Aconitum: A Beauty that Kills

Posted on February 24, 2013 by Alina Goldenberg — No Comments ↓

Growing up we commonly hear of the deadly poisonous mushrooms blooming in the nearby parks. We are educated on how to spot and avoid them. However, few of us are familiar with the seemingly innocent but mischievously potent poisonous flowers readily found nationwide. Ingestion of such plants is one of the top 10 causes of poisoning worldwide.

Aconitum plants are one of the more common kinds of poisonous flowers. The name originated from the Greek world “akovitov” meaning without struggle to signify the plants’ rapid deadly effects. They include over 250 different types of flowers which carry the nicknames of “aconite,” “monkshood,” and “wolfsbane.”

Photograph by B.Datzer 2003 on wikipedia.com

These plants prefer to grow in shady areas of mountain meadows all throughout the northern hemisphere and can be incidentally spotted both in the wild and as decorative plants. The flowers are tall with large blue, purple or sometimes white flowers in the form of a cylinder.

Initially grown for their supposed medicinal powers, Aconite is found in many Chinese traditional herbal remedies. More commonly, because of its poisonous capacity Aconite has been used in many popular stories ranging from those of Greek mythology to even modern-day Harry Potter books! (Does the Wolfsbane Potion of the werewolves ring a bell?)

The specific mechanism of how the Aconite flower leads to death is quite complex. Its main actions center around our cardiovascular system, which includes our heart, the blood vessels that run to and from it, and all the energy and electricity needed to keep the heart going. One of the most important elements for our heart health is none other than the main ingredient in simple salt – that is, sodium!

By Finnian Mc Causland, http://renalfellow.blogspot.com

Sodium makes up less than 1% of our total body volume, but without it we would not be alive today! One of Sodium’s more important roles is its help in the generation of energy for our muscles. The heart, one very strong bundle of muscles, requires a well regulated amount of Sodium to be readily available at all times. Other organs like the kidneys help our body maintain a pretty constant amount of Sodium floating around our cells. When this concentration is altered in any way, our body’s energy production system is jeopardized leaving the heart scrambling to keep beating.

Aconite tampers with our body’s ability to precisely regulate the amount of Sodium available in our body. In turn, the heart beat becomes very irregular disallowing for steady blood flow to the rest of our organs—a process called arrhythmia. Since blood carries oxygen, essential for all life, without proper blood supply all organs, including the brain, begin to slowly shut down.

http://www.wardywellnesschiro.com

The severity of the poisoning depends on the amount of the flower eaten. For mice, a lethal dose is less than ¼ of a milligram; for humans 2 mg may be enough to prove fatal. Initial symptoms may include sneezing, sweating and chills, feelings of weakness, and a numbing sensation around the mouth. Overtime, the numbness can spread and more serious side effects like vomiting, diarrhea will begin. The heart rate can initially slow down or can speed up and be “irregular.” Overtime, as the brain continues to be deprived of blood and oxygen it begins to shut down leading to confusion and even seizures. Most people die because of the initial shock on the heart and the deadly effects of arrhythmia. These symptoms can begin after 3 minutes to 2 hours after ingestion of the flower, but typically start within 10-20 minutes.

http://mykentuckyheart.com/information/Ventricularfibrillation.htm

There are no known antidotes for the Aconite flowers, and most of the things doctors can do in the hospital attempt to only buy time and help the body rid itself of the poison. Treatments include cleansing the stomach of the ingested flowers; making sure the patient is able to breath by supporting the airway; and providing adequate amounts of oxygen. Fortunately, serious poisoning from plants is rare in children because the quantity of the plant required to cause serious poisoning is usually greater than what a small child ingests. Serious toxicity or death is a common risk for household pets; in adults, fatality usually occurs as a result of intentional abuse by those trying to hurt themselves or others.

Photograph by Schnobby, Feb 2011 on Wikipedia.com

The beautiful Aconite flowers entice onlookers by their bright outer coloration but pose a very dangerous threat on the inside. Kids and adults must beware of these deadly plants, always handle them with gloves, and wash any clothing which may have come in contact with the flowers. With a good ability to spot these plants and a few precautionary guidelines Aconite poisoning can become just a story of the past rather than a realistic threat in our communities.

References:

Daubert GP. Chapter 5. Aconite and Other Sodium Channel Openers. In: Olson KR, ed. Poisoning & Drug Overdose. 6th ed. New York: McGraw-Hill; 2012. http://www.accessmedicine.com/content.aspx?aID=55972774. Accessed January 22, 2013.
Hostetler MA, Schneider SM. Chapter 215. Poisonous Plants. In: Tintinalli JE, Stapczynski JS, Cline DM, Ma OJ, Cydulka RK, Meckler GD, eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill; 2011. http://www.accessmedicine.com/content.aspx?aID=6386032. Accessed January 22, 2013.
Chan TY (April 2009). “Aconite poisoning”. Clin Toxicol (Phila) 47 (4): 279 85 PMID 19514874.
Chinese Herbal Medicine: Materia Medica, Third Edition by Dan Bensky, Steven Clavey, Erich Stoger, and Andrew Gamble (Hardcover – Sep 2004)

Posted in Dog Care, Preventive Medicine, Wilderness Medicine, Your Animals

Sledding: Hit the Slopes (but NOT Your Head!)

Posted on February 24, 2013 by Francesco Dandekar — No Comments ↓

Wikipedia Image; Photo submitted by M. Rehemtulla

Sledding has long been a popular recreational pastime in cold weather climates. While providing fun and excitement, it also harbors its share of dangers. Over 20,000 children and teenagers are brought to the Emergency Department each year due to injuries sustained while sledding. Injuries include cuts and bruises, fractures of the arms, legs, and neck, and traumatic brain injuries.

Sleds were first utilized by several North American Indian tribes for transporting goods and belongings. The Cree, Anishinabe, Innu, and Chippewa tribes constructed them from thin hardwood boards; one end was heated, bent, and stabilized with crossbars to produce the curved front, and a rope was attached to the front. The sleds could be pulled by people or teams of dogs, and were extremely helpful for moving heavy loads over longer distances.

While initially used as a utilitarian tool, modern sleds come in several different forms and are used primarily for recreation. Snow sleds, or carioles, are used to transport people and consist of a mostly enclosed cabin with a partial roof. They feature long thin runners, which reduce surface friction and thereby allow for the transport of heavier loads. Olympic sleds, or bobsleds, were invented by the Swiss and boast a steering mechanism and protective chassis. The sleds are used by children and adults alike to coast down snowy slopes come in many shapes and sizes; while fundamentally similar to the initial toboggans used by the North American Indians, they are now often comprised of laminated plastic bodies for speed and affordability.

So what can you do to minimize your risk of getting hurt while still enjoying the new snowfall? First, understand your equipment. Sleds that can rotate, such as disks and snow tubes, should be avoided due to their unpredictability and lack of control. Preferably, use a sled with runners and a steering mechanism. Never sled headfirst! Doing so makes it more likely that your head will absorb the brunt of any impact; sledders should sit facing forward with their feet extended in front of them. Helmets should be worn to protect from serious head trauma in case of a crash or fall, and wearing multiple layers of clothing can provide padding and shield you from the cold.

It is also critically important to be aware of your environment. Never sled in the dark, as poor visibility increases your chances of crashing into an unseen object. Only sled in designated areas that are free of trees, signposts, fences, and rocks. Also, make sure that your sledding run does not end in a street, parking lot, or pond; a study by the Department of Pediatrics at the Seattle Children’s Hospital showed a significant increase in risk of injury when sledding in the streets as opposed to in parks. As a final word, it is never a good idea to sled while being pulled by a motorized vehicle, such as a car, snowmobile, or ATV. By following these recommendations, you can be safe on the slopes!

Tagged with: sled, sledding, snow
Posted in Preventive Medicine, Wilderness Medicine

Thumb’s Up: Skier’s (Gamekeeper’s) Thumb

Posted on January 20, 2013 by Kristen D Kelley — No Comments ↓

Skiers thumb occurs when the UCL (ligament spanning the space indicated by the arrow) is torn (Wikipedia, James Heilman, MD)

Before you go out to enjoy the beautiful mountains this winter make sure you know how to avoid the most common injuries! (Stock.xchange.hu)

Having recently examined a common snowboarding injury, let’s now turn to an injury that frequently occurs to those who navigate the slopes on skis – “skier’s thumb.” Although not as common as knee injuries, skier’s thumb isn’t far behind and accounts for about 1 out of 10 of all ski injuries.

Skier’s thumb is an injury to the ulnar collateral ligament (UCL), which runs between the two bones on the interior side of your thumb and holds the bones of the thumb together. The injury can occur when you fall on your outstretched hands while holding a ski pole, causing the thumb to either bend backwards or too far out to the side.

This type of thumb injury is also sometimes referred to as “gamekeeper’s thumb” because it was first seen in gamekeepers (people who work in the countryside to make sure there is enough game for hunting). It was noticed that many gamekeepers were getting chronic thumb injuries from wringing the necks of chickens and hares between their thumb and index fingers. You are much more likely to incur this as an acute injury when skiing rather than from chronic use – unless, of course, you decide to pursue the now-rare profession of gamekeeping!

Skier shredding down the mountain (stock.xchange.hu)

As with any injury, the best treatment is to prevent it from occurring in the first place! There are a few easy steps you can take to drastically reduce your risk of skier’s thumb while enjoying the fresh powder this winter season. First, choose ski poles that have finger groove grips but also don’t have any sort of restraint such as a wrist strap. Also, hopefully when you learned how to ski you were taught to let go of your poles if you do take a spill to reduce injuries of this nature.

Falling on outstretched hands in any situation puts you at risk for many upper extremity injuries, including injuries to the wrist, shoulder, hand and thumb. So how do you figure out if you have skier’s thumb? The most important clue is if you notice significant weakness or are completely unable to squeeze or hold things between your thumb and index finger (and it may be really painful since you have torn the ligament that controls that movement!). Your thumb will also be very likely to be sensitive to touch along the side of your thumb close to your index finger. There also can be swelling or bruising of the thumb, but these symptoms might not show up initially. If you have some of these symptoms along with pain in the wrist don’t yet rule out skier’s thumb and assume it’s a wrist injury only. You may still have a thumb injury and could be experiencing what is called “referred pain.” Referred pain is a complex phenomenon that causes you to feel pain at a location different from the original site of the injury. It is caused by the complex pattern of nerves that bring pain signals from the site of the injury to be processed by the central nervous system.

Skiers thumb occurs when the UCL (ligament spanning the space indicated by the arrow) is torn (Wikipedia, James Heilman, MD)

If you or a friend take a spill on the slopes and experience these symptoms, it is best to seek medical attention quickly. It is important to determine whether your fall also resulted in another injury such as a wrist fracture, which will need treatment fairly quickly. There are some actions you can take to lessen the pain while waiting to see the doctor. Take ibuprofen (Advil or Motrin) as soon as possible if you are medically okay to do so. This will help reduce the pain and can also reduce swelling of the thumb. You can also apply ice to the thumb for “20 minutes on and 20 minutes off” until you reach medical attention as this will also help with the pain as well as keep the swelling minimized. If you have an ACE bandage in your first aide kit, loosely wrapping the thumb can also help reduce the pain and swelling as well as protect the thumb from further injury.

Once you have been diagnosed with skier’s thumb, you will likely be referred to an orthopedic doctor who will be able to evaluate your injury and help you decide on a treatment option. Depending on the severity of your injury, the thumb may have to be immobilized in a brace or cast for a few weeks, or in more severe cases (or if the UCL is completely torn), surgery may be required.

Hopefully you can enjoy the mountains during this winter season without having to tour the local hospital! So bundle up, remember all the precautions you can take, and hit the slopes equipped with the knowledge of what to do if you have an unfortunate fall!

Posted in boonDOCS Show, Wilderness Medicine, Your Health

A Cold Wind Blowing: Wind Chill!

Posted on January 20, 2013 by Brian Nuyen — No Comments ↓

When we’re outdoors, temperature means everything. Not just the temperature that our thermometers read and the weather forecasters say, but the temperature we actually feel. So, what is really going on when a strong gust of wind picks up out of nowhere and makes it feel like the the temperature dropped 10 degrees – even though the reading on the thermometer has not changed?

The sensation that the temperature in the presence of wind is colder than the temperature without wind is called wind chill. We are not just talking about “weather wind” because the air rushing over our skin during activities such as skiing or snowboarding, for example, can drop the felt temperature, too. Wind chill can put us at risk for frostbite or hypothermia more easily, so knowing about it can make a huge difference!

The intensity of the wind chill phenomenon really depends on two things:

The “still-air” temperature (i.e., the temperature without considering the effect of wind)
The wind velocity (i.e., how fast the wind is blowing)

Because our human bodies constantly give off heat, our skin heats the air around it. Consequently, the air right around our skin becomes warm and forms something similar to an invisible, heated “air jacket.” When wind blows, however, this warmer air around our skin gets quickly blown away and is replaced by the colder moving air of the wind. The faster the wind blows, the less of a chance we get to heat the air just around our skin. So, the colder we feel!

The chart below shows how given a “still-air” temperature and a wind velocity, you can estimate the temperature that you’re actually feeling because of the wind chill effect:

A chart depicting different wind chill temperatures for given dry bulb temperatures and wind speeds.
SOURCE: National Weather Service (http://www.weather.gov/os/windchill/images/windchillchart3.pdf)

The dry-bulb thermometer (left) shows the current “still air” temperature, whereas the wet-bulb thermometer (right) shows a somewhat lower “wind chill” temperature. This phenomenon is the result of the latent heat of evaporation, which depends on the relative humidity of the air.

Fortunately, you can predict the temperature-dropping effects of wind chill pretty accurately by making your own “wind chill-o-meter” or, more formally, a wet-bulb thermometer. Here is what you need:

A regular dry-bulb thermometer (e.g. mercury in glass)
A hollow cotton shoelace
A rubber band

INSTRUCTIONS: Cut off the plastic tip ends of the shoelace and spread apart the lace to create a narrow cotton tube. Put just the bulb of the thermometer into the tube of a shoelace, and secure it with a rubber band. Now, take the free end of the shoelace and place at least 3 in. of that end in a container of water. With the moisture contained and absorbed by the shoelace, this thermometer now models how we humans experience wind chill.

Try it out! Turn on a fan or swing your wind chill-o-meter around and notice how the temperature reading drops!

Posted in Preventive Medicine, Wilderness Medicine, Your Health

Taking the Chill Out of Chilblains!

Posted on December 19, 2012 by Alina Goldenberg — 1 Comment ↓

Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K: Fitzpatrcik’s Dermatology in General Medicine, 8th Edition: www.accessmedicine.com

In the heart of winter we dare not test the weather. Getting ready to go outside is as much of a process in itself as the outdoor activities we are planning to do! Layers of warm clothing and waterproof boots not only keep the cold away but also serve as protection against some of the most peculiar skin disorders, like chilblains.

Chilblains (CHILL-blayns), known more commonly as pernio, is a rare and painful response of our blood vessels to cold, specifically, in above freezing temperatures. Actually, the temperature itself doesn’t play much of a difference; instead, it is the exposure of skin to dampness and wind that is most crucial. For this reason chilblains has been seen most often in mild-temperature regions where cold and damp winters are rare leaving people surprised by and least prepared for the occasion. England, known for its wet and chilly climate, has about 10% new cases of chilblains per year. Most surprisingly, the usually hot and humid Hong Kong has some chilblains cases reported annually during its coldest months of January and February.

http://pgbeautyscience.com/functions-of-the-dermis.php

How or why chilblains develops is not entirely understood. Our skin acts like a thermometer and helps sense the temperature outside and inside our body; it makes sure we are always perfectly warm at 37° Celsius (98.6° Fahrenheit) . When the temperature outside lowers, our skin tries to preserve our internal heat by sending signals to our farthest blood vessels in our hands, feet, and tip of our nose telling those vessels to squeeze tight; this slows the flow of hot blood to our most distant tissues and retains heat toward the center of our body. In chilblains, those distant “shut-off” areas begin to react abnormally to the lack of blood flow. The blood vessels closest to the skin surface, and with the least blood, wage a full inflammatory response asking the body to pay attention to them. Instead of helping the situation, the inflammation actually leads to the destruction of blood vessels and real damage to the skin above them.

Chilblains can look like single or multiple, red or purple swellings or blisters. Many affected people complain of severe itching, burning, and pain in the areas. Fingers and toes are the most commonly affected areas.

http://dermatlas.med.jhmi.edu/image/pernio_2_050103

Some people are at higher risk of developing chilblains than others. Those with chronic diseases of poor blood circulation, like diabetes, are more sensitive to temperature changes since their blood vessels are not as reactive to skin’s signals. Young, horse-riding women are also somewhat more susceptible! This group of women ride their horses for hours during winter months. Their tight and improperly-insulated riding outfits squeeze skin and blood vessels and, thus, interfere with the intricate cold temperature response mechanism leading to large, tender chilblains-like spots on the lateral calves and thighs.

Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K: Fitzpatrcik’s Dermatology in General Medicine, 8th Edition: www.accessmedicine.com

Smoking cigarettes also increases your risk of chilblains because the ingredients in tobacco – including nicotine – directly damage your blood vessels. Thus, overtime the vessels are much more likely to have an abnormal reaction in response to cold temperatures leading to a painful chilblains reaction.

To decrease your risks and prevent this condition, wear properly-insulated, waterproof, and loose-fitting clothing in layers. Crucially, strive to keep the most distant parts of your body – toes and fingers, for example – warm and dry. Avoiding sitting in one place, and try to maintain motion in order to promote better blood circulation.

Some healthcare providers may be unfamiliar with this rare disorder, which sometimes leads to unnecessary hospital admissions and extensive laboratory and imaging evaluations. The good news is that chilblains usually goes away on its own in a couple of weeks without much treatment! Thus, it is vital for you to become familiar with this rare, painful but non-life threatening condition which can pop up in a cold, wet, and windy situation.

References

1. Piérard GE, Quatresooz P, Piérard-Franchimont C. Chapter 94. Cold Injuries. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Dallas NA, eds. Fitzpatrick’s Dermatology in General Medicine 8th ed. New York: McGraw-Hill; 2012. http://www.accessmedicine.com/content.aspx?aID=56052321. Accessed December 18, 2012.

2. Emedicine: http://emedicine.medscape.com/article/1087946

3. Mayoclinic: http://www.mayoclinic.com/health/chilblains/

Posted in Skin Care: Your Birthday Suit Owner's Manual!, Wilderness Medicine, Your Health