A Conversation With ... Dr. Juris Simanis

provided by Dr. Juris Simanis

You were among the first five physicians worldwide to complete all three programs of the Wilderness Medical Society’s Triple Crown program. Tell me about what that certification is and what was involved in achieving that.
The Wilderness Medical Society is a group that was formed that brings together a really large different mix of people. People usually have some sort of a medical background, but it’s very diverse. We define wilderness as places that are uninhabited, remote, inhospitable. But you also have jungle, mountains, sea, the oceans, deserts, caves. We also talk about the concrete jungle and I mention that because we also do disaster relief. There’s expedition medicine, survival medicine, wilderness trauma interaction. Then you just think about interaction with animals, fish, snakes. And even to the point where it involves public health because we deal a lot with mosquito-borne diseases. Wilderness medicine is not just being out somewhere in Alaska or somewhere on Mount Everest, it can be in New York if you have a disaster or an area where there’s limited resources. When you see the larger picture, you start to understand that there are different niches. These programs that I took part in break those down into sections. There’s one that’s called diploma in mountain medicine. You can think of summer, like being in Utah, and you are in a working environment where there’s steep cliffs, we think about rescue. But we also take care of, for instance, the forest fires in California. How do you treat the firefighters that are there, the exposure to the elements? It’s not just recreational, it’s also the workers who live there or the people who even live there, people who live at elevation, they are susceptible to certain conditions. You spend a week out in the wilderness or in the areas like this working to get an understanding of what it’s like. We worked in Utah doing high-angle rescue type of work. We hiked by Mount Rainier. You had to hike up with a 60-pound backpack up to 10,000 feet of elevation. Then there’s a diploma in dive and marine medicine. That encompasses drowning and marine life, your encounters. You stay on a liveaboard boat and you’re having to learn how to sail, environment exposure, diving, swimming. We do quite a bit of diving because there’s an aspect not only for recreational but there are people who are scientists who have to dive for scientific reasons, oil rigs, there are deep sea divers. You have to be certified in dive rescue. It is quite intensive. It takes a lot of time to learn all these elements. The last thing was the fellowship in wilderness medicine. In family practice, you can become a board-certified family practitioner. But then we have a distinction, which I have, which is called the fellowship in American Academy of Family Practice. And that’s when fellowships typically recognize when you’ve done extra work. So in family medicine, I enjoy teaching, I’ve written articles. In the wilderness field, it’s the same kind of thing, I am active in the ski patrol. I’ve always been involved in wilderness and I’ve always been outside in nature. Once you accumulate so many aspects above and beyond sort of the basics, then you can get the designation of fellow and it takes usually several years to get that. Mine’s been a journey since 2017.

What behind your interest in mountain medicine?
Everyone in this group, we all have a deep respect for these natural resources. They’re precious and you get less and less of it. You might’ve heard of blue spaces and green spaces. In terms of our own health, people who live in blue and green spaces, we talk about them being healthier, blood pressure’s lower. That’s what drew me to it. I have a degree in public health. It just seems like every part of my life that I’ve gone through has always somehow been connected to these areas.

You primarily specialize in sports medicine. How does this wilderness training connect?
In sports medicine, we think of athletes, but there are enormous different types of athletes. It spans from 8 or 10 years old all the way to 90 year olds who are breaking world records. With the wilderness part, it’s not just races, there are ultramarathon races, they race through deserts. Even mountain bikes. They’re doing this in remote areas. Divers who see how far deep they can dive. How deep can you go with one breath of air? It involves regular people who just want to go hike the Grand Canyon, or want to go to Utah to ski. Those people experience the same injuries, the same conditions that our athletes do. Same thing with workers who have to go there. How do we keep people who have conditions healthy enough to continue to enjoy and either work in those environments or be able to recreate in those environments? I kind of feel like it’s really an extension of sports medicine.

There are stories every year, for example, of people going on a trail and dying because they didn’t bring enough water or they get lost. What’s your best advice for someone as they approach going out in nature?
You have to understand the whims of nature. You go hiking and you think, well, how bad can it be? This is a popular area, I’m not going to get injured or hurt. But you have to be humble. Be aware of the environment you go into. If you are going to Grand Canyon, are you truthful about your level of fitness? Going down is a lot easier than coming back up. There’s not a lot of air movement and that increases the heat stress on the body. You know what you can’t do at home, you’re going to want to stick with the same level that you’re at. If you want to do more, absolutely, but then you also want to train or to kind of least get your body acclimated to the level of activity that you’re going to be doing. If you want to go snorkeling and swimming, probably behoove yourself to get into a pool, do some laps, get some exercise in the pool. If you want to do hike in the mountains, you can get on the StairMaster. That’s how I trained to go up Mount Rainier. If you go into it naive, that’s the people who get in trouble.