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Nick Gatel
(ngatel) - MLife

Locale: Southern California
Re: prejudice much? on 04/03/2013 20:54:02 MDT Print View

Nancy,

From David's past posts (especially in Chaff) maybe he didn't word this right... sometimes we rush when typing a post. I have seen many passionate posts by him defending many groups to include gays. But his sentence does seem objectionable taken out of context and not knowing him (well as many of us only know him via BPL).

There are diseases that can be passed by contact with body fluids. Attending to a bleeding cut could put those providing aid at risk. Another reason to hike solo :)

Hamish McHamish
(El_Canyon) - M

Locale: USA
_ on 04/03/2013 21:05:56 MDT Print View

I've been trained by 18D's too. Plus the MD's that train the 18D's.

"...Quik-Clot was stopped by the US Military because it was causing Quik-Clots in the heart."

Careful folks, if you don't really know what you're talking about please don't post about medical things. It was WoundStat that was dropped due to some emboli cropping up. Strictly speaking Quik Clot wasn't dropped for causing tissue necrosis. The burns issue really wasn't that bad in light of the wounds being treated. Form factor and dovetailing with existing training were the big wins for Combat Gauze.

Most UL hikers are right to discount the risk of serious bleeds. But if you're hunting or working a lot with an axe then serious bleeds are a nontrivial risk. Direct pressure and proper wound packing go a long way. But I throw in a roll of Combat Gauze to hedge my bets a little more. The cost in weight and bulk is negligible and it really can make a difference.

I just can't bring myself to bring a CAT for the trail, although I would if I was a hunter. However I do have an extra large bandanna and the knowledge (backed with practice) to fashion a proper tourniquet from it.

Doug I.
(idester) - MLife

Locale: MidAtlantic
Re: Re: prejudice much? on 04/03/2013 21:15:43 MDT Print View

"From David's past posts (especially in Chaff) maybe he didn't word this right... sometimes we rush when typing a post."

+1. I've found David to be one of the most open-minded, level headed people on this forum. I'm inclined to give him the benefit of the doubt.

Hamish McHamish
(El_Canyon) - M

Locale: USA
Re: prejudice much? on 04/03/2013 21:18:07 MDT Print View

>"prejudice much?"

Political correctness much?

Nancy Twilley
(goodcaver2)

Locale: STL
sounds fishy to me on 04/03/2013 21:35:07 MDT Print View

I know he's a regular poster here on the forums, but from the post his intent seems fairly clear to me. If he meant something else, he can feel free to say so.

David Thomas
(DavidinKenai) - MLife

Locale: North Woods. Far North.
Re: Tylenol is acetominophen on 04/03/2013 21:41:42 MDT Print View

Charles: quite right. I went to spell check on google, hopped back to BPL, and screwed up.

Advil AND Tylenol

Or, if your prefer:

Ibuprofen AND acetaminophen.

jerry adams
(retiredjerry) - MLife

Locale: Oregon and Washington
Re: Re: Tylenol is acetominophen on 04/03/2013 21:55:56 MDT Print View

Between Ibuprofen and Acetaminophen, isn't one of them damaging to some people's livers or something? Maybe if you take just a little more than recommended dose?

David Thomas
(DavidinKenai) - MLife

Locale: North Woods. Far North.
Re: sounds fishy to me on 04/03/2013 22:04:34 MDT Print View

Nancy: my bad if I was unclear. (1) it is the Internet and no one not on the R2R2R Grand Canyon trip has ever seen me smile and (2) I've been on 22 flights for business and volunteer reasons in the last two weeks so, like now, I post from an iPhone at 33,000 feet and can't reread and edit my whole post on one screen. But, again, my bad.

About me: straight guy. Married. Two kids. Nerd. Politically very liberal in a very conservative town. Not afraid, though, to start a PFLAG chapter locally, advocate for non-discrimination policies before the school board (unsuccessful) and (successfully) pass non-discrimination policies at the fourth largest employer within 150 miles (I'm on the BOD). I'm such a fricking ally,
I perhaps am clueless to inaccurate perceptions I can create. And I say true stuff like "I've dated more lesbians (unknowingly) than most out women do in a decade." that people who don't know me take the wrong way.

About that situation: my wife (an MD) and my SIL (another MD) took the unpaid and, I thought, helpful task of gathering a ton of medical supplies and information prior to a private Colorado River raft trip through GCNP. They sent out forms about medical history because that's what docs do. If you're unconscious, they'd still like to provide appropriate care and not, you know, kill you due to a drug allergy or unknown, underlying medical condition.

Everyone seemed to take it that way and emailed forms to the docs and I NEVER SAW THEM. I never do. My wife and I have these annoying-to-me conversations where she vents about something that went wrong at the hospital while using only non-gendered pronouns and non-age-specific terms.

But I knew one guy (out of 16 people) hadn't returned the form. He was the manscaped guy. Who'd most recently been to the GCNP at age 30 WITH HIS MOTHER. And he showed up with another twink guy. And in a crowd of lesbian oarmen (to use an oxymoronic phrase) and liberal straights, he was the only one to not be out (be out, I include LGBTQXYZ, whatever). So maybe I was inaccurately stereotyping him or maybe after decades in SF/Berkeley and living in Northampton, I have a bit of gaydar. That assessment is left for the reader. Of course his orientation has no bearing on medical treatment. But his serum status could very well have a lot of bearing on his health and need for health care. And my strong sense is that a closeted guy is less likely to disclose his serum status than someone who is more self-accepting.

To be continued . . .

Okay, I'm back at ground level. A mile high, but at ground level at another airport with contaminated groundwater (DEN).

My point was that telling your companions about your health issues can help YOU. If there'd been a 300-pound women who refused sweets, was constantly thristy, pricking her finger many times a day and hadn't disclosed anything, I'd infer she likely had poorly controlled diabetes and I'd wonder WTF she wouldn't let the people most able to help in an emergency help her more. But there wasn't that person along on any trip I've been on. The person who may well have been the sickest person hadn't imparted any info to anyone. Mostly, that's to his deteriment. But while both docs along had trained for years in SF and are totally up on universal precautions, sure, anyone would be even more careful if they know someone is pos.

Edited by DavidinKenai on 04/04/2013 01:20:03 MDT.

Ian Destroyer of Forums
(IDBLOOM) - MLife

Locale: PNW
Easy on 04/03/2013 22:11:23 MDT Print View

Medicine/first aid isn't always an exact science but more of a collection theories and assumptions. Ask five different physicians and you'll likely hear five slightly different opinions. I have many thousands of hours invested into EMS, WFR, and advanced first aid training. If I give advice in reference to first aid, it's because I have experience or at the very least, have received relevant training in that area. You are entitled to have a difference of opinion but I'm willing to take an 18D with three combat tours plus the experiences of dozens of combat vets at their word. These same people recommend combat guaze. To be honest, we didn't carry it when I was deployed in the '90s nor did any of the ambulance companies I worked for ever carry it so I haven't personally used it. I carry it at work now but fortunately haven't had a need to use it.

I've been doing this long enough to see some dramatic changes in medical protocols and conflicting guidelines from medical authorities so nothing is ever set in stone when it comes to this topic.

Edited by IDBLOOM on 04/03/2013 22:25:43 MDT.

David Thomas
(DavidinKenai) - MLife

Locale: North Woods. Far North.
Re: prejudice much? No. Maybe overly at ease about it, though. on 04/04/2013 01:40:39 MDT Print View

Nancy,

On your specific points:

1) assumed you knew the man was gay

Yeah, I did. Shaved chest - like his traveling partner, road trips with Mom, no mention of any partner/dating on a LONG trip on which everyone else was open about their varied lives. Mannerisms. Affect. There's nothing wrong with that - nothing at all - and I never said there was.

2) assumed that because he was gay he either had AIDS or had a high chance of having it.

Partly true. Gay men, on this planet, in the last 35 years, DO have a higher chance of being HIV+. I don't assume that so much as think I know that. From, well, actual data. All those peer-reviewed medical journals laying around the house - NEJ, JAMA - rags that like.

Much more so, being the only one to not convey medical info to the physicians on the trip really stood out.

You might want to wikipedia AIDS versus HIV+. The later can, untreated, lead to the former, but there's a big difference between them and while my snarky remark was only about someone who didn't seem to be willing to decrease his risks on the trip, everything I've written has been about the increased probability that he was poz. Nothing I saw, inferred, or wrote suggested he had AIDS.

Hamish McHamish
(El_Canyon) - M

Locale: USA
Re: Easy on 04/04/2013 07:40:15 MDT Print View

Ian, what you initially posted was error, not opinion. If an 18d told you that QuikClot was nailed for causing "quick clots in the heart" then he is wrong. He almost certainly just mis-spoke (meaning to say WoundStat).

I'm posting from my phone so it's a pain to paste in links but Google quik clot emboli to find the DoD directive where quik clot was superseded by combat gauze. Woundstat was shown to cause emboli, not quik clot, but in a bit of overkill they dropped all granular hemostatics.

Erik Basil
(EBasil) - M

Locale: Atzlan
Combat Gauze on 04/04/2013 08:03:29 MDT Print View

1. I like the Adventure Medical kits, and use one as my base kit for modification/customizing. I like the light container, some of the gear it comes with and the price when one gets it on clearance from Sierra Trading. Mine sits inside the bottom section of a quart milk container. I don't have combat gauze in there, or any styptic, but I think this might be a great idea. "Be Prepared" always winds up "Being Heavy", ha ha!

2. Who's got a hot tip on the smart/economical way to get combat gauze? I see it online, but have no frame of reference for price.

3. Acetaminophen ("tylenol") is the med that can badly damage the liver if taken in excess dose or in the presence of alcohol in the blood. This is the real deal, but it's also excellent for basic pain and, particularly, headaches. Since headaches can be strong and common at altitude, acetaminophen is definitely an arrow in my first aid quiver. Key detail when dealing with youth: get permission and learn up on dosing by weight.

4. Good job, David. Both on the excellent listing post and in dealing with the hysterical response to one of your comments.

Ian Destroyer of Forums
(IDBLOOM) - MLife

Locale: PNW
Read again James on 04/04/2013 08:39:53 MDT Print View

I never said that Quick Clot caused emboli. Re read my first response.

Edit the comment you are referring to is from Max.

Edited by IDBLOOM on 04/04/2013 08:45:45 MDT.

Hamish McHamish
(El_Canyon) - M

Locale: USA
Re: Read again James on 04/04/2013 08:52:20 MDT Print View

You are right, that was Max's statement. Your post entitled "easy" didn't quote anyone and I thought you were responding to me. In which case my comment applies doubly to Max's statement.

Ian Destroyer of Forums
(IDBLOOM) - MLife

Locale: PNW
No problem on 04/04/2013 09:02:28 MDT Print View

You made reference to the emboli and necrosis so I assumed you were addressing both of us. Like I've said, I've seen medical protocol which was gospel on a Monday blown out of the water on Tuesday (eg reducing O2 treatment for COPD re hypoxic drive concerns) so I try to stay current. Unfortunately these discoveries aren't received or adopted by all health care professionals simultaneously for a multitude of reasons and trying to sift through conflicting guidelines can be frustrating. I believe we're more or less on the same sheet of music as far as this topic goes.

Nancy Twilley
(goodcaver2)

Locale: STL
sigh on 04/04/2013 09:04:11 MDT Print View

Wikipedia it, eh? Let's try to leave the snark aside for a minute -- I'm well aware of how HIV leads to AIDS and of the history and prevalance of the disease in this country and around the world, among gay men as well as other social groups. If you want to get into a contest about who's got the better education on the subject we can do that, but I don't think that's going to solve the problem here.

It seems like you do want to be an ally to the gay community -- if you really want to do that, I maintain that you really need to check your privilege / prejudice here. As a gay person, I read the statements you're making and I don't see them as statements my allies make. You might start by watching how you throw around terms like "twink" -- while this is widely used within the community, from straight people it's suspect. Just like making assumptions based on mannerisms or stereotypes like being close with one's mother -- nothing wrong with thinking hey, that guy's probably gay, but when you start attaching other stereotypes to that (hey, that guy might be HIV+, hey, that guy probably has mommy issues), you're working counterproductive to your goal.

If everyone was required to turn in a medical form and one person didn't turn it in, I can see why that's a problem. In that case, you should have said "(including ONE PERSON who wouldn't disclose his health status). The fact that he was gay did not necessarily mean he was HIV+, and it's not helpful (if you actually care about connecting to gay people or helping the gay community) to automatically assume that he was. You know as well as I do that ANYONE in this country can be HIV+ -- treating an individual differently because he belongs to a certain social demographic is prejudice.

Ian Destroyer of Forums
(IDBLOOM) - MLife

Locale: PNW
BSI never a bad idea on 04/04/2013 09:23:58 MDT Print View

Wearing gloves, eye protection, etc when dealing with body fluids is obviously never a bad idea regardless of who the patient is.

I'm in a similar situation to David in that I'm comfortable around my LGBT friends and we're not afraid to have these conversations. I personally find this to be symptomatic of a society which is evolving away form stupid prejudices against homosexuals. Intelligent and polite conversation should always be encouraged.

Bob Gross
(--B.G.--) - F

Locale: Silicon Valley
Re: Combat Gauze on 04/04/2013 12:35:27 MDT Print View

"3. Acetaminophen ("tylenol") is the med that can badly damage the liver if taken in excess dose "

Also kidneys.

A friend of mine had to undergo kidney dialysis after too much Tylenol.

--B.G.--

David Thomas
(DavidinKenai) - MLife

Locale: North Woods. Far North.
Acetaminophen on 04/04/2013 14:26:45 MDT Print View

After donating blood one time, it came back with a poor result on a liver function test. I wasn't taking a ton of Tylenol, and it was all within the OTC limits, but I was taking a lot do to the aches and pains of a 40-something building a house, plumbing, etc. It was a helpful wake up call to dial it back.

I was struck, 17 years ago, working in a professional (engineers + geologists) office, how no one else knew you can kill yourself (or end up on dialysis) by ODing on Tynelol. A co-worker's daughter had OD'ed in a cry-for-help move, and she and her parents were clueless about how serious it could have be until they were in teh ER. There's this assumption that OTC meds can be popped like candy. Actually, if you stay within the recommended dosages and durations, you'll minimize your risk. But some drugs have a surprisingly small ratio between the theraputic and toxic doses. And alcohol use, advanced age, or a different metabolism, and that ratio could fall below 1.

David Thomas
(DavidinKenai) - MLife

Locale: North Woods. Far North.
Combat Gauze on the cheap on 04/04/2013 14:49:38 MDT Print View

>"2. Who's got a hot tip on the smart/economical way to get combat gauze? I see it online, but have no frame of reference for price."

$100 per dressing? $200? Maybe more. Something in that ballpark. It will be a long time before you see it in Walgrens next to the Ace wraps and finger splints.

This probably won't work for you, but my wife, a month before that fateful GCNP raft trip (when I was apparently the mortal enemy of all gay people everywhere) asked for a professional sample. The company sent some out along with a video where some pig pigs bleed like, you guessed it!, "stuck pigs" and other had vastly less blood loss. Maybe they calculated the extent of the wound very carefully, but they had some impressive comparision numbers for treating massive blood loss traditionally and with their clayey bandaid. It was something like 10% survival without and 90% survival with their wonder bandaids. I'll look around for it. We don't have any big, remote trips planned for awhile and she could always do the same thing again. She's also more particular about expiration dates than I am. It was clay 10 million years ago, it was clay last year, I'm pretty sure it will be clay in a decade. I'll check and maybe I can send you those sample pack.

It was striking to me that it is basically a dressing impregnated with bentonite clay. Wyoming has cubic miles of the stuff and I use fancy versions (powders and different-sized pellets) when constructing air- and water-wells. I literally have some under my fingernails right now, sitting in this DEN airport lounge because I was just pilot testing some treatment systems at a fuel-spill site this morning. I have NO idea if blood clotting is the same in salmon (the species I most often dispatch), but I'm tempted to slap some bentonite clay on a Johnston&Johnston gauze pad the next time a 4-H'er has a few pigs to slaughter. I suspect the incredibly high adsorptive capacity, and high surface energy of those very tiny clay particles would work just as a well as the FDA-approved vendor's version.