Wednesday, April 15, 2015

That Dreaded Giardia


As a ridgerunner, I've dealt with several cases of hikers unknowingly infected with giardia while on their long distance hike of the Appalachian Trail. You can bet it did not add to their experience to be waylaid by constant "runs". Below is an interesting scientific summary of this illness and its cause and treatment, written by SOLO Wilderness Medicine. SOLO is a terrific resource for all manner of health issues that can affect outdoor enthusiasts. I encourage you to receive their monthly e-mail newsletter and even consider taking a course sponsored by them. Check out also my previous blog on water purification methods when in the wilderness.

Even pristine water sources can still contain harmful microbes that cause illness


GIARDIASIS & DIARRHEA

Double-trouble for the gut
Giardia lamblia (Giardia lamblia) is a flagellated protozoan parasite that infects the small intestine causing diarrhea, bloating, and bad gas. People contract giardia when they consume contaminated food or water.

Giardia has a very simple life cycle. The dormant giardia cyst, ingested along with contaminated food or water, makes its home in the small intestine where the cyst hatches and changes into a trophozoite. (The trophozoites cause the illness-the un-hatched cysts do not.) The trophozoites then reproduce by binary fission (cell division) and the population grows. 

Utilizing a suction disk, the trophozoites anchor themselves onto the wall of the small intestine. They absorb nutrients from within the lumen of the small intestine. Interestingly, they do not feed on, or harm, the cells lining the small intestine. However, as the population increases, the trophozoites spread out across the surface of the small intestine and effectively block the absorption of nutrients out of the intestine. When this occurs, the body tries to rid itself of the parasite by rinsing it out, thus causing the primary symptom of giardiasis-diarrhea.

Giardia is the most common protozoal infection of the human intestine
         It is the most common cause of epidemic and endemic diarrheal illness in the world.
         It is estimated that one out of six people have giardiasis worldwide.
         It is estimated that 50 percent of individuals with giardiasis are asymptomatic.
         The most common symptom of giardiasis is acute, watery diarrhea.
         It is usually a self-limiting disease.
         Death is extremely rare, usually occurring only in malnourished children.
         Consumption of contaminated food or water is the main way that giardiasis is spread.

Etiology (cause) of giardiasis
Giardiasis is caused by consuming food or water that has been contaminated with the giardia cyst. Once the cyst is ingested, it changes into the infectious trophozoite form that begins to reproduce and populate the lumen of the small intestine. This process of reproduction delays the onset of symptoms by 14 - 21 days.

The symptoms of giardiasis are caused by the proliferation and colonization of the lumen of the small intestine by trophozoites. As their population increases, the body's primary protective mechanism to rid itself of the parasite is a mechanical attempt to flush the parasite out via diarrhea. Symptoms include (in order of frequency):

                          Diarrhea
                          Malaise
                          Excessive gas (often a foul-tasting and smelly sulfuric flatulence, or belching)
                          Steatorrhea (pale, foul-smelling, greasy stools)
                          Epigastric pain
                          Bloating
                          Nausea
                          Anorexia (loss of appetite)
                          Nausea
                          Vomiting (rare)

Diagnosis of giardiasis
Diagnosis can by made by taking a patient history, determining potential exposure, and observing the clinical symptoms of acute, watery diarrhea and smelly gas.
Diagnosis is confirmed when microscopic examination of the patient's stool reveals cysts or trophozoites.
Diagnosis is also confirmed when an antigen test of the stool detects giardiasis. 

Treatment of giardiasis
metronidazole (Flagyl) 250mg po tid for 5 days, or
tinidazole (Tindamax) 2g po once with food, or
furazolidone (Furoxone) 100mg po qid for 7 days. (This is typically used for treating children, as it is available in a liquid suspension.) The pediatric dose is 25 - 50mg po qid for 7 days, or
nitazoxanide (Alinia) 500mg po bid for 3 days

This Medical Tidbits article was first published as part of a larger article from the Wilderness Medicine Newsletter Volume 21 Number 5, September/October 2008

Tuesday, April 07, 2015

Plan Ahead and Prepare for that Trip!

The spring and summer hiking season is gearing up and with that comes the excitement of a backpacking trip. But every year hikers go out having failed to plan and prepare for their trip They end up miserable, possibly in danger, or having to end the journey prematurely. Because of it, they lacked what was needed to help ensure a timely and safe hike.


With that in mind, I have taken principles from the Leave No Trace web site to help illustrate some good ideas when deciding on a hiking trip. Plus I add a few of my own.  

"Adequate trip planning and preparation helps backcountry travelers accomplish trip goals safely and enjoyably, while simultaneously minimizing damage to the land.

PRE-TRIP PLANNING
Poor planning often results in miserable campers and damage to natural and cultural resources. Rangers often tell stories of campers they have encountered who, because of poor planning and unexpected conditions, degrade backcountry resources and put themselves at risk.

WHY IS TRIP PLANNING IMPORTANT?
You may want to create additional answers for this list:
  • It helps ensure the safety of groups and individuals.
  • It prepares you to Leave No Trace and minimizes resource damage.
  • It contributes to accomplishing trip goals safely and enjoyably.
  • It increases self-confidence and opportunities for learning more about nature.

SEVEN ELEMENTS TO CONSIDER WHEN PLANNING A TRIP

  • Identify the goals (expectations) of your trip.
  • Identify the skill and ability of trip participants.
  • Select destinations that match your goals, skills, and abilities.
  • Gain knowledge of the area you plan to visit from land managers, maps, literature and online resources.
  • Choose equipment and clothing for comfort, safety, and Leave No Trace qualities.
  • Plan trip activities to match your goals, skills, and abilities.
  • Evaluate your trip upon return note changes you will make next time.
CONSIDER Also:
  • Weather
  • Terrain
  • Regulations/restrictions (permits, camping areas, fires)
  • Private land boundaries
  • Average hiking speed of group and anticipated food consumption
  • Group size (does it meet regulations, trip purpose and Leave No Trace criteria?)
Meals are another element to trip planning that can have a profound effect on the impact a group has on a backcountry area.

Benefits of Good Meal Planning:



  • Reduced trash.
  • Reduced pack weight, resulting in faster hiking times and less fatigue.
  • Reduced dependence upon campfires for cooking.
  • One-Pot Meals and Food Repackaging

Planning for one-pot meals and light weight snacks requires a minimum of packing and preparation time, lightens loads and decreases garbage. One-pot meals require minimal cooking utensils and eliminate the need for a campfire. Two backpack stoves can be used to cook all meals for large groups if you have two large pots (one large pot can be balanced on two stoves when quick heating is desired). Don't rely on campfire cooking (and please, do not make aluminum foil HOBO meals. I have seen too much foil left in campfire rings). Most food should be removed from its commercial packing and placed in sealable bags before packing your backpacks. Sealable bags (like ziploc bags) secure food and reduce bulk and garbage. Empty bags can be placed inside each other and packed out. This method can reduce the amount of garbage you must pack out at the end of the trip and eliminate the undesirable need of burying unwanted trash or burning it in a campfire (NEVER burn your trash!)"


Other things to consider. It's important to know before you go. Know where you are going. Know your physical limits, especially as you are carrying a backpack over uneven terrain. Bring maps, compass, guidebooks of the area you plan to hike. There are map apps for your phone. In some areas it's good to have a GPS device. Familiarize yourself with the area. Bring a cell phone for emergencies. Know first aid and what to do in an emergency, for unplanned weather, or if you are injured. Bring adequate clothing and equipment like a good tent (don't rely on trail shelters) and water purification. Always pack an extra day of food in case you must stay for an extra  day because of bad weather. Don't rely on fires to keep you warm but have a good sleeping bag and warm weather clothing like merino wool underwear, an insulated jacket, a hat, and rain gear. Be sure to keep your sleeping bag and clothing dry at all costs.

Don't let poor planning and preparation ruin your dream.  


Monday, March 30, 2015

First Aid Tips for Your Dog on a Hike

Dogs, like people, can have issues on the trail requring some canine "first aid". Check out these great tips offered by the makers of Kriser for keeping your pet happy and healthy trailside. Above all, the best remedy to avoid many of these issues is to keep your pet on a leash at all times (and trails through many areas require this, so check ahead of time).

Our Australian Shepherd "Katie" enjoys Shenandoah National Park

To ensure you and your dog have a safe trek on the trails, Brad Kriser, healthy pet expert and owner of Kriser’s, a multi-unit retailer specializing in all-natural pet food and supplies, offers the following advice on what to do—and what to bring— in case your dog does one of the following:

·         Ingests harmful water – Lake, pond or stream water can be toxic to your dog if ingested. In some cases, it creates Giardia—an infection in the small intestines. If your dog drinks contaminated water, give him treated, fresh water to try to flush his system. If symptoms occur, such as diarrhea, abdominal pain or fatigue, visit a vet for additional treatment.

·         Injures a paw – If you discover a cut on your dog’s paws, soak the paw in sea-salt water, remove any debris and use a disinfectant to clean the wound. Bandage the wound with three layers of rolled gauze in a taught manner. Use an anti-inflammatory spray, such as Dr. Rose’s Remedies Skin Treatment Spray, to help the irritation.

·         Is stung by a bee – The first thing you should do is look for the pest/stinger to remove it. Be sure not to break it or more poison might go into your dog’s blood stream. Clean the area with a baking soda and water paste. If the irritation continues, consult your vet about giving your dog an over-the-counter antihistamine, like Benadryl, to counteract reactions.


·         Walks through a poisonous plant – If your dog comes in contact with poison ivy, poison oak or poison sumac, do not touch his coat until you are wearing protective gloves. Even though a dog’s coat adds a great layer of protection, vulnerable spots with less hair, like the ears and stomach, can react to poisonous plants. To help prevent infection, bathe your dog in warm water, using a mild shampoo and rinse thoroughly to remove the plant’s oil. If your dog continues to itch, consult a vet about an antihistamine.


·         Gets bit by a venomous snake – The best way to react is to stay calm and immediately find a veterinarian. Restrict movement in your pet as much as possible, even if it means carrying your dog. Do not try to treat the bite yourself by applying ice, removing the venom or applying a tourniquet. If you are nowhere near a vet, a snakebite kit can also be used.  Other preventative options include snake aversion training or vaccinating your dog against snakebites.


If your dog is in the appropriate shape, have him hike with his own pack, carrying a first-aid kit with supplies. This is especially important if you plan on hiking or camping in a location that’s not close to medical help.

Friday, March 20, 2015

Foot Care

Caring for your feet while hiking is a vital part of the trail experience. Take it from one who had to abandon a hike for a small irritated blister under one toe – issues with feet can wreak havoc on your
plans. Proper care of feet ahead of time can help avoid a lot of misery on the trail and also avoid injury.

Shoes
Hiking shoes are really a personal preference in many instances. I have worn both boots and trail runners and am now a convert when it comes to using trail runners for East Coast trails. The lightweight ability of these shoes, the quick drying capacity in wet, soggy conditions, and the ability to navigate rocky terrain have all helped me remain with this type of footwear. But I also made sure I got checked by a professional when buying shoes. I went to a professional running shop and had them evaluate my foot type for the type of shoe I needed. I ended up with what is called a motion control shoe because I pronate. Different shoe types, based on construction, can make your foot, then your leg and hip, move differently. Ill-fitting footwear can affect not only your foot but can cause knee and hip issues and even injuries. Hence the need for a foot professional to make sure you are wearing the right type of shoe for your foot. I also go with a size larger shoe than my foot size as well.
Trail Runners dry ultra quick after being in slush

Insoles
I am a big believer in proper insoles. This can take some doing as there are so many to choose from. A professional can help you determine what type will work. I actually worked with a physical therapist after having some nerve issues in my calf, and he recommended the blue Superfeet. I have worn them ever since. Get a professional opinion on the right insole to match your foot type. It adds to the support of your foot and makes for a better journey and less injury.

Socks
Socks are very important to help minimize pressure points and blister formation. Going with a good merino wool blend helps to wick moisture way from your foot which can cause blisters. DO NOT wear cotton “gym” type socks. As your foot sweats, they get wet, stay wet, and the moisture will make you suffer with blisters that will pop up after only a few miles of walking. In a follow-up blog I will rate a few socks I have tried.

Foot Care
Make sure you are doing proper foot care on your journey. Whenever you stop, take off your shoes, remove the insoles, and take off your socks. Let them all dry in the sun if possible and air out your feet. You will find instant relief if they are feeling hot and tired. Also, be sure you are carrying a proper first aid kit (with duct tape, band aids, etc) should there be issues with hot spots and blister formation. Check out the blog on blister care should they happen.


Your feet will take you wherever you need to go on your hiking journey with some proper care and TLC




Thursday, March 12, 2015

When to Use the Phrase “Hike Your Own Hike” (HYOH)


HYOH!!


I have seen the phrase Hike Your Own Hike (or HYOH) used quite frequently on hiker forums and Facebook groups when it comes to various hiking issues. It appears to be the pet phrase of choice whenever there are issues that crop up, including anything from water treatment to bear bagging to camping illegally or using drugs trailside. There is a reason to say “Hike your own Hike” (HYOH) and a reason not to use it as an excuse for something illegal, immoral or downright dangerous. It would be akin, I suppose, to saying – “Hey...do whatever you want.” 

But you can’t just do whatever you want if it restricts another’s enjoyment of the woods, if it will destroy or harm wildlife and or the trail or wilderness, if it will endanger your life or someone else’s, or it’s just plain against the law.

I once saw this phrase used when someone, for instance, instead of following the white blaze of the Appalachian Trail, decides they feel like a wander down a blue blaze trail to see other scenery, or they decide maybe they would rather canoe the river instead of hiking or bicycle or road walk a portion. In that instance they are doing their journey the way they want without the legalistic approach following a white blaze or the trail. They are hiking their own hike.

Contrary, a hiker says he’s going to forgo Maryland’s rules of no camping between designated areas and set up his tent wherever he chooses. Or consuming alcohol at the shelter areas in MD (it is posted no drinking along the AT there as its a state park).That is not HYOH - Hike Your Own Hike. This is disobeying posted regulations which are put there for a purpose. It’s not to restrict but to protect both the hiker and the wilderness experience from the multitude of other hikers also looking for a pristine place to wander. Or a hiker plans not to use bear-proof technique to guard food from wildlife which is against the ethics of Leave No Trace and protecting wildlife. This is also not Hiking Your Own Hike.

It is hoped people will use the wisdom of HYOH the way it is meant to be used – to enjoy the trail and the journey that best suits your needs and plans. It should not be used as a catch-all phrase and excuse that can potentially harm you, another hiker, or the wilderness.
  

   

Thursday, March 05, 2015

What Goes in Maildrops?


I often see hikers ask what a typical maildrop contains. Here is mine for a reference. Adapt it to your needs and your specific trail you are hiking.

Food for that time period – to avoid lots of extras at a store (like having to purchase a big box of Pop Tarts or oatmeal packets) I’ll put in what I need for the days until my next drop. See the food blog for other food ideas I pack (including dehydrated products like homemade jerky, dried veggies etc). Items I can get easily at a small store (candy bars, granola bars, cracker packs) I buy in town as well as perishables like bread and cheese and heavier items such as a small jar of peanut butter. 

       Sometimes extra treats can be put into the box from home you can’t get elsewhere to enjoy on your day off from the trail.

       A roll of toilet paper in a Ziploc along with some baby wipes. For women, light pads are helpful

       Two Ziploc sandwich bags for AM and PM medications – see the first aid blog for what I add vitamin-wise (I usually carry enough meds for a week)

       Maps and pages copied from the Companion or other trail guide you need for the section you are hiking

If I’ve been on the trail a few weeks, I also add this – 

       Some brand new Ziploc bags to replace the ones I use in my pack

       A sandwich Ziploc with some extra Advil and Tylenol

       A few extra band aids and some duct tape to replenish the first aid kit 

       For women - if you have already used up your supply, pack a Ziploc with sanitary products needed for the next time the monthly cycle calls (if you use them)

Gear: If you are thru hiking the Appalachian Trail northbound, typically gear is switched out around Pearisburg, VA for the summer (after you pass the Mt Rogers area) or by mid May and pick up colder weather gear at Glencliff, NH for the Whites, including clothing and sleeping bag (if you go with a different bag). For southbounders it depends on your start date, but you will need colder weather gear by mid October (I had mine for southern VA to Springer by then). NOTE: At Glencliff, NH you can also send your box to the Hiker's Welcome Hostel or earlier in Hanover, NH. 


For other trails such as the PCT and CDT, check your guidebooks for recommendations on gear changes you need to add to your drop as well as places to mail food drops. Yogi has a great Handbooks for this planning. Check other websites for other long distance trails for towns to mail drops.


If you mail a fuel canister to yourself, mail it separately from the main food drop and send it surface mail ONLY via the USPS. And yes, canisters can be mailed!


Be sure to send your food drop Priority Mail with Delivery Confirmation and allow plenty of time. 


The drop should be addressed as follows for a Post Office delivery (Use your REAL name and be sure to carry your license to pick up at the PO).
Jane Doe
General Delivery
Hanover, NH  03755
Hold for AT Hiker: ETA (state the expected date of your arrival)


Other businesses, hostels, etc are accepting maildrops. If you mail to those places, be sure to put your real name and "c/o" - care of and the address being sent. Include your ETA.


If you are going to be late (like more than five days), courtesy asks that you call the place holding your drop and alert them. If you sent your drop Priority Mail to the PO and you have not received it or are going to be too late to get it, they can bounce it up the trail for you at no charge. See the mailing blog for other mailing information.

    

Wednesday, February 25, 2015

Sickness on the Trail

It's that time - when hikers head for the trails and yes, disease can also follow. Here are some reminders on how to keep healthy and stay illness free.

The chief complaint on the trail like the AT is the Norovirus, which seems to strike every hiking season.

Noroviruses are found in the stool or vomit of infected people and on infected surfaces that have been touched by ill people. Outbreaks occur more often where there are more people in a small area, such cruise ships (and AT hostels/shelters).

How noroviruses are spread
People can become infected with the virus by:

  • Eating food or drinking liquids infected with noroviruses
  • Touching surfaces or objects infected with noroviruses and then touching own mouth, nose, or eyes
  • Having person-to-person contact (with a norovirus-infected person) by
    • being present while someone is vomiting
    • sharing food or eating from the same utensils
    • caring for a sick person
    • shaking hands
    • (also) eating out of contaminated food bags or food contaminated by the virus
  • Not washing hands after using the bathroom and before eating or preparing food.

Norovirus infections are not usually serious
Noroviruses are highly contagious, but infections are not usually serious. People may feel very sick and vomit often or get diarrhea, becoming dehydrated if lost liquids are not replaced. Most people recover within 1 or 2 days and have no long-term adverse health effects.


What to do if you get norovirus (I am adding more to this)

  • Rest
  • Drink plenty of fluids as you tolerate it. Start with clear fluids first - like broth from Ramen, Gatorade, weak tea with a little sugar, just plain water, jello and popsicles (if you can get it). As your stomach allows, eat bland foods like crackers, white bread, Ramen noodle soup, jello if you can get it. Advance your diet very slowly. Avoid greasy and fried foods. When you can tolerate it, replace electrolytes and bacteria lost with bananas and yogurt.
  • Wash hands often.
  • Baby wipes can help clean irritation left from the "runs"

How to prevent getting and spreading noroviruses (and other illnesses)

  • Wash hands often. Wash hands after using the bathroom and before eating or preparing food. Wash hands more often when someone in your hostel/shelter is sick.
  • Avoid shaking hands during outbreaks
  • Use alcohol-based hand sanitizer along with handwashing or if facilities for handwashing are unavailable. Make sure the sanitizer is at least 70% alcohol. I recommend Purell Advanced.
  • Do not eat out of another hiker's food bag (like passing the bag of GORP or bag of chips around the campsite or shelter) Be careful where you are accepting food at hiker feeds and by generous trail angels. Packaged food is best. use had sanitizer whenever possible.
  • Avoiding shelter areas and other communicable spots, esp during the disease season.
  • Carrying packets of Emergen C to add to water helps replace vitamins lost and can boost your immune system.
  • Boost your immune system by eating good healthy foods while hiking. A balance of proteins, fats, carbs, supplemented by dried veggies and fruits is best. Avoid empty carbs and sugars. Consider also taking a vitamin supplement.

Friday, February 20, 2015

10 Things to Do Before You Begin Your Long Distance Hike

You’ve been thinking abut this trip forever, it seems. Your big step onto a long distance trail hike. The nerves are getting to you a bit but so is great expectation. Especially the gnawing sensation if you have everything you really need to do this. Try this checklist to see if you have covered all your bases before you embark on your adventure.

1. Your gear. Have you got everything you need for what may lie ahead? Esp. weather wise? Try this
Gear choices can be overwhelming. Do the best you can.
gear list to see if you may have forgotten something, even the small stuff. Have some money on hand during your hike to replace some gear issues for long distance hiking. Even if your gear choices aren't perfect, it will be ok. Some extra money can help remedy some of that, esp if it is a safety issue. Other times, just let it go.

2. Your means of communication. While we like to get away from the electronics out in the wild, electronics are necessary for planning ahead, calling home, checking on shuttles and hostels, unplanned emergencies, etc. Plan for a cell phone. Some family members may want to follow your progress so consider a SPOT or similar device. Leave an itinerary at home. Though it may change, it gives your loved ones an idea where you will be.

3. Your navigation. Most say just follow the blazes, but lots of time, esp. in surprise weather, that doesn’t always work. Have the means for navigation on you. Maps (or map apps for your cell phone), current guidebook and / or guidebook pages, etc. If using a phone for map apps, be sure you have an extra power pack for it. A compass is an added bonus, but make sure you know how to use it. Same for a GPS for certain hard to follow trails.

 
4. Your health. Have you been to the doctor AND dentist for all necessary checkups? Make sure you will have the medicines you need. How about extra prescriptions, esp. for glasses should they break while on the trail? Do you have a prescription for things like doxycycline for a tick bite on the trail? Also, be up to date on shots like Tetanus. Don’t forget to bring a good first aid kit and consider taking a first aid course before the trip. 

5. Your money. Check your accounts to make sure everything is up to date and you have the money you need should you have to spend a few extra days in town due to bad weather, illness, gear replacement, etc. Carry some cash on you as well as a debit card and credit card on you, along with your driver’s license or other form of ID. Be sure you have an extra debit card at home to mail out just in case the magnetic strip wears out.

6. Your trail mail. Are you expecting mail on the trail? Make sure you have your mail drops ready to go or a person ready to do them for you and a responsible person to mail them. As things can change en route, be sure you give yourself plenty of time for the drops to get there. Use Priority Mailing case you need to forward drops (which can be done for free if you don’t pick up the box at the PO). Use this checklist for maildrops and what to put in them.

7. Your house, bills, pets. Is your place or residence being cared for as well as the bills for it? Things like this can really distract from a hike unless you have prepared for it. Make sure all these things are covered. That also includes any pets left at home – that they are cared for by responsible people and have the food, medicines, vet info, etc they need.

8. Your job. If you have a leave from your job, make sure everything is OK at work for you to return. If you quit your job, have some ideas what you will do when you get back. Maybe make a list or have an idea of a job that interests you.  Be sure there is money to cover several months of bills after you get back as you look for a job or to pay the bills until you start work and get paid.

9. After the trail. Prepare for the after the trail doldrums. See my blog on coping with post-trail issues
which are very real after any major hike. Don’t
let depression and other issues kill the joy of your great adventure.

10. Now…Relax. The bases are covered, so get out there and enjoy it. Take it day by day. And don’t be afraid to change things on your hike if needed. Be flexible. The journey is more mental than physical.