Date: 2017-11-08
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Miles today: 0.0

My answer to this question is, ¢Don¢t!¢ I¢ll discuss common sense things I try to do to minimize the risk of injury, but I don¢t always follow my advice. Sometimes things just happen.   I acknowledge that I assume a certain risk by hiking in the woods, especially alone. What¢s the worst that can happen? Bluntly, I can die, die alone, die a painful death. Okay, I accept that. Naturally, that leads to a story.I worked in a hospital, in respiratory therapy, right after college. I was privileged to attend many deaths, both in the emergency room and on the medical floors. The worst was a very good looking young man with a single gunshot wound to the temple. We kept him ventilated while the neurosurgeon evaluated his trauma and decided that nothing could be done. That one was difficult. The treatment of COPD is much improved today, but back then dying from emphysema was a long drawn out process with repeated hospitalizations. One patient in particular, whom we all called ¢Pops,¢ changed from being the kindest gentlest person to an avaricious soul, covetous of his oxygen supply. Death was a blessing but not one that he embraced. Then there was an old retired English Army officer who had served in the British Raj, when Britain occupied the Indian subcontinent. He looked like Colonel Mustard from the game Clue and was dying from drug-resistant tuberculous. He was confined to protective care and treating him meant double gowning, double gloving, and double masking, but the advantage was that supervisors rarely went into that ward. I worked the evening shift and tried to schedule him last, to minimize the risk of carrying resistant germs to other patients. It also meant that I was never rushed when I attended to him. After his treatment, he would say Evening Prayer from the Anglican Book of Common Prayer. I sometimes joined him in the responses and and the psalm. One night, he asked me to stay after Vespers and asked me to hold his hand. I did, and he simply turned to the wall and died in utter peace and dignity. That would be my choice, rather than being mauled by a bear or falling off a cliff. But however death comes, I am comfortable with the concept and unafraid of the physical part, because I¢ve seen it often. That¢s been a tremendous blessing. In this country, most people are insulated from death and it remains a dreadful mystery to them. So if the fear of death is behind the question, ¢What if you get hurt?¢ get over it. Perhaps volunteer in a hospice. Make peace with mortality. Saint Francis put it this way in his Canticle of the Sun, ¢Praise be You, my Lord, through our Sister Bodily Death, for whom no living man can escape.¢ The Appalachian Trail Conservancy estimates three to four million visitors to the Appalachian Trail annually, including thru-hikers, section hikers, weekenders, day hikers and simply folks who park at a scenic overlook along the Skyline Drive and walk ten feet along the Appalachian Trail before returning to their cars. How many of them die? According to Laurie Potteiger, Information Service Manager for ATC, also known as Trail Mom for her loving care of hikers, prospective hikers, and the merely curious, about three or four persons die on the Appalachian Trail each year. About half of these die from heart attacks, perhaps one dies from heat stress or hypothermia, and there have been a few deaths from drowning, falling, lightning strike, one from a falling tree, and most tragically, an older woman who died of exposure in Maine in 2013 after becoming seriously lost. How many deaths have been from bears and snakes? None. Let¢s deal with the common causes of hiker death, rare as they are, and how you might prevent them.If you suffer a heart attack on the trail, you will probably die, even if you are hiking with a cardiologist or an EMT. But cheer up. Your odds of surviving the heart attack are not appreciably diminished for having gone into the woods. The American Heart Association reports that less than eight percent of people who suffer cardiac arrest outside of the hospital survive. To minimize your risk of this very rare happening, visit with your doctor before starting your hike. Find a doctor who understands that lugging a heavy backpack up and down mountains is quite strenuous. Lose any excess weight, both from around your waist and in your pack. Train in advance, preferably under similar circumstances. Find a pace that lets you keep a conversation going. Start going up the mountain at a pace that you can maintain until you summit.  Heat stress, whether heat exhaustion or stroke, can sneak up on you. Be aware of conditions, especially high temperatures and high humidity. Stay hydrated, consider the use of electrolyte sports drink powders and tablets, and above all, rest out of the sun. Consider starting your hike early in the morning, taking a long siesta, and then hiking into the evening. The combination of high heat and high humidity is not something you need bully your way through in order to stay on an artificial schedule. Be flexible in your planning.I know more about hypothermia having had two bouts of borderline hypothermia. When planning what to bring on a hike, I now look at the average and record temperatures for a town near the section of trail I¢ll be hiking, and adjust them downward 3.3 degrees for each 1,000 foot gain in elevation to the trail. I carry layers that will give me comfort at the average low temperature and survivability at the adjusted record low. While hiking Vermont¢s Long Trail in July 2002, I tented one night at the base of Worth Mountain, near Middlebury College¢s Snow Bowl. When I woke up, it was in the upper 40¢s and gently raining. I put my rain gear on over my shorts and wicking t-shirt and was quite comfortable going up the mountain.  On the ridge, the wind was howling on the open ski slopes, sucking the heat from my body. I took a break when I got to Boyce Shelter, sitting on the front edge out of the rain, and had a snack. I was unable to recall how I had gotten there, typical of the mental confusion in the early stages of hypothermia. I forced myself to focus and saw on the map that an enclosed cabin, Skylight Lodge, was just under two miles away. As soon as I got safely indoors, I fixed myself some hot soup and got into my sleeping bag. My shivering warmed me up eventually. I¢ve since learned that I could have filled a water bottle with warm water and placed it in my arm pits or groin for faster warming. And I should have worn my long underwear under the rain suit and prevented the entire mishap.There are streams and rivers in Maine without bridges that need to be forded and techniques that minimize the risk, such as facing upstream, using hiking poles and maintaining three points of contact on the bottom. If the water is too high for a safe crossing, wait for the level to fall. Carry extra food so you don¢t feel compelled to cross anyway. Drowning is far worse than going hungry if it comes down to it.  I described my first hike and sitting on the side of a mountain for four hours while lightening played on the ridge. Most summer thunderstorms along the Appalachians move toward the northeast. Be aware of storms in your area, and if you can hear thunder, avoid the ridges and open balds. I lived in Florida for most of my life and have a healthy respect for lightning. Golfers were struck each year under blue sky by lightning angling out from the leading edge of a storm. Carrying the equivalent of a lightning rod and lifting it to the sky doesn¢t help.  I thought I could quickly Google up a table comparing the relative risks of hiking to other sports and daily activities such as driving and showering and cut and paste it into this entry. I couldn¢t find one. There are annual mortality reports ranking the causes of death including sports, but the figures are of little meaning without knowledge of the extent of participation. Annual reports of causes of emergency room visits similarly lack context.  I did find a Spanish study published in the International Journal of Epidemiology in 2010 that followed about 14,000 sports participants over a six-year period and looked at the relative risks of injury requiring medical treatment. The risks were adjusted for time spent in the activity, overall energy expenditure in other activities, body mass index (BMI), and age. Higher risk activities included soccer and other team sports, skiing, and running. Lower risk activities included aerobics, gardening, walking, swimming, and yes, mountain hiking. Mountain hiking increased the hazard ratio approximately 3% as compared to study participants who did not report hiking. Participating in soccer increased the hazard ratio by 46%.So all things considered, hiking is a relatively safe activity. That being said, there was a survey of long distance hikers in 2013-2014. Participants were asked, ¢Did you experience injury for more than a few days of aches and pains?¢ Sixty-one percent of Appalachian Trail hikers responded affirmatively. The most common ailments were blisters, joint and muscle soreness, and diarrhea.  Blisters can be mostly avoided by well-fitted shoes and socks. Beware of salespeople who want to teach you special lacing techniques or who insist that the shoe or boot will be perfect once it breaks in. Especially with today¢s lighter weight shoes and boots, they should be comfortable right out of the box. Test them on a ramp, and when no one is looking, kick the wall to make sure that your toes don¢t impact. I have narrow, low volume (meaning flat) feet and find the best fit in European-brand shoes, like the Scarpa Rapid hiking shoes I¢m now using, modified by replacing the factory insoles with green Superfeet. A very popular brand of socks is Darned Tough, made in Vermont. I feel like a traitor saying this, but my preference is FITS socks based in Tennessee. Blisters are caused friction and can be exasperated by moisture. For this reason, in warmer weather I avoid Gore-Tex and other waterproof breathable membranes that seem to hold moisture in the shoe. I prefer a well-ventilated shoe that gets wet quickly and dries quickly from the heat of hiking.  It is rare for two hikers to agree about shoes and socks. Keep looking. Somewhere out there is the perfect fit and combination for you! I start each day by applying a foot lubricant, like Glide, before pulling on my socks. Others will use liner socks.  Even with perfect shoes and socks, most hikers will occasionally have blisters. There are remedies offered in every drug store, but few will adhere for long to sweaty feet unless you cover the remedy with either Leukotape (if you are not allergic to Latex like I am) or duct tape. Googling ¢care of blisters while hiking¢ returns 996,000 results. If the blister is open or I need to drain it to hike on, I apply antibiotic ointment under a bandage and then wrap duct tape around the toe or foot and check daily for any sign of infection. On a longer hike, you can afford to take a day or two off if necessary to allow bad blisters to heal, but on a shorter hike with a rigid schedule, blisters can mean the end of the hike. It¢s happened to me, so now I focus on prevention.  Related to foot blisters is chaffing, primarily between the legs and buttocks, and known inelegantly as monkey butt or crotch rot, caused by the combination of moisture and friction.  Wicking underwear and good personal hygiene, hard to achieve in the woods, are key to prevention. I carry an extra pair of underwear so I can wash one out and let it dry on the back of my pack. I wore a hiking kilt with nothing underneath for a couple of years, and it was quite cool and effective. I never learned to sit properly in it, either keeping my knees together or pushing the fabric down between my legs, but it was really hiking the Chatooga River Trail, through the ravine where Deliverance was filmed, that cured me of it. It is easy to laugh at such a personal problem like chaffing, until you suffer it. My first bout was in 1999, hiking north from Harpers Ferry, West Virginia. I walked bowlegged into a small town in Pennsylvania just north of the Mason Dixon Line. A kindly pharmacist recognized the telltale gait and recommended a 1% Clotrimazole anti-fungal cr me. It worked overnight and I¢ve carried it ever since.There is a saying among hikers that joint and muscle pain that moves is good pain since it means there¢s probably not an underlying trauma. Unfortunately, that¢s not always true. Joint and muscle pain that moves is a symptom of Lyme Disease, which is only one of a number of tick borne diseases. I¢ve contracted Lyme Disease once, in Vermont, and it isn¢t fun. On this hike, I will be wearing clothing made of Permethrin-treated fibers, good for 70 washings, and will send my socks off for treatment as well.  On short hikes, I¢ve depended on DEET, but I can¢t see exposing myself to that for six-months. I also carry a tick key, weighing 0.2 ounces, that is much easier to use than tweezers to remove the noxious beasts. For years now, my daily routine has included a dynamic stretching protocol, Assisted Isolated Stretching developed by Aaron Mattes, as well some physical therapy exercises primarily to stretch my quadriceps. Stretching is controversial, but it helps me, and I intend to continue the discipline on the trail. More universal among hikers is taking an anti-inflammatory. Ibuprofen is so common that it¢s known as Vitamin I among hikers. I personally prefer Naproxen (Aleve). Diarrhea has many causes, including simply the combination of intense exercise and relatively low-fiber diet, but the most talked about are Giardia (a protozoan) and Norovirus. Some people are unaffected by Giardia; others manage to expel it in one explosive bout; others carry it asymptomatically spreading the wealth as it were; and others require medical intervention. Treating drinking water either chemically, by ultraviolet light, or by filtration is effective, but there is some thinking that the Giardia is spread among hikers primarily by hand-to-hand contact and by sharing food, activities best avoided since hiker hygiene is less than ideal. For the past few years, Norovirus, a highly contagious stomach virus, has been a problem in crowded shelters and hostels especially among northbound thru-hikers. I hope to avoid it and them. The First Aid App by the American Red Cross is free and is an excellent resource to have for yourself or to assist others. It is not wilderness-oriented but does cover many basic topics, including allergies, bleeding, burns, choking, shock, and stings. Many of the treatment recommendations include calling 911, often a fine idea if there is cell phone reception. Leaving a victim unattended is usually a bad idea, but if you must in order to find a cell phone signal, leave a note pinned to the victim noting what you think is going on, the time, and what direction you are going. You might even consider taking a wilderness first aid course and becoming certified as a wilderness first responder.As a solo-hiker, I make it a rule to stay on the main Appalachian Trail and to avoid alternative routes. If I need more care than I can provide to myself, someone will be along before too long unless I¢m hiking out of season. I also make sure that Tom at home has my schedule, updated as I go along. Do you remember Aron Ralston, who in 2003 had to amputate his own arm with a dull pocket knife after being trapped by a dislodged boulder? He was celebrated as a hero, even though he violated the basic rule of informing someone of his hiking plans and staying on his planned route. If you are going to walk off into the wilderness without letting anyone know, at least make sure you have a sharp knife.