By Jeff Daniels EBS Medical Columnist

Every year since Thanksgiving of 1994, the ski season at the Medical Clinic of Big Sky kicks off a little differently based on skier volume, the terrain that’s open, and the number of injuries finding their way to the clinic.

With the snow and cold temperatures that came to southwest Montana in October and into November, it looked like we would be headed for a great start to the 2017-2018 ski season. It did get warmer and rainy the week before opening day, but Nov. 23 provided for a much grander opening than in the previous three or four years. People were skiing off the Tram on opening day, compared to last year when just the Explorer chairlift was spinning on opening day, accompanied by a line snaking all the way up to the ski patrol building and our clinic.

The parking lot looked full on Thanksgiving Thursday, and within an hour, a man from Bozeman walked in with a big gash in his knee. He was skiing down the Bowl when his skis got stuck and he ejected into some rocks. He ruined a good pair of ski pants that day!

His British accent matched that of my student, Nicole Erasmus, of South Africa. The patient was actually a Big Sky veteran of many years, and we shared some memories of things past as we sutured a small hole in his knee. Then he pulled down his bloody pants leg and went back out skiing, taking another student, Amanda Mullen, who’d helped with the suturing, back up to the Bowl for a couple of runs.

I warned him to get it all in today, because when a knee gets deeply cut, the next day will usually be fraught with pain and swelling, a reaction that most knees give when the laceration involves some of the internal sacs, or bursa, of the knee joint.

We sat around the rest of the day, and luckily for everybody out there, we didn’t treat any more accidents at the clinic that day. We had to wait until the Saturday after Thanksgiving for more accidents to happen. Our first patient was an MSU student who fell hard onto his left shoulder, causing significant swelling as well as pain and disability, with only a mild degree of separation of his acromioclavicular (A-C) joint.

Then we got a rancher from Cody with a very swollen knee, a good pop when he fell, and the instability that goes along with a lot of torn ligaments. We diagnosed a completely torn ACL and MCL, and he had to leave on crutches. We had another patient with a torn ACL later that day who was able to walk out in a brace. Both face the prospect of surgery to reconstruct their ACLs.

A face plant into the hard-packed snow sent one young man to the clinic, wondering if we had to straighten out his nose. We could not demonstrate any bony fractures, and the swelling on one side of his nose made it look a little displaced, but in actuality, his nose was in the proper position. It looked normal again when the swelling dissipated.

Our last patient of the day presented with incredible pain in the shoulder after a fall directly onto it. He was literally writhing in pain. An X-ray showed a separated A-C joint, and a quick jab of local anesthesia into the separation greatly lessened his pain.

After Saturday, things got awfully quiet in the clinic again. I guess I’ll have to get excited about giving flu shots until the influx of tourists in mid-December.

The Medical Clinic is open seven days per week on the Mountain, and Monday, Tuesday, Thursday and Friday in the Town Center.

Dr. Jeff Daniels was the recipient of the 2015 Chamber of Commerce Chet Huntley Lifetime Achievement Award and has been practicing medicine in Big Sky since 1994, when he and his family moved here from New York City. A unique program he implements has attracted more than 800 medical students and young doctors to train with the Medical Clinic of Big Sky.