Medicine for the Outdoors celebrates two year anniversary

by Erik McLaughlin on

Travel health and the emerging specialty of “wilderness medicine” have obvious overlap. Dr. Paul Auerbach is one of the leaders in wilderness medicine: helping found the Wilderness Medical Society, co-author of A Field Guide to Wilderness Medicine and numerous journal articles and serving as faculty to the Stanford Fellowship in Wilderness Medicine.

His blog, Medicine for the Outdoors, is celebrating the two year anniversary. For those who haven’t yet had a chance to visit, it is filled with practical information and advice for those exploring their environment and wanting to come back from the experience in good health. Travel and expedition medicine is the focus of my career and I find myself citing Dr. Auerbach’s work and information, in my work. He is one of the pioneering physicians who helped elevate this field of medicine to a new and unique specialty.

A visit to his blog will allow the reader to learn about things from jellyfish stings and dislocated shoulders on the trail to malaria medications and outdoor recreation. This is truly an opportunity to read, first hand, the information from a leader in wilderness and expedition medicine. I highly recommend a visit to his blog, if you get a chance. Oh, and don’t forget to congratulate him on his two-years of dispensing great advice!

Gadling TAKE FIVE: Week of June 6–June 13

by Jamie Rhein on

Sorry to have missed last week’s Take FIVE post, but I was off in Hocking Hills, Ohio without WiFi, something I didn’t expect. In a few hours I’ll be heading to Tennessee. Who knows what will happen when I leave the house? Therefore, here’s this week’s Take Five before I go.

With summer travel comes footwear choices. Abha, Iva and Heather all had something to say about shoes. Flip-flops, Crocs or stew shoes? Which ones are safer? What about fashion?

Along with thinking about footwear options, summer is a time you can learn new things. Matthew has some suggestions for singing karaoke with the best of them. And, Aaron passes along tips about a Turkish bath.

Since I missed last week, here are a few more summer tidbits. Erik offers up sunburn advice, Kent knows just how to savor a meal in Paris and Jeremy provides details about GPS and location services to help you get where you’re going.

Happy Friday the 13th, Happy Father’s Day, and enjoy the weekend. As for me, I have to pack.

Are the shoes worth the blisters? (and what to do if they are!)

by Erik McLaughlin on

It is unfortunate that what looks good, doesn’t always feel good. I think this is no more apparent than with a pair of shoes. You have a killer pair of new shoes that you’ve been waiting to wear on your trip and that day is finally here! New shoes on your feet, you head out for a day of sightseeing in your new city. But this is a recipe for blisters — nothing can slow down a day of hiking, shopping or sight seeing quicker than hotspots on your feet.

Understanding how blisters form and some basic treatments just might allow you to ambulate with less pain and save that pair of shoes, as well.

If you remember from the hazy days of high school biology, the skin is made of 2 layers: a thick, inner layer (dermis) and a thin, outer layer (epidermis). As heat, caused by friction and rubbing, forms a “hotspot” on the foot, the two layers of skin begin to separate and fluid fills in this space. Moisture from sweat or water acts as a lubricant between the sock and the foot as well as softening the skin. This increases friction potential and a greater chance for a blister. This concept is key for helping to understand blister prevention.

Blisters commonly occur in areas of softer skin, that are not used to being roughed up by shoes. The shoes you wear everyday have already toughened up your feet in the areas that that specific shoe rubs. However, the new pair of shoes or the shoes you do not commonly wear will rub your feet in new,potentially soft areas. Common sense dictates that you should not wear a pair of shoes new to your feet on a day that you have a lot of walking to do. If you have the time, try wearing your shoes around for a few hours at a time with thick and comfy socks. Even if you are just walking around your house, having the shoes on your feet help decreases the chances of future blisters. That’s in a perfect world, however, and I don’t know about you, but I rarely visit there.

One of my best “tricks of the trade” for blister prevention was taught to me when I was a doing some adventure racing. Remember that refresher on skin anatomy and moisture acting as a lubricant to increase friction? Decreasing moisture on the feet decreases the chance of hotspot formation that will lead to a blister. Roll-on or stick deodorant is the ticket. Not only will it help your feet smell like an alpine meadow, but stick deodorant is an effective anti-perspirant. A good coating on both your feet, getting all surfaces, will reduce “feet sweat” and the friction that a sweaty sock allows. Apply this stick deodorant liberally and then place a sock over the foot. Try not to remove this sock until you know you are done for the day. There are some commercially made products, such as Bodyglide, that are designed to increase lubrication/friction as well, eliminating the chaff associated with unprotected skin. I suggest some personal trials before your trip to find which method works best for you.

Should you find yourself in the very unlucky position of feeling a hotspot forming on your feet, don’t give up hope! You can still finish your walking tour or make it to the end of the shopping area, with minimal pain. Moleskin is a product bought at most stores that sell athletic footwear or hiking stores and is a self-adhesive sheet of padding that works miracles on blisters. This sheet of fabric can be cut to proper size and placed directly over the hotspot at the first sign of irritation. Acting as additional padding and a friction reducer, moleskin will allow you to finish your day with minimal problems. Just make sure to cut a little hole in the center of your piece of moleskin about the size of your blister. A kind of “moleskin dough-nut” is the goal — you’re going to stick that moleskin over the blister allowing it to poke through the little hole you cut. This keeps the blister from popping, hopefully, and takes away some of the pain associated with the raw and inflamed tissue. Some athletic tape also can be applied over the moleskin dough-nut to help it adhere to the foot a little better and prevent it from moving out of position.

“To pop or not to pop” is a common question with blisters. I think that a popped blister is merely a nice route for infection to enter your body and I generally try to avoid popping blisters unless it involves a more extensive treatment process. A popped blister merely has had the fluid removed from it — there is still a space created by heat and friction between the two layers of skin and they will continue to rub together, causing more damage. A blister has been “unroofed” when the top layer of skin has come off or been removed. This is now exposed and raw skin. The area should be cleaned with soap and cool, clean water. A topical antibiotic, such as Neosporin, works great for helping prevent infections.

As with most travel related health issues, some proper prior planning prevents poor performance. Remember to break those shoes in, before your trip. A coating of stick deodorant can go a long way in hotspot and blister prevention and moleskin is a great tool too use when the hotspots and blisters start forming. Also, if you see somebody hobbling around in killer but brand-new shoes, offer them some of your moleskin, you’ll save their day.

War no more: Six countries that are (now) safe to visit

by Aaron Hotfelder on

Whenever a country is labeled “war-torn” or “conflict-stricken,” you can bet that tourists will stay away from that country long after it is once again safe to visit. Just ask Nicaragua, El Salvador, Colombia, or Cambodia, and they’ll tell you that the “war-torn” description is a tough stink to wash off.

The folks over at ProTraveller realize this, and that’s why they recently wrote about 6 Upcoming Countries Worth Visiting Now the Conflict Is Over. Despite their glaring omission of just about all of Central America, the article is well worth reading. Some of the highlights:

  • Angola: “In 2002 a ceasefire was reached and the political situation began to stabilise. Angola is not yet a democratic nation but the internal warring appears to be done, at least for the time being. In recent years, Angola has topped the lists of post-conflict countries for making developments in the area of peace.” [Pictured above, by the way, are Angola’s impressive Calandula Waterfalls.]
  • Northern Ireland: “The small province is blessed with some of the most spectacular coastal scenery you’ll find anywhere in the world, with the Causeway Coast being the jewel in the crown. Elsewhere in the province, Belfast is in the midst of a remarkable transformation from being deeply depressed and introverted into a cosmopolitan and lively city with excellent hotels, restaurants, shopping and nightlife.”
  • Indonesia: “A recent string of bombings in Bali caused temporary concern. However, it is an increasingly safe location that is gaining in popularity with globetrotters. Islands such as Bali, Lombok and Sumbawa are great places for watersports such as surfing and windsurfing. The cost of living is cheap, the inland scenery spectacularly lush and the beaches tropical; there’s certainly plenty to see and do!”

Read the whole thing here, why doncha.

[thanks to Andy Boyd for the tip]

Don’t get burned on your next trip

by Erik McLaughlin on

You are finally there…the perfect beach, the perfect companion and the perfect drink in your hand. This is what you’ve been working and waiting for. You’ve left the mobile phone off and are dedicated to not letting anything ruin your trip. Besides the calls from work though, sunburn can ruin a holiday pretty quick.

Basics: Your Skin and the Sun’s Rays

You may remember from hazy days in high school biology that the skin has two main layers: epidermis (thin, outer layer) and the dermis (thicker, inner layer). The skin has many functions and one of them is protection from the sun. The amount of melanin in the skin can effect the skin’s ability to protect against sunburn and damage from ultraviolet light, as most light skinned people can tell you. Being very light skinned, I get a “light pink” just going outside to get my mail.

This sun’s ultraviolet light has three main types, UVA, UVB and UVC. People are exposed to much, much more UVA light than UVB, but it is actually UVB that is responsible for most sunlight induced erythema (sunburns). The UVC light is largely absorbed by the Earth’s atmosphere. An interesting article that discusses the interplay of UVA and UVB and UVA’s possible role in skin damage can be found here

Prevention

The best way to avoid getting a sunburn is to protect yourself and there are several ways to do this. Sunscreens, clothing, sunglasses and avoidance of peak sun hours (10 am to 3 pm) are all common tools in the war on sunburn. Glasses, contact lenses and sunglasses protect the eye from most UVB rays. For those of you that are “into shades” you can read a bit more about things like light transmission and distortion.

Sun protection clothing is a very useful item and quality counts — specifically the tightness of the weave in the garment. Material, proper, does not seem to be as important as this “weave tightness”, as evidenced by Lycra. When stretched, Lycra blocks only 2% of UVR compared to 100% when lax. The term to know is UPF (ultraviolet protection factor) and is similar to SPF for sunscreen. This is the amount of UV rays that are able to pass through the clothing. A UPF rating of 50 means only 1/50 of the sun’s UV rays pass through, offering substantial protection because only 2% of the suns rays get to your skin.

Sun Protection Factors (SPF)

The famous SPF rating of sunscreens is a commonly misunderstood factor that compares protection times of different strengths of sunscreen. This number is actually a ratio that uses the amount of time it takes to get a sunburn in a person wearing sunscreen versus one without protection.

For example, a person gets a sunburn in 10 minutes of sun exposure, without sunscreen. Wearing SPF 2 will protect their skin from sunburn for 20 minutes, or double their “unprotected” time it takes to burn. Wearing SPF 15 will give 150 minutes of protection or about 2 1/2 hours and SPF 50 offers 500 minutes of protection, or 8.3 hours. SPF merely gives an amount of time one is supposed to be protected from a sunburn. Interestingly, higher SPF values are associated with protection from UVB absorption. SPF 2 only blocks about 50% of UVB, while SPF 15 blocks 93% of UVB and SPF 50 blocks 98% of UVB rays.

Sunscreen

The method by which the sunscreen is applied is very important. Creams and lotions generally spread well and allow good skin penetration. Gels tend to wash or sweat off easily, and some contain alcohol which can sting the skin. Sticks make it hard to cover a large area of skin. Oils traditionally spread thin and some can cause acne. Ointments/waxes are generally left to extreme environments and help resist skin chap and frostbite. Aerosolized and sprays make an even coating difficult, allowing for unprotected patches.

The biggest problem with sunscreen is that it is not properly used. This means adequate application in the beginning and re-application — frequently. Apply the sunscreen, liberally, to all exposed skin areas. Remember to get the neck, ears and backs of hands, too! Re-apply after swimming or water contact. Sunscreen goes on the skin first, then bug spray goes on top. Remember that use of DEET and sunscreen together decreases the sunscreen’s protection by 34%. Try not to let the sunscreen run into your eyes, as this will cause some irritation, trust me.

Sunscreens are a major cause of skin irritation, also. Oxybenzone is a common link in these products and is commonly know as PABA (p-aminobenzoic acid). Up to 4% of the population are adversely affected by this compound. If you have a sensitivity to PABA, make sure to select a PABA-free lotion.

Sunburn Treatment

OK, it happens. Forgot the sunscreen, didn’t re-apply, didn’t use enough the first time, whatever. You now have a burn and it hurts. For immediate relief, cool water soaks or compresses help with pain. Topical anesthetics do work and the preferred ones include menthol or camphor. Aspirin and ibuprofen are very good at reducing pain and swelling/inflammation. Sun avoidance for 48 hours may also help speed healing time. Lastly, ensure adequate hydration. My personal “sunburn remedy” is a lot of water.

More severe sunburns can be associated with blistering of the skin, fevers/chills, and even vomiting. If your skin blisters, try not to beak them. If they do break, wash the area with soap and water and consider applying a thin layer of antibiotic cream.

Hopefully, most everybody associates sun exposure and burns with skin damage and even cancers, later in life. Even if this is not as catchy as the “Everybody’s Free to Wear Sunscreen” essay, hopefully this will help you remember to wear your sunscreen and avoid a few days of discomfort on your “perfect beach holiday”.

For more information check out:

CDC Travel Health: Sunburn