Born Free


Diana Muldaur as Joy Adamson from the television program Born Free–NBC Television

Born Free, that’s the song running through my mind this morning as I am writing this post.

Er, not the Kid Rock song.

I hope there are some readers who are familiar with the movie ‘Born Free’ and its theme song.  Or perhaps they watched the TV series in the early 70’s…..I hope I don’t go too far at revealing my true age here (I’m a Baby Boomer) as I wax nostalgic about the beautifully filmed movie about a lion and its human family in Africa.

Perhaps it’s not surprising that this is currently the ‘theme song’ of my life, because I have Africa and ‘Wilderness’ on my mind: in three days  I head out to South Africa en route to the 16th biennial congress of the South African Sports Medicine Association(SASMA 2015); and I’m still reading through and enjoying our fabulous September 2015 CJSM, entirely dedicated to the subject of Wilderness Medicine.

I want to note here and now that our Wilderness Medicine theme issue, published just a month ago, remains free as of this writing–each article is freely available for a time, the better to widely (wildly?) disperse the messages about pre-participation evaluation, risk stratification, and injury prevention in the wilderness adventurer/athlete.

One of the articles I particularly enjoyed was written by Tracy Cushing et al., “General Medical Considerations for the Wilderness Adventurer:  Medical Conditions That May Worsen With or Present Challenges to Coping With Wilderness Exposure.” I especially liked this because I learned so much from it.  If I have a patient heading to altitude who has a bleeding diathesis, how do I manage that?  A patient with Parkinson’s heading to an Antarctic adventure of a lifetime–are there risks I should anticipate? There are so many similar questions, pertaining to combinations of disease and wilderness/adventure exposure, that this article addresses.


Big Cats (and Dogs) in store at SASMA2015

As things get a bit ‘wild’ in my personal life–as I toggle between seeing Big Cats on safari (e.g. Lions) and Big Dogs at SASMA2015 (e.g. Lyle Micheli)–I’ll check in as ever on this blog and on the CJSM Twitter stream.  Follow the hashtags #SASMA2015 and #AMSSM2015TF for documentation of these adventures. Look me up, please, if you are in Johannseburg for SASMA2015, and look up the current issue of CJSM regardless of where you are–you’ll be sure to learn a lot about managing those patients heading to….well, places like Africa!

CJSM Podcast 11: The Wilderness Medicine Issue

JSM-Podcast-BG (1)We’ve been working on the September 2015 CJSM issue for a long time–and by ‘we’ I mean a team of individuals, ranging from the CJSM editors to authors and thematic issue editors from the American Medical Society for Sports Medicine (AMSSM) and the Wilderness Medical Society.

chris madden

Dr. Chris Madden in his ‘office.’

Our guest for this, our 11th podcast, is Dr. Christopher Madden, a past president of the AMSSM and one of this issue’s editors (and an author too).  Dr. Madden is a hard-working clinician at Longs Peak Family Medicine, and practices the full range of family and sports medicine.

In between circumcisions, vasectomies, concussions, and mountain bike rides, he was able to find that ‘sweet spot’ to sit and talk with us for a little bit about the newly published Wilderness Medicine thematic issue.

We covered an array of topics–from diagnosing acute mountain sickness in pre-verbal children to the top 3 most memorable parts of his year as AMSSM president.

We enjoyed the chat, and we hope you do too.  Check it out here.

Wild at Heart


Mt. Adams, in the Cascades. Photo by Pugetopolis, Wikimedia

September is here, and the first of the month is when we would normally be publishing the fifth edition of CJSM for 2015.  But ‘things’ are a little special this time around.

We’re publishing on 9/9/15 this year, after the Labor Day weekend in the USA has passed.  And we’re not just ‘publishing,’ we are ‘co-publishing’:  along with Wilderness and Environmental Medicine (WEM), the official journal of the Wilderness Medical Society (WMS), we are producing a themed issue on the pre-participation evaluation of adventure and wilderness athletes.

And so, while President Obama is making his own mountain news with the change of a name, we’ll be looking to make a mark in the media and social media with this special wilderness issue (perhaps not as big — @POTUS has almost 4 million followers on Twitter).

We publish research relevant to this world of adventure/wilderness medicine frequently.  In the blog, in the last year, I have written about ‘High Altitude Medicine,’ risk factors for Acute Mountain Sickness (AMS) , and the Badwater 135, the ultra-marathon run through Death Valley in the summer time. In the journal, we have recently published the Canadian Academy of Sport and Exercise Medicine (CASEM) Position Statement on High Altitude Medicine; original research on the renal function of runners participating in an Ultra-Distance Mountain run; and multiple case studies involving adventure athletes, including this interesting one on the ‘heel-hook’ rock climbing maneuver, creating a specific pattern of knee injury.

What is so special about the September 2015 issue is that members of the American Medical Society for Sports Medicine (AMSSM) and the WMS collaborated on the project–the editors and individual authors were members of either or both AMSSM and WMS.  And the final product–a series of articles focused on primary injury prevention and pre-participation evaluation of this special type of athlete–is being co-published by WEM and CJSM.  It’s the culmination of a process nearly two years old, and took the effort of a great many people to put into production.

We have planned several posts and a podcast to highlight various aspects of the new issue.  You’ll be hearing a lot about it, here on the blog and on our social media feeds. You’ll here about it in this podcast too!   And, most importantly, we hope you visit to read the issue itself.

Let the adventure begin……

High Altitude Medicine

I was thinking about Mt. Everest the other day.


Mount Everest. Photo by Kerem Barut.

No, I will NOT be attempting the mountain myself!  In my youth I had such dreams……the story of Sir Edmund Hilary and Sherpa Tenzing Norgay thrilled and inspired me.

I think one of the defining experiences of middle age is to be certain that some dreams will never be fulfilled; to be content with that realization; and also, to know that there are other dreams, other challenges that can excite.

Yes, I am middle aged!

What got me to thinking about the mountain?  I am sure you have read, there was a terrible accident taking the lives of at least thirteen Sherpas which occurred last week. In reading the reports of that event, I realized that the spring summit period for the mountain had begun:  a narrow window in May  represents a period during which a huge number of ascents are attempted.  For instance, it was May 1996 when the climbing expeditions described by John Krakauer in ‘Into Thin Air’ took place.  This book introduced me to the reality of commercial climbing on the mountain.

If anything, it would seem that ever-greater numbers of people with perhaps limited technical climbing skills are attempting Everest:  an article in today’s New York Times notes that there are 334 expeditions planned for the 2014 climbing season!  This same article also notes in the wake of this most recent climbing disaster involving the Sherpas that this group of expert climbers–so vital to the performance of expeditions on the mountain–is planning a ‘work stoppage.’  I do not know all their demands, but the Times article notes that the stoppage was proposed in the wake of the Nepali government’s offer of a mere $400+ dollars as compensation for the families of the dead climbers.

On a more quotidian front, May represents for us here at CJSM our own challenge:  bringing out the third issue of the journal for 2014!  It’s too soon to say goodbye, however, to the March 2014 issue, and in light of the events on Everest I did want to commend to you an excellent piece in that issue:  The Canadian Academy of Sport and Exercise Medicine Position Statement:  Athletes at High Altitude.

As I’ve said, I, at least, may never make any Himalayan summits….but I fully expect as a sports medicine physician to care for people who succumb to one of the variety of altitude illnesses described in this article.  As the position statement emphasizes, injuries and illnesses associated with high altitude are no longer seen only in mountaineering: athletes, including many from the endurance disciplines, will train at altitude; and many athletes, of all types, will compete at altitude (think Mexico City Olympics, or even coastal Californian on a long-weekend’s ski trip to Aspen).  Staying ‘on top’ of the current thinking regarding this issue would be de rigueur for any of us clinicians caring for athletes. Read more of this post

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