your urine so acidic that bacteria can’t live in it. For UTIs, Outward Bound Wilderness First-aid recommends taking 1 gram of vitamin C 4 times a day.

If those don’t work I take antibiotics. I usually carry the antibiotic– Septra DS or the generic equivalent. You’ll need a prescription. The generic version is only 4 dollars at Walmart. They are worth the weight to be able to take care of myself. Finding a doctor to prescribe them and a pharmacy to fill them can seem like an insurmountable task when I’m sick and on the trail. Septra DS can also be used for other kinds of infections.

Recommended dosage of Septra DS 80/160 is twice a day (3 days for bladder/urethral infections, 10 days for kidney infections)

From “Where Women have no Doctor“:

Bladder infection signs:

• need to pass urine very often. (It may also feel as though some urine is still left inside.)
• pain or a burning feeling while passing urine
• pain in the lower belly just after passing urine
• urine smells bad, or looks cloudy, or has blood or pus in it.
(Dark urine can be a sign of hepatitis.)

Kidney infection signs:

• any bladder infection signs
• fever and chills
• lower back pain, often severe, that can go from the front, around the sides, and into the back
• nausea and vomiting
• feeling very ill and weak
If you have signs of both a bladder and a kidney infection, you probably have a kidney infection.

From “The Thru-hikers Medical guide”:

The development of fevers, vomiting or pain in your back could signify that the infection has spread to the kidneys. Kidney infections can be serious, so go to the ER if flank pain or fevers develop.

Phrophlatic pain relief—maybe not such a good idea.

I used to take ibuprofen almost every day when I was hiking.

I remember on my first hike of the PCT(Pacific Crest Trail) having to buy 5 little bottles of ibuprofen just to finish the last 90 miles.

On my last day on the Appalachian Trail, I got up early, swallowed every last pain reliever I had, and said, “That’s enough to get me up Katahdin; I don’t know about back down but I’ll make it up.”

No one should take as many pain relievers as I did. It’s a wonder I didn’t end up dead. In later hikes I felt I could use less ibuprofen by taking it prophetically in the morning before the pain started.

This article, “Does Ibuprofen Help or Hurt During Exercise?”, says taking ibuprofen before and during exercise could have a detrimental effect on your health and performance.

Good thing I don’t need pain relievers anymore. My last two thru-hikes of the PCT, I hardly used any pain relievers. I attribute this miracle to taking Acetyl L-Carnitine HCl & Alpha Lipoic Acid.

I started taking it to improve brain function. Old mice given Acetyl L-Carnitine HCl & Alpha Lipoic Acid were able to to run a maze as fast a young mice. The scientist said this pointed to an increase in mental function.

Maybe the reason the old mice could run the maze as fast as the young ones is the supplement stopped their knees from hurting….that’s what it did for me.

Related post: The Cure for Sore Knees (I think)

Super glue with brush on applicator

This is the kind of super glue I carry to repair cracks in my feet—the kind in a bottle with a brush-on applicator. It’s the best vehicle for carrying and applying it—it doesn’t break open and it’s easy to apply.

I got mine at Walmart in the office supplies aisle.

Super glue is easy to find in the towns along the trail but the kind with the brush on applicator is not, so, I get a bottle before I leave. Mine weighs .4 ounces full.

Here is a link to a physicians forum discussing using super glue to close wounds and cracks.

Related Post: Cracked feet

Giardia meds

Stewart Anderson, MD of The Thru-Hikers Medical Guide fame, recommends carrying, “Flagyl OR Tinidazole for chronic diarrhea (Giardia)–(Tinidazole is only one time dosing, so I prefer it)” So, I thought I’d carry Tinidazole instead of metronidazole(flagyl) this trip.

I wish I had known that (1) it is really hard to find a pharmacy that has Tinidazole. And (2) Tinidazole is expensive–30 dollars for one dose from Wallgreens– were as Metrondidazole(flagyl) is only 4 dollars at Wallmart.

So if you are going to get Tinidazole be sure and order it well in advance, so it will be there before your trip. Walmart said that they would order it and it would be about 1/2 the price of Wallgreens, but I need to get hiking, so I bought it from Wallgreens.

Wilderness Medicine book

My benevolent son bought me this Wilderness Medicine book. I’ve wanted it for a long time but didn’t want to part with the money. I have the field guide by the same author but this book has a lot more detail, better pictures and more information. It’s a great book for people who might want to form a plan for when they get hurt in the wilderness besides lay in the dirt and mewl for help.

It has lots of ways to improvise first aid treatment. For instance, this nifty way to close a gaping head wound.

Possible solution to the “anemic” feeling hiker.

Somewhere in the Sierras, I got tired. It got hard to go uphill. I was slow and out of breath with any uphill. I suspected I was anemic. One afternoon I sat down to take a break and I couldn’t get myself to get up again. I thought I should put up my tent to avoid the mosquitoes, but I was too tired. Finally, I just pulled out my sleeping bag and slept next to the trail. In the morning, it was hard to roust myself and I got a late start.

I don’t know what was wrong, but after reading other peoples journals and this article on altitude illness, I’m suspecting that problems with altitude is what is getting to some hikers in the Sierras.

The first time I hiked the PCT (Pacific Crest Trail) I remember getting tired in the Sierras. So tired I had thoughts about quitting.

When I took an Outward Bound class in the Sierras I got unreasonably tired and a debilitating dry cough.

I may be sensitive to altitude. I mean, by the time I hit the Sierras, I was doing consistent 30 mile days and had been at fairly high altitudes so there is no reason to think that I should have been getting that much more tired. You wouldn’t think that the added couple of thousand feet would make a difference but something was wrong.

Next time I hike the PCT (Pacific Crest Trail), I’m going to try to get some Acetazolamide (Diamox) and see if it helps.

Update: The article on acetazolamide was followed by this article about how in one study, taking 80 milligrams of ginkgo biloba every 12 hours, out preformed Acetazolamide in the prevention of altitude sickness.

Do it yourself medicine books

Now free, online, and available for download. http://www.mrbill.net/survival/

The Thru-Hiker’s Medical Guide

A thru-hiking ER doctor put together this medical guide for the long distance hiker. http://www.whiteblaze.net/index.php?page=med_guide

Backpacking first aid kit.

This is what is what I carry when backpacking:
Neosporin. I apply to any wound or infection. Someone told me that if you put some on your urethra you can prevent urinary track infections.
Bandaids Most blisters, I pop with a needle, put some Neosporin on them, and cover with a bandaid. Some bandaids work better than others. If your bandaid keeps falling off you can duct tape it on. In the beginning of a long hike you may need lots of blister stuff. After I have been on the trail for awhile, I don’t get blisters very often. Second Skin is also good for blisters. It’s sort of heavy but in the beginning of your hike it may be worth carrying.
Pain relievers, -Ibuprofen is my personal favorite though I often bring a variety. Don’t rely on aspirin as a your main pain reliever as it increases bleeding and puts you at and risk in the event of an accident for excessive blood lost. Some people in addition carry some heavy duty prescription pain medications, like Oxycontin/Oxycodine, or morphine in case of a break or sprain. A good idea if you can get them.
Aspirin– just a little, good for your heart. Don’t take too much as it will increase bleeding in the event of injury.
Benedryl– not only good for allergies but also good if you are having trouble sleeping. -not just good for airborne allergic reactions but also plant and insect bite reactions.
Claritain. Good for allergies when you don’t want to be sleepy.
Decongestants– also good if you need to stay awake to hike out in an emergency. These are sold without a prescription but apparently you have to ask for them, now.
Emer’gen-C good for replacing electrolytes in the event of dehydration. At an advanced wilderness first aid course, the instructor said that heavy doses of Vitamin C can prevent and even cure urinary track infections by making your urine so acid that nothing can live in it.
Tums or some kind of antacid. Sometimes trail food can cause acid indigestion and make for a really horrible night.

I carry a needle in my dental floss case to pop blisters. I carry duct tape wrapped around one of my water bottles, not just for repairs, but also for taping a splint made from my pad on if I needed to. Every thing is kept in a plastic ziplock.

On my last hiking trip, I pulled a thigh muscle and a hiker I meet gave me her ace bandage. Later in my hike, I met a woman with a sore knee and I passed it on to her. I’m thinking of starting to bring an ace bandage with me. It does offer some relief.

Lyme disease on the trail.

Hiking through Connecticut on the Appalachian Trail, I got a lot of warnings about Lyme disease. They said when I got done with my hike that I should take 4 weeks of doxycycline because the chances of getting it were so high. They told me stories of how they were not treated or under-treated with antibiotics and had serious complications from Lyme disease. They said to get 4- 6 weeks of antibiotics.

I wasn’t feeling well for awhile, tired and achy but that is sort of normal for being on a long distance trail. One morning I got up and started hiking… I hadn’t been hiking long when I laid down on a big rock in the sun and went to sleep. I just wanted to sleep, but after awhile I forced myself up and started hiking, after a couple of miles I laid down again for a nap, and then hiked a couple of miles with my knees aching and laid down for another nap ; I was so tired. I looked at my guide book and saw that from the next road crossing I could hitch-hike to town. I sat down on the road, too tired to stand and hitched a ride to a big old three storied B& B.

I told the women at the B& B, that I was more tired than I had ever been in my whole life. She said “I’ll show you to your room�?. She walked me up all these flights of stairs each landing I would hopefully think we were there. Finally we got to the room and I went to lie down, but she said, “No, you need to check in first�? so back down all those stairs with my aching knees and so tired it was really everything I could do to concentrate on getting down them. I checked in and walked back up all those stairs. I wasn’t there 5 minutes when she called me on the telephone and said that she hadn’t charged me enough and that I would need to come back down and pay her 5 more dollars. I said, “I can’t. You can come up and get it, or I will pay you in the morning but I’m not doing those stairs another time.�? Even in my weakened state, I thought it was sort of comical making a sick person climb all those stairs.

I took a shower and looked in the mirror and found a tick on me. I scratched it off. There is no telling how many ticks I had had on me. I found that one because I was at a hotel, I wouldn’t have found it had I been on the trail. Now it wasn’t just my knees that ached but every joint in my body. I called my son and through looking on the Internet he determined that I had Lyme disease. My neck ached terribly and I would get chilled and be looking at my sleeping bag on the floor, yet I would be too tired to get it. Then I would get really hot and look at a glass of water but I was too tired to reach for it.

The next day I climbed down the stairs and called a taxi to take me to Great Barrington Hospital. I slept in the chair in the waiting room. The nurse practitioner said that she would not prescribe antibiotics unless she was positive I had Lyme disease and that the test was not valid unless you had it for a long while and sometimes even still if wouldn’t necessarily be right. She took my temperature, and said, “See you have a temperature, that’s why you are tired.�? I said, “what about my joint pain�?. She shrugged her shoulders and charged me 125.00 dollars.

That night I moaned all night long from the pain in every joint. I had chills and then fevers. The next morning I had a bull’s-eye rash. I called that nurse practitioner and she said that she would have to see it before she would prescribe any antibiotics. I had taken a bus to another town and told her I was very tired and couldn’t make the trip back. She still refused me antibiotics. I made an appointment with a doctor that was closer to the motel and he looked at the rash and said it was a textbook picture of a Lyme disease rash. When he said that he would prescribe 2 weeks of doxycycline. I said, “No, everyone says 4-6 weeks.�? But that is all he would give me and I was too tired to put up much of a fight. Then he charged me 85 dollars and sent me on my way. I took the antibiotics and in a few days, I was ready to head back out on the trail.

After I finished the trail I started getting hot achy knees, I read in the Merck manual that that is a sign of the kind of arthritis that you get from Lyme disease that hasn’t been treated fully. Also from reading stuff on the internet I learned that you should have 4 weeks of doxycycline. I found a Lyme disease specialist and went to him. He said that I was under-treated and that it may be too late. He prescribed 6 weeks of double doses of doxycycline and amoxicillin and charged me 175 dollars. I took them all and since then have not had the hot achy knees.

It’s really hard to find decent medical care when you are sick on the trail. It’s hard to get to the doctor and it’s hard to fight with them when you are sick. Many of the hiker’s doctors would prescribe the doxy for them. If you have a doctor see if you can get a prescription before you leave in case you need it. It’s criminal that the medicines that we need are locked up. I’m willing to take the consequences of my incompetence but it is so frustrating, unfair, and deadly to be at the mercy of incompetent doctors.

This year, when I went hiking, I soaked my clothes and my tent in Sawyer Premium Insect Repellent Military Style Clothing Treatment, Soak System It’s supposed to last for 6 washings. I don’t like deet and would rather the insect repellent be on my clothes then on me.

Ponderosa Pine needles cause abortion… and prevent scurvy.

From http://stripe.colorado.edu/~mitton/ponderosa%20pine.htm:Pine needles have been used to produce abortions in many societies, for a long time. Dioscorides and Pliny the Elder, physicians writing almost 2,000 years ago, both reported that snow on Ponderosa pine consumption of pine needles caused abortion. American Indians, including the Arapaho, independently acquired and used the same knowledge. During harsh circumstances, a pregnancy had a low probability of producing a healthy child and it endangered the life of the mother; a tea of ponderosa needles was used to produce an abortion.

From the site http://www.wsdot.wa.gov/Environment/CulRes/conifers.htm: Ponderosa pine needles and branches may cause abortions and stillbirths in pregnant cows browsing them, and a tea of needles is reputed to cause miscarriages in pregnant women (Turner et al., 1980).

From http://en.wikipedia.org/wiki/Pine : “A tea made by steeping young, green pine needles in boiling water (known as “strunt” in Sweden) is high in vitamins A and C.�?

Seems like the perfect famine tea, causes abortion and prevents scurvy.

Self reliant medicine.

I have an interest in wilderness medicine, so when I come across some remedy, I save it. Here are a few that I have found.

Snake bite

“I asked her to prepare a poultice of warm ashes and vinegar, and I applied it to my leg, which was already much swollen. The application gave me some relief, but the swelling did not abate. The dread of being disabled was greater than the physical pain I endured.

My friend asked an old woman, who doctored among the slaves, what was good for the bite of a snake or a lizard. She told her to steep a dozen coppers in vinegar, overnight, and apply the cankered vinegar to the inflamed part.”

“The poison of a snake is a powerful acid, and is counteracted by powerful alkalies, such as potash, ammonia, &c. The Indians are accustomed to apply wet ashes, or plunge the limb into strong lie. White men, employed to lay out railroads in snaky places, often carry ammonia with them as an antidote.�?
(I would think baking soda would work, too, and it could also be used for brushing your teeth, bathing, and indigestion. I would also think that taking some antihistamines might be helpful.)

I copied the following from a book that I read on the Project Gutenberg DVD.

Appendicitis
“I have appendicitis; what shall I do to be saved?

_Don’t eat anything until well. Use a stomach tube and wash out the stomach; then use a fountain syringe and wash out the bowels; take a hot bath as hot as can be borne, and stay in the tub until all the pain is gone, or as long as possible; then go to bed, put ice on the bowels and keep it on until the temperature is reduced to 101 degree F. then apply hot applications or poultices and continue the poulticing until the bowels move, and the bowels will not move until the abscess breaks.Use an enema every night as a routine, and drink all the water desired, when there is no nausea.

Don’t manipulate the forming abscess, nor allow anyone else to do so.

The bowels will move in fourteen to twenty eight days from the beginning of the attack. Then the fast can be broken by giving a glass of hot milk, which is to be chewed well, or given in the form of junket; this is to be repeated three times a day for a week, or give the milk twice a day and a plate of mutton broth for the third meal. I do not give solid food because there is a large abscess cavity opening into the bowels, and if solid food is given before it has time to close, it is liable to find its way into this cavity, thereby preventing healing, and bringing on a chronic condition that will ultimately end in death. The less food taken for one week after the discharge takes place, the better. Any rational individual should see that withholding food is the proper treatment. Milk should be thoroughly mixed with saliva or not taken at all. Remember that if milk is not taken with great deliberation, and great care given to _thoroughly insalivate each sip, then it amounts to the same thing as eating solid food.”

Antibiotics
“Observations of cow tongues have recently revealed the presence of natural antibiotics on the tongue. The antibiotics are peptides that can prevent infection of cuts in the mouth by resident bacteria. Similar antibiotics are presumed to be produced by the human tongue as well.”

Honey is a natural antibiotic, as well. I read about a man that was treating people with infected wounds by dissolving sugar in honey and then packing it in to the wounds. The wounds were healing with very little scaring.

Two of my favorite books for learning self reliant medical care are: Where There Is No Doctor: A Village Health Care Handbook and Where There Is No Dentist. I also refer to, The Merck Manual of Medical Information, home edition .