Summer/Fall 2002 need:

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rade can seem like nothing short of bestowing manna from heaven. However: It is illegal for someone who is not 1. Medications for Minor Illnesses, Ailments and licensed to dispense prescription medications to friends or Pain. others (i.e. a group leader cannot share or give them to oth2. Wound Management. ers in the group). This is practicing and dispensing medica3. Bone/Joint (Orthopedic) Injury Management. tion without a license. Liability also exists for potential mis4. Vital Sign Monitoring diagnosis, allergic reactions, harmful side effects, and drug 5. Infectious/ Venomous Disease Control interactions. Having said that, the good news is most docUnfortunately, when it comes to these supplies, most of tors will prescribe appropriate medications for their patients us stock medical kits like a bad salad, too heavy on the when they travel. Really. Just ask for the common medicadressings and too light every where else. While wound tions (antibiotics or painkillers) that may be helpful in a care supplies are vital (especially remote, wilderness setting. Ask knuckle Band-Aids), it is just as “.. a medical kit can make for specific instructions for use important to focus on the minor aildosing, and potential or break an entire trip, or including ment stuff for those pesky little afflicside effects, or common drug keep it from launching interactions. If your doc doesn’t tions that’ll drive you nuts (and possibly others), like a toothache or an altogether. want to do it, find one who unrelenting, nighttime cough. You We’re out there. Like personal flotation will. don’t need an entire pharmacy, but Otherwise, and even better, is you do need more than a couple of devices, they are to try to get individuals to carry aspirin. (See list.) mandatory for boaters their own antibiotics or other While there are no hard and fast prescription medication from on most permitted their doctor with specific rules, here are a few suggestions. First, remember that if the bowels are whitewater rivers.” instructions for use in certain happy, you’re happy. Diarrhea is a horsituations, especially if they are rible, frustrating thing on a river trip. Bring an anti-diarprone to certain problems. For example, a woman prone to rheal such as Imodium AD. (see AmmoCanDoc, A River bladder infections should try to get the appropriate antibiRuns Through Me, The Waiting List, Feb. 1999, pg. 24, otic supply for her trip. It shouldn’t be the responsibility of May 1999, pg. 26) For floatin’ and bloatin,’ consider “the medic” on the trip to provide a cornucopia of medicaDucolax, which is good for constipation. For the stubborn tions. It can be a never-ending battle, and it gets really variety, bring the suppository form of Ducolax as well, so expensive. For what it’s worth, if I had one oral antibiotic you can sneak up on it from behind. Pepto-Bismol, or to bring it wound be Keflex (cephalexin) which is good for Mylanta can help an upset stomach, and consider Zantac skin or wound infections, as well as upper respiratory infecfor heartburn after too much spaghetti or one too many tions (bronchitis or sinusitis). My prescription painkiller brewskis. While cold and cough preparations are a dime a would be Vicodin. It is moderately potent and tolerated dozen, Robitussin DM is probably the best bang for the fairly well. buck for a nagging cough and Sudafed for congestion A few quick final pearls: relatively primitive but invalualone. For the combo sneezing, sniffling, stuffy nose, able medical tools include a reliable watch, a good tweezers, coughing, so-you-can-rest medicine, Dimetapp, Contac, a decent scissors and a SAM splint. A watch with a second or Tylenol Cold Sinus is probably reasonable. Plain hand or digital readout is good for monitoring vital signs, Benadryl is a good antihistamine for itching or allergic i.e. pulse and respirations, (which can make a sick or reactions. Vitamin I (ibuprofen) is good for inflamed injured person think you’re “doing something” even if aching, sore joints, and Tylenol for fever or pain, and for you’re not, and can keep you from being late for dinner on those who can’t stomach ibuprofen. Oragel or Eugenol can enchilada night). Invest in a good tweezers (forceps), one help a toothache. A good skin moisturizer (Curel, petrolewith a fairly pointed end that closes really well. They’re um jelly) is mandatory for any attempt at healthy skin. great for everything from teeny, weenie splinters to eyeglass Superglue is excellent for cracking skin (see screws. A good small scissors and EMT shears for cutting AmmoCanDoc, Summer 2000, The Waiting List, pg.28), tape, bandages, moleskin etc., is worth the money. SAM and you can never have too much sunscreen. splints are the greatest things since sliced bread for splinting As for prescription medications, anyone whose ever orthopedic injuries. done a long wilderness trip knows being able to render Lastly, where to store all this stuff? For river trips it’s antibiotics or prescription pain killers to a suffering comusually easy because space shouldn’t be an (continued on next page)

THE Waiting

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List

(continued from preceding page)

issue (except unsupported kayak trips). A 20 mm. ammo can is great for the major medical, and smaller ammo cans for the minor first aid. Make sure they don’t leak! (Test them empty in the bathtub). They should ideally be painted white with a red cross for quick identification. Put medications in labeled zip-lock baggies, and use labeled Tupper Ware for compartmentalization. Consider a medium-sized, separate, zippered pouch for wound management supplies that you can access quickly or throw in a daypack, for treating those minor dings and scrapes. Make sure everyone knows where the kits are, and don’t bury them! Individuals with potentially serious health problems like asthma, diabetes etc., should have extra medication carried by someone else on a separate boat. As for other emergency essentials that should be part of all trips, but not necessarily crammed into a medical kit, is some sort of distress signaling device. Satellite phones are the best. Signal mirrors should be obtained at least for backup. These should be in the sweep boat as well as the major medical kit for most reliable accessibility.

RECOMMENDED MEDICAL SUPPLIES (for up to 21 Day Trip, up to 16 persons) Pocket medical guide (1) “Field Guide” by Jim Morrissey, EMT-P, WEMT $19.95 Wilderness Medical Associates, 189 Dudley Road, Bryant Pond, ME 04219 www.wildmed.com Notebook, pencil (1)

VITAL SIGN MONITORING Watch with second hand (1) Thermometer: Hyperthermia (97-107F) (1) Hypothermia (86-100F) (1) Blood Pressure Cuff (optional) Stethoscope (optional)

INFECTIOUS/VENOMOUS DISEASE CONTROL CPR Microshield (1) Sawyer Extractor (for snakebite) (1) Infectious Control Bag (Resealable Biohazard) (1) Rubber Gloves (4) Antimicrobial Hand Wipes (2) Soap (2)

WOUND MANAGEMENT: EMT Shears (1) Small Bandage Scissors (1) Splinter Removal Forceps (tweezers) (1) • For Wound Cleaning: 20cc irrigation syringe with 18 gauge flexible catheter tip (1) Povidone Iodine Solution (or swabs) 1 oz. (2) Antiseptic Towlettes (6) Q-Tips (4)

• For Wound Closure: Wound closure or steri-strips (1/4”x4”-10 strips) (1) Tincture of Benzoin (1/2 - 1 oz., to secure wound closure strips) (1) Band-Aids, several sizes (10) Knuckle Bandages (10) • For Wound Dressing: Triple Antibiotic Ointment (6) Sterile gauze squares: 2 x 2 (8) 4 x 4 (8) Non-adherent pads (Telfa) (4) Sterile self-adhering 3” roller gauze wrap (Kerlex or Kling) (2) Adhesive Tape (waterproof ) 1” x 10 yards (1)

BONE/JOINT AND INJURY BANDAGE MATERIAL SAM Splint (36”x 4.25”) (1) ACE Elastic Bandage (Velcro): 3” (1) Safety Pins (1/2” length) (3) Eye Pad (2) Trauma Pad (8”x 10”) (2) Triangular Bandage (for sling) (1) Blister Materials Moleskin (7”x 4”)/Molefoam or Spenco 2nd Skin Package (2) (Alternative: adhesive or duct tape around hot spots)

• Medications: Aloe Vera Gel 100% (soothing burns) 3/4 oz. (4) Antacid Tablets (Mylanta or Pepto-Bismol) (12) Anti-diarrheal (Imodium AD) box of 12 (2) Antibiotic Ointment (see Wound Dressing) Antihistamine (Diphenhydramine 25 mg. (12) Antifungal Cream (Tinactin, Lotrimin) (3) Decongestant Tablets (Sudafed) (12)

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And Nasal Spray (Afrin) (1) * or decongestant/antihistamine combination, i.e. Actifed, Contact, Dimetapp Ducolax Tablets (for constipation) (12) “ Suppositories (4) Extra Strength Tylenol 500 mg. (20) Glucose Paste (1) Hydrocortisone cream 2% (4) Ibuprofen 200 mg. (20)

• Other Sunscreen (>15 SPF) Elmers Glue, small bottle (for cactus spine removal) Fine tooth pocket comb (for cactus spine removal) Superglue (for cracked skin on feet or hands, or avulsed teeth) Duct Tape (multi-functional) Lip Balm (>15 SPF) Petroleum Jelly Insect Repellent (containing DEET) Eugenol (oil of cloves for dental pain) Survival (Space) Blanket Optional for Trained Individuals: - Anaphylaxis Kit - Suture Kit - Advanced Life Support Equipment (i.e. airway) - Traction Splint

MEDICATION SUMMARY • NONPRESCRIPTION MEDICATIONS: Antihistamine (Diphenhydramine or Benadryl) - For relief of mild allergic symptoms or insomnia. Antacids (Mylanta, Pepto-Bismol, Zantac) - For relief of minor heart burn, indigestion or upset stomach. Anti-diarrheal (Imodium AD) - Relief of diarrhea Anti-inflammatory (Ibuprofen) - For relief of minor pain, fever and inflammation. Antibiotic Ointment (Triple Antibiotic): - Treat and prevent bacterial wound infection. Antifungal Cream (Tinactin, Monistat) - Treat fungal infection of feet or vaginal yeast infections. Constipation (Ducolax tablets, and/or suppositories) - for relief of constipation. Cough - (Robitussin DM) - for cough suppression, expectoration

Decongestants - (or with antihistamine combination; Sudafed, Afrin, Contact, Dimetapp) - may provide symptom relief from upper respiratory congestion during “colds” or sinus infections. - nasal spray may aid in controlling nosebleeds. Pain or Fever - (Acetaminophen, i.e. Tylenol or Ibuprofen) - For relief of minor pain and fever. Alternative for those with aspirin allergy. - Does NOT have anti-inflammatory effect. Rash, allergic- (Hydrocortisone Cream, Cortisone 2%) - For allergic skin reactions, itching (i.e. insect bites).

PRESCRIPTION MEDICATIONS TO CONSIDER AntibioticsOral: - Amoxicillin: for sinus, upper respiratory or dental infections. - Erythromycin: same as Amoxicillin, and also lower respiratory infections. Also a substitute for penicillin/amoxicillin allergy. - Keflex: for infected skin or wounds, or upper respiratory infections. - Bactrim: for urinary tract infections or infectious diarrhea. - Cipro: same as Bactrim, also upper and lower respiratory infections. Eye or Ear Antibiotics: - Cortisporin Otic Suspension- for “swimmer’s ear” infection. - Erythromycin Ophthalmic Ointment- for eye infection. Painkillers- Tylenol #3 (acetaminophen with codeine)for moderate pain. - Vicodin (acetaminophen with hydrocodone)for moderate to severe pain. Tom Myers, M.D.

y

You can find a complete listing of AmmoCanDoc articles, including those refer enced in this story by going to: www.gcpba.org do a “search” on Ammo Can Doc

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THE

Waiting List

The Ammo Can Doc

A River Runs Through Me Parts I & II Waterborne Disease in Grand Canyon

M

y group will be doing a 16-day trip in the next couple of weeks. Several of the people in the group anr very concerned about getting ill from guiardia in the water . I've assured them the ceremic filter we will take is a very good one. I've been several times to the Grand now and I’ve not known anyone to have that problem. .. They even want to put iodine in the water after we filter it. Question—my feeling on this is a lot of overkill. There aren’t too many things that I know stay alive for long in water that is 45 degrees. Can someone offer input? Thanks Roger

Which is worse? Diarrhea while kayaking in a wet suit or Lava Falls at high water? Both can be unpredictable, explosive and watery, and both could have influenced the name "Squirt Boat." I know which one I'd take, and it usually doesn't require changing pants.. (except on occasion, especially at high water but I'll take my chances). Diarrhea no doubt is one of life's more unpleasant experiences. It's bad enough in the privacy of home with an unoccupied bathroom, but it can make life flat-out miserable on a river trip, worse yet, in a kayak. And just like acne, you never know where or when it may rear its ugly head. It is also in the Grand Canyon edition of Murphy's Laws that if you haven't had it in years, you WILL get it during your private trip that you've waited 12 years for. That's the bad news. The good news is if you do, you probably didn't get it from Grand Canyon. Even better, you are more than likely going to recover without any treatment in a few days. So relax. Have a good time. However, if you insist on losing sleep, just pretend your going to Mexico and don't drink the water. Demand the bottled variety for yourself. As for the rest of us, what if we do.. (gulp), drink the water? Well, speaking from personal experience since my late teens I've had to drink untreated water from a variety of potholes, sidestreams and the Colorado River in Grand Canyon on quite a few occasions and have yet to get sick (I knock on my head as I say this). Still, I try to drink only treated water when I have the chance. Why? Someone told me to of course. It's because of a problem called "waterborne diseases", which are basically all the nasty bugs and germs that could make you sick by drinking water that isn't treated.

WATERBORNE DISEASE The potential for humans to acquire disease from microorganisms in water exists during recreational activity in/or consumption of water that is polluted by fecal waste (animal or human).

Infected animals or humans can transmit more than 150 types of potentially infectious microorganisms through feces or oral secretions. Common infectious waterborne microorganisms include protozoan parasites, enteric bacteria (human or animal) and human enteric viruses. Fortunately, with regards to the both the wilderness experience and risk for waterborne diseases, the Grand Canyon is difficult to top. The region is remote, dry and relatively inaccessible. Sidestreams emerge through these great natural filters of rock like Redwall limestone. There are no major metropolitan area nearby dumping raw sewage into the river, large herds of grazing animals don't litter the sidestreams, and beaver, which are frequent carriers of the intestinal parasite called Giardia, are uncommon. Additionally, the National Park Service has these neat rules and regulations to protect water sources (and prevent sandbar surprises) from human backcountry users, like making river runners use a portable toilet system on the river and haul out all fecal waste. As a result, the Canyon's waters aren't teeming with infectious causing microorganisms. In fact, in 1997, as part of a five year study of the Colorado River and its tributaries in Grand Canyon between Lees Ferry (RM 0) and Diamond Creek (RM 226); researchers from the University of Arizona's Dept. of Soil, Water and Environmental Science and the Coconino County Dept. of Public Health concluded: 1. Low occurrence and concentrations of protozoan parasites Cryptosporidium and Giardia, suggest that the waters in the Grand Canyon are RELATIVELY PRISTINE. 2. Human enteroviruses (those that cause illness in man are transmitted only by other humans) were not detected, which indicates little impact of human waste. The study also found that the highest concentration

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of Cryptosporidium and Giardia occurred in water samples from Vasey's Paradise spring in 6/95, with 46.2 and 13.2 cysts/100 liters found respectively. Yet, samples at the same site one month later failed to detect any parasites. So what does this translate to as to risk? Well, with the infective dose of parasite to humans being 10-25 cysts, even if you had been a really thirsty researcher in 6/95 you would have needed to theoretically drink 50 to 100 liters of untreated water from the worst sample at Vasey's to become infected. 50 -100 liters! So why worry? Well, if the organism is there, the potential risk for infection is there. And when the water is turbid, all bets are off. Turbid water is caused by sediment disruption from activity in or nearby the water source, or increased runoff into the source. Sediments can contain harmful microorganisms. Turbid water should always be considered contaminated (duh), as accidental ingestion (during recreational use) or inadequate disinfection prior to drinking poses substantial increase for the risk for infection. In Grand Canyon, tributaries that especially show high bacteria levels during periods of high turbidity and/or discharge include: the Little Colorado River, Tapeats, Havasu, Kanab, Saddle, Deer, Kwagunt and Nankoweap Creeks. Anyway, because of the presence of microorganisms, the researchers recommended all water be treated prior to ingestion. Filtering was recommended as the treatment method of choice, because of disinfection resistant Cryptosporidium.

“THE

BIGGEST PROBLEM GENERALLY ISN’T THE DRINKS IN THE HAND, BUT THE HANDS ON THE DRINK..”

I

t is important to understand several points about diarrhea before going any further. First, despite being extremely common, diagnosing and treatment for diarrhea can be difficult. Multiple causes exist besides infection or waterborne related (viruses, bacteria or parasites) including: heat illness (dehydration or water intoxication), drugs (excessive caffeine, laxatives, medications), stress (anxiety, pain), other illness (i.e. appendicitis), and pre-existing bowel disorders (irritable bowel syndrome, colitis, food allergy, lactose intolerance). Second, electrolytes (sodium and potassium) are lost in diarrhea, and severe dehydration can develop despite oral fluid intake. Third, of infection related diarrheas, the vast majority are acquired by person-to-person transmission and are not waterborne. Fourth, frequent handwashing is absolutely the most important factor for prevention, especially after toilet use, but is no guarantee against transmission. Finally, even if one does acquire infectionrelated diarrhea the illness is typically self-limited without medication in 85% of cases, even if from a bacterial cause. And remember filtration is the recommended method for field treatment of water because of disinfectant resistant organisms. With more than 150 potentially infectious organisms than can cause diarrhea in man, the following discussion is a summary limited to a few of the more common etiologies. All follow the general treatment guidelines for diarrhea listed below. Any additional treatment is discussed under each sub- heading.

VIRUSES Viruses, e.g. Rotavirus, Norwalk (“Stomach Flu”) are by far the most prevalent cause, accounting for 50-70% of cases of diarrhea. They may affect an entire river or backpacking party. The incubation period is fast, only 24-72 hours. Transmission is person-to-person and these viruses are very contagious. It may be waterborne as well; however, human enteroviruses have not been detected in Grand Canyon water sources. In summer 1994, there was a large outbreak of infectious related diarrhea involving commercial guides and their passengers that was most likely viral in origin. Severity of the illness is variable. It typically begins with malaise, low-grade fever, headache, body aches (flu-like symptoms), nausea and abdominal cramps. Vomiting, then diarrhea usually follows this. Stools are usually loose, watery, and non-bloody, up to several per hour. The vomiting usually resolves within 2 days (range 1-5). The diarrhea typically lasts 3-5 days (occasionally longer). Additionally, the viruses may cause temporary lactose (dairy) intolerance, e.g. loose stool after eating dairy product lasting 1-2 weeks. Fortunately, the course of illness is self-limited from 3-5 days.

BACTERIA Bacteria produce gastrointestinal symptoms by two mechanisms: either secreting a toxin or by invading (attaching) to the intestinal lining. Such infections are vastly more common in developing countries with poor sanitation or inadequate sewage treatment and confined populations. Still, they can occur in a wilderness setting if water sources become contaminated. They also follow general diarrhea treatment guidelines; however, prescription oral antibiotics early in these bacterial illnesses (within 48 hrs) may shorten duration and severity (e.g. Cipro 500mg or Bactrim DS twice daily for 3 days). E. Coli (coliform)- (“Traveler’s Diarrhea” or “Montezuma’s Revenge”) E. Coli has several strains that can either produce toxins or invade the intestinal lining. It is the toxin form that is more commonly acquired through contaminated water. Person-to-person spread is infrequent. It has an incubation period of 24-72 hours. The illness presents with flu-like symptoms, cramping and watery, non-bloody stools. A typical course of illness is self- limited in 1-7 days without antibiotic (continued on next page) treatment.

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List

(continued from preceding page)

Shigella (“Shigellosis”) Two outbreaks of Shigellosis dysentery were documented in Grand Canyon among river runners in 1972 and 1979. No common source was ever found, but the epidemics led to initiation of human waste management regulations and improved sanitary practices for river runners. There have been no confirmed epidemics in the Canyon since. Shigella has an incubation of 1-2 days. Transmission is often person-to-person from poor hygiene, or from contaminated food or water. It also begins with low-grade fever and flu-like symptoms, followed by abdominal cramping and watery diarrhea. After 2-3 days, the diarrhea may become severe, or dysenteric, with up to 20-30 bouts of bloody stool/day. Associated fever occurs in nearly all serious cases, and vomiting occurs in about half. Spontaneous resolution occurs typically within 4-7 days, but complications, even death can occur in some cases. Campylobacter (one of two”Backpacker’s Diarrhea”) is an invasive bacteria, and the most common of bacterial causes found in the wilderness. Possible transmission sources include birds and animals. Incubation is 2-5 days. Symptoms are similar Shigella, and may result in bloody diarrhea, but usually not severe. More serious cases may mimic acute appendicitis. It is usually self -limited to 5-14 days in duration, but recurrences are common without antibiotic eradication. Staphylococcus Bacteria Toxin (“Food Poisoning”) is the most common cause of food poisoning. Incubation is 1-6 hours, and is the result of a bacterial toxin. Transmission is typically from poor hygiene by food handlers, inadequately prepared or stored foods, especially with mayonnaise. Typically the toxin causes abrupt explosive diarrhea, abdominal cramping and vomiting several hours after eating in someone whom had otherwise felt fine previously (i.e. lacked preceding flu-like symptoms). The toxin does not cause fever. A large outbreak of similar symptoms in individuals who ate the same food is usually the best tip-off to the diagnosis. It is self-limited in 6-10 hours after onset of symptoms. As for prevention, frequent hand washing, especially by those preparing food should stressed. Salmonella Species, non-typhoid (“ Food Poisoning”, “Salmonellolis”) has incubation 8-48 hours. Transmission sources include contaminated water, Grade A shell eggs, poultry, unpasteurized milk. Nausea, vomiting, malaise, headache and lowgrade fever may precede abdominal cramps and diarrhea. Stools are usually foul, green-brown to watery, with variable amounts of mucus and blood. A typical course is self-limited in 2-5 days without antibiotic treatment.

PARASITES Parasites may take 1-3 weeks to incubate; therefore, infections acquired in Grand Canyon often become symptomatic after return home. Giardia (the other “Backpacker’s Diarrhea” or “Beaver Diarrhea”) Incubation is 1-3 weeks, with a mean of 9 days. It is the trophozoite form in the host that causes illness, but the “encysted” form of the trophozoite secreted fecal material that transmits the infection. 10-25 cysts is the infective dose to humans. Person-to-person transmission is common in households of infected individuals who pass infectious cysts in their stool. Beavers and muskrats are believed to be major sources in natural waters, with cysts retaining viability as long as 2-3 months in cold water. Symptoms include repeated, intermittent abdominal cramping (often intense), with associated bloating, and non-bloody, and non-dysenteric diarrhea. A small percentage of people experience an abrupt onset of explosive watery diarrhea, with abdominal cramps, foul flatus, vomiting, fever and malaise which may last 3-4 days. In most patients the onset is more insidious. Stools become mushy, greasy and malodorous. Watery diarrhea may alternate with loose stools or even constipation, and are recurrent and persistent. Upper gastrointestinal symptoms may be present as well including upper abdominal cramping and bloating, foul smelling sulfurous belching, acid indigestion and heartburn, and early satiety. Eating may trigger symptoms. The infection is non-fatal in otherwise healthy individuals, but untreated cases may last up to six months! Prescription oral antibiotics are the treatment of choice and usually curative, i.e. Flagyl (metronidazole) 250mg three times daily for 7 days. Alcohol must avoided while on Flagyl because secondary adverse interactions (unless you enjoy puking your guts out). It may also be helpful to follow a low fat, lactose free diet. Unfortunately, relapse can occur even after antibiotic therapy. Cryptosporidium generally requires 1-2 weeks to incubate. Cattle and other domestic animals are believed to are major sources of this parasite in water (potential infection risk increases with streams or washes draining ranches or livestock grazing areas). It is the most disinfectant-resistant waterborne organism known. Only reliable way of elimination is by filtration. Illness includes mild flu-like symptoms with watery diarrhea lasting 5-12 days on average. There is no clearly effective prescription antibiotic treatment, but complete recovery is expected in otherwise healthy individuals.

General Treatment for Infectious Diarrhea: 1. Rest. Activity often makes diarrhea worse. 2. Diarrhea Diet - Day one: Clear liquids with electrolytes for first 24 hours (Gatorade, soup broth, and flat soda). - WAIT 1-2 hours after last episode of vomiting before beginning sips of fluid. Maintaining adequate hydration is extremely important as as is electrolyte (sodium, potassium) replacement! - Avoid caffeine, dairy or alcohol. - Day two: Crackers and BRATT diet (bananas, rice applesauce, tea, toast. Day three: Regular diet, except avoid dairy for up two 1- 2 weeks if associated diarrhea persists.

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3. Consider non-prescription antidiarrheal medication if: any associated abdominal pain is not severe, no associated high fever (>102), and no blood or pus in stool. - Pepto-Bismol (adult dose: 2 tabs 4 times/day for 1-2 days, or 2 tbsp every 1/2 hour for 8 doses/24 hours) - Imodium A-D (2 capsule initially, then one after each loose stool, up to 8/24 hours total. 4.

Prescription antibiotics may be warranted for suspected bacterial or parasitic infections. Contact a physician.

5. EVACUATE: - persistent, uncontrolled symptoms,significant dehydration or associated severe abdominal pain. Well, so much for a dirty subject. It really isn’t worth losing sleep over, especially in Grand Canyon. Just be extra careful where you put or point your fingers, especially if you’re the one who hasn’t washed them. Guano! Tom Myers, M.D.

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Addendum ~

Safe Water a Source of Mystery Virus THE SALT LAKE TRIBUNE Thursday, October 31, 2002 by CHRISTOPHER SMITH

WASHINGTON -- A virus believed to have made more than 130 Grand Canyon rafters sick this summer has been discovered in water flowing into the Colorado River from the sewage treatment plant inside Glen Canyon Dam, according to federal health investigators. Finding the virus thriving in water that already has been treated to meet public health standards has scientists wondering if it could threaten other municipal water supplies and recreational waterways. Reports of the so-called "canyon flu" began June 1 and peaked in mid-June and early September. All victims reported similar symptoms of nausea, vomiting and diarrhea. Healthy adults recovered in 48 to 60 hours, but the virus poses greater risk to elderly and young people with compromised immune systems, especially since medical assistance in the canyon is not immediately available. Preliminary findings from an outbreak investigation report released Wednesday pinpointed the cause as Norwalk virus, a highly infectious agent that causes acute gastrointestinal illness. "We looked at genetic material in a river water sample from Lee's Ferry and a sample of water emitted from the sewage treatment plant that serves the visitor center at the dam, and both tested positive for Norwalk," said Chuck Higgins, regional public health consultant for the National Park Service in Denver. "Recent work indicates Norwalk may be somewhat resistant to chlorine, and if we find Norwalk is surviving standard sewage treatment, that could have national implications." Researchers from the Park Service, Centers for Disease Control and state of Arizona are now breaking down the genetic code of the viral strains found in the river and in the treated wastewater to see if they match. The outbreak affected river runners on at least 17 river trips. All infected runners used river water as their primary drinking water source, treating it with on-board filtration devices. Most cleaned their water filters on a daily basis, indicating filters may be contaminated by the virus when handled by infected staff or passengers. Saturday, Grand Canyon National Park officials will meet with commercial river guides to discuss the report and emphasize the need for enhanced water purification and hygiene practices. Park spokeswoman Maureen Oltrogge said an educational program also is planned for noncommercial float trips. "Because this virus has no other animal hosts than people, we probably have a good chance of finding the source and eliminating it," said Higgins. "But this is a big, long open body of water and we are now developing a research agenda. There's probably 12 dissertations here."

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BLEACH BOTTLES, STYROFOAM

AND

List

PLYWOOD ..

The Story of “ The Sub ”

O

n the Colorado River in the 1960s it was nicknamed “The Sub.” This one-of-a-kind boat made specifically for running through the Grand Canyon was different from most other river craft. The Sub went right through waves, while other boats road up and over them. Its real name was Flavell II and this wooden boat that was built in a garage became one of the most unique craft to ever run the river, which it did from 1962 to 1970. To understand this boat we must go back to 1958. It was late in the afternoon when V.R. “Brick” Mortenson and Dwain “Nort” Norton pushed off in the original Flavell from Deer Creek Falls. That year Deer Creek was falling directly into the muddy Colorado. In those pre-Glen Canyon Dam days, the Colorado was flowing at 90,000 cfs and the river was truly too thick to drink and too thin to plow. Brick and Nort were tired from a day of hiking as they pushed off the Flavell, along with PT “Pat” Reilly in the Susie R and Moulton “Moulty” Fulmer in the Gem. The other two boats quickly hit the current but the Flavell got stuck on a sand bar. After several minutes, the Flavell was free but now behind the other boats that were hard to see in the late afternoon sunlight. A little down river at Mile 137.5, which is sometimes call Doris Rapid, a mishap occurred and the Flavell was upset. Brick and Nort found themselves in the muddy Colorado. Wearing their life jackets and hanging on to the Flavell, they were swept out of the rapid and on down river. Waiting in an eddy, Pat saw the red bottom of the Flavell and he and Moulty rowed out to catch the capsized boat. In a short while they had Nort in Pat’s boat and got a line on the Flavell with Brick hanging onto its side. They almost made an eddy above Fishtail Rapid but the flow of the river was too strong. The rescue boats took on a load of water in the rapid so they cut the Flavell loose. Brick let go of the Flavell to get to the Susie R, but a

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page nineteen

surge in the powerful river swept him down below the two Another feature was a boat self-rescue device at the rescue boats. Four miles later, after Brick had run Fishtail stern of the craft. Inside was a reel with 200 feet of paraand Mile 140 rapids in his life jacket, the rescue boats chute line and on the outside end a float was attached. caught him and he was rescued. The Flavell was found Around the float was a stainless steel round bar shaped like half-sunk way down river by Georgie White and towed into a steering wheel to protect the foam and to provide a person Temple Bar. in the water something to hold at the stern of the flipped Three years later, in 1961, Pat Reilly called Brick and boat. With the float in hand, the boat could be saved by asked him if he wanted to be a boatman again and run the swimming to shore and securing the line around a rock. river in 1962 before Glen Canyon Dam stopped the water The current would push the boat to the shore. and changed the Colorado for a long, long time. Brick It was the procedure when running the river with Pat quickly accepted . . . but there was a catch. Pat had no Reilly that safety was a big concern. There were not many boats since the Flavell and the Susie R were retied in 1959. people on the river so a trip had to be on their own. As a Pat and his other boatman for this trip, Martin Litton, were precaution boats were often run without passengers through going to modify McKenzie River the bigger rapids or the boats boats that became the Susie Too and were lined down along the ON A VERY HOT SUMMER DAY, rapid. Pat never ran Lava Falls the Portola. This design would become the Dories of today. (Pat’s THERE WAS NO BETTER WAY TO for example. Anticipating this boat, Susie Two that was renamed procedure to continue, Brick COOL OFF THAN RIDE the Music Temple, can now be seen designed a cover over the front at the Visitors Center at the South ‘THE SUB’ cockpit of the Flavell II to keep Rim.) water out when the boat was THROUGH A RAPID Brick decided that designing running rapids with only a and building his own boat was a better way to go. boatman or it was being lined. Especially with ideas he had been mulling over for years as a Brick, who worked the evening shift at Lockheed result of the 1958 flip. So out of sheets of marine plywood Aircraft, used every morning and almost every weekend to and oak boards the Flavell II was born. She was 16 feet 8 get the boat built. With the help of family and friends, the inches long, 66 inches wide at the beam and 20 inches Flavell II was completed barely on time to make its first deep at the chine. It was a low-profile craft, being flat on river trip in June of 1962. Everyone made the journey to the top along its horizontal axis, although its decks rounded Lees Ferry and the three new boats were launched with to the sides. The bow had a depth of 15 inches while the appropriate fanfare. The Susie Too and the Portola were put stern had a depth of only 11 inches. in the water without incident. When the Flavell II was The boat was configured with a bench seat in a front launched it immediately started to fill with water. “cockpit” that sat two people who faced forward. The boatBrick had designed a self-bailing system so that if the man sat in the middle with another passenger seat in the front cockpit were filled with water while running a rapid rear. Four removable storage compartments were situated in gravity would do the bailing. At least that was the theory. the center portion of the boat. These compartments were Unfortunately, Brick had been in such a rush to finish the lifted out and carried to the campsite, which greatly simpliboat that the drain openings had not been properly sealed fied setting up nightly camps. and they leaked. No way to fix it at Lees Ferry so the boat The front, back and sides of the boat had watertight was turned over and the openings epoxied closed, sealing compartments that were filled with foam. The process of the leaks and eliminating the self-bailing system. filling these spaces was not simple. The expensive ingrediWhen the Flavell II was turned over to do the repair ents were mixed and the foam would chemically form. work a little bit of Brick’s humor was revealed. On the botSometimes! It was a very sensitive mix that was affected by tom of the boat was painted in large white letters the word temperature. It seemed the foam would either fail to work “whoops!” If the Flavell II were to flip it would at least be or else work too well. Another problem was its cost, so good for pictures. Brick came up with the idea of placing plastic bottles in the On June 25, 1962, the Flavell II began its first run of space and having the foam encapsulate them. In 1962, not the Colorado that had a flow of 52,200 cfs. The many things came in plastic bottles. For example, soft Flavell II handled great with its 9-foot oars. The boatman drinks were either in cans or glass bottles. The source of sat in a bucketed seat that kept him in place and there was cheep plastic bottles was found by having Brick’s 13-yearan adjustable footrest for comfort. It was very smooth in old son dig through all the local Laundromat’s trash for the water, it had especially great lateral stability and because empty bleach bottles. of its low profile it had great visibility. (continued on next page)

page twenty In rapids the Flavell would attack the water and dive right into the waves. To everyone’s surprise, the boat’s design seemed to keep the water out. Around the front cockpit was a metal splashguard that worked so well that rarely were more then sponges used to bail the front cockpit. On that first trip the Flavell II only totally filled with water once when its stern was sucked down in a large whirlpool and the water flowed in from the back. The Flavell II was sold to Martin Litton’s son John after the 1962 trip. It became one of the boats used by the commercial Grand Canyon Dories that Litton started. John ran all the rapids in the Flavell II and it developed its reputation as “The Sub.” During the late 1960s, Brick’s design of the boat paid-off as related in a letter written to him by Pat Reilly. “This will make you feel good and certainly raises hell with opinion that the boat was overgadgeted. Anyway, Johnnie (Litton) was running Hance and he had only three oars. Part way down, a big wave took one oar right out of his hand, oarlock and all. He got the spare into play but in a short distance it broke. There he was with only one oar and he still had to run lower Hance, which has become pretty rough in days of clear water. He remembered the nylon line and the float, grabbed it and jumped overboard. He made it to shore OK and reeled, and reeled, and reeled. He had nylon line up to his knees when he pulled the boat up on the sand. He still can’t understand how you had all that line cached in that compartment without having the boat 2 feet longer. Anyway, it worked very well. So now you can go ahead with more gadgets — and I’ll shut up.” This was not the only time John Litton used the boat rescue reel. Once, while trying to run Lava Falls, John was thrown out of the boat. The boat stayed upright but John grabbed the steering wheel and, to those laughing on shore, it looked like he was trying to steer the boat. He then swam to shore with the float and rescued the boat. Just the way Brick designed it. On another trip, the Flavell II lost its nose in Horn Creek Rapid after a nosedive to the bottom. The trip had a biologist named John Hall who was gathering critters on the trip and placing them in plywood boxes. Well, some of these boxes became the new nose. Once the Flavell II was renamed to save the Grand

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Canyon. In this era, some river runners had the idea that if the big bureaucrats at Reclamation could just experience the Canyon and the river they would not want to build dams. Martin Litton, who always liked good jokes, found a great subject when the deputy director of Reclamation was on a trip. Unknown to the director, who was seated in the Flavell II, the name of the congressman who was the biggest enemy of the Bureau was placed on the outside of the splash shield. So for photographs and one rapid, the Flavell II became the John P. Saylor. Secretary Stewart Udall later called the bureaucrat in to see the great photo of him running the Colorado. The end of the Flavell came in 1970 and is told by John Blaustein who at 23 became a boatman on the Flavell II and related the following: “Martin (Litton) had done everything he could to teach me to row during my first trip. As we all know, however, it takes far more than one trip to prepare a complete novice to row the Grand Canyon in a wooden boat. I flipped “The Sub” in 23-Mile Rapid, but flipping there was not uncommon in those days. “As was usually the case, we spent the night below the Little Colorado at the camp above Unkar on the right. Bright and early the next morning we were all prepared for the Upper Granite Gorge. This would be the first of two days of the ‘really big rapids.’ Typically for me, in those days, I was terrified! As we pushed off from shore, Martin called to the boats behind him to remind everyone to stay away from the wall. Martin went first, and I followed close behind. As we drifted toward the rapid, it was hard to see ahead since we were in the bright morning sun, and the rapid was in the shade of that huge wall. The closer Martin drifted to the rapid, the farther left he was going. At the last minute, Martin started pulling right — the classic ‘Major Powell’ move. He beautifully cut across the diagonal waves at the top, pivoted to the right and straightened out the boat to float effortlessly down the middle of Unkar. “I was not so skilled and not so lucky. By the time I realized what Martin had done . . . it was too late! I was in the main current, heading right into the ‘big stuff ’ along