Sunday, August 27, 2006

Improving the Medical Blogosphere

Newcomers to any group often bring fresh ideas and insights to that group which are worthy of consideration and may even generate change. Traveling Doc, the blogger of Borneo Breezes, is such a newcomer, and has a new post up on her blog which deserves thoughtful consideration by medical bloggers. I won't try to synopsize her post, as it needs to be read in its entirety; go over and read what she has to say. Read the comments too, as she further elucidates her ideas there.

Moof also blogged about the post on Borneo Breezes, and--as usual--has additional food for thought. Her comment section also contains some good feedback.

As Traveling Doc suggests, diversity of opinion--politely discussed--is an essential component of growth and change, and is to be encouraged. Blogs are an ideal format for such discussion. The medical blogosphere can only benefit from more such critical thinking as she is offering.


Saturday, August 26, 2006

Fishing the Kisaralik, Conclusion

...continued from Part 2...

By nightfall, the sky was clouding up again. The brothers turned in early, and Henry, Dutch and I sat a while longer by the fire. The wind was picking up and Henry predicted more rain that night.

“We may want to think about leaving pretty early tomorrow,” he said, as he left for his tent.

Dutch and I sat watching the dying coals and thinking our own thoughts. Bear was a pile of fur next to Dutch’s feet, but Pepper was in alert mode, patrolling the camp perimeter. She did not seem alarmed, just paying attention. I wondered if she were picking up bear-scent.

We finished dinner clean-up and had the kitchen tent in order before turning in when a few fat drops of rain began to sizzle on the remains of the fire. With a whoop, Dutch grabbed my hand and we ran for the tent just as a burst of rain showered our camp. Both dogs were close behind and fully expected shelter from the storm in our tent that night. The shower was a brief one, and by the time we drifted to sleep it had stopped.

I awoke several times during the night, but heard no more rain falling. The dogs were in and out of the tent at will; with a wall tent, no human assistance is required. At some point just before dawn, Pepper woke me with a bark that had a mild alarm sound to it; nothing serious, she was not taking out after anything, or trying to climb in bed with me. But when I remembered it later, I recognized a level of anxiety in her sound that is not usually present.

Dad and Uncle Bob were the first ones up, and soon they were scratching on our tent flap, saying “You guys better get up, we may have a problem.” Pepper was continuing her anxious in-and-out behavior too, which told me something was wrong.

We dressed quickly and joined them in front of the tents. The river had risen overnight and was starting to reclaim our gravel bar. The situation was not yet alarming, but it could get that way. The sky remained very overcast and looked as though more rain could fall at any moment.

I went to get the coffee started while Dutch relayed the weather conditions to Henry, who was still in his tent. He appeared several minutes later, took a look at the river, and said “Holy crap, you guys! We may be in trouble here!”

He grabbed a long stick and stuck it in the gravel at the edge of the water as a marker to monitor the rising water level. The upper end of the gravel bar was gone, and water was approaching the campfire. Henry got it burning again to add some warmth to the damp morning; he couldn’t stand letting the river reclaim the wood we’d worked so hard to gather.

It was clear we needed to break camp and pack the boats without wasting a lot of time, but there was no need for neck-breaking speed about it. A hot breakfast would fuel our efforts, so I attended to that while the guys worked on emptying tents and hauling gear to the boats. In the two hours it took us to get packed up, the water rose another foot or so.

The kitchen tent was actually on the bank, not on the gravel bar, and was getting cut off by an encroaching slough of water which began running between the bank and bar as the river rose. The dogs knew the shallowest crossing, and Uncle—ever the engineer—grabbed a shovel and began moving gravel to bridge up their crossing spot. It helped for a while, but the steady rise of the river eventually overcame his dirt works. We got the kitchen completely moved out shortly before the slough became deeper than our knee boots.

While we were eating breakfast, we talked about the phenomenon we were observing with the river. It was puzzling to me; we had had a huge deluge of rain two nights before and had not seen much change in the river. Last night we had only a small amount of rain, by comparison. This late in August there would not be a sudden melting of ice and snow in the mountains to increase the volume in the river, as can happen in the spring. So what is causing this flooding now? If it is from the rain, why didn’t it happen Friday morning?

“The answer,” said Henry “is the beavers. There are thousands of them all through these hills and streams. They have dams built on all the smaller tributaries to the rivers. For a day or two after a really heavy rain, all those dams will hold the water back from rushing into the river. But if rain continues, even without being heavy, eventually the dams will be overcome and all the water will be released at once into the river. That’s what happened last night, and we’re seeing the result of it this morning.”

His words inspired a great mental image of thousands of busy, furry little engineers building thousands of dams on the many streams feeding into the Kisaralik River. He said that, depending on the terrain, some of the dams could be four or five feet tall.

Uncle was immediately interested in beaver-work-crew organization. “Is there a main beaver boss who directs the construction?” he wondered.

“Usually there is a dominant male in each beaver colony who is in charge of construction,” Henry said. “He is the one who is patrolling the territory, looking for problems, while the younger worker beavers are out chewing down saplings and dragging them to the construction site.”

In my mental image, I could see the boss beaver doing inspections, and all the worker beavers wearing hard hats and carrying tiny chain saws. It made me smile.

The river continued rising while we packed the boats, and by the time we were ready to depart, there was not a lot of our gravel bar left. The campfire had succumbed to the river and was floating downstream. I was glad it had not started six hours earlier, or we’d have awakened in soggy beds.

We headed back for civilization with Dad and Uncle Bob driving my boat, and Dutch and me in Henry’s boat with him. We had one dog in each boat, but Bear was so loudly unhappy to be separated from his “pack” that we soon pulled the boats together and let him join us in Henry’s boat. He was all smiles after that.

A half hour or so downriver from where we had camped, we saw the same two rafters we had passed two days earlier. Dutch and Henry had also passed them on their logging run (which I forgot to mention) and Henry had stated at dinner that night that the pair had looked pretty tired and ready to quit. Now, two days and more rain later, they looked even more so.

Henry pulled up next to them for a chat. They had started on the lake which gives birth to the Kisaralik way up in the mountains twelve days ago. In that time, they had had two days without rain. They had two more days to go before the appointed rendezvous time with their transportation back to Bethel, and they were a day ahead of their rowing schedule due to the high, fast current in the river. So they’d have to sit around at the meeting spot and just wait for the guy who was coming to get them. They looked pretty glum.

“I can take you back, if you want,” Henry said. “We can load your raft and gear right here in my boat and have you back in Bethel in about two hours.” The look on their faces was both surprise and gratitude.

“That would be great!” the guy said. “We’d be happy to pay you.”

“I don’t want money,” Henry responded. “I’m glad to help.”

So we transferred them and their gear into Henry’s boat, and then the guy and Dutch lifted the raft over our gunnel and set it on top of the gear. During the discussion, Dad had brought my boat along side and all three craft were floating together downstream while we talked. As their gear was transferred, I hopped over to my boat with the dogs, to make more room on Henry’s boat. Those were two very happy, water-logged rafters.

We made it home to Bethel without any further problems. Mounds of wet camping gear had to be sorted and dried, but that too was accomplished. We ate fresh salmon for dinner and put lots more in the freezer for Dad and Uncle Bob to take home with them. And we all appreciated a real bed to sleep in; ain’t none of us spring chickens any more!

Dad and Uncle stayed three more days, and we did more fishing as day trips out of Bethel. One trip was with Henry to do subsistence fishing with the drift net, which they were glad to have the opportunity to observe.

They left on Wednesday, taking with them a cooler full of salmon and a cram-packed week’s worth of fun and memories. Maybe a little rainier fun than they might have liked, but as Uncle said, “adventure without adversity is soon forgot; adventure with adversity is long remembered.” This was one adventure we will all long remember.


Wednesday, August 23, 2006

Fishing the Kisaralik, Part 2

...continued from Part 1...

Henry took Dad and Uncle Bob in his boat and they headed upriver to find some good fishing holes. Dutch and I stayed in camp for the morning to get the kitchen tent organized, set up the latrine arrangement, and search the nearby willows and cottonwoods for any burnable wood for the campfire. Everything was sodden from the all-night downpour, and we found nothing promising. But at least the rain was tapering off to occasional misting showers and large patches of blue sky held the promise of drier times to come.

By midday the fishing contingent was back, and the big smiles on their faces told us they had had some success. Uncle Bob bounded from the boat gleefully and couldn’t wait to show us the six bright silver salmon they had landed.

“Fresh salmon for dinner tonight!” he crowed.

They were beautiful fish, each one about ten to twelve pounds. He and Dad filleted them expertly and put them on ice in the fish cooler while I made sandwiches for lunch and Dutch brewed a fresh pot of coffee.

After a leisurely lunch break, the brothers were ready to try again, so I took them upriver in my boat while Dutch and Henry took his boat downriver for a logging expedition. Henry had his eye on some dead standing fir we had passed the day before which should be dry enough to burn, as well as a small birch grove which should yield some fine tent poles. Bear went with them, and Pepper stayed with us.

The spot where they had had success in the morning was quite enticing, a long finger of gravel bar that protruded into the river at a bend creating a large eddy between it and the river bank. Dad headed to the upriver end of it to try his fly rod in the shallower end of the eddy, and Uncle and I casted from the tip of the finger across the mouth of the eddy. With the brighter sun and warming temperature, the fish were not as active. Dad brought back a nice silver caught on an egg pattern fly with a purple flash, and Uncle Bob caught a small pike and a silver.

“Let’s try a new spot,” Dad said, so we headed further up.

As we rounded a bend in the river, we saw a small rubber raft floating down with two people in it, a man and a woman. It had a single set of oars, and the woman was rowing. There was a large mound of gear behind her held to the raft with a bungee net. We slowed down until we were creating no wake behind the boat, so as not to bounce them around and waved as we passed. The grim look on their faces told us that they had probably had a worse night in the storm than we did.

We spent another hour and tried a few more fishing spots upriver, but had no further luck, so we headed back to camp. Henry and Dutch had arrived just ahead of us and had done well with their logging effort. They dropped two good-sized dead standing fir trees and bucked them up into two foot lengths. The bark was wet, but the interiors were dry, and Dutch split them into firewood with an axe. They had also found good, straight birch saplings to make support poles for our wall tent.

Uncle Bob and Dad got a nice campfire going while Dutch and Henry pitched the third tent, and soon we were all relaxing around the fire swapping stories of the day and telling tales of other adventures. Dad has a lifetime of fishing stories to tell, and he is a great storyteller. He and Uncle Bob play off each other so well, they are nearly like a standup comedy pair, and they had us laughing into the evening.

Henry brought along his heavy-duty folding grate to set up over the fire for cooking salmon, and he took over that part of dinner. I made couscous and cole slaw to go with it, and we feasted ourselves on the finest, freshest salmon available, seasoned with wood smoke from the fire and a little garlic salt and lemon pepper. Dogs were quite happy with salmon skin left-overs.

It was a delightful evening of good food and camaraderie, big laughs and tall tales. The sky was clear, except for a few clouds on the horizon; after a slow sunset, twilight seemed to go on forever, with more and more stars popping out as the light faded. Uncle Bob remarked several times at how different the evening light was from what he is used to in Alabama, where twilight doesn’t linger long. Dutch laughed and told him to come back in mid June, when twilight is all the darkness he will get, and not a whole lot of that.

Weather continued to hold for us, and Saturday was part clouds/part sun with only a few light rain showers that passed quickly. The luxury of a plentiful supply of firewood allowed us to enjoy our morning coffee around a campfire that warmed the early chill. The brothers took over bacon cooking in my big iron skillet on the fire grill while I made a batch of scrambled eggs with onions and mushrooms on the Coleman stove. There was no rush to the morning; if we did not catch another fish the entire trip it would not matter. Experiencing the river and being on “river time” was far more important.

There is something so nostalgic about the smell of bacon cooking in the outdoors, and this was no exception. After all the rain, the air was clean and sweet. The dampness of the woods around us added a pungent, earthy scent, and the fast-moving river next to us had the very mildest whiff of fish which was not at all unpleasant. Even though summer is waning now, there is still a turbulent growth of grasses and wildflowers which added another layer of “green” smell. I could stand with my eyes closed and inhale the wilderness and the delightful smell of sizzling bacon wafting through it, hear the river rippling past, feel the warmth of my dog leaning against my leg. Dutch walked up behind me and quietly put his arms around me, and I knew in that moment what heaven was for me.

After breakfast and clean-up, Henry wanted to go exploring upriver. He has been through this area in the winter with his dog team, but not in the summer in a boat. He wanted to see how much farther up he could get, and Dad and Uncle were happy to go along to fish any likely spots he might find. Dutch and I decided to stay in camp and explore the open tundra across the river from our camp for blueberries. I was hoping to find enough to make a blueberry cobbler for dinner.

We had been cautioned before leaving Bethel that there was a good chance we might encounter black bears this far up the Kisaralik, so we were prepared with weaponry. Henry had his 30-30 rifle with him. I had my 30-06, and Dutch had his favorite hand gun, a Beretta. We are all three pretty decent shots, and Dutch is rated “expert” in several weapons from his military training. We were literally loaded for bear, and each group had a dog for early bear alert; Little Dog went with Henry in the boat and Big Dog stayed with Dutch and me.

I packed sandwiches and coffee for the boat crew and they took off up the river. Once the sound of the boat died away, it was amazingly quiet in camp. We were in no hurry to move, and so we just sat for a time near the fire with the dog at our feet, watching the river slide by and the huge sky overhead, lost in our own thoughts and enjoying each other’s nearness.

The ways that Dutch and I can spend time together never cease to amaze me. Sometimes we talk endlessly, sharing our deepest thoughts. Other times we go for long periods without saying a word, feeling a connection that needs none. We can communicate volumes in a glance, or a touch. I will be forever grateful for the dimension that he has brought to my life: a true experience of unconditional love, and the deepest level of understanding I have ever felt with another person. We are soul mates, in the fullest sense of the phrase.

By midday the sun warmed up to shirt-sleeve weather, so we took our berry buckets and ferried across the river to a spot where the low bluff dipped down nearly to the water’s edge. Approaching the mud face of the bluff, we could see a rather large “ice lens”, a smooth obelisk of pure ice embedded in the exposed surface of the bluff. It was a foot wide and about five feet tall, and looked like a giant finger had inserted it into the dirt. We asked Henry about it later, but though he has seen many of them, he wasn’t sure why or how it formed.

We scrambled up the ragged tundra hanging over the edge of the bluff and climbed to the top. From there we could see several bends of the river in each direction. I realized with disappointment that I had left my camera in camp.

No bears in sight, but lots of ripe blueberries. I am greedy when it comes to blueberries; I eat as many as I put in the bucket and always want more. Dutch, on the other hand, picks diligently without eating any, so his bucket fills more rapidly than mine. After an hour of picking, he had a full quart of berries and I had half that much. Our backs were ready for a rest from the bent-over position that berry-picking demands on the tundra, so we walked to the far side of the bluff where a small stand of cottonwood offered a nice resting spot. He pulled sandwiches and a light blanket from his backpack and we leaned against the largest tree while we ate them. Bear had been racing around the tundra like a mad dog while we were picking, but as soon as he saw food come out he was riveted to the ground at our feet, eyes hopeful, tongue lolling. Once he got his fair share of tidbits, he sprawled out next to Dutch with his head on Dutch’s knee.

The light breeze at the top of the bluff stirred the cottonwood leaves into a muted rustle and kept any flying insects at bay. The drowsy afternoon was perfect for napping, and we slept for an hour or so. I opened my eyes without moving, and idly wondered what that small dark form was that I could see at the edge of the bluff overlooking the river. It wasn’t very big, and I had no sense of alarm about it, but I knew it had not been there an hour before. I rubbed my eyes and focused on it. About three feet tall. White head. It was a bald eagle! And it was just sitting on the tundra, looking down at the river, perhaps twenty yards away.

We have a few eagles in this part of southwest Alaska, both bald and golden, but not that many. We had seen two, a golden and an immature bald, on Thursday afternoon, not far from the mouth of the Kisaralik. But I had never been this close to an eagle sitting on the ground. I nudged Dutch awake and pointed with my chin.

“Wow,” he said quietly, and placed a restraining hand on Bear’s collar. We hadn’t moved, so Bear was not alarmed.

We watched for a few moments in silent awe at this splendid bird. He stood motionless at the edge of the cliff with a fierce eye trained on the river’s surface, hunting for fish. Perhaps the wind shifted, or perhaps he saw something of interest; he simply spread his tremendous wings and lifted into the updraft of wind blowing up the face of the bluff. And then he was gone. Dutch and I just looked at each other and smiled.

It seemed like a cue, so we packed our berries and blanket and headed back down to the boat. First I had to stand where the eagle had stood, and see the view that he saw. He left us a gift; a single long feather lay in the tundra growth.

The exploring fishermen were not far behind the berry pickers in returning to camp. They made it several miles up the river before the water got too shallow for easy maneuvering, and found two more good fishing holes. They had five more silvers to add to the fish cooler. No sign of bears.

Dinner that night was extravagant. Dad brought two lovely three-pound beef tenderloins with him, hand-carved by his butcher in Washington State. A master grillsman, he knew just the arrangement of coals that he wanted for the height of the grill to assure a slow, even cooking process, combined with an artful tent of heavy duty aluminum foil to hold in the heat. The campfire was started early to give sufficient time to create good coals, and to bake the foil-wrapped potatoes I planned to go with the steak. I also had fresh zucchini, sweet onions, and tomatoes for a skillet sauté to be cooked on the Coleman stove. And for dessert: blueberry cobbler, baked in my cast iron Dutch oven nestled in the coals. No light-weight backpacking style camping trip, this one, no! I take full advantage of the Chuck Wagon’s load-carrying capacity. The only thing we lacked was ice cream for the cobbler, but no one complained.

Seems like I am always learning something new from my dad, and this trip was no exception. As we enjoyed pre-dinner beverages around the campfire while Dad worked his magic on the grill, a discussion ensued about how to tell when beef is cooked to the desired level of doneness without cutting into it to see the color.

“Well,” Dad said, “it’s easy. You poke it.”

“Yeah, but…” we all said.

“Hold out your hand, palm up, fingers spread,” he said. “Now poke the big muscle at the base of your thumb. That’s raw. Now, gently touch your thumb to your index finger and poke the same place. That’s rare. Now touch thumb to long finger and poke again. That’s medium rare. Now touch thumb to ring finger and poke; that’s well done.”

We sat there in a circle, all poking our thenar eminences (eminencii?) and being amazed at the turgor changes in the different positions.

“Hot damn!” said Uncle Bob. “Where’d you learn that?”

Dad just shrugged and smiled that knowing smile of his.

…to be continued…


Monday, August 21, 2006

Fishing the Kisaralik, Part 1

Dad and Uncle Bob arrived in Bethel last Wednesday, right on schedule. The long spell of rainy, cloudy weather had started to clear two days earlier, and Wednesday was a beautiful, clear and sunny day. My hopes were high that we were headed for some great summer camping weather.

Thursday morning was spent on the final details of sorting gear and packing food for the trip. High clouds had moved back in and we had light rain off and on, but not enough to dampen our high spirits. Henry’s boat was packed and ready to launch, and mine was moored at one of the docks at the small boat harbor. By early afternoon we were ready to take off.

Henry and Dutch took the lead in Henry’s boat and the brothers and I followed in my boat, along with the Big Dog, Bear, and the Little Dog, Pepper. Known fondly as “the chuck wagon” for its large load-carrying capacity, my boat is a big boxy aluminum craft built by my Dad before I moved to Alaska. It is 22 feet long and 7 feet wide, a flat bottomed johnboat that is ideal for river work. It has a very shallow draft, even heavily loaded, and is pushed by a big 115 horse Honda four-stroke.

Our goal was the middle stretch of the Kisaralik River, a clear and fast-moving tributary of the Kuskokwim River. The Kisaralik is popular among sport fishermen in August for its large population of silver salmon and rainbow trout. It is also well-known as a fun river to float down in a rubber raft. Numerous outfitters can be hired to fly you in a float plane up to the large lake it flows out of, drop you off with a raft and all the gear, and pick you up at the mouth of the river any number of days later. Floaters in rafts of all sizes are commonly encountered on the Kisaralik.

It took us about three hours to reach the area we were headed for. All the rain our region has had in the last month meant that the water level in all the rivers was high, which is nice for the boating part—less risk of running aground—but not great for the fishing part; the water is muddier and fish are not biting as well. We did not have a specific campsite in mind. I had never been up this river before, and Henry had not been here in years. We were looking as we went for a nice gravel bar, or a spot on the bank with easy river access, a clearing in the trees, and a few dead standing trees to provide dry firewood. Henry never travels on the river without a chain saw.

We were far enough upriver that the mud banks were starting to show some gravel when we passed a bend in the river with a nice large gravel bar on the inside of the curve. Despite the swift current, the river was still pretty muddy, so Henry wanted to explore a little further, hoping to find clearer water for our campsite which would be closer to good fishing.

I was driving about 50 yards behind Henry, watching the banks and chatting with Dad and Uncle Bob. I looked back at the boat in front of us to see that Henry had suddenly run aground; his boat was stopped dead still and the current was swinging his bow around as he maneuvered to get unstuck from the sand bar. All we could see of Dutch was his feet sticking up in the air over the boat’s middle transom. We stopped and watched as Henry worked his boat back into deeper water. Dutch didn’t move, and my heart started to sink. What had happened to him? Why didn’t he move? We hadn’t seen the moment of impact; had he hit his head? Broken his leg? Henry was wrestling with the boat and couldn’t go forward to help him. Dread crowded into my mind as we watched helplessly from the second boat.

The moments seemed endless as Henry got his boat free. Finally, we saw Dutch move, and I could breathe again. Slowly he stood up, favoring one leg, a pained expression on his face, but at least moving as if no bones were broken. They passed us heading downriver and we turned and followed. Henry pulled up on the gravel bar we had seen earlier, and I pulled in beside him.

Sand bars in these rivers are sudden occurrences; the water can go from six feet to six inches deep in the space of a few feet. When Henry hit the sand bar, Dutch had been standing next to the transom facing the stern. The boat lurched to a stop and he went down backwards with nothing to break his fall. His hip hit the bottom of the boat hard, but fortunately he did not hit his head. Coming down from his 6’4” height meant that his upper body made quite an impact, and his hip hurt so badly he thought it might be broken, so was afraid to move at first. Those were some long moments for me.

He limped a little getting off the boat, but was able to walk around and shake it off. Joints ok, bones ok, head ok. Lucky it wasn’t worse. The magnificent bruise that developed on his upper thigh over the next 48 hours was truly impressive, but the hematoma that developed underneath it has remained reasonably small, about three inches in diameter. He has been on a daily aspirin for the last two years.

The gravel bar was fine for our needs, aside from the river not being as clear as we’d have liked. Misty rain was continuing to fall, so we quickly set up two of the three tents and tarped over an area in the trees for the kitchen set up. I fired up the Coleman stove and heated up the moose stew I had prepared earlier for an easy first-night supper. A loaf of homemade bread with butter and a bottle of wine completed an excellent repast for five damp and hungry travelers.

The rain became more constant and there was no dead standing in the vicinity, so we did not have a campfire that night. We were all pretty beat, so we turned in as the light was dying around 11 pm. Henry was in his wall tent, and Dutch and I shared the six-person Alaskan Guide Tent from Cabela’s with Dad and Uncle Bob. The wall tent that Dutch and I planned to sleep in required saplings to be cut for support poles, and that would have to wait until the morrow.

The designation of a tent as “six person” is somewhat optimistic. Four people and a little gear easily fill it up. No room for dogs. By the time we were zipped into our sleeping bags, the rain was coming down steadily. As the night deepened, the rain intensified. Within an hour it was drumming hard on the tents. Occasional lightening brightened the world outside, a rare occasion in Alaska which has few thunderstorms. The rain was so intense and unremitting that I feared for tent failure. Wind was lashing us, and the rain was absolutely pouring down. Hours crawled slowly by without any change in the deluge, and sleep was elusive for all of us.

There are two things guaranteed to turn Pepper into a quivering neurotic mess: thunder and firecrackers. When Dad unzipped the tent door to look out at the storm, she came barreling in to find me, a soggy, muddy, shaking bundle of dog. She immediately curled up in a tight ball next to me (after a good shake, of course) and I did not have the heart to send her back out. At least she had not scratched a hole in the tent wall first. Once inside, she settled down and did not move again the whole night.

By first light, around 6 am, we ventured out into a wet world and were pleased to see that the tents were fine and the tarp over the kitchen area had survived without incident. The Big Dog was curled into a dry corner where he had happily spent the night unmolested by the elements. The rain had stopped, and the clouds were high and thinning rapidly. Fresh coffee, a hearty breakfast, and we were ready to catch some fish.

…to be continued…



Home again, home again, jiggity jig!

Our fishing and camping adventure is safely concluded, with stories and photos to follow (and LOTS of salmon to eat!)...


Wednesday, August 16, 2006

Off Label Use

What is it about dogs and stink? All breeds, all sizes, they just seem to love it. Whether it is rolling in a seaweed tangle of dead fish at the beach or digging through some disgusting refuse pile on the street, dogs just seem to love coming home wearing an odor that makes your eyes water. I think it may harken back to the hunting instincts of their wolf ancestors: disguise your own smell and the prey won't run as quickly.

The very top of the stinky-dog list, in my book, is a dog that has been skunked. Ten years ago, I lived in Spokane, Washington, not far from the Little Spokane River. It is a very nice, moderately large city, but one of its dirty little secrets is that quite a few skunks claim the Little Spokane as their natural habitat. Skunks were frequently seen—or smelled—wandering through the neighborhood. Calling the local Animal Control Officer about it got a “Yeah... right!” response.

The inevitable collision of inquisitive dog and haughty skunk had to occur. The Little Dog, Pepper, was just a youngster then, and exuberant about life. She was obedience and agility trained, and responded to voice command, so she was allowed off-leash outside the house. One evening a skunk was sashaying through the yard just as she went out for her evening piddle. I heard her howl of pain and disbelief only a moment before I smelled the result of the encounter. Oh-my-god! Is there anything worse than the smell of a freshly skunked dog? If so, I have yet to encounter it. Even stinkheads aren’t as bad.

Poor Pepper had to sleep on the deck that night; I could not let her in the house. The next day I went to the grocery store for tomato juice and doused her in it. Ugh. Tomatoey skunk is no better than plain skunk.

At that point I called my vet for advice. Her first question was whether I had put ammonia in the tomato juice. No, I never heard of that. She said the tomato juice had to have ammonia in it to do any good. But, she said, what works much better is…Massengill Douche! I thought she was kidding. But no. Any of the various “flavors” it comes in will work fine, she said. Just shampoo the dog with a good strong soap like dishwashing liquid or Dr. Bronner’s liquid peppermint soap, and then apply the douche solution and work it into the fur and skin really well, especially around the face, which is usually the initial point of contact with skunk spray. Be careful around the eyes, but it won’t hurt them. Leave it on for several minutes, then rinse.

I gave it a try and was amazed at the result. Not only did Pepper smell great afterward, her fur was more soft and silky. It was like a crème rinse treatment.

I am now a convert; forget the tomato juice, it’s Massengill Douche for me and my dogs! I keep a box on the shelf at all times for those occasions when one of the dogs comes home wearing stinkhead (no skunks in Alaska, thank goodness!). After all my years as a health care provider encouraging women NOT to douche, I find myself uncontrollably explaining to the check out person at the grocery store that I am buying the product for my dogs. I know they don’t care, but I seem compelled to do it. I am just glad to find something that works.

Blogger is being tempermental again; I had a great photo of the Little Dog with her favorite bath product...


Sunday, August 13, 2006

Picking Berries

Berry picking is a major subsistence activity for the Yupik Eskimos. The tundra is covered in berry-producing shrubs that yield lots of fruit in the summer. Berries are the only native source of Vitamin C in this region, and as such, are an important part of the diet.

There are a half dozen different types of berries that grow here. Salmonberries are a multilobed berry that look like an orange version of the blackberry common to the Lower 48. They are very juicy and have rather large seeds. I love the flavor, but don’t like the seeds. The other berries are single-lobed fruit like the traditional blueberry, only much smaller. Blueberries, blackberries (which look like Montana’s huckleberry) and redberries are the most common. There are both low-bush and high-bush cranberries which grow on dry ground, not in bogs like the cranberries of the Lower 48. All of them are much smaller than their downstates cousins.

My favorite is the blueberry. Tundra blueberries are tiny, intensely flavorful, and very tart. They are wonderful in pies, pancakes, and coffeecake. Cooking with them requires more sugar not to shock your mouth, and any dish that includes them will turn your tongue and your gums purple!

Most people either make jam from the berries or freeze them for later use. The favorite dessert of many Alaska Natives is agutak, or Eskimo ice cream. It consists of Crisco, berries, sugar, and a “texturizer”, either boiled white fish or mashed potatoes. I know, it sounds pretty bizarre, but it is actually quite tasty.

Crisco is placed in a large bowl and whipped with a bare hand, folding in lots of air, until is light and fluffy. Sugar and berries are added with lots more whipping. Then cold boiled white fish is added (or mashed potatoes), and more whipping, until it has a smooth, homogenous texture. The end product is something like cake frosting. It can be eaten at room temperature, or chilled, or frozen. The fish or potatoes do not add a flavor to the dish, but simply change the texture so it does not feel slippery on the tongue. The key is in the whipping; lots of air must be whipped in for it to be light, not heavy. Poorly made agutak is about as appetizing as sticking your spoon into the Crisco can and eating it. Well made agutak is yummy, light and flavorful and tasting of berries. It is a power-packed food, essentially fat, sugar, and Vitamin C. When eaten along with dried salmon for protein, it is pure energy that will keep you warm in the coldest weather.

Blueberries are also an excellent source of anti-oxidants. There has been some thought that they may be helpful in speeding recovery from extended exercise. A number of top mushers, including Susan Butcher, have experimented with feeding blueberries to sled dogs after long runs, and felt that the dogs recovered more quickly as a result. And the dogs love them!

The tundra in front of our house is covered in blue and black berries right now. Dutch and I went out and picked berries for about an hour this afternoon, and came back with a half gallon. That will be enough for a pie and a blueberry pancake breakfast for Dad and Uncle Bob when they get here in a few days. Maybe some blueberry scones, too. We only picked about half of the area in front of the house; if time and energy allow, I’ll go out and pick some more after work tomorrow. I’d sure love to have a few quarts in the freezer for winter. If I get a pie made before the upcoming camping trip, I’ll share my favorite recipe (with photo) for tundra berry pie.

Now if this darned rain will just stop…

Photo of Fadusia Shorty, Yupik elder from the Yukon village of Marshall, making agutak; from a postcard.


Saturday, August 12, 2006

More Fishing

For two solid weeks we’ve had nothing but rain, wind, fog, cold, and general misery. The rain has taken every form from a mist so light you could call it “heavy dew” to a driving downpour that washes out roads and floods low lying areas within an hour. Many of Bethel’s roads are looking like a stage for a tractor pull, despite the hard work of Dutch’s road crew to keep them well graded and graveled up. The thermometer seems stuck between 48 and 52 degrees. The dogs are miserable, wet, bedraggled and muddy. And people are just tired of it, and getting grumpy, me included. (Yeah, OK, whining a bit here.)

The one bright spot in this soggy fortnight occurred last Sunday. The skies suddenly cleared, the sun beamed brightly on us, and we had one glorious day of late summer weather. Henry’s wife, Betty, called it a “champagne day” and that struck me as so appropriate; the light was golden, and people’s spirits rose like tiny bubbles.

The silver salmon (coho) have been running since late July, and Henry was ready to grab the first fine day to go get some. Dutch and I were happy to get out on the river with him to enjoy the day. And it was such a fine one. The sun was warm, the air was cool, there was a slight breeze to keep the bugs off (mosquitoes are pretty much gone, but there are a few black flies and gnats around), and the river was calm and flat. We went out on an incoming tide, which can make the river nearly currentless, and more like a lake.

Once the net was in the water, we lounged on the boat drinking coffee and eating sandwiches. It was so nice to see the huge sky above us, after so many days of heavy, low-hanging clouds. The vastness of this land seems absolutely endless on a clear day. So big, and with so little evidence of human occupation. The place we are fishing is only 10 minutes upriver from Bethel, and the boat we are sitting in is the only man-made thing we can see for miles in any direction. There is only a great big river, and trees, and sky; no buildings, no channel markers in the river, no other boats, no planes in the sky, no other people. It is really kind of amazing; it is true wilderness.

After a 45-minute drift in which the boat never moved (incoming tide overcoming river current), Dutch and I hauled in the net, picking fish as we went. The silvers were beautiful! Bright and fresh, about five to eight pounds apiece. And what was even nicer, not too many of them. We had about 35 fish in the net; Henry called it “gentleman” fishing, as opposed to the “combat” variety of our last trip when the net had 300 fish in it.

We did a second drift and brought in another 30 or so silvers, for a total of one full tote of beautiful fish. We also had a few chum and humpies for the dogs, but no reds or kings; those species have finished their runs. The silver run on the Kuskokwim River is one of the finest in the world.

Silvers are great sport fish for rod-and-reel or fly fishing; they are vigorous fighters. When you catch a silver on a line, it will take off with a zing and run hard. As you work it back in, it will continue taking off, jumping and fighting all the time. A 10 pounder may take half an hour to land, and can wear you out. And there are so many of them that nearly every cast gets a hit. It is lots of fun!

In anticipation of this, my dad and his brother, my favorite uncle Bob are coming up next week for some camping and fishing Alaska style. I’m nearly as excited as they are! Uncle Bob has never been to Alaska before and he is really looking forward to it. Dad has been up several times; in June of 2001, he and three of his buddies flew up in a small plane from Washington State and we went 300 miles (two days) up the Kuskokwim to the Holitna River for a week of camping and fishing. It was a large event; besides the four guys from downstates, there was Henry, his nephew-in-law Trevor, his niece Meredith (Andrea’s sister), and my partner at the time, Les, along with four dogs, three boats, and a ton of camping gear.

This trip will be a little smaller scale: Henry, Dutch and I, and Dad and Uncle. We’ll take two boats, mine and Henry’s, and three dogs. Our plan is to go up the Kisaralik River, which is about an hour upriver from Bethel. It is a clear, fast tributary of the Kuskokwim, and good place to catch both silver salmon and rainbow trout. It may be possible to do a little hunting as well. The fall migration of departing ducks, geese and cranes has started, and Henry is hoping we might get a bird. The area we will be in is also home to black bear, and we could see a few of those. Grizzly is much more rare in that area, but not unheard of. I’d just as soon miss seeing ole’ griz; he is a cantankerous and unpredictable animal that I’d rather not come across.

The get-ready has started, and this weekend’s To Do list is a long one. Blogging may be sparse in the next two weeks, but I’ll try to post updates when possible. Right now I’m praying for a week-long weather break to start by next Tuesday. Keep your fingers crossed for us, OK?


Tuesday, August 08, 2006

Grand Rounds Vol. 2 No. 46 up at Mexico Medical Student. The host is an American going to medical school in Guadalajara, and his "focus" (not exactly a "theme") is cultural convergence. The top honor went to Borneo Breezes, the new blogger I recently welcomed here. I am really pleased for her; the post she wrote is excellent. The new twist in this week's Grand Rounds is the addition of music. Our host has added a number of mostly classical selections which play in pop-up windows when clicked on. It adds another layer to the Grand Rounds reading experience which I found very enjoyable. As always, there is plenty of great reading there... (and my post on Home Remedies made third place! I'm jazzed!)


Monday, August 07, 2006

Passing of a Legend

The world of mushing lost one of its most beloved members on Saturday, August 5th, 2006. Susan Butcher’s death from complications of leukemia treatment is a blow to all Alaskans, and especially those of us who love the sport of dog mushing. She was one of the greatest mushers who ever lived, and an inspiration to us all.

Susan was born in Boston in 1954. She was a lover of animals from the very beginning, and after graduating high school in 1972, she moved to Colorado to pursue a career in veterinary medicine. There she was introduced to the sport of dog mushing, which was to become her great love. After three years she completed vet tech training and followed her heart to Alaska.

In 1975, dog mushing was still in transition from being a traditional Arctic mode of transportation to being a competitive sport. Joe Reddington, Sr., and a small group of dedicated mushers had started the Iditarod Trail Sled Dog Race a few years earlier. There was still controversy surrounding the race, and whether a single sled dog team could safely race 1100 miles from Anchorage to Nome. In those early days, the race took three to four weeks.

Susan apprenticed herself to Joe, and learned everything she could from him about mushing. She was intensely interested in sled dog breeding; she believed it was key to a winning team. She also had the radical idea that the musher and the dog team are a unit, that the bonds between them are forged from close association and deep love. Each dog was a friend, not just a four-footed furry pulling machine.

After a few years working with, and learning from Joe, Susan struck out on her own. She moved to a cabin in the wilderness where she lived alone with her dogs. She trained intensely, twelve to fifteen hours a day. She worked on developing a breed line of sled dogs with stamina, heart, and toughness.

She ran the Iditarod for the first time in 1978, and finished in 19th place, a notable accomplishment for a rookie. And then she ran every Iditarod for the next 16 years. She only scratched once, in 1985. She was in the lead; it was the first half of the race and she was traveling at night when a starvation-crazed moose stomped its way through her team, killing two dogs and seriously wounding 13 more. It was devastating to Susan. That was the year that Libby Riddles became the first woman to win the Iditarod. One can’t help but wonder whether Susan would have had that honor had the moose not intervened.

The following year, 1986, Susan did win this incredible, grueling race. And the year after, ’87. And the year after that, ’88. She remains to this day the only musher to win three consecutive Iditarods. She was the source of the oft-repeated saying, “Alaska—where men are men, and women win the Iditarod!”

In 1989, Susan came in second by a matter of minutes. In 1990 she achieved her fourth Iditarod win. Only one musher, Rick Swenson, has won more Iditarods than Susan. He has five wins. Susan’s fastest race was in 1993, when she finished 4th—in 10 days, 22 hours, 3 minutes.

She retired from racing in 1995 to have a family with her husband and fellow dog musher Dave Monson. They have two daughters, 10 and 5 years old.

She continued to breed and train sled dogs, and to be an avid promoter of the sport. She and her husband own Trail Breaker Kennels in Fairbanks, and I was delighted to purchase a beautiful young female from them in 2001. I spoke with Susan several times by phone, discussing mushing philosophy and which dog would best suit my needs. She was always warm and friendly and easy to talk to. I regret that I never had the opportunity to meet her.

Susan Butcher has been an inspiration to mushers the world over for twenty years. She was a superb athlete, with total dedication to her sport. She set a high standard for quality dog care in racing. As the sport of mushing began to penetrate American awareness in the Lower 48, hers was the name and the face that people knew. She personified dog mushing, and was its tireless ambassador. Her death at age 51 is a devastating loss to all Alaskans, and to all dog mushers.


Saturday, August 05, 2006

Yupik Eskimo Home Remedies

The delivery of health care in southwest Alaska is a daily collision between two cultures. Western medicine/culture is a marching band playing John Phillip Souza; we charge right into the patient’s life with lots of questions, tests, exam maneuvers, pokes-and-prods, needles and medicines, and ranks of health care workers marching in formation to the drum major/physician’s baton. The attitude of the music is that we know what is best, we’ll solve the problem, and the patient must simply cooperate and do what we tell him. Many times that is exactly what happens, and miracles are achieved.

Yupik Eskimo culture and orientation toward healing, on the other hand, is a string quartet playing Mozart. Delicate, slow, intricate, often soft, sometimes haunting; the attitude is carried by a question mark, not an exclamation point. Both approaches have something of value to offer.

The Yupik people survived on this land, in this very harsh climate, for thousands of years before Caucasians arrived bringing Western culture to “improve” their lives, and they did quite well. Their healers were well versed in the use of plant and animal products to alleviate pain and speed the body’s natural healing ability, and much of that knowledge continues today. Most villages have an elder or two whose parent or grandparent was a healer and who remembers some of the “old ways.”

Village health aides are the bridge between Western medicine and Native healing. They are trained by the hospital to gather patient data according to Western guidelines, but their cultural foundation includes a somewhat mystical belief structure about the functioning of the human body in health and illness. Health aides often walk a fine line in honoring both cultures.

One question health aides routinely ask patients is “What home remedies have you tried?” The health aide may not be surprised by the answer, but I sometimes am.

Herbal teas and poltices are common home remedies, and the prince of plants on the tundra is called chaithluk or stinkweed. Boiling the leaves in water and drinking the tea is soothing for a cold and believed to have some anti-viral properties (studies are lacking). It even tastes reasonably good, especially with a little honey. The boiled leaves are then used as a poltice on the chest to reduce congestion and cough. Fresh, raw leaves are also used. Sometimes the leaves are placed directly on the skin, and sometimes they are chopped and mixed into that all-purpose vehicle, Crisco (possibly the single greatest contribution of Western culture to the Yupik people). If chaithluk is out of season and none has been dried for winter use, then Crisco alone is often used. Before there was Crisco, the people used rendered fat from various animals, most commonly seal, walrus, beaver or caribou.

The leaves of chaithluk are also used as an astringent for cleaning wounds. For patients with wheezing and cough, the dried plant is burned on hot coals to produce a smoke for the patient to inhale; the use of nebulized albuterol has pretty much replaced this practice, but elders say that it did help some. And the whole plant is often brought fresh into the steambath to use as a skin stimulant and invigorator. After you work up a good sweat, you smack yourself along the the arms, legs, and back with a small bouquet of the long leafy stems. It actually feels quite nice, reduces the sting of the steam, and creates a nice smell in the steambath.

Several other plants are frequently used for medicinal purposes. There is a tundra variety of chamomile which produces a small hard yellow “berry” which is chewed raw or boiled and drunk as a tea for stomachache or mouth sores. Stinging nettle leaves are boiled and eaten, and the tea drunk, for acne problems and pimples. And probably the best-known remedy the world over, the leaves and bark of the willow tree are chewed for their pain and fever relieving properties. The bark is said to contain an elemental form of salicylic acid, from which aspirin is made.

Infections resulting from minor skin insults are common among the Yupik, and can quickly progress to ascending lymphangitis. Once a red streak shows up, many people tie a red string or strip of cloth around the extremity (not tightly) to prevent the streak from getting any longer. They strongly believe that it prevents the red streak from coming any closer to the heart.

The most stunning example of a home remedy that I have yet encountered was related to me by a retired health aide from a Yukon River village. She had a tooth with a deep cavity in it and was delaying a trip to Dental Clinic until she had some time off. Until then, she was achieving excellent anesthesia by packing the hole with a hard brown chunky powder.

“Here,” she said. “Put some between your cheek and gum and feel how numb it gets.” I’m game for most things, and had just watched her pack the tooth with the same stuff, so I tried it. It worked like a charm; in less than a minute that spot in my mouth was noticeably numb. She said it would work for several hours if I kept it in there.

I took the piece out of my mouth and looked at. Dark brown, it looked like a small chunk of wood and had no odor.

“OK, I give. What is it?”

Pausing for effect, she grinned slyly at me. “Dried beaver balls!”

I think I might have stopped breathing for about ten seconds. She was kidding, wasn’t she? Nope. She was dead serious.

“You cut the testicles off a dead beaver and hang them from the ceiling over the wood stove. They dry out in a couple weeks, then you chop ‘em into little pieces and store ‘em in a dry place. They’ll last for years if you keep ‘em dry.” I can’t help but wonder how this got figured out in the first place; it is right up there with the first person to ever eat an oyster. Talk about brave.

I was trying hard not to look stunned. She knew better than to tell me what it was before I put it in my mouth! But I was glad I tried it; it certainly works. The village clinics keep clove oil in stock for the same application; it also works, with less culture-shock to us Westerners.

The practice of medicine up here is an ongoing education. I learn new things nearly every day. I am honored by the trust that people place in me, and their willingness to allow me into their lives at such vulnerable times as illness can create. The culture which has provided tools for survival in one of the harshest of earth’s climates deserves—and receives—my ultimate respect.

Marching band photo from U.S. Military Academy archives, 1950.

Beaver photo from Smithsonian Institute, National Zoo.


Wednesday, August 02, 2006

New Blogger Welcome!

We have a new blogger in the medblogosphere: a warm welcome to Borneo Breezes! This is a delightful blog written by Traveling Doc, a female physician of Canadian origin who is teaching in the Master's in Public Health program at the University of Malaysia in Sarawak. For those of you, like me, whose world geography is not as finely tuned as it might be, Sarawak is on the island of Borneo, the third largest island in the world, located a few hundred miles north of western Australia. It sits smack on the equator (so which way does the water swirl down the drain? Do they have drains?).

She made her Grand Rounds debut in Vol 2, No 44, In the Garden, at
Medical Humanities blog. We were grouped together in The Greenhouse, where "you can grow specimens in specialised conditions. The blogs in this section are revealing of cultural differences and show the value of different perspectives." Our blogs are definitely doing that, while coming from opposite ends of the earth and precisely opposite climates.

I enjoy reading her blog, and corresponding with her. Stop by and visit for a glimpse of something completely different.


Tuesday, August 01, 2006

Grand Rounds Is Up!

It is Tuesday and Grand Rounds is posted at Inside Surgery. A nice collection of reading this week. (How did I become Tundra Medicine Man?)

One extra benny of living in Alaska: I get to read Grand Rounds before going to bed on Monday night!