I just got back from Moab, Utah.  For those of you who haven’t heard of Moab (don’t worry, you’re not alone), it is a tiny town in the middle of nowhere in Eastern Utah.  It is a veritable mecca of all things outdoors.  People travel from all over the world to partake of the mountain biking trails, the many National Parks, and some of the most breathtaking vistas I have ever seen in my life.

I was fortunate enough to visit Arches National Park, Dead Horse Point State Park, and Bar M Ranch while I was there to do some hiking and trail running.

All of this fresh air was certainly invigorating.  But the official reason for my visit to Utah was for a training course – Advanced Wilderness Life Support (AWLS).  This was hands down some of the best instruction I have ever received in my life.  AWLS is essentially a 4-day course that involves both didactic time as well as hands-on outdoor scenarios.  The purpose is to gain an understanding of both what can go wrong in the wilderness, and what to do about it should  such luckless events occur.  This particular course was put on in part by the University of Utah with the assistance of instructors from the Madigan Army Medical Center.  Absolutely everyone involved in the course was really knowledgeable, approachable, and enjoyable to learn from.

The outdoor scenarios are where, in my opinion, the course really shined.  There were local individuals hired as actors who served as our unwitting patients.  We would essentially walk up to a scene that one could easily imagine happening in the wilderness (falling while rock climbing, near-drowning in a river, over the handle-bars of a mountain bike), and have to spring into action.  By working as a 5 or 6 person team, we learned how to secure a scene, stabilize patients, determine an evacuation plan, and also work together.  Part of the hands-on training involved learning how to build different litters (or patient carrying devices) in order to help get individuals to help if one were deep in the back-country.  It is amazing what you can do with a climbing rope and a piece of tarp!  It was helpful to actually have to try and package up a patient in one of these makeshift litters.  Not to mention seeing how physically taxing it is to carry an individual over uneven terrain.  After just 100 yards, our entire team was already starting to feel fatigue set in.  Our instructor shared that a rescue effort should typically consider having 24 rescuers in order to carry out an injured person for anything more than a couple hundred yards.  I get it.

Although it does look like a large tarp burrito, this is our team evacuating a “patient”.

I’m really glad that I went to this course.  And I think it would be beneficial to anyone who spends significant time in the outdoors.  Check out the AWLS website to see all of their different course offerings.  I feel like I learned a lot of practical skills, and it was good to think through different potential scenarios.  Hopefully it will better equip me to take care of people no matter where I am in the world!

Nothing too wilderness medicine-y to report here today.  Just wanted to tell my readers how ecstatic I am because it seems like Spring has finally hit Upstate New York!  I went for a run at Green Lakes State Park on Saturday, and then a nice long hike at Clark Reservation on Sunday.  I was very much like the cliche that we always joke about in Wisconsin…. after a long, cold winter it isn’t uncommon to see people out washing their cars in short sleeves as soon as the temperature hits like 30 degrees.  Well I was out there in my little running capri’s and a long-sleeve top in 42 degrees.  I’m trying to run and hike as much as possible in anticipation of my next upcoming race: GlobalLimits Bhutan – The Last Secret

This will be another multi-day ultra race.  The catch is that this race will cross three 11,000+ foot passes.  And yours truly will be slogging along after the last runner with my medical equipment.  There is nothing cool about the team doctor needed to be resuscitated….  So as much physical activity as possible is on the docket until I get on that airplane.

Here’s the weather less than a week ago:

(Yes those are blossoms on the tree, but those are also snow flurries in the air)

And now the gorgeous weekend:

On another exciting note, Nick and I were able to recently fly my airplane back to Syracuse.  It was a gorgeous 3.5 hour flight from my home base in Hartford, WI.  There was still ice on Lake Ontario.  I assure you that the inflight food and beverage service was much better than what you would get on the airlines (thanks for packing our lunch Mom!)

Okay, first of all, I have returned from the Arctic only to have snow fall on April 23 in Syracuse.  It just doesn’t seem fair.  My trip was absolutely incredible.  I have never visited any place else on Earth that even came close to approximating the desolation and stark beauty of the far North.  It took 2 days and 4 flights to get all the way to Cambridge Bay.  The local airline that we flew from Edmonton, FirstAir, was surprisingly nice.  We even got fed on the tiny cargo planes !?!

North:

Norther:

Even in April, there is so much snow and ice everywhere that it is nearly impossible to tell when you are on land versus the water.  The local folks told us that the ice doesn’t start to break up until June.  The wind just whips through the area since there are no trees to act as any kind of a wind break.  Most days, the wind chill caused it to feel roughly 20 degrees F cooler than the actual temperature.

This far North, everything has to get flown in from far distances.  A trip to the local general store was a real eye opener.  Bags of salad greens were $9.00, a pineapple was $12.00, and you better hope that you are a lucky hunter since a beef roast was $56.00!  We couldn’t resist checking out the local KFC/Pizza Hut that was attached to the general store.  They were out of pizza, bread sticks, wings, and chicken strips.  And they didn’t even have fried chicken on the menu.  We settled for a $13 snack of popcorn chicken.

The local Inuit people are a model of hardiness and innovation.  They don’t just survive but actually thrive in the harsh cold. And they could not have been more friendly and welcoming to us.  One afternoon, we got to go out fishing with a small group of local individuals.  They cheerfully drove our group out in sled boxes pulled behind snowmobiles.  Even one of the guide’s 2-year-old daughter was out with us.  She was bundled up from head to toe in fur and homemade clothing without an inch of skin exposed.  When she finally became cold, the mother placed her in a papoose on her back, and literally zipped her in under her jacket.  Unfortunately neither Nick nor I caught any fish, but the experience was certainly unforgettable.

The ice was between 6 and 8 feet deep.  It was incredibly clear and smooth, allowing to see through it in some spots.

Muskox – no idea if this was ice or land….

We stayed in a cabin one night about 12 miles from town.  It was a cozy set-up with propane heat, and bunk beds.  One of the local women cooked for our group.  I don’t think a simple stew has ever tasted better after being out in the cold for 9 hours.  Typically this cabin is used in the summer for a place to hunt and fish from.  The sunset was incredible.

So that was our Arctic vacation.  The title refers to the fact that I still have all ten fingers and toes.  Although, I did get a touch of 1st degree frostbite on my hands.  With my mittens off for only 2-3 minutes, I had sensation loss in all ten digits even with liner gloves on.  Fortunately I didn’t have any tissue loss, but I still have numbness and tingling of 6 of my finger tips.  Check out the wolf gloves that I was borrowed while I was up there:

In another day, I will be headed up to the wilds of the Arctic.  My destination is Cambridge Bay – a small hamlet above the Arctic Circle located on Victoria Island.  I have never been this far North, and it will take my boyfriend and I two full days to get up there.  We can get to Edmonton pretty easily, but then the next day entails taking flights on increasingly small charter planes to get all of the way to Cambridge Bay.  Here’s where we are going:

  

Why would anyone go to a place where the temperatures are currently ranging from -40 to -20F when Spring is attempting to visit the northern US?  Well it’s not for my Wilderness Medicine fellowship this time.  It’s actually a crazy trip that I have choosen to go on of my own volition.  And my incredibly understanding (and fun!) boyfriend, Nick, has agreed to go with me.  It just seems like such an adventure to go this far North.  I’ve got wild ideas in my head of seeing a polar bear and the Northern Lights, but I’m sure the reality of this far flung destination will be beyond any of my expectations.

I’ve tried to prepare myself for this trip in two different ways.  Nick and I spent some time hiking in the White Mountains this winter (and my die hard followers already know all about my experience at the winter mountaineering school). 

Check out the beardsicle:

   

 

I’ve also been reading a beautifully written and poetic book about the Arctic – “Arctic Dreams” by Barry Lopez.  Lopez spent a fair bit of time in the Arctic, and the book is a compilation of his thoughts about the terrain, the surprising abundance of wildlife, the indigenous peoples, and the history of Arctic exploration.  I’m looking forward to finding myself in this mysterious and desolate landscape.  

I had a fun little weekend.  I was asked to work at the Syracuse Half Marathon on Sunday.  It was kind of ironic because I had tried to sign up to run the race, but it had been sold out.  Then two days later, an email arrived in my inbox inviting me to provide physician coverage during the event.  Weird.

The race went off without a hitch.  There was extensive EMS coverage on the course in addition to the little blue tent that we had set up in the exhibit hall where the finish line was.  Other than some sprained ankles and requests for ice packs, my morning was mainly spent getting to know some of the local EMT’s and Paramedics.  It was certainly much different than my usual race experience of essentially living with the runners for a week at a time.  I’m glad that I got to gain additional experience in race medicine and event planning.  Plus, I now have this awesome picture of myself in the blue tent looking very official with my very own walkie-talkie…

On another note, I have submitted my first paper to a peer reviewed journal!  It was the first of my two papers about the ancient Incan remedy, coca.  It was submitted to the Journal of Ethnopharmacology since it very much focuses on coca from an anthropological perspective.  I have no idea how long it will take for the journal to make a decision about acceptance of the article, but hopefully they won’t keep me waiting for too long.  So please wish me luck!

As promised, here’s the 2nd half of GlobalLimits – The Wild Elephant Trail….

Stage 4

This was a loooooong and grumpy-inducing day.  We had a late start of this (long) stage because of the many wild elephants in the area.

  

(This is not a wild elephant…. we hit up the elephant orphanage on the way to the airport)

I was at checkpoint 2 which was pretty much in the middle of nowhere.  Everyone ended up coming through a little quicker than expected.  There were no major medical issues with anyone – it was satisfying to see everyone doing so well.  After the last runner came through, it was time to get in the truck for 2 hours with the driver either slamming on the gas or mashing on the brakes all the way to the finish.  

I spent about 7 hours at the finish line, waiting for all of the runners to make it through.  

   

 

A few people ended up lying down right across the finish line.  And there was a girl who ran the last mile in her bare feet because she was so fed up with her shoes hurting her.  There were open heel wounds, and a little exhaustion with some nausea thrown in.  But overall, nothing too major.  Despite the strenuous day, the mood was buoyant at camp.  It’s easy to see that a huge weight is lifted off of the racers’ shoulders after completing the long stage.  It’s crazy what the human body can do, and maybe even crazier how little it needs to do it.  There is a gentleman here who only started running 6 months ago, and had never run further than a 20k.  There is a runner who never really stops at the checkpoints to get water.  There is another infamous racer who re-hydrates with beer, and lights a cigarette the moment that he crosses the finish line.  Depiste the ubiquitous nature of fancy energy gels and drinks, some people get by on Coca-Cola alone.  Pretty interesting.  

After everyone was safely at camp and all medical issues dealt with, it was finally time to climb into my hammock.  Which setting up was a hoot.  A few local guys saw me trying to set it up and came over to “help.”  They kept trying to tie the cords to all of the wrong places, and it was comical trying to explain to them what I was actually trying to accomplish since they didn’t speak a word of English.  But it was sweet of them to help, and it definitely made setting up my humgle abode for the night a little more entertaining.  

Stage 5

Despite having a late race start today (9am because most of the original trail was totally flooded), everyone still got up pretty early.  There were a lot of feet issues to deal with this morning.  People got in so late the day before that their feet didn’t get a chance to dry out before bed.  So my morning was spent with stinky runners’ feet on my lap with a cup of tea in my hand.  Most folks say thank you about a million times though for any podiatric assistance.  It is really nice to have people who are actually appreciative.  

The mud ended up making it a total cluster to get to the checkpoints.  I eventually found my spot at a 5-way intersection in a tiny village.  I set up in front of a Buddha statue.  The local villagers were very interested to see a little white girl hanging around their town.  Lots of people came over just to stare at me.  There was a guy who kept shouting at me.  As the other villagers would pass, they would point to their heads as if to tell me “don’t worry, this guy is just crazy.”  Apparently international sign language exists for this kind of circumstance.  

We had a runner with a questionable stress fracture so I ended up following the last runner to camp on foot.  It was a lovely 10k walk in the rain.  After winding through thin jungle paths, through tiny villages, and along major roads where every tuk tuk driver was convinced that I needed a ride, I finally got into camp (or paradise – see below) with the last racer.  Everyone was waiting to cheer him home.  The sense of community is both refreshing and inspiring.

  

Camp was pretty cool.  It was an open field with tents strewn around and make-shift rain covers.  

   

 

After a quick rinse in a river whirlpool, it was time to retire to our tent palace.  No one wanted much medical help tonight since they figure that they will all pretty much finish no matter what at this point.  Fires were lit around our camp area in order to keep the elephants away.  Last night in the bush!  Tomorrow is the big finish!!!

The Grand Finale – Stage 6

A very early morning since our split times were 6:15 and 6:45 this AM.  Last stage!!!!!!  We hopped in trucks as the runners were lining up for the start so that we could beat them to the finish line.  After a quick ride to Sigiriya Rock, we began the hike to the top.  It was great to be there early because there were very few tourists nosing around.  

  

It was quite the climb up steep and slick granite steps.  I think someone said that it was 1,800 steps to the very top.  

  

It is incredibly rewarding to watch the runners cross the finish line.  There was such a palpable feel of camraderie and accomplishement.  It ended up pouring down rain while we were on the top.  It didn’t spoil the mood at all though.  

   

 

After about a billion pictures taken, and many thanks offered by the runners, it was time to head to the hotel.  It took a while to get down because the steps were utterly clogged with tourists:

  

Another race finished!  No major injuries, and everyone finished!!!  Congrats everyone!

The GlobalLimits Sri Lanka race is complete, and I have lived to tell about it!  



Or, perhaps more importantly, all of the runners have also lived to tell about it.  The race went incredibly well, and in fact, all runners finished.  There were far fewer medical issues than in Cambodia – much to my relief.  And I learned the joy of being part of a rock solid medical team.  The other physician on the trip was Nia Owens.  She is not only a phenomenal expedition doctor, but also an absolute blast to be with.  She is originally from the UK but is currently practicing in Australia, and has worked numerous large scale endurance race events.  I know that it is absolutely ridiculous, but I think that we got as good at taking selfies as we did at taking care of runners….  Here’s just one example:



So the race was a total of 210km broken down over 6 consecutive stages.  The stages ranged in length from 15km to almost 60km.  The higher km stages made for some long days for our runners, but everyone seemed to really enjoy the scenery and remained in good spirits throughout the week.  Once again, I was both humbled and impressed by the mental and physical toughness of the runners.  Here’s a brief breakdown of the different stages:

Stage 1

The race began at Yapahuwa Temple, a site that served as the capital of Sri Lanka in the latter part of the 13th century.  There is a huge granite rock rising almost 100 meters above the surrounding jungle, and it was midway up this steep incline that the race began.  Prior to charging off, there was a blessing performed by two Buddhist monks.



Our transportation on the race course is mainly via tuk tuk. 



 I’m not sure that these little vehicles are much faster than some of the runners.  The runners looked great as they poured through my checkpoint, and they were all handling the heat quite well.  I’m starting a study to look at nausea in endurance runners, and so began the bombardment of everyone with questions about if they felt like they had to throw up.  I’m sure they felt like it after a whole week of my questioning…. 

The finish line and camp was at another sacred Buddhist site – the Temple of Sasseruwa.  There were busloads of school children arriving to the ground, and then lining up side by side in their white uniforms.  They seemed delighted to be able to yell “hi” and wave at us.



There were no medical issues in camp this evening – not even any feet to tape!?!  And very little nausea.  Which was good for the runners, bad for my study, and in stark contrast to the puke-fest of the Cambodian race.

Stage 2

The day started with the usual routine of eating breakfast, drinking tea, packing up everything, and then quickly checking in with the runners.  I went via truck to a checkpoint where I spent the day waiting for and then divvying out water for the runners.  After the checkpoint was shut down, the debacle began…  My driver managed to get us lost for 2.5 hours on the way to camp.  He would drive 100 feet, then stop and ask for directions, then drive another 100 feet, then stop and ask for directions, repeat ad nauseam.  I finally got so frustrated that I got out of the car and walked to camp via the race markings.  



Only a few minor ailments with the runners this day.  There was a very sweet older gentleman who took a spill while running, and needed his knees tidied up.  There was also heat rash, and the inevitable tide of blisters began.  Nia and I held a foot clinic in order to teach the runners about how to take care of their feet.  A lot of people ended up coming over, and everyone actually seemed really interested in learning.

We were staying in a little village tonight.  The local people were kind enough to clear out from their homes so that our group could have a place to sleep.  After seeing a scorpion on the wall in our house, I opted to try out my hammock for the first time.  It’s a Hennessy Hammock Expedition Asym Classic, and it’s awesome!  I slept like a baby in it.  And I was grateful to have the fully enclosed mosquito netting after I saw a large-ish (to me anyway) spider hanging out underneath me.





Stage 3

The team went to our respective checkpoints this morning in a convoy to try and avoid getting lost again.  Unfortunately, it didn’t work out that well as we blew past checkpoint 1 and had to backtrack quite a ways.  There weren’t many issues at the checkpoint today – medical ones anyway.  Three runners got lost on the course and had to be found via tuk tuk.  They were fine, just a little irate that they went a little further than they had to.  I reached camp by noon, and spent several hours at the finish line, waiting for the runners to come through.  I enjoyed my daily lukewarm coke.  I don’t know what it is, but you can go anywhere in the world and always find a coke.  And for whatever reason, they are always insanely delicious when you are in a random foreign country.  

The foot issues are starting to ramp up.  Several people had subungual hematomas (also known as runner’s toe). This is basically when the downward pressure exerted on the nail bed while running leads to bleeding and pooling of blood underneath the nail plate.  It tends to be pretty uncomfortable, and people get relief through trephination.  Which is a slightly barbaric procedure of whittling a sharp, heated beveled needle through the nail. But oddly enough, runners do thank you after releasing the pressure.

The race plans for the next stage have slightly changed due to wild elephants being close to camp.  I would have loved to see one, but given how dangerous they can be, I doubt we will get anywhere close.

The medical team working hard at the finish:



Our accommodations:

Stay tuned for the 2nd half of the race…

I have made it to Sri Lanka – home of wild elephants and delicious Ceylon tea.  It was a long journey here, but everything went surprisingly smooth.  Qatar Airways was insanely nice to fly.  None of my flights were delayed or cancelled.  And….  Both of my duffel bags showed up on the baggage carousel in Sri Lanka!  This is a somewhat unusual occurence for me.  The airport in Colombo is a little disconcerting when you’ve been traveling for 26 hours.  There is a huge duty free shopping center before you go through immigration or customs.  You can even buy a washer and dryer there.  

Our hotel is right on the beach:





The medical team (Nia, myself, and Laura) enjoying our first Sri Lankan tuk-tuk ride:



We have just about gotten everyone checked in for the race.  It seems like another great group of people.  We leave tomorrow for the starting point of the race.  Wish us all luck!

Well, here I go.  I’m in Philadelphia now, en route to Sri Lanka via Doha, Qatar.  I got everything packed last night, and the baggage situation ended up being pretty manageable:



One last parting thought before I hit foreign soil…. while I was researching local fauna and flora of Sri Lanka, I stumbled across this:



Are you kidding me???  I hate spiders!  I am uncontrollably and irrationally terrified of them.  They are my Achilles heel.  All I could think of was Indiana Jones:



Except of course, exchange SPIDERS for snakes.  Thanks for reading!

I have been gearing up for my next trip – Sri Lanka!  This is another GlobalLimits multi-stage ultra-marathon.  I am incredibly excited for the chance to get to visit yet another unseen area of the world.  And to get to take care of runners again.  There will be some racers at Sri Lanka who I have already had the pleasure to get to know while in Cambodia last year.  I look forward to once again getting enveloped in their very elite and close-knit community.  

And hopefully this time around, I will have my medical kit a little more fine-tuned.  In Cambodia, I schlepped about 40 pounds of medical gear between 3 un-wieldy bags.  I have been paring down equipment to fit solely into my super fancy cuben fiber pack (of past blog fame).  I’m not quite sure exactly what the transportation situation will be once there, so I want to be able to easily carry all medical necessities comfortably. I’ve also been putting a lot of thought into my “24 hour kit.”  This essentially should be a quick grab bag for when you need to get to someone who is quite sick (not that I am expecting anything this terrifying by any means…).  It’s definitely a useful (and sobering) exercise to think through what are the ailments that are capable of killing someone quickly, and then what items you might need to keep them alive for 24 hours.  This concept was introduced to me by my program director a mere days prior to my Cambodia trip, and I can assure you that it led to many a sleepless night.  But I guess it should, you really need to think through every possible scenario before going out into the wilderness.  It’s a concept in the aviation world that pilots refer to as “chair” or “hanger” flying.  When flying an airplane, you never want to get what’s called: behind the airplane.  Meaning that you always need to be thinking ahead to what’s next, so that you are in total control of the aircraft.  I’m trying to translate this much used thought exercise to wilderness medicine – how about calling it “desk doctoring.”  So after much research and obsessing, I think I finally have a handle on my scary badness kit.  I’m sure that it will change or evolve over time, but I have very much enjoyed the learning which has taken place regarding this one piece of my medical kit.

For those of you who are trying to imagine what it looks like to have an entire 2nd bedroom dedicated to wilderness medicine endeavors, feast your eyes on this:



This is the aftermath of Winter School with a smattering of preparing an expedition medical kit thrown in.

In between all of these fun trips, I have been working on two separate papers about the Andean folk medicine, coca.  I love the field of anthropology so it has been very intellectually stimulating to research this traditional remedy, and then to collate my findings into papers that I hope to submit to peer-reviewed academic journals.  I have also gotten pretty jazzed up about ultra running, and have been reading some really interesting stuff regarding running from an evolutionary perspective.  My hope is that I will become an expert in race medicine, and be able to take care of my runners with the absolute best care that is out there.  And who knows, maybe I will be one of these crazy yahoos who runs an ultra!

Here is the less glamorous side of wilderness medicine fellowship:



I leave on Tuesday for Sri Lanka, so:

Stay tuned… this blog is about to get exciting again!