By Jeff Daniels EBS Medical Columnist

With the cold weather and snow in the mountains, hopes for a long Indian summer fade, and we are prompted to get ready for the ski season, which starts in less than six weeks.

For the past 11 years, the Medical Clinic of Big Sky has waited until Thanksgiving Day to make the transition up to the Mountain Clinic, which will then be open seven days a week throughout the ski season. This year, the ski season has been extended through the third Sunday in April. As we’ve done in the past, we will keep the Town Center Clinic open at least four days per week—Monday, Tuesday, Thursday and Friday. Both will operate as urgent care clinics, prepared to handle ski-related injuries as well as other injuries and illnesses. This is our 24th ski season serving the Big Sky community, and we’ve seen it all!

Now, we are starting to stock up on the essential items that help us provide the best care to those injured on the slopes. This includes various types of knee braces, the latest technologies in wrist and shoulder stabilization, as well as the basics like crutches and slings.

We’re also brushing up on our techniques for treating injuries that we rarely see after the ski season finishes and before the next one begins. A common injury in the ski season is a dislocated shoulder, probably 30 or 40 every winter. When a fast moving adult falls and flails an arm behind, the shoulder joint can be forced to dislocate. Just the sheer number of people skiing and snowboarding and risking a fall is all that it takes to give us such a high number compared to the summer. Golf and fishing are very low risk. Falling off a mountain bike much more commonly leads to a fracture of the clavicle, but we’ve also had an occasional bike-associated dislocation come in, covered with mud and pine needles instead of snow.

People sometimes ask how I keep “trained” to handle the dislocations that we see mainly in the winter. Well, every few weeks from May through November, I get a new crew of medical students and residents, and I give them all a lecture on diagnosing and treating a dislocated shoulder. First, we discuss the anatomy and look at X-rays. Then I go through my history of learning how to reduce a dislocation and the techniques we used to use. Next, a volunteer lets me pull on their arm in various positions—standing first, then sitting, and finally lying down if it hasn’t gotten (theoretically!) back into place.

In the rare instance that I can’t reduce a shoulder in a couple of minutes without any drugs, we have to consider conscious sedation to relax the patient. There are several standard drugs that clinics, emergency rooms and hospitals will use to achieve sedation, as well as associated equipment to have on hand if there are problems or complications caused by the procedure.

My students get a kick out of all this, especially the ones who have had their own dislocated shoulders in the past. Even in the summer, most of the clinic’s students have outdoor experiences and are avid skiers and snowboarders; many of them have had the typical injuries, like ACL tears and broken clavicles.

So we’ll be ready to deal with the ski season when it starts on Thanksgiving Day. Our skis will be tuned and we’ll be anxious to hit the slopes. And again, our “pilgrimage” up to the Mountain Clinic will be completed before our turkey dinner.

Dr. Jeff Daniels was the recipient of the 2015 Chamber of Commerce Chet Huntley Lifetime Achievement Award had 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.