medicine

On Mountains and Medicine

As things are wont to do when you’re in your 20s and a year has passed since you’ve written, so much has changed since my last post.

After being forced off the PCT because of Lyme, I returned home to help my mother with her new business, eventually recovered, visited Pine Nut in Seattle, relapsed and reached my all-time Lyme low at the start of 2016, discovered a deep passion for fiber art, decided to go into the medical field, walked a winding yellow arrow of Caminos, explored Western Europe, enrolled and (very) successfully completed four weeks of pre-med courses, and then suffered from Lyme or carbon monoxide poisoning (long story) and had to withdraw.  Now I’m back at my “old Kentucky home,” creating fiber art, feeling strong, and pondering my next move.

Healthy people on career tracks might be so caught up in the day-to-day challenges that they are not afforded the chance to pause and take stock of where they’re going.  Getting to do so once every few years is a treat.  Getting to do so once every few months because of the cycles of remission and relapse (or carbon monoxide poisoning, you know) is a little excessive.

It’s not that I’d rather avoid being deliberate and mindful; it’s just that I’d prefer not to question my deliberate, mindful choices at such frequent junctures.  I feel completely smitten by mountains and art and the biological sciences; how am I supposed to choose just one?  (Perhaps I should take a page from polyamory and refuse to choose.)

I feel relatively certain that I would enjoy the lifestyle of a locum tenens hospitalist, traveling to various assignments and using modern medicine in the acute care setting where it most excels.  I would enjoy keeping abreast of the latest research and working through differential diagnoses to problem solve.  Most importantly, I would enjoy doing my best to ensure patients even more ill than I’ve been get the chance to hike another mountain.

But, the journey to that point feels daunting.  I’d forgotten about the competitiveness – the Slytherin atmosphere – of school; I’d forgotten what it felt like to live in a world where statuses and resumes are important.  It’s not a place where I feel as though I belong.

Thus, in my mind, the question right now, at this unusual limbo before registration for next semester opens, is whether I will find a place for myself – without losing myself – in med school. Should I be focusing on getting these last prereqs under my belt, when I’m not sure whether what comes next is a good choice for me?  I don’t want to go into medicine in spite of needing to go to med school; I want to be able to enjoy the journey.  I’m not opposed to hard work; I have just learned that life is too unpredictable to spend healthy days in unhealthy settings.

So, that’s where I am in my thoughts, at least today.  I welcome feedback, especially from med students who are finding their way toward their dreams.

On the PCT: Sidelined with Lyme Disease

Throughout my fight with Lyme disease, I have tried to be patient and calm.  After finding that anxiety and depression got me nowhere, I have tried to embrace a Zen attitude about being ill for an indefinite period of time.  I have worked to relish the good days and accept the bad days, acknowledge the failures but savor the successes.  I don’t feel like doing any of that today.

Today, I feel the need to write a rare, less-than-optimistic post.  Forced off the Pacific Crest Trail because of Lyme, I’m not in the mood to look for the silver lining of my illness, not interested in thinking about the gratitude or perspective being chronically ill has given me.  Stuck in bed, tired, dizzy, achy, and twitchy, I’m finding it difficult to be positive or hopeful.  Today, I need to rant.

I’m angry.  I’m angry that some bacteria that entered my body when I was bitten by a barely-visible tick four years ago has the power to knock me off the trail, which I was hiking as a fundraiser for Lyme disease research.  I’m angry that the same bacteria makes it difficult to hold down a job or go back to school or be in a relationship.  I’m angry that it has changed the course of my life in dramatic ways.

I’m frustrated. I’m frustrated that, according to the CDC, I never had Lyme and that, if I did, it would have been cured a few years ago, after a couple weeks of antibiotics.  I’m frustrated that there are so many unanswered questions about Lyme, that there is so much research that needs to be done.  I’m frustrated that there are so few doctors who are familiar with treating it and that there are so few success stories.  I’m frustrated that many people are far more ill than I am and that it seems as though little is being done to help them.

I’m sad.  I’m sad that being sick made me lose some friends.  I’m sad that a shortage of “spoons” made me flaky and unreliable.  I’m sad that a gap grew between some of my old friends and me, as I could no longer easily relate to twentysomethings who were able to live like typical twentysomethings.  I’m sad that people who’ve known me when I’ve been well aren’t sure how to respond when I’m sick.  I’m sad that our society doesn’t understand invisible illnesses and that a whole lot of health privilege goes appreciated.

I’m grieving.  I’m grieving for the years that I can’t remember and for the year I’ve basically lost to being bedbound.  I’m grieving for the brain I used to have, the intellectual competence and confidence I once knew.  I’m grieving for the way I used to be able to make plans for my future, for the feeling that I could achieve most anything if I worked at it long or hard enough.  I’m grieving for the marathon I haven’t yet run, the Masters degree I haven’t yet earned, the career I haven’t yet found.

I’m tired.  I’m tired of feeling like I’m fighting this alone.  I’m tired of not knowing what my next step should be.  I’m tired of wondering what the spirochetes inside of me are doing, of having no idea that the troops are rallying before they rise up and send me crashing.  I’m tired of being sick.

On the PCT: Warner Springs

Anyone who has ever had a hiking partner knows how special they can be.  Hiking partners are people you can stand to spend “23.5 hours a day” with.  They’re the ones who are able to lift you up when you’ve fallen, physically or emotionally.  They’re the ones with whom you share backcountry culinary advice (such as the wonders of cold Idahoan potatoes) and Dr. Bonner’s soap (when it’s days before the resupply box containing shampoo arrives) and something magical called Badger Balm.  They’re the people who are there to hear you gasp at beautiful scenery and who enjoy retelling stories from the “Type II” fun you experienced.  I generally hike solo, but the time I’ve spent with my hiking partners, such as Quiver, is time that I treasure.

From Mount Laguna to Warner Springs, I was treated to the company of another 2012 Appalachian Trail thru-hiker, SunRoof.  I met SunRoof when he came out of the woods and into the Burnt Rancheria Campground at Mount Laguna.  After I’d identified myself as Rainbow Dash, he hurried to give me a hug from Gluten Puff.

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SunRoof and me

Six miles into my hike the next day, I stopped to rest and was caught by SunRoof.  We spent the next three days hiking and camping together.

For most of that time, I felt great.  SunRoof and I put in three days of 19-21 miles, and I enjoyed every moment of them.  Time and Doxycycline were working their magic, and I no longer felt ill.

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The rain shadow effect

I was having a blast contour-walking in the high desert, weaving in and out of shaded cirques.  I was loving the array of colors the desert bloom brought to the desert and chaparral.  I was enjoying the cool nights, the breezy mornings, the mid-day siestas, and the invigorating evening air.  I’d met all of the hikers in our bubble and was appreciating the community formation.  I’d figured out how to drink an appropriate quantity of water and rehydrate my food without a stove.  I was hitting my stride.

However, I started to notice a nagging pain in my left heel.  I doctored it by cutting some of the padding off the top of my shoe–and then by adding a moleskin heel lift inside my shoe.  Thirty miles later, I needed to do the same with my right foot.

Maybe I was walking unusually in order to compensate for the knee pain I’d written about in Mount Laguna.  Or, maybe, thanks to Lyme hijacking my spring marathon plans, I was not conditioned enough to be hauling large quantities of water up, down, and around mountains.

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Sunrise from a high meadow

In any case, when I took off my shoe at the Warner Springs Resource Center it was obvious that something was very wrong:  Where the profile of my leg should have been concave above my heel, it was convex.  I had Achilles tendonitis.

So, currently, I’m RICEing in Warner Springs and trying to figure out what lies ahead.  Is this just a little road bump that I’ll recover from in a few days, or will healing be more complicated than that?  Here’s hoping it’s the former!

If anyone has any advice or words of encouragement, they’re more than welcome!  I feel frustrated, but I also know that it’s still early in the game; there’s plenty of time to get to Canada.

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"I know he'd be a poorer man if he never saw an eagle fly..."

Hypothermia, Spider Bites, and Pogo Sticks: Wilderness First Responder Training

It’s not that there aren’t backpackers and outdoor adventurers in rural Kentucky; there are. But, I rarely seem to meet any of them, and, as a result, I generally don’t talk much about my outdoor experiences and aspirations. There are plenty of other things to talk about, and I genuinely enjoy visiting with friends and neighbors in the Bluegrass State. However, one of my favorite things about taking a Wilderness First Responder course at the Outward Bound campus of Table Rock, NC, is being surrounded by dozens of other wanderers and outdoor adventurers.IMG_20150323_102234_979

It became apparent that I was among kindred spirits — people who could understand my having five addresses in eight months, and who admire the latest outdoor gear but are roughly the age of their cars — when the first day of our course began with introductions, which included the place we each “receive mail.”

While we share the passion of adventuring outdoors, the specific sports and activities that we each enjoy are varied. I am one of a few people in our class who primarily consider themselves to be backpackers, and there are rock climbers and skiers and snowboarders and white water athletes and flat water boaters and hunters and horse packers in our group. There are instructors and group leaders; there are people who generally enter the backcountry with others and people who generally adventure alone. All of this has contributed to some varied perspectives and biases in how we have assessed and reacted to staged scenarios of disasters in the wilderness.

IMG_20150322_114631_036I came to Table Rock to take a Landmark Learning Wilderness First Responder course, which is a prerequisite for the outdoor leadership program I was just accepted to in Greenfield, MA. A WFR course is 80 hours and involves both lectures and laboratory time, during which instructors watch as we treat mock patients taking part in contrived scenarios. In the last few days, I’ve treated an asthmatic rock climber, a hypothermic naturalist, an unresponsive hiker, an adventurer suffering from altitude sickness, and a pogo stick champion with a broken wrist. I’ve been a birder with hypertension, an avid paintballer with a broken rib, and a Gore-tex-sponsored competitive runner suffering from heat stroke. Acting in the role of rescuer, I’ve been a lead responder, a member of medical teams, a patient advocate, and part of a volunteer response crew. And, in study sessions, some new friends and I have reenacted some of my favorite stories of health-related misadventures on the Appalachian Trail, including the tale of the Barrington Crater.

I’d be lying if I said that I haven’t been having fun. However, there is also a real gravity to the WFR course. Every day, we learn about the traumatic injuries, environmental threats, and medical issues that can affect us and those we love while we’re doing the things we love to do. We hear recounts of tragedies, and we evaluate stories of successes and failures of medicine in the field. We acknowledge the limits of our abilities and consider the ways in which we can make a difference. The responsibility of becoming a/the person who, among a random group of thru-hikers, should know what to do in a given situation is something I’ve continued to think about throughout the course.IMG_20150320_182608_627

Maybe it’s my love of method acting catching up to me, or maybe it’s the memory of Emma’s fall on Mount Washington last year, but I have a difficult time distancing myself emotionally from some of the material I’ve been learning. It’s not that I’d felt invincible in the outdoors, but I have felt safe, secure in my experience and physical ability. While increased awareness of what can go wrong might make me a bit more anxious about scaling a wet and rocky incline alone, I think the knowledge and ability to respond to an emergency situation also engenders a sense of confidence that puts some of those worries to rest. As our instructors love to say, “Prevention trumps medicine.” Let’s mitigate the risks that can be mitigated and know how to respond to the problems that may occur.

Long story short, if you’ll also be thru-hiking the PCT this year, do everything you can to avoid dehydration, heat exhaustion, hyponatremia, rattlesnake bites, and traumatic injuries. But, if a problem does arise, I think you’ll be in good hands if you happen to have said problem around me or another WFR.

Be safe out there, friends.

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Q&A: How to Avoid Getting Giardia

Earlier today, I was talking about the PCT with some friends of my family, and they started asking me about the terrifying wildlife I might see along the trail. Their worries were of encounters with rattlesnakes, scorpions, and bears. Honestly, it’s not those creatures that make me anxious; if my battle with Lyme Disease has taught me anything, it’s that it’s the little guys that you’ve got to be afraid of: ticks, the air-borne fungus that causes Valley Fever, and Giardia. DSCF7268

I’m of the opinion that, anytime you’re dealing with living creatures, it’s impossible to speak in terms of absolutes. I doubt that a certain series of behaviors could completely prevent the contraction of Giardia; however, there are some behaviors that can mitigate your risk.

First of all, there’s personal hygiene. In thinking about how to be clean in the woods, I’m reminded of Disney’s Mulan: “Just because I look like a man doesn’t mean I have to smell like one.”

I know a couple people who, when they’re backpacking, are capable of looking like they just stepped into the woods for a day-hike. Most of us aren’t that lucky. Fortunately, you don’t have to look like part of an REI ad to lessen your risk of contracting Giardia.

At the risk of sounding like a preschool teacher, the best thing you can do is keep your hands clean. Clean them after cat-holing and before eating. Wet Ones and alcohol swabs are perennial favorites for many hikers; just be certain to pack out any wipes you use.

That said, the fact is that your own body’s cooties are far less likely to make you sick than those from another person. And, that’s why there’s a saying on the trail that Booksmarts taught me back in 2011: “The communal gorp bag is poured from, not reached into.” If you’re fortunate enough to be on the receiving end of some trail magic from another hiker, don’t stick your hand into the bag to extract some Reese’s Pieces, blueberries, or Swedish Fish. Instead, pour out a handful.

Since Giardia can be water-borne, choosing water sources carefully goes a long way toward reducing a backpacker’s risk of getting sick. I remember meeting two young guys early on my hike of the Appalachian Trail who were excited to get to a river that we were due to cross later that morning, since that’s where they were planning to fill up their water bottles. I questioned their plan, suggesting drinking from any of the little streams and springs we’d be passing before then, but they explained that they love quick-flowing, large sources of water.

In my mind, the Potomac, which flows very quickly and is very large, is not the paragon of water sources.

Small sources draining small watersheds can be very good water sources. It’s important to consider the watershed that is supporting a given water source. Does the land around the water seem healthy? Is there a good plant cover (i.e., grasses, herbaceous plants, etc.) that filters rainwater? Are there any dead animals or obvious animal fecal matter in the vicinity? Are there cow pastures or herbicide/pesticide-laden farm fields upstream? Be water-aware, and you’re likely to find good drinking water.

Most thru-hikers will agree that one of their favorite things about long-distance hiking is tasting water from mountain springs. Fresh, cold water is such a simple gift, but it’s something we certainly appreciate. Some springs have dramatic flow rates, where water gushes out of rock (sometimes through a channeling pipe, soda bottle, or curled leaf. Other springs just look like puddles of water.DSCF3592

While stagnant water is not a preferable water source, the puddle-variety of spring, with a steady stream of “new” water bubbling up from the earth, is great.

Now, I say all this, and in a couple months I’ll be departing on the Pacific Crest Trail, where water sources include a cattle trough, several horse- and cattle-frequented streams, and cisterns where chipmunks have drowned. A number of ultralight hikers insist on hiking sans water treatment, but I know that my compromised immune system would never tolerate that.

I definitely have enjoyed live water when I have seen a spring’s source or in some unfrequented high elevation streams; however, Giardia and its partner-in-crime, Crytosporidium, have been cultured and contracted from even these sorts of water sources, as several of my hiking friends and this blogger can attest to.

Some hikers feel that being cautious about hygiene and water sources takes some of the fun out of backpacking and leaves them feeling out-of-touch with the natural world. I appreciate that perspective, but, especially because of my tendency to get sick easily, I’d rather take risks in climbing Mount Whitney, attempting consecutive “marathon days,” crossing snowmelt-swollen streams, and meeting new people while hiking and hitchhiking. And, I’ve really had it with microbes.

Fellow hikers, have you had any run-ins with microbes while in the backcountry?  How do you avoid them?