Living under the strict Communist regime of Chaochescue had led the rural people of Transylvania (and I’m sure countless other communities throughout the world) to distill their own liquor. This was normally distilled from plums or like the Irish version from potatoes. This potent brew was popular and always presented to guests as an icebreaker no matter what time of day. It always made me nervous as to the source of this booze, partly due to smuggling stories I had heard where false car radiators were rigged in trucks crossing the boarder to and from neighbouring Russia. Why was I so worried? Well antifreeze content for a start.  Antifreeze is tricky. For several hours after someone swallows it everything seems fine. But as the body is busy breaking down the antifreeze (ethylene glycol) into a number of substances that affect your blood chemistry, nervous system and kidneys. After a few hours, someone poisoned by antifreeze may seem drunk or groggy and complain of  stomach distress. After a few more hours the victim may go into a coma. The kidneys can be damaged and stop making urine. If the victim survives, there may be permanent damage to the kidneys and brain.  There is an antidote but typically the damage has already been done. You can see my dilemma. So what did i do? Excuses varied from being a priest, a recovering alcoholic and having an allergy, but sometimes I just went for it, never quiet relaxed and always thinking of where the nearest hospital was!

The best time to treat is BEFORE symptoms develop!! If you think someone has swallowed antifreeze, call the poison center right away at 1-800-222-1222. The poison center experts will tell you exactly what to do. If hospital care is needed, treatment may include an IV The antidote and kidney dialysis.

Growing up in the UK (a place not re-known for it’s political correctness), any kind of skin problem was known as the ‘dreaded lurgey’, which may be a reference to our age old association with the great plague, the black death and other historical medical disasters. When one of my students complained of ‘blisters’ on his legs it got the alarm bells ringing. What you can (hopefully) see in the picture is a nice example of impetigo, the name derives from the Latin impetere(“assail”).  Impetigo is usually caused by the same streptococcus strain that causes strep throat, what we see here is bullous impetigo, this starts as small itchy blisters and develops into large ‘bullies’ as my expedition doctor described them, these are huge blisters up to one and a half inches in diameter and filled with fluid. Being incredibly itchy and very contagious it’s a serious problem that requires strong antibiotics, and strict isolation of the patient. We had our reluctant victim washing away from the group with his own personal bucket of water, and a strict ‘do not touch the patient’ regime in place. Pretty nasty, but curable. What was funny is when we had our initial outbreak our Doctor had us construct a tent out of tarps, we would then strip down to our undies and then be inspected! Embarrassing, but good practice. Watch out for the bullies!!

This here is a little fellow that you may or may not be luckily enough to encounter a BOT-FLY larvae. The eggs of this particular fly (Dermatuatobia hominis)are laid on a mosquito. The mosquito then goes on to do all the dirty work by actually getting this  into you skin. From personal experience it starts off looking like a spot. A little inflamed but over time it gets bigger and eventually resembles a boil or abscess. Patients with a bot-fly often talk of feeling it move around under the skin. One of my clients in Belize had just that feeling, eventually becoming quiet attached to the little grub and naming it ELVIS. We would get daily reports as to the movement of Elvis and his favourite time of day (usually morning). Our nurse on this expedition (Sam), tried a couple of times to remove it by dripping hot wax over the breather hole, this would suffocate the parasite and after an hour or so we’d peel back the wax and try to grab the breathing tube with tweezers. Sadly he was too fast or too small and we never managed to get him that way, we’d all stand round in anticipation as Friday night would be ‘bot-fly night’. Roll up, roll up and see the live maggot pulled out of a living person.. Since writing this I’ve seen and read about numerous methods, one of the most effective seems to be Vaseline and tape, a similar method to the wax in that you are trying to asphyxiate the thing. What happened to Elvis? Well after having it slowly growing for almost a month our patient commented that she had not felt him move for a couple of days, instinctivly our client gave the boil a squeeze, and out he popped Elvis, dead! No wax, chewing tobacco, Vaseline or anything, just dead. The thing was in her armpit and the joke for the rest of the expedition was that it was asphyxiated by her severe B.O!

 Here’s a bit of chat about an injury that happened on the July Borneo trip. One of the students injured her ‘heel’ before the expedition and complained of some soreness, but nothing that would prevent her from climbing the second highest mountain in Northern Borneo! Brave words, still it needed to checked out by a doctor before the all-clear for the trek was given. Dosed up with an anti-inflammatory she did well on the way up, although as we all know going up is the easy part.  Coming down hill puts far more strain on muscles, bones, ligaments and tendons. Normally we follow the RICE (Rest, Ice, Compression and Elevation) acronym for any sprain or strain, with the thought being that one minuet delay in RICE’ing an injury can add one hour to the overall healing time. New thoughts on caring for sprains and strains suggests that anti-inflammatories are avoided  for the first 24hrs as it can prevent the natural clotting process of the capillaries damaged by the initial injury. BUT, on the side of a mountain in the middle of a tropical rain-forest, with the humidity of 98% and temperatures in the 80′s all of the components of ‘RICE’ are not that readily available. Sometimes the best option is to strap up the injury, dose with painkillers and get them out rather than prolong an evacuation and put the rest of the team at risk.

I tried making a walking splint by slotting a samsplint into the patients boot (see picture) and then strapping with an ace bandage. Not bad, looking at the picture the strapping should have gone all the way down over the boot, remember the ankle was also strapped up under the samsplint. It worked for a couple of miles and got the injured student over the worst of the rough terrain. Would I recommend using it again? Maybe. The main problem was caused by movement at the ankle joint, and although reduced by the splint, the splint eventually split and tore. A couple of sticks could have solved this I guess, so I’ll just have to wait until the next ankle injury, shouldn’t be too long, seems to be the most common injury on expedition. So what was the outcome? Good I’m glad to say, in so much as we managed to get her off the mountain safely. After many visits to doctors at home, physio-therapy and an eventual MRI it was found that she’d actually ruptured a ligament, no surgery required, but a lot more physio and rest..  

So my point is, if people are suing for turning in drives, by God you better be prepared in the wilderness. One of the main medical subjects was the use of Epinephrine (Epi) in the wilderness and whether or not outdoor instructors should carry it. SOLO has long stood by the thought that leaders should absolutely  carry Epi, (an artificial form or adrenaline that treats the symptoms of anaphylactic shock caused by many things including bees), but only after proper training and understanding that Epi only relieves the symptoms and doesn’t treat the root cause, for that we use an anti-histamine such as benadryl ASAP. It was still interesting to hear how several big outdoor adventure providers do not carry Epi due to the possible legal ramifications that could arise from inappropriate use or the unlikely event that someone will die as a direct result of being administered the EPI and not the anaphylactic reaction itself. I mean come-on people, without help  a severe reaction to a bee sting, nuts or whatever may cause someone to die, sure carry Epi if they have a pre-existing condition but what if?? When I was down in Belize last year one thing we frequently came into contact with was poison wood. Just standing next to the stuff can start you wheezing, cut it down and your in trouble, burn it,  and well put it this way you won’t be on my Christmas card list anymore. Of course we train our staff and students in what to look out for but what if? Use the old adage, ‘be prepared’ I say, I’d never go overseas without at least three Epi-pens or the equivalent, and I’d recommend that trip leaders in the US carry at least two, BUT they should always know how to use them.  

Happy Christmas,

Jono