[pct-l] Some Lessons Learned the Hard Way

[Don Billings]

Dave,

I didn't read all the details you posted but I read enough to see how serious 
the trouble was.

I picked up a nasty case of celluitis once which I think started with a tiny 
blister on
one of my toes. Before I knew it, my foot & leg was swollen almost up to the 
knee and I
experience great pain upon placing weight on it. I was treated with oral 
antibiotics on
an outpatient basis so it didn't make it to the IV antibiotics, but I didn't 
realize how close I came to the
troubles you described. A friend of mine kept saying, "you might lose your 
foot!"

Don



----- Original Message ----
From: david woods <dkwoods33 at gmail.com>
To: ned at mountaineducation.org
Cc: PCT MailingList <pct-l at backcountry.net>
Sent: Wed, August 25, 2010 2:27:00 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 <dkwoods33 at gmail.com>
> *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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