Backpacker Magazine - Epinephrine for snakebite?

MEDICINE MAN - BUCK TILTON - ASK THE EXPERT

Submit Your Question

Epinephrine for snakebite?

Q.} Would an EpiPen serve any good purpose in treating a snakebite?
Submitted by: Mike, San Jose, CA

A.} A severe allergic reaction to the bites of poisonous critters of all shapes and sizes is always possible—in which case, yes, your EpiPen would most likely reverse the reaction and prevent you from entering anaphylactic shock. But, no, epinephrine will not help—and should not be used—to aid your body in dealing with its reaction to the venom itself. You want to stay calm when envenomated, and epi does not help you stay calm. It excites you. To find out the right way to treat a snakebite (and to see other myths dispelled), click here.

Subscribe to Backpacker magazine
Sign up for our free weekly e-newsletter

PRINT THIS PAGE EMAIL THIS PAGE RSS FEED

Your rating:

Reader Rating: -

READERS COMMENTS

Swifty PA-C WFR

Mar 11, 2011

If you really want to know what to do in the wildernes, take a wilderness first aid course or better yet a WFR course. I am a physician assistant and still learned lots of valueable information and skills.

Brion

Nov 11, 2010

Anyone care to comment on what harm a sawyer extractor could do immeadiately following a bite from a venomous critter?

John and Dave, great informative post. So many previous articles and post are so far out of the reality range - your discussion is WFR centric. Do no additional harm, the golden hour does not exist, use all resources available, become knowledgeable about your environment and make no other victim. Awsome post, you'd be on my A team. Thanks!

Argosinu

Nov 04, 2010

For those of us with remote cabins and known snakes, is antivenim available by prescription?

Anonymous

Oct 30, 2010

I'm an old Paramedic (Number 200 something on Ohio's registry system) long since retired and not current. So for what it is worth.

DO NOT use your Epi pen because of snake bite. It does the opposite of what you need.

To the best of my knowledge the only venomous snake in the US that causes respiratory distress as its primary affect is Fla's coral snake.

I understand (maybe wrongly) that a full dose of its venom takes seconds to reach maximum result (you die).

Epi pens have saved many lives, including my niece's. It is not a magic wand. It is useful only for its intended purpose.

Like tourniquets it can cause more harm then good used for anything other then the narrow reasons it is intended.

David G, RN/Paramedic

Oct 19, 2010

First, I AM NOT a doctor. So this is my educated opinion from knowledge and research, not a medical opinion. I have however been a RN/Paramedic/Firefighter for almost 17 years, and have treated many allergic reactions. Also, let me say that if you carry an epi-pen, you should READ THE INSTRUCTIONS and understand how (TRUST ME, the needle will go through a large man�s thumb, finger nail, and out the other side wasting the medication into the air or your face if used upside down!!!), where, and WHEN to administer it. Do not waste it when someone is hyperventilating because they are scared, or afraid they "might" have a reaction. Epi will only make these issues worse, and only has a limited half-life (length of time it works) so if given before you start to have true symptoms [hives, severe itching all over, swelling (especially of the lips and face), difficulty breathing, vomiting, diarrhea, cramping, and a fall in blood pressure (in the field you will notice a weakening pulse, seeing spots or getting dizzy, and will initially have some relief of these symptoms if you lay down because it allows blood back to your brain.)], you limit the benefit you will gain since the medication typically only lasts 10-20 minutes. Though there is still the balancing act making sure to give it as soon as possible if it is truly needed. Again, research and reading the instructions will help with that. Also realize that epi degrades quickly (12-18 months) in good conditions, and unless you always hike in 77 degree weather or go out on trips >59 or <86 degrees (the recommended temperature for storage and use) then it will degrade faster. Once degraded it is practically useless. Remember, the harsher the temperatures, the less time it is effective. My personal opinion is that at a minimum you should get a new one every year. If you are a serious year round hiker/backpacker/etc... I would get a new one each quarter if I was truly that allergic. With your doctors advise I would get more than one if I planned to be several miles/days into the backcountry. Remember effects only last about 10-20 minutes and a repeat dose is recommended at 15 minutes if symptoms do not noticeably improve.
As for the previous discussion, most of what I read here is true... however, while Epi does not "block" or "stop" histamine from working, it does temporarily stop the mast cells from producing the histamine there-by stopping the release of more histamine into the system. (This is because the Immunoglobulin E that attaches to mast cells after the exposure (sting, etc�) causes degranulation, or the secretion of histamine as well as other inflammatory agents. Epi also has some effect on the Basophils, but I will focus on the histamine problem here.) So, while I agree that epi does help reverse the bronchoconstriction and swelling of the airway... and it causes vasoconstriction to help prevent cardiovascular collapse (bottoming out of your blood pressure), the key is RAPID use of epi is. Using the epi ASAP stops the release of histamine ASAP and there-by prevents all of the other "SYMPTOMS" of the reaction. Remember, treat the "CAUSE" (histamine release) and you stop the �EFFECT� (all of the symptoms listed in the prior post: angioedema, bronchoconstriction, etc...) So, in that it stops the histamine release, epi is more a true treatment than Benadryl which only treats the symptoms of the histamine. �If ya don�t release histamine, ya don�t have to block it!!! �
As for Benadryl... it is the initial treatment of choice for "blocking" the histamine, and should definitely be given. Epi actually potentiates (increases the effect) the Benadryl. I do agree that immediately using Benadryl is important if there is a decent chance of a reaction, and saving the Epi until true symptoms arise, but as I have explained, Benadryl blocks the effects of histamine� but more and more is being released there for it is not the �treatment� for the allergic reaction, it is a treatment for a symptom of the reaction. Stopping the histamine release is key, especially for those of us who are days away from an ambulance and not in cell phone range. If this situation (the JUST NOT POSSIBLE event) is likely in your case, then a serious, honest discussion about your risks with your family doctor could probably lead to (at your request) him prescribing you Solu-Medrol (sometimes as a Medrol dose pack, because it comes is an easy to follow dosing packet� it�s the same drug). This is light, easy to carry, treats the allergic reaction more intensely and long term than Benadryl, and most importantly can be taken for SEVERAL days to a week in order to allow a chance to recover and then evacuate yourself as is often needed. Please don�t forget this is hard on your already calorie starved body, and you must eat to gain the strength required to fight the reaction and still be able to get to safety. Another positive effect, for those of us with joint swelling issues, is that this medication will significantly prevent/minimize the pain and swelling allowing an easier/faster self-evacuation if required. (Bash me if you want, but I am an avid solo backpacker. Sending for or receiving help is very unlikely in my case, but isn�t that self-reliance part of what makes us spend days or weeks at a time alone in the wilderness anyway?!?!?!) Note: Prednisone will not typically cause the drowsiness that Benadryl will, but Benadryl (and epi if needed) should still be used initially while waiting for the prednisone to take effect.

EPI TREATMENT FOR A SNAKEBITE: While there can be a VERY minuscule argument to say that epi can help support the cardiovascular collapse (dropped BP) in a snake bite victim, the chances of increasing necrosis of the site if injected too close and ESSPCIALLY the fact that epi significantly increases heart rate, force of contraction, and thereby stroke volume (i.e. a lot more blood pumping around to spread the venom). Snakebites DO NOT RELEASE HISTAMINE and therefore, Epi or Benadryl will not have any medically significant positive effect for their treatment. As just stated, it is much more likely to make it worse. This also applies to the venomous spiders in North America. Treatment for snakebites is another post, but for this post� the answer is NO, EPINEPHRINE IS NOT TO BE USED ON SNAKE BITES!!! You might find a few references online, but 99.9% of them say to use epi when the patient is given ANTIVENIN (improperly referred to as anti-venom) because the antivenin has a high rate of allergic reaction� but this has nothing to do with the effects of the snake bite itself. (The other 0.1% do not know what they are talking about!!!) Also, remember that at least 25% of bites do not even inject venom. You are not the snake�s prey, sometimes it is a bite to scare you away. Why waste the venom it needs to catch its actual food??? I don�t think we would be that tasty to them!!! LOL
I hope this helps someone. While a little of this is from my own knowledge base, I have researched to verify everything I said here. Anyone can �google� it, but I tried to sort through some of the medical mumbo-jumbo for you and shorten it significantly while also providing enough detail for my fellow medical backpackers out there.
P.S. I had a couple great links, but the site wouldn't post my comment with them. At a minimum pull up the package insert for the epi-pen.

David G. RN/Paramedic

Oct 19, 2010

First, I AM NOT a doctor. So this is my educated opinion from knowledge and research, not a medical opinion. I have however been a RN/Paramedic/Firefighter for almost 17 years, and have treated many allergic reactions. Also, let me say that if you carry an epi-pen, you should READ THE INSTRUCTIONS and understand how (TRUST ME, the needle will go through a large man�s thumb, finger nail, and out the other side wasting the medication into the air or your face if used upside down!!!), where, and WHEN to administer it. Do not waste it when someone is hyperventilating because they are scared, or afraid they "might" have a reaction. Epi will only make these issues worse, and only has a limited half-life (length of time it works) so if given before you start to have true symptoms [hives, severe itching all over, swelling (especially of the lips and face), difficulty breathing, vomiting, diarrhea, cramping, and a fall in blood pressure (in the field you will notice a weakening pulse, seeing spots or getting dizzy, and will initially have some relief of these symptoms if you lay down because it allows blood back to your brain.)], you limit the benefit you will gain since the medication typically only lasts 10-20 minutes. Though there is still the balancing act making sure to give it as soon as possible if it is truly needed. Again, research and reading the instructions will help with that. Also realize that epi degrades quickly (12-18 months) in good conditions, and unless you always hike in 77 degree weather or go out on trips >59 or <86 degrees (the recommended temperature for storage and use) then it will degrade faster. Once degraded it is practically useless. Remember, the harsher the temperatures, the less time it is effective. My personal opinion is that at a minimum you should get a new one every year. If you are a serious year round hiker/backpacker/etc... I would get a new one each quarter if I was truly that allergic. With your doctors advise I would get more than one if I planned to be several miles/days into the backcountry. Remember effects only last about 10-20 minutes and a repeat dose is recommended at 15 minutes if symptoms do not noticeably improve.
If this will accept web sites, here is the package insert for an epi-pen and you can verify a lot of what I am telling you. I would definitely read this if planning to carry one along on your next trip.
http://www.epipen.com/files/Legacy-Physician-Insert.pdf
As for the previous discussion, most of what I read here is true... however, while Epi does not "block" or "stop" histamine from working, it does temporarily stop the mast cells from producing the histamine there-by stopping the release of more histamine into the system. (This is because the Immunoglobulin E that attaches to mast cells after the exposure (sting, etc�) causes degranulation, or the secretion of histamine as well as other inflammatory agents. Epi also has some effect on the Basophils, but I will focus on the histamine problem here.) So, while I agree that epi does help reverse the bronchoconstriction and swelling of the airway... and it causes vasoconstriction to help prevent cardiovascular collapse (bottoming out of your blood pressure), the key is RAPID use of epi is. Using the epi ASAP stops the release of histamine ASAP and there-by prevents all of the other "SYMPTOMS" of the reaction. Remember, treat the "CAUSE" (histamine release) and you stop the �EFFECT� (all of the symptoms listed in the prior post: angioedema, bronchoconstriction, etc...) So, in that it stops the histamine release, epi is more a true treatment than Benadryl which only treats the symptoms of the histamine. �If ya don�t release histamine, ya don�t have to block it!!! �
As for Benadryl... it is the initial treatment of choice for "blocking" the histamine, and should definitely be given. Epi actually potentiates (increases the effect) the Benadryl. I do agree that immediately using Benadryl is important if there is a decent chance of a reaction, and saving the Epi until true symptoms arise, but as I have explained, Benadryl blocks the effects of histamine� but more and more is being released there for it is not the �treatment� for the allergic reaction, it is a treatment for a symptom of the reaction. Stopping the histamine release is key, especially for those of us who are days away from an ambulance and not in cell phone range. If this situation (the JUST NOT POSSIBLE event) is likely in your case, then a serious, honest discussion about your risks with your family doctor could probably lead to (at your request) him prescribing you Solu-Medrol (sometimes as a Medrol dose pack, because it comes is an easy to follow dosing packet� it�s the same drug). This is light, easy to carry, treats the allergic reaction more intensely and long term than Benadryl, and most importantly can be taken for SEVERAL days to a week in order to allow a chance to recover and then evacuate yourself as is often needed. Please don�t forget this is hard on your already calorie starved body, and you must eat to gain the strength required to fight the reaction and still be able to get to safety. Another positive effect, for those of us with joint swelling issues, is that this medication will significantly prevent/minimize the pain and swelling allowing an easier/faster self-evacuation if required. (Bash me if you want, but I am an avid solo backpacker. Sending for or receiving help is very unlikely in my case, but isn�t that self-reliance part of what makes us spend days or weeks at a time alone in the wilderness anyway?!?!?!) Note: Prednisone will not typically cause the drowsiness that Benadryl will, but Benadryl (and epi if needed) should still be used initially while waiting for the prednisone to take effect.

EPI TREATMENT FOR A SNAKEBITE: While there can be a VERY minuscule argument to say that epi can help support the cardiovascular collapse (dropped BP) in a snake bite victim, the chances of increasing necrosis of the site if injected too close and ESSPCIALLY the fact that epi significantly increases heart rate, force of contraction, and thereby stroke volume (i.e. a lot more blood pumping around to spread the venom). Snakebites DO NOT RELEASE HISTAMINE and therefore, Epi or Benadryl will not have any medically significant positive effect for their treatment. As just stated, it is much more likely to make it worse. This also applies to the venomous spiders in North America. Treatment for snakebites is another post, but for this post� the answer is NO, EPINEPHRINE IS NOT TO BE USED ON SNAKE BITES!!! You might find a few references online, but 99.9% of them say to use epi when the patient is given ANTIVENIN (improperly referred to as anti-venom) because the antivenin has a high rate of allergic reaction� but this has nothing to do with the effects of the snake bite itself. (The other 0.1% do not know what they are talking about!!!) Also, remember that at least 25% of bites do not even inject venom. You are not the snake�s prey, sometimes it is a bite to scare you away. Why waste the venom it needs to catch its actual food??? I don�t think we would be that tasty to them!!! LOL
Again, if they will allow a website, here is a great reliable website to read about snakebites and their treatment: http://www.aafp.org/afp/2002/0401/p1367.html

I hope this helps someone. While a little of this is from my own knowledge base, I have researched to verify everything I said here. Anyone can �google� it, but I tried to sort through some of the medical mumbo-jumbo for you and shorten it significantly while also providing enough detail for my fellow medical backpackers out there.
1. Be neat and clean.
2. Be courteous and polite.
3. Always obey your parents.
4. Protect the weak and help them.
5. Be brave but never take chances.
6. Study hard and learn all you can.
7. Be kind to animals and take care of them.
8. Eat all your food and never waste any.
9. Love God and go to Sunday school regularly.
10. Always respect our flag and our country.
And as the well known song says, �Happy trails to you, until we meet again.�

John I. Gutierrez

Oct 16, 2010

Adding to what I just wrote, you should First and Foremost remove the allergen from the offending environment or yourself (or the patient) from the offending environment (common sense but easy to forget, obviously). While waiting for EMS, follow the proper dosages on the DPH (diphenhydramine HCL), and be ready to administer the Epi if the reaction reoccurs. You probably don't carry three or four epi-pens around so make sure you've called EMS in case your dose of Epi is ineffective(breathing is pretty important). In fact, if you've had a serious allergic reaction at all, CALL, even if you're "fine" now, because secondary reactions can still occur within 12-24 hours.

John I. Gutierrez

Oct 15, 2010

On Epi: Epinephrine is a bronchodilator and a vasoconstrictor, and does NOT "treat" an allergic reaction. In other words, it doesn't stop the histamine reaction from continuing, it just opens up the airway temporarily, which can be life-saving, because an Anaphylactic reaction to any type of "allergen" (whether dandelions or bumblebees or shellfish or cat dander) can cause Angioedema, possibly resulting in a complete airway obstruction, and thus a respiratory emergency (Read: asphyxia (suffocation)). If you cannot breath and thus swallow, secondary to the edema (swelling), Epi opens up the airway TEMPORARILY and allows you a window to administer an actual treatment (a dose of antihistamine like Diphenhydramine HCL "Benadryl"). SO, the idea is that you "treat" as soon as possible, because the antihistamine can take about fifteen minutes to kick in - nip that #*$% in the butt before it gets bad so you don't waste the epinephrine, because you might need to use it later if the reaction doesn't cease before EMS has arrived ...you've called EMS, right?! (they've got more Epi and DPH and other good drugs to help if needed)

Tom B.

Oct 15, 2010

YES use an Epi pen if you have a severe allergic reaction to the venom.
NO do not use there is no allergic reaction.
Epinephrine is for allergies.
Elevate and evacuate.

Eric Killian

Oct 14, 2010

Soo... I'm not clear in the answer. Use or do NOT use an epipen for snake bikes (or beers, wasps and other allergic reactions) when medical care is a long hike away?

Rev. Thom Leettola

Oct 14, 2010

So much has been written about getting snake bit victims to medical care as soon as possible, yet there are those times when that is JUST NOT POSSIBLE... yet I cannot recall ever reading about what to do under those less than ideal circumstances.

ADD A COMMENT

Is an ultraviolet light, like a SteriPen, better for treating filtered water than iodine tablets?
Read more...

If you melt snow for drinking water in the winter, do you need to boil it for purification?
Read more...

What’s the best way to remove and treat a tick bite? My recent attempt severed the head, which required a hospital visit to remove.
Read more...

Can altitude increase the effect of thyroid medications? I recently hiked four days in the Grand Canyon and had an experience which felt like an overdose of my thyroid meds. I skipped a dose and all the symptoms went away, even after climbing another 3,000 feet. What's up?
Read more...

The day after a long, tough, hike I often feel like my head is filled with cotton and like my eyes won't fully open. What can I do to prevent or cure this? I drink a lot of water, but that doesn't seem to help.
Read more...

I was recently introduced to "wicking" blisters--putting material under the skin to drain the fluid. I am a certified Wilderness First Responder, but I couldn't recall any mention of "wicking" blisters in my training, and I didn't find any in the Wilderness Medical Institute's training book. I think it is a great way to get a very bad infection. What do you think?
Read more...

What would be the best snack to eat just before going to bed to help stay warm? Would it be something high in fat and high in calories or something high in protein because you burn more calories digesting protein, which would increase your metabolism?
Read more...

Why do I get the shivers about 20 mins after along, hard winter hike, even after changing into dry clothes and blasting the heat? What can I do to prevent this?
Read more...

I have two questions about cramps: How can I avoid or prevent cramps just above my knees, in my quads? And how can I stretch out cramps in that area?
Read more...

If I had to survive on bad water for several days (say I fell in a canyon with no water) would enemas of the bad water actually keep me from dying of dehydration and not give me diarrhea? I heard of a family lost at sea with a hydration bladder was able to survive this way.
Read more...

I tore tendons in my left ankle when I was younger, and as a result, don't have the most stable of ankles while hiking. Braces tend to be too hot and irritating inside a boot - is there any specialty boot or aftermarket product to help?
Read more...

My dog joins me on many of my hiking trips. Is there anything short of giving her a bath that will remove the oils from poison oak/ivy?
Read more...

Does bleach repel rattlesnakes?
Read more...

What do you recommend including in a medical kit for a five-day hike with four (middle age) adults?
Read more...

Are there any side effects/risks/weird complications with taking Adderall at altitude? I take Adderall occasionally to help me focus - I'm wondering if I should avoid is when, say, climbing a Fourteener.
Read more...

What�s the SPF of a deciduous forest?
Read more...

I've had Lyme disease now for three years, misdiagnosed at first, I am a hiker and a climber and continue to do so even though the pain in my shoulders and knees is sometimes bad. I�m going to climb Mts. Whitney and Rusell soon. Will the high altitude affect my Lyme disease?
Read more...

Why is it advised to leave odor free deodorant or antiperspirant behind in the backcountry when sunscreen and bug spray are considered ok? Wouldn't the same premise apply to all?
Read more...

My grandfather told me many years ago that using rubbing alcohol on your feet a few weeks before a backpacking trip will help prevent blisters. Have you heard this before?
Read more...

I am leading a crew to Philmont Scout Ranch in New Mexico. We are covering 115 miles in 10 days and summiting four peaks around 12,000 ft. What workouts would you recommend to prepare 12 guys around the age of 16 for this trek?
Read more...

What is the fastest way to recover for hiking from a sprained ankle? What exercises can I do to strengthen my ankle muscles?
Read more...

Can hiking with an aluminum external frame pack pose a hazard during an electrical storm?
Read more...

Just standing flat footed and lifting my toes I get a sharp pain shooting from the ball through the underside of my toe and my hiking has ceased. What could the problem be?
Read more...

I recently went on a seven-day 100 mile hike. My knees where killing me on the down hills. What exercise can I do to prevent this from happen?
Read more...

You run out of water on a long, hot dayhike. You find a full water bottle trailside, and also find a clear running stream. Drink from the stream, drink from the bottle, or abstain?
Read more...

How long should water boil at 14,000 feet altitude where it boils at 60 degrees Celsius?
Read more...

Why is it that wild animals can drink water that's unsafe for humans?
Read more...

My boots seem to fit me well, but after about three hours of backpacking the balls of my feet become sore. Friction probably plays a role, so I duct tape the balls of my feet to slow down the pain process. Eventually they do get sore. Any suggestions?
Read more...

I am a backpacker and mountain climber and am trying to find out more information specific to diet and keeping up my endurance, energy and strength. I have celiac disease and there doesn't seem to be a lot of information on obtaining the right carbs.
Read more...

As a CO native, hiking Fourteeners in the summer is a favorite activity of mine. I'm excited to introduce my one-year-old to an easy one this summer (carrying him in a baby backpack, of course), but am a bit concerned about him and altitude sickness. Should I be?
Read more...

Why do I get headaches nearing the end of hikes? I drink enough water, eat enough, but the last two miles of so of any hike I get a killer headache.
Read more...

Does hiking and sleeping at altitude for the weekend one to three weeks prior to taking a hike at 14,000 help acclimating? I would be back at sea level for the work weeks in between.
Read more...

How soon after exposure to poison ivy do I need to wash my skin? If I apply an alcohol-based hand sanitizer after contact with poison ivy, will it reduce my reaction, or stop it altogether?
Read more...

When I through-hiked the PCT a number of people I was hiking with came down with giardia. We drank from the same sources for weeks. They treated their water and I never did and I still never got sick. Why?
Read more...

Are giardia issues now greater than they were, say, in the 60s? In the 60's I often drank out of remote streams, with no ill effects.
Read more...

What is a mosquito's hunting range? A group of us spent an hour at a campsite killing mosquitoes by hand, and we pretty well cleared out the area. I will be trying insect-killer spray this summer. Much faster!
Read more...

I have kneecap arthritis but I still want to hike. Aside from using hiking poles and losing weight (ha!), what else can I do so I can still hike?
Read more...

I've read that household bleach—add four drops per liter of water and up to eight for questionable sources), then wait a half hour—can be used to purify water. Your thoughts?
Read more...

I am an avid backpacker, and I often have trouble with my hands falling asleep and getting itchy when I'm hiking. I've read that trekking poles can fix this problem. Can I use my cross-country ski poles?
Read more...

How many quarts of water per person per day should you carry when packing in the desert Southwest in the middle of May?
Read more...

Is it true that placing a rope around your sleeping bag will discourage snakes from crossing it?
Read more...

When I'm camping, I frequently wake up during the night with my arms and/or hands feeling numb. Is there something I can do to prevent this?
Read more...

Although I am conscientious about treating surface water before drinking it, is there any danger with drinking untreated water if it comes out of the ground (for example, a spring) and there is no development or agriculture at a higher elevation?.
Read more...

I like sleeping under the stars. Is the fabled "rattler joins camper in his sleeping bag" tale at all a meaningful risk?
Read more...

What is the shelf life of chlorine dioxide tablets?
Read more...

How long does it take for human feces in a cathole to break down into soil?
Read more...

For months, I had moderate stabbing pain in the front of the index toe (the one next to the big toe). The pain has subsided, but now my toe bends to the left. Should I do anything about this or just accept that my foot will look different than it has for the past 60 years?
Read more...

I have always used the "Potable Aqua" iodine pills to treat water in the wilderness. Now I hear that they won't kill one or two specific water-borne diseases. Is this true, and if so, what can I do to kill the extra germs?
Read more...

Three days into a five-day hike, your knee blows up to the size of a softball—no fall, no trauma. Why, and what can you do to help the knee?
Read more...

Is QuikClot a friend or foe?
Read more...

I want to do some backpacking in Florida, but I know the water in the Everglades and most streams is high in tannins. Is the water safe to drink after filtering it or using purification pills?
Read more...

What is a good way to treat and prevent plantar warts on the trail?
Read more...

My understanding is that the maximum amount of sodium you should have in your diet is about 2,400 mg. Is there a minimum amount you should have? I perspire excessively and get headaches without salt replenishment.
Read more...

Is there a medicine that will treat leg cramps?
Read more...

I have very poor circulation in my fingers and toes. What is the best way to keep them warm consistenty without overheating?
Read more...

A friend of mine swears that his body puffs up at high altitude, making his ski boots fit tighter. Is there any truth to this?
Read more...

I take insulin. This means I can have low blood sugar, especially in the middle of the night after backpacking. Do you have suggestions for a glucose boost that I can keep in the tent that will not attract Bear?
Read more...

I'm researching water treatment for desert backpacks. All desert water is very questionable since it often contains heavy metals and mine runoff. Any suggestions on how I should purify it?
Read more...

While winter camping, is it safe to put icicles in my drink?
Read more...

I have a friend going to an altitude much higher than where he lives. Is there any way to train to be better prepared?
Read more...

I heard that the salt in sweat crystalizes and that's what causes chafing on your inner thighs. Have you heard this? A quick wash with hand sanitizer seems to help, but it burns like crazy if you've started chaffing. Water doesn't seem to work as well.
Read more...

I've had knee problems for the last 15-plus years. I was recently told that I no longer have any cartilage in either of my knees. I'm only 31, and total knee replacement isn't an option at my age or activity level, I'm told. I try to keep my pack under 30 pounds. What else can I do to stay on the trail?
Read more...

Will bear spray work on a mountian lion? And is pepper spray just as effective?
Read more...

I turn 62 in the spring and will be retired, and I want to take up backpacking. Will I be too old to start? If not, what injuries will I be more prone to incur and what can I do to prevent them?
Read more...

Does going to higher altitude make it difficult for your lungs to clear moisture? I'm not a smoker, but every morning I had to cough to clear my lungs.
Read more...

What should you do when the ground is frozen and you have to dig a cathole?
Read more...

Should ibuprofen be thrown away after the expiration date, or is it really still OK to use?
Read more...

We all know about the risks of drinking untreated water. But is there any risk of infection with other activities such as shaving, where there's an opening of the pores and a potential for cuts?
Read more...

I'll be climbing 6,000-meter peaks next year, but I suffer with ankle arthritis from a compound fracture 20 years ago. I have pain but put up with it. Will the pain get worse at altitude? And can you take anti-inflammatory medication at high altitude?
Read more...

I am doing some primitive camping with my one-year-old. What meds and ointments should I have in my pack? Are permethrin and deet OK for her now?
Read more...

I have Raynaud's syndrome, and last winter, my fingers got painfully cold after hiking for an hour at 30 degrees while wearing heavy ski gloves. How can I keep my hands warm hiking in North Carolina in November?
Read more...

Is it OK/safe to clean dirty dishes with bio soap in unfiltered/nonpurified water (from a stream)? I'm not sure how long a dried dish needs to sit before it is safe to use again.
Read more...

I've had problems with toenail loss on my great toes. Recently I lost my left toenail after a six-day hike on the AT. My right foot was fine. A thru hiker says I need larger boots, but my toes don't touch the end of the boot, so what is a good remedy?
Read more...

What food can someone with high blood pressure pack? Most freeze-dried dinners have a lot of sodium.
Read more...

I had my L4 and L5 vertebrae fused. I want to get back to hiking, but I also want to try to ensure that I do not get 10 miles in and have a problem that forces a ranger to have to come get me. I have lost weight and continue to do core exercises to make sure that is strong. So I guess my question is: Is there special equipment I should bring, or things I should modify when hiking? I know that Denali is out, but would like to hit some 14,000-foot peaks in Colorado. 
Read more...

Would an EpiPen serve any good purpose in treating a snakebite?
Read more...

I've just had a spinal fusion at the last two disks in my lower spine. As an avid hiker and backpacker, what suggestions do you have for me? I would truly hate to give up this passion.
Read more...

Somebody recently told me that climbing a Fourteener kills brain cells because of the low oxygen levels. Is this true?
Read more...

I have arthritis in my hands and need to replace some worn out Leki trekking poles. They had a straight foam grip rather than a shaped grip. I'm hoping to find something that will hurt my hands less. Can you recommend anything?
Read more...

Can you recommend some good stretches for treating shin splints?
Read more...

What goes on first, sunscreen or bug repellent?
Read more...

A while ago, someone asked you whether eating matches will keep mosquitoes away because of the sulfur. You replied saying not to try it because "matches contain poisonous chemicals in addition to sulfur." So here's my question: Is there a safer source of sulfur by which to test this?
Read more...

Are titanium trekking poles dangerous in a lightning storm? What do you recommend?
Read more...

Is it true that your foot size will increase up to a full size after hiking the AT? If so, is the increase permanent?
Read more...

Have you used SAM Splints or Quick Clot bandages? Do you know of any advantages or disadvantages? I'm a WFR student with a SAR K9 team.
Read more...

Any ideas on a bug repellent for my dog? She has almost no fur and gets chewed up pretty bad.
Read more...

On long hikes, my knees almost always start hurting on the sides during the descent. It feels like a sharp pain. My body is not fatigued, and the rest of my muscles aren't sore at all. It's only my knees that hurt. What am I doing wrong?
Read more...

Since I am allergic to deet, what is an efffective mosquito repellent I could try?
Read more...

I don’t do well in hot temperatures and have suffered heat exhaustion a couple of times. Is there a way to acclimatize?
Read more...

The first day after a strenuous hike or backpacking trip, we feel fine. It's not until the second day that we feel fatigued and sluggish. Why is this and what can be done?
Read more...

I get long, horizontal blisters very low down on the medial (inside) side of my heels. One on each foot. I hardly ever get any other type of blister and have tried changing boot and insoles. What is most likely causing them?
Read more...

I have a whole lot of birthday candles on my cake and have seen many major changes in the way cuts are handled. It used to be common practice to get out the needle and thread and just sew them up. I don't recall ever seeing any real issues with this?
Read more...

Last weekend I was bitten by nine ticks (five deer ticks and four wood ticks) in a single outing. When bitten, what's the safest way to remove them, what are the chances I'll contract a disease, and should I see a doctor right away (I have an appointment next week)?
Read more...

A few times while dayhiking, I have noticed that my fingers swell (water retention). Can you please explain what causes this?
Read more...

What is the best black fly repellent?
Read more...

I have sleep apnea and sleep with a CPAP (continuous positive airway pressure) machine. Do you have any suggestions for a better night's sleep in the field?
Read more...

Are there any negative effects or benefits of ingesting your own sweat? I am a heavy sweater, and when I ride my bike or do strenuous exercise, I sometimes ingest some salty sweat as it pours off my face.
Read more...

When you're above 10,000 feet, is normal sunscreen adequate?
Read more...

Recently, while hiking up to 12,000 feet in the Snowy Range, Wyoming, I developed a pounding headache. I thought it was due to a slight case of altitude sickness. However, while hiking a 10-mile trail in Illinois, I again developed a severe headache. Why?
Read more...

Can smoke from a campfire or chimney predict weather?
Read more...

Could activated charcoal be part of a venomous-bite kit ? I've heard that cutting and sucking isn't very effective at removing venom. Is this true? I wonder if cutting and putting a little charcoal in the wound would work. Or would drinking the charcoal be better?
Read more...

I am concerned about fleas and the plague. Should I not take my dog hiking with me? Can I get it if he doesn't come?
Read more...

I'm on a search-and-rescue team, and I keep my pack in my vehicle so I can deploy quickly. How long will water stay potable in my hydration bladder? Can I add anything to make it last longer?
Read more...

I have discovered hammock camping. I was wondering if it is safe to remain in the hammock during a thunderstorm? Should I leave the shelter of the rain fly between the trees, or set it up on the ground with trekking poles?
Read more...

I recently came off trail in the night and nearly stepped on a rattlesnake in the Smokies. If bitten and you are an hour or two out, would you recommend to keep moving to get out?
Read more...

While trying to sleep in the backcountry my mind wants to stay in alert mode at night causing considerable sleep loss. I've tried OTC sleep aids and melatonin (3 mg) to only modest success. Any additional suggestions would be very appreciated.
Read more...

Is there something that works better than water and if so, what? Also, does warm liquid hydrate better than cold, or vice versa?
Read more...

Buck, what's the best in-the-field painkiller on the market. Do you recommend one more than another?
Read more...

I went to Nepal this year and trekked thru the foothills of the Annapurna. After hitting one of the highest points of the trek, I started swelling in my hands, feet, and face. What exactly can I do to prevent this in the future?
Read more...

I hike in the Midwest and I was told that in a lightning storm that it's best to stay away from hardwoods like hickory trees and oak trees. Is this true? And if so, why?
Read more...

After long, multiday trips, I get calluses on the bottoms of my feet. Lately they have been very painful. I’ve had this problem before and the pain went away after a two-day rest—but it’s not going away now. Can you help?

Read more...

I've heard that bleach and iodine tablets are only good for water purification for six months. What about white vinegar? Will it purify water? And does it have an expiration date?
Read more...

I have a burning sensation in the soles of my feet when I am long-distance hiking, but no blisters. Do you have a solution?
Read more...

I've just returned from some bad weather in the mountains. The top half of my big toes have been numb during the trip till now. Should I be concerned? Will they regain feeling again in time to come?
Read more...

Can snoring deter bears and other animals from your campsite? I know that my friends like to not tent next to me.
Read more...

How much time does it take for the body to absorb water into the system after drinking it?
Read more...

Will white vinegar (used to clean camping kitchen gear) attract bears?
Read more...

What would you recommend for chafing, the nasty red rash that can develop on the inner thighs on a long hike? Is there an over-the-counter treatment?
Read more...

Once a heel blister starts to get better/heal, does keeping it exposed to air each night (so the area dries after the day of hiking) improve healing, or is keeping the area moist and soft with a dressing better?
Read more...

If cups and cook pots are exposed to untreated water, are they safe to use after they air dry?
Read more...

Can you get rabies or other diseases by using a bite valve that some animal has been nibbling on? Will alcohol sanitizer "sterilize" it?
Read more...

Can an electric jolt from a DC source (i.e., spark plug wire, hand-held stunner) neutralize snake venom? I recall a series of articles on this published in the late '60s by an outdoor magazine. The DC current allegedly polarized the molecules of the venom.
Read more...

I once heard that pouring granulated sugar into a deep, bloody wound would aid in clotting–but I've always heard that putting anything into an open would is bad. Set me straight, Buck!
Read more...

Camping in bear country with children and diapers: Do diapers inside the tent, wet or dry, attract bears?
Read more...

I saw an episode of Survivorman where he drank water knowing it was contaminated and would cause him to have diarrhea. He said that having diarrhea would be better than being dehydrated. Would you agree?
Read more...

I heard somewhere that it isn't necessary to bring water to a boil in order to purify it, as long as you get the temperature up to 140 degrees or more. Is this true?
Read more...

Is it possible to experience mild altitude sickness with backpacking trips below 10,000 feet? I experience gas pain during the trip, and after I return, I’m somewhat tired, short of breath and sickly feeling for days after. I'm in great shape. Any ideas?
Read more...

What are the best options for treating heat exhaustion in a remote area (no cell phone service) with no one else around? Is there something I can add to my first aid kit that would help?
Read more...

Does using sunscreen or bug repellent attract bears?
Read more...

Regarding Giardia and crypto: Can one develop a tolerance or immunity to them? I remember drinking from streams as a child while fishing and hiking in the backcountry. Surely I couldn't have been lucky than many times.

Read more...

I'm having my first child this summer, and I plan to hike and camp with her in the mountains as soon as she can hold her head up. How will I know if she's acclimatized to the altitude?
Read more...

How long does it take to start feeling the effects of poison oak exposure?
Read more...

Can you get some of the waterborne parasites, such as Giardia, through open wounds or cuts and scrapes?

Read more...

Buck, I have heard that the bonding agents like Super Glue or Krazy Glue can be used to seal wounds in the backcountry, But I also understand that they could cause the patient problems. Is this true, and what's the risk vs. benefit?

Read more...

In a bivy, what are the chances of a rattler crawling in with me and/or of me rolling over on one with my arms and torso bare? I'm not sleeping well with this!
Read more...

Will placing a copper penny on a wasp, hornet, or bee sting reduce the pain and swelling?
Read more...

I'm preparing for a trip in bear/mountain lion country. I've seen bells marketed as a way to notify animals that you are in the area. Could use of the bell actually attract predators that are used to hearing bells on livestock?

Read more...

My wife, who's allergic to bees, is reluctant to hike with me. What can I do to ease her fear of getting stung?
Read more...

I use duct tape for potential hot spots on my feet when I go for a long hike, and it works great. I want to try the same for chafing between the legs, but I'm too scared to try. Do you know if this works better than lotions or creams?
Read more...

A friend who used to read electric meters told me that all the readers carried a squirt gun loaded with ammonia to repel dogs. Would it work for bears too?
Read more...

Do odorproof bags work? And are they any more effective than standard zip-top bags for keeping in smells?
Read more...

Can you advise on how to deal with a cougar encounter?
Read more...

Is bear spray effective against snakes?
Read more...

Is it safe to wear DEET in summer when bears are around? I've heard the bear will come after you because it smells.

Read more...

Q: A friend told me today that if a bear (or alligator) chases you, it is possible to outrun them if you run in a zigzag pattern because they don't turn very well. Is this true?
Read more...

What is the best lightning safety strategy when camping above treeline, and the storm strikes in the middle of the night when you are all asleep in tents?
Read more...

I am hiking from Mexico to Canada this May (2,650 miles), and my two friends are mostly going to munch on trail mixes--but I can't eat nuts! What can I eat that is lightweight, yet gives me what my body needs to hike 20-plus miles a day?
Read more...

I've used a UV light pen for water treatment, and typically scoop water into the bottle. But will the pen kill any parasites, bacteria, and viruses that are in the droplets around the rim of the bottle, or does it just kill those in the water being stirred?
Read more...

I've been backpacking for ten years and have never had any pain in my legs, but recently I've been getting a severe pain down the front of my legs and swelling in my feet. What could I be experiencing?
Read more...

I sprained my ankle two months ago playing volleyball. I can hike on level surfaces, but side-to-side motion—typical of backpacking—hurts. I wear a lace-up cast when hiking. Should I stay off it, or use therapy and exercise to strengthen it?
Read more...

Does dark-colored clothing really attract more mosquitoes then light-colored clothing?
Read more...

Would taking an over-the-counter antihistamine (like Zyrtec) before getting in the tent help get rid of the itch from mosquitoes or other itchy things for the next day?
Read more...

What is the best thing you can do to train for a climb or long hike?

Read more...

I once punched a black bear in the nose that was sniffing my hammock while I was in it. The bruin retreated and huffed at me for a while, and I huffed back. Since then I've always wondered, does huffing at a bear encourage it to act aggressively?
Read more...

I want to wear deodorant, but I don't want to attract attention from bears. Is baking soda a good solution?

Read more...

Will drinking urine when no water is available allow you to survive longer? I have heard conflicting information.
Read more...

I'm curious about insect repellents for kids. Is DEET okay to use on a six-year-old? Thanks!

Read more...

I recently did a tough 14-mile hike and woke up with a huge headache and nausea. I thought it was dehydration, but ended up in an emergency room being treated for an exercise-induced migraine. Anything I can do to prevent this from happening again?
Read more...

Does bear spray really work? I have heard mixed things. If it does work, how?
Read more...

What is best diet at high altitude--fish, carbohydrate etc?

Read more...

I have been an avid backpacker for most of my life, and now that I'm getting up there in age I'm noticing my posture getting poorer. Does backpacking contribute to this? And do products like the posture girdle straps I've seen online help—or do the muscles and bones require more support than that? Is this a job for the chiropractor?

Read more...

How toxic is methanol? Is it safe to get on my body?
Read more...

Cold weather sleeping--is it correct to don the clothes you intend to wear the next day, so you're not sleeping in sweat-dampened attire and then becoming chilled overnight?

Read more...

During my hikes in the fall, between the summer and winter layers, moisture builds up and my chest tends to rub raw. What is the best way to stop this, besides changing shirts more often? Could I use something like Vaseline?
Read more...

Just had a wonderful time hiking the Grand Canyon. But after 28 miles, I have swollen, painful legs from the knee through the ankle. Any tips for recovery?

Read more...

If I take my dog on a high-altitude excursion with me, should I acclimatize Fido as well as myself before we go?

Full Name:
Address 1:
Address 2:
City:
State:	Zip Code:
Email: (required)