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Antibiotics on the JMT...

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  • Dave Park
    Hi all, I have been putting a lot of thought into the planning of my 2015 JMT hike. One aspect I haven t seen mentioned on my relatively short time on this
    Message 1 of 30 , Jun 12, 2014
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      Hi all,

      I have been putting a lot of thought into the planning of my 2015 JMT hike.

      One aspect I haven't seen mentioned on my relatively short time on this list, and searching the archives, is pre-emptive prescriptions for antibiotics. I think it is smart to see a friendly doctor and get a course of a broad spectrum antibiotic that you can start to take, *if* you get an infection on the trail. 

      There are locations on the trail where even a minor infection can cause huge problems, and you could be a three or four day hike from medical support.

      Would someone more knowledgeable like to make recommendations of what to ask for from my Doctor? Also, it may seem an unusual request to ask for a prescription for an illness you don't have yet, and may not even get. Has anyone found any approaches particularly successful?

      I will be getting AMS meds at the same time. They will go with the usual suspects: aspirin, ibuprofen, imodium and an anti-histamine.

      Secondly, prescription bottles can be heavy and bulky - more than necessary, but removing prescription medications from their container can be an offense in some cases. Any recommendations or advice on how to efficiently carry these with me on the trail?

      Dave
    • Carolsteveyoung
      Suggestion to consider for Rx: Get those tiny ziplocks and put the label from the bottle inside the bag with the pills. Stuff all the ziplocks into just one Rx
      Message 2 of 30 , Jun 12, 2014
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        Suggestion to consider for Rx:
        Get those tiny ziplocks and put the label from the bottle inside the bag with the pills. Stuff all the ziplocks into just one Rx bottle. At least you could say they are in. Rx bottle

        Btw in my experience there are a fair number of doctors who hike the trail. 

        Steve Young
        Geneva IL


        On Jun 12, 2014, at 2:56 PM, "Dave Park plasticuser@... [johnmuirtrail]" <johnmuirtrail@yahoogroups.com> wrote:

         

        Hi all,

        I have been putting a lot of thought into the planning of my 2015 JMT hike.

        One aspect I haven't seen mentioned on my relatively short time on this list, and searching the archives, is pre-emptive prescriptions for antibiotics. I think it is smart to see a friendly doctor and get a course of a broad spectrum antibiotic that you can start to take, *if* you get an infection on the trail. 

        There are locations on the trail where even a minor infection can cause huge problems, and you could be a three or four day hike from medical support.

        Would someone more knowledgeable like to make recommendations of what to ask for from my Doctor? Also, it may seem an unusual request to ask for a prescription for an illness you don't have yet, and may not even get. Has anyone found any approaches particularly successful?

        I will be getting AMS meds at the same time. They will go with the usual suspects: aspirin, ibuprofen, imodium and an anti-histamine.

        Secondly, prescription bottles can be heavy and bulky - more than necessary, but removing prescription medications from their container can be an offense in some cases. Any recommendations or advice on how to efficiently carry these with me on the trail?

        Dave

      • Carolsteveyoung
        One more idea: wash hands at appropriate times in plain water then follow up with a tiny squirt of antibacterial hand gel. Let air dry There was a pretty
        Message 3 of 30 , Jun 12, 2014
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          One more idea: wash hands at appropriate times in plain water then follow up with a tiny squirt of antibacterial hand gel. Let air dry  

          There was a pretty thorough study by a microbiologist that settled on that as best practice in the field. No soap to rinse into environment either. 

          Steve Young
          Geneva IL

          On Jun 12, 2014, at 2:56 PM, "Dave Park plasticuser@... [johnmuirtrail]" <johnmuirtrail@yahoogroups.com> wrote:

           

          Hi all,

          I have been putting a lot of thought into the planning of my 2015 JMT hike.

          One aspect I haven't seen mentioned on my relatively short time on this list, and searching the archives, is pre-emptive prescriptions for antibiotics. I think it is smart to see a friendly doctor and get a course of a broad spectrum antibiotic that you can start to take, *if* you get an infection on the trail. 

          There are locations on the trail where even a minor infection can cause huge problems, and you could be a three or four day hike from medical support.

          Would someone more knowledgeable like to make recommendations of what to ask for from my Doctor? Also, it may seem an unusual request to ask for a prescription for an illness you don't have yet, and may not even get. Has anyone found any approaches particularly successful?

          I will be getting AMS meds at the same time. They will go with the usual suspects: aspirin, ibuprofen, imodium and an anti-histamine.

          Secondly, prescription bottles can be heavy and bulky - more than necessary, but removing prescription medications from their container can be an offense in some cases. Any recommendations or advice on how to efficiently carry these with me on the trail?

          Dave

        • Deborah Rhoton
          As a RN, I discourage the use of antibiotics, even broad spectrum ones, for any infection that hasn t been appropriately diagnosed. If someone still insists,
          Message 4 of 30 , Jun 12, 2014
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            As a RN, I discourage the use of antibiotics, even broad spectrum ones, for any "infection" that hasn't been appropriately diagnosed. If someone still insists, Cipro would cover most infections one would face in the backcountry. There are valid arguments on both sides for or against the antibiotics. You are right in saying that it could easily be 3-4 days before one could exit the trail and having antibiotics would be handy to go ahead and start. My argument for the other side would be that it may give someone a false sense of security. A person may decide they do not need to exit the trail and seek appropriate medical care and unfortunately the antibiotic they have doesn't cover their infection, finding themselves in a worse state of illness. Just my 2 cents worth!

            Deb

            Sent from my iPhone

            On Jun 12, 2014, at 2:56 PM, "Dave Park plasticuser@... [johnmuirtrail]" <johnmuirtrail@yahoogroups.com> wrote:

             

            Hi all,

            I have been putting a lot of thought into the planning of my 2015 JMT hike.

            One aspect I haven't seen mentioned on my relatively short time on this list, and searching the archives, is pre-emptive prescriptions for antibiotics. I think it is smart to see a friendly doctor and get a course of a broad spectrum antibiotic that you can start to take, *if* you get an infection on the trail. 

            There are locations on the trail where even a minor infection can cause huge problems, and you could be a three or four day hike from medical support.

            Would someone more knowledgeable like to make recommendations of what to ask for from my Doctor? Also, it may seem an unusual request to ask for a prescription for an illness you don't have yet, and may not even get. Has anyone found any approaches particularly successful?

            I will be getting AMS meds at the same time. They will go with the usual suspects: aspirin, ibuprofen, imodium and an anti-histamine.

            Secondly, prescription bottles can be heavy and bulky - more than necessary, but removing prescription medications from their container can be an offense in some cases. Any recommendations or advice on how to efficiently carry these with me on the trail?

            Dave

          • tripsalot2000
            I bought a Monday-Sunday 7 compartment prescription holder (it s circular shaped) at the dollar store and I organize my different med types in each
            Message 5 of 30 , Jun 12, 2014
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              I bought a Monday-Sunday 7 compartment prescription holder (it's circular shaped) at the dollar store and I organize my different med types in each compartment. I keep this with my first aid kit (which is a small ziplock with other first aid items...moleskin, ointments, etc.

              Good luck finding a friendly doctor....my nurse flat out refused to give me a prescription for altitude sickness because (and I am literally quoting her here), she "doesn't like to prescribe that." She said I was young and healthy and should be fine without it. Needless to say, I was not pleased! She then said I should see a Sports Doctor (and of course pay my $45 co-pay a second time).

              I asked your same question in the ladies of the JMT Facebook page and one really good suggestion (I thought) was to ask for a prescription for skin infections because with all those blisters (and less than ideal hygiene), your chances are pretty good that you'll get a skin infection. The ladies (including one doctor) advised against general spectrum antibiotics....they said it's just not worth it.

              Hope that info helps!

              Nicole
            • Jason Luban
              I second Deb s emotion. Whenever I travel (including on the JMT), the only prescription medication that I bring with me is Cipro. I rarely use it (I only have
              Message 6 of 30 , Jun 12, 2014
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                I second Deb's emotion.  Whenever I travel (including on the JMT), the only prescription medication that I bring with me is Cipro. I rarely use it (I only have in Central and South America on medical aid trips/Doctiors Without Borders), but on the few occasions that I have needed it, it has quite literally saved my ass. It is best for bacterial dysentery and urinary tract infections, but unfortunately, people abuse it and use it for colds and all kinds of other inappropriate uses when they are given an open prescription. I say it is fine to have it on hand, but know ahead of time the exact situations for which you would be using it. It will not really work for skin or sinus infections the way it will for issues of the bowel and urogenital areas, and those issues need to be bacterial in nature. The abuse of antibacterials, and Cipro in particular, are a real serious problem for reasons that most of you already understand. Cipro is a very powerful, broad-spectrum antibiotic--powerful enough to be used as the drug of choice for anthrax poisoning. Keep it on hand perhaps, but use it with great discretion.

                -Jason


                On Thu, Jun 12, 2014 at 2:10 PM, Deborah Rhoton deborahrhoton@... [johnmuirtrail] <johnmuirtrail@yahoogroups.com> wrote:
                 

                As a RN, I discourage the use of antibiotics, even broad spectrum ones, for any "infection" that hasn't been appropriately diagnosed. If someone still insists, Cipro would cover most infections one would face in the backcountry. There are valid arguments on both sides for or against the antibiotics. You are right in saying that it could easily be 3-4 days before one could exit the trail and having antibiotics would be handy to go ahead and start. My argument for the other side would be that it may give someone a false sense of security. A person may decide they do not need to exit the trail and seek appropriate medical care and unfortunately the antibiotic they have doesn't cover their infection, finding themselves in a worse state of illness. Just my 2 cents worth!

                Deb

                Sent from my iPhone

                On Jun 12, 2014, at 2:56 PM, "Dave Park plasticuser@... [johnmuirtrail]" <johnmuirtrail@yahoogroups.com> wrote:

                 

                Hi all,

                I have been putting a lot of thought into the planning of my 2015 JMT hike.

                One aspect I haven't seen mentioned on my relatively short time on this list, and searching the archives, is pre-emptive prescriptions for antibiotics. I think it is smart to see a friendly doctor and get a course of a broad spectrum antibiotic that you can start to take, *if* you get an infection on the trail. 

                There are locations on the trail where even a minor infection can cause huge problems, and you could be a three or four day hike from medical support.

                Would someone more knowledgeable like to make recommendations of what to ask for from my Doctor? Also, it may seem an unusual request to ask for a prescription for an illness you don't have yet, and may not even get. Has anyone found any approaches particularly successful?

                I will be getting AMS meds at the same time. They will go with the usual suspects: aspirin, ibuprofen, imodium and an anti-histamine.

                Secondly, prescription bottles can be heavy and bulky - more than necessary, but removing prescription medications from their container can be an offense in some cases. Any recommendations or advice on how to efficiently carry these with me on the trail?

                Dave


              • Inga Aksamit
                First, most doctors will not balk at writing prophylactic prescriptions for backpacking trips and overseas travel. I have an arsenal of antibiotics for
                Message 7 of 30 , Jun 12, 2014
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                  First, most doctors will not balk at writing prophylactic prescriptions for backpacking trips and overseas travel. I have an arsenal of antibiotics for overseas travel but just saw my doctor and she just recommended Cipro for me--good for GI and whatever ails you (I have a couple of allergies so sulfa and keflex are out for me, but keflex might be a good option for some, for skin infections). I know others will have different opinions. Sadly, I can't take Diamox either due to the sulfa allergy (yes, I know that some people don't have the cross-reactivity but some do and I usually fall into the category of being very sensitive to everything so it's not worth it) so I have a prescription for dexamethasone in case I have altitude problems. I bring 2-3 narcotic pain pills in case of such disasters as broken bones.  I use those little tiny plastic zip tops that most pharmacies sell, labeled--that's what I've used countless times through airports without a question. I use Neosporin liberally for anything bothering my skin. I have steri-strips, too. 

                  I wrote to a wilderness-MD about Diamox (before I realized I can't take it) and here's what he said about dosing: "The trend has been to go lower and lower, and I now recommend 1/2 of a 125mg tab (62 mg)  at bedtime ONLY, starting 2 nights before the trip.  FAR fewer side effects than in the past."

                  Inga Aksamit 
                  Mobile: 415-470-1812
                  Email: Iaksamit@...
                  Twitter.com/IngaAksamit
                • Dave Park
                  Hi Deb, I agree with you 100%. I am very aware of two aspect of this: 1. overprescribing of antibiotics and 2: people thinking antibiotics work against
                  Message 8 of 30 , Jun 12, 2014
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                    Hi Deb,

                    I agree with you 100%. I am very aware of two aspect of this: 1. overprescribing of antibiotics and 2: people thinking antibiotics work against viruses, etc.

                    In this case, I have a very clear protocol in mind that in the event of an infection that meets the criteria to start taking the antibiotic, I could start treatment and either going ahead or backtracking, take my quickest route off the trail to professional medical care. It's not an excuse to carry on - continuing would only happen if that was the quickest way off. I am not 'entirely dumb' in these matters (I am a forensic anthropologist) but I do know the limits of my knowledge so I am doing the best I can to get myself informed before making a decision ;)

                    Dave


                    On Thu, Jun 12, 2014 at 4:10 PM, Deborah Rhoton deborahrhoton@... [johnmuirtrail] <johnmuirtrail@yahoogroups.com> wrote:
                     

                    As a RN, I discourage the use of antibiotics, even broad spectrum ones, for any "infection" that hasn't been appropriately diagnosed. If someone still insists, Cipro would cover most infections one would face in the backcountry. There are valid arguments on both sides for or against the antibiotics. You are right in saying that it could easily be 3-4 days before one could exit the trail and having antibiotics would be handy to go ahead and start. My argument for the other side would be that it may give someone a false sense of security. A person may decide they do not need to exit the trail and seek appropriate medical care and unfortunately the antibiotic they have doesn't cover their infection, finding themselves in a worse state of illness. Just my 2 cents worth!

                    Deb


                  • Kelly Sanderson
                    OK, I ll bite, but I m sure there will be those who disagree. I would probably lean against prescribing a medication like this to someone who is doing a
                    Message 9 of 30 , Jun 12, 2014
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                      OK, I'll bite, but I'm sure there will be those who disagree. 
                       
                      I would probably lean against prescribing a medication like this to someone who is doing a JMT-caliber hike, for the following reasons:
                       
                      • The vast majority of respiratory (I'm including ear/sinus/throat in this category) and gastrointestinal illnesses you would likely encounter would be viral, not bacterial, so the antibiotic wouldn't help....and taking an antibiotic in these cases (including certain bacterial infections) might make you even worse.
                      • I've noticed that a lot of people (including health care providers!) have a hard time differentiating a skin infection from some other source of irritation, so again, I'd be afraid that folks would take antibiotics unnecessarily and end up worse off than they started.  Also, lots of common skin infections will resolve just fine with warm compresses/soaks (which most folks could arrange on the trail) and watchful waiting. 
                      • The odds of you encountering a repiratory- or GI-causing bug I think are actually likely less in the backcoutnry, given that you're not exposed to nearly as many people. (Although some of the resupply spots could be tricky.) 
                      An exception I'd make would be for the woman who is prone to urinary tract infections--those suckers can get ugly quickly, and there's evidence out there that treating-without-seeing is reasonably safe and effective. 
                       
                      From a health perspective, I'd instead focus my energies on maintaining good hygiene, preventing blisters and other skin breakdown, and knowing my bailout options at any given point.
                       
                      My two cents!  I'd love to hear some counter-arguments...
                       
                      Kelly (nurse practitioner, working in primary care)
                    • Deborah Rhoton
                      Dave, Excellent plan! Thanks and best wishes for a great hike!! :-) Deb Sent from my iPhone
                      Message 10 of 30 , Jun 12, 2014
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                        Dave, 

                        Excellent plan!  Thanks and best wishes for a great hike!! :-)

                        Deb

                        Sent from my iPhone

                        On Jun 12, 2014, at 4:49 PM, "Dave Park plasticuser@... [johnmuirtrail]" <johnmuirtrail@yahoogroups.com> wrote:

                         

                        Hi Deb,

                        I agree with you 100%. I am very aware of two aspect of this: 1. overprescribing of antibiotics and 2: people thinking antibiotics work against viruses, etc.

                        In this case, I have a very clear protocol in mind that in the event of an infection that meets the criteria to start taking the antibiotic, I could start treatment and either going ahead or backtracking, take my quickest route off the trail to professional medical care. It's not an excuse to carry on - continuing would only happen if that was the quickest way off. I am not 'entirely dumb' in these matters (I am a forensic anthropologist) but I do know the limits of my knowledge so I am doing the best I can to get myself informed before making a decision ;)

                        Dave


                        On Thu, Jun 12, 2014 at 4:10 PM, Deborah Rhoton deborahrhoton@... [johnmuirtrail] <johnmuirtrail@yahoogroups.com> wrote:
                         

                        As a RN, I discourage the use of antibiotics, even broad spectrum ones, for any "infection" that hasn't been appropriately diagnosed. If someone still insists, Cipro would cover most infections one would face in the backcountry. There are valid arguments on both sides for or against the antibiotics. You are right in saying that it could easily be 3-4 days before one could exit the trail and having antibiotics would be handy to go ahead and start. My argument for the other side would be that it may give someone a false sense of security. A person may decide they do not need to exit the trail and seek appropriate medical care and unfortunately the antibiotic they have doesn't cover their infection, finding themselves in a worse state of illness. Just my 2 cents worth!

                        Deb


                      • Steve Eddy
                        And antibiotics sometimes make people very sick. On Jun 12, 2014 2:10 PM, Deborah Rhoton deborahrhoton@yahoo.com
                        Message 11 of 30 , Jun 12, 2014
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                          And antibiotics sometimes make people very sick.

                          On Jun 12, 2014 2:10 PM, "Deborah Rhoton deborahrhoton@... [johnmuirtrail]" <johnmuirtrail@yahoogroups.com> wrote:
                           

                          As a RN, I discourage the use of antibiotics, even broad spectrum ones, for any "infection" that hasn't been appropriately diagnosed. If someone still insists, Cipro would cover most infections one would face in the backcountry. There are valid arguments on both sides for or against the antibiotics. You are right in saying that it could easily be 3-4 days before one could exit the trail and having antibiotics would be handy to go ahead and start. My argument for the other side would be that it may give someone a false sense of security. A person may decide they do not need to exit the trail and seek appropriate medical care and unfortunately the antibiotic they have doesn't cover their infection, finding themselves in a worse state of illness. Just my 2 cents worth!

                          Deb

                          Sent from my iPhone

                          On Jun 12, 2014, at 2:56 PM, "Dave Park plasticuser@... [johnmuirtrail]" <johnmuirtrail@yahoogroups.com> wrote:

                           

                          Hi all,

                          I have been putting a lot of thought into the planning of my 2015 JMT hike.

                          One aspect I haven't seen mentioned on my relatively short time on this list, and searching the archives, is pre-emptive prescriptions for antibiotics. I think it is smart to see a friendly doctor and get a course of a broad spectrum antibiotic that you can start to take, *if* you get an infection on the trail. 

                          There are locations on the trail where even a minor infection can cause huge problems, and you could be a three or four day hike from medical support.

                          Would someone more knowledgeable like to make recommendations of what to ask for from my Doctor? Also, it may seem an unusual request to ask for a prescription for an illness you don't have yet, and may not even get. Has anyone found any approaches particularly successful?

                          I will be getting AMS meds at the same time. They will go with the usual suspects: aspirin, ibuprofen, imodium and an anti-histamine.

                          Secondly, prescription bottles can be heavy and bulky - more than necessary, but removing prescription medications from their container can be an offense in some cases. Any recommendations or advice on how to efficiently carry these with me on the trail?

                          Dave

                        • Dave Park
                          On Thu, Jun 12, 2014 at 5:10 PM, Steve Eddy steveddy54@gmail.com ... So do peanuts... ? My take is if an ill-informed person takes antibiotics with them, feels
                          Message 12 of 30 , Jun 12, 2014
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                            On Thu, Jun 12, 2014 at 5:10 PM, Steve Eddy steveddy54@... [johnmuirtrail] <johnmuirtrail@yahoogroups.com> wrote:
                             

                            And antibiotics sometimes make people very sick.


                            So do peanuts... ?

                            My take is if an ill-informed person takes antibiotics with them, feels off one day and takes an antibiotic and feels better so they stop taking the antibiotic, they'll probably turn into patient X and destroy mankind. *ick*

                            If an informed person takes antibiotics with them, *in case of emergency* and they know it's an anti-biotic they're not allergic to, if they don't take it, it doesn't create a problem. If they have "some" medical knowledge, enough to make a reasonable judgment call whether an infection would benefit from starting treatment and leaving the trail, as long as they finish the course of treatment, no harm is done even if the treatment wasn't applicable, as long as all the bacteria affected by that antibiotic do die because the person finished the course. So in the case of a false positive, the harm is small to zero. However, if a person has an infection, and good medical help is 3-4 days away, *if they are even well enough to walk*, then taking the antibiotic can give them enough of a head start on the infection to get off trail and get to someone who can render a skilled diagnosis.

                            We're not taking it as a preventative. That is entirely not an option.

                            My personal view is it's something I'd rather have and not need, than need and not have. I know the types of infections I'm prone to, and the types of secondary infections I am prone to when I fight off a primary infection. For me, this is a sensible precaution.

                            Dave
                          • John Ladd
                            I carry a fairly large arsenal of Rx and self-medicate as needed. I m sure there are times when I medicated something that didn t need it, but I think my
                            Message 13 of 30 , Jun 12, 2014
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                              I carry a fairly large arsenal of Rx and self-medicate as needed. I'm
                              sure there are times when I medicated something that didn't need it,
                              but I think my travelling pharmacy has also saved several trips.

                              For every medication I carry, I have a cheat sheet with the
                              indications and counter indications for the medication, to the extent
                              applicable to me, the recommended and maximum dosage and possible
                              interactions and problems. Typical notes are

                              white oval tablet 5312/500 or CR500 Cipro 1 tab x 2/day; for bacterial
                              infections incl bad diarrhea (better than Z-pak for E Coli caused
                              diarrhea) - Achilles tendinitis risks are high for 60+ and when used
                              with corticosteroids (Hydrocortisone or Betamethasone) CR500 expir
                              5/14

                              cylindrical white scored tablet marked Watson 349 (racetrack shape) =
                              500 mg APAP (Acetaminophen_ and 5 mg hydrocodone bitartrate (contains
                              an opiate, don't share, drug of abuse) take 1-2 as needed ev 4-6 hrs,
                              max 8 per day, esp when setting up camp and at bedtime for pain
                              control esp low back or knee spasm; can also be taken to suppress
                              severe cough; may aggravate any constipation; don't take with Tylenol
                              (also APAP). 500/5 form no longer recommended - replace with 325/5

                              I only bring medications that I have used in the past and know that I tolerate.

                              Since the notes include the coding printed on the tablet, I can put
                              all the meds in one bottle.
                              John Curran Ladd
                              1616 Castro Street
                              San Francisco, CA 94114-3707
                              415-648-9279


                              On Thu, Jun 12, 2014 at 12:56 PM, Dave Park plasticuser@...
                              [johnmuirtrail] <johnmuirtrail@yahoogroups.com> wrote:
                              >
                              >
                              > Hi all,
                              >
                              > I have been putting a lot of thought into the planning of my 2015 JMT hike.
                              >
                              > One aspect I haven't seen mentioned on my relatively short time on this
                              > list, and searching the archives, is pre-emptive prescriptions for
                              > antibiotics. I think it is smart to see a friendly doctor and get a course
                              > of a broad spectrum antibiotic that you can start to take, *if* you get an
                              > infection on the trail.
                              >
                              > There are locations on the trail where even a minor infection can cause huge
                              > problems, and you could be a three or four day hike from medical support.
                              >
                              > Would someone more knowledgeable like to make recommendations of what to ask
                              > for from my Doctor? Also, it may seem an unusual request to ask for a
                              > prescription for an illness you don't have yet, and may not even get. Has
                              > anyone found any approaches particularly successful?
                              >
                              > I will be getting AMS meds at the same time. They will go with the usual
                              > suspects: aspirin, ibuprofen, imodium and an anti-histamine.
                              >
                              > Secondly, prescription bottles can be heavy and bulky - more than necessary,
                              > but removing prescription medications from their container can be an offense
                              > in some cases. Any recommendations or advice on how to efficiently carry
                              > these with me on the trail?
                              >
                              > Dave
                              >
                              >
                            • Kelly Sanderson
                              Folks, I also feel it s important to note that while it is accepted practice to prescribe antibiotics for diarrhea encountered when travelling overseas (pretty
                              Message 14 of 30 , Jun 12, 2014
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                                Folks, I also feel it's important to note that while it is accepted practice to prescribe antibiotics for diarrhea encountered when travelling overseas (pretty much anywhere else besides N and W. Europe, Japan, Canada, Australia/NZ) because most diarrhea encountered in these places is bacterial in origin. The United States really has a low relative risk of contracting a GI bug.  (I'd actually be interested in seeing what the travel recommendations are for folks coming over here, but my 10 second Google search didn't come up with anything.)
                                 
                                Also, to correct John's statement about Cipro, we no longer prescribe this for traveler's diarrhea in certain parts of the word for traveler's diarrhea due to--you guessed it!--antibiotic resistance.  Azithromycin (aka the Zpack, taken a bit differently than the typical Zpack course) is the treatment of choice in these regions. 
                              • Stephen Kundell
                                I am a physician and I dont bring antibiotics hiking, except for a little antibiotic ointment and betadine with my suture set. Many so called broad spectrum
                                Message 15 of 30 , Jun 12, 2014
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                                  I am a physician and I dont bring antibiotics hiking, except for a
                                  little antibiotic ointment and betadine with my suture set. Many so
                                  called broad spectrum antibiotics (think zpak, cipro) no longer work
                                  that well because of years of overprescribing and overuse in the food
                                  chain. If you have a history of frequent recurrent infections such as
                                  sinusitis, or are prone to MRSA infections, it would be reasonable to
                                  bring something to target your specific issue. I myself would only
                                  prescribe cipro or azithromycin (zpak not zpacks) for patients traveling
                                  to third world countries who might get bloody diarrhea from
                                  campylobacter or salmonella from contaminated food or water. Not an
                                  issue on the JMT if you take reasonable precautions. If you are
                                  seriously ill, you need to get out of there.

                                  Bring pain medication (narcotic), anti-inflammatories , imodium, maybe a
                                  little zofran (from your doctor), band aids, antibiotic ointment, soap,
                                  benadryl. The things that happen are unpredictable and you will not
                                  cover all contingencies. I lost a dental crown chewing on a mango strip
                                  while on the JMT, spit out the rock I thought was in my mouth only to
                                  find half a tooth missing (spit into the decomposing granite, never to
                                  be found). I was careful about chewing for several days, but got by.

                                  A similar issue has been raised about taking epi pens. People who have
                                  known allergies should take epi pens, steroids, bronchodilators,
                                  benadryl, emergency communicators, and know how to use all the meds. An
                                  epi pen alone buys you less than an hour in the event of serious allergies.

                                  Stephen
                                • Stephen Kundell
                                  John, Good point about cipro and the achilles tendon. There is actually a risk of rupture of the achilles tendon with vigorous physical activity while on cipro
                                  Message 16 of 30 , Jun 12, 2014
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                                    John,
                                    Good point about cipro and the achilles tendon. There is actually a risk
                                    of rupture of the achilles tendon with vigorous physical activity while
                                    on cipro and it applies to all age groups, even adolescents. I typically
                                    advise against vigorous physical activity when on cipro.
                                    I think many good issues are being raised in this thread, and the issues
                                    are clearly different for men and women.

                                    Regarding the person who can not take diamox. I would recommend taking
                                    the dexamethasone 4mg twice daily on the day you start hiking and for
                                    the next 2 days if you are rapidly going to high altitude, rather than
                                    waiting for symptoms. One of the most common early symptoms of altitude
                                    sickness is vomiting, making it difficult to hold down your meds.
                                    Dexamethasone may reduce the risk of high altitude pulmonary edema and
                                    cerebral edema, but it does not correct sleep apnea the same way diamox
                                    does.
                                    Stephen
                                  • debrabrownbear
                                    Deb, I agree. I developed an infection on the JMT last year, and knew I needed antibiotics. I didn t have any, and elected to leave the trail at VVR and see a
                                    Message 17 of 30 , Jun 12, 2014
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                                      Deb, I agree. I developed an infection on the JMT last year, and knew I needed antibiotics. I didn't have any, and elected to leave the trail at VVR and see a doctor. Which turned out to be the right decision. If I'd had antibiotics, I might have tried to tough it out, which likely would have led to a worse situation. Debra
                                    • Dave Park
                                      All, This is the sort of situation I m talking about. If you re taking antibiotics, your trek is over and you re headed to the nearest exit point. There are a
                                      Message 18 of 30 , Jun 12, 2014
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                                        All,

                                        This is the sort of situation I'm talking about. If you're taking antibiotics, your trek is over and you're headed to the nearest exit point.

                                        There are a few of us that for one reason or another (eg: chemo) are immune compromised. Knowing that, but still being healthy enough to do JMT, this is a sensible precaution worth taking - as long as you structure it with strict rules that say if you trigger antibiotics, you're not finishing the trail....unless, of course, you're close to Mt Whitney, in which case that's your quickest route to support.

                                        The posts saying "don't take antibiotics with you" represent a valid view, but it's unhelpful in the context of this thread. We know the risks of antibiotics, but we also know the risks we personally face too, so then it becomes a matter of judging which are the likeliest infection risks on the JMT, and preparing for those with a clear exit strategy in the event someone gets sick. 

                                        Dave


                                        On Thu, Jun 12, 2014 at 7:26 PM, debrabrownbear@... [johnmuirtrail] <johnmuirtrail@yahoogroups.com> wrote:
                                         

                                        Deb, I agree. I developed an infection on the JMT last year, and knew I needed antibiotics. I didn't have any, and elected to leave the trail at VVR and see a doctor. Which turned out to be the right decision. If I'd had antibiotics, I might have tried to tough it out, which likely would have led to a worse situation. Debra


                                      • Arla Hile
                                        My kit comes with an emergency room physician who is fellowship trained in wilderness medicine, and who trains park rangers who want to be Parkmedic certified
                                        Message 19 of 30 , Jun 12, 2014
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                                          My kit comes with an emergency room physician who is fellowship trained in wilderness medicine, and who trains park rangers who want to be Parkmedic certified in the National Park Service. She is a Fresno County Search and Rescue Deputy. She lectures on emergency medicine in the wilderness at the national level as well. I feel pretty safe!

                                          Anyway, this is a photo of her with her first aid kit for a four-day backpacking trip we did last November in the Sierra over Glen Pass. I see a lighter, duct tape, a tube of what I think is antibiotic ointment. I suspect she has moleskin, ibuprofen and zofran (an anti-nausea med) because I've seen her hand those out on other trips. She has told me that she has a safety pin and a tampon because they have many uses in the field. There was something about using a pen (or ?) for making a tracheotomy (yikes). I could ask her what's in her kit. Of course all of this assumes you know what you're doing, which I certainly don't! 

                                          I asked her why she had so few first aid supplies, and her answer was that there's only so much you can do out there, often the best thing is to get out of there!

                                          Photo: Ultralight backpacking First Aid kit! It even comes with a doctor!


                                          On Thursday, June 12, 2014 5:27 PM, "debrabrownbear@... [johnmuirtrail]" <johnmuirtrail@yahoogroups.com> wrote:


                                           
                                          Deb, I agree. I developed an infection on the JMT last year, and knew I needed antibiotics. I didn't have any, and elected to leave the trail at VVR and see a doctor. Which turned out to be the right decision. If I'd had antibiotics, I might have tried to tough it out, which likely would have led to a worse situation. Debra


                                        • kellymelissaray
                                          Dave, I think we misunderstood your original email. I interpreted your What to ask from my doctor question as which antibiotics you should be asking
                                          Message 20 of 30 , Jun 12, 2014
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                                            Dave, I think we misunderstood your original email.  I interpreted your "What to ask from my doctor" question as which antibiotics you should be asking for...but perhaps in hindsight this wasn't what you were asking?

                                            I stand by my sentiment that for the average, healthy hiker, antibiotics are probably going to get you into more trouble than they'll help.  But if you have some personal medical history that makes you a better candidate for self-treatment on the trail, by all means make your case to your medical provider.  As a prescriber, if you can give me information about where you'll be going, what conditions you'll be dealing with, how far away from help you'll be, etc..that might make justifying antibiotics a little easier.  The prescriber should presumably already have a handle on your past medical history, but if not, be prepared to explain that as well.  If you happen to already have a good sense about when it is/isn't appropriate to take an antibiotic in a given scenario, demonstrating that to me also helps me feel more comfortable.

                                            In the case of altitude illness prophylaxis...if for some reason you were to encounter some resistance to getting the prescription, you might consider bringing in the CDC's info on the subject, along with details about what your itinerary looks like, elevation wise.


                                            There's a nice table that shows when prophylaxis really isn't necessary, when when it should be considered.

                                            Hope this helps,

                                            Kelly

                                          • Dave Park
                                            Hi Kelly, Thank you for your thoughtful response. :) Exactly. What I am trying to do is collect the experiences of JMT hikers of what the specific risks are to
                                            Message 21 of 30 , Jun 12, 2014
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                                              Hi Kelly,

                                              Thank you for your thoughtful response. :)

                                              Exactly. What I am trying to do is collect the experiences of JMT hikers of what the specific risks are to that trail and area. That way I can present an accurate idea of the risks and they can make an informed decision about if or what to prescribe, as a precaution. I would not go against their advice. I apologize if I phrased my question badly. Also, I apologize for being private about my own health. I know that physically I can do the JMT and I am averse to taking risks. I just don't want to put my companions in the difficult position of having to carry me off the mountain with something unpleasant if I can do it under my own steam.

                                              I'm truly just trying to have an intelligent discussion with my Dr about it. It's hard to do that if I do not know the specific risks.

                                              One way I am blessed: I am one of the 15% who has absolutely no reaction to poison ivy or poison oak. I've seen a few hikes utterly ruined for people by a brush with a plant, or contact with someone's clothes that touched a plant down trail... Utter misery. I guess it's a trade-off.

                                              Dave


                                              On Thu, Jun 12, 2014 at 8:25 PM, kelly.m.sanderson@... [johnmuirtrail] <johnmuirtrail@yahoogroups.com> wrote:
                                               

                                              Dave, I think we misunderstood your original email.  I interpreted your "What to ask from my doctor" question as which antibiotics you should be asking for...but perhaps in hindsight this wasn't what you were asking?


                                              I stand by my sentiment that for the average, healthy hiker, antibiotics are probably going to get you into more trouble than they'll help.  But if you have some personal medical history that makes you a better candidate for self-treatment on the trail, by all means make your case to your medical provider.  As a prescriber, if you can give me information about where you'll be going, what conditions you'll be dealing with, how far away from help you'll be, etc..that might make justifying antibiotics a little easier.  The prescriber should presumably already have a handle on your past medical history, but if not, be prepared to explain that as well.  If you happen to already have a good sense about when it is/isn't appropriate to take an antibiotic in a given scenario, demonstrating that to me also helps me feel more comfortable.

                                              In the case of altitude illness prophylaxis...if for some reason you were to encounter some resistance to getting the prescription, you might consider bringing in the CDC's info on the subject, along with details about what your itinerary looks like, elevation wise.


                                              There's a nice table that shows when prophylaxis really isn't necessary, when when it should be considered.

                                              Hope this helps,

                                              Kelly


                                            • kellymelissaray
                                              That s why I love this group so much...lots of thoughtful folks discussing very interesting things! And no need to apologize about wanting to maintain your
                                              Message 22 of 30 , Jun 12, 2014
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                                                That's why I love this group so much...lots of thoughtful folks discussing very interesting things!  And no need to apologize about wanting to maintain your privacy...that's totally normal.  I'd have been a little worried about you if you had laid out a bunch of personal details and asked a group of strangers to weigh in...

                                                I am not much help when it comes to discussing specific risks on the trail, although I think I'd first try to look at John Ladd's JMT hiker survey from last year and see what kinds of things people have encountered.  As I recall, when it comes to showstoppers, blisters and musculoskeletal issues far outweigh infectious diseases, but you might  notice some problems that could cause you, specifically, to have a worse time on the trail than others.
                                              • berdomb
                                                I would not take Cipro, it is linked with tendon ruptures. One of the benefits I like to point out, of carrying a light pack, is the trail becomes a much
                                                Message 23 of 30 , Jun 12, 2014
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                                                  I would not take Cipro, it is linked with tendon ruptures.

                                                  One of the benefits I like to point out, of  carrying a light pack, is the trail becomes a much smaller place.  When you routinely hike ~20 mpd, and know you can hike 30 miles in a day if you had too, you dont worry about things going wrong as much.  Civilization, is rarely more than a day away if you have to get there.


                                                  .
                                                • KLazzarini
                                                  Thanks all for this thread. I am physician too but as a radiologist and psychiatrist I always joke that the most I can do for you in the field is ask you how
                                                  Message 24 of 30 , Jun 13, 2014
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                                                    Thanks all for this thread. I am physician too but as a radiologist and psychiatrist I always joke that the most I can do for you in the field is ask you how you "feel" about your pain! Attempting to remedy that, I took one of the NOLS WUMP courses this winter. After that training (mostly what I needed to learn was how to work with musculoskeletal stuff in the field) I am revamping my first aid kit and if anything, going lighter than in the past. While I will likely add Zofran and Imodium to my bag, I still think one of the most important prescription medications I carry is Vicodan! One of the few definitive treatments you can provide in the back country is pain relief.

                                                    Kathi
                                                  • berdomb
                                                    Message 25 of 30 , Jun 13, 2014
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                                                    • nedtibbits
                                                      Arla! Do I understand this correctly: Your friend in the picture is - an ER Physician, - a Fellow with the Wilderness Medical Society, - Park Medic Instructor
                                                      Message 26 of 30 , Jun 19, 2014
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                                                        Arla!
                                                         
                                                        Do I understand this correctly: Your friend in the picture is
                                                         
                                                        - an ER Physician,
                                                        - a Fellow with the Wilderness Medical Society,
                                                        - Park Medic Instructor Certified with the National Park Service, and
                                                        - a Fresno County Deputy Sheriff SAR Coordinator?
                                                         
                                                        Not bad for her age! How does she keep up all those qualifications?
                                                         
                                                         
                                                        Ned Tibbits, Director
                                                        Mountain Education
                                                        www.mountaineducation.org
                                                         
                                                        Sent: Thursday, June 12, 2014 5:54 PM
                                                        Subject: Re: [John Muir Trail] Antibiotics on the JMT...
                                                         
                                                         

                                                        My kit comes with an emergency room physician who is fellowship trained in wilderness medicine, and who trains park rangers who want to be Parkmedic certified in the National Park Service. She is a Fresno County Search and Rescue Deputy. She lectures on emergency medicine in the wilderness at the national level as well. I feel pretty safe!

                                                        Anyway, this is a photo of her with her first aid kit for a four-day backpacking trip we did last November in the Sierra over Glen Pass. I see a lighter, duct tape, a tube of what I think is antibiotic ointment. I suspect she has moleskin, ibuprofen and zofran (an anti-nausea med) because I've seen her hand those out on other trips. She has told me that she has a safety pin and a tampon because they have many uses in the field. There was something about using a pen (or ?) for making a tracheotomy (yikes). I could ask her what's in her kit. Of course all of this assumes you know what you're doing, which I certainly don't!

                                                        I asked her why she had so few first aid supplies, and her answer was that there's only so much you can do out there, often the best thing is to get out of there!

                                                        Photo: Ultralight backpacking First Aid kit! It even comes with a doctor!


                                                        On Thursday, June 12, 2014 5:27 PM, "debrabrownbear@... [johnmuirtrail]" <johnmuirtrail@yahoogroups.com> wrote:


                                                         
                                                        Deb, I agree. I developed an infection on the JMT last year, and knew I needed antibiotics. I didn't have any, and elected to leave the trail at VVR and see a doctor. Which turned out to be the right decision. If I'd had antibiotics, I might have tried to tough it out, which likely would have led to a worse situation. Debra


                                                      • Arla Hile
                                                        Heehee - she looks like she s 12, doesn t she?  To be clear, I don t believe I said she was a fellow with the WMS, rather that she completed a Wilderness
                                                        Message 27 of 30 , Jun 19, 2014
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                                                          Heehee - she looks like she's 12, doesn't she? 

                                                          To be clear, I don't believe I said she was a fellow with the WMS, rather that she completed a Wilderness Medicine 1-year fellowship that is approved by (I think), ACEP (American College of Emergency Physicians). She completed the fellowship right after residency. 

                                                          Also, I'm not aware of any formal certification per se from the NPS for ParkMedic instructors, I just know that she and her colleagues train rangers who are seeking park medic training (she's on the UCSF-Fresno faculty, they have a group within the emergency dept. that coordinates this training). 

                                                          Finally, she is a deputized member of Fresno County SAR, not a SAR coordinator. 

                                                          I don't want to mislead anyone! 

                                                          Cheers,
                                                          Arla


                                                          On Thursday, June 19, 2014 12:21 PM, "ned@... [johnmuirtrail]" <johnmuirtrail@yahoogroups.com> wrote:


                                                           
                                                          Arla!
                                                           
                                                          Do I understand this correctly: Your friend in the picture is
                                                           
                                                          - an ER Physician,
                                                          - a Fellow with the Wilderness Medical Society,
                                                          - Park Medic Instructor Certified with the National Park Service, and
                                                          - a Fresno County Deputy Sheriff SAR Coordinator?
                                                           
                                                          Not bad for her age! How does she keep up all those qualifications?
                                                           
                                                           
                                                          Ned Tibbits, Director
                                                          Mountain Education
                                                          www.mountaineducation.org
                                                           
                                                          Sent: Thursday, June 12, 2014 5:54 PM
                                                          Subject: Re: [John Muir Trail] Antibiotics on the JMT...
                                                           
                                                           
                                                          My kit comes with an emergency room physician who is fellowship trained in wilderness medicine, and who trains park rangers who want to be Parkmedic certified in the National Park Service. She is a Fresno County Search and Rescue Deputy. She lectures on emergency medicine in the wilderness at the national level as well. I feel pretty safe!

                                                          Anyway, this is a photo of her with her first aid kit for a four-day backpacking trip we did last November in the Sierra over Glen Pass. I see a lighter, duct tape, a tube of what I think is antibiotic ointment. I suspect she has moleskin, ibuprofen and zofran (an anti-nausea med) because I've seen her hand those out on other trips. She has told me that she has a safety pin and a tampon because they have many uses in the field. There was something about using a pen (or ?) for making a tracheotomy (yikes). I could ask her what's in her kit. Of course all of this assumes you know what you're doing, which I certainly don't!

                                                          I asked her why she had so few first aid supplies, and her answer was that there's only so much you can do out there, often the best thing is to get out of there!

                                                          Photo: Ultralight backpacking First Aid kit! It even comes with a doctor!


                                                          On Thursday, June 12, 2014 5:27 PM, "debrabrownbear@... [johnmuirtrail]" <johnmuirtrail@yahoogroups.com> wrote:


                                                           
                                                          Deb, I agree. I developed an infection on the JMT last year, and knew I needed antibiotics. I didn't have any, and elected to leave the trail at VVR and see a doctor. Which turned out to be the right decision. If I'd had antibiotics, I might have tried to tough it out, which likely would have led to a worse situation. Debra




                                                        • Ned Tibbits
                                                          Fascinating, Arla! Thanks for clarifying. As a member of two Sheriff’s Department’s SAR units, I don’t know what a deputized SAR member is. Is she a
                                                          Message 28 of 30 , Jun 19, 2014
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                                                            Fascinating, Arla! Thanks for clarifying. As a member of two Sheriff’s Department’s SAR units, I don’t know what a deputized SAR member is. Is she a Sheriff’s Deputy or a formal member of the SAR unit?
                                                             
                                                            At any rate, what a great thing she is doing for the hiking community in her position with UCSF!
                                                             
                                                             
                                                            Ned Tibbits, Director
                                                            Mountain Education
                                                            www.mountaineducation.org
                                                             
                                                            Sent: Thursday, June 19, 2014 1:07 PM
                                                            Subject: Re: [John Muir Trail] Antibiotics on the JMT...
                                                             
                                                             

                                                            Heehee - she looks like she's 12, doesn't she?

                                                            To be clear, I don't believe I said she was a fellow with the WMS, rather that she completed a Wilderness Medicine 1-year fellowship that is approved by (I think), ACEP (American College of Emergency Physicians). She completed the fellowship right after residency.

                                                            Also, I'm not aware of any formal certification per se from the NPS for ParkMedic instructors, I just know that she and her colleagues train rangers who are seeking park medic training (she's on the UCSF-Fresno faculty, they have a group within the emergency dept. that coordinates this training).

                                                            Finally, she is a deputized member of Fresno County SAR, not a SAR coordinator.

                                                            I don't want to mislead anyone!

                                                            Cheers,
                                                            Arla


                                                            On Thursday, June 19, 2014 12:21 PM, "ned@... [johnmuirtrail]" <johnmuirtrail@yahoogroups.com> wrote:


                                                             
                                                            Arla!
                                                             
                                                            Do I understand this correctly: Your friend in the picture is
                                                             
                                                            - an ER Physician,
                                                            - a Fellow with the Wilderness Medical Society,
                                                            - Park Medic Instructor Certified with the National Park Service, and
                                                            - a Fresno County Deputy Sheriff SAR Coordinator?
                                                             
                                                            Not bad for her age! How does she keep up all those qualifications?
                                                             
                                                             
                                                            Ned Tibbits, Director
                                                            Mountain Education
                                                            www.mountaineducation.org
                                                             
                                                            Sent: Thursday, June 12, 2014 5:54 PM
                                                            Subject: Re: [John Muir Trail] Antibiotics on the JMT...
                                                             
                                                             
                                                            My kit comes with an emergency room physician who is fellowship trained in wilderness medicine, and who trains park rangers who want to be Parkmedic certified in the National Park Service. She is a Fresno County Search and Rescue Deputy. She lectures on emergency medicine in the wilderness at the national level as well. I feel pretty safe!

                                                            Anyway, this is a photo of her with her first aid kit for a four-day backpacking trip we did last November in the Sierra over Glen Pass. I see a lighter, duct tape, a tube of what I think is antibiotic ointment. I suspect she has moleskin, ibuprofen and zofran (an anti-nausea med) because I've seen her hand those out on other trips. She has told me that she has a safety pin and a tampon because they have many uses in the field. There was something about using a pen (or ?) for making a tracheotomy (yikes). I could ask her what's in her kit. Of course all of this assumes you know what you're doing, which I certainly don't!

                                                            I asked her why she had so few first aid supplies, and her answer was that there's only so much you can do out there, often the best thing is to get out of there!

                                                            Photo: Ultralight backpacking First Aid kit! It even comes with a doctor!


                                                            On Thursday, June 12, 2014 5:27 PM, "debrabrownbear@... [johnmuirtrail]" <johnmuirtrail@yahoogroups.com> wrote:


                                                             
                                                            Deb, I agree. I developed an infection on the JMT last year, and knew I needed antibiotics. I didn't have any, and elected to leave the trail at VVR and see a doctor. Which turned out to be the right decision. If I'd had antibiotics, I might have tried to tough it out, which likely would have led to a worse situation. Debra




                                                          • jerome provensal
                                                            I still wouldn t mind having her in my party. And she does look 12. Is it a case of benjamin button-ism? Jérôme / Blog / FB
                                                            Message 29 of 30 , Jun 19, 2014
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                                                              I still wouldn't mind having her in my party.
                                                              And she does look 12. Is it a case of  benjamin button-ism?

                                                              Jérôme  Blog / FB / LinkedIn / IG / Tumblr /


                                                              On Thu, Jun 19, 2014 at 1:07 PM, Arla Hile crocov502@... [johnmuirtrail] <johnmuirtrail@yahoogroups.com> wrote:
                                                               

                                                              Heehee - she looks like she's 12, doesn't she? 

                                                              To be clear, I don't believe I said she was a fellow with the WMS, rather that she completed a Wilderness Medicine 1-year fellowship that is approved by (I think), ACEP (American College of Emergency Physicians). She completed the fellowship right after residency. 

                                                              Also, I'm not aware of any formal certification per se from the NPS for ParkMedic instructors, I just know that she and her colleagues train rangers who are seeking park medic training (she's on the UCSF-Fresno faculty, they have a group within the emergency dept. that coordinates this training). 

                                                              Finally, she is a deputized member of Fresno County SAR, not a SAR coordinator. 

                                                              I don't want to mislead anyone! 

                                                              Cheers,
                                                              Arla


                                                              On Thursday, June 19, 2014 12:21 PM, "ned@... [johnmuirtrail]" <johnmuirtrail@yahoogroups.com> wrote:


                                                               
                                                              Arla!
                                                               
                                                              Do I understand this correctly: Your friend in the picture is
                                                               
                                                              - an ER Physician,
                                                              - a Fellow with the Wilderness Medical Society,
                                                              - Park Medic Instructor Certified with the National Park Service, and
                                                              - a Fresno County Deputy Sheriff SAR Coordinator?
                                                               
                                                              Not bad for her age! How does she keep up all those qualifications?
                                                               
                                                               
                                                              Ned Tibbits, Director
                                                              Mountain Education
                                                              www.mountaineducation.org
                                                               
                                                              Sent: Thursday, June 12, 2014 5:54 PM
                                                              Subject: Re: [John Muir Trail] Antibiotics on the JMT...
                                                               
                                                               
                                                              My kit comes with an emergency room physician who is fellowship trained in wilderness medicine, and who trains park rangers who want to be Parkmedic certified in the National Park Service. She is a Fresno County Search and Rescue Deputy. She lectures on emergency medicine in the wilderness at the national level as well. I feel pretty safe!

                                                              Anyway, this is a photo of her with her first aid kit for a four-day backpacking trip we did last November in the Sierra over Glen Pass. I see a lighter, duct tape, a tube of what I think is antibiotic ointment. I suspect she has moleskin, ibuprofen and zofran (an anti-nausea med) because I've seen her hand those out on other trips. She has told me that she has a safety pin and a tampon because they have many uses in the field. There was something about using a pen (or ?) for making a tracheotomy (yikes). I could ask her what's in her kit. Of course all of this assumes you know what you're doing, which I certainly don't!

                                                              I asked her why she had so few first aid supplies, and her answer was that there's only so much you can do out there, often the best thing is to get out of there!

                                                              Photo: Ultralight backpacking First Aid kit! It even comes with a doctor!


                                                              On Thursday, June 12, 2014 5:27 PM, "debrabrownbear@... [johnmuirtrail]" <johnmuirtrail@yahoogroups.com> wrote:


                                                               
                                                              Deb, I agree. I developed an infection on the JMT last year, and knew I needed antibiotics. I didn't have any, and elected to leave the trail at VVR and see a doctor. Which turned out to be the right decision. If I'd had antibiotics, I might have tried to tough it out, which likely would have led to a worse situation. Debra





                                                            • straw_marmot
                                                              I fully appreciate Deb s comments about self medication with antibiotics on the trail. Usually, if you really need them, you should be getting out of there
                                                              Message 30 of 30 , Jun 20, 2014
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                                                                I fully appreciate Deb's comments about self medication with antibiotics on the trail.  Usually, if you really need them, you should be getting out of there ASAP to seek proper medical attention.   The research on risk homeostasis (aka risk compensation) is pretty interesting (some evidence, for example, that mandating use of bicycle helmets does not reduce injuries & fatalities).

                                                                However, I like to feel that as an individual I can overcome any tendency to risk homeostasis, and that I can educate myself sufficiently on the appropriate use of antibiotics in the backcountry.

                                                                Since I often hike alone, my major concern is not really GI or respiratory problems.  It's
                                                                (a) A deep debilitating wound that might mean I had to stay put until (hopefully) eventually rescued;
                                                                (b) Debilitating pain.  Dental infection comes to mind.

                                                                In other words, I like protection against infection in potential situations where I'm simply unable to escape the backcountry rapidly, or where the pain of the infection might inhibit my ability to do so.

                                                                When I explained this to my GP, he prescribed Azithromycin.  Any physicians have an opinion on that?

                                                                Ralph
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