Backpacking Science and Privilege: Food

On long-distance backpacking trips we don’t take the same things for granted that we do at home and as a result we can gain some insights into our privilege and how it affects the way we hike our hikes, and pack our packs. In this series of three posts I’m going to talk about how science and privilege influence the way I pack my pack. Using science as my guide, I’m going to break the discussion into three parts (requirements for physiological homeostasis in the wilderness):

  1. Food: Our ability to regulate blood sugar levels (glycoregulation).
  2. Water: Our ability to regulate water and minerals (osmoregulation).
  3. Shelter/Heat: Our ability to regulate body temperature (thermoregulation).

Continue reading

Complications: The 0.1%

Before the trail even ended, I was already starting to miss it. I was almost reluctant to finish up the 100 mile wilderness and to summit Mt. Katahdin because it would mean that my amazing adventure and awesome thru-hike of the Appalachian Trail was done. Then again, I was cold and hungry, and I missed my family, my friends, indoor plumbing, buildings with four walls and heat, and all of the tasty tasty food associated with civilization.

As I got into the car with my mom to leave the mountains and head home, I was in a state of shock. It was over. I had hiked the entire Appalachian Trail from Georgia to Maine and was officially a thru-hiker. I was awash in the sights, the sounds, the foods, and the people of civilization, and it was overwhelming. Most people take some time to get used to all of this and transition from their carefree (only concerned about their own survival) life on the trail to the stresses and demands of modern society where there are a myriad of things that are constantly competing for our attention.

Per usual, I found myself taking the crash course… I went from hiking the trail one minute to sitting in the hospital reviewing CT scans and consulting with my fathers surgeon the next minute. The minor issue that had landed my dad in the hospital as I headed into the 100 mile wilderness had gotten complicated… complicated enough that when I researched it I was only able to find a couple of cases similar to his in the literature. Research was what I did for a living before I headed off on my Appalachian Trail adventures and now, less than 24 hrs after I summitted Katahdin, I had unlimited access to high-speed internet and was researching my dads condition. It felt good to be learning and using my brain in ways that I hadn’t been using it for a long time, I just wished that the circumstances had felt less dire.

I remembered a lot about my dad’s general condition from some courses that I’d taken at Harvard Medical School, but now I became a self-proclaimed expert in all of the nuances of his particular complications and his particular case. By all accounts he should have been getting better and improving day by day, but instead he was slowly getting worse. Why?! With my dad’s permission I reviewed his CT Scans, his medical history, his current lab reports, and his current medications before delving into the literature. I was determined to solve this medical mystery and to save my dad!

It wasn’t until the wee hours of the morning that I finally figured out a potential reason why he wasn’t getting better. They had told us that the IV antibiotic that he was on was the ‘top gun. It was the newest, latest, and greatest antibiotic out there and there wasn’t anything better, stronger or more effective out there. Normally, roughly 99.9% of the time, that would be true for people with my dad’s condition, but things with my dad had gotten complicated. It’s not always good to be different and unique, he was the 0.1%, and they were wrong. The fancy new antibiotic that they were using was the only antibiotic in it’s class that the literature said would be completely ineffective when it came to treating my dad’s case.

I knew that my dad’s case was unusual and complicated, but was it possible that a simple misstep in the choice of antibiotic was responsible for his deteriorating condition? The more I looked into it the clearer it became… it was not only possible, but probable. When I returned to the hospital the next day I double-checked the antibiotic hanging from my dad’s IV pole, it was as I remembered and was definitely the wrong antibiotic. We paged the nurse and told her that we wanted to talk to the doctor as soon as possible and then we waited… and waited… and waited for the doctor to come and speak to us.

Waiting for the doctor to come and help ease the suffering of someone you care about is almost impossibly hard. In my experience pain does not breed patience, and if someone I know and care about is in pain I want to fix it and I want to fix it NOW! Unfortunately the doctors usually have at least a dozen other patients that are all looking to him/her to ease their suffering, so we had to wait our turn.

The surgeon was the first doctor to wander into the room. He came to tell us some good news, whatever was going on with dad, it wasn’t going to require surgical intervention. Since he was there I told him my thoughts about the antibiotic. He was willing to discuss it with me, but he said that the hospitalist was the person in charge of that aspect of my dad’s care. He and I looked through my dads chart again and verified that I was right, the IV antibiotic they were giving my dad was not not the right one for his infection. The surgeon offered to back me up, and then helped me get a hold of the hospitalist.

We found the hospitalist and before long the hospitalist and I were having a high level discussion about the nuances of each antibiotic in the class of antibiotics that my dad was taking. The hospitalist insisted that the antibiotic that was hanging was the correct antibiotic for my dad. I was frustrated, but I understand where the hospitalists was coming from. The antibiotic he was using was from the right class of antibiotics, and under normal circumstances it would be the right antibiotic, in fact in 99.9% of cases it would be right, but my dads lab reports showed that his case was different and in his anomalous case that antibiotic was ineffective. It was becoming obvious (both to me, my dad, the hospitalist, and the surgeon) that I knew a lot more about this class of antibiotics and this antibiotic in particular than the hospitalist did. This wasn’t at all fair to him since I only had one case that I needed to be an expert on and I had just reviewed all of the information about my dads case and all of the antibiotics in question the night before. I understood that this was an unusual case, I just wanted it to get fixed and wanted my dad to get better. Eventually the hospitalist switched tactics, hedged his bets, and reluctantly agreed to look into it the nuances of the antibiotics that we were discussing. I had made my point and then some, and though I didn’t think he was handling things with as much grace as I had hoped, I did have the feeling that he was going to go look into the antibiotics issue as soon as he left the room. At that point we quickly wrapped up our conversation, and the hospitalist left (hopefully to go look up the damn antibiotics).

After the doctor left, my dad squeezed my hand and said, “I thought that you handled that well.” I looked at him with confusion, “What do you mean?” “Well, you didn’t get angry, you didn’t call him an idiot, and you gave him a way to save face. Not everybody would have handled it that way.” I wasn’t so sure, the wrong antibiotic was still hanging, and my dad was still sick.

20 minutes later (lightening speed by hospital standards) the nurse came in and switched my dad’s antibiotic from the ineffective one to the one that I had suggested. Would that be enough to turn the tides and set him back on the path to recovery?

The short answer was yes, within 24 hours both quantitative and qualitative measures showed that my dad was getting better, but the complications didn’t end there. To our surprise when the weekend shift came on we had a new hospitalist, and a new plan of care. They were going to send my dad home that day, and even more surprisingly, they were going to send him home without any antibiotics at all! (I could only assume that the insurance company and the hospitalist that came in over the weekend didn’t realize that dad had only been on the effective antibiotics for 24 hours, they just saw that he’d been on antibiotics for over a week and was doing better now). I was skeptical (at best) about this course of action, but I hoped that I was wrong and that all would be well. Unfortunately, I was right and in less than a week dad was back in the hospital and undergoing emergency surgery. That should have been the end of it, but once again my dad was special. He was the 0.1% and ended up having complications from the surgery. As soon as they started getting those complications under control they decided to send him home again.

I was skeptical. Sure he was improving, but he’d undergone some major interventions just the day before and I wasn’t convinced that he had really stabilized, but they assured us that he would be fine. Once again, within a week we had to bring dad back to the hospital where he was readmitted and put under the knife. You’d think that that would be the end of it, but no, dad ended up having complications from this surgery too. We were now dealing with layer upon layer upon layer of complications. I was definitely getting very, very tired of complications, but sometimes the road is long and arduous, and there were still a couple more complications that were going to crop up before they finally released dad from the hospital for what we hope was the last time.

Instead of getting off of the trail and focusing on me and what I was going to do next, I was completely occupied with advocating and caring for my dad. I felt very lucky to get to spend this time with my parents, though the circumstances were far from ideal, but now that dad is starting to improve again, it’s time to start thinking about what’s next for me again.

As the days since Katahdin have turned into weeks and months, I find myself missing the trail more and more. I miss the simple sense of purpose that hiking the trail gives me, I miss knowing that I am going to wake up every morning and do something that I love… I miss walking. Life on the trail was simple, it was beautiful, and I loved it.

So, what do I want to do next? The answer is obvious, I want to return to the woods, I want to explore, I want to wake up every morning and walk. I’ve decided that I am going to continue to follow my dreams, which for now means heading west to the Pacific Crest Trail (PCT) this spring to embark upon a new adventure!

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.

Hungry hungry hikers (500 miles to go)

I was looking back at my old posts and saw The Hunger. Back at Day 22 & 23 I thought I was hungry. I had to laugh, I had no idea what hunger felt like then. Sure, I may have thought I was hungry, but it wasn’t the kind of all consuming thought removing hunger that was to come later. The kind of hunger that demands your attention and starts making your decisions for you.

Hiking 20 miles a day through the mountains with a full pack means that we are burning lots and lots of calories, probably 8000 to 10000 calories a day. The reason why thru-hikers are hungry all the time (and why we keep losing weight) is because most of us are only able to carry about 2500 calories of food for each day. That means that all of us are working with at least a 5000 calorie per day deficit. We try to make up for some of those deficits by going into town and eating as much as we can in town, but it’s not enough.

When I started the trail I weighed 185 lbs and was wearing women’s snug size 14. By day 22-23 those pants were falling off of me. When I got to mile 500 I weighed about 155 lbs and bought myself a new pair of pants (size 8). I don’t know what I weigh right now, but with 500 miles to go those size 8 pants are falling off of me.

20130902-103225.jpg

Size 4 pants and shorts are the ones that fit me now. I’ve dropped 10 pant sizes since I started this trip and I’m back to weighing what I weighed when I was in high school. When I catch a glance of myself in mirrors I barely recognize the person I see there.

Thru-hikers tend to be very calorie conscious… We’re counting calories to make sure that we get as many as we can. As a rule we try not to put anything into our packs that is less than 100 calories/ounce. For breakfast I eat a meal replacement protein bar (~400 calories), a cheese wedge (~120 calories), and have some shot blocks (~200 calories). For lunch I eat 3 more cheese wedges (~360 calories), 4 fruit roll ups (~400 calories), another protein bar (~200 calories) and another shot blocks (~200 calories). For dinner I usually have a mountain house meal (~800 calories) and tuna fish in olive oil (~190 calories). All of these calories are heavy and after I resupply I tend to be carrying about 10 lbs of food.

One of the best things the trail angels do for us is to give us food, or leave trail magic food and sodas at places where the trail crosses the road. After a long day of hiking, finding a trail magic cooler full of food at a road crossing is truly magical! Fresh fruit, vegetables, and snacks… Beautiful beautiful calories. It is sometimes enough to bring tears to our eyes.

My mom and my grandma are some of my favorite trail angels. They make me my favorite meals and snacks and try to keep my calorie counts up. It is truly a joy to be able to eat so many of my grandmother’s homemade doughnuts!

20130902-161534.jpg

Earning My Name (Days 53-55)

20130704-210726.jpg

Patches. That’s the theme for this post. Patches of fog on the trail, patches of rain, patches of thunderstorms, and white patches on my throat (uvula and soft palette).

I’ve been feeling draggy and have been struggling with a sore throat for a few days, but had assumed that it was just allergies (probably from dealing with all of those dogs). When I got into town I spotted a mirror and pulled out my headlamp to take a peek at my throat. Sure enough, it was covered with white patches. The white patches meant one of two things: strep throat or thrush. Either way, I was going to have to take a day off of the trail and go to the doctors.

What do you do when you’re on the trail and need to see a doctor? You wander into the nearest clinic.

20130704-214212.jpg

So I wandered into the clinic and got checked out by an M.D. It turns out that the pretty, lacy white patches that were making my throat bleed were from thrush, which is a pretty common side effect from the daily use of my asthma meds (inhaled corticosteroids) in the backcountry. The doctor prescribed a nystatin mouthwash (which is annoyingly heavy for backpacking) and gave me a prescription for some systemic meds in case the mouthwash doesn’t eradicate those nasty white patches. I’m happy that my asthma is under control enough that the side effects of the asthma are worse than the asthma itself.

While I was there I also had the doc look at the patches of rash that have
developed all over my legs, hips, butt, and thighs in this hot, humid, and very wet weather. The doc determined that it was folliculitis and prescribed me some antibiotics for it after making sure I was doing everything else correctly first.