medicine

On Doctors and Thru-Hikers

Since I had a doctor’s appointment today and am anxiously awaiting blood test results (Lyme-related, because life), I thought I’d write about my experiences with doctors as I walked from Georgia to Maine.

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I remember seeing these feet on a hiker I’d met during my first foray on the Appalachian Trail and being horrified. That was before I’d discovered the podiatric awesomeness of duct tape myself.

It seems that the modern medical community doesn’t really know what to do with thru-hikers.  The demands we choose to place on our bodies are extreme, our hygiene standards are rarely seen anywhere else in the developed world, and, while we look like ambition-less hippies, we have a (self-imposed) deadline of getting to Katahdin before Baxter State Park closes.

I will never forget the face of the doctor I saw at a walk-in clinic in western Vermont as he listened to my responses to his questions.  I’d gone to the clinic because I suspected that the wounds my hand had received during my fall on a road in Massachusetts had given me an ingrown fingernail.  (They had.)

“How long ago did you fall?” he asked.

“Oh, I don’t know.  A week or so ago.  Maybe two.  Sometime in Massachusetts.”

I got a similar response when I couldn’t tolerate an itchy rash any longer and had to see a doctor in New Hampshire:

“When did you first notice the rash?” he asked.

“Several hundred miles ago.  Whenever I was in southern Pennsylvania.  I think that puts it sometime in mid-July.”

After taking one look at me (before he even saw the rash), he assumed that it had to be Herpes.  He didn’t listen as I insisted that wasn’t possible and sent me out of his office with enough anti-virals and, luckily, antibiotics, to last the rest of my hike.

During much of my thru-hike, I was generally healthy.  There were a few days when I was under the weather, including one night during which I had the worst fever of my life (which is saying something), but, most of the time, I felt strong and healthy.  However, when I got to New England, I was perpetually exhausted — not that I ever visited doctors’ offices for my tiredness.  Instead, my first visit to an ER on trail was necessitated by a bruised and swollen foot.

I was near White River Junction in Vermont when my foot became terribly sore.  It had been cranky for a few hundred miles because it seemed to consider my second pair of boots (which were the same size as my first but not yet 1442-miles-worn-in) too small.  At a makeshift campsite I’d found during a night hike through a hemlock forest (more on that later), my foot’s whines gave way to screams.  The rain on my tent fly eventually lulled me to sleep, but I woke up still very much in pain.  The next morning, I loosely laced up my boot and limped several miles to the next road crossing.

When I got to the road, I breakfasted, dried my gear, and napped in the warm sun while trying to figure out what I should do.  I decided to keep walking to the next town, where I’d be able to get an easy hitch to a hospital.  In my mind, ten miles wasn’t a big deal; even with a limp, I’d be able to knock that out in half a day or so.  But, friends in New Hampshire (whom my mother contacted when I’d called her from my breakfast spot) would hear none of it.  They picked me up and drove me to the hospital, where I learned that I didn’t have a stress fracture but rather a bad case of tendonitis.

The doctor advised me to stay off my feet for a while.  I nodded politely to assuage him but set out two mornings later in Chacos, with my foot wrapped securely with athletic tape.

I would deal with tendonitis for the remainder of my hike — and then a stress fracture in my left foot.  The latter brought me to tears, but I didn’t get it diagnosed until I was back in Kentucky and frustrated that I couldn’t run without pain.

When I was a child, I remember watching the Olympics and thinking how crazy it was that the athletes would continue competing on injuries, competing to the point that they were doing permanent damage to their bodies, because competing in the Olympics was one of the things they wanted most to do in life.  Maybe it was the stubborn streak I’d inherited from my mother, or maybe it was that I’d channeled my inner Olympian.  All I know is that I was bound and determined to get to Maine.

Healing the Barrington Crater

My worst injury on the Appalachian Trail happened when I fell on a road.

Yes, you read that correctly.  I’d walked 1500 miles, arrived in Massachusetts, climbed up the relatively impressive Everett and Race, descended to a road, took one step on it, and fell to the ground.

Trigger warning:  There will be blood.

I blame a combination of new, t00-small boots and a branch on the road, but fault didn’t matter.  What did matter was the fact that I was on my hands and knees in the middle of the road with my full pack on my back, nauseated because of the pain shooting from my knee.

Sitting so that I could look at my knee, I had my first glance of the Barrington Crater, as I came to call it.  In falling, I’d taken a sizable amount of flesh out of my knee, and blood was flowing from the resulting crater.  At this point, I should explain that I grew up on a little farm; I’ve dealt with all sorts of animal emergencies and am generally calm and tough in such situations.  Likewise, I’ve been able to stay calm and think clearly in emergencies involving other people.  This was not the case when I looked at my knee and realized that the fluid dripping down my bent leg while I was sitting on the road was my own blood.  I grew faint and worked to remain conscious.DSCF3103

Luckily, at that moment, a thru-hiking family came up the trail behind me, and a southbounder arrived just moments later.  While I was busy being barely communicative, they helped me to scoot out of the middle of the road, pooled their first aid resources together, and started working to clean me up.

As they were tending to me, an SUV started rumbling down the road toward us and then promptly pulled off the road nearby.  The driver, a petite, middle-aged woman, jumped out of the vehicle and came hurrying our way.

Talking to me quietly and asking me simple questions, she worked to help me remain conscious while she bandaged up my knee.

“Where are you staying tonight?” she asked as she finished.

“Not far,” I said.  “I’ll camp in the woods around here.”

DSCF3101Without hesitation, she invited not only me but also Palm Tree, who’d been hiking with me for a few days and was just a few minutes behind me when I’d fallen, to her home.  I was so relieved at the thought of being able to be off my leg and keep it clean for a couple days.  Palm Tree and Mary Kate helped me into the latter’s car.

Regardless of the fact that we were sweaty and dirty and bloody (or, at least, I was), Mary Kate welcomed us into her living room, where she continued to tend to my knee (and other, smaller, wounds).  She ordered pizza for us and her teenage and young adult children, and we enjoyed a wonderful meal together.

For the next two days, I felt like part of Mary Kate’s family.  Palm Tree and I ate, talked, and shopped with her and her children.  We stayed in “the clubhouse,” a shed in the backyard that was cozy and comfortable.  And, I served as Palm Tree’s sous chef as he created a delicious Thai meal to thank Mary Kate and her family.

While I’d had no problem escaping the Neels Gap vortex, the Hot Springs vortex, or the Waynesboro vortex, I must confess that I found it rather difficult to leave Mary Kate and keep hiking north — and not just because my knee was tender.  Her hospitality, generosity, and kindness made me see her not just as an exemplary trail angel but as an exemplary human being, and I like to think that I became a bit like her because of the time I spent with her.  I certainly consider her part of the reason that I stood atop Katahdin.

On Thanksgiving and Lyme Disease

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A visit to the ER in January

In the bathroom of a Wal-Mart in southern Pennsylvania in 2011, I found an engorged deer tick under the elastic of the running shorts I was wearing on a month-long hike of the Appalachian Trail. After a couple years of having some sporadic health issues but nothing particularly alarming — and six months of thru-hiking the trail — I came down with mononucleosis in September 2013. I crawled into bed to rest it off and, with few exceptions, barely got out until nearly 10 months later.

I had Lyme Disease.

The working hypothesis is that the bacteria that causes Lyme had lain dormant in my body until mono wreaked havoc on my immune system. With my white blood cells otherwise occupied, the spirochetes ran rampant.

At first, the only symptom I was presenting with was my tiredness. Extreme tiredness. In an essay in early winter, I wrote, “There is a particular tiredness that comes with mono. It is the type of exhaustion that seems to seep into one’s bones, weighing them down so that nothing sounds more appealing than an afternoon nap. Or a morning nap. Or a nap that stretches from an hour after one nap to an hour before another one.”

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Fun times.

All autumn long, I slept more than 14 hours and as much as 20 hours each night. When I was awake, I tried my best to be productive, but I scarcely had enough energy to feed or wash myself, let alone get any work done.

With winter came a breaking of my symptoms, a respite that I’d later recognize not as recovery but as remission of a pattern typical to Lyme. Able to go to the office, I enjoyed the chance to finally “get things done” for my AmeriCorps service position. I got back to exercising a bit and explored the region of Massachusetts that I’d moved to a couple weeks before getting sick. Suddenly, everything was perfect, minus some “brain fog” that I just couldn’t seem to shake.

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Post-surgery “sister selfie” with Candice the Kidney

While visiting my family for the holidays, I developed a migraine that lasted and lasted — for ten days. I spent most of that time hiding in a dark room, waiting for the pain to subside. Eventually, I felt well enough to travel again and rode a bus back to New England for 26 hours, sleeping most of the way.

Winter saw a whole different set of symptoms: achy joints, anxiety and panic attacks, and amplified memory issues. I struggled to discern reality from my increasingly weird dreams and often repeated stories (and falsehoods that I thought were true) while talking to my friends and family.

Then, I started feeling better again. For three weeks, apart from brain fog, I felt normal, and I lived life as fully as I could. I dated and contra danced and planned summertime adventures.

But, in mid-February, I caught a cold. The cold became a fever, which became a complete flaring up of all my symptoms — and then some.

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I should write an ode to Doxycycline.

At the end of February, I went to the ER with intense abdominal pain. A day and an hour-long ambulance ride later, I was taken to the OR for what was thought to be a miniscule kidney stone. As I was struggling to come out of an anesthesia-induced daze, I learned that the cause of my pain wasn’t a kidney stone at all and was, unfortunately, an issue that would require more surgery in a few weeks’ time.

In the meantime, my condition continued to deteriorate. Physically and emotionally, I was miserable. Mentally, I was nowhere near myself. My roommates put a cushion in the kitchen with blankets, and I would lie there and talk with them when I could. They also took to taking me out on Saturday drives when I was healthy enough to leave the house. One of my roommates in particular became a caregiver to me: Kate ensured that I had food to eat, picked up medications for me, and called an ambulance when I passed out as she was helping to get me back to my room.

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Going home from the hospital was so exciting.

Eventually, I felt a bit better, and I flew to Kentucky to be near my family for the kidney surgery and the month-long recovery period; however, the stress of travel made “mono” roar its ugly head yet again.

My family couldn’t believe the state I was in. I went back to sleeping around the clock, and I grew so weak that I couldn’t wash my hair or lift my full water bottle. My muscles ached and twitched, and I sometimes hurt so much that I couldn’t sleep. I was perpetually dizzy, my circulation was terrible, and sunlight made me nauseated. It seemed that I didn’t have a bodily system that had been spared by whatever illness it was that I had, which my mother insisted wasn’t mono.

During a visit to my childhood doctor, I asked whether I could be tested for Lyme. Several days later, on April 21, 2014, I learned that my ELISA test was equivocal for Lyme; while more tests were ordered, I began a two-week prescription of Doxycycline. Surgery was postponed until Lyme was under control.

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After surgery, my sister, Kelly, painted my nails to give me something pretty to look at while I was stuck in bed. She also kept me and my Lyme- and Oxycodone-addled brain happy with songs, bead pets, and coloring books.

The Western Blot that my doctor ordered ended up coming back negative, as did a future ELISA test, but by the time they received my results, it was readily apparent that the Doxycycline was having a positive impact (after a Herxheimer reaction). A physician’s assistant and family friend who works in that doctor office decided to keep me on antibiotics.

The day after my 25th birthday and just over one month after beginning Doxycycline, I fasted for surgery. The following day, I had abdominal surgery that left me with a Lyme flare and the need for too much Oxycodone and Valium. Over the next month, with more help from my sister than I can ever repay and Doxycycline, I got the Lyme back in remission, made significant strides toward recovering from surgery, and weaned myself off the other medications. As June turned into July, I started walking again — first down the driveway and then down the road. My brain seemed to start working again, and I dared to hope that Lyme was gone for good.

These days, recent bloodwork seems to indicate that I might be ready for another bout of Lyme, but I’m making the most of this health while it lasts. In August, I was strong enough to hike, and I was able to backpack in September and October. I’ve got my sights set on the Pacific Crest Trail next summer, and my trek will be a benefit hike for the International Lyme and Associated Diseases Society (ILADS). The ILADS treatment protocol gave me my old lifestyle back, and supporting their important work is incredibly meaningful to me.

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When I was well enough to be outside but couldn’t be in the sun or sit, Kelly set up an air mattress on the porch for me. Ohana (our dog) appreciated it, too.

 

So, this Thanksgiving, I’m thinking back to where I was one year ago, and I am tremendously grateful to all the people who have helped me recover. Having faced a chronic illness and feeling well again has left me wonderfully grateful for each day that goes by. Every moment that I’m not in bed feels like a precious gift, a beautiful blessing. My family, roommates, friends, and doctors got me through what has been the most difficult experience of my life. To each of you: Thank you. Thank you. Thank you.

If you would like to learn more about my hike or sponsor me as I walk for ILADS, please click the Making Lymeade tab and visit my HikeFor.com page. Happy Thanksgiving, and thank you!