Foraging in the Catskills by Tatiana Havryliuk

Last month we foraged for medicinal and edible plants in the Catskills. There is hardly a better way to spend a partly cloudy and rainy weekend with diehard SLR WM interest group members!

     

Below are some of the things we learned from the expert forager, herbalist and RN,  Marguerite Uhlman-Bower. Please see references below.

Also, a small disclosure: do not start randomly eating plants. Make sure to use ID books and get professional guidance (not this blog) before you eat wild things.

  

1.   Rose leaves/flowers and wild strawberry leaves have astringent/drying qualities and can stop bleeding from a cut  (chew and place directly on cut) or even from your gastrointestinal tract (strong tea)!

 2.    Dandelions have potassium-sparing diuretic properties and also contain large amount of inulin – a complex carbohydrate  that is indigestible and is good for the gut micro flora. There are also close to 20 types of dandelions and they are all safe to eat!

 3.     Plantango(plantain) major is a broad-leafed plant commonly encountered on the trails that has anti-microbial properties and can be chewed and then applied to various wounds (bee stings or splinters) or made as tea and applied as a wound wash.

4.     Wild garlic mustard plant  is one of our favorites. The leaves actually taste like garlic. It’s great in salads and also has  blood thinning properties.  

 5.     Red clover is sweet and delicious and helps maintain balance during hormonal changes. One should avoid it in estrogen- dominant cancers.

 6.     Mullen is a large leafy plant with velvet texture that strengthens lungs and kidneys. Its flowers can be made into oil and used to treat ear infections!









7.     Valerian root  teas and tinctures are sedating and anxiolytic.  However for 20% of population it has stimulating effect.

8.     St. Johns wort can be used topically for neuropathic pain  (i.e. sciatica, neuralgias). Check for medication interactions before use.

9.     Milk weed is supposed to takes like broccoli and asparagus after complicated cooking procedure (boiling twice!). However it didn’t pass our taste test. Also it has a toxic look-a-like Dogbane. So it’s better to just stay away!

 10. Golden rods makes tea that cures your sniffles during allergy season. There are about 75 varieties, so you can go crazy!










11. Pine needles are rich in Vitamin C and have anti-viral property. Make them as tea. You can eat them fresh when they are still soft at the tips of  the branches. If there were more pine trees in NYC  that’d be my staple snack! Caution – make sure you are not eating the pine needles from American Yew as that can kill you! Check your references and consult with the pros.

 12. Turkey Tails are the mushrooms found on dead trees that come out in December and have anti-cancer properties, especially for lung.

 And Ramona thought it was all weeds in her backyard… This is just a little sampler and there is a lot more to learn. Please don’t become a cocky novice forager who gets renal failure and/or dies. That won’t be our fault!

In conclusion, we ate a foraged meal supplemented with handmade pasta and wine, the latter two were purchased. We ate edible rose petals in our salad, it was so luxurious that you might need to try it out.

Happy foraging!

References:

Plant Walk May 30, 2015 by Marguerite Uhlman-Bower. This also includes techniques on preparation of tea, oils, and tinctures and an extensive reference list on plant identification, edibles and mushrooms. 

Notes from Antarctica - Part I: Motion Sickness by Jamie Edelstein

Hello SLR Wilderness people!

This New Years I was the onboard physician for an “expedition” to Antarctica. I joined roughly over 200 luxury travelers and staff on a “modern, stable super-yacht” to the last continent. Our trusty ship is listed as having an “ice-strengthened hull”, but not as being a true “ice-breaker” (you would additionally need to have an ice clearing shape and the power to push through sea ice to nab that distinction). Our itinerary was to navigate through the unpredictable waters of the Drake Passage and cruise around making stops at highlights in the Antarctic Peninsula, Antarctica’s most north region (I could only get 2 weeks off, after all). You guys may have seen the pictures, but now you get the salacious medical backstory!






Drake:

A pair of fun older Midwestern ladies had gotten T-shirts that simply read “Drake.” from their local Iowan university in anticipation of the Antarctica hazing ritual that is cruising through the Drake Passage. The Drake (or Mar de Hoces depending if you’re on Team Spain or Team England) is the water path between the southern tip of South America and the South Shetland Islands of Antarctica, where the Atlantic Ocean meets the Pacific. The waters can be quite rough. For that reason I was asked to make a quick sea safety announcement at cruise orientation and hold a seasickness clinic later in the evening.



Basic sea safety: Keep hands out of door frames (swinging doors=broken fingers), wear shoes with traction, avoid alcohol.



A few pearls (pearls! Sea-stuff!) on sea-sickness:



What is seasickness?



Naus: Greek for ship!

-Spectrum includes nausea, vomiting, pallor, cold sweats, hypersalivation, hyperventilation and headaches.

-Caused by repetitive angular and linear acceleration and deceleration due to different modes of travel, amusement rides, or viewing movies or virtual reality.

-Theorized to be due to the mismatch between the sensory perception of movement received via the eyes, vestibular system, and muscles and joints and the expected internal model of movement.

-More intense when acceleration is in a direction perpendicular to the body and with up and down motion.

-Slightly higher incidence in women

-Peak incidence between ages 3 and 12 years

-Less of a risk on larger, more stable vessels

-One study cited the incidence of seasickness on cruises at 8%



How can it be avoided?

-Questionable whether reduced incidence depending on location on cruise ship

-Avoiding alcohol, large heavy meals

-Focusing on the horizon
-Don’t read

-Preventive medications



What are some traditional treatments?

-Anti-cholinergics, anti-histamines, sympathomimetics and opiods. biofeedback modification.

-Inhalational isopropyl alcohol and other aromatherapies

-Anticholinergics disrupt the transmission of vestibular input to the CNS.

-Acupunture or acupressure to the inside of the wrist (point “P6”), available as wrist bands.



What is in the sack of pills and patches given to passengers by their physicians? How do we recommend they use them?

-Pills are logically better at prevention than treatment, start your therapy 12-24 hours prior to anticipated “motion”.



Our infirmary’s supply of Phenergan and Meclizine was robust. The patients had mostly brought their own stuff. Dramamine. Balance bracelets. Meclizine. Phenergan. Zofran. The cutting edge in motion sickness management seems to be the scopolamine patch, which is great! But also not great because information about it wasn’t in the ship’s copy of Tintanelli or my Epocrates, and, boy, did passengers have questions about the medication that was already seeping into their bloodstream. The patches are applied behind the ear prior to embarkation, are effective for up to three days, effects can last up 24 hours after premature removal, and side effects include drowsiness, disorientation, dry mouth, blurred vision, dilated pupils, confusion, hallucinations, difficulty urinating and rash.



The trip back had a few cases of seasickness, but no one required parenteral treatment, and we returned to port feeling fine!



Ask me in person why penguins are suited up in black and white (warning, my response is from answers.com)!!



Ten Tips to Prevent Motion Sickness - Medicinenet.com
15 Tips for Avoiding Seasickness - SportDiver.com

Scopolamine - drug information
Motion Sickness - UpToDate.com

Last Sunday, the SLR Wilderness Medicine group met for our second outdoor trip this year: snow-shoeing and cross country skiing in Fahnestock State Park, NY.  In the spirit of winter sports, we did a quick review about frostbite.  As a bonus, we learned how to build an emergency snow shelter.  

On one of the snow shoe trails

Cross country skiing around a lake

Here is a recap from Dr. Havryliuk on frostbite:

Pathophysiology:

-Pre-freeze: Tissue cooling with vasoconstriction and ischemia; paresthesias; no ice crystals. 

-Freeze-thaw: Ice crystal formation intra/extra cellularly, protein and lipid derangement, electrolyte shifts, cellular dehydration and cell death. Thawing process may lead to ischemia-reperfusion injury and inflammatory response.

-Vascular stasis: Vessels may fluctuate between constriction and dilation; blood may leak or coagulate.

-Late ischemic: Progressive tissue ischemia and infarction from cascade of events.

Classification:

-Frostnip: Distinct from frostbite but may precede it; frostnip is a superficial non-freezing cold injury associated with intense vasoconstriction on exposed skin, usually cheeks, ears, or nose; ice crystals, appearing as frost, form on the surface of the skin.

 -First-degree frostbite: Presents with numbness and erythema; a white or yellow firm, slightly raised plaque develops in the area of injury; no gross tissue infarction occurs; there may be slight epidermal sloughing and mild edema.

-Second-degree frostbite: Injury results in superficial skin vesiculation; a clear or milky fluid is present in the blisters, surrounded by erythema and edema.

 -Third-degree frostbite: Creates deeper hemorrhagic blisters, indicating that the injury has extended into the reticular dermis and beneath the dermal vascular plexus.

-Fourth-degree frostbite: Injury extends completely through the dermis and involves the comparatively avascular subcutaneous tissues, with necrosis extending into muscle and to the level of bone.

Simplified classification scheme:

-Superficial: No or minimal anticipated tissue loss, corresponding to 1st- and 2nd-degree injury

-Deep: Deeper injury and anticipated tissue loss, corresponding to 3rd- and 4th-degree injury

Diagnostic studies:

Use angiography and technecium 99 bone scan to evaluate and follow extent of injury

Treatment:

-Active rewarming in water bath at 38C with added antiseptic solution

-Treat moderate/severe hypothermia first (warm to 35C)

-IVF

-Ibuprofen (at least 400mg BID)

-Aloe vera: for superficial frostbite

-Dress and immobilize: avoid ambulation

-Blister care: aspiration prn, in general don’t touch hemorrhagic blisters

-Oxygen: if hypoxic or above 4000m

-Tetanus booster

-TPA: best if given intra-arterially within 24h, convince your vascular surgeons (references in the guidelines)

-Iloprost (prostacyclin analogue): not available in the US, some evidence from European studies

-Consider IV vasodilators (nitro) and heparin

-After 24h:

     -Hydrotherapy

     -Sympathectomy: long-term option for pain, paresthesias, hyperhidrosis

     -Amputation: usually 6-12 weeks out after well demarcated

The type of shelter we built was a quinzee.  This is somewhat labor intensive.  It's best for a group of 6-8 people who all have small shovels with them (you had to expect the possibility of needing an emergency shelter before heading outdoors).  Essentially you build a big mound of snow and then clear out the center.  Placing bags at the center of the mound makes the process a lot easier by occupying volume.  This shelter can protect you from the wind and precipitation and help you make it through the night.  It can take a few hours to make, especially if there are not many people helping out, so don't wait until the last minute to start if you actually need a snow shelter.

First, clear out space for the shelter.

Place packs in the center.  We only had one bag here, but more bags would have made the process easier.  The more packs you use, the less snow you need to shovel.

Start shoveling snow onto the pack.

As snow is added, it needs to be compacted.

Keep shoveling.

And keep packing the snow as tight as possible.

The mound is getting bigger.  Note the use of an avalanche probe here to help estimate the desired height.  Later on, when snow is being scooped out of the pile to create shelter space, the probe can be used to help achieve the right thickness of the walls.

Compacting the snow is really important.

Dinner break.  Everything was home made by one of our attendings who lives near the park.  Black beans, vegan chili, skillet corn bread, mashed yucca, meat, and plenty of good drinks.  It was delicious.

Once the desired size is attained (ours was quite small), start to shovel out an entrance hole from one of the sides (ideally the downhill side).

Keep digging through until you find the bag(s) at the bottom of the mound.

As you get deeper into the mound, it may be hard to fit the whole shovel inside.  If the shovel's handle is detachable, it will probably be easier to take it off at this point.

Pull out the bag.

And keep digging.

View of digging from the inside.  

Inside of our shelter.  

We ended up being able to fit 4 people inside of our snow shelter at once.

AWLS - March 13-15 in NYC

Advanced Wilderness Life Support (AWLS) course is coming to NYC! It is a great intro course for outdoor enthusiasts with any level of medical training. It covers all the common wilderness injuries and illnesses and gives plenty of hands-on training.  Check out the details at awls.org and register at http://coloradowm.org/wfrwfa.html. FAWM credits available.