[pct-l] Some Lessons Learned the Hard Way

[david woods]

Dan's oldest sister who researched all this tells us there is a very
specific antibiotic used for spider bites. Of course one of the first
questions he was asked in the ER was if he had had any insect or spider
bites.

On Wed, Aug 25, 2010 at 4:14 PM, <ned at mountaineducation.org> wrote:

>
> 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 <dkwoods33 at gmail.com>
> *To:* ned at mountaineducation.org
> *Cc:* PCT MailingList <pct-l at backcountry.net>
> *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 <dkwoods33 at gmail.com>
>> *To:* ned at mountaineducation.org
>>   *Cc:* PCT MailingList <pct-l at backcountry.net>
>> *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 <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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>>>
>>
>