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It's all about the water

Most people, especially around the hot, summer months, begin trying to get near some water. Lakes, rivers and beaches are very popular places to spend a few days away from "regular life". Just as water provides a great recreation area, it also provides life for us mammals. The importance of staying well hydrated, especially in summer months, cannot be underestimated.

The amount of water and fluid in your body is something few people think about until there is a problem -- problems can occur with too much or too little. A basic guide for figuring the basic amount of oral fluids a person should be drinking is based on weight. A 20 kilogram (44 lbs) person should be taking in about 1500 mL per day. For those of us that weigh more than that, just add 20 mL of fluid, per day, for each additional kilogram. A person weighing 150 lbs (68 kg) should be drinking about 2.5 liters of water, providing there are no prior medical conditions that limit water intake, daily. This is more than most people I know drink, and they are not doing fun stuff like playing at the beach, hiking or exploring a new city on a hot summer day. The people that are exerting themselves in hot climates need to pay attention to how hydrated they are.

There is no easy way to say this, but one of the most effective ways of judging your hydration status is to check the toilet. How often are you urinating and what color is it? Early doctors used to taste patient's urine as part of their analysis. You can skip that part and just see if your urine is a nice, clear color or darker yellow. Darker yellow urine may mean that your are dehydrated. When somebody becomes more and more dehydrated, they begin to urinate less and less. Oh, don't try to fool yourself by thinking "I am going to pee all the time, I am fine" if you are drinking alcohol. Alcohol is a diuretic and makes you urinate more, but leaving you further dehydrated.

Avoid "un-packing breakfast" due to motion sickness

Lots of people get motion sickness. It is rumored that Christopher Columbus even had trouble with sea sickness. Fortunately, you don't have to dread that ship, car or plane trip for fear of "un-packing your breakfast" in full public view. There are a number of effective treatments and preventions for those who suffer from motion sickness -- the goal is to keep trying until you find one that works, for you!

The basic problem with motion sickness is not in the stomach, but in the discoordination of the visual signals sent by the eyes, the inner ear (responsible for balance) and the brain. The Travel and Tropical Medicine Manual cited one study involving over 20,000 passengers crossing the English Channel and the North and Irish Seas. Their data showed that motion sickness was more common in females than males and the older you were, the less likely you were to be effected. Over one-third of the passengers in the study felt symptoms of motion sickness. For the lucky ones that have never felt motion sickness, the symptoms include cold sweats, nausea and weakness.

Where to sit and Where to look

Choose a seat with the smoothest ride, if possible. Over the wings of a plane, the front seat of a car, forward facing seats and laying flat on your back are all places to help minimize motion sickness. When the "feeling of yuck" starts to creep in, try to focus on a distant object (it will be moving the least) or close your eyes. Avoid reading or focusing on objects close by -- their motion is much more obvious.

Medicine for the Outdoors celebrates two year anniversary

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!

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

Photo: Daniel MorrisIt 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.

Don't get burned on your next trip

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


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.

Infectious disease spread on airplanes

A recent post of mine seemed to briefly address the issue of the spread of infectious disease during air travel, without giving too much "meat" behind it. I thought there might be some interest in this subject and I would like to refer to an outstanding article, from the Lancet 2005; 365: 989-96, written by Mangili and Gendreau.

Clearly, the number of people who travel via air, is a staggering number with annual estimates well over 1,000,000,000 worldwide and over 600,000,000 in America, alone. Air travel is exciting and can be the most enjoyable part of the trip for some, but it also places one at risk for infectious disease.

The Cabin Environment

The spread of infection in commercial aircraft cabins is subject to several factors. The environment of the the cabin itself is perhaps the most important. The cabin, offering a pressurized environment and low humidity, requires that passengers and crew are in close proximity of each other. When parked, the fresh air is supplied via an auxilary power unit but during flight, fresh air is sent into the cabin from the engines where it is has been heated and compressed; outside air at typical cruising altitude is presumed to be sterile. Air enters the cabin from overhead, circulating downward and exiting from the floor. This is designed to help limit the spread of airborne particulate through the cabin.

Most commercial airliners use 50% re-circulated air for improved fuel performance and humidity control. This re-circulated air is filtered with a HEPA (high efficiency particulate air filter) system. Several studies have shown that standard cabin air is exchanged 15-20 times per hour compared to 12 per hour in a typical office. A survey demonstrated that most airlines use HEPA filters, although it is not a federal requirement.

Bacteria in aircraft a low risk to travelers

Science Daily released an interesting article, based on research conducted at University of Massachusetts Amherst, that shows the low risk of air travel and bacterial illness.

Bacteria that was present in aircraft -- with exotic names like Psuedomonas, Bacillus and Staphylococcus -- are commonly found on healthy skin and not generally causative organisms of disease.

The research team sampled the air from twelve aircraft (Boeing 767) cabins with flight times of 4.5 to 6.5 hours. The samples were taken from the coach section of the plane at 6 different intervals, including boarding, climb, cruise and deplaning. As expected, the highest concentrations of bacteria was found during boarding and deplaning. When the passengers move through the plane, their activity stirs up dust and skin bacteria, releasing it into the cabin air. During the flight, the bacteria levels decreased, likely due to a decrease in activity in the cabin.

Doc, I have malaria...why are you looking down there?

Medical News Today ran an interesting article covering the efficacy of rectally given anti-malarial medications. The purpose of using a suppository to deliver the medicine, Artemisinins, is a fairly new concept and can prove useful to prevent a life-threatening delay of intra-venous medications to combat severe forms of malaria.

The study looked at over 1000 patients and compared rectal administrations of several different medical compounds, all artemisinin derivatives. Interestingly, the article also compared these medicines with a standard treatment of quinine.

Ease of administration, portability and lack of special training for use are benefits of rectally administered medications. Delays in treatment of severe forms of malaria can result in death and travelers who are in remote locations and suffering from malaria might benefit from beginning this form of treatment, while seeking definitive medical care.

This might also serve as a reminder that the person trying to treat you for malaria in a remote area actually knows what they are doing when they are "checking down there".

My Weekend in Azeroth

This last weekend, I had very little time off and was in bad need of a trip and a little adventure. Knowing that I had to work this weekend, I chose to take my "vacation" to Azeroth. My decision to visit there was a great choice and I had a weekend full of adventures, looted treasure, monsters and magic. I visited several continents around Azeroth and only died a few times.

For my trip, I booked a tour with Naturally Rebellious, a guild with a lot of experience touring "noobs" around both continents. I can say that my guides were very professional, gave great service and explanations as we went, including history of the areas. They even cooked for me, secured lodgings and taught me a few things to keep me out of trouble on the journey. In fact, they had to heal me after several close calls, including a severe bear mauling, outside Astranaar.

The tour started in the beautiful city of Darnassus, the capital of the Night Elves and probably the safest city on both continents. My guides met me at the Warrior's Terrace and made sure I was properly equipped for adventures. I needed a sword, bow, armor, magical potions and some food.

Darnassus was a great city and very beautiful. Merchants and craftsmen have their shops built, alongside houses, right into the massive trees. It reminded me of the redwood forests in Northern California. There is even a large lake in the center, where I learned to fish. After a few tries, I was able to start dragging some Longjaw Mud Slappers to the shore. After a bit of preparation and the standard guide safety briefing, including waivers and something about "risk of death and if death does occur, Naturally Rebellious is required to resurrect said corpse within 5 minutes" we started. It was a little un-settling.

The trip out of Darnassus involved an animal called a Gryphon. This is basically a large flying bird, ridden like a horse. Surprisingly, they were kept in very good condition by their trainers and did not smell as bad as I expected. I learned this was to be our primary means of transport, for the tour. Darnassus is on an island, and there are boats to travel to the mainland, but the gryphon was a great way to get a "bird's eye view" of the landscape and see the area. Next stop...the Continent of Kalimdor and the port city of Auberdine.

Auberdine was my first real chance to get some adventuring in and test out my newly acquired skills. We gathered some herbs and I learned to make some potions of my own. I was fighting with the bears for a bit and had a great time. I noticed I was quickly ushered out of the city by my guides and told it was "for my own protection". Apparently, this is a favorite raiding area for the "bad guys" of the world, the vile Horde. True to form, the horde showed up and laid quite a massacre on the unprepared and those insane enough to join the fight. I would advise extreme caution in this town, due to political instability and civil unrest. Still, the town was nice and the clam chowder was superb.

Pushing on, we took the gryphons to the Barrens for a wildlife safari. Roaming around the vast, dusty plains allowed us to see some exciting animals, very up close and personal. Highlights included the Zhevra, a cross between a unicorn and a zebra and the Kodo, a very large and slow dinosaur type creature. We visited the Goblin city of Ratchet. A meal of bear steaks and blood sausage topped off the visit, before we headed down to the Shimmering Flats to watch a drag car race at Mirage Raceway. I even got an autograph and picture with the champion driver Nazz Steamboil!

Our next leg was one of the most exciting for me, because we got to take a long boat trip, from the port city of Ratchet, to the other continents of the Eastern Kindgoms. We docked in Booty Bay, a pirate and goblin town on the southern most part of the land. Fishing is the center of business in Booty Bay, unless you count piracy. After a hard day of fishing and fighting both buccaneers and angry gorillas, we stayed at the notorious Salty Sailor Tavern. This was my first experience with Junglevine Wine and we ate some very good Spotted Yellowtail and Rockscale Cod. I even entered the weekly fishing tournament and won a lucky fishing hat! If you make it by the Salty Sailor, tell Nixxrax Fillamug, the bartender, I sent you.

Our final stop was the human's capital city, Stormwind. This is Azeroth's version of New York City. Everything is here and you can learn or buy what ever you can imagine. The Trade District was bustling with people chatting, checking their mail, making trades, purchasing new gear and running from district to district, within the city. The statues lining the entrance to the city were majestic and I even enjoyed the smoky and noisy Dwarven District. No trip to Stormwind is complete without a trip to the Mage Quarter and the Wizard's Sanctum that houses the Stormwind Academy of Arcan Sciences.

With great sadness, I knew this trip to Azeroth was over. I wasn't too worried because I knew I would visit again, very soon. I made some great friends and killed a few Orcs at the same time. If this sounds like your type of fun, pick up a copy of World of Warcraft and take a trip you won't soon forget. When was the last time you got to save a princess, overthrow an empire and catch some fish all in the same day? Now that is a vacation!

Getting High on Your Holiday

Sure, we've all thought about it and some of us do it often. Getting high on your holiday trip can be pretty fun, in fact. I mean really high, above 11,500 feet (3500 m). Not everything cool is on a beach at sea-level. Ruins in the Andes, trekking in the Himalayas and chasing back country powder are a few things you have to get high, to do. These trips are all "dream vacations," so why risk a problem with altitude sickness?

High altitude is considered to be 1500 - 3500 m (4950 - 11,500 ft) while very high altitude covers 3500 to 5500 m (11,500-18,050 ft). Anything above 5500 m falls into the extreme altitude category. Altitude sickness is not related to physical fitness and can have some deadly consequences, if not recognized and treated promptly.

Accute Mountain Sickness generally includes symptoms of headache, worse at night or during straining, nausea/vomiting and dizziness. The symptoms are often described as a "bad hangover".

Some conditions associated with more severe forms of altitude sickness or AMS (acute mountain sickness) include HACE (high altitude cerebral edema) and HAPE (high altitude pulmonary edema). These conditions involve swelling and fluid accumulation in the respective tissues. Swelling of the brain, as seen in HACE, can present as marked stupor and confusion. HAPE, with fluid collecting in the person's lungs, often starts as a cough followed by progressive shortness of breath.

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