[pct-l] Some Lessons Learned the Hard Way
ned at mountaineducation.org
ned at mountaineducation.org
Wed Aug 25 18:14:55 CDT 2010
Dave,
I used to be a Paramedic for a few years back in the '80s and saw and learned quite a bit about the human body in crisis, yet I was unprepared to deal on-trail with an infection that came from a simple spider bite! Though I carried a topical antibiotic, it wasn't the right one, I let it go too long, and it spread to a swollen leg up to my knee. This happened in Cedar Grove, KCNP, while I was waiting for a resupply to be driven in to me on my pct thru in 1974, and after a bear had disemboweled my pack one night. A spider had crawled into my sleeping bag through the open door of my North Face Mountain Tent during the day while I was sewing up the pack at my campsite picnic table. It bit me while I slept, I rubbed it with my other dirty foot and got it infected. Whether my infection was due to the bite, opening the wound and contaminating it by rubbing it with my dirty foot, or both, I still don't know.
That and a scorpion incident when I was younger is why we promote sleeping in tents with the doors closed. (I'm not a bug fan...)
Ned Tibbits, Director
Mountain Education
1106A Ski Run Blvd
South Lake Tahoe, Ca. 96150
P: 888-996-8333
F: 530-541-1456
C: 530-721-1551
http://www.mountaineducation.org
----- Original Message -----
From: david woods
To: ned at mountaineducation.org
Cc: PCT MailingList
Sent: Wednesday, August 25, 2010 3:31 PM
Subject: Re: [pct-l] Some Lessons Learned the Hard Way
His hospital Doc told him his lymph system was involved. A friend who is a PA said it sounded like "Lymphedema" to her. It is all Greek to me.
On Wed, Aug 25, 2010 at 3:03 PM, <ned at mountaineducation.org> wrote:
David,
Sounds like your son, Dan, did exactly the right thing and wasn't careless or unwise at all. Like you said, from now on he will be all the more wise and careful regarding his on-trail treatment of future blisters. Thankfully, he was able to get off the trail and find (with your help) medical aid before things could get worse. I had no idea cellulites could be so bad!
Halfmile pointed out that "Sandals" suffered a very similar experience:
http://trailjournals.com/entry.cfm?id=188333
Ned Tibbits, Director
Mountain Education
1106A Ski Run Blvd
South Lake Tahoe, Ca. 96150
P: 888-996-8333
F: 530-541-1456
C: 530-721-1551
http://www.mountaineducation.org
----- Original Message -----
From: david woods
To: ned at mountaineducation.org
Cc: PCT MailingList
Sent: Wednesday, August 25, 2010 2:27 PM
Subject: Re: [pct-l] Some Lessons Learned the Hard Way
I do not want to get too defensive here but I will say that Dan has walked almost 6K miles on the trail including a supported 90 day thru hike last year and this is his first problem. Of course your first problem can be your last but I would not describe him as careless or unwise. In retrospect he was probably a bit careless and unwise about his blistered heel but based on past experience he thought he was doing OK with it at the time. He was wise enough to stop walking as soon as he saw what was going on and that is why he never got to the point of septic shock or a bone infection both of which are much nastier than Cellulitis.
On Wed, Aug 25, 2010 at 11:45 AM, <ned at mountaineducation.org> wrote:
Dave,
Yes, confidence can come with experience, but without wisdom it leads to the carelessness you refer to. This ordeal, this experience, will have added that wisdom to his quiver and he'll be the safer for it.
That is why we try to encourage all wilderness travelers through our "Hands-On" school's courses to "Get Experience" by going out there and applying whatever Understanding they may have, perhaps only acquired thru the reading of Trail Journals, cautiously and slowly at first to find out for themselves the wisdom in each thing they do (and not do) and situation they encounter in order for it to be realized and cemented-in. That is why we talk to the thrus at the Kickoff about the realities ahead of snow and the challenges it will demand of them.
Dehydration is very common in the snow at altitude whether the sun is out or not. Infection, even when from a spider bite which sent me to the hospital on my PCT thru in 1974, is something not to be disregarded or trivialized when you're way back in the backcountry.
However, most thru hikers, unfortunately, romanticize the dream, do not have the requisite experience going into it to know the realities of the trail ahead and, therefore, how to plan and prepare for it (meaning both what "works for them," i.e., what to bring and why, borne out of on-trail trial and testing, and what skills they need to have to get through safely), and often hastily and blindly invest a lot of time and money that leads them to the first few weeks on the trail that become so hard--and many are forced to leave the dream for awhile until they "get wisdom" enough to try it again.
I'm sure your son did and will!
Ned Tibbits, Director
Mountain Education
1106A Ski Run Blvd
South Lake Tahoe, Ca. 96150
P: 888-996-8333
F: 530-541-1456
C: 530-721-1551
http://www.mountaineducation.org
----- Original Message -----
From: david woods
To: ned at mountaineducation.org
Sent: Tuesday, August 24, 2010 7:13 PM
Subject: Re: [pct-l] Some Lessons Learned the Hard Way
Ned,
Yes you may use our story. If it keeps this from happening to one person it is worth it.
1. He did not have septic shock nor did it get into the bone. It was confined to his skin and lymph system. He was lucky in that regard.
2. It seems most probable to me that it came through the blister but that is just my opinion. I do not understand the mechanism by which the gut can leak but the colon has large blood vessels close to the surface which are used to remove water from the feces so it may not take much of an injury to allow a leak. Perhaps dehydration allows stools to stick a bit and tear the tissue a when they finally move. You will have to ask a doctor to get more than my uneducated guess.
3. He was wearing the standard thru hike footwear, low cut trail running shoes (Montrail Hardrock) and black nylon dress socks. Since 2005 he has hiked over 5000 miles on the PCT including one successful 89.5 day thru hike in 2009 using the same kind of footwear. This is his first problem. Is he getting more confident and hence careless about blisters and water? Did he just get unlucky and step in the wrong place? Who can say BUT I will bet he will not ignore a blister and hopefully his water supply in the future.
Dave
On Tue, Aug 24, 2010 at 11:07 AM, <ned at mountaineducation.org> wrote:
Hi, David!
We're so sorry to hear of your ordeal, but we're glad that you were directed to the right end.
Since we teach our students that planning and preparation for the realities of the trail can make their trips safer and more fun, would you be willing to let us repeat the description of your son's lesson in dehydration and septic shock?
Sounds like the Docs weren't too sure how the infection found its way in, either via the blister (open wound) or the intestine. How does the intestine rupture based on dehydration? What type of shoes was your son wearing such that they allowed animal feces inside to contaminate the blister?
Any info you pass on to our school will be used to help future students learn of and avoid the circumstances that led to your son's illness.
Thanks so much for your time on this; I'm sure you have lots of other things to do...
Ned Tibbits, Director
Mountain Education
1106A Ski Run Blvd
South Lake Tahoe, Ca. 96150
P: 888-996-8333
F: 530-541-1456
C: 530-721-1551
http://www.mountaineducation.org
----- Original Message ----- From: "david woods" <dkwoods33 at gmail.com>
To: <pct-l at backcountry.net>
Sent: Monday, August 23, 2010 5:19 PM
Subject: [pct-l] Some Lessons Learned the Hard Way
This is a cautionary tale for all hikers and especially the long distance
type.
My son, Dan, set out from Mount Ashland in OR on the afternoon of July 25,
2010, on a PCT section hike to Whitney Portal. I was playing the support
role meeting him at roads with supplies, etc.
On Tuesday afternoon, August 10, I was waiting for him at Packer Saddle just
north of Sierra Buttes and above Sierra City (no cell signal). I was
expecting him in the evening and was reading when a car pulled in next to
me. I was in a very peaceful place and was a bit annoyed that the car had
parked so close to me. I glanced over and the driver, a woman who said, “I
have your son.” At first it did not register then he got out of her car and
showed me his left ankle, which was the close to the size of a football. The
swelling was also part way up his shin. This was the first act of a 12-day
adventure nobody wishes or needs to repeat.
He had left Beldon Town late in the afternoon of the 8th and had walked 45
miles to Quincy-La Porte Road on the 9th to be sure of making our rendezvous
the next day. When he woke up on the 10th his ankle was swollen and he could
not walk well enough to continue. He also had a raw blister on his heel. He
was able to hitch to Quincy then to Highway 49 where the woman who delivered
him to Packer Saddle picked him up. She is a PCT hiker and was willing to go
way out of her way to bring him up to me in the boonies. Thank you whom ever
you are.
The woman told us there is a clinic in Graeagle and hospitals in Quincy and
Portola. At this point we thought he would take a few antibiotics for a few
days and then we would resume the hike so we headed for the closest place,
Graeagle. The nurses there took one look at his ankle and heel and told us
to go to the emergency room in Portola which was only 10 miles away. The
doctor there ordered an ultra sound to check for clotting and gave him a
dose of two antibiotics and a dose to take in the morning and a prescription
for a 10 day supply and sent us on our way with instructions to come back if
the swelling spread, etc.
After checking out the motels in town we decided to go to Reno to get a
better rate on a better room. We checked into the Motel6 near downtown and
waited for the antibiotics to kick in. This was Tuesday evening. By
Wednesday evening the swelling was above his knee and he was experiencing
vomiting and diarrhea (probably an allergic reaction to one of the
antibiotics). His oldest sister who I was in touch with by phone wanted me
to take him to the ER then. He wanted to wait to give the antibiotics a
chance to work. He woke up at 3:00 Thursday morning and was sick enough to
want to go to the ER so we looked on the web (thank goodness for cell phones
and laptop computers) and found the nearest hospital which is St. Mary’s and
is about a mile from the motel.
Within an hour of arriving at the hospital he was in the ER on IV
antibiotics, had had an X-ray and blood drawn for culture. Later in the day
he was admitted to the hospital and had an MRI. To make a long story a bit
shorter, he was in the hospital 9 ½ days during which time the swelling
progressed as far as his armpit and out onto his rib cage. He had surgery on
his heel and was infused with many doses of several different antibiotics,
first generics then “designer”. He is now at home taking expensive oral
antibiotics for 2 weeks. Of course this all scared the heck out of his
family and the bill is sure to be a thing of beauty.
A doctor friend of Dan’s sister told her that this type of infection can
result from the bacteria (Enterococcus) leaking from one’s own gut due to
constipation and/or dehydration. Of course walking in animal or human poo
with an open wound is also a possibility.
Dan had at least 2 instances of walking long distances with no water on this
hike. He also had an untreated or marginally treated blister for 1-2 weeks
(we cannot agree on when it first appeared).
The moral is to take care of your blisters, drink plenty of water, even if
you have to go off trail to get it, and make your diet as fiber rich as
possible. This party had a happy ending but it could just as well have gone
the other direction. We are all very glad it did not.
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