Patches the Asthma Girl! (Asthma Ditty)

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I’m Patches the asthma girl!
I’m Patches the asthma girl!
(Puff! Puff!)
I’m hiking across the world.
With new lands to see
I’m happy as can be!
I’m Patches the asthma girl!
(Puff! Puff!)

I feel healthy
And I feel strong
‘Cause I’m hiking
The whole day long.

I used to struggle
And I used to wheeze
Now I just
Give the inhaler a squeeze
(Puff! Puff!)

There’s no mountain too high
And no trail that’s too long
When I have my inhaler along
(Puff! Puff!)

I’m Patches the asthma girl!
I’m Patches the asthma girl!
(Puff! Puff!)
I’m hiking across the world.
With new lands to see
I’m happy as can be!
I’m Patches the asthma girl!
(Puff! Puff!)

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Confessions of an Asthmatic (PCT Days 63-65)

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Hello, my name is Patches. I’m a thru-hiker and an asthmatic. It’s been 10 days since I last took a full, deep, lung and chest expanding breath and 3 hrs since I last used my emergency inhaler. I can already feel my lungs beginning to constrict again in an angry protest against my attempts to breath while climbing up this mountain and I’m counting the minutes until I can use my inhaler again.

Asthma is the reason why I quit my job and hiked the Appalachian Trail in 2013.. After I returned from my Appalachian Trail journey I checked in with my pulmonologist and I’d regained 100% normal lung function. I was incredibly excited… My plan had worked, hiking the Appalachian Trail had helped my asthma… 100% normal lung function!!! I hadn’t imagined that it would get that much better! Since my asthma had been occupational asthma and I no longer had that occupation, maybe my asthma would be gone for good?!

My continuing good health (and lack of asthma attacks) slowly reinforced the idea that my asthma wasn’t something that I needed to worry about anymore (as long as I took my maintenance meds). As I hiked through the desert sections of the PCT I felt strong and my lungs felt strong. I’d gone to Burning Man (a desert festival) twice, and both times the dust storms had aggravated my lungs leading to nasty bouts of asthmatic bronchitis followed by pneumonia, so I had been extremely nervous about desert dust storms on the PCT… But I’d gotten through the desert without any trouble with my asthma… During the first 700 miles of the PCT I’d only used my emergency inhaler once.

As I left the desert behind, I left my worries about asthma behind too… I even sent all but one of my emergency inhalers home (I’d been carrying 2 or 3 in case I lost one, or miscounted how many doses were left in them).

It came as a real shock to me when I entered the high Sierra and started routinely having breathing issues… I’d hiked over 700 miles, keeping pace with my peers, and my asthma hadn’t been a problem… Despite the daily maintenance meds I take for my asthma, I’d managed to completely forget that I was asthmatic.

At elevations above ~9000 feet, the second the trail started going uphill, I started slowing down, way down. At first I thought that the same thing was happening to everyone else too… “Aha,” I thought, “I can explain to people that being asthmatic is like constantly trying to hike uphill at high elevation.” I clearly remembered that this was exactly what it had felt like trying to climb the three flights of stairs up to my apartment when my asthma had been really bad… My body had shifted to moving very slowly and taking the fast shallow breaths that would keep my blood oxygen levels high, but that wouldn’t trigger an asthma attack, and I was taking frequent breaks… A break after every step or two.

It took me a couple of days before I realized that nobody else was responding to the altitude in quite the same way that I was… To realize that it wasn’t just one bad day… The people that I had easily outpaced in the desert and at lower elevations were all passing me. Everyone else seemed to be adapting to the altitude… But not me… My friends were all outpacing me… It wasn’t a choice… I just couldn’t keep up… And suddenly the thin veil of denial melted away…

I have asthma… It didn’t go away… Asthma doesn’t go away.

I would have taken a deep breath as I processed the realization, but I hadn’t been able to take a deep breath in days. I would have laughed at myself for being in such denial that I didn’t recognize that it was asthma until I actually had an asthma attack on top of Pinchot Pass, but laughing triggers my asthma attacks when my lungs are being cranky. Instead, I sighed… It seems like no matter how bad my asthma is I can always manage to sigh.

I have asthma. In the last year I had gotten so much better that I’d been able to forget what it was like to struggle to breath… I’d fallen back into denial (despite the pound and a half of maintenance meds I was carrying with me and taking everyday). Being at altitude wasn’t like having asthma, it was triggering my asthma, especially since the altitude was combined with lots of cold dry air.

My rescue inhaler which had been left largely unused throughout the latter portion of the AT and the beginning of the PCT was being used on a daily basis again… When I’d forced myself to keep working at the job that had triggered the asthma I remembered that after 2-3 hrs I’d start watching the clock to see if I could use my inhaler again… Here at the higher altitudes I found myself doing the same thing… Was it time yet? How about now? How about now?

I carefully monitored myself for signs of altitude sickness… Could I tell the difference between high altitude and cold temperatures triggering my asthma and HAPE (high altitude pulmonary edema)? I wasn’t 100% sure, but I did know that the inhaler helped for 2-3 hrs and that carefully controlling my pace meant that I could keep breathing at 8000ft, 9000ft, 10,000ft, 11,000ft, 12,000ft, 13,000ft and 14,000ft…

It felt like my asthma to me… and it wasn’t getting progressively worse or coupled with any other symptoms of altitude sickness… No nausea, no headaches. Just breathing issues and asthma attacks that frequent breaks and using my emergency inhaler seemed to keep at bay.

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Though slowing down and having to stop to catch my breath more often meant having to hike alone, it also meant that I had more time to just watch and absorb all of the spectacular scenery around me… The high Sierra is breathtakingly beautiful!!

As I hiked through the snow-covered mountains and forded the icy streams of the Sierra I thought about how I hadn’t really believed that I had asthma until I was hospitalized for it. Why did I have so much trouble admitting, even to myself, that I have asthma?

Close your eyes and try to picture an asthmatic. When I did that, the first image that came to mind was that of a ten year old boy wearing a blue shirt and a red baseball cap staring longingly out of his bedroom window at his friends playing baseball… It’s an image from some tv show or movie from my childhood which lodged a stereotype in my head, “asthmatics don’t get to go outside and play.” But I love to go outside and play! I don’t want to be sick, weak, and trapped inside… With those images of asthma lodged in my head it’s no wonder that I didn’t want to accept that I have asthma.

Clearly I needed to exchange those old images of asthma and asthmatics for newer ones. I thought of myself standing on top of Mount Whitney at sunrise… Triumphant and strong… On top of the world… That’s the image of an asthmatic that I want to hold on to, that I want to come to mind first and foremost when I think about asthma. To get to the summit of Mount Whitney I needed to admit to myself that I had asthma, I needed to use my inhalers, I needed to respect my body, and I needed to go my own pace. I worked really hard to get there, but I did it, and it was absolutely amazing. My asthma didn’t prevent me from going outside and playing and living my dreams.

My name is Patches, I’m a thru-hiker, and I have asthma. My asthma is still there, I’m still hiking at high altitudes, I’m still going slowly, and I’m still out here living my dreams on the PCT in the high Sierra and loving it… Me, my backpack, the mountains, and my inhaler! :)

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Health, HIPAA, and Hospitals

I’m used to sharing *my* story and stories here, online, in an incredibly public forum. Since I’ve been off of the trail my story has been dominated not by issues with my health, but with issues associated with my fathers health. This has left me in a bit of a quandry, and has resulted in a long period of blog silence. Dealing with how much health information you want to share with your friends, your family, your colleagues, and complete strangers is a complicated enough issue by itself and one that people tend to feel strongly about and have differing boundaries for, but when its somebody else’s health information its even more complicated. I think that the amount of health information you decide to share with your friends and your family is a deeply personal issue and that each individual needs to decide those boundaries for themselves.

How much health information you share with colleagues and the internet is a much bigger issue because it has the potential to impact your current and future employment. Before disclosing any information about my health on this blog, I thought long and hard about whether or not I was ok with current or future employers learning about my health information (and any other personal information) that I share here. It made/makes me uncomfortable to think that someone might discriminate against me based on the health information that I disclose here. That, in conjunction with having had some negative experiences with stalkers in the past, made me decide to keep my blog somewhat anonymous at first. I still choose not to link this site with my full name, but at the same time I realize that everything I post online (no matter how anonymous) can be linked to me, it’s just a matter of how motivated someone is, and how much time they want to spend… there are no secrets on the internet.

There are four laws in place that are designed to prevent employer’s from discriminating against people based on their health issues and/or disabilities and to protect the privacy of health information. The four major laws that deal with employee health information are: The Americans with Disabilities Act (ADA), The Rehabilitation Act of 1973 (Rehab Act), The Family and Medical Leave Act (FMLA), and The Health Insurance Portability and Accountability Act (HIPAA). These laws are designed to allow you to keep your health information private (you throw some of that away by posting your health information all over the internet), and to prevent employers from using your health information when making decisions about hiring, firing, and promoting you. These laws are imperfect (employers with fewer that 15 employees are exempt from the ADA for example) and the waters get muddier in terms of how much information and what information to disclose if you want to take advantage of the disability accommodations associated with the ADA, or apply for leave through the FMLA. My point in mentioning these laws is to remind people that health information is important and that whether we like it or not, strangers, friends, and employers may judge us based on our health information now and in the future. If you are posting about a cold or a sprained ankle, this is unlikely to bias a future employer about your employability, but if you are chronically sick or have chronic illnesses (like asthma and ulcerative colitis) then it might be hard for a potential employer not to worry about whether or not your illness will impact your ability to perform your job, or if you’ll cost them more money than your healthier compatriates that won’t require accommodations, won’t take as many sick days, and presumably won’t need to invoke the FMLA.

I had to look into and think about all of these issues when I acquired occupational asthma. I tried to work with my employer to come up with reasonable accommodations because I *wanted* to keep working. The accommodations they came up with were minimal and not as effective as I would have hoped (they didn’t prevent me from getting sicker). The people in occupational health suggested that my best course of action would be to leave my job. I was incredibly frustrated, I was getting sick because of something someone down the hall was doing, I had no control over it, but my employer did. I looked into the FMLA trying to decide if that would help me manage my occupational exposure and my health, but ultimately I decided that the people in occupational health were right. As long as I stayed at my job there I would remain sick. In addition to the formal issues associated with health information at the work place, I also felt constant pressure from my colleagues to share more of my health information than I felt comfortable with. At one point I was accused of being a poor communicator because I was unwilling to provide as many details about my health as my peers wanted. Finally, having a boss sit you down and tell you that you need to consider yourself disabled (because of your asthma) and that you should approach your life accordingly is not even a little bit fun.

I came away from that situation resolved to prove to myself that my asthma wouldn’t prevent me from living my dreams, that I didn’t have to let my health dictate my dreams even if I did have to carefully manage my health so that I could achieve my dreams. I left the job that was killing me and my dreams to go live my dreams on the Appalachian Trail. It was the best decision that I have ever made. I managed my asthma well enough to walk 2200 miles over countless mountains and I am confident that my asthma won’t prevent me from following any of my other dreams.

Dealing with my occupational asthma made me realize how challenging it can be to manage your health and health information in a work environment. Knowing how challenging it has been to manage my own health information, I am very sensitive about how and where it is appropriate to share other people’s health information. Unless someone asks me to share their information for them, or explicitly tells me that I can share their information, then its not my place to post it online… even if its relevant to my story, to my emotional state, to my life. I will try to respect your privacy, I will try to respect the privacy of my future self, and I have dreams of a future internet where the majority of users try to do the same.

I hope and expect to have my dad home and healthy soon. As the gift giving season approaches I will try to get at least some of my gear reviews online (special review requests will be posted first), but my focus this holiday season will remain on my family and friends. On the trail my blog and the internet was the only connection I had to many of the people that I care about and love, this season I am thankful for the opportunity to connect with these people in person.

Marathon Training: A two week program?

Sometime back in June or July my brothers texted me and asked if I would be interested in running a marathon with them. Back in high school I’d been really into running and was decently good at it (my fastest time for the mile was around 5:30), but as I grew older and more and more out of shape, I’d been running less and less until I got to the point where I’d stopped running all together. A few times in the past couple of years I’d signed up for races and attempted to train for them. I ended up running all the races that I signed up for, but I failed at training for them. Between my asthma and being thoroughly out of shape, running seemed more painful than fun. I’d try to run a block or two, then I’d have to stop and try to catch my breath while fumbling for my inhaler. Sometimes I’d sit on the curb for a minute or two before slowly walking back to my apartment feeling defeated by my lungs and my body. After doing that once or twice, I’d give up on the training and just show up for the race (since I’d already paid for it) and wing it. I managed to finish all of those races, but it certainly wasn’t pretty.

The Marine Corps Marathon, which my brothers were trying to talk me into, was scheduled for October. At the time October felt like some point in a very distant future. I remembered that when I’m in shape I love running, and I figured that when I finished hiking the AT I would be in the best shape of my life. All of those things, combined with the fact that I’d always wanted to run a marathon, made it seem like a no brainer… of course I’d run the marathon with my brothers in October!

Before I knew it October was here, I’d finished hiking the AT, and I was in the best shape of my life. The only problem was that I only had two weeks to train for the upcoming marathon. According to coolrunning.com 20 weeks is a sensible training schedule for a marathon and, “You should not run a marathon unless you have at least a year of running experience behind you to prepare both mind and muscle for the miles and months of training ahead.” Well, I had at least a year of running experience behind me… way way behind me, say almost 20 years behind me. I decided that surely that still counted ;) It seemed to me that backpacking for 5 months should have trained my mind to persevere over long distances and through physical hardship, so the remaining question was how much of the training of my muscles for backpacking would overlap and translate to training for running a marathon? I wasn’t entirely sure.

From backpacking I knew that I could hike 26.2 miles, or a marathon, with a full pack in one day. I’d done that the day that I’d hiked from Boiling Springs, PA to Duncannon, PA. I also knew that with relatively good terrain I could hike 20+ miles a day at a 3-4 mph pace. How did that compare to the pace required to complete the Marine Corps Marathon? My brother had said that you had to complete the first 20 miles at a 14 minute per mile pace (~4.29 mph) and then you had to do at least 16 minute miles (3.75 mph) for the remainder of the race. Looking at it that way, it seemed entirely possible that I could finish the marathon in 6 hrs and 19 minutes, all I had to do was bump up my hiking pace just a little bit. Since I wouldn’t have a 35 lb backpack to deal with, or any mountains to climb, I hoped that that would be entirely manageable, but first I had to answer one important question: after tormenting my joints for five months on the trail, could I run at all?

When I got off of the trail my legs were a bit sore, my right knee was tempermental at best, and there was still that pesky labral tear in my hip. It was possible that my body would put up a painful protest when I attempted to speed it up and make it go for a run, but I had to start somewhere. I decided that I would try to go on some short runs first just to see how my body tolerated this whole running thing. I shied away from longer runs afraid that I might injure myself before I even got to the starting line. However, I ran into my first challenge before I even got out the door. I didn’t have any running shoes that fit me because my feet had gotten bigger as I’d hiked the trail. From past experience (the Dublin Half Marathon) I knew that it was a bad idea to run in hiking shoes (I painfully lost two toe nails figuring that out), so I borrowed a pair of my dad’s running shoes and set out for a two mile run. I started out gingerly, my knee aching a bit, and my body confused by the different mechanics involved in running compared to hiking, but eventually I hit my stride and remembered how much I enjoyed running. Being in good cardio-vascular shape and with my asthma under control it was downright fun to move through the world at 6 mph (10 minute miles). I returned home feeling somewhat reassured that I could at least run a little bit. My only complaint was that my upper body was a sore. I decided not to press my luck, so I took a day off before hitting the road again for another 2 mile run. This time I ran it at 6.67 mph (9 minute miles) and felt like I could have kept on running forever. The next day, however, my knee was sore, so I decided I better give it a little more time off to recover. It was also clear that my dad’s running sneakers were too big for me and I was going to have to get a pair of new shoes before the marathon.

Now, with a week to go before the marathon, the longest run I’d done was just two miles, and I still didn’t have a pair or running shoes that fit. I wanted to get at least one longer run in before the marathon, preferable in the new shoes that I hadn’t bought yet. Without a car, I was finding it hard to go somewhere and try on shoes to buy, and I was reluctant to buy shoes online without trying them on first. Eventually, with just days to go before the marathon, I asked my brothers which kind of running shoes they used and ordered a pair online. They would arrive the day before I flew into Washington DC for the marathon. In the meantime I decided I better get in my long run, a 4 mile run, before they arrived. I breezed through my 4 mile run with a 9 minute mile pace and once again felt like I could have gone on forever. If I ran the first 5 miles of the race at that pace, I would build up a buffer of 25 minutes and could walk the rest of the race at 4 mph (15 minute miles) and finish before the marathon cutoff times. It might not be pretty, but I was hopeful that I’d at least be able to finish the marathon.

It was time to pack my bags and hope that my hasty two week training plan would be enough this time. I went to the closet and pulled out a small duffel bag since I only had to bring a few things and didn’t want to have to pay to check any luggage. I was going to go to Boston, then fly to DC, and then fly from there to Florida for a much needed vacation after the marathon. It felt strange to be packing a duffel bag instead of my backpack. There was no reason to pack a sleeping bag or my tent. Suddenly I was having separation anxiety about leaving my pack behind. Even though I hadn’t used my backpack in a couple of weeks, I always knew it was right there… Ready for me to grab it and disappear into the woods at a moments notice. I hadn’t realized that I’d been using its presence as a security blanket as I continued to try to adapt to the post trail life.

This was it though, I was leaving my security blanket, heading into the city for the first time since April or May, and embarking on my next adventure: Running the Marine Corps Marathon!

Inhaler Physics (AT Days 64 & 65)

The skies opened up once again and began dumping rain on me at 1-2 inches and hour. I sighed and resigned myself to getting soaking wet again… The same thing had happened yesterday and the day before. Today, however, I only had two miles of hiking left and then I was headed into town to a nice dry hostel.

Even though I’d resigned myself to getting wet, the thunder, lightning, and really heavy rain weren’t making it the most enjoyable of experiences. I was hiking at about 2 miles/hr so I figured I only had about an hour of uphill in the rain to go. Suddenly I had an epiphany, if I jogged I could be out of the rain in 30 minutes or less… That would be much better than hiking in the nasty nasty weather for an hour!

I tightened the straps of my pack and with water streaming down from the sky and through the trail I started running. It felt good to stretch out my stride and navigate around the rocks and roots.

Not long after initiating this plan the slope of the uphill increased and I realized that I’d forgotten something. I’d forgotten that I have asthma. Doh! I stopped running, pulled out my rescue inhaler (which I always keep handy), and almost hungrily inhaled the medicine that would make it so that I could breath comfortably again.

However, instead of getting the usual easing of my breath as my chest opens up and my lungs full with air, I felt a caustic burning of my throat and lungs and if anything it felt like my lungs constricted even more.

Shocked and confused and now definitely having an asthma attack I looked accusingly at my inhaler. Had I
Accidentally grabbed my pepper spray instead? No, it was definitely my inhaler that I held in my hand. Perhaps it had gotten some sort of particulate in/on it that I had just accidentally propelled into my lungs (everything gets dirty when you’re backpacking). I carefully wiped off the mouthpiece inside and out and took a second puff of the inhaler sure that I’d fixed the problem and would soon be breathing easy again.

F***!!!! Burning, searing, pain as my lungs really ceased up. I threw my inhaler onto the ground; I threw my backpack onto the ground; I threw myself onto the ground. Stupid inhaler, why was it hurting instead of helping?! For the moment I didn’t care. I closed my eyes, leaned forward onto my knees and focused on breathing… It was starting to work, but I was still coughing and feeling short of breath. I reached over and grabbed my water. It soothed my throat and after a couple of minutes I’d stopped coughing.

I was still short of breath, but at least I could think again. What the heck had happened with my inhaler? I remembered the trouble I’d had with my inhaler at the ice hotel in Quebec City over the weekend. It was so cold outside that the inhaler wasn’t working… A common problem with canisters of compressed gases at low temperatures… And suddenly I was thinking about the ideal gas law (PV=nrT), and the compressibility of gases, and thermodynamics.

Was my inhaler acting up because of the weather? It was around 90 degrees out, 100% humidity, plus a low pressure system with a severe thunderstorm raining 2 inches/hr on me. I decided that somehow I must be having the opposite problem from Quebec City, that the compressed gas from the inhaler was still rapidly expanding as it hit the tissue of my throat and lungs. Since the expansion of gas is endothermic, that could essentially burn my throat and lungs with intense cold.

I had a hypothesis… Could I test it? Hmmm… I reached over and picked up my inhaler, which was still sitting in the middle of the trail where I’d thrown it in frustration and anger, and looked at it for a minute. My hypothesis was that the weather conditions were causing the compressed gas in the inhaler to expand over a larger area than usually, so that a noticeable endothermic reaction was still occurring as that compressed air hit my lungs. Based on that hypothesis I would predict noticeable plume as the inhaler was puffed into the open air around me instead of into my lungs.

I pointed the inhaler away from me and delivered a puff over the trail. It looked liked the white plume of breath that you see when someone exhales moist air on a cold winters day… Except that it actually had a propellant, so the plume extended out for about 3 feet.

I was still short of breath, so now I needed a plan. How to get the drugs from my inhaler into my lungs without giving them frostbite? I decided to use my hand as a spacer tube, hoping it would allow the gases to expand in my hand and not my lungs, while still directing the medication into my lungs.

With some trepidation, I squeezed down on the inhaler and inhaled (rather cautiously this time). It worked!!! No horrible burning sensation, and my lungs started to open up. I took a second puff the same way, and my breathing returned to normal.

Now I *really* was drenched. The rain kept pouring down as I walked the rest of the way to the road. I made it in 45 minutes.

Extra credit assignment: Demonstrate mathematically the crucial parameter/s (was it the humidity? the thunderstorm? or a combination of the humidity, thunderstorm, and temperature?) that led to the inhaler doing more harm than good. If I were at home I would have modeled this already and figured out the critical parameters both for this story and for the ice hotel… I miss having pencil, paper, and the easy ability to look things up and research them!