Rx Drugs On The Trail

To combat headaches, twisted ankles, and other unexpected maladies, most backwoods amblers add various over-the-counter (OTC) drugs to their basic first-aid kits. When you’ll be miles away from the nearest medicine cabinet (see Body Language, September 1999), some simple meds are a wise precaution.

But sometimes your luck turns really sour, and your ounce of prevention

just isn’t enough. You may experience pain that ibuprofen can’t handle or come down with a serious respiratory infection. In such cases, you need prescription drugs more potent than your average OTC medications. Doctors know this, and that’s why they pack powerful drugs when in the back of beyond. We interviewed a few trail-savvy M.D.’s about medicines they won’t leave home without. Each physician had his or her own preferences, but all agreed that four types of prescription drugs are essential for hikes of 3 days or more.

Painkiller. According to William “Doc” Forgey, M.D., president of the Wilderness Medical Society, if discomfort is so severe that you can’t hike, forget the OTC pain relievers. He packs Stadol NS, a nasal spray that “provides powerful pain relief instantly. Karen Halsell, M.D., a pediatrician in Dallas, Texas, and avid backpacker, carries Tylenol 3 tablets (acetaminophen with codeine). Herbie Ogden, M.D., medical advisor to the National Outdoor Leadership School (NOLS), prefers Vicodin tablets or Tylox capsules for quieting serious pain (see “Pain Explained, Body Language, June 2001). Ask your physician which painkiller is right for you.

Antibiotic. If you have a bacterial infection (green mucus or a wound with pus are sure signs) and you’re more than a day’s hike from medical help, an antibiotic is in order. If you misdiagnose, don’t worry. This type of wonder drugin its prescribed dosage is relatively harmless when taken unnecessarily. Dr. Forgey likes to stock his first-aid kit with Levaquin tablets, an antibiotic that can tackle “most GI (gastrointestinal), respiratory, sinus, ear, eye, and skin infections. Augmentin is Dr. Ogden’s favorite because it treats just about anything, except intestinal infections. Both Dr. Halsell and Colin Grissom, M.D., director of the High Altitude Medical Research Station on Alaska’s Mt. McKinley, prefer ciprofloxacin tablets, which are effective against diarrhea caused by intestinal infections, as well as bone, sinus, lower respiratory, and urinary tract infections. However, Dr. Halsell is quick to point out that “cipro should not be used for treating children younger than 18 because it can have serious side effects.

Epinephrine. Of all the drugs that people carry into the backcountry, injectable epinephrine (in the form of an EpiPen or an Ana-Kit) is the one most likely to make the difference between life and death. It’s often used to treat serious allergic reactions caused by insect bites, including anaphylactic shock with severe breathing problems.

Antidiarrheal. Dr. Halsell carries Phenergan suppositories for “horrible vomiting and/or diarrhea. Dr. Ogden says Lomotil tablets also “plug the GI tract during bad bouts of diarrhea. Either drug will prevent a hiker from becoming dangerously dehydrated.

Other favorites. Dr. Forgey carries multipurpose TobraDex ophthalmic drops for “eye infections, ear infections, disinfecting wounds, and treating allergic skin reactions. Dr. Grissom says that two generic medications acetazolamide and dexamethasone are effective (and can be used in combination) in treating altitude sickness: “aceta for acute mountain sickness, “dex for high-altitude cerebral edema (brain swelling; for more on altitude sickness, see “Heave Ho! August 1999). For women vulnerable to urinary tract infections, Dr. Halsell advises packing Suprax tablets, which is also “fairly effective against bacterial GI pathogens.

Full Disclosure

You’re allergic to bee stings, just got zapped by one of the buggers, and are going into anaphylactic shock. You can’t breathe, and you need help fast. Does your hiking partner know there’s sting medicine in your first-aid kit and how to use it?

If you have special medication needs and carry prescription drugs in your kit, make a list of important information. Keep the list handy and let everyone in your party know about it. Consult your pharmacist, the Physician’s Desk Reference (a massive volume published annually that’s available in most libraries), or www.rxlist.com for this information.

Here’s what to include:

• Drug name: brand name and generic name
• Dose: how much to take and how often to take it. Note: Failure to follow exact dosage instructions can alter the efficacy of a drug, and in some cases, make it harmful.
• Uses or indications: why you need to take this specific drug
• Contraindications: reasons to avoid taking this drug for example, if you’re pregnant or under 14 years of age or you’re taking another medication
• Side effects: possible adverse reactions
• Interactions: what not to mix with this drug
• Description: color and shape, just in case drugs get mixed up