Forms and Instructions
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We are fortunate here in Colorado that our state is blessed with so much natural beauty. A healthy result of this is that many of us get aerobic exercise when we take to the outdoors for recreation. While skiing, hiking, bicycling and other sports can be beneficial as well as fun, there are some inherent risks in the outdoors that we need to be prepared for as we venture out — even when just going for a long walk— or we may be unpleasantly surprised. For example, almost everyone knows that sunburn is a problem in the summer with our sunny climate and high altitude, just as hypothermia is a risk snow lovers face in the winter. Most people, however would be surprised to learn that summer and winter aren't always the peak times for these injuries.
Sunburn
The classic bad sunburn occurs in the spring, after it's become warm enough to shed those extra layers of clothing but before we've developed a protective tan. Severe second degree burns (with blistering of the skin) frequently occur on unsuspecting skiers who have less sky above them to filter out harmful rays compared to the sky down here on the plains. Exposure is made even worse because of reflected light from the snow. Treatment for first degree burns (redness without blistering) is with topical anesthetics such as Solarcaine, soothing creams, and oral anti-inflammatory pain relievers such as ibuprofen. Second degree and worse burns should be evaluated by your doctor. You may need a tetanus booster to protect you from more serious complications. A tan, by the way, is our body's protective response to sun damage already done to your skin, and so it isn't a healthy idea. Frequent tanners also seem to age more quickly, as to suggest that our immunity to illness drops with excessive sun exposure.
Sunburns are also linked to skin cancer, with the burns we experience over a lifetime contributing to the overall risk. This is why children and teens should be especially careful. Australians, who have the world's highest skin cancer rate, fight back with the motto "slip-slap-slop" — slip on a long sleeved lightweight shirt, slap on a broad-brimmed hat and slop on some sunscreen to reduce risk. Sunscreen is rated by it's SPF, or Sun Protection Factor: an SPF of 4 keeps you from burning four times as long as using no sunscreen, for example. Using a sunscreen with a SPF rating of 8 to 20 is usually recommended; higher SPF's provide little additional benefit despite higher cost.
Hypothermia
Hypothermia is another surprising risk factor for the outdoor adventurer. While potential risk is greatest for this in the winter, when the temperatures in the mountains are in the 20's or lower, it occurs more commonly when the temperatures are 35 to 45 degrees — or even higher. The reason for this is that outdoor enthusiasts are often less prepared for cool weather during warmer temperatures, when they tend to wear cotton clothing and bring along fewer extra layers to wear. Cotton clothing is to be avoided when outdoors for long periods, as it loses nearly all of its insulating ability when it gets wet. While a skier may be comfortably warm dressed in polypropylene and wool , even if they are wet on a frigid day, a person in the mountains wearing cotton clothing (even on a hot summer day) is at risk for hypothermia; a brief dousing in a thunderstorm can turn a pleasant outing into a dangerous one. Those who like to "bag 14'ers" should especially take note of this fact. Unfortunately, many people on the trails of our highest peaks are woefully unprepared.
Hypothermia usually starts with uncontrollable shivering, which progresses to stumbling, sleepiness, and confusion; it becomes an emergency at the point when shaking stops, which also makes it harder for people to become aware of the problem. Treatment involves promptly warming the person in a warm room with freshly heated blankets and warm drinks, if possible. Or, if too far from civilization, joining another undressed warm person in a sleeping bag to transfer heat. Alcoholic beverages should always be avoided when you feel cold: They bring warm blood to the skin surface, which deceptively makes you feel warmer while allowing more heat to be lost since the skin acts as a radiator and cools the blood (and body core, when the blood returns through the veins).
Although almost all hobbies have inherent risks, with proper preparation, outdoor activities can be safe, and have been shown to help the body in many ways: lowering blood pressure and cholesterol, improving sleep and daytime energy levels, reducing weight, aiding depression, and reducing the risks of heart attacks and strokes. If you already have a history of heart or lung disease, or have significant risk factors for heart disease or strokes, contact you doctor before embarking on any exercise program, but everyone can — and should — enjoy the world class beauty right in our backyard.
Richard E. Jacobi, M.D., is a family physician at Longmont Clinic.
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